Pathways to Prevention: Raising Awareness and Understanding of ACEs

By Sara Jo Johnson
CFLE Network

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Sara Jo Johnson

My educational journey began in Criminal Justice. I was fascinated with criminology. I hoped to find an answer to what drives these persons to commit heinous acts, like murder and rape. More importantly was it possible to intervene, counteract their original wiring, and work towards rehabilitation? I took a college class covering juvenile delinquency, which transformed my perspective and rerouted my educational journey. Antisocial behavior could be prevented or at least ameliorated through early professional intervention in a child’s life. Many issues could be sidestepped altogether if resources and education were freely available.

The movement that promoted family well-being beckoned me. I came from a background of physical and emotional abuse that required my siblings and me to be superhero strong and resilient. After my younger brother committed suicide at age 38, I questioned if abuse could be related to physical as well as mental health.

Dr. Bridget Walsh invited me to attend a special interest group via a conference call with Dr. Mary Sciaraffa and Jennifer Best to discuss ACEs, or adverse childhood experiences and its context to family life educators. My curiosity was piqued because from personal and professional experience and my academic studies, I knew that adverse experiences influenced delinquent behavior and negative life outcomes. Prior to this special interest group, I was not familiar with the term ACEs, nor the original ACEs study, which explored the relationship of childhood, experiences with later adult health outcomes.

In the original ACE Study (Felitti et al., 1998) the relationship between traumatic and stressful incidences before age 18 was linked to later challenges related to health and mental well-being. Researchers have identified 10 ACEs within the three categories of abuse, household dysfunction and neglect. The ten ACEs are: emotional/psychological, physical and sexual abuse; parental substance abuse, parental separation/divorce, parental mental illness, violence between parents or abuse of mother/stepmother, parent incarceration; and emotional and physical neglect.

Nadine Burke Harris in her TED Talk, “How childhood trauma affects health across a lifetime,” uses the analogy of meeting a bear in the woods. Imagine the physiological responses, the fight or flight adrenaline rush. This is natural and important for survival. If the bear lives in your home, the stress response would be continuously triggered and could be toxic. For children, the stress can affect crucial stages of brain development, influencing physical, cognitive, and socio-emotional growth.

As a recent HDFS graduate and an aspiring Certified Family Life Educator (CFLE), I was motivated to read more about ACEs and the lifespan. Exposure to chronic negative experiences is more likely to influence negative coping mechanisms. These in turn shape health behaviors and lifestyles that can lead to disease and early death. The psychological health of a person can be affected by traumatic or negative events. The ACEs study found that the more ACEs a child experienced, the greater the long-term health risks as an adult. Many of these health risks present as leading causes of death, such as ischemic heart disease and cancer (Felitti et al., 1998). The likelihood of these risks remains high even if the person with multiple ACEs does not engage in negative health behaviors (Harris, 2014).

Additionally, ACEs are not limited to socioeconomic status; instead, it crosses borders and zip codes. The original ACEs study found that 70% of the 17,500 participants were white with a college education (CDC, 2016; Harris, 2014). Lifespan development is affected in multiple contexts. The ecological systems perspective prompts thinking about ACEs within the child’s microsystem, such as the home, parents, and siblings; those closest to the child. ACEs can be cyclical and intergenerational. Generational family life programs directed at both the child and the parents can promote prevention. In order to accelerate intergenerational transformation, we need to consider a systems perspective because change must happen within and across the systems to improve health and quality of life.

Behavioral, emotional, and physical issues are better explained if we look outside the family scope. I refer to my little brother who, along with our six other siblings and myself, lived in daily fear of the bear at home. I found relief at school. The teachers encouraged my education and my circle of school friends supported me as a person. I don’t remember that occurring for my brother. I remember him having focus issues in school, and the anger it ignited at home when the grades plummeted. The educational delays led to bullying and teasing by other classmates. At school, he faced a new bear every day and found no reprieve at home.

More Questions than Answers

While ACEs are not confined to one demographic, what if the ACE is the circumstances in the neighborhood? What about a silent community that gives consent and condones the trauma? What about the neighborhood laden with observable violence? What are the underlying economic and social inequities that may influence community regulations, like drug laws or zero tolerance policies in school? Additionally, modern technology has moved us to a stage of cyberbullying and social media-induced depression.

It is important to stand for prevention science and efforts. As Dr. Anda proposed, “What’s predictable is preventable.” Awareness and connection seem to be good starting points to a prevention mindset. Dr. Allison Jackson, a trauma-informed Care Specialist, insisted in her TED Talk, “A Call to Connection: Making Childhood Trauma Personal,” that we talk about it because raising awareness and breaking the silence opens the door to and boots out the feared bear.

Many Paths Lead to Improved Outcomes

During My HDFS practicum experiences, I enjoyed the multidisciplinary nature of the family sciences and the importance of collaborating with a multidisciplinary team—healthcare providers, law enforcement officers, teachers. All of them are adopting trauma-informed care practices. Within the medical sector, direct interaction with patients and their families can include ACEs screening during intake and other routine screening. A few law enforcement agencies have adopted trauma-informed care when working with the public as well as for their own well-being and to prevent burn-out from harrowing things they are exposed to professionally. Teachers are addressing behavioral and academic issues with students, as what has happened to the child rather than the child is the problem.

CFLEs can strive towards prevention. Researchers of physical development throughout the lifespan have found that the brain can create new pathways based on positive learning experiences and environments. The risk factors attributed to ACEs can be offset by the presence of one stable, caring, and dependable adult. I was fortunate to have experienced this type of caring firsthand, and it has helped me seek out a positive and healthy support network. I have gone beyond the ordinary to foster the well-being of my own family and children. I hope to listen, to connect with families, and to educate them so that their story can change and the cycles of abuse and dysfunction can end. Even if this requires a team effort, let us collaborate to confront and chase out the threatening bear of adverse childhood experiences.



Center for Disease Control and Prevention. (2016) About the CDC-Kaiser ACE Study. Retrieved from

Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M. and Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258.

Harris, N. B. (2014, September). Nadine Burke Harris: How childhood trauma affects health across a lifetime. [Video file]. Retrieved from

TED. (2016, May). Jackson, A., Ph.D.. Allison Jackson: A call to connection: Making childhood trauma personal. [Video file]. Retrieved from