Intersection of Suicide, Overdose, and Adverse Childhood Experiences

The intersection of suicide, overdose, and adverse childhood experiences (ACEs) is an exceedingly critical area in the field of public health. The relationship between these three issues is complex, as they share overlapping risk and protective factors and can lead to harmful social and behavioral health outcomes.

AC Es Overdose Suicide infographic v3

Such outcomes can affect the mental, physical, and emotional health of individuals, families, and communities across generations. The development and implementation of comprehensive strategies that aim to reduce risk factors and enhance protective factors may help prevent and mitigate future harms.

This webpage will serve as a resource hub on this issue, providing information, resources, and tools for local health departments seeking to build their capacity to address these converging epidemics within their own communities.

With support from the Centers for Disease Control and Prevention (CDC), NACCHO began work with the Association for State and Territorial Health Officials (ASTHO) to create a tool designed to assess capacity in suicide, overdose, and ACE prevention.

AC Es Suicide Overdose Venn Diagram v2

Acknowledging the urgency to address the threats of these issues potentially exacerbated by the COVID-19 pandemic, the Suicide, Overdose, and ACE Prevention Capacity Assessment Tool (SPACECAT) was developed.

SPACECAT will help health departments build and sustain their capacity to address these topics through the identification of cross-cutting needs and gaps in their prevention strategies. This assessment tool can provide insight for strategic planning, program improvement, technical assistance requests, and relevant funding opportunities. SPACECAT can strengthen local, state, and territorial health agency capacity to address their jurisdiction’s needs now and in the future.

The SPACECAT Tool is available now.

NACCHO has invited a selection of local health departments to participate in a national fielding of the SPACECAT tool in order to provide a description of infrastructure and practice in suicide, overdose, and ACEs prevention at the local level. The information from the survey will help NACCHO:

  • Highlight cross-cutting strengths and needs
  • Provide insight for strategic planning, partnership development, and relevant funding opportunities
  • Better understand the impacts of COVID-19 on LHDs' capacity to address shared risk and protective factors for social and behavioral outcomes to inform future technical assistance and capacity building across sectors

Today’s local health departments are being reshaped by many economic, social, and political forces. Information about these changes is critical as it allows NACCHO to speak authoritatively on behalf of local health departments. We extend our sincere appreciate to the participants of the national fielding. Visit our webpage for more updates about the data gathered from the fielding and more information about the SPACECAT tool.

New Resource

Issue Brief

Learn more about the intersection of suicide, overdose, and adverse childhood experiences, in this new NACCHO issue brief.

New Resource

Issue Brief

001 Checklist

Get Access

Additional SPACECAT Resources

Visit ASTHO's webpage to access additional SPACECAT resources including their ASTHOExperts video series and a SPACECAT Roadmap.

Get Access

Additional SPACECAT Resources

NACCHO is collecting resources to help LHDs develop their capacity in those areas identified by the results of the SPACECAT tool.

These tools and resources are mapped to the domains within the SPACECAT Tool and are divided into two categories: Infrastructure Capacity and Topical Capacity.

Additional information overviewing these topic areas can be found through the CDC’s Injury Center:

For any requests to submit materials that support for LHDs and their partners, please contact us at

This collection of resources provides guidance for building public health infrastructure at the local level that addresses the areas of suicide, overdose, and ACEs. These resources can also be used to gauge an agency's capacity to build infrastructure.

  • Securing Buy-in (State)— A framework from Advancing Health Equity that provides several strategies to obtain buy-in from various sources including staff, patients, and the community.
  • Lessons Learned from Implementing Project Lazarus in North Carolina (Local) — An evaluation report from University of North Carolina at Chapel Hill that reviews Project Lazarus, a local initiative developed to reduce harms associated with the opioid epidemic in North Carolina.
  • Engaging Leadership and Gaining Buy-In (State)— A training presentation from the Association of State and Territorial Health Officials that provides perspectives on engaging leadership and gaining buy-in.
  • Public Health Finance Bootcamp (National)— A toolkit from Public Health Finance & Management that provides several tutorials on public health finance. Some tutorials provided include: financial planning and budgeting, financial reporting, and assessing financial performance.
  • Search for Funding (Local)— A resource repository from Public Health Finance that lists databases to search for public health funding opportunities.
  • PHUND$ (Local)— A database from NACCHO that serves as a web-based public health financial data collection and analysis portal.
  • Determining and Distributing Costs of Shared Public Health Services (National)— A primer from the Center for Sharing and Public Health Services that provides guidance on cost apportionment between shared services.
  • Prevention Funding Opportunities (National)— A database available through the U.S. Department of Health and Human Services to search for prevention funding opportunities.
  • Grant Writing Guidance & Tips (National)— A resource repository from the Centers for Disease Control and Prevention that includes information on CDC grant policy guidelines, contract, and tips on applying for grants.
  • Keys To Writing a Successful Rural Health Opioid Program Grant Application (State)— A presentation from the National Organization of State Offices of Rural Health that provides information on how to write competitive grant applications for rural health opioid programs.
  • Public Health Finance (Local)— A resource repository from NACCHO that provides resources to help local health departments increase their knowledge of local public health finance and enhance their individual organizational financial health.
  • Social Impact Bonds for Public Health Programs: An Overview (Local)— A program description from the National Governor's Association that outlines the use of social impact bonds as a financing mechanism for use on the state level.
  • Pay For Success (Local)— A local initiative from the Institute for Child Success that describes the use of an innovative performance-based financing mechanism on the local level.
  • Generating, Managing, and Sustaining Financial Resources(National)— A compilation of resources from Community Tool Box that provide information on grant writing and other sustainability planning.
  • Sample Agreements (State)— A list of sample agreements, organized by type, from the Centers for Public Health services that help govern cross-jurisdictional sharing arrangements.
  • Publications from the Center for Sharing Public Health Services (National)— A resource repository from the Centers for Sharing Public Health Services that provides several guidelines, sample agreements, and templates to strengthen sharing initiatives.
  • This collection of tools and resources helps LHDs develop their knowledge and ability to implement evidence-based prevention strategies for suicide, overdose, and ACEs.
  • Acadia Hospital-Penobscot County Jail Diversion Collaborative (Local)— A program description from the Acadia Hospital-Penobscot County Jail that provides information on their partnership between the Sheriff's Office, the National Alliance of Mental Illness Maine, and the Acadia Hospital to provide suicide prevention training for corrections staff and law enforcement.
  • Racial Inequities in Substance Use (Local)— A webinar from the Providers Clinical Support System that provides an overview of strategies to combat racial inequities in treating substance use disorder.
  • Trauma, Equity, and Resilience (Local)— A resource repository from the Milken Institute School of Public Health and the Sumner M. Redstone Global Center for Prevention & Wellness that includes information on fostering health equity and building community resilience, including a series of modules designed to highlight the underpinnings of structural racism and to guide conversations about equity.
  • How to Identify and Plan for at-risk populations (Local)— An online tool from NACCHO, the Vulnerable and At-Risk Population Resource Guide (VARP), that assists local health departments in their preparedness planning for vulnerable and at-risk populations.
  • Public Health is for Everyone: An Inclusive Planning Toolkit for Public Health Professionals (Local)— An online toolkit from NACCHO that serves as a one-stop resource to increase the capacity of public health professionals to create programs that benefit entire communities, including people who have disabilities.
  • Health Equity in Response to Drug Overdose (Local)— A resource repository from NACCHO providing a variety of actionable and supplemental resources on health equity in drug overdose prevention and response.
  • Strategies to Address the Opioid Epidemic in Black and Hispanic/Latinx Communities (Local)— A webinar series and supplementary resources from the Substance Abuse and Mental Health Services Administration Office of Behavioral Health Equity that provides an overview of the opioid epidemic in minority communities. The webinar also provides strategies to decrease the proportion of Black and Latinx populations dealing with substance use disorders.
  • THRIVE: Tool for Health & Resilience in Vulnerable Environments (State)— A guideline from the Prevention Institute that can help support health equity and inform programming and policy under this lens.
  • Roots of Health Inequity (National)— An online learning collaborative from NACCHO that provides participants with information on how to explore the social processes that produce health inequities, strategize effective ways to combat these inequities, and work with other local health departments to ensure an emphasis on the incorporation of equity in programming.
  • Health Equity Guide (National)— A resource repository from that contains categories of strategic practices to advance health equity on the local level.
  • Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health (State)— A workbook from the Centers for Disease Control and Prevention containing frameworks, guidelines, and program descriptions of health equity initiatives in various communities.
  • Health Equity (National)— A resource repository from the American Public Health Association that includes health equity fact sheets, briefs, reports, and infographics.
  • Resources for Professionals (National)— A resource repository from ACEs Action Alliance that contains resources for trauma-informed community partners and health providers on ACE prevention.
  • Preventing Adverse Childhood Experiences Training Modules (State)— A series of training modules from VetoViolence on ACE prevention, categorized by audience type.
  • Arizona Adverse Childhood Experiences Consortium Online Learning (National)— A repository of resources from the Arizona Adverse Childhood Experiences Consortium that includes courses on childhood trauma, ACEs, and substance use disorders.
  • Suicide Prevention Modules (National)— A series of modules from the Prevention Institute that provide suicide prevention training to government agencies and community-based organizations.
  • On-Demand Webinars (Local)— A database of past and upcoming events from the Providers Clinical Support System that provide workforce training in various topics related to substance use disorders.
  • SUD for Non-Clinical Staff (Local)— A series of modules from the Providers Clinical Support System on substance use, designed for all staff in a health care or public health setting.
  • Suicide Care Training Options (National)— A series of suicide prevention trainings from Zero Suicide for a diverse set of audiences.
  • Free Trauma Informed Care Training Courses (State)— A series of free trauma-informed care trainings from the TIC Training Center that include mental health wellness, child trauma, and a trauma-informed care webinar series.
  • Professional Development Series (State)— A national initiative from The Jason Foundation that provides a series of professional development courses on youth suicide and prevention.
  • Suicide Prevention Through Lethal Means Reduction (Local)— A state initiative from Intermountain Health Care that provides a course on suicide prevention through lethal means reduction.
  • Training (National)— A training resource repository from the Suicide Prevention Resource Center that contains information on workshops, online courses, virtual learning labs, micro-learning resources, and webinars about suicide prevention.
  • Mental Health First Aid (National)— A description of the mental health first aid course from The National Council for Mental Wellbeing. The course trains participants in the skills needed to identify, understand, and respond to mental health and substance use issues.
  • Workforce Development and Training (National)— A resource repository from NACCHO that outlines a variety of workshops and trainings currently being offered to strengthen the public health workforce.
  • Overdose, Self Harm, Suicide and the Gray Areas in Between (Local)— A virtual learning presentation from the American Society of Addiction Medicine that provides insight on the relatedness of overdose and suicide, including discussion on diagnosis, prevalence, intervention, and screening.

Community Health Program

Stacy Stanford

Senior Director, Overdose, Injury, and Violence Prevention

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Community Health Program

Caroline Snyder

Director, Injury and Violence Prevention

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Jasmyn Rudd

Senior Program Assistant

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1. United States, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (n.d.). Urgent, Related, Preventable: Adverse Childhood Experiences, Overdose, and Suicide. Retrieved 2021, from

2. Merrick MT, Ford DC, Ports KA, et al. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. MMWR Morb Mortal Wkly Rep. 2019;68(44):999-1005. doi:10.15585/mmwr.mm6844e1

3. Hedegaard, M.D., H., & Spencer, M.P.H., M. R. (2021, March). NCHS Data Brief: Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019 (Rep. No. 403). Retrieved April, 2021, from U.S. Department of Health and Human Services website:

4. WISQARS (Web-based Injury Statistics Query and Reporting System)|Injury Center|CDC. Accessed March 26, 2021.

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