The BCR Approach

The BCR (Building Community Resilience) process is informed by cross-sector research on barriers to addressing the root causes of community and childhood adversity.

Childhood adversity or trauma such as exposure to abuse and neglect, parental substance abuse and incarceration are often rooted in community environments lacking equity, as measured by concentrated poverty, poor housing conditions, higher risk to violence and victimization and homelessness. These are adverse childhood experiences occurring in the context of adverse community environments – what BCR has coined the "Pair of ACEs."


The Pair of ACEs

The Pair of ACEs Tree
FIg. 1: Pair of Aces Tree. See below for alt text.

The Pair of ACEs tree illustrates the relationship between Adverse Childhood Experiences, experienced at the individual level within a family, and Adverse Community Environments.

The Pair of ACEs tree communicates – in simple terms – the issues we aim to address. By doing so, we are able to engage diverse stakeholders in developing policy goals that support efforts to address adversity rooted in systems and communities. By asking the question “What’s in your soil?,” communities can begin to set goals and implement policy and practice change that builds community resilience.

Adverse childhood experiences in the context of adverse community environments continuously assault the developing minds of children and negatively impact health across the lifespan. These negative impacts include higher risk for mental health problems, early initiation of drug and substance abuse, school dropout, juvenile delinquency, risky sexual behavior and teen pregnancy. In Building Community Resilience, we understand that many adverse childhood experiences can be linked to policy and systems driven inequities. Many of these policies are driven by and reinforce institutional racism. The resulting inequities include lack of access to economic mobility that may allow families to secure safe and affordable housing and living wages.

Explore more Pair of ACEs resources

Fig. 1: Pair of Aces Tree Alternate text

The Pair of ACEs

Large tree with leafless branches (Adverse Childhood Experiences) and roots expanding below ground (Adverse Community Environments):

Adverse Childhood Experiences

  • Maternal Depression
  • Emotional & Sexual Abuse
  • Domestic Violence
  • Physical & Emotional Neglect
  • Divorce
  • Mental Illness
  • Incarceration
  • Homelessness

Adverse Community Environments

  • Poverty
  • Discrimination
  • Community Disruption
  • Violence
  • Poor Housing Quality & Affordability
  • Lack of Opportunity, Economic Mobility & Social Capital



Until now, no process has existed to create a multi-sector response to address the Pair of ACEs or the policies and practices driving the inequitable outcomes they produce. Using the BCR process, tools and resources, community partners across the country are bringing together diverse coalitions to address long-standing inequities, communicating ACEs as a national public health concern, and shaping policy, practice and programs to support and build resilience.

BCR employs a systematic approach based on four central components applied as a continuous improvement model:

  1. Creating shared understanding of childhood and community adversity;
  2. Assessing system readiness;
  3. Developing cross-sector partnerships; and
  4. Engaging families and residents in a collaborative response to prevent and address the Pair of ACEs.
Chart: BCR Process
Fig. 2 : BCR Process; see alt text below.


Learn more: Ellis, WR, Dietz, WH. A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience Model. Acad Pediatr. 2017 Sept - Oct;17(7S):S86-S93.

Fig. 2: BCR Process Alternate text

Building Community Resilience: Process of Assessment, Readiness, Implementation & Sustainability

Round chart is split in fourths, with counterclockwise arrows connecting  sections. Each of the following sections has a list of components:

  1. Shared Understanding
    • ACES
    • Resilience
    • Narratives of the Community
  2. State of Readiness
    • Provider Capacity / Capability
    • System Capacity / Capability
    • Policy Support
  3. Cross-Sector Partners
    • How to Connect
    • Resource Distribution
    • Community & Political Partnerships
    • Collaboration
  4. Community
    • Organizational Linkages
    • Citizen Leadership
    • Social Supports
    • Attachment to Place