Adverse Childhood Experiences (ACE's) Context, Research, & Tools


Original Adverse Childhood Experience Study

  • Systematic study of the long-suspected links between early childhood trauma/adversity with health outcomes through adulthood
  • Collaborative effort by Vincent Felitti and Robert Anda, CDC and Kaiser Permanente
  • Over 17,000 Kaiser HMO participants
  • Measured:

             – 9 ACE indicators including child abuse, neglect and household dysfunction

             – Health and behavior outcomes

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  • An ACE score is a tally of different types of abuse, neglect, and other hallmarks of a rough childhood. According to the Adverse Childhood Experiences study, the more toxic stress you encountered during your childhood, the higher your score is likely to be and the higher your risk for later health problems. 

The Philadelphia Adverse Childhood Experiences Project: The Urban ACE Study

  • The Philadelphia ACE Project is a collaborative, led by the Institute for Safe Families (ISF), to develop and implement research, practice and policies in urban pediatric settings based on the Adverse Childhood Experiences (ACE) study.
  • ISF contracted Public Health Management Corporation (PHMC) to survey Philadelphia (PHL) adults about their childhood experiences and subsequent health outcomes
  • Urban ACE Module developed by Philadelphia ACE Task Force and PHMC to assess how Urban ACE stressors further impact health

5 newly identified Urban ACE indicators:

  • Experiencing racism;
  • Witnessing violence;
  • Living in an unsafe neighborhood;
  • Living in foster care or;
  • Experiencing bullying

9 original ACE indicators:

  • Experiencing physical, sexual or emotional abuse;
  • Experiencing physical or emotional neglect;
  • Witnessing domestic violence in the home;
  • Living with someone who abused substances, was mentally ill, or who was imprisoned/sentenced to serve time


Minnesota ACE's Study

The 2011 Minnesota Behavioral Risk Factor Surveillance System (BRFSS) data was collected through interviews with adults reached at randomly selected telephone numbers. Minnesota results reflect a dual frame sample design that includes both cellular and landline telephone numbers. Respondents reached by cell phone comprised 31 percent of the sample and were selected based on their positive response to three questions confirming Minnesota residency, age (18 years or older), and that the phone was not used for business purposes. For the landline sample, a census of household members by age and gender was enumerated and one adult was selected at random. The Minnesota ACE sample is comprised of 15,266 respondents of which 13,520 responded to the ACE module of questions.

The Minnesota ACE questions are consistent with those that have been used in other states over the course of the last several years. There are 11 questions that yield 9 ACEs in the module that assesses the occurrence of adverse experiences prior to the age of 18. The ACE categories include events relating to emotional, physical, and sexual abuse and adverse household situations including mental illness, incarceration of a household member, parent separation or divorce, presence of drug or alcohol abuse, or exposure to violence between adults.

As documented in the initial ACE study and in other states’ ACE studies, adverse childhood experiences have a lifelong impact on the physical health, mental health, and social well-being of Minnesotans. This study confirms that a majority of Minnesotans are experiencing ACEs in childhood. As in other states, ACEs tend to occur together. This study also confirms that there is an association between the number of ACEs and health and social outcomes so that the more ACEs a person has the greater the effect on physical and mental health and social well-being. In this section, a summary of ACEs in Minnesota by select socioeconomic factors is provided. This helps to understand who experiences ACEs in Minnesota, the prevalence of ACEs being reported, and the types of ACEs experienced in childhood. In the following section, the ACE scores and the association of these scores with selected health conditions and risk behaviors are presented.

Read The Full Report Here.

Defining ace's

The CDC continues ongoing surveillance of ACEs by assessing the medical status of the study participants via periodic updates of morbidity and mortality data.

Adverse Childhood Experiences (ACEs) are categorized into three groups: abuse, neglect, and family/household challenges. Each category is further divided into multiple subcategories. Participant demographic information is available by gender, race, age, and education. The prevalence of ACEs is organized by category.

All ACE questions refer to the respondent’s first 18 years of life.

  • Abuse
    • Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt.
    • Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured.
    • Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you.
  • Household Challenges
    • Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother’s boyfriend.
    • Household substance abuse: A household member was a problem drinker or alcoholic or a household member used street drugs.
    • Mental illness in household: A household member was depressed or mentally ill or a household member attempted suicide.
    • Parental separation or divorce: Your parents were ever separated or divorced.
    • Criminal household member: A household member went to prison.
  • Neglect
    • Emotional neglect: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support.
    • Physical neglect: There was someone to take care of you, protect you, and take you to the doctor if you needed it, you didn’t have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.



The Effects of ACE's


What Can Be Done About ACES?

Safe, stable and nurturing relationships and environments (SSNRs) can have a positive impact on a broad range of health problems and on the development of skills that will help children reach their full potential. Strategies that address the needs of children and their families include:

  • Voluntary home visiting programs can help families by strengthening maternal parenting practices, the quality of the child's home environment, and children s development
  • Home visiting to pregnant women and families with newborns
  • Parenting training programs
  • Intimate partner violence prevention
  • Social support for parents
  • Parent support programs for teens and teen pregnancy prevention programs
  • Mental illness and substance abuse treatment
  • High quality child care
  • Sufficient Income support for lower income families