“ACEs” stands for “Adverse Childhood Experiences.” These experiences can include things like physical and emotional abuse, neglect, caregiver mental illness, and household violence. Adversity also includes community and systemic causes—such as violence in the child’s community and experiences with racism and chronic poverty—because the body’s stress response does not distinguish between overt threats from inside or outside the home environment, it just recognizes when there is a threat, and goes on high alert. The more ACEs a child experiences, the more likely he or she is to suffer from things like heart disease and diabetes, poor academic achievement, and substance abuse later in life.

To help public health practitioners, policymakers, community leaders and individuals better understand the causes of ACEs, Dr. Wendy Ellis created the Pair of Aces Tree below. The tree illustrates the adversities that must be addressed to build and support resilient communities and families. The leaves represent adverse childhood experiences (ACEs). The tree is planted in poor soil – adverse community environments (ACEs) – that is steeped in systemic inequities, robbing it of nutrients necessary to support a thriving community.

The ideal approach to ACEs is one that prevents the need for all levels of services: by reducing the sources of stress in people’s lives. Supporting responsive relationships with a parent or caregiver can also help to buffer a child from the effects of stress and can strengthen the building blocks of resilience. This focus on strengthening families protective factors—reducing stress, building responsive relationships, and strengthening parenting skills—are core parts of the HEALthy 4 You clinical trial and will examine how engaged community  to prevent the long-term effects of ACEs. The ultimate goal of this program is to stop the cycle of trauma and put children on a new trajectory of improved emotional and physical health.