Experiencing trauma can have significant negative consequences that persist long after the trauma has ended. Early exposure to trauma undermines brain development, socioemotional development, ability to develop secure attachments, emotion regulation, sense of agency, and self-efficacy. Children who have been exposed to trauma, particularly multiple traumas, are at risk for developing emotional and behavioral problems, such as depression, anxiety, dissociation, post-traumatic stress disorder, low self-esteem, hopelessness, withdrawn behaviors, and impaired peer relationships. The effects of trauma on adults can range from subtle to destructive and can manifest in diminished cognitive ability as well as worsening physical and mental health. More broadly, “community trauma” affects social groups or neighborhoods long subjected to interpersonal violence, structural violence, and historical harms. Community and systems trauma, like individual trauma, affects cognitive decisionmaking that can lead to reduced civic engagement and weakened social networks and social cohesion; it can also adversely influence how individuals view themselves, their capabilities, and their social status.

Metric: Adverse Childhood Experiences scale

The Adverse Childhood Experiences (ACE) scale is a survey-based scale comprising 17 items that measure childhood exposure to trauma such as psychological, physical, or sexual abuse; neglect; mental illness; domestic violence; divorce; and having a parent in prison. Each question relates to an experience growing up during the first 18 years of life and solicits a “yes” or “no” response. More “yes” answers mean that the respondent has gone through more types of childhood trauma. To construct this metric, community leaders would need to collect data locally.

Validity: A significant body of research finds that that higher ACE scores, indicating more childhood trauma, correlate with several outcomes related to lower mobility. Higher ACE scores are associated with poor performance at work and financial problems as adults as well as higher rates of chronic disease, depression, and lower health-related quality of life as adults. The metric may be most useful as an indicator of a need for trauma-informed care at the community level.

Availability: This information is not available widely enough in existing data sources to provide coverage at the local level across many geographies.

Frequency: The frequency of how often data for the metric would be collected would depend upon local data collection efforts, but we recommend regular follow-up data collection at least every two years.

Geography: The level of geography that the metric would represent (e.g., county, city, or zip code) would depend on the sampling frame, stratification, and the number of people ultimately surveyed to obtain sufficient power for the survey.

Consistency: The degree of consistency in this metric across different places will vary with the extensiveness of the survey design and number of people surveyed in each place. Ideally, the metric would be consistent across some base level of geography (such as the city or county), but some places would likely have more extensive coverage of residents who have completed the ACE scale.

Subgroups: Like geography, the range of subgroups represented and the ability to compare subgroups (people of color and white people; married and single people; people with children and those without) would depend on the sampling frame, stratification, and the number of people surveyed.

Limitations: The key limitation is the need for local partners to collect representative data. Original data collection may also make benchmarking against other places challenging, depending on the scale and representativeness of data collection in other places. This metric may be sensitive to residential mobility because those reporting experiences of trauma in the past may have lived in a different jurisdiction at the time.