What are Adverse Childhood Experiences?
In the 1990s, the Centers for Disease Control and Kaiser Permanente conducted one of the largest studies on childhood adversity ever undertaken. The ACE Study — Adverse Childhood Experiences — followed more than 17,000 adults and asked them about ten categories of childhood experience. What they found changed how researchers, doctors, and policymakers understand health, behavior, and life outcomes.
The ten ACE categories are divided into three groups:
Abuse
- Physical abuse
- Emotional abuse
- Sexual abuse
Neglect
- Physical neglect
- Emotional neglect
Household dysfunction
- Domestic violence
- Substance abuse in the household
- Mental illness in the household
- Parental separation or divorce
- Incarceration of a family member
Each category present in a person's childhood counts as one point, giving an ACE score between 0 and 10. The study found that the higher the ACE score, the greater the risk for a wide range of negative outcomes across health, mental health, relationships, and behavior — not as moral failures, but as predictable biological and neurological consequences of growing up in an environment the developing brain was not built to handle.
The key insight: the brain adapts to survive
A child raised in an environment of chronic stress, unpredictability, or violence does not develop a "broken" brain. They develop a brain that is extremely well-adapted to that environment — hypervigilant, reactive, distrustful of authority, and oriented toward immediate survival over long-term consequence. Those adaptations often become liabilities in adulthood. Understanding this does not excuse behavior. It explains where it comes from — which is the necessary starting point for changing it.
ACEs and incarceration — the data
The relationship between ACE scores and incarceration is one of the strongest correlations in the research. These are not speculative connections — they are documented outcomes measured across large populations.
97%
of incarcerated people have at least one ACE
vs. 64% of the general U.S. population
75%+
of incarcerated people have 4 or more ACEs
vs. ~12–16% of the general population
10×
higher likelihood of incarceration with an ACE score of 6 or more
Compared to someone with a score of 0
Note that one of the ten ACE categories is itself incarceration of a family member. Children who grow up with a parent or sibling behind bars carry that experience as an ACE — which means incarceration is not only a consequence of trauma, it is also a cause of it in the next generation. This cycle is not inevitable, but it is also not broken by punishment alone.
The connection between ACEs and incarceration runs through several documented pathways: untreated trauma leading to substance use as self-medication; impaired emotional regulation leading to violent or impulsive behavior; damaged attachment and trust leading to gang affiliation or other surrogate family structures; and chronic stress in early childhood literally altering brain development in ways that affect decision-making, impulse control, and the ability to anticipate consequences.
Why this matters for families on the outside
Many families report confusion, frustration, or guilt about their loved one's choices and behavior — both before and during incarceration. Understanding the ACE framework often shifts that experience from judgment to context. It does not remove accountability, but it makes behavior more legible. And for families supporting someone through the rehabilitative process, understanding what drove the behavior in the first place is essential to understanding what healing actually requires.
What this means for families
Families often carry their own ACEs — sometimes the same ones. Parents who experienced abuse, neglect, or household dysfunction in their own childhoods may recognize the patterns in their loved one's story. Sometimes they blame themselves. Sometimes the shared experience creates a kind of paralysis around what to do next.
The research is clear that healing is possible — not easy, not linear, but real. The brain retains more plasticity than previously understood, and trauma responses that were adaptive in childhood can be unlearned when people are given the right conditions, relationships, and tools. This is what the programs described in the programs and activities guide are actually doing — creating those conditions inside an environment that often makes them harder to sustain.
For families, the most useful thing is often to develop a framework for understanding what your loved one is working through — not to absorb their trauma as your own, and not to minimize it, but to hold both at once. The two books below are the most widely recommended starting points. They are not academic texts. They are readable, specific, and often described by families as changing the entire way they understood what happened.
Essential reading
Book
What Happened to You? Conversations on Trauma, Resilience, and Healing
Bruce D. Perry, M.D., Ph.D. and Oprah Winfrey — Flatiron Books, 2021
Written as a series of conversations between neuroscientist and trauma pioneer Dr. Bruce Perry and Oprah Winfrey — who draws on her own history of childhood abuse and neglect — this book makes the science of trauma accessible without losing its precision. The central reframe is in the title itself: the shift from "what is wrong with you?" to "what happened to you?" is not rhetorical. It reflects a fundamental change in how traumatized behavior should be understood.
Perry explains how adverse experiences in early childhood literally alter the architecture of the developing brain — particularly the regions responsible for emotional regulation, impulse control, and the capacity to feel safe. He shows how these alterations produce behaviors in adulthood that look like choices but are often automatic responses to threat cues that were programmed decades earlier. The book also explores what healing requires: not just insight, but consistent relational experiences that help the nervous system learn that safety is possible.
This is often the first book recommended to families trying to understand a loved one's history and behavior. It is honest, hopeful, and grounded in decades of clinical and research experience.
Book
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
Bessel van der Kolk, M.D. — Viking, 2014
Dr. Bessel van der Kolk spent decades working with trauma survivors — veterans, abuse survivors, people whose early lives were marked by violence or neglect. What he documented, and what this book argues with extensive clinical and neurological evidence, is that trauma does not live primarily in the story a person tells about what happened to them. It lives in the body — in the nervous system, the muscles, the automatic threat responses that fire before conscious thought is possible.
This explains something families often observe but struggle to name: why a person can know intellectually that a situation is not dangerous but still react as if it is. Why certain tones of voice, certain postures, certain environments trigger responses that seem completely disproportionate. Those responses are not irrational — they are exactly what a nervous system trained by early trauma is supposed to do.
Van der Kolk also explores what actually works in treatment: movement, breath, theater, yoga, EMDR, neurofeedback, and other approaches that engage the body rather than bypassing it. This is directly relevant to understanding why the programs described in this guide — from cognitive behavioral work to faith-based groups to restorative justice — are effective when they engage people at more than just the intellectual level.
Organizations doing the work inside
A growing number of organizations bring trauma-informed programs, healing modalities, and community accountability work directly into California prisons. These are not generic prison support groups. They are structured interventions built specifically around understanding what trauma does and creating conditions for genuine change. Many operate as activity groups coordinated through the institution's Community Resource Manager (CRM).
Program availability varies by institution. Your loved one or their CRM can confirm which of these organizations are active at their facility.
Compassion Prison Project
compassionprisonproject.orgFounded by Fritzi Horstman, CPP is explicitly built around the ACE framework. Their work brings trauma awareness education inside prisons — helping incarcerated people understand their own histories, and helping staff and administrators understand the populations they work with. CPP describes its mission as creating trauma-informed prisons and communities.
GRIP — Guiding Rage Into Power
grip-traininginstitute.orgA one-year intensive program developed over 25 years of direct work at San Quentin and other CDCR institutions. GRIP guides incarcerated people through deep transformation and accountability around violent behavior, rooted in understanding trauma's role. Now active at Avenal, Mule Creek, CTF, DVI, and other facilities. Peer-led and evidence-informed.
Barrios Unidos — Prison Project
scbarriosunidos.org/prison-projectRooted in restorative and transformative justice, Barrios Unidos works with incarcerated Latinx individuals on healing from the trauma of violence and state systems. Their approach integrates cultural identity, community advocacy, and direct engagement with the causes of incarceration.
Insight Prison Project
insightprisonproject.orgOffers evidence-based programs at 7 California state prisons. Their flagship 18-month Victim/Offender Education Group (VOEG) was developed by licensed mental health therapists alongside survivors of violent crime. Dramatically reduces recidivism by addressing the emotional and relational roots of violent behavior.
Anti-Recidivism Coalition (ARC)
antirecidivism.orgProvides peer-led in-prison mentoring alongside comprehensive reentry services — housing, employment, education, mental health support. ARC's network of currently and formerly incarcerated leaders creates a sustained connection between the inside experience and post-release success.
TUMI — The Urban Ministry Institute
tumi.orgA Christian-based theological education program with 16 structured ten-week courses leading to ministry credentials. Active in California prisons including CSP-Solano and Salinas Valley. TUMI approaches healing through faith formation, community, and the development of leadership and purpose.
Prison Law Office
prisonlaw.comProvides free legal services to California state prisoners. While primarily a legal advocacy organization, PLO is a key resource for families and incarcerated people navigating CDCR systems, including access to programming and mental health care.
Veterans Transition Center of California (VTC)
vtcofcalifornia.orgVTC created the nation's first dedicated prison yard for incarcerated veterans at CTF Soledad. Programs include Narration Therapy, DeCruit, Anger Management, Domestic Violence Prevention, Road to Freedom, Narcotics Anonymous, and Breathwork. Their Transformative Re-entry program (LTORR) has supported 160+ formerly incarcerated veterans — with a reported 0% recidivism rate among participants compared to California's statewide rate of approximately 42%.
Veterans Healing Veterans from the Inside Out (VHV)
veteranshealingveterans.comFounded by Ron Self — a TEDx San Quentin speaker — VHV is a trauma recovery and suicide prevention program using peer support, narration therapy, and mind/body integration to heal PTSD and reduce veteran suicide. Currently operating 9 active peer processing groups across five CDCR institutions: San Quentin, Deuel Vocational Institution, Solano, Sacramento State Prison, and CTF Soledad.
Transformative Justice Center — Empathy in Action
transformativejusticecenter.orgFounded and directed by Megan McDrew, TJC runs Empathy in Action: Bridge to Redemption — an 8-week, year-round inside-out educational exchange program at CTF Soledad. Meeting once a week for two hours, the program uses literature and personal storytelling to build empathy, insight, and healing between incarcerated people and outside community members including college students and faculty. Built around the Action, Reflection, and Transformation (ART) model and grounded in eight socio-psychological competencies.
Uncommon Law
uncommonlaw.orgProvides direct legal representation at Board of Parole Hearings and in disciplinary proceedings. Uncommon Law attorneys understand how to present a person's trauma history and programming record as evidence of genuine change in the parole context.
How to access these programs
Most of these organizations operate as activity groups coordinated through the institution's Community Resource Manager (CRM). Your loved one can submit a CDCR 22 (Request for Interview) addressed to the CRM asking whether a specific organization is active at their facility and how to join. For organizations not yet present at a facility, the CRM can sometimes facilitate contact between outside organizations and the institution to establish a new program. See the programs and activities guide for more detail on how the CRM process works.
Resources
Additional reading and research on ACEs, trauma, and the intersection with the criminal legal system.
CDC — About Adverse Childhood Experiences
cdc.gov/violenceprevention/acesThe CDC's official ACE resource page, including the original study methodology, current research, and public health guidance on prevention and intervention.
Compassion Prison Project — Childhood Trauma Statistics
compassionprisonproject.org/childhood-trauma-statisticsA well-organized compilation of research linking childhood trauma and ACE scores to incarceration, substance use, and mental health outcomes. Useful for families seeking the underlying data.
CDCR Integrated Substance Use Disorder Treatment (ISUDT)
cchcs.ca.gov/isudtCDCR's flagship trauma-adjacent treatment program. ISUDT explicitly recognizes that substance use disorder is frequently a trauma response, and its programming reflects that framework.
988 Suicide & Crisis Lifeline
988lifeline.orgCall or text 988. Available 24/7. For families or incarcerated people in crisis. Veterans can press 1 for the Veterans Crisis Line.
The statistics and research cited in this guide are drawn from published academic studies, the CDC-Kaiser ACE Study, and program outcome reports. Book summaries are based on the published works; they are not endorsements of any specific therapeutic approach. This page is informational only and is not a substitute for professional mental health support. RVR Review is not affiliated with any of the organizations listed here.