The FACES Assessment

An Expanded ACEs Tool

Developed by Dr. Jamie Freeny, the FACES Assessment is a universal, 24-item screening tool that expands on the original ACEs framework to reflect modern adversities affecting children, adolescents, and families. It captures population-level trauma data, informing effective interventions, equitable funding decisions, and strategic partnerships.

What is FACES?

"FACES" represents the countless expressions worn by those who have lived through trauma and toxic stress. It is a reminder that pain is not always visible. People often wear different faces to survive, to belong, and to carry on. These faces may hide deep wounds, silent battles, and the lingering effects of past experiences. Just as trauma touches every corner of society, the faces we see reflect the vast diversity of those impacted. The name also honors the many racial, cultural, and lived experiences of people across the United States—each face telling a unique story, yet bound by a shared need for healing, understanding, and hope.

FACES is an expanded and inclusive adaptation of the original Adverse Childhood Experiences (ACE) survey, preserving the foundational terminology established by Dr. Vincent Felitti and Dr. Robert Anda. This modernized tool acknowledges the evolving and diverse realities of today's youth, offering a broader lens through which trauma is recognized and understood.

The development and promotion of FACES is deeply inspired by the groundbreaking work of Dr. Nadine Burke Harris and her unwavering commitment to addressing childhood trauma as a public health crisis. Her leadership continues to influence our mission to ensure that all youth are seen, supported, and given a chance to heal.

FACES Captures a Broader Range of Trauma

The expanded FACES questionnaire incorporates fourteen additional stressors that can significantly impact a child's developing brain and long-term well-being, aiming to capture adversity experienced by various populations more comprehensively. Key examples include:

• Death of a family member or friend

• Discrimination and experiences of racism

• Bullying and cyberbullying

• Extreme pressure for academic achievement

• Displacement due to natural disasters

Research, including a scoping review by SmithBattle et al. (2021), has highlighted the need to revise and expand ACEs screening tools to capture a more complete picture of childhood adversity. Furthermore, studies like that by Zhen-Duan et al. (2023) emphasize the importance of including expanded ACEs to better understand disparities in areas like substance use across different racial and ethnic groups. By considering this wider array of stressors and being more inclusive of diverse experiences, FACES aims to provide a more nuanced and accurate understanding of the cumulative impact of early adversity on individuals and communities.

About the Author

Dr. Jamie Freeny is a public health leader, mental health advocate, and nationally recognized voice for children and adolescents impacted by trauma and toxic stress. With more than two decades of experience in mental and behavioral health, she has worked at the intersection of policy, prevention, and practice to center youth mental well-being across schools, healthcare systems, and communities.

Her commitment to creating the FACES Assessment is deeply rooted in both lived experience and academic training. As a master's student in public health, Dr. Freeny began studying adverse childhood experiences (ACEs) and trauma-informed care, building a strong foundation in how early adversity influences lifelong health and behavior. Through this work, she identified critical gaps in the original ACEs framework and the need for a more inclusive, culturally responsive tool. The FACES Assessment incorporates additional adversities identified by youth themselves such as academic pressure, displacement due to natural disasters, and the pervasive effects of human trafficking, particularly relevant in Texas. During her doctoral studies, she expanded this work by piloting an early version of FACES to examine the prevalence of adversity among youth and its correlation with mental health risks.

Dr. Freeny's perspective is also shaped by years of direct service with young people. She has worked in child and adolescent units at a behavioral health residential hospital, supported students in middle and high school classrooms, mentored teens, and volunteered with numerous youth-serving organizations. These experiences illuminated the powerful impact of non-medical drivers of health such as grief, housing instability, and systemic inequities that often go unrecognized but profoundly shape a young person's trajectory.

FACES was born from her belief that trauma is not always visible, and that many young people wear different faces to survive in environments that have not fully seen or supported them. Influenced by the pioneering work of Dr. Nadine Burke Harris, Dr. Freeny's approach is grounded in the conviction that healing begins with understanding.

Through FACES, she offers an expanded and inclusive tool that empowers schools, clinics, and community organizations to recognize trauma, respond with compassion, and restore hope, especially for youth whose stories have too often been overlooked.