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Positive and Adve​rse Childhood Experiences (PACEs)​​

A group of elementary school-aged children working together on a project with an adult mentor providing support.

Positive Childhood Experiences (PCEs)

Positive Childhood Experiences (PCEs) are experiences that engage the child, a caregiver and the caregiver-child relationship to achieve positive child health outcomes. PCEs, like talking to family about feelings, participating in community traditions and feeling supported by friends, have been shown to improve mental health and social and emotional well-being in adults. They can also reduce some of the harmful effects of Adverse Childhood Experiences (ACEs), such as toxic stress and poor physical health.[1] Safe, stable, nurturing relationships and environments promote resilience among youth and pave the way to healthy development.[2]

There are four PCE categories:​​

  • ​Nurturing and supportive relationships
  • Social engagement and connectedness
  • Safe, stable, protective and equitable environments
  • Social and emotional learning

​Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences (ACEs) are traumatic events that occur before the age of 18.  These events may disrupt healthy brain development, alter the immune and endocrine systems and change how the body responds to stress.[3] ACEs can negatively impact education, employment, earnings and health over a person’s lifetime and can extend to future generations.[4] 
Experiencing four or more ACEs has a strong relationship with increased risk for several leading causes of death in adulthood, including:
  • ​​Heart disease
  • Cancer
  • Chronic obstructive pulmonary disease (COPD)
  • Alzheimer's
  • Suicide[3, 5] 
Since the first ACE study was published, other studies have identified additional childhood adversities across the socioecological model including witnessing violence, experiencing discrimination, feeling unsafe outside the home, being bullied, experiencing living in poverty, or being in foster care.[6] ​​

Strategies that can promote PCEs throughout the life course

Strategies Implementation Examples/Resources
Connect Youth to Caring Adults.
  • Provide education on where opportunities exist for communities to engage in policy change (e.g., Local Control Accountability Plans, participatory budgeting practices) to sustainably expand youth access to mentoring and after-school programs.
  • Support connection of youth to caring adults and activities to counter ACEs and promote PCEs.
Promote Social Norms that Protect Against Violence and Adversity.
  • ​​​Share PACEs data and CDC-evidenced based strategies with statewide and local public education/policy change campaigns to reduce and prevent ACEs and promote PCEs.
  • ​Share the benefits of engaging in local violence prevention coalition activities and efforts. 
  • Partner with violence prevention programs to promote social norm change that protects again violence and adversity.
Educate Californians about the benefits of tax filing to collect tax credits. Review this resource for more information about how to help families understand the benefit of tax filing: Connecting Families to Tax Credits to Improve Child Wellbeing in California: A Brief for Local Health Department and Child and Family Services Providers​
Educate about where opportunities exist to create policy change that strengthen economic supports and create social norm change. Review this resource for more information: Reimagining Child Wellbeing: Local Policy Strategies to Prevent and Reduce Adverse Childhood Experiences (ACEs) in California’s Communities
Engage with local coalitions who are working to create policy change that improves the lives of children. Review this resource for more information: Essentials for Childhood Initiative: California Child Wellbeing Coalition e-Guide
Share and utilize data about the health and wellbeing of children in California. Website
Educate about the warning signs of physical abuse, neglect, and sexual abuse in children. For information about reporting child abuse and neglect and the legal obligations of mandated reporters, review the Child Abuse Identification and Reporting Guidelines from the California Department of Education (CDE) and the California Department of Social Services (CDSS)
Utilize information about strategies that create change and improve the lives of children, CDC Technical Package. Review this resource for more information about strategies to improve child wellbeing: Child Abuse and Neglect Prevention: Resource for Action.
Utilize information about strategies with the best available evidence to reduce suicide (CDC’s Suicide Prevention Resource for Action). Review this resource for more information that describes how communities can prioritize the suicide prevention activities most likely to have an impact: Suicide Prevention Resource for Action
Learn about existing efforts underway within California to address ACEs and toxic stress and the Office of the California Surgeon General’s shared vision for how to extend these efforts. Review this resource for more information from California’s Surgeon General about how ACEs can lead to toxic stress and review a blueprint for how a coordinated cross-sector response across sectors can function to achieve prevention and treatment strategies: Roadmap for Resilience: California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health​


[1] Sege, R., Bethell, C., Linkenbach, J., Jones, J., Klika, B. & Pecora, P.J. (2017). Balancing adverse childhood experiences with HOPE: New insights into the role of positive experience on child and family development. Boston: The Medical Foundation. Accessed on the Center for the Study of Social Policy website (

[2]  Centers for Disease Control and Prevention. (2019). Preventing adverse childhood experiences: Leveraging the best available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

[3]  Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. About Adverse Childhood Experiences. Accessed June 20, 2023 on the Center for Disease Control and Prevention About Adverse Childhood Experiences webpage  (

[4]  Bhushan D, Kotz K, McCall J, Wirtz S, Gilgoff R, Dube SR, Powers C, Olson-Morgan J, Galeste M, Patterson K, Harris L, Mills A, Bethell C, Burke Harris N, Office of the California Surgeon General. Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Office of the California Surgeon General, 2020. DOI: 10.48019/PEAM8812.

[5]  Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine.1998;14(4):245-258. doi webpage (

[6]  Choi KR, McCreary M, Ford JD, Koushkaki SR, Kenan KN, Zima BT. Validation of the Traumatic Events Screening Inventory for ACEs. Pediatrics. 2019;143(4). doi webpage(​2/peds.201​8-2546​)​​​​​

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