Taking ACES Upstream: Strengthening Prevention of Adverse Childhood Experiences—Recommendations from Prevent Child Abuse America and Its State Chapter Network

Background: The continued findings and research from the Adverse Childhood Experience Study (ACES) have identified robust associations between a child experiencing early trauma and a wide array of poor health, economic, and life outcomes. The study has led to significant reform efforts in health care, social services and child welfare, primarily focused on educating staff about “trauma-informed care” and identifying ways to ameliorate the impact of early trauma after it has happened.

In June 2018, Prevent Child Abuse America (PCA America) created the Taking ACES Upstream Affinity Group—a voluntary network of PCA America state-chapter leaders to  share ideas focused on using the research from the ACE study to strengthen prevention of trauma—before it ever happens. The two primary goals of the group included sharing promising ideas and strategies and issuing a set of recommendations for state and national policy to strengthen prevention of early childhood trauma based on the findings from the ACE study.

Process:  The affinity group consisted of more than 30 executive directors and staff of PCA America state chapters, working with PCA America senior staff, including Dr. Bart Klika, Chief Research and Strategy Officer; Marissa Morabito, Director of Policy; and Anita Odom, Director of Chapter Services.  Dr. Melissa Merrick, then Senior Epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC), also participated. Rush Russell, Executive Director from PCA New Jersey, served as the chairperson. The group held a series of meetings, including reviews of the most recent research, perspectives from the CDC, state experiences with CDC’s Essentials for Childhood Initiative, and training and education initiatives, such as ACE Interface and Master Connections.


  1. Support a national expansion of the CDC’s Essentials for Childhood (EFC) Initiative:  PCA A and its state-chapter network should advocate for funding for the CDC to expand the EFC to all 50 states.  The EFC provides a rigorous and flexible research-informed framework that allows states to address four critical elements related to preventing ACEs and strengthening resilience for children.  It would provide resources, national scientific leadership, technical and evaluation assistance to build a stronger and more cohesive national effort to prevent ACEs.
  2. A priority effort should be undertaken to educate local, state and federal elected officials about the ACE Study and its implications for policies affecting children and families.  Despite the groundbreaking research from the ACE Study and accompanying brain science, many of the most influential leaders at the local, state and federal levels – elected members of Congress, state legislators and local elected officials – are not yet aware of the Study and how it affects the future of children. PCAA and its state chapter network, NCSL, the CDC and other stakeholder groups should support efforts to educate policymakers with this important new research and the implications for the future of children.
  3. Advocate for policies shown to be effective in preventing child abuse and neglect and other forms of early childhood trauma. The CDC has identified a number of policies shown to be effective in preventing ACEs, including strengthening economic supports for families, family-friendly work-polices and connecting youth to caring adults. PCAA and its chapter network should collaborate with the CDC and other stakeholder groups to lead advocacy efforts in support of effective policies to prevent ACEs and build resilience among children who have experienced prior trauma.
  4. Create a national public awareness campaign to reach parents and other key members of the general public about the ACE study and implications for prevention of child abuse. Because up to 70% of Americans have an ACE score of at least one, the campaign to prevent ACEs has the potential to engage a broader segment of the population than the narrower topic of child abuse and therefore, strengthen political will in support of solutions.  However, most parents, teachers, business leaders and other community members are not aware of the ACE Study and how it may affect a child’s future development and our future workforce.  PCAA and the state chapter network should work in collaboration with the media and other stakeholder groups to develop and implement new awareness campaigns to disseminate the important findings and messages from the ACE Study nationwide,  Campaigns should emphasize actions everyone can take to prevent ACES and strengthen resilience among children.
  5. Support advocacy efforts in support of a substantial expansion of evidenced-based home visiting programs. Home visiting programs, such as Healthy Families America, have more than 25 years of rigorous research documenting their effectiveness in preventing child abuse and improving a broad array of child health and development outcomes for children and parents.  However, such programs only reach a small percentage of families who could benefit from the services.  Home visiting programs represent a proven effective strategy to alleviate “toxic stress” among families with our youngest children.
  6. Major systems serving young children and their parents, especially early education and primary health care, should receive training about adapting their policies and practices based on systems of trauma-informed/trauma-sensitive care. Over the past 10 years, many professionals in systems serving children and youth, including child welfare, health care, and education have received training about trauma-informed care.  These efforts should be expanded to reach a high percentage of our youngest children 0–5 to maximize the opportunity for prevention by reaching parents starting on day one and involving all of the major systems—touch points—who now serve children on a universal basis.

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