AAIP partners with the CDC to increase American Indian and Alaska Native vaccine coverage. LEARN MORE >></st

ACEs Toolkit

Strengthening our Native Communities:

How Understanding Adverse Childhood Experiences Can Help

Children and Families thrive when they have access to safe, stable, nurturing relationships and environments. Indigenous people have long known that unhealthy relationships and environments impact health and wellbeing, and these adverse effects can carry on from one generation to the next. As such, it is critical that we work together to develop and promote policies and programs that are supportive of children and families to prevent adversity and promote healing so that our communities thrive.

Native communities face many challenges. Too often the strengths of families are strained by these challenges, and finding effective ways to support our families can be difficult.  Our communities often find themselves dealing with the results of family and community disruption, (alcohol or drug abuse, unintended pregnancies, dropping out of school, etc) and are challenged to address the core issues.

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) study. The original ACE study asked about common childhood problems and found strong associations between those problems and numerous health and social problems, such as:





ACE scores are significantly higher in indigenous American communities than in the broader population. ACEs  can provide a framework for understanding many of the physical and mental health challenges facing indigenous communities. At the same time, the science of ACEs may point to solutions built upon the cultural foundations and strong resilience within our communities.

The findings from the ACE study have led to the design of a pyramid of risk that defines how ACEs can lead to poor adult health outcomes:

 ACEs Pyramid of Risk

Generally, ACEs include the following experiences during the first 18 years of life:


An “ACE score” is developed based on the number of these challenges a person experienced growing up.  The higher the ACE score, the more of these adverse experiences a person has had, and the greater their risk for poor health outcomes.  

It seems likely that indigenous people experience unique ACEs that may include boarding schools experiences,  historical trauma from loss of land, culture, and language, as well as community-specific experiences

ACEs are preventable, and their effects can be reduced

There are multiple strategies that communities can undertake to both prevent ACEs and to buffer their effects.  It is important to note that the ACE study provides a strategy for improving health within our communities. It is especially important to recognize that having a high ACE score does not necessarily mean that an individual is fated to suffer poor health or engage in risky behaviors. When children’s positive experiences outweigh the negative, the child is more likely to have positive outcomes later in life. Our communities are rich with protective factors that provide these essential, positive experiences, including native traditions, language, spirituality, elders, and connectedness.

Strategies that bolster these protective factors can promote strength and resilience, both in individuals and communities, and have a high likelihood of preventing and reducing the impact of ACEs.   Both the Trauma-informed care model (http://www.menominee-nsn.gov/CommunityPages/FosteringFutures/FosteringFuturesMain.aspx) and the Family Spirit program (http://caih.jhu.edu/programs/family-spirit) represent successful efforts to prevent and reduce the impact of ACEs in tribal communities.

Other resources:

From the Centers for Disease Control:


ACEs in Indigenous Communities:

DOI: https://doi.org/10.1353/hpu.2017.0133

Essentials for Childhood – EFC is CDC’s framework for preventing child abuse and neglect and other ACEs. This document proposes strategies that communities can consider to promote the types of relationships and environments that help children grow up to be healthy and productive citizens. https://www.cdc.gov/violenceprevention/pdf/essentials_for_childhood_framework.pdf

Child abuse and Neglect Technical Package - A collection of strategies that represent the best available evidence to prevent or reduce child abuse and neglect. The package supports CDC’s Essentials for Childhood framework. https://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf

Southcentral Foundation Nutaqsiivik Nurse-Family Partnership is a home-visiting program that works with families, mothers and infants to provide education and support as a supplement to regular prenatal care and well-child checkups for Alaskan Native and American Indian families. https://www.southcentralfoundation.com/services/home-based-services

The Tribal Home Visiting Program brings critical services to the nation’s most vulnerable American Indian and Alaska Native (AIAN) children and families. The program is part of the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), the Federal Home Visiting Program, which is administered by the Administration for Children and Families (ACF) in collaboration with the Health Resources and Services Administration (HRSA). https://www.acf.hhs.gov/ecd/tribal-home-visiting-report-to-congress

CDC’s ACE website: https://www.cdc.gov/violenceprevention/acestudy/about_ace.html