ACEs Toolkit

About ACEs

Adverse Childhood Experiences (ACEs) are potentially traumatic events that happen 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 the child’s environment can 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 of a parent.

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.

What Everyone Needs to Know About ACEs


Trauma isn’t something a child simply outgrows. Unaddressed, issues can lead to lifelong physical and mental health problems. Research shows that cumulative adversity, particularly during critical and sensitive developmental periods, is a root cause to some of the most harmful, persistent and expensive health challenges facing our nation.

To learn more about the impact of ACEs, feel free to download and distribute these brochures we developed:

Fostering Community-Wide Awareness

In collaboration with Palm Beach County's Birth to 22 Becoming a Trauma Sensitive Community Action Team, this short video was developed to increase community awareness about the impact of unbuffered ACEs and trauma on lifelong health, mental and physical.

The video is narrated by Dominika Nolan, Director of Center for Child Counseling's Education and Prevention Services. Click below to learn about our PACEs and Trauma-Informed Care training:

What Everyone Needs to Know About PCEs


The good news is that Positive Childhood Experiences (PCEs) are the antidote to ACEs. Positive, protective relationships buffer the impact of childhood trauma.

The 7 studied PCEs include:

  1. The ability to talk with family about feelings.
  2. The sense that family is supportive during difficult times.
  3. The enjoyment of participation in community traditions.
  4. Feeling a sense of belonging in high school.
  5. Feeling supported by friends.
  6. Having at least two non-parent adults who genuinely cared.
  7. Feeling safe and protected by an adult in the home.

Source: Dr. Christina Bethell, 2019 Study at Johns Hopkins

White Paper: A Public Health Approach to Fighting ACEs

Download Now


The PACEs Trees

Download the trees to use in your practice or training.

ACEs and Resilience Surveys

10 types of ACEs were measured in the CDC-Kaiser Permanente Adverse Childhood Experiences Study. Click the link below to download the ACEs and Resilience Surveys.

There are, of course, many other types of ACEs and childhood trauma not identified in the study, including racism, bullying, watching a sibling being abused, losing a caregiver, homelessness, surviving and recovering from a severe accident, involvement with the foster care system, or involvement with the juvenile justice system. Adverse Community Environments add to the burden.

It is critical to remember is that the ACE score is not the full picture. Positive Childhood Experiences (PCEs) are the antidote to ACEs, buffering the impact of these experiences. 

The ACEs scores should not be used to guide clinical decision-making. To adequately address trauma, individual-level assessment requires an understanding of the triad of adversity (ACEs and other traumatic events), protective factors (resources and strengths), and distress (both physical and emotional).

Fighting ACEs

Awareness. Action. Advocacy.


Childhood trauma is a pervasive issue that affects countless families, communities, and our nation. The costs of inaction are significant and the need for action is more urgent than ever. By engaging leaders with diverse voices, Lead the Fight aims to bring awareness, action, and advocacy to the critical issue of preventing and mitigating the impact of Adverse Childhood Experiences (ACEs) and childhood trauma.

Conversations, with local and national experts, are helping to create solutions, mobilize action, and support lasting change.


Benjamin Perks, UNICEF

Mr. Perks, in his keynote for our Lead the Fight event on February 18 2022, discusses the impact of ACEs, childhood trauma, and how toxic stress derails healthy child development. "Every child needs to have their inner world promoted and protected."

Dr. Gabor Maté

“Ask not why the addiction, ask why the pain.” This was one of the many profound statements that trauma and addiction expert and international best-selling author Dr. Gabor Maté shared during Part II of our 2023 Lead the Fight series.

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