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Home » Trauma Informed Schools Resources

Trauma Informed Schools Resources

Contact Information

Student Support

Cindi Wiek
Administrative Support Supervisor
Tammy Bolen
Program Supervisor

This site directs you to resources to include books, web links, scientific literature, and downloadable infographics. The study of Trauma, Adverse Childhood Experiences, and Toxic Stress is moving at a rapid pace with new research and publications. Please explore and enjoy the many resources we have tried to share and we thank you for your patience as we continue to build and add to this site with the growing field.

Attachment and Trauma Network

ATN’s Trauma-Sensitive Schools Initiative is devoted to creating school-wide trauma-sensitive reform. Our experienced educators and those with expertise in early childhood trauma are working together to develop Professional Development Programs for Educators.

National Association of School Psychologists

Resources/Topics include:  Brief Tips and Policy Recommendations, Role of School Psychologists in Supporting Trauma-Sensitive Schools, Policy Recommendations, Opportunities to Advance Trauma-Sensitive Schools in ESSA.

Trauma and Learning Policy Initiative (TLPI)

Mission:  The Trauma and Learning Policy Initiative’s (TLPI) mission is to ensure that children traumatized by exposure to family violence and other adverse childhood experiences succeed in school. To accomplish this mission, TLPI engages in a host of advocacy strategies including: providing support to schools to become trauma sensitive environments;  research and report writing; legislative and administrative advocacy for laws, regulations and policies that support schools to develop trauma-sensitive environments; coalition building; outreach and education; and limited individual case representation in special education where a child’s traumatic experiences are interfacing with his or her disabilities.

Treatment and Services Adaptation Center

Promoting trauma-informed school systems that provide prevention and early intervention strategies to create supportive and nurturing school environments.

ACES Too High

A news site that reports on research about adverse childhood experiences, including developments in epidemiology, neurobiology, and the biomedical and epigenetic consequences of toxic stress. We also cover how people, organizations, agencies and communities are implementing practices based on the research.

Center on the Developing Child – Harvard University

ACEs and Toxic Stress:  Frequently Asked Questions

Centers for Disease Control and Prevention

Childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue. Much of the foundational research in this area has been referred to as Adverse Childhood Experiences (ACEs). ACEs can be prevented. Learn more about preventing ACEs in your community.

Department of Health:  Adverse Childhood Experiences

ACEs - additional resources

The National Child Traumatic Stress Network

Helps educators and school staff recognize the signs and symptoms of complex trauma and offers recommendations on how to help students heal.

National Scientific Council on the Developing Child

Healthy development in the early years provides the building blocks for educational achievement, economic productivity, responsible citizenship, lifelong health, strong communities, and successful parenting of the next generation. This three-part video series from the Center and the National Scientific Council on the Developing Child depicts how advances in neuroscience, molecular biology, and genomics now give us a much better understanding of how early experiences are built into our bodies and brains, for better or for worse.

Office of Superintendent of Public Instruction

Compassionate Schools: The Heart of Learning and Teaching. - The Compassionate Schools Initiative within Student Engagement and Support at OSPI provides resources to schools aspiring to consider a trauma responsive infrastructure. Compassionate Schools support all students and are focused ultimately on helping Washington teachers understand fundamental brain development and function, learning pedagogy, recognize a mandate for self-care, correctly interpret behaviors, manage negative behaviors successfully with compassionate and effective strategies, and engage students, families, and the community.

Robert Wood Johnson Foundation

Resources for communities working to address the impact of adverse childhood experiences (ACEs), and help every child have a healthy start in life.

Substance Abuse and Mental Health Services Administration (SAMHSA)

Adverse Childhood Experiences

Washington State ACEs Action

A forum to inform and connect individuals and communities working to promote safe, stable, nurturing relationships and environments and prevent and mitigate ACEs in Washington State.

Washington State University:  Child and Family Research Unit

Complex Trauma Resources


Centers for Disease Control and Prevention

Preventing Adverse Childhood Experiences – Training Modules

Community Resilience Initiative

Resilience Based Trainings to address Trauma


Parenting classes and trauma trainings for professionals and community members that draw from the latest scientific research on brain and child development, as well as the effects of childhood toxic stress. (Los Angeles)

Improving School Outcomes for Trauma-Impacted Students, National Dropout Prevention Center

Trauma Skilled Model (pdf)

National Center of Safe and Supportive Learning Environments

Trauma-Sensitive Schools Training Package.

Neurosequential Network

The Neurosequential Model in Education (NME) draws upon the NMT (a neurodevelopmentally-informed, biologically respectful perspective on human development and functioning) to help educators understand student behavior and performance.  

The goals of NME are to educate faculty and students in basic concepts of neurosequential development and then teach them how to apply this knowledge to the teaching and learning process.  NME is not a specific “intervention”; it is a way to educate school staff about brain development and developmental trauma and then to further teach them how to apply that knowledge to their work with students in and outside the classroom, particularly those students with adverse childhood experiences.

Office of Superintendent of Public Instruction

The Washington State Compassionate Schools Training on: “The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success”

This training tool has been designed to allow individuals to intensively study the manual that was written in 2009 entitled, “The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success.” This tool may also be used by individuals who wish to train others on the content of this manual.

ACEs Action Alliance

The ACEs Action Alliance is a multi-sector collaborative of individuals, public and private organizations. We work together to promote a trauma-informed, resilient Clark County. We align local efforts by convening partners, assessing needs, raising awareness about the causes and impact of trauma and toxic stress, measuring progress, and promoting approaches that build individual, family and community resilience. We meet monthly and welcome new members. Please see the calendar for the date of our next meeting. Clark County

Community Resilience Initiative:  Resilience Trumps ACEs

Walla Walla

Kitsap Strong

A community initiative to improve the health and well-being of all children, families, and adults in Kitsap.

Spokane Regional Health District

1-2-3-Care:  A trauma-sensitive toolkit for caregivers of children

Adverse Childhood Experiences (ACEs): brief overview (video 1:20)

Community – “We Can Prevent ACEs” (video - 4:32)

Five-minute primer about Adverse Childhood Experiences Study:  ACEs Too High (5:00)

How Childhood Trauma Affects Health across a Lifetime:  Nadine Burke Harris (TED Talk - 15:59)

Paper Tigers:  Movie Trailer (2:10)

Using PBIS to Develop Trauma Sensitive Schools (23:40)

Why We Need Trauma-Sensitive Schools (YouTube video 10:49)

CBS News – Oprah Winfrey discusses childhood trauma on 60 minutes (7:24)

60 Minutes Overtime – The “life-changing” story Oprah reports (segment) – Oprah Winfrey (5:11)

title="Resources for Caregivers"

Harris NB. The Deepest Well. New York, NY: Houghton Mifflin Harcourt; 2018

A pioneering physician reveals just how deeply our bodies can be imprinted for life by childhood adversity–and what we can do to break the cycle.

Dr. Nadine Burke Harris was already known as a crusading physician delivering targeted care to vulnerable children. But it was Diego—a boy who had stopped growing after a sexual assault—who galvanized her to dig deeper into the connections between toxic stress and the lifelong illnesses she was tracking among so many of her patients and their families.

A study by healthcare giant Kaiser Permanente and the Center for Disease Control of more than 17,000 adult patients has led to our understanding that “Adverse Childhood Experiences”—like abuse, neglect, parental addiction or mental illness, and even divorce—can have lasting effects on human health. But the stunning news of Dr. Nadine Burke Harris’ research is just how, and how deeply, our bodies can be imprinted for life by these ACEs. Childhood adversity changes our biological systems, and lasts a lifetime. From stress responses to growth rates to diabetes, asthma, heart disease, and more, we are all a product of our childhood environments.

Through powerful storytelling and fascinating scientific insight, Burke Harris illuminates her journey of discovery, from research labs nationwide to her own pediatric practice in San Francisco’s Bayview Hunters Point. For anyone who has faced a difficult childhood, or who cares about the millions of children who do, the innovative and acclaimed health interventions outlined in The Deepest Well will represent vitally important hope for preventing lifelong illness for those we love and for generations to come

Medina J. Brain Rules. Seattle, WA: Pear Press; 2014

Most of us have no idea what’s really going on inside our heads. Yet brain scientists have uncovered details every business leader, parent, and teacher should know—like the need for physical activity to get your brain working its best.

How do we learn? What exactly do sleep and stress do to our brains? Why is multi-tasking a myth? Why is it so easy to forget—and so important to repeat new knowledge? Is it true that men and women have different brains?

In Brain Rules, Dr. John Medina, a molecular biologist, shares his lifelong interest in how the brain sciences might influence the way we teach our children and the way we work. In each chapter, he describes a brain rule—what scientists know for sure about how our brains work—and then offers transformative ideas for our daily lives.

Medina’s fascinating stories and infectious sense of humor breathe life into brain science. You’ll learn why Michael Jordan was no good at baseball. You’ll peer over a surgeon’s shoulder as he proves that most of us have a Jennifer Aniston neuron. You’ll meet a boy who has an amazing memory for music but can’t tie his own shoes.

You will discover how:

  • Every brain is wired differently
  • Exercise improves cognition
  • We are designed to never stop learning and exploring
  • Memories are volatile
  • Sleep is powerfully linked with the ability to learn
  • Vision trumps all of the other senses
  • Stress changes the way we learn

In the end, you’ll understand how your brain really works—and how to get the most out of it.

Perry BD, Szalavitz M. The Boy Who Was Raised as a Dog - and Other Stories from a Child Psychiatrist’s Notebook - What Traumatized Children can Teach us about Loss, Love and Healing. New York, NY: Basic Books; 2006, 2017

A renowned psychiatrist reveals how trauma affects children – and outlines the path to recovery.

“Fascinating and upbeat….Dr. Perry is both a world-class creative scientist and a compassionate therapist.” – Mary Pipher, PhD, author of Reviving Ophelia

How does trauma affect a child’s mind-and how can that mind recover? In the classic The Boy Who Was Raised as a Dog, Dr. Perry explains what happens to the brains of children exposed to extreme stress and shares their lessons of courage, humanity, and hope. Only when we understand the science of the mind and the power of love and nurturing, can we hope to heal the spirit of even the most wounded child.

Sadin M, Levy N, Sadin T. Teachers Guide to Trauma:  20 Things Kids With Trauma Wish Their Teachers Knew.  Monroe TWP,NJ: NL Books LLC; 2018

The “Teachers Guide to Trauma” provides an introduction to the neurobiological and psychological impact of early childhood trauma. This guide is designed to provide an overview of how trauma impacts learning and behavior in school. True stories and practical strategies help teachers and parents understand how best to meet the learning and behavior needs of children with trauma.

Sorrels B. Reaching and Teaching Children Exposed to Trauma. Lewisville, NC: Gryphon House, Inc.; 2015, 2018.

What does a harmed child look like? It’s the little girl on the playground who has mysterious bruises on her legs. It’s the three-month-old baby boy who arches his back when you try to hold him. It’s the four-year-old who bites and hits when asked to clean up. These are the faces of traumatized children.

As an early childhood professional, you play a key role in the early identification of maltreatment and unhealthy patterns of development. You are also the gateway to healing. In Reaching and Teaching Children Exposed to Trauma, you will find the tools and strategies to connect with harmed children and start them on the path to healing.

Dr. Sorrels offers practical strategies that caregivers need to help these littlest victims.

  • Connecting with a harmed child using games, music, gentle touch, and play
  • Meeting children’s sensory needs throughout the day: morning arrival, group time, meal times, outdoor play, and naptime
  • Creating a sensory-rich classroom environment with easy, simple ideas
  • Teaching a traumatized child self-regulation skills and impulse control using visual cues, rehearsal and role play, games, and scripted stories
  • Coaching and supporting social skills: turn taking, sharing, joining in play, empathy, and conflict resolution
  • Communicating unconditional love and acceptance to children from hard places

Souers K, Hall P. Fostering Resilient Learners:  Strategies for Creating a Trauma-Sensitive Classroom. Alexandria, VA: ASCD; 2016.

In this galvanizing book for all educators, Kristin Souers and Pete Hall explore an urgent and growing issue—childhood trauma—and its profound effect on learning and teaching.

Grounded in research and the authors' experience working with trauma-affected students and their teachers, Fostering Resilient Learners will help you cultivate a trauma-sensitive learning environment for students across all content areas, grade levels, and educational settings. The authors—a mental health therapist and a veteran principal—provide proven, reliable strategies to help you

  • Understand what trauma is and how it hinders the learning, motivation, and success of all students in the classroom.
  • Build strong relationships and create a safe space to enable students to learn at high levels.
  • Adopt a strengths-based approach that leads you to recalibrate how you view destructive student behaviors and to perceive what students need to break negative cycles.
  • Head off frustration and burnout with essential self-care techniques that will help you and your students flourish.

Each chapter also includes questions and exercises to encourage reflection and extension of the ideas in this book.

As an educator, you face the impact of trauma in the classroom every day. Let this book be your guide to seeking solutions rather than dwelling on problems, to building relationships that allow students to grow, thrive, and—most assuredly—learn at high levels.

Wolpow R, Johnson MM, Hertel R, Kincaid SO. The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success. Olympia, WA: The Office of Superintendent of Public Instruction (OSPI) Compassionate Schools; 2009.

The Heart of Learning: Compassion, Resiliency, and Academic Success is a handbook for teachers written and compiled by OSPI and Western Washington University staff. It contains valuable information that will be helpful to you on a daily basis as you work with students whose learning has been adversely impacted by trauma in their lives.

Bellis MA, Hughes K, Ford K, et al. Adverse childhood experiences and sources of childhood resilience:  a retrospective study of their combined relationships with child health and educational attendance. BMC Public Health. 2018;18:792.



Adverse childhood experiences (ACEs) including maltreatment and exposure to household stressors can impact the health of children. Community factors that provide support, friendship and opportunities for development may build children’s resilience and protect them against some harmful impacts of ACEs. We examine if a history of ACEs is associated with poor childhood health and school attendance and the extent to which such outcomes are counteracted by community resilience assets.


A national (Wales) cross-sectional retrospective survey (n = 2452) using a stratified random probability sampling methodology and including a boost sample (n = 471) of Welsh speakers. Data collection used face-to-face interviews at participants’ places of residence. Outcome measures were self-reported poor childhood health, specific conditions (asthma, allergies, headaches, digestive disorders) and school absenteeism.


Prevalence of each common childhood condition, poor childhood health and school absenteeism increased with number of ACEs reported. Childhood community resilience assets (being treated fairly, supportive childhood friends, being given opportunities to use your abilities, access to a trusted adult and having someone to look up to) were independently linked to better outcomes. In those with ≥4 ACEs the presence of all significant resilience assets (vs none) reduced adjusted prevalence of poor childhood health from 59.8 to 21.3%.


Better prevention of ACEs through the combined actions of public services may reduce levels of common childhood conditions, improve school attendance and help alleviate pressures on public services. Whilst the eradication of ACEs remains unlikely, actions to strengthen community resilience assets may partially offset their immediate harms.

Bellis MA, Hardcastle K, Ford K, et al. Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences-a retrospective study on adult health harm-harming behaviors and mental well-being. BMC Psychiatry. 2017;17:110.



Adverse childhood experiences (ACEs) including child abuse and household problems (e.g. domestic violence) increase risks of poor health and mental well-being in adulthood. Factors such as having access to a trusted adult as a child may impart resilience against developing such negative outcomes. How much childhood adversity is mitigated by such resilience is poorly quantified. Here we test if access to a trusted adult in childhood is associated with reduced impacts of ACEs on adoption of health-harming behaviors and lower mental well-being in adults.


Cross-sectional, face-to-face household surveys (aged 18–69 years, February-September 2015) examining ACEs suffered, always available adult (AAA) support from someone you trust in childhood and current diet, smoking, alcohol consumption and mental well-being were undertaken in four UK regions. Sampling used stratified random probability methods (n = 7,047). Analyses used chi squared, binary and multinomial logistic regression.


Adult prevalence of poor diet, daily smoking and heavier alcohol consumption increased with ACE count and decreased with AAA support in childhood. Prevalence of having any two such behaviors increased from 1.8% (0 ACEs, AAA support, most affluent quintile of residence) to 21.5% (≥4 ACEs, lacking AAA support, most deprived quintile). However, the increase was reduced to 7.1% with AAA support (≥4 ACEs, most deprived quintile). Lower mental well-being was 3.27 (95% CIs, 2.16–4.96) times more likely with ≥4 ACEs and AAA support from someone you trust in childhood (vs. 0 ACE, with AAA support) increasing to 8.32 (95% CIs, 6.53–10.61) times more likely with ≥4 ACEs but without AAA support in childhood. Multiple health-harming behaviors combined with lower mental well-being rose dramatically with ACE count and lack of AAA support in childhood (adjusted odds ratio 32.01, 95% CIs 18.31–55.98, ≥4 ACEs, without AAA support vs. 0 ACEs, with AAA support).


Adverse childhood experiences negatively impact mental and physical health across the life-course. Such impacts may be substantively mitigated by always having support from an adult you trust in childhood. Developing resilience in children as well as reducing childhood adversity are critical if low mental well-being, health-harming behaviors and their combined contribution to non-communicable disease are to be reduced.

Biglan A, Ryzin MJ, Hawkins D. Evolving a more nurturing society to prevent adverse childhood experiences. Acad Pediatr. 2017;17(7):S150-157.


This article presents a framework for evolving a society that nurtures the health and well-being of its population. We review evidence that adverse social conditions, including poverty, conflict, discrimination, and other forms of social rejection, contribute immensely to our most ubiquitous psychological, behavioral, and health problems. We then enumerate the ways that effective family and school prevention programs could ameliorate much of the social adversity leading to these problems. The widespread and effective implementation of these programs—in primary care, social services, and education— must be a high priority. Beyond the implementation of specific programs, however, we must also make a more concerted effort to promote prosocial values that support nurturing families and schools. Our society’s priorities must be to generate specific policies that reduce poverty and discrimination and, in so doing, reduce the risk for negative health-related outcomes.

Dorado JS, Martinez M, McArthur LE, Leibovitz T. Healthy Environments and response to trauma in schools (HEARTS): A whole-school, multi-level, prevention and intervention program or creating trauma-informed, safe and supportive schools. School Mental Health. 2016;8:163-176.


The University of California, San Francisco’s Healthy Environments and Response to Trauma in Schools (HEARTS) Program promotes school success for trauma-impacted students through a whole-school approach utilizing the response to intervention multi-tiered framework. Tier 1 involves school-wide universal supports to change school cultures into learning environments that are more safe, supportive and trauma-informed. Tier 2 involves capacity building with school staff to facilitate the incorporation of a trauma-informed lens into the development of supports for at-risk students, school-wide concerns and disciplinary procedures. Tier 3 involves intensive interventions for students suffering from the impact of trauma. Program evaluation questions were: (1) Was there an increase in school personnel’s knowledge about addressing trauma and in their use of trauma-sensitive practices? (2) Was there an improvement in students’ school engagement? (3) Was there a decrease in behavioral problems associated with loss of students’ instructional time due to disciplinary measures taken? (4) Was there a decrease in trauma-related symptoms in students who received HEARTS therapy? Results indicate preliminary support for the effectiveness of the HEARTS program for each of the evaluation questions examined, suggesting that a whole-school, multi-tiered approach providing support at the student, school personnel and system levels can help mitigate the effects of trauma and chronic stress. Key areas for further studies include (a) an examination of data across more HEARTS schools that includes comparison control schools and (b) disaggregating disciplinary data by race and ethnicity to determine whether disproportionality in the meting out of disciplinary actions is reduced.

Fang X, Brown DS, Florence C, Mercy JA. The economic burden of child maltreatment in the United States and implications for prevention. Child abuse Negl. 2012;36(2):156-165.



To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach.


This study used the best available secondary data to develop cost per case estimates. For each cost category, the paper used attributable costs whenever possible. For those categories that attributable cost data were not available, costs were estimated as the product of incremental effect of child maltreatment on a specific outcome multiplied by the estimated cost associated with that outcome. The estimate of the aggregate lifetime cost of child maltreatment in 2008 was obtained by multiplying per-victim lifetime cost estimates by the estimated cases of new child maltreatment in 2008.


The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in 2010 dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion. In sensitivity analysis, the total burden is estimated to be as large as $585 billion.


Compared with other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment.

Garrido EF, Weiler LM, Taussig HN. Adverse childhood experiences and health-risk behaviors in vulnerable early adolescents. J early adolesc. 2017;38(5):661-680.


Adverse childhood experiences (ACEs) are associated with health-risk behaviors in general samples of adults and adolescents. The current study examined the association between ACEs and these behaviors among a high-risk sample of early adolescents. Five hundred and fifteen 9-11-year-old children placed in foster care due to maltreatment were interviewed about their engagement in violence, substance use, and delinquency. A multi-informant ACEs score was derived based on exposure to six adverse experiences. Regression analyses examined the relationship between ACEs and risk behaviors and the potential moderating effects of age, sex, and minority status. ACE scores were predictive of risk behaviors after controlling for age, sex, and minority status. Although males and older youth were more likely to engage in risk behaviors, none of the demographic characteristics moderated the ACE-risk behavior association. This study extends previous research by demonstrating an association between ACEs and risk behaviors in extremely vulnerable early adolescents.

Luby JL, Barch D, Whalen D, Tillman R, Belden A. Association between early life adversity and risk for poor emotional and physical health in adolescence: a putative mechanistic neurodevelopmental pathway. JAMA Pediatr. 2017;17(12):1168-1175.



Adverse childhood experiences (ACEs) have been associated with poor mental and physical health outcomes. However, the mechanism of this effect, critical to enhancing public health, remains poorly understood.


To investigate the neurodevelopmental trajectory of the association between early ACEs and adolescent general and emotional health outcomes.


A prospective longitudinal study that began when patients were aged 3 to 6 years who underwent neuroimaging later at ages 7 to 12 years and whose mental and physical health outcomes were observed at ages 9 to 15 years. Sequential mediation models were used to investigate associations between early ACEs and brain structure, emotion development, and health outcomes longitudinally. Children were recruited from an academic medical center research unit.


Early life adversity.


Early ACEs in children aged 3 to 7 years; volume of a subregion of the prefrontal cortex, the inferior frontal gyrus, in children aged 6 to 12 years; and emotional awareness, depression severity, and general health outcomes in children and adolescents aged 9 to 15 years.


The mean (SD) age of 119 patients was 9.65 (1.31) years at the time of scan. The mean (SD) ACE score was 5.44 (3.46). The mean (SD) depression severity scores were 2.61 (1.78) at preschool, 1.77 (1.58) at time 2, and 2.16 (1.64) at time 3. The mean (SD) global physical health scores at time 2 and time 3 were 0.30 (0.38) and 0.33 (0.42), respectively. Sequential mediation in the association between high early ACEs and emotional and physical health outcomes were found. Smaller inferior frontal gyrus volumes and poor emotional awareness sequentially mediated the association between early ACEs and poor general health (model parameter estimate = 0.002; 95% CI, 0.0002-0.056) and higher depression severity (model parameter estimate = 0.007; 95% CI, 0.001-0.021) in adolescence. An increase from 0 to 3 early ACEs was associated with 15% and 25% increases in depression severity and physical health problems, respectively.


Study findings highlight 1 putative neurodevelopmental mechanism by which the association between early ACEs and later poor mental and physical health outcomes may operate. This identified risk trajectory may be useful to target preventive interventions.

McKelvey LM, Edge NC, Mesman GR, Whiteside-Mansell L, Bradley RH. Adverse experiences in infancy and toddlerhood:  relations to adaptive behavior and academic status in middle childhood. Child abuse Negl. 2018;82:168-177.


Findings from the Adverse Childhood Experiences (ACE) study articulated the negative effects of childhood trauma on long-term well-being. The purpose of the current study is to examine the associations between ACEs experienced in infancy and toddlerhood and adaptive behavior and academic status in middle childhood. We used data collected from a sample of low-income families during the impacts study of Early Head Start (EHS). Data were collected by trained interviewers demonstrating at least 85% reliability with protocols. Data come from 1469 socio-demographically diverse mothers and children collected at or near ages 1, 2, 3, and 11. At ages 1, 2, and 3, an EHS-ACEs index was created based on interview and observation items. The EHS-ACEs indices were averaged to represent exposure across infancy and toddlerhood. At age 11, parents were asked about school outcomes and completed the Child Behavior Checklist. Across development, children were exposed to zero (19%), one (31%), two (27%), and three or more ACEs (23%). Logistic regression analyses, controlling for EHS program assignment, and parent, school, and child characteristics, showed ACEs were significantly associated with parental report of the child: having an individualized educational program since starting school and in the current school year, having been retained a grade in school, and problems with externalizing and internalizing behavior, as well as attention. Findings suggest that ACEs influence children’s behavioral and academic outcomes early in development.

Pachter LM, Lieberman L, Bloom SL, Fein JA. Developing a community-wide initiative to address childhood adversity and toxic stress:  a case study of the Philadelphia ACE task force. Acad Pediatr. 2017;17(7):S130-135.


The Philadelphia ACE Task Force is a community based collaborative of health care providers, researchers, community-based organizations, funders, and public sector representatives. The mission of the task force is to provide a venue to address childhood adversity and its consequences in the Philadelphia metropolitan region. In this article we describe the origins and metamorphosis of the Philadelphia ACE Task Force, which initially was narrowly focused on screening for adverse childhood experiences (ACEs) in health care settings but expanded its focus to better represent a true community-based approach to sharing experiences with addressing childhood adversity in multiple sectors of the city and region. The task force has been successful in developing a research agenda and conducting research on ACEs in the urban context, and has identified foci of local activity in the areas of professional training and workforce development, community education, and local practical interventions around adversity, trauma, and resiliency. In this article we also address the lessons learned over the first 5 years of the task force's existence and offers recommendations for future efforts to build a local community-based ACEs collaborative.

Soleimanpour S, Geierstanger S, Brindis CD. Adverse childhood experiences and resilience:  addressing the unique needs of adolescents. Acad Pediatr. 2017;17(7):S108-114.


Adolescents exposed to adverse childhood experiences (ACEs) have unique developmental needs that must be addressed by the health, education, and social welfare systems that serve them. Nationwide, over half of adolescents have reportedly been exposed to ACEs. This exposure can have detrimental effects, including increased risk for learning and behavioral issues and suicidal ideation. In response, clinical and community systems need to carefully plan and coordinate services to support adolescents who have been exposed to ACEs, with a particular focus on special populations. We discuss how adolescents' needs can be met, including considering confidentiality concerns and emerging independence; tailoring and testing screening tools for specific use with adolescents; identifying effective multipronged and cross-system trauma-informed interventions; and advocating for improved policies.

Stempel H, Cox-Martin M, Bronsert M, Dickinson LM, Allison MA. Chronic school absenteeism and the role of adverse childhood experiences. Acad Pediatr. 2017;17(8):837-843.



To examine the association between chronic school absenteeism and adverse childhood experiences (ACEs) among school-age children.


We conducted a secondary analysis of data from the 2011-2012 National Survey of Children's Health including children 6 to 17 years old. The primary outcome variable was chronic school absenteeism (≥15 days absent in the past year). We examined the association between chronic school absenteeism and ACEs by logistic regression with weighting for individual ACEs, summed ACE score, and latent class analysis of ACEs.


Among the 58,765 school-age children in the study sample, 2416 (4.1%) experienced chronic school absenteeism. Witnessing or experiencing neighborhood violence was the only individual ACE significantly associated with chronic absenteeism (adjusted odds ratio [aOR] 1.55, 95% confidence interval [CI] 1.20-2.01). Having 1 or more ACE was significantly associated with chronic absenteeism: 1 ACE (aOR 1.35, 95% CI 1.02-1.79), 2 to 3 ACEs (aOR 1.81, 95% CI 1.39-2.36), and ≥4 ACEs (aOR 1.79, 95% CI 1.32-2.43). Three of the latent classes were also associated with chronic absenteeism, and children in these classes had a high probability of endorsing neighborhood violence, family substance use, or having multiple ACEs.


ACE exposure was associated with chronic school absenteeism in school-age children. To improve school attendance, along with future graduation rates and long-term health, these findings highlight the need for an interdisciplinary approach to address child adversity that involves pediatricians, mental health providers, schools, and public health partners.

Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Wolitzky-Taylor K, Sewart A, Vrshek-Schallhorn S, et al. The effects of childhood and adolescent adversity on substance use disorders and poor health in early adulthood. J Youth Adolesc, 2017:46(1):15-27.


Childhood and adolescent adversity have been shown to predict later mental and physical health outcomes. Understanding which aspects and developmental timings of adversity are important, and the mechanisms by which they have their impact may help guide intervention approaches. A large subset of adolescents (N= 457; Female 68.9%) from the 10-year longitudinal Youth Emotion Project was examined to better understand the associations among childhood/adolescent adversity, substance use disorder, and later health quality. Adolescent (but not childhood) adversities were associated with poorer health in late adolescence/early adulthood, adolescent adversities were associated with subsequent onset of substance use disorder, and adolescent adversities continued to be associated with poorer health in late adolescence/early adulthood after accounting for the variance explained by substance use disorder onset. These associations were observed after statistically accounting for emotional disorders and socioeconomic status. Specific domains of adversity uniquely predicted substance use disorder and poorer health outcomes. In contrast with current recent research, our findings suggest the association between childhood/adolescent adversity and poorer health outcomes in late adolescence and emerging adulthood are not entirely accounted for by substance use disorder, suggesting efforts to curtail family-based adolescent adversity may have downstream health benefits.











The Truth about ACEs Infographic:   Robert Wood Johnson Foundation