Purpose Adverse Childhood Experiences (ACEs) are typically assessed as a retrospective report of the adult’s childhood and are predictive of poor health in adulthood.1,2 ACE assessment includes childhood maltreatment, household dysfunction, and parental factors. Recent studies have linked a preschool ACE screen with childhood development.3-5 Assessing ACEs in preschool allows providers, childcare professionals, and other early childhood professionals to support families to protect children. This study examined the The Family Map Inventories (FMIs) as a preschool assessment. The FMIs engage providers and families in goal directed partnerships. The FMI are structured interviews used to identify environmental risks and protective factors.6,7 The FMI is accepted by parents and endorsed by educators.7-9 Methods This study included FMI data from parents of children (N=2,885) attending a variety of center-based preschool programs (N=17) targeting low-income children in seven states. Parent interviewed were most often the biological mother (91.7%, step/adoptive parent 2.9%, other family 4.7% or foster parent 1.5%). Parents were 31.5 years-of-age (SD=8.5). Children were 47.5 months (SD=10.4) and 49.2% male. Both parents were in 50.0% of homes. Measure. Imbedded in the FMIs is a system to compute an ACE score (FMI-ACE). The FMIs are recorded and scored using a web-based interactive portal that allow easy access to individual and agency-wide summary of assessments. ACE scores were computed as described by McKelvey at al.5 Other screens included in the FMI assessment included child chronic health, access to medical care, and health care utilization. Results Children were exposed to one (32.2%), two (15.4%), three (8.4%) or four or more ACEs (4.9%, Table 1). Children’s risk for a chronic health condition increased as ACEs increased (p<.001). Children with more ACEs were less likely to receive primary care/well-child visits than children with no ACEs (p<.001), despite non-significant differences in access to health insurance. ACEs were also associated with greater emergency medical treatment (p<.001). ACEs predicted the child having a chronic health condition (p<.001). Conclusions The quality of the environment of children, particularly preschoolers, is in the hands of the adults who provide their care. As a result, asking parents responsible for their home environment to report on trauma and risky home environments is problematic. As an alternative, the FMI is family-friendly tool being used by many early childcare providers. Our findings are similar to findings in a study of high-risk families enrolled in home visiting programs.5 This is finding supports the generalizability of the FMI as an ACE screen in multiple contexts. In this study, children with high FMI-ACEs had increased risk of chronic health conditions but fewer medical care visits. This finding suggests that FMI-ACE has the potential for translations into other settings or used in collaborations between early childcare providers and clinical staff.