Adverse Childhood Experiences (ACEs) and Trauma-Informed Resilience-Oriented Care (TIRO)

Adverse Childhood Experiences (ACEs) and toxic stress are public health crises. ACEs are stressful or traumatic events experienced by age eighteen, identified in the landmark Centers for Disease Control and Prevention (CDC) and Kaiser Permanente (KP) Adverse Childhood Experiences Study, to be strongly associated with increased health and social risks. Early detection and intervention can help prevent or reduce the health risks associated with ACEs.

Trauma-Informed, Resilience-Oriented Care (TIRO) is an organizational culture, structure, and treatment framework built on understanding, recognizing, and responding to all kinds of trauma and places focus on protective, resilience-oriented approaches to the entire organization. Adopting TIRO practices can improve patient engagement, treatment adherence, and health outcomes, as well as provider and staff wellness.

ACEs, Toxic Stress and Patient Education: A Performance Improvement Project

Over sixty-two percent of California adults have experienced at least one ACE and over sixteen percent have experienced four or more. Many of our patients do not realize that exposure to ACEs is associated with increased risk for health problems across the lifespan.

This Performance Improvement Project is designed to improve patient and physician ACEs awareness and patient education, and to study the impact of educational materials on patients’ understanding of the ACEs’ health impacts. Participating physicians will survey patients, distribute educational materials, analyze survey data, and reflect on resulting practice improvement.
Final ABFM PI Report

Family Medicine Initiative on Trauma-Informed Care (FIT)

This peer-to-peer learning initiative was funded by the Office of the California Surgeon General, the Department of Health Care services, and ACES Aware. Now concluded, it raised awareness about Adverse Childhood Experiences (ACEs).

CAFP organized a series of regionally-based, peer-to-peer learning workshops concerning ACEs screening rationale and methods, followed by peer-to-peer discussion groups on best practices, overcoming barriers to care, and practice approaches for this new screening tool. Participants addressed trauma-informed communication techniques, building a patient’s resiliency, and a trauma-informed physical exam.
ACEs Screening Quick Reference Guide

Education Hosted by

FROM TRAUMA TO HEALING: FOR OUR PATIENTS, OUR COMMUNITIES, AND OURSELVES to help address the root causes of our patients’ poor health and provide more engaging care.


TEDTalk: Nadine Burke Harris

How childhood trauma affects health across a lifetime

Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris, former Surgeon General of California, explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.

Watch Here

More Training

Access ACEs Aware training and self-attestation to certify physicians for MediCal payment.

ACEs Resources

Resources to help support your trauma-informed family practice.

Connect with your local CAFP chapter

Find fellow family physicians in your neighborhood.
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