By Meg Hargreaves, Community Science

Research has shown that adverse childhood experiences (ACEs) involving child abuse, neglect, and household violence as well as mental illness, incarceration, and substance abuse are linked to a lifetime of poor health outcomes. ACEs disrupt brain development and harm the immune system, resulting in cognitive impairment, risky health behaviors, chronic disease, and early death.

An international network of researchers, health officials, foundations, service agencies, and community advocates is working to increase awareness of the harm of ACEs and develop effective strategies for their prevention, mitigation, and treatment. As the evaluator of several important ACEs initiatives, Community Science is developing groundbreaking evaluation tools and approaches to advance the science of how to address this complex problem more effectively at multiple levels.

The issue was first identified in the 1990s when Robert Anda and Vincent Felitti, researchers from the Centers for Disease Control and Prevention and the Kaiser Permanente Health Plan’s Department of Preventive Medicine Kaiser, began studying the influence of ACEs on human health and development. The study found that ACEs are very common. Almost two-thirds (64 percent) of the patients they surveyed had at least one ACE, and most of those had several ACEs. About one in eight (12 percent) had four or more. The study found that as the number of ACEs increases, so does the risk for negative health outcomes.

Advances in neuroscience research have identified the epigenetic (biological) impacts of ACEs that are linked to poor health. The latest evidence shows that the toxic stress associated with exposure to childhood adversity affects brain development, the endocrine (hormonal) system, and the immune system, impairing decision-making, impulse control, and resistance to disease— precursors to disruptions in cognitive development, increases in risky health behaviors, and early onset of disease.

National leaders in health care, public health, and child development conclude that the enormity of these findings cannot be overstated. Dr. Robert Block, the former head of the American Academy of Pediatrics, named ACEs “the single greatest unaddressed public health threat facing our nation today.” In response, an international network of researchers, foundations, state and national government leaders, social service organizations, and concerned communities is working to increase awareness and understanding of the impact of ACEs and the need to develop effective innovative interventions to prevent, mitigate, and treat ACEs.

Community Science is involved in several of these initiatives, including the evaluations of the ACEs Public Private Initiative (APPI) and the Alliance for Strong Families and Communities' Change in Mind initiative.

Through these projects, Community Science is developing important new tools to advance the science of how to address ACEs more effectively at multiple levels:

  • Increasing individual awareness
  • Improving program outcomes
  • Changing organizational practices
  • Collaborating on systems change, and advocating for new policies

For the APPI evaluation, we are creating the APPI Collective Community Capacity Index by addressing ACEs, resilience, and healthy child development. For the Change in Mind evaluation, we are working to develop and test multilevel theories of change, using rapid-cycle developmental evaluation methods.