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Focus of Presentation Adverse Childhood Experiences (ACEs) have been shown to increase health risk behaviors and negative health outcomes. ACE surveys have been well documented in high income countries, but have been less widely used in low and middle-income countries. The current project included three phases and used a mixed methods study design to understand ACEs in Munsieville, South Africa. The first phase included focus groups to modify the World Health Organization’s ACE International Questionnaire (ACE-IQ) for cultural competence and relevance. The second phase included a community wide survey using the adapted ACE-IQ. The third phase closed the feedback loop and disseminated the findings to the community to identify steps to build a trauma-informed community. Findings Focus groups identified 23 questions and four response options for modification and two questions for deletion. Survey results (N = 917) showed ACEs are common in Munsieville: 53.7% had a guardian die, 30.1% lived with someone who abused substances or alcohol, 54.7% experienced emotional abuse, 41.4% physical abuse, 11.5% reported sexual abuse. Most people did not report their abuse (74.6%). Community violence was common with 75.3% witnessing someone being beaten up and 58.7% witnessing someone being stabbed or shot. Conclusions/Implications The community recommended providing training on trauma, creating a center that would serve as a safe, centralized location for services, and identifying key stakeholders and partners in the community to build a trauma-informed system of care. Key messages The mixed methods approach proved valuable to understand and describe the prevalence of ACEs, provide feedback to the community, and determine community driven next steps.

457A mixed methods approach to understanding Adverse Childhood Experiences (ACEs) in Munsieville, South Africa