Information and Resources

Roadmap for Resilience: California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health

Serves as a blueprint for how communities, states, and nations can recognize and effectively address Adverse Childhood Experiences (ACEs) and toxic stress as a root cause to some of the most harmful, persistent, and expensive societal and health challenges facing our world today. The report provides clear cross-sector and equitable response solutions, models, and best practices to be replicated or tailored to serve community needs. This comprehensive report brings together ​insights from global experts across sectors, specialties, and disciplines to promote science-based approaches to primary, secondary, and tertiary prevention strategies for ACEs and toxic stress. The report further specifies a sector-specific and cross-sector roadmap for addressing ACEs and toxic stress at the state level, prioritizing prevention, ​early detection, evidence-based interventions and equity in outcomes, ​highlighting the need for enhanced coordination across the following sectors: Healthcare; Public health; Social services; Early childhood; Education; and Justice.

roadmap resilence pdf.

COVID-19 – Manage Stress for Health


While we take action to lessen the immediate impacts of COVID-19 on our communities and our health care systems, it is also important to minimize the secondary health effects of this pandemic. Widespread stress and anxiety regarding COVID-19, compounded by the economic distress due to lost wages, employment and financial assets, mass school closures, and necessary physical distancing can result in an increase of stress-related health conditions.

California’s ACEs Aware Initiative Trains Nearly 14,000 Health Care Providers in Trauma-Informed Care


“Becoming ACEs Aware in California” trains health care providers to screen patients for ACEs and to recognize and respond to the symptoms of toxic stress. Health care providers who have taken the training can be found through the Provider Directory.

Cost of ACEs in California


New research shows impact of Adverse Childhood Experiences and toxic stress costs $112.5 billion per year to California. “Adverse Childhood Experiences and toxic stress will cost California over a trillion dollars in the next 10 years,” said California Surgeon General Dr. Nadine Burke Harris. “This research demonstrates that our imperative is not only ethical and moral, we have a strong economic imperative as well.” Read the news alert with key takeaways here

House Education Subcommittee Hearing on the Effects of Childhood Trauma


On September 11, 2019, The House Education and Labor Subcommittee on Early Childhood, Elementary and Secondary Education held a hearing to examine the effects of trauma on children and their development. The committee heard testimony from school administrators from West Virginia, Illinois and Oklahoma, as well as California Surgeon General Dr. Nadine Burke Harris. Watch the full Hearing here.


Dr. Nadine Burke Harris speaking at UCSF – Photo Courtesy of Susan Merrel

CAForAll_Box_Logo-EN Smaller.


Find information on COVID-19 updates and impacts, as well as resources for health care providers, patients, and families.

  • If you are feeling stressed, worried, or frustrated about COVID-19, calling the CalHOPE Warm Line connects you to people who offer emotional support and coping mechanisms. Call (833) 317-HOPE (4673) to talk with a peer counselor. Find more information at CALHOPE.
  • NAMI COVID-19 Resource and Information Guide: National Alliance of Mental Illness (NAMI)’s COVID-19 Resource and Information Guide includes information on mental and physical health implications, pursuing treatment, and how to find support.
aces-aware logo.

ACEs Aware

  • ACEs Aware Resources for COVID-19 & Stress: ACEs Aware supports health care providers, their teams, and all those on the front lines of administering care and interventions as California addresses stress and anxiety related to COVID-19.
  • The newly launched ACEs Aware Provider Directory offers patients a way to find and connect with trained ACEs Aware providers throughout California.
NBH and patient.

Dr. Nadine Burke Harris sees a patient during her time at the Center for Youth Wellness – Photo Courtesy of the Center for Youth Wellness

ACEs and Toxic Stress

  • Learn more about ACEs and Toxic Stress
  • ACEs Aware: The Office of the California Surgeon General, in partnership with the California Department of Health Care Services (DHCS), is creating a first-in-the-nation statewide effort to screen patients for Adverse Childhood Experiences (ACEs) that lead to trauma and the increased likelihood of ACEs-Associated-Health Conditions due to toxic stress. The bold goal of this initiative is to reduce ACEs and toxic stress by half in one generation. Additional details about the healthcare provider training and ACEs Aware Initiative are available at

Early Childhood

  • The Master Plan for Early Learning and Care: California for All Kids provides a strong research-based roadmap for building a comprehensive and equitable early learning and care system over the next decade. More information can be found at Master Plan for Early Learning and Care: California for All Kids.
  • The California Surgeon General serves as chair of the Early Childhood Policy Council (ECPC). The ECPC will elevate the needs of young children and their families as well as advise the Governor, Legislature and the Superintendent of Public Instruction on statewide early learning, care and child development. For more information visit the Early Childhood Policy Council.
  • California’s Preschool Development Grant Birth Through Five (PDG) articulates a vision for the state’s early learning and care (ELC) system: Children age birth through five, their families, and communities will thrive through an effective and impactful ELC mixed delivery system that is efficiently connected to additional child, family, and program supports. To learn more about visit the Preschool Development Grant Renewal.
  • California for All’s Early Learning & Care Playbook: California for All’s Early Learning & Care Playbook offers resources for families about safe practices during the COVID-19 pandemic, including information on hygiene, nutrition, child care, and financial relief resources. View the whole playbook here.
  • First 5 California: First 5 California provides support for children prenatal to age 5, families, and caregivers through funding and services for education, health services, and childcare in communities throughout California. For additional information, visit here.

Health Equity

  • The COVID-19 pandemic has highlighted existing systemic health and social inequities. Data has shown that the same communities who have experienced systemic health and social inequities are also disproportionately impacted by COVID-19. Visit the California Department of Public Health (CDPH) COVID-19 Data on Racial Demographics ( for more information.
  • As announced on August 28, 2020, the Blueprint for a Safer Economy includes a health equity metric which will be used (along with other metrics) to ensure California reopens its economy safely by reducing disease transmission in all communities. For more information, visit California Health Equity Metric (
  • The California Surgeon General serves as co-chair of the Vaccine Advisory Committee and supports the principles of transparency, safety and equity as a foundation for the vaccine planning, procurement/allocation, distribution and rollout process.  Dr. Burke Harris will support the bi-directional role of this committee – meaning that the committee members both serve to inform government strategies and serve as trusted messengers to their communities. To learn more, go to Community Vaccine Advisory Committee (
  • Find additional resources from CDPH Office of Health Equity (