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- Definition: Estimated percentage of women with a live birth who before age 14 experienced childhood hardships, by prenatal health insurance type (e.g., an estimated 4.7% of privately insured California women with a live birth in 2013-2014 experienced four or more childhood hardships).
- Data Source: California Department of Public Health, Maternal, Child and Adolescent Health (MCAH) Program, & University of California, San Francisco, Center on Social Disparities in Health, Maternal and Infant Health Assessment (MIHA) Survey (Mar. 2018).
- Footnote: This indicator reports the prevalence of seven childhood hardships: (1) basic needs not met, (2) parental drinking or drug problem, (3) parental legal trouble or incarceration, (4) parental divorce or separation, (5) family hunger, (6) relocation due to problems paying rent or mortgage, (7) foster care placement. MIHA is an annual population-based survey of California resident women with a live birth in the calendar year. Percentages are weighted to represent all women with a live birth in California and counties during the time period. Refer to the MIHA technical notes for information on weighting methods.
- Measures of Childhood Adversity and Resilience on Kidsdata.org
Childhood adversity and resilience measures on kidsdata.org originate from three separate data sources and provide a rich and conceptually-related perspective on childhood adversity. Taken together, they present a broad framework to look at child adversity across the lifespan and provide useful data to inform and facilitate interventions. However, due to differences in methodology, data from the three sources should not be compared. The data sources are:Each of these data sources produces at least one overall index of childhood adversity. An overall index should be viewed as a more comprehensive measure than any of its individual items because it captures the cumulative magnitude of experiencing hardships.
NSCH data are collected by the U.S. Census Bureau on behalf of the Maternal and Child Health Bureau of the Department of Health and Human Services. NSCH uses a set of family, economic, and community adversity indicators to ask parents about current adverse experiences to which their children (ages 0 to 17) have been exposed. This is the most direct population-based survey measure of adversity among California children because it asks parents about the trauma their children have experienced while they are still children, compared with more traditional methods of asking adults to recall their childhood experiences.
MIHA is a collaborative effort of the Maternal, Child and Adolescent Health Division and the Women, Infant and Children Division of the California Department of Public Health and the Center on Social Disparities in Health at UC San Francisco. MIHA surveys postpartum women (ages 15 and older) who deliver a live birth about their own childhood hardships prior to age 14.
The BRFSS ACEs Module is adapted from the Adverse Childhood Experiences (ACEs) study by Kaiser Permanente and the Centers for Disease Control and Prevention. The data presented here were prepared by the UC Davis Violence Prevention Research Program, with support from the California Department of Public Health and the Public Health Survey Research Program at CSU Sacramento. They are based on adult recollections of their childhood experiences during the first 17 years of life and thus do not provide direct information about the current status of California's children.
NSCH, MIHA, and BRFSS data together provide a comprehensive framework for understanding and addressing child adversity across the lifespan. Among these three data sources, NSCH indicators are the most contemporary because they tap into parents' views of their children's current experiences. MIHA adds an intergenerational perspective by providing information about childhood hardships experienced by mothers of newborns. BRFSS provides a well-established standard measure of adult retrospective reports of adverse childhood experiences. Both NSCH and MIHA include a wider range of potentially adverse experiences, such as exposure to extreme poverty, community violence, and food and housing insecurity, whereas BRFSS focuses primarily on family dysfunction. Each source provides a unique but conceptually-related perspective on childhood adversity.
- Childhood Adversity and Resilience
- Children with Adverse Experiences (Parent Reported), by Number (CA & U.S. Only)
- Children with Adverse Experiences (Parent Reported), by Type (CA & U.S. Only)
- Children with Two or More Adverse Experiences (Parent Reported), by Race/Ethnicity (CA & U.S. Only)
- Children Who Are Resilient (Parent Reported)
- Prevalence of Childhood Hardships (Maternal Retrospective)
- Basic Needs Not Met (Maternal Retrospective)
- Parental Drinking or Drug Problem (Maternal Retrospective)
- Parental Legal Trouble or Incarceration (Maternal Retrospective)
- Parental Divorce or Separation (Maternal Retrospective)
- Family Hunger (Maternal Retrospective)
- Moved Due to Problems Paying Rent or Mortgage (Maternal Retrospective)
- Foster Care Placement (Maternal Retrospective)
- Prevalence of Adverse Childhood Experiences (Adult Retrospective)
- Characteristics of Children with Special Needs
- Child Abuse and Neglect
- Family Structure
- Food Security
- Housing Affordability and Resources
- Foster Care
- First Entries into Foster Care
- Children in Foster Care
- Foster Youth in Public Schools
- Timely Medical Exams for Children in Foster Care
- Timely Dental Exams for Children in Foster Care
- Median Number of Months in Foster Care
- Number of Placements After One Year in Foster Care
- Placement Distance from Home After One Year in Foster Care
- Exit Status One Year After Entry into Foster Care
- Exit Status Four Years After Entry into Foster Care
- Re-Entries into Foster Care
- Length of Time from Foster Care to Adoption
- Intimate Partner Violence
- Why This Topic Is Important
Childhood adversity—such as child abuse, exposure to violence, family alcohol or drug abuse, and poverty—can have negative, long-term impacts on health and well being (1, 2). Nearly half of U.S. children have experienced at least one adverse childhood event (3, 4). Early experiences affect brain structure and function, which provide the foundation for learning, emotional development, behavior, and health (5). The toxic stress associated with traumatic, and often cumulative, early adverse experiences can disrupt healthy development and lead to behavioral, emotional, school, and health problems during childhood and adolescence (2, 3, 4, 6). It also can lead to serious behavioral, emotional, and health issues in adulthood, such as chronic diseases, obesity, alcohol and other substance abuse, and depression (1, 2, 4). The more traumatic and toxic events experienced by a child, the more likely the impact will be substantial and long-lasting (7).
Resilience, an adaptive response to hardship, can mitigate the effects of adverse childhood experiences (3, 6, 8). It is a process of adapting well in the face of adversity, trauma, threats, or other significant sources of stress. Resilience involves a combination of internal and external factors. Internally, it involves behaviors, thoughts, and actions that anyone can learn and develop. Resilience is also strengthened by having safe, stable, nurturing relationships and environments within and outside the family (6, 8, 9).For more information on childhood adversity and resilience, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Centers for Disease Control and Prevention. (2020). Preventing adverse childhood experiences. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html
2. Shonkoff, J. P., et al. (2016). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246. Retrieved from: https://pediatrics.aappublications.org/content/129/1/e232
3. Bethell, C. D., et al. (2017). A national and across-state profile on adverse childhood experiences among U.S. children and possibilities to heal and thrive. Child and Adolescent Health Measurement Initiative. Retrieved from: https://www.cahmi.org/wp-content/uploads/2018/05/aces_brief_final.pdf
4. Sacks, V., & Murphey, D. (2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. Child Trends. Retrieved from: https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity
5. Center on the Developing Child. (n.d.). Brain architecture. Retrieved from: https://developingchild.harvard.edu/science/key-concepts/brain-architecture
6. Bethell, C. D., et al. (2014). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Affairs, 33(12), 2106-2115. Retrieved from: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0914
7. Center for Youth Wellness. (2014). A hidden crisis: Findings on adverse childhood experiences in California. Retrieved from: https://centerforyouthwellness.org/wp-content/themes/cyw/build/img/building-a-movement/hidden-crisis.pdf
8. Center on the Developing Child. (2015). The science of resilience. Retrieved from: https://developingchild.harvard.edu/resources/inbrief-the-science-of-resilience
9. Pinderhughes, H., et al. (2015). Adverse community experiences and resilience: A framework for addressing and preventing community trauma. Prevention Institute. Retrieved from: https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing
- How Children Are Faring
Childhood adversity is common among California children, and many children experience multiple adverse circumstances or events that can pose a lifelong threat to their well being. The most timely assessment of childhood adversity comes from the National Survey of Children's Health (NSCH), in which parents report on the current status of their children. NSCH estimates from 2016-2019 show that 36% of California children ages 0-17 had been exposed to one or more adverse childhood experiences (ACEs), and around 4% had been exposed to four or more. At the local level, the share of children with two or more adverse experiences ranged from fewer than 1 in 8 (12%) to more than 1 in 4 (29%) across regions with data. Statewide and nationally, African American/black children were more likely than their Hispanic/Latino and white peers to have two or more ACEs in 2016-2019.
According to the 2013-2014 Maternal and Infant Health Assessment, one in four California women with a recent birth (25%) experienced two or more childhood hardships before age 14. Among young mothers ages 15-19, one-third (33%) experienced two or more hardship as children, compared with fewer than one-fifth (19%) of mothers ages 35 and older. Statewide, an estimated 34% of postpartum women living at or below the federal poverty guideline were exposed to at least two childhood hardships, more than double the estimate (16%) for women with higher family incomes (above 200% of the federal poverty guideline).
The California Behavioral Risk Factor Surveillance System ACEs Module, combining data from 2011 to 2017, shows that among California adults living in households with children, an estimated 17% experienced at least four ACEs before age 18.
- Policy Implications
In recent years, policymakers, researchers, and advocates increasingly have focused on childhood adversity (e.g., physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship), recognizing that such experiences can have harmful, lifelong consequences (1, 2). For example, children exposed to multiple adverse childhood experiences (ACEs) are more likely to develop negative health behaviors and chronic diseases in adulthood (1). Unaddressed ACEs place strain on public systems, including child welfare, education, health care, and juvenile justice (1). Policymakers have a role in helping to prevent ACEs, as well as in ensuring early identification and intervention for parents and children affected by trauma. While California has made strides in these areas, continued efforts are needed to ensure that all families have the opportunity to help their children thrive and reach their full potential (1, 3).
Policy and program options to help prevent, interrupt, and mitigate the effects of childhood adversity include:
For more information related to ACEs and resilience, see kidsdata.org’s Research & Links section or visit ACEs Connection, Center for Youth Wellness, and Prevention Institute. Also see Policy Implications in kidsdata.org’s Child and Youth Safety and Emotional and Behavioral Health topics.
- Raising public awareness about ACEs and their negative, lasting effects on children and families (1)
- Ensuring effective prevention services are in place, including strength-based parenting education, family support, and home-visiting services for families in need (4)
- Promoting policies that help reduce family stress and increase stability for children, e.g., policies to improve the social safety net for families in need, support family-friendly business practices, and ensure quality child care is affordable and accessible (4)
- Institutionalizing trauma-informed policies and practices for public and private systems and organizations (designed specifically to address the consequences of trauma and facilitate resilience and healing), including screening and intervention with reimbursement mechanisms (1, 3)
- Supporting formal workforce education about ACEs and trauma-informed approaches for professionals who work with families and children, such as administrators, doctors, nurses, educators, social workers, and juvenile justice staff (1, 3)
- Promoting increased collaboration across organizations and systems (e.g., local and state government, education, health care, juvenile justice, child welfare, and nonprofits) to address systemic barriers to preventing or treating trauma and toxic stress, including improving service coordination, sharing data, and aligning measures of success (1, 4)
- Supporting ongoing strategies to provide accessible, culturally competent, trauma informed, and resilience-building systems of mental health, substance abuse treatment, and other community services (1, 3, 5)
- Expanding data collection related to ACEs and resilience to study and advance effective interventions aimed at preventing and reducing the impacts of trauma on children, families, organizations, systems, and communities (1, 3)
Sources for this narrative:
1. Center for Youth Wellness. (2015). Children can thrive: A vision for California's response to adverse childhood experiences. Retrieved from: https://centerforyouthwellness.org/wp-content/themes/cyw/build/img/building-a-movement/children-can-thrive.pdf
2. Bethell, C. D., et al. (2017). A national and across-state profile on adverse childhood experiences among U.S. children and possibilities to heal and thrive. Child and Adolescent Health Measurement Initiative. Retrieved from: https://www.cahmi.org/wp-content/uploads/2018/05/aces_brief_final.pdf
3. Bradshaw, J. (2015). Helping children heal: Promising community programs and policy recommendations. Children's Defense Fund - California. Retrieved from: https://rysecenter.squarespace.com/s/helping-children-heal.pdf
4. Centers for Disease Control and Prevention. (2019). Essentials for childhood: Creating safe, stable, nurturing relationships and environments for all children. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/essentials.html
5. California Department of Social Services, & California Department of Health Care Services. (2018). The California integrated core practice model for children, youth, and families. Retrieved from: https://cdss.ca.gov/inforesources/the-integrated-core-practice-model
- Websites with Related Information
- ACEs Aware. California Dept. of Health Care Services & Office of the California Surgeon General.
- California Dept. of Social Services: Office of Child Abuse Prevention
- California Essentials for Childhood (EfC) Initiative. California Dept. of Public Health & California Dept. of Social Services.
- Center for Youth Wellness
- Center on the Developing Child. Harvard University.
- Centers for Disease Control and Prevention: Adverse Childhood Experiences (ACEs)
- Changing Minds. Futures Without Violence, et al.
- Child and Adolescent Health Measurement Initiative: Childhood Trauma and Positive Health
- Child Welfare Information Gateway. U.S. Dept. of Health and Human Services, Children’s Bureau.
- National Child Traumatic Stress Network
- PACEs Connection
- Robert Wood Johnson Foundation: Adverse Childhood Experiences
- Key Reports and Research
- ACE Screening Implementation How-To Guide. (2021). ACEs Aware Subcommittee, California Dept. of Health Care Services, & Office of the California Surgeon General. Marques, S., et al.
- Adult Health Burden and Costs in California During 2013 Associated with Prior Adverse Childhood Experiences. (2020). PLoS One. Miller, T. R., et al.
- Adverse Childhood Experiences Data Report: Behavorial Risk Factor Surveillance System (BRFSS), 2011-2017. (2020). California Dept. of Public Health & California Dept. of Social Services.
- Beyond Screening: Achieving California's Bold Goal of Reducing Exposure to Childhood Trauma. (2020). California Funders Workgroup on Prevention and Equity & Prevention Institute. Sims, J., & Aboelata, M. J.
- Building Community Resilience Toolkit. Strategies 2.0.
- California Essentials for Childhood Case Study: Collective Impact Through Strategic Opportunities. (2019). International Journal on Child Maltreatment: Research, Policy and Practice. Abbott, M., & Wirtz, S.
- Child Well-Being and Adverse Childhood Experiences in the U.S. (2017). Academic Pediatrics. Solloway, M. R., et al. (Eds.)
- Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. (2019). Morbidity and Mortality Weekly Report. Merrick, M. T., et al.
- Evaluating Community-Based Family Support Networks to Reduce Adverse Childhood Experiences. Mathematica Policy Research.
- Home Visiting Is a Valuable Investment in California’s Families. (2018). California Budget and Policy Center. Hutchful, E.
- How to Implement Trauma-Informed Care to Build Resilience to Childhood Trauma. (2019). Child Trends. Dym Bartlett, J., & Steber, K.
- Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. (2019). Centers for Disease Control and Prevention.
- Receipt of Behavioral Health Services Among U.S. Children and Youth with Adverse Childhood Experiences or Mental Health Symptoms. (2021). JAMA Network Open. Finkelhor, D., et al.
- Responding to ACEs with HOPE: Health Outcomes from Positive Experiences. (2017). Academic Pediatrics. Sege, R. D., & Harper Browne, C.
- Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. (2020). Office of the California Surgeon General. Bhushan, D., et al.
- Screening Kids from Birth to Age 5 for Trauma. (2019). Children Now. Francis, L.
- The Promise of Adolescence: Realizing Opportunity for All Youth. (2019). National Academies Press. National Academies of Sciences, Engineering, and Medicine.
- Transforming Practice with HOPE (Healthy Outcomes from Positive Experiences). (2021). Maternal and Child Health Journal. Burstein, D., et al.
- Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity. (2019). National Academies of Sciences, Engineering, and Medicine.
- County/Regional Reports
- Data Briefs on Adverse Childhood Events Among California’s Children. (2014). Child and Adolescent Health Measurement Initiative.
- More Data Sources For Childhood Adversity and Resilience
- California Behavioral Risk Factor Surveillance System. California State University Sacramento.
- Maternal and Infant Health Assessment (MIHA) California Dept. of Public Health & University of California San Francisco.
- National Survey of Children's Health: Adverse Childhood Experiences. Child and Adolescent Health Measurement Initiative.
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