Frontline Initiative Trauma-Informed Care

The Adverse Childhood Experiences (ACE) study is one of the largest investigations ever conducted to assess associations between childhood adverse experiences, and health and well-being later in life. The study was conducted by the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego.

More than 17,000 Health Maintenance Organization (HMO) members provided details about childhood experiences during comprehensive physical examinations. They reported information about abuse, neglect, and family challenges. The results showed that childhood abuse, neglect, and exposure to other traumatic stressors are common. Nearly two-thirds of study participants reported at least one adverse childhood experience (ACE), and more than one of five reported three or more ACEs.

The results also suggested that certain early experiences are major risk factors for negative short- and long-term outcomes. Risk factors such as smoking, alcohol abuse, and certain risky sexual behaviors in adulthood were strongly associated with ACEs. Additionally, risk factors for many common diseases were not randomly distributed in the population. They tended to concentrate in the population that reported ACE. Risk factors for many chronic diseases tended to cluster: persons who had one risk factor tended to have one or more other risk factors too.

The ACE Pyramid represents the conceptual framework for the study. The information collected helps to bridge some of the gaps identified in previous research. Researchers hoped to identify influences of disease, disability and early death among those who report ACE. By providing this information, scientists hoped to develop new and more effective prevention programs.

The information from the ACE study regarding the impact of adverse childhood experiences can improve efforts towards prevention and recovery. This research has informed development of public education and prevention programs. The Centers for Disease Control and Prevention has also suggested some paths to encourage recovery. These are reported below. Importantly, safe, stable and nurturing relationships for those who have experienced one or more ACE is key in this process. DSPs are in a unique position to provide such relationships to the individuals they support.