How We Developed a Tool to Measure Tribal Adverse Childhood Experiences and Resilience

Allyson Kelley

Nov 6

5 min read

The Beginnings of Our Work

We have been on a journey. This journey started about five years ago, when a Tribal Organization asked us at AKA to help create and then validate a tool that measured culture, community connectedness, resilience, coping, and adverse childhood experiences (ACEs). If you have been on similar journeys as a researcher, clinician, evaluator, methodologist, or program, then you know the complexities of understanding ACES from both Indigenous and Western perspectives. This narrative documents what we did and why it matters.

Understanding ACEs

Within Indigenous communities, ACEs have a unique meaning because of historical trauma and the intergenerational impacts of colonization, boarding schools, genocide, and forced removal from traditional lands. Indian Boarding Schools in the 19^th and 20^th centuries removed children from their families and attempted to systematically destroy Native cultures and communities to “Kill the Indian and Save the Man”. This resulted in an era of historical and systemic ACEs where more than a third of American Indian children were taken from their families and places into non-Native homes. Survivors experienced Boarding School Syndrome, which is a form of post-traumatic stress disorder.

Indigenous researchers before us paved the way for a better understanding of trauma and healing. Here are four Indigenous authors that we learned from while developing this study.

1998 - Maria Yellow Horse Brave Heart and Lemyra M. DeBruyn’s publication, The American Indian Holocaust: Healing Historical Unresolved Grief, links historical trauma and unresolved grief to social ills. They suggest social ills are primarily the product of a legacy of chronic trauma and unresolved grief across generations. Historically unresolved grief emerges as a key term for understanding the loss of lives, land, and vital aspects of Native culture that resulted from colonization.

2003 - 2011- Maria Yellow Horse Brave Heart and colleagues' publication, Historical trauma among Indigenous Peoples of the Americas: concepts, research, and clinical considerations, defined historical trauma as cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma. Her work explored current and future practices for community-level interventions to address trauma.

2006- Eduardo Duran’s book, Healing the Soul Wound, emerged as a new approach to understanding trauma, where the spirit is wounded and needs healing. His work shows how colonization created trauma passed down from one generation to the next. He puts forward the concept that trauma and addiction are spirits and therefore healing must happen at the spirit level.

2023 - Joseph P. Gone’s publication, Indigenous Historical Trauma: Alter-Native Explanations for Mental Health Inequities, theorized historical trauma as a collective issue where shared pain and shared recovery are possible.

We also learned from other authors.

1980s- Drs. Felitti and Anda, with the Centers for Disease Control and Prevention and Kaiser Permanente, began to notice that many patients had hidden histories of childhood abuse or trauma. They did a study and found that ACEs impact nearly every aspect of health and wellbeing, including injuries, mental health, maternal health, infectious disease, chronic disease, risky behaviors, and opportunities. Individuals experienced traumatic events that impacted their safety, connections, attachment, and belonging.

We know that people are more than a number, more than an ACE score, and that people heal.

What We Did … We worked alongside three Tribal Health Programs and a Tribal organization. Our partnership with them spans more than a decade. Our work balanced standardized ACE questions with Tribally focused questions centered on hope, cultural connections, strengths, and resilience. This was not easy, but many people and programs made it all possible.

3 Tribal Health Programs and 500+ Tribal community members
5 PhD-level Clinicians, Statisticians, and Experts
1 Tribal Advisory Board
2 Directors of Tribal Consortium Departments
1 Senior Evaluator
1 Writer

Our goal was to include questions in the survey tool that would help us better understand ACEs and cultural connections, resilience, and coping. This tool can be easily adapted to fit any Tribal community's needs, practices, or ideas. Measuring ACE scores is not new. But we needed to ask the right questions to understand how ACEs impact individuals and communities. For example, research consistently shows that if you have an ACE score higher than 6, then the odds of experiencing alcohol misuse, smoking, and drug dependence later in life increase. Research does not show what happens when you have an ACE score higher than 6, AND you are connected to your culture, practice your traditions, language, and are connected to the kinship offered in your community. We wanted to understand how culture buffers ACEs and, eventually, how people transcend trauma and heal.

Traveling and Gathering to Share the TACE Tool

We partnered with a Tribal Epidemiology Center
We traveled to the American Public Health Association conference and presented a poster
We shared this work at national conferences
We talked and shared our work during the UCLA-UCSF ACEs Aware Family Resilience Network gathering
We wrote a practice paper on incorporating Indigenous Perspectives into practice
We published a paper in a peer-reviewed journal

ACEs and Strength-based Attributes

We used strengths-based statements to explore resilience, coping, culture, and community (see Table below).

Two statements were associated with lower ACE scores, self-satisfaction, and healthy relationships; both anchor a balanced, healthy life.

The TACE tool can serve as a culturally responsive, unifying framework to promote new trauma-informed care practices that heal and restore well-being in AI/AN populations.

Looking Back, Looking Forward … The TACE tool has been validated and deemed reliable for use in Tribal populations. Funding, persistence, patience, and humility come to mind when we look back on this journey. The ancestors must have come many times to intervene on our behalf. It’s a miracle this work made it into the world, and a publication in October 2026.

Our Prayers… We want the TACE tool to be read, known, and used. We pray it will help people heal. Not just people in a clinic seeking services, but all people and families. We hope that clinicians will use this tool to ask the right questions. It’s not just ACEs that have the potential to pathologize and stigmatize individuals rather than validate suffering and recognize the need for healing. It is people's strengths-based resilience, their spiritual practices, community connections, and what helps them heal. We pray that by elevating this work and sharing it with the world, we can prevent ACEs.

We’ve learned it is not enough to ask questions about trauma, especially in childhood, and give someone an ACE score.

I asked an elder, “How do we move from trauma to healing? As individuals and as a community?”

The elder said, “Change does not occur when people are comfortable. Words are not just words; they are what people are going through and intergenerational trauma. How do we stabilize enough to do the healing work?”

That is the question we must answer.

There are 9.7 million+ Native people in the U.S. and 575+ Tribes. The TACE tool is offered to these people and Tribes as a way to measure trauma, transcend trauma, and stabilize enough to do the healing work.

What We Know for Sure

Trauma is

Unspeakable

Uncurable

Unseen

Healing from trauma is

A process

A realization

That something was harmed

And needs to be healed

An inward journey

To stabilize our connections