Understanding Adverse Childhood Experiences (ACEs) and Toxic Stress

1. Understanding Adverse Childhood Experiences (ACEs) and Toxic Stress A Comprehensive Guide to Prevention, Screening, and Trauma-Informed Care Western Youth Services Creating a Healthier Future for Children, Families, and Communities September 2025

2. Adverse Childhood Experiences (ACEs) and Toxic Stress Contents 1 Introduction to Adverse Childhood Experiences (ACEs) 2 2 Why Understanding ACEs Matters 2 3 Trauma-Informed Care 3.1 What is Trauma-Informed Care? . . . . . . . . . . . . . . . . . . . . . . 3.2 Implementing Trauma-Informed Care . . . . . . . . . . . . . . . . . . 2 2 3 4 Clinical Assessment and Treatment for ACEs 4.1 Screening for ACEs 4.2 Evidence-Based Interventions 3 3 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Health Equity and ACEs 5.1 Addressing Disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 Strategies for Equity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4 4 6 Benefits of Screening for ACEs 4 7 Resources for Providers 5 8 Conclusion 5 1

3. Adverse Childhood Experiences (ACEs) and Toxic Stress 1 Introduction to Adverse Childhood Experiences (ACEs) Adverse Childhood Experiences (ACEs) refer to traumatic events that occur dur- ing childhood, which can have profound and lasting effects on an individual’s physical, emotional, and mental health. These experiences include abuse (phys- ical, emotional, or sexual), neglect, household dysfunction (such as domestic vi- olence, substance abuse, or parental separation), and other forms of adversity. Toxic stress, a prolonged and harmful stress response, often results from expo- sure to ACEs without adequate support, leading to significant health challenges across a person’s lifespan. This document aims to provide a comprehensive understanding of ACEs, their impact, and the importance of trauma-informed care, screening, and equitable healthpractices. ByaddressingACEsproactively,wecancreateabrighter,health- ier future for children, families, and communities. 2 Why Understanding ACEs Matters ACEs are not isolated incidents; they are widespread and can affect individuals across all socioeconomic backgrounds. Research shows that nearly two-thirds of adults have experienced at least one ACE, and the cumulative impact of multiple ACEs increases the risk of chronic health conditions, mental health disorders, and social challenges. By understanding ACEs, healthcare providers, educators, and community leaders can: • Identify individuals at risk of toxic stress early. • Implement preventive measures to reduce long-term health impacts. • Foster resilience through supportive interventions. • Promote health equity by addressing disparities in access to care. WesternYouthServicesiscommittedtoraisingawarenessaboutACEsandequip- ping providers and communities with the tools to address them effectively. 3 Trauma-Informed Care 3.1 What is Trauma-Informed Care? Trauma-informed care (TIC) is an approach that recognizes the widespread im- pact of trauma and integrates this understanding into healthcare practices, poli- cies, and interactions. TIC seeks to create a safe, supportive environment for individuals who have experienced ACEs or toxic stress. It is built on six key prin- ciples: 1. Safety: Ensuring physical and emotional safety for patients and staff. 2. Trustworthiness and Transparency: Building trust through clear com- munication and consistent practices. 2

4. Adverse Childhood Experiences (ACEs) and Toxic Stress 3. Peer Support: Encouraging connections with others who have shared ex- periences. 4. Collaboration: Involving patients in their care decisions to foster empow- erment. 5. Empowerment and Choice: Prioritizing patient autonomy and voice. 6. Cultural Sensitivity: Addressing cultural, historical, and gender-related issues in care. 3.2 Implementing Trauma-Informed Care Healthcare providers can adopt TIC by training staff to recognize trauma symp- toms, creating welcoming environments, and using patient-centered communi- cation. For example, asking open-ended questions like, ”Can you tell me about your experiences?” rather than assuming a patient’s background can build trust and uncover critical information for tailored care. 4 Clinical Assessment and Treatment for ACEs 4.1 Screening for ACEs Screening for ACEs involves using validated tools to identify individuals who have experienced childhood adversity. These tools, such as the ACEs question- naire,askaboutspecificexperienceslikeabuse,neglect,orhouseholdchallenges. Screening is a critical first step in understanding a patient’s health risks and tai- loring interventions. 4.2 Evidence-Based Interventions OnceACEsareidentified, providerscanuseevidence-basedinterventionstomit- igate toxic stress. These include: • Cognitive Behavioral Therapy (CBT): Helps patients process trauma and develop coping strategies. • MindfulnessandStressReduction: Techniqueslikemeditationorbreath- ing exercises can reduce stress responses. • Therapy: Supports families in creating stable, nurturing environments. • Interventions: Addressing physical health conditions linked to toxic stress, such as cardiovascular or autoimmune disorders. By combining screening with trauma-informed interventions, providers can im- prove both physical and mental health outcomes for patients. 3

5. Adverse Childhood Experiences (ACEs) and Toxic Stress 5 Health Equity and ACEs 5.1 Addressing Disparities ACEsdisproportionatelyaffectmarginalizedcommunities,includinglow-income families, racial and ethnic minorities, and those with limited access to health- care. Addressing health equity means ensuring that all individuals, regardless of background, have access to screening, treatment, and support for ACEs. AsDr. NadineBurkeHarris,formerCaliforniaSurgeonGeneral,stated: “Through ACEs Aware, we can realize a more just and equitable reality where we can truly prevent and provide healing from childhood adversity for all Californians.” This vision underscores the importance of equitable care in breaking the cycle of ad- versity. 5.2 Strategies for Equity To promote health equity, organizations can: • Offer free or low-cost ACEs screenings in underserved communities. • Provide culturally competent care that respects diverse backgrounds. • Advocate for policies that increase access to mental health resources. • Partner with community organizations to reach at-risk populations. 6 Benefits of Screening for ACEs Screening for ACEs offers numerous benefits that enhance patient care and im- prove health outcomes. These include: • Prevention: Identifying risk factors early to prevent long-term health is- sues. • Early Detection: Recognizing signs of toxic stress before they escalate. • Early Intervention: Implementing timely support to mitigate harm. • ImprovedClinicalAssessment: Gainingaholisticviewofapatient’shealth. • Patient Education: Empowering individuals with knowledge about their health risks. • TreatmentPlanning: Creatingpersonalizedcareplansbasedonscreening results. • Empowerment: Encouraging patients to take an active role in their heal- ing. • Positive Outcomes: Reducing chronic disease, mental health challenges, and social disparities. 4

6. Adverse Childhood Experiences (ACEs) and Toxic Stress 7 Resources for Providers WesternYouthServicesoffersarangeofresourcestosupporthealthcareproviders in addressing ACEs: • ProviderTraining: SignupfortrainingsessionstolearnaboutACEsscreen- ingandtrauma-informedcare. Visithttps://www.westernyouthservices. org/aces-expertise/ for details. • ProvidersToolkit: Downloadacomprehensivetoolkitwithscreeningtools, guidelines, and best practices. • ACEs Practice Paper: Access the latest research and recommendations on ACEs and toxic stress. • Stress Busters: Explore practical strategies for patients to manage stress and build resilience. 8 Conclusion Adverse Childhood Experiences and toxic stress are critical public health issues thatrequireacoordinated,compassionateresponse. Byadoptingtrauma-informed care, screening for ACEs, and promoting health equity, we can create a health- ier, moreresilientfutureforchildren, families, andcommunities. WesternYouth Services is proud to lead this effort through education, resources, and advocacy. Formoreinformation,visithttps://www.westernyouthservices.org/aces-expertise/ or contact us to get involved. This document is provided by Western Youth Services to raise awareness and support providersinaddressingACEs. Foradditionalresources,includingmentalhealthsupport and provider tools, please visit our website. 5