Adverse Childhood Experiences (ACEs) Impact on the Medical Field

From the Wyoming Department of Family Services

As medicine has evolved over time the answers to complicated medical and social-emotional issues continue to elude the field. As more research and knowledge is gained, especially in neurodevelopment, a philosophical shift is being seen through identification of physical and emotional components of health and the impacts of early experiences. Based on research by Dr. Robert Anda from the CDC and Dr. Vincent Felitti from Kaiser Permanente in the 1990’s the answers to more complicated medical questions become easier to address.

Their research consisted of surveying approximately 17,500 adult members of Kaiser about early adverse experiences.  Based on ten questions related to abuse, neglect and household dysfunction, they were able to make a direct correlation to the trauma that children experience and how it impacts their adult health outcomes.

These ten questions focus on physical, sexual and emotional abuse, physical and emotional neglect, incarceration of a parent, a caregiver with mental illness, domestic violence, substance abuse in the home, and parental separation. For every “yes” response, the participant scored one point. They found that there was a direct dose response, the higher the Adverse Childhood Experiences (ACEs) score the more susceptible to ailments such as COPD, Ischemic Heart Disease, diabetes, and cancer. An individual’s relative risk of suicide is 12 times more likely with an ACEs score of four or more than an individual with an ACEs score of zero.

The impacts of negative early experiences are costly across Wyoming. Currently, Wyoming is spending over 1.5 million dollars each month to serve children and families in the child welfare system.  Approximately one third of these children are five-year-old and under. These costs go well beyond the immediate investment and continue to follow these individuals for a lifetime.  In Wyoming, the large majority of substantiated child welfare cases involve caregiver substance abuse.  In 2014, the Child Welfare League of America reported there was an estimated 3,000 children ages 12 to 17 and 40,000 adults age 18 and older were dependent on or abusing illicit drugs or alcohol in Wyoming. The costs of substance abuse are astronomical to our healthcare system, our child welfare system, our legal system, and family well-being.

This information clearly indicates that these are societal issues that do not stand alone in the medical community. These are systemic, societal issues that every person needs to take ownership of. In order to make a difference in health outcomes and healthcare costs, communities need to be asking, “What is the underlying issue?” and address those issues before there is an opportunity to impact an individual’s ACEs score.

As a result of the initial ACEs study, additional research has been conducted in an attempt to better understand the science of brain development and stress responses, especially in young children.  Dr. Jack Shonkoff from Harvard University has researched the developing brains of young children and how exposure to adversity impacts their development. His research shows that in order to positively impact brain development, it is essential to have healthy connections between children and caregivers.

As families access a continuum of services, there is a responsibility of all providers to investigate underlying issues that may be impacting health and well-being.  In order to impact change, society must support and promote healthy family relationships and be willing to intervene in all ways possible to ensure safety and well-being in the next generation.  Through utilization of the Strengthening Families Protective Factors Framework of addressing parental resilience, social connections, concrete supports in times of need, knowledge of child development, and social-emotional competence of children professionals can begin to approach health and well-being from a different perspective.  It should be a professional expectation to understand the impacts of trauma and to investigate how Protective Factors Framework can be implemented to lift-up the strengths in the families.

For more information on the ACE’s study,  or the Strengthening Families Protective Factors Framework,

If you are interested in trainings related to the ACEs study or the Strengthening Families Protective Factors Framework, please contact Jennifer Davis, Wyoming Children’s Trust Fund at or Alli Anderson, Prevent Child Abuse Wyoming at