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Breaking Cycles: Preventing and Addressing Childhood Adversity and Toxic Stress

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Resources to address and prevent early adversity provide hope and healing, helping end generational transmission of ACEs, toxic stress, and their impacts.

Sarah Marikos, M.P.H.

Executive Director, ACE Resource Network

A public health leader and epidemiologist, Sarah leads ACE Resource Network’s national and community-based efforts, along with their work to advance research on the biology of trauma.

ACEs — or Adverse Childhood Experiences — are stressful, potentially traumatic events or circumstances that occur before the age of 18, and include experiences such as abuse, neglect, and having a family member with a substance use issue or mental health challenge.

The more ACEs we experience without safe, stable, and supportive adults and environments, the higher the likelihood that we may experience physical and mental health conditions — including later in life.


The science behind childhood adversity and its impacts came to light following a landmark study by the CDC and Kaiser Permanente in 1997. The science shows that ACEs and the impacts of toxic stress — prolonged activation of the body’s stress response — can directly affect our physical and mental health, and that the higher our ACE score, the greater the odds are that we may experience chronic conditions like cancer, diabetes, stroke, heart disease, and depression.

However, ACEs are not destiny. Research shows that increased awareness, early support, and evidence-based interventions can reduce negative impacts, and that prevention and healing are possible. As parents, caregivers, and community members, we can disrupt patterns we’ve inherited and change not only our own futures, but the lives of generations to come.

According to Dr. Nadine Burke Harris, “Science clearly demonstrates how our early experiences shape our lifelong health trajectories. There’s also an abundance of evidence affirming our remarkable capacity for healing.”

“Now more than ever, preventing and addressing childhood adversity and toxic stress are urgent priorities for the health and well-being of our young people.”


Dr. Nadine Burke Harris

Senior Advisor, ACE Resource Network

Dr. Burke Harris, an esteemed physician, researcher, and public health leader who served as California’s first-ever Surgeon General, has been recognized for her career-long efforts to bring widespread attention to childhood trauma and adversity, and their impacts. Early in her career, while working in one of San Francisco’s most underserved communities, Dr. Burke Harris identified ACEs as a major risk factor affecting the health of her patients and began using applied research from the CDC and Kaiser Permanente study to develop a novel clinical screening protocol.

Since then, she has remained committed to advancing pediatric medicine, raising awareness, and transforming the way society responds to children exposed to ACEs and toxic stress. Renowned for launching a first-in-the-nation statewide effort to train over 20,000 healthcare providers on how to screen for ACEs and respond with trauma-informed care while serving as California’s Surgeon General, and for authoring “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity,” Dr. Burke Harris remains committed to building solutions for children and families.

“Now more than ever, preventing and addressing childhood adversity and toxic stress are urgent priorities for the health and well-being of our young people — and for getting to the root of many of our nation’s most pressing health and social challenges,” said Dr. Burke Harris, who serves as Senior Advisor to ACE Resource Network, a national organization working to build awareness and solutions around childhood adversity, toxic stress, and their impacts.

With research showing much of a child’s brain development happens before the age of 5, it is vital that parents and caregivers of young children have accessible tools for a strong start — especially when caregivers may be looking to do things differently from how they were raised.

Through a partnership between ACE Resource Network and the American Society for the Positive Care of Children (SPCC), parents and caregivers now have access to We All Have a Number Story: Your Child’s First Chapters — a first-of-its-kind caregiver toolkit dedicated to a child’s earliest years. With research-backed tools to support the positive parenting of babies and children ages 0 to 5, the toolkit provides an understanding of the potential impacts of childhood adversity and toxic stress on our health and development as kids and on our experience as caregivers, and how we can reduce stress and build resilience in our kids, ourselves, and our families.


“When parents and caregivers gain the tools and support they need to parent positively, they have the power to break cycles of trauma or abuse that may have been passed down to them as a child,” said Genevieve Rivera, Executive Director of American SPCC. “Education is key when it comes to changing our parenting patterns and ultimately building stronger, happier, and more resilient children.”

Visit for more on ACEs, toxic stress, their impacts, and strategies and resources for healing and prevention.

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