Adverse Childhood Experiences (ACEs): Working with Children, Youth and Families
April Ferguson LCSW-C
Senior Practice Associate
May 2025
Adverse Childhood Experiences are negative or traumatic
events that may have harmful consequences to a child or adult’s health and
mental wellbeing across the lifespan. ACES are linked to poor health, suicides,
overdoses, and mental health challenges. ACEs include but are not limited to:
- Parent and child separation
- Child Maltreatment
- Divorce
-
Death of a parent/guardian
-
Exposure to domestic violence
-
Addiction in the household
ACEs are a public health concern and children, youth and
family (CYF) social workers experience this public health challenge in schools,
the child welfare system, the field of juvenile justice, health/mental health care
settings and other children’s service agencies.
Messaging from the American Public Health Association (APHA)
and the Center for Diseases Control and Prevention (CDC) provides a framework
to understand ACEs and risks associated with ACEs as a public health crisis. APHA
and CDC identifies ACEs, overdoses and suicides as urgent, related and
preventable public health challenges. Data from APHA and CDC points to the urgent
need to address these three issues as one out of six adults have more than one
ACE. In addition, over a million people have died by overdose since 1999 and in
2022 and there was one suicide death every eleven minutes. ACEs, overdoses and suicides are also related
as individuals exposed to ACEs are at an increased risk for overdose and suicide,
but the good news is that all three are preventable
(APHA and CDC,
n.d.)
.
Social Worker’s Role
The social worker’s role in prevention of ACEs can
contribute to the improvement of public health
(Anda,
Felitti, & Larkin, 2014)
. CYF social workers
may work with clients that experience ACEs, in many settings that serve
children and adolescents. The goal is to improve the health and well-being of
clients through interventions, treatment, case management and macro-level
advocacy. Social workers are particularly skilled at tackling challenges
related to ACEs because the field looks at the whole person in planning
interventions. The field utilizes a biopsychosocial approach to address adversity
(Anda,
Felitti, & Larkin, 2014)
. Social workers
consider the person in environment, childhood history, family systems and other
societal factors that create challenges for individuals. A thorough understanding
of ACEs can inform treatment practices and advocacy for clients.
When CYF social workers recognize the impact of ACEs and the
associated risks, this knowledge creates an opportunity to provide prevention
and intervention efforts that reduce the consequences of ACES.
For example, clients struggling with
addiction may have started using substances as a coping skill to manage the
stress related to childhood trauma. Only treating the client’s substance use
fails to address the root causes associated with ACEs. A comprehensive lens of how
client challenges are related helps to tailor treatment responses to the
client’s individual needs. This is especially important when working with young
people and their families. Social workers should consider how family systems,
communities, peer groups, and age/stage of development are related and how multiple
factors impact the client’s experience.
Prevention Strategies for Social Workers
CYF social workers can support clients by engaging in ACEs
prevention efforts at the macro and field levels of social work. The goals of
prevention are to minimize the negative effects of ACEs and prevent their
occurrence, with the hope of reducing the likelihood of associated risks such
as overdose, suicide, and other related outcomes. There are three prevention
strategies, screening, increase protective factors, and spread awareness.
- Screening
Lessening the harm of ACEs includes screenings and
interventions. Screening tools allow social workers to determine the best intervention
strategies and client diagnoses. However, clinicians do not consistently screen
for ACEs because they are not trained to properly utilize ACEs screens and they
are not trained to communicate with parents about ACEs
(Houry, Jones,
& Merrick, 2020)
. The National Child Traumatic Stress
Network and the America Academy of Pediatrics are resources for screening tools
to assess ACEs in children and their parents. Assessments and screenings may
occur at pediatricians’ offices, schools, child welfare settings, and/or mental
health agencies. With appropriate screening, social workers can help clients
access therapy, case management services, home visitation programs, school
engagement services, family resource centers and other community programs.
- Increase Protective Factors
According to the CDC definition, “Protective
factors are characteristics that may decrease the likelihood of experiencing
adverse childhood experiences.”
Social workers can assist families with
increasing protective factors that keep children safe and strengthen families.
Through a strength-based lens, social workers can help families identify
current familial and community support to reduce challenges. Tools that help
children and adolescents increase protective factors include:
-
Genograms: Help children identify relatives and define
relationships within the family to strengthen or build new connections.
- Family Finding Resources: Help children in the
child welfare system identify relatives for permanency and connection.
- School System: Help parents/guardians connect
with school supports such as after school programs, guidance counselors and
school social workers.
- Community Supports: Help parents/guardians
connect with community support such as libraries, faith-based organizations,
family visitation programs and family resource centers.
- Referrals: Based on assessments and screens,
refer families to appropriate economic support, health and mental health
services.
- Care Delivery: Provide clients with
trauma-informed services that help to reduce the impact of ACEs
(Houry, Jones,
& Merrick, 2020)
. Trauma informed care includes
treatment from trauma trained staff and interventions that aim to treat trauma
symptoms.
Increasing protective factors are especially important for children
that need child welfare services. The child welfare system supports children
that experience abuse, neglect, and trauma but prevention efforts can support
families when there are risks to a child’s safety. When children engage in the
system through investigations, family preservation, or out of home placement,
each point of engagement requires that families receive access to the appropriate
support. Access to services can reduce the need for removal or reduce the time
that children are placed out of the home.
- Spread Awareness
The NASW Code of Ethics, states that the “Social workers’
primary goal is to help people in need and to address social problems.”
ACEs
are a social problem to tackle through prevention.
ACEs prevention includes efforts to
increase awareness and understanding among partners
(Centers for
Disease Control and Prevention, 2021)
. Through collaboration
and partnerships, social workers can educate clients and communities about ACEs
prevention. Social workers can provide psycho education to children and their families
to help caregivers understand the connection between ACEs and their child’s
diagnoses/symptoms
(Brookover, Cheng, Johnson, &
Zyromski, 2022)
.
Social workers can educate community members through awareness campaigns and shared
messaging resources that are accessible and easy for others to understand. APHA and CDC offer clear messaging for social
workers to advocate for ACEs prevention through toolkits, one pagers, talking
points and videos that help social workers speak to clients and other constituents.
The data from this messaging framework is also useful for policy reform and
communication with policymakers. Social workers can also use the messaging
tools to formulate testimonials of their experience with ACEs, overdoses and
suicides and the impact on children and families. Clients can also be empowered
to share their own lived experience and engage in their own advocacy around
prevention.
Conclusion
Understanding ACEs as a public health issue is key to
responding to the needs of clients. Case management services, referrals, treatment
and early interventions for youth and adults can help to alleviate the impact
of ACES and prevent them from occurring. Young people and their families face
many challenges, and social workers can help to strengthen families and
communities that serve as protective factors against the risks associated with
ACEs. Partnerships, advocacy and collaboration are also tools that help to
develop policies and communities that are strong enough to support families.
Resources
Adverse Childhood Experiences
(ACEs): Risks and Protective Factors
https://www.cdc.gov/aces/risk-factors/index.html
APHA Champions of Change
https://www.instagram.com/americanpublichealth/p/C-X6cQ7N8zF/
The Associations between Adverse
Childhood Experiences and Social Services Use among Head Start-Eligible
Low-Income Families
https://www.socialworkblog.org/nasw-press/2022/08/the-associations-between-adverse-childhood-experiences-and-social-services-use-among-head-start-eligible-low-income-families/
UNICEF USA: An Ounce of
Prevention: Addressing Disparities in Child Well-being, the Report Card 19
Supplement
https://www.unicefusa.org/sites/default/files/2025-05/An%20Ounce%20of%20Prevention.pdf
Urgent. Related. Preventable.
http://www.urgentrelatedpreventable.org/
References
Anda, R., Felitti, V., & Larkin, H. (2014).
Social Work a Adverse Childhood Experiences Research: Implications for
Practice and Health Policy.
Social Work in Public Health, 1-16.
doi:10.1080/19371918.2011.619433
APHA and CDC. (n.d.). Urgent. Related.
Preventable.
Retrieved from http://www.urgentrelatedpreventable.org/
Brookover, D., Cheng, S., Johnson, K., &
Zyromski, B. (2022). Adverse Childhood Expereinces as context for youth
assessment and diagnosis.
Journal of Counseling & Development.
doi:10.1002/jcad.12460
Centers for Disease Control and Prevention. (2021). Adverse
Childhood Experiences Prevention Strategy. National Center for Injury
Prevention and Control.
Houry, D., Jones, C., & Merrick, M. (2020,
January 7). Indentifying and Preventing Adverse Childhood Experiences:
Implications for Clinical Practice. doi:10.1001/jama.2019.18499