California Surgeon General’s Report

Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health
Roadmap for Resilience 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.
Part I: The Science, Scope, and Impacts of ACEs and Toxic Stress
- Framing the Public Health Crisis of ACEs and Toxic Stress (PDF)
- Defining ACEs and Toxic Stress (PDF)
- The Biology of Toxic Stress (PDF)
- Intergenerational Transmission of Adversity (PDF)
- Establishing Causality between ACEs and Poor Health Outcomes (PDF)
- The Economic Costs of ACEs and Toxic Stress (PDF)
Part II: The Public Health Approach for Cutting ACEs and Toxic Stress in Half within a Generation
- Primary, Secondary, and Tertiary Prevention of ACEs and Toxic Stress: An Overview (PDF)
- Primary and Secondary Prevention Strategies in Healthcare (PDF)
- Tertiary Prevention Strategies in Healthcare (PDF)
- Primary, Secondary, and Tertiary Prevention Strategies in Public Health (PDF)
- Primary, Secondary, and Tertiary Prevention Strategies in Social Services (PDF)
- Primary, Secondary, and Tertiary Prevention Strategies in Early Childhood Supports (PDF)
- Primary, Secondary, and Tertiary Prevention Strategies in Education (PDF)
- Primary, Secondary, and Tertiary Prevention Strategies in Justice (PDF)
Part III: California’s Response to ACEs and Toxic Stress
- State Tools and Strategies for Responding to ACEs and Toxic Stress (PDF)
- The ACEs Aware Initiative (PDF)
- Clinical Implementation Case Studies (PDF)
- Systems-Level Implementation Considerations (PDF)
- Approach to Environmental Scans of Statewide Trauma-Informed Work (PDF)
Part IV: What Lies Ahead
- Executive Summary for Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health (PDF)
- Adverse Childhood Experiences and Toxic Stress: A Public Health Crisis (PDF)
- COVID-19 and Toxic Stress (PDF)
- The Financial Costs of ACEs and Toxic Stress (PDF)
- Statewide Tools and Strategies for Responding to ACEs and Toxic Stress (PDF)
- The ACEs Aware Initiative (PDF)
- What Lies Ahead? (PDF)
Sector-Specific Briefs:
- Early Childhood Sector: From Adversity to Resilience (PDF)
- Education Sector: From Adversity to Resilience (PDF)
- Healthcare Sector: From Adversity to Resilience (PDF)
- Justice Sector: From Adversity to Resilience (PDF)
- Public Health Sector: From Adversity to Resilience (PDF)
- Social Services Sector: From Adversity to Resilience (PDF)
Help get the word out! Here are social media messages to share details on the Roadmap for Resilience.
- Dr. Nadine Burke Harris SG Report Quote–Twitter (JPG)
- Dr. Nadine Burke Harris SG Report Quote–Instagram/Facebook (JPG)
- First CA Surgeon General’s Report–Twitter (JPG)
- First CA Surgeon General’s Report–Instagram/Facebook (JPG)
- SG Report ACEs and Toxic Stress as a Public Health Crisis–Twitter (JPG)
- SG Report ACEs and Toxic Stress as a Public Health Crisis–Instagram/Facebook (JPG)
- SG Report Cross-Sector Roadmap–Twitter (JPG)
- SG Report Secretary Ghaly Quote–Twitter (JPG)
- SG Report Secretary Ghaly Quote–Instagram/Facebook (JPG)
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.