Resource page: Ohio Adverse Childhood Experiences (ACEs) Impact Project

Ohio ACEs Impact project

Led by the Health Policy Institute of Ohio and informed by a multi-sector advisory group, this project includes a series of three policy briefs and this resource page to build on and amplify current efforts to address ACEs in Ohio. Exposure to ACEs is a pervasive problem in Ohio and across the nation. Nearly two-thirds of Ohioans have been exposed to an ACE, with more than one-third of Ohioans exposed to two or more ACEs.1

In August 2020, HPIO released the first brief in this project, Health impact of ACEs in Ohio, which summarizes current research and provides new analysis on the health impacts of ACEs on Ohioans. The second brief, Economic impact of ACEs in Ohio, released in February 2021, summarizes national research and provides Ohio-specific analysis on healthcare and other costs attributable to ACEs in Ohio. The third brief, A strategic approach to prevent ACEs in Ohio, builds on previous briefs by identifying evidence-informed and cost-effective strategies to prevent and mitigate the impacts of ACEs.

This resource page provides links to data, research and other information to further understanding of the health and economic impacts of ACEs and will be updated throughout the duration of this project.

The conceptual framework below illustrates the project’s expected outcomes.  For more information, or to see all phases of the project, click here.

ACEs conceptual framework

Click to enlarge


If you have a resource you would like HPIO to consider adding to this page, please email Carrie Almasi at

Adverse Childhood Experiences (ACEs) basics

Federal resources

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Adverse Childhood Experiences (ACEs), Children’s Bureau, U.S. Department of Health and Human Services

This webpage provides information on ACEs and a list of resources to address ACEs.

Adverse Childhood Experiences (ACEs), Centers for Disease Control and Prevention (CDC)

The CDC provides ACEs fast facts, research, resources, prevention strategies and data on this page.

Exploring the Rural Context for Adverse Childhood Experiences (ACEs), National Advisory Committee on Rural Health and Human Services, U.S. Department of Health and Human Services

This policy brief provides recommendations to lessen the healthcare disparities that exist in rural communities by addressing ACEs.

Understanding Child Trauma, Substance Abuse and Mental Health Services Administration (SAMHSA)

This page provides resources, learning materials and research related to child trauma and stress.

National or community-level resources

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ACEs Science 101, ACEs Connection

This page summarizes research and resources on ACEs, toxic stress and their effects on health.

ACEs Resources for Family Life Educators, National Council on Family Relations

This page contains a collection of resources that provide a foundational understanding of ACEs.

ACE Resources, ACEs Aware, an initiative of the Office of the California Surgeon General and the California Department of Health Care Services

This page provides an aggregation of resources to advance the standard of care for ACEs and toxic stress.

Adverse Childhood Experiences/Trauma, Prevention Lane, an initiative of Lane County, Oregon

This compilation of resources pertains to ACEs and trauma-informed care.

Adverse Childhood Experiences, Robert Wood Johnson Foundation (RWJF)

This collection of resources can be used by communities looking to address the impacts of ACEs.

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

This study, published in 1998, serves as a foundation for how ACEs are talked about and understood today.

Health impacts of ACEs

Federal resources

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Long-Term Consequences of Child Abuse and Neglect, Children’s Bureau, U.S. Department of Health and Human Services

This publication details the long-term physical, psychological, behavioral and societal consequences of child abuse and neglect.

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention, Centers for Disease Control and Prevention (CDC)

This article highlights the adverse health and socioeconomic impacts of ACEs on adults using the same Behavioral Risk Factor Surveillance System data as the first policy brief in HPIO’s ACEs Impact Project, Health Impact of ACEs in Ohio.

National or community-level resources

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Adverse Childhood Experiences, The American Academy of Family Physicians 

This publication explains how ACEs can negatively impact health outcomes.

Adverse Childhood Experiences and the Lifelong Consequences of Trauma, American Academy of Pediatrics

This publication by the American Academy of Pediatrics explains how ACEs can negatively impact health outcomes.

ACEs and Toxic Stress: Frequently Asked Questions, Center on the Developing Child, Harvard University

This guide discusses how ACEs can lead to toxic stress and how to mitigate the effects of toxic stress.

Adverse Childhood Experiences Increase Risk for Chronic Diseases – It’s Not Psychological, ACEs Connection

This article explains how ACEs can manifest in physical health issues.

Childhood Trauma Has Lifelong Health Consequences for Women, Population Reference Bureau

This article highlights the effects of ACEs on women’s lifelong health.

Excessive Stress Disrupts the Architecture of the Developing Brain, National Scientific Council on the Developing Child

This working paper discusses the damage that toxic stress can have on children and how to design policies to minimize this damage.

Racism is an Adverse Childhood Experience, Jordan Institute for Families, University of North Carolina at Chapel Hill

This webpage examines the exposure to institutional/systematic racism as a child can impact future health outcomes.

The Long Shadow of Adverse Childhood Experiences, American Psychological Association

This webpage looks at pertaining to the negative long-term effects ACEs can have on mental health.

Toxic Stress and Children’s Outcomes, Economic Policy Institute

This webpage reviews the variation of toxic stress amongst different races and social classes and how it can have negative health outcomes.

Economic impacts of ACEs

National research

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The Economic Burden of Child Maltreatment in the U.S. and Implications for Prevention (2012), Child Abuse & Neglect

This study by the Centerfor Disease Control and Prevention (CDC) calculated that the estimated average lifetime cost per victim of nonfatal child maltreatment was $210,012 in the United States in 2010. In 2008, the total lifetime economic burden of nonfatal and fatal cases of child maltreatment was approximately $124 billion. Factors that contribute to these costs include health care, child welfare, criminal justice, special education and lost productivity costs. 

The economic burden of child maltreatment in the United States (2018), Child Abuse & Neglect

This study updated the previous CDC cost estimates and calculated the average lifetime cost of nonfatal child maltreatment ($831,000) and fatal child maltreatment ($16.6 million) in the United States, based on data from 2015. The authors included pain and suffering costs, in addition to health care, special education, child welfare, criminal justice and lost productivity costs. 

Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis  (2019), The Lancet Public Health

This study calculated the combined annual costs of depression and anxiety attributed to ACEs in North America at approximately $82 billion. The study estimated that a 10% reduction in ACEs in North America would lead to annual savings of $56 billion.  


State research

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Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences (2020), PLOS One

This study explored the prevalence and cost of ACEs in California. ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013. The estimated burden per adult exposed to ACEs was $6,358. 

The Economic Cost of ACEs in Tennessee (2019), The Sycamore Institute

This study calculated that, in 2017, ACEs experienced by Tennessee adults led to an estimated $5.2 billion in medical costs and lost productivity. This cost was associated with eight ACE-related health outcomes in which cigarette smoking ($2.1 billion) and depression ($923 million) were the highest 

Economic Costs of Adverse Childhood Experiences in Alaska (2015), State of Alaska Department of Health and Social Services

This report found that, if all ACEs were eliminated in Alaska, the state would save nearly $800 million dollars annually.  

The Economics of Child Abuse: A Study of California (2019), Safe & Sound

This report found that the cumulative financial impact on California for 71,289 verified claims of child maltreatment in 2017 was $19.31 billion. The report also estimates that the individual lifetime cost of child maltreatment for survivors was $268,544 in 2017 

Protective factors

Federal resources

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National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

Protective Factors Approaches in Child Welfare, Children’s Bureau, U.S. Department of Health and Human Services

Using this guide, individuals can learn more about protective factors and how to put them into practice.

Risk and Protective Factors, Substance Abuse and Mental Health Services Administration (SAMHSA)

This publication describes risk factors, protective factors and types of interventions.


National or community-level resources

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From Best Practices to Breakthrough Impacts, Center on the Developing Child, Harvard University

This resource outlines the key concepts from child development research and provides guidance to improve the quality of existing early childhood programming.

Healthy Outcomes from Positive Experiences: Publications, HOPE, Tufts Medical Center

This series of publications detail how the HOPE framework can be used to promote healthy childhood development and be used to prevent ACEs from occurring.

How to Implement Trauma-Informed Care to Build Resilience to Childhood Trauma, Child Trends

This brief by Child Trends summarizes the importance of trauma-informed care in addressing the impacts of childhood trauma.

Positive Childhood Experiences May Buffer Against Health Effects of Adverse Ones, NPR

NPR correspondent Selena Simons-Duffin interviews researcher Christina Bethell to learn how positive experiences in childhood could counteract ACEs.

Preventing and Mitigating the Effects of Adverse Childhood Experiences, National Conference of State Legislatures

This report highlights strategies that policymakers can implement to minimize the damage of ACEs on communities.

Road to Resilience: Raising Healthy Kids, Mayo Clinic Health System

This program developed by the Mayo Clinic can be used as a resource to combat the effects of ACEs.

Resiliency Resources, National Center on Safe Supportive Learning Environments

This list of resources is provided by the National Center on Safe Supportive Learning Environments to help parents and caregivers instill resilience in children, teens and young adults.

Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience, National Scientific Council on the Developing Child

This report highlights the importance of protective factors in building resilience and combatting the negative effects of ACEs for children.

Strengthening Families, Center for the Study of Social Policy

This framework developed by The Center for the Study of Social Policy focuses on developing protective factors to proactively address ACEs.

Strategies to prevent and mitigate ACEs 

Sources of evidence-informed strategies to prevent and mitigate the impacts of ACEs 

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California Evidence-Based Clearinghouse (CEBC) for Child Welfare, California Department of Social Services 

This evidence registry provides information regarding evidence-based practices relevant to child welfare.  

CDC  Technical Packages for Violence Prevention, Centers for Disease Control and Prevention (CDC) 

These reports compile the best available strategies and approaches for states and communities to prevent violence.  

HI-5 (Health Impact in Five Years)Centers for Disease Control and Prevention (CDC) 

This resource offers details on CDC-recommended strategies that have evidence of positive, cost-effective health impacts that produce results within five years.  

Office of Planning, Research and Evaluation Title IV-E Prevention Services Clearinghouse, Administration for Children and Families, U.S. Department of Health and Human Services 

This resource rates the strength of evidence for programs and services that provide enhanced supports to children and families and prevent foster care placements. 

Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available EvidenceCDC 

This report details recommended strategies to help states and communities take advantage of the best available evidence to prevent and monitor ACEs.  

Preventing and Mitigating the Effects of Adverse Childhood Experiences, National Conference of State Legislatures 

This brief presents research on ACEs and highlights strategies to screen, prevent and reduce their occurrence and negative consequences.  

Social Programs that Work (SPTW)Arnold Ventures 

This evidence registry reviews rigorous randomized control trials of social programs to determine their impact and effectiveness to inform policymakers. 

The Guide to Community Preventive Services (Community Guide)CDC 

These systematic reviews provide evidence-based recommendations, identified by the Community Preventive Services Task Forceto improve health and prevent disease. 

U.S. Preventive Services Task Force Recommendations (USPSTF), USPSTF 

These systematic reviews offer healthcare professionals evidence-based recommendations for clinical preventive services, such as screenings, counseling services and preventive medications.

What Works for Health (WWFH), County Health Rankings and Roadmaps 

This evidence registry lists evidence-informed policies, programs and system changes that can improve factors that affect health. 

Information about the cost-effectiveness or return on investment (ROI) of potential strategies

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Community Health Advisor, Health Partners Institute 

This calculator helps determine which policies will most effectively decrease health and medical costs in a community. 

Return on Investment (ROI) Calculator for Partnerships to Address the Social Determinants of Health, The Commonwealth Fund 

This calculator explores the ROI of the delivery of social services to high-need, high-cost patients. 

Benefit-Cost Results, Washington State Institute for Public Policy (WSIPP)

This database assesses and compares the benefits and costs of evidence-informed policy options. Although the analysis is focused on Washington State, the benefit-cost research may be applicable to people in other states.

Resources and guidance for implementing ACEs interventions

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Adverse Childhood Experiences (ACEs): Interventions to Prevent and Mitigate the Impact of ACEs in Canada, Public Health Ontario  

This report provides a list of interventions implemented in Canada to address ACEs in home-based, clinical, community-based and online settings. 

Healing Iowa, Iowa ACEs 360 Coalition 

This report discusses the different response strategies and policy options Iowa is considering or implementing to address ACEs. 

Preventing Adverse Childhood Experiences Framework, Association of State and Territorial Health Officials (ASTHO) 

This tool provides strategic objectives on ACEs-related data, policy, financing, messaging and cross-sector partnerships for community and state health agencies. 

Preventing and Mitigating the Effects of ACEs by Building Community Capacity and Resilience: APPI Cross-Site Evaluation Findings, Mathematica Policy Research 

This report analyzes efforts of communities in Washington State to prevent child maltreatment, decrease exposure to toxic stress and improve development outcomes. 

Prevention, Intervention, and Policy Strategies to Reduce the Individual and Societal Costs Associated with Adverse Childhood Experiences (ACEs) for Children in Baltimore City, Abell Foundation 

This report provides research from the city of Baltimore on interventions to prevent and mitigate ACEs. 

Trauma Screenings and Trauma-Informed Care Provider Trainings, California Department of Health Care Services 

This resource provides an extensive list of ACEs-related screenings for children, adolescents and adults. 



Last updated 8/18/2021


This project is funded by the Ohio Department of Mental Health and Addiction Services (OhioMHAS) supported by Ohio’s 2020-2021 SAMHSA Community Mental Health Block Grant, the Harmony Project, the Ohio Children’s Hospital Association, Interact for Health and HPIO’s core funders.  



  1. Health Policy Institute of Ohio. “Adverse Childhood Experiences (ACEs): Health Impact of ACEs in Ohio,” August 2020.