Adverse Childhood Experiences (ACEs)


Adverse childhood experiences (ACEs) refers to traumatic events experienced in childhood that impact health over the lifespan. These include physical, emotional, and sexual abuse, neglect, and/or family dysfunction. The link to health outcomes was revealed in a groundbreaking long-term study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC).

The original study identified nine specific ACEs linked to negative health outcomes in adulthood. More recently, practitioners often use expanded lists to assess for trauma exposure. Examples include experiencing homelessness, community violence, discrimination, and deportation or migration.

A trauma-informed approach to health care and community services can minimize negative outcomes and build resilience.

Current Health Status

The Washington State Essentials for Childhood Initiative supports safe, stable, and nurturing relationships and environments.

Many local and regional groups are implementing trauma-informed approaches to family and community health and well-being. The nature of the specific efforts vary but they share a common mission to prevent adverse childhood experiences and promote resilience. Information can be found through:

Emerging Issues

ACEs research continues and some of the key issues identified include:

  • Toxic stress from ACEs impacts brain development as well as physical and emotional health
  • High levels of trauma over time can alter DNA and be passed from generation to generation
  • Trauma-informed care and resiliency-building interventions are both healing and preventative of future problems
Health Equity Concerns

Childhood trauma occurs across racial and socio-economic lines, however it does disproportionately impact certain populations.

Key Data and Sources

Nationwide and Washington State ACEs data for children aged 0-17 is available through the National Survey of Children’s Health.

2018 Washington State Health Assessment includes Adverse Childhood Experiences prevalence data

Recommended Strategies
  • Implement a trauma-informed approach in primary care settings.
  • Implement trauma-informed approaches in communities, including child care settings, schools, and law enforcement.
  • Ask the ACEs questions and use the information to inform treatment plans.
  • Encourage and support healthy living, including sleep, nutrition, and physical activity.
  • Incorporate self-care for healthcare providers and those in the helping professions, who often experience secondary trauma and compassion fatigue.