Adverse Childhood Experiences Capacity Assessment Tool Roadmap

The Association of State and Territorial Health Officials (ASTHO), in collaboration with CDC, developed the Adverse Childhood Experiences Capacity Assessment Tool (ACECAT) to help health agencies identify opportunities to work on this public health issue to maximize resources and impact. ASTHO fielded the ACECAT in 2019 to all 59 health agencies and received responses from 44 agencies for a 75% response rate. The ACECAT benefits health agencies by allowing them to inventory their current capacity to address and prevent ACEs. Health agencies can use the results to identify technical assistance needs and generate ideas to respond to future funding opportunities. This resource—the ACECAT roadmap—is a companion piece that provides concrete steps to completing the ACECAT asynchronously. For each section of the roadmap, there is an estimated amount of time to complete that section, as well as a number of steps.


  • Getting Started
  • Completing the ACECAT
  • Utilizing the ACECAT Results
  • Appendices

Getting Started (1+ Hours)
  1. Familiarize yourself with the ACECAT.
  2. Review the following:
    • Glossary of terms (see Appendix A below): This serves as a glossary for participants to reference when completing the ACECAT.
    • Capacity scale (see Appendix B below): A four-point scale used in the ACECAT.
    • Notetaking template: A template to take notes as your team completes the ACECAT.
  3. Identify and contact the key health agency staff (e.g., Injury and Violence Prevention Director, Maternal and Child Health Director, Suicide Prevention Program Manager, Drug Overdose Prevention Program Manager) who work on ACEs prevention (i.e., behavioral health/mental health, family health services, MCH, IVP, substance misuse prevention, suicide prevention) and form a team to complete the ACECAT. The primary audience for this tool is health agencies, but feel free to include partners who play a role in day-to-day ACEs work.
  4. Reach out to ASTHO's Social and Behavioral Health team with any questions.
Completing the ACECAT (2+ Hours)

Preparing to Complete the ACECAT

  1. Convene your health agency's ACECAT team for an intake meeting to walk through the PDF version of the ACECAT to understand expectations for completion.
  2. As a team, review the ACECAT and identify questions that may require further input from other health agency staff.
  3. Schedule a working meeting to complete the ACECAT fillable PDF.

Completing the ACECAT

  1. Convene your health agency ACECAT team in-person or virtually to complete the ACECAT.
  2. Have the group choose a lead to insert the responses into the ACECAT. If convening virtually, your staff lead should also be the one to share their screen while filling out the ACECAT.
  3. Your team should discuss each question and reach a consensus on the appropriate response.
Utilizing the ACECAT Results (No Time Constraint)

Discuss the Results

  1. Convene your health agency ACECAT team in person or virtually to review the ACECAT results.
  2. Choose a facilitator for a team discussion (e.g., what stood out to you from the shared risk and protective factor section? Infrastructure? Topical? Are there strengths to continue enhancing? What strengths could we use to address barriers or challenges? Where do we want to address challenges?)

Action Planning

  1. Review relevant resources (Appendix E) for action planning.
  2. Have the team use this Kanban board (Appendix D) to discuss what activities the agency might undertake to address different challenges.

Continuing the Work

  1. Keep the work moving forward by convening your ACECAT team regularly.
  2. After one year, re-take the ACECAT to track progress made.
Appendix A: Glossary
Term Definition
ACECAT ASTHO's Adverse Childhood Experiences Capacity Assessment Tool
Adverse childhood experiences Stressful or traumatic incidents that occur in childhood that can harm social, cognitive, and emotional functioning and undermine the safe, nurturing environments children need to thrive.
Health disparities Differences in health outcomes and their causes among groups of people.
Positive childhood experiences Creating and promoting activities and experiences that enhance a child's life results in successful mental and physical health outcomes.
Primary prevention of ACEs Prevention strategies to stop ACEs from ever occurring (e.g., strengthening family financial supports, early head start, positive parenting skill-building).
Secondary prevention of ACEs Prevention strategies that attempt to identify individuals at high risk for ACEs through early screening and assessment (e.g., workforce training on ACEs).
Tertiary prevention of ACEs Prevention strategies that reduce the health impact of ACEs for vulnerable populations (e.g., workforce training on ACEs, identification of high-risk populations).
Appendix B: Capacity Scale

Please refer to the following scale to define your agency's capacity. We recommend downloading the capacity scale for reference throughout the ACECAT.

0 = Not Applicable (N/A): Your agency does not perform this work directly. However, the health agency may support other partners at the community or local level who perform this work.
1= No Capacity: No efforts are currently underway (e.g., due to lack of funding or other reasons).
2= Limited Capacity: Preliminary efforts and plans are underway (e.g., an action plan).
3= Some Capacity: Have assessed and developed initial responses, but important program gaps or challenges remain.
4= Full Capacity: Have targeted initiatives for those in need. Your agency has addressed most gaps and challenges related to implementing strategy.

*Please leave any questions blank if you are unsure about the answer.

Appendix C: ACECAT Notetaking Template

Purpose: This supplemental notetaking sheet is an optional handout that you and your team can utilize to capture any additional comments, questions, or takeaways that arise during the completion of the tool.

Instructions: Please note the date that you completed the tool and the names of the agency staff members who contributed to the completion of the tool. As you and your team complete the tool, please use the blank column to elaborate on the conversations you and your team had as you completed each section. You may use the italicized questions in the left-side column to help guide notetaking and discussion among your team. Once you and your team have finished the tool, feel free to use the Decisions & Action Items section to develop the next steps for integrating any main takeaways into your work.

Download the ACECAT Notetaking Template (Word Download)

Appendix D: Kanban Board

Audience: Any size group.

Facilitator: Optimal.

Time Needed: Minimum 30 minutes, depending on depth of the initiative and roles involved.

Virtual or In-Person: Either.

Materials: Physical or virtual sticky notes; Kanban sketch.

Prompt:  What activities might the agency undertake to address XYZ? [XYZ is the situation about which you are action planning, whether that is addressing ACECAT assessment results, or beginning an ACEs project, or other situation.]  You may want to ask follow-on prompts for aspects of who will do the work, specifically when the work will be done, etc. If so, allow additional time.

Roles:  Everyone has equal opportunity to contribute. Having a facilitator is optimal though not required.

Preparation: A Kanban board is a tool for workflow visualization.

  • Sketch a basic Kanban board (physical or virtual) with columns for Nice to Have, Critical, To Do, Doing, Done. An example is provided on the next page.
  • On the board, include the prompt above.
  • Assign/provide a different color sticky note to each unique team/person/function.

Sequence and Time Allocation:

  1. Facilitator: [2 min.] Aloud, explain the instructions and answer questions for clarity.
  2. Individuals or functional teams: [5 min.] Considering the prompt above, write responses on sticky notes, using your assigned function/role color. Also, only write one task per sticky note. Post on the Kanban, but do not assign to a column just yet.
  3. All: [15-20 min.] Together, review all posts, group into similar posts, and label these groupings if desired. Discuss the general order of when each task needs to occur and whether each task is critical to the success of the project or simply nice to have. Then place each task in either the Critical or Nice to Have column, in sequence of occurrence. Select a few tasks to be done first (those early in the sequence) and place in the To Do   
  4. Next Steps: [2 min.] Discuss the process for updating the Kanban as tasks begin and all the way through completion.

Context: The Kanban is intended to be a high-level tracker so 'don't spend too much time refining. Even so, your team may choose to add a few more particulars, such as:

  • More columns may be added to track progress. Examples include Optional, Ready to Do, Waiting on X, Testing, Ready for Review, Awaiting Approval,
  • To provide more insight into timeframes, items could be noted with the timeframe needed to accomplish an activity, such as Six Months, Three Months, etc., or you could note due dates.
  • If several teams/functions will be working together or if steps are voluminous, you may want to provide swim lanes (horizontal rows), one lane for each team or major role.
  • Third-party tools such as Trello, Jira, or Kanbanize may be used to track in-depth Kanban boards.

Sample of Basic Kanban Board in Mural:

Template of a Kanban Board in Mural


Appendix E: Additional Resources

While some of these resources are specific to the intersection of ACEs Suicide and Overdose, they are relevant to ACEs prevention work.

Infrastructure Resources:

Topical Capacity Resources: