Globally Reduce Adverse Childhood Experience Initiative

The Globally Reduce Adverse Childhood Experience (GRACE) Initiative aims to advance and translate the science of adverse childhood experiences (ACEs) to improve the lives of children and families worldwide.

The Context

The early years of life comprise a crucial period during which humans go through critical physical, physiological, neurological, behavioral and emotional development. During this stage, not only are infants and children more vulnerable to biological pathogens and environmental toxins, they are also more susceptible to certain traumatic events, known collectively as adverse childhood experiences (ACE). These can include:

• Physical or emotional neglect
• Verbal, sexual and physical abuse
• Family dysfunction
• Other toxic stressors

ACEs have been linked to multiple hard-to-treat and expensive mental health, communicable and non-communicable diseases during childhood and into adulthood.

In some countries, as many as half of the entire population is exposed to at least one of the 10 original ACEs; thus, the long-term damage due to ACEs is high, especially in settings and communities that have been affected by war, famine and displacement.

While the science of ACEs and trauma-informed care is still in its early stages, the existing knowledge is rarely used in research efforts conducted in the global settings or incorporated into clinical practice. Lack of attention to ACEs undermines efforts to reduce health disparities in those communities. The GRACE Initiative will address these obstacles via several activities.

Focus Areas

Translational research & knowledge transfer

We conduct rigorous systematic reviews of the literature to understand what works and what doesn’t to mitigate the effects of ACEs and make that knowledge widely accessible in order to inform policy, design programs, identify research gaps and propose innovative ACE prevention approaches. We leverage our own existing methods applied to other diseases, incorporating economic evidence to identify return on investment for various interventions, thus enhancing the value of our work for policy and program development. Our research framework includes adversities beyond the 10 original ACEs assessed in the CDC and Kaiser Permanente landmark study.

While we recognize the needs of people who have been affected by ACEs, we strive to shift the health policy paradigm exclusively from treatment to include primary prevention. We will leverage the science of knowledge transfer to engage policy-makers, raise awareness about the importance of the root causes of the public health problems, and advocate for primary prevention of ACEs.

ACE-focused scientific community at UCSF and beyond

As one of the leaders in the field, UCSF is home to numerous individuals and research groups (see UCSF Related Organizations) engaged in groundbreaking ACE-related activities including education, research, prevention, treatment, advocacy and policy.

We aim to build on the work of these individual research initiatives and build a community of faculty, students, staff, affiliates and partners who share a passion for addressing childhood adversities. We plan to include people from the Bay Area community and partner with local, national and international communities and organizations. We will convene meetings and annual symposia within UCSF to foster collaboration and will serve as a liaison to domestic and global health ACE research activities and programs. Join our community and tell your stories here.

De-stigmatization program

We will raise awareness about ACEs in specific target communities and inspire and engage children, parents, healthcare providers, teachers, community leaders and other stakeholders with our mission. We seek to normalize the ACEs conversation via convening engaging community events and creating safe spaces for children and their families to connect, play, and learn. In particular, we will conduct research to cultivate and enhance the role of the father in resilience-building in children.

While almost all families and children can potentially benefit from our work, our initiative directly focuses on those who have been exposed to or are at risk of ACEs, especially in communities affected by war, forced displacement, or ongoing social and economic injustices worldwide. BRIX: Connect & Care is our early phase initiative that uses recycled LEGO™ bricks to build communities in refugee camps, underserved communities in Mexico and in Modesto, California.