What are Adverse Childhood Experiences (ACEs)?

This will be a two-part blog series on Adverse Childhood Experiences, with part one below providing a brief overview of ACEs and correlated health impacts, as well as how California’s children are faring.  Part two in this series will offer strengths-based approaches to addressing Adverse Childhood Experiences, and noting evidence-based examples from the field that can be adopted community-wide. 

Over the last two decades, critical measures of childhood well-being have pioneered the assessment of childhood adversities, which include the social determinants of health, and more recently, an examination of the disproportionate disparities among children of color. This assessment process utilized a screening tool called Adverse Childhood Experiences, or ACEs, which is based upon a groundbreaking study conducted from 1995-1997, whereby an ACEs screening tool was administered to adults to determine later-life health and well-being.[i]  Given the potential impacts of trauma and toxic stress on childhood and older adulthood, it is imperative to explore approaches that can address these adversities. To this end, Applied Survey Research (ASR) champions health and well-being for all through the critical examination of county health rankings, alongside our partners and community allies, who implement strengths-based approaches for family and community practice to support positive childhood experiences. 

What childhood adversities does the ACEs tool measure?

ACEs today commonly refer to seven to nine categories of childhood adversities, depending upon which tool is used[ii]:

  1. Physical abuse

  2. Sexual abuse

  3. Emotional abuse

  4. Having a mother who was treated violently

  5. Living with someone who was mentally ill

  6. Living with someone who abused alcohol or drugs

  7. Incarceration of a member of a household, and/or

  8. Parental divorce or separation, and/or

  9. Social disadvantage (e.g., economic hardship, homelessness, community violence, discrimination, historical trauma).       

As the number of ACEs experienced increases, so do negative health outcomes. 

Health impacts of Adverse Childhood Experiences (ACEs) 

The landmark ACEs study in 1995-1997 determined that per individual, as the number of ACEs experienced increases, so do negative health outcomes. The tipping point of having experienced 3 or more ACEs as a child correlates with increased risk for developing negative health outcomes.[iii] The study illustrated this through the ACE Pyramid, which represents how ACEs are linked over the life course to negative well-being and risk factors for disease.  

Source: National Center for Injury Prevention and Control, Division of Violence Prevention

Source: National Center for Injury Prevention and Control, Division of Violence Prevention

Understanding the linkage between these childhood adversities and potential negative health impacts serves as a call to action for all to support the well-being of children.

The study named specific negative health outcomes that correlated with ACEs. Unsurprisingly, these negative health outcomes can be common challenges in adolescence (as well as adulthood), and when used with the ACEs tool, this correlation helps to frame a larger context upon which providers can best determine youth (or adult) health interventions.

Source: National Center for Injury Prevention and Control, Division of Violence Prevention

Source: National Center for Injury Prevention and Control, Division of Violence Prevention

Understanding the linkage between these childhood adversities and potential negative health impacts serves as a call to action for all to support the well-being of children.

How are California’s children faring?

To examine how California’s children have fared regarding Adverse Childhood Experiences requires an examination of adults who experienced ACEs as a child.  According to the percentage of adults experiencing ACEs as a child, there were regional differences among Northern California counties.   Across 2 out of 4 of the Northern California counties highlighted below (Sacramento and Santa Cruz Counties), more adults have experienced 4 or more ACEs as a child, compared to the state average (15.9%), while Solano County scored equally with the state.  This trend is similar when looking at the three specific ACE indicators highlighted below, with Sacramento and Santa Cruz Counties scoring well above the state average, and Solano County scoring equally with California.  Santa Clara County, across all indicators, was the only county that scored below the state average on all indicators, reflecting the best outcomes for children out of the four counties. 

This is unsurprising, as ASR has partnered with many organizations in Santa Clara to collaborate and assess vital community issues, and Santa Clara County continues to rank as one of the highest counties overall in the state for health outcomes, according to the Fresno Bee.[iv]  Moreover, 2019 County Health Rankings found that Santa Clara ranked #4 in the overall ranking in health factors across the state, compared to Santa Cruz (#14), Sacramento (#25), and Solano Counties (#26).[v]  ASR’s close tracking and utilization of this assessment tool demonstrates a commitment to examining community well-being and how California’s population is faring. 

In response to acknowledging ACEs and correlated health impacts on children and adults, part two of this series will address strengths-based approaches to addressing Adverse Childhood Experiences, and offer evidence-based examples from the field that support children, family, and community well-being.

References

[i] Bartlett, Jessica D. & Sacks, Vanessa (2019).  “Adverse childhood experiences are different than child trauma, and it’s critical to understand why.”  Child Trends.  April 11, 2019. 

[ii] Bartlett, Jessica D. & Sacks, Vanessa (2019).  “Adverse childhood experiences are different than child trauma, and it’s critical to understand why.”  Child Trends.  April 11, 2019; National Center for Injury Prevention and Control, Division of Violence Prevention (2019).  Centers for Disease Control and Prevention.  Accessed at:   https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html on March 12, 2019.

[iii]  Felitti, Vincent, J., Anda, Robert F., Nordenberg, Dale, Williamson, David F., Spitz, Alison M., Edwards, Valerie, Koss, Mary P., Marks, James S. (1998).  “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study.”  May 1998: 14(4), 245-258.  Accessed at: https://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract on April 16, 2019.

[iv] County Health Rankings and Roadmaps (2019).  “2019 County Health Rankings & Roadmaps.”  Accessed at: http://www.countyhealthrankings.org/app/california/2019/overview on April 23, 2019. 

 [v] County Health Rankings and Roadmaps (2019).  “2019 County Health Rankings & Roadmaps.”  Accessed at: http://www.countyhealthrankings.org/app/california/2019/overview on April 23, 2019. 

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