ACEs Toolkit
Understanding adversity. Promoting positive experiences. Building resilience.
A comprehensive resource for parents, educators, healthcare professionals, and community leaders — grounded in the science of Adverse Childhood Experiences, Positive Childhood Experiences, and the HOPE framework.
Understanding Adverse Childhood Experiences
Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur before age 18 — including experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide. Aspects of a child's environment can also undermine their sense of safety, stability, and bonding, such as growing up in a household with substance misuse, mental health problems, or instability due to parental separation or incarceration.
The landmark CDC-Kaiser Permanente Adverse Childhood Experiences Study — one of the largest investigations of childhood abuse and neglect — found that ACEs are remarkably common and have profound, lasting impacts on health and well-being across the lifespan.
The 10 ACEs Measured in the CDC-Kaiser Study
Source: CDC Violence Prevention — ACEs
There are many other types of adversity not captured in the original study — including racism, bullying, witnessing a sibling being abused, loss of a caregiver, homelessness, involvement with foster care or juvenile justice systems, and adverse community environments. The ACE score is not the full picture.
How ACEs Affect the Developing Brain
Toxic stress in childhood can change the architecture of the developing brain and impacts everything — behaviors, learning, the ability to self-regulate — and heightens the risk for future mental and physical health problems. Trauma isn't something a child simply outgrows. Unaddressed, it can lead to lifelong physical and mental health challenges.
Research shows that cumulative adversity, particularly during critical and sensitive developmental periods, is a root cause of some of the most harmful, persistent, and expensive health challenges facing our nation. But the science also shows that ACEs are not destiny — and that's where HOPE comes in.
It is critical to remember that the ACE score is not the full picture. Positive Childhood Experiences are the antidote to ACEs, buffering the impact of these experiences. ACE scores should not be used to guide clinical decision-making. To adequately address trauma, assessment requires understanding the triad of adversity, protective factors, and distress.
Preventing Adverse Childhood Experiences — CDC
Positive Childhood Experiences
The good news is that Positive Childhood Experiences (PCEs) are the antidote to ACEs. Research shows that positive, protective relationships buffer the impact of childhood trauma — and that PCEs independently promote adult mental health, regardless of ACE exposure.
Source: Dr. Christina Bethell, 2019 Study — Johns Hopkins Bloomberg School of Public Health
The HOPE Framework
The HOPE framework — Healthy Outcomes from Positive Experiences — developed by the HOPE National Resource Center at Tufts Medical Center, provides the science-backed roadmap for promoting positive experiences. HOPE shifts the conversation from "What happened to you?" to "What went right?" and from "What's wrong with you?" to "What's strong with you?"
The PACEs Trees
A powerful visual showing how Positive and Adverse Childhood Experiences shape a child's development — and how community environments add to the picture.
Download the PACEs Trees (PDF) →ACEs Resources
Download and distribute these resources developed by Center for Child Counseling to help educate your community.
A Public Health Approach to Fighting ACEs
Our comprehensive white paper examining the scope and impact of ACEs in Palm Beach County and outlining a community-wide strategy for prevention, early intervention, and healing grounded in the HOPE framework.
Read the White Paper ↓Fighting ACEs: Awareness. Action. Advocacy.
Through our Lead the Fight initiative, we bring nationally and internationally renowned experts to Palm Beach County to create solutions, mobilize action, and support lasting change.
Trusted ACEs Resources
Explore these respected national organizations and research centers for additional information about ACEs, toxic stress, resilience, and healing.
ACEs & Resilience Surveys
The 10 ACEs measured in the CDC-Kaiser study, plus resilience factors. Download the surveys to use in your community education efforts.
Access ACEs Resources at CDC →Have Questions About ACEs or HOPE?
Our HOPE Assistant can answer your questions about ACEs, PCEs, the HOPE framework, and how to support children and families.
ACEs Are Not Destiny
Center for Child Counseling provides therapy, prevention education, and family support grounded in the HOPE framework — helping children and families heal, grow, and thrive.