Adverse Childhood Experiences (ACEs)
Adverse Childhood Experiences Screening (ACEs) Benefit
What are Adverse Childhood Experiences?
Adverse childhood experiences (also known as ACEs) are stressful or traumatic events that occur in childhood.
ACEs are potentially traumatic events that occur in childhood. ACEs include violence, abuse, and growing up in a family with mental health or substance use problems. ACEs are strongly connected to brain development and many health problems that can occur throughout a person's lifetime. By identifying these experiences, individuals and families can get support to help them stay healthy and succeed in life.
Table of Contents
Why do ACEs Matter?
How can the Negative Effects of ACEs be Mitigated?
What are Protective Factors, Resilience and Positive Childhood Experiences?
Why Screen Children and Adolescents for ACEs?
Why Screen Adults for ACEs?
How can I get Screened for ACEs?
Why Would I Talk to my Doctor about ACEs Screening?
Services to address ACEs and more information
Why do ACEs Matter?
ACEs are very common.
When families experience many challenges, the effects of ACEs can add up over time. People living in poverty or affected by racism are more likely to have ACEs.
ACEs can contribute to toxic stress. Toxic stress is the body’s response to lasting and serious stress, without enough support from a caregiver. When children don’t get the help they need, their bodies can’t turn off the stress response. This lasting stress can harm children’s bodies and brains and can cause trouble in school, relationships and lifelong health problems. Addressing the impact of ACEs can help to improve the health of the individual, children, families and future generations.
Adults with a history of ACEs are at increased risk for many health challenges. The more ACEs someone experiences, the higher the risk.
Health challenges may include:
- Heart Disease
- Diabetes
- Depression, Anxiety
- Substance Use Disorders
- Difficulties in maintaining healthy relationships
- Smoking and excessive alcohol use.
How to Reduce the Impact of ACEs
For children, the impact of ACEs can be reduced or eliminated with supportive adult relationships. These relationships can be the building blocks for protective factors and resilience.
Protective factors, resilience, and positive childhood experiences can all reduce the impact of ACEs.
What are Protective Factors, Resilience, and Positive Childhood Experiences?
Protective Factors
Protective factors are characteristics that can help build resilience in children, parents, caregivers and adults. Protective factors may decrease the possibility of ACEs and their impact and help build positive childhood experiences.
The most important protective factor for children is having at least one consistent, supportive relationship with a parent, caregiver or other adult.
Protective factors also include:
- Supportive and caring relationships and social connections
- An inclusive environment welcoming of different backgrounds, beliefs, and cultures
- A healthy lifestyle, that may include regular exercise, mindfulness, getting enough sleep and eating healthy and nutritious food
- Economic support/stability for families
- Quality childcare and education early in life
Resilience
Resilience is the ability to bounce back from challenges and hardship. Building resilience in parents and caregivers can help their children and families.
Resilience in caregivers and children can reduce the negative impacts of ACEs.
Parents and caregivers are part of the solution to addressing ACEs in their children, even if they have their own struggles.
Positive Childhood Experiences
Safe, stable and nurturing relationships help build positive childhood experiences. These relationships can help children to build important skills that help them thrive. These relationships can also reduce the potential harms of ACEs.
Additional positive childhood experiences include children:
- Feeling safe talking about their feelings,
- Having a sense of belonging at school, and
- Feeling supported when things are tough.
Why Screen Children and Adolescents for Adverse Childhood Experiences?
By screening for ACEs, the child, parents, caregivers and healthcare providers can better understand the needs of children and adolescents.
Routine or annual screenings can help identify important opportunities for prevention, early detection, and intervention. Screening can improve the assessment of childhood health conditions. Screening can also help identify support or treatment needs for children and adolescents that could help them to thrive and stay healthy.
Parents and caregivers of children and adolescents can talk to their child's trusted healthcare provider, such as a pediatrician or nurse practitioner, about screening for ACEs. A healthcare provider trained in trauma-informed care can best screen for ACEs and have safe conversations with the family.
Because ACEs may have happened in the past, it is not always important to share about the specific ACEs experienced by that individual, child, or family. However, if someone is experiencing current abuse, violence, neglect or threats to their safety or well-being, it is important to share about those specific challenges with trusted healthcare providers.
Why Screen Adults for Adverse Childhood Experiences?
Adults can benefit from being screened for ACEs and/or sharing their ACEs score with their trusted healthcare provider.
By talking about ACEs with a trusted healthcare provider, an adult that has experienced ACEs in the past can feel validated and empowered. ACEs screening can also help adults build resilience and get support, if needed.
Individuals who are pregnant, already parents, or caregivers can benefit from ACEs screening and conversations about ACEs. This can help individuals learn how to manage their response to stress.
Learning healthy responses to stress can:
- Help improve individual health,
- Help improve the entire family's health, and
- Help improve the next generation's health by reducing the impact of trauma that can be passed onto children.
How Can I Get Screened for Adverse Childhood Experiences?
- Adults can screen themselves and their dependent children with or without the help of a healthcare provider.
- A commonly used ACEs screen for children can be found here: English - Spanish - Multiple Languages (External Links)
- A commonly used ACEs screen for adults can be found here: English - Spanish - Multiple Languages (External Links)
- Some healthcare providers screen for ACEs.
- For Medicaid-enrolled children under the age of 21, reimbursement is available yearly. For Medicaid-enrolled adults 21 and above, reimbursement is once per lifetime.
- Healthcare providers can be reimbursed every year for screening children under age 21 and once per lifetime in adults age 21 and older.
Why Would I Talk to my Healthcare Provider about Adverse Childhood Experiences Screening?
For adults:
- It is up to you as to whether to share your screening results or agree to be screened.
- Sometimes adults prefer to share their total ACEs score rather than which ACEs they score positive for.
- Talking to your primary care doctor about your overall ACEs score may help to address underlying causes of health problems.
For Parents and Caregivers of Children:
- It is up to the parent or caregiver as to whether you allow your child to be screened for ACEs.
- It may be important to discuss any new ACEs with a child's healthcare provider, especially when there are concerns with safety, abuse, neglect, or violence.
- However, if ACEs have already been addressed and there are no current concerns, it is okay to share a total ACEs score.
If you choose to have a conversation about ACEs with your healthcare provider, it is important that you do not feel blamed or shamed for your experiences and challenges.
Crisis Support for Anyone Who Needs Help
- The 988 Suicide & Crisis Lifeline connects children, teens, or adults to trained crisis counselors 24/7.
- 988 can help anyone thinking about suicide, struggling with substance use, experiencing a mental health crisis, or any other kind of emotional distress.
- You can also call, text or chat 988 if you are worried about someone you care about who may need crisis support.
- More information about 988 can be found using the link below:
Additional Resources
- ACEs Aware Stress Buster handout
- Centers for Disease Control ACEs webpages:
- New York Office of Children and Family services ACEs webpage
- ACEs Aware resources for families
- New York State Medicaid ACEs webpage (for healthcare providers)
- New York State Health Hub resources for children and families
