Children’s positive or negative experiences during the prenatal-to-three period have a lasting impact on future development, health and well-being. Studies have found that adverse childhood experiences (ACEs)— defined as abuse, neglect or household challenges like substance use or an incarcerated parent—can cause toxic stress, which may lead to increased risk for physical and mental health conditions, decreased life expectancy and poorer educational outcomes throughout the lifespan. Recent research has expanded beyond the ACEs defined in the original study to explore how community and systemic factors, such as poverty and racism, can also cause toxic stress that affects brain and body development.
While ACEs can be traumatic, they are not inevitable. Especially in the first three years of a child’s life, safe, stable and nurturing relationships and environments can reduce the likelihood of ACEs and prevent toxic stress from occurring. As the frontline safety net for residents, counties administer and invest heavily in health and human services and are well-positioned take the lead on primary prevention strategies that increase protective factors and mitigate trauma. Counties connect families to economic and social supports, partner with stakeholders to increase the supply of high-quality child care and offer effective evidence-based home visiting programs to support new parents. County leaders can also leverage their platform to raise public awareness on ACEs and create a cross-sector, community-wide vision for preventing ACEs and creating safe, nurturing spaces where infants, toddlers and families thrive.
County strategies
Supporting healthy parent-child relationships
Madison County, N.Y.: The county’s health department offers the Healthy Families home visiting program to support expectant families. Through the program, public health nurses visit parents at home during and after pregnancy to connect parents to community resources, provide education on parenting and child development and assess children for developmental delays. The county also throws a community baby shower where expectant mothers can ask questions about having a baby in a relaxed, informal setting and receive a gift bag with baby essentials.
Connecting families to economic supports and resources
Contra Costa County, Calif.: First Five Contra Costa has partnered with a local medical clinic to implement ACEs screening and connect families to resources. Providers screen both young children and new or expectant mothers for signs of toxic stress and refer families to the local Help Me Grow (HMG) affiliate. HMG staff answer questions about child development and connect families to needed resources and services. The ACEs screening is funded by ACEs Aware, a statewide initiative which awards grants at the local level to educate clinicians and communities about ACEs and toxic stress.
Convening stakeholders across sectors to create a cohesive vision for ACEs and resiliency
Clatsop County, Ore.: Resilient Clatsop County, a coalition of local organizations who serve children and families, is working to reduce ACEs and build resilience. The coalition convenes working groups who explore specific trauma-prevention strategies for the education, healthcare and child welfare sectors as well as the community. The coalition is tracking outcomes and impact with a robust data dashboard.
Durham County, N.C.: In 2019, the Board of County Commissioners passed a resolution pledging to take a community action approach for becoming an ACEs-informed community and developing a community resilience plan. The county also hosts an active ACEs resilience taskforce whose mission is to build upon the strengths of Durham communities and systems and advance an equitable and culturally responsive approach to prevent and respond to toxic stress and trauma.
Learn More
Centers for Disease Control and Prevention: Preventing Adverse Childhood Experiences toolkit
PACEs Connection: Positive and Adverse Childhood Experiences Science 101
Guide to establish a local PACEs initiative
Handouts for parents: Understanding ACEs and Parenting to Prevent and Heal ACEs (available in additional languages here)
University of North Carolina: Racism is an Adverse Childhood Experience
Explore state-level efforts
California: ACEs Aware
Ohio: Health Policy Institute of Ohio ACEs advisory group