Police adverse career experiences (PACEs): development of a police in-service outcome survey tool

The adverse childhood experiences (ACEs) framework originated in a mid-1990s study prompted by clinical observations in an obesity treatment programme, where treatment-resistant obesity was frequently linked to significant childhood adversity (Felitti et al., 1998). This led to the ACE Study and the development of a survey instrument drawing on existing literature and clinical tools, refined to ten core questions assessing adverse events before age 18 across three domains: abuse, neglect and household dysfunction (Felitti et al., 1998; Dube et al., 2003).

The approach reflects an exposure–outcome framework consistent with life course epidemiology and cumulative risk research. Life course perspectives emphasise that outcome-related risk is shaped by the timing and persistence of adversity exposure (Ben-Shlomo and Kuh, 2002) and by the cumulative burden of multiple distinct adversities (Evans et al., 2013). Biopsychological accounts highlight increased allostatic load as a plausible mechanism, whereby chronic or repeated stress produces physical and psychological wear and tear over time (McEwen, 1998). The ACE framework operationalises this logic and has consistently demonstrated a graded, dose–response relationship between cumulative exposure and later adverse outcomes (Felitti et al., 1998; Hughes et al., 2017).

As a tool, The ACE framework was never intended as a comprehensive inventory of childhood adversity. It was designed to capture common, measurable, high-impact experiences that could be feasibly assessed via retrospective self-report. Consequently, it is limited by a lack of specificity about the causes of adversity, assumptions of exposure equivalence and limited capacity to account for patterned or differential effects (Lacey and Minnis, 2020; McLennan et al., 2021), which matters because some ACEs may exert greater influence on outcomes (Fitzgerald and Bishop, 2025; Lacey and Minnis, 2020). Despite these constraints, its simplicity and scalability underpin its enduring public health influence (Finkelhor, 2018). ACE-style measures have therefore been adopted internationally and applied across domains to examine associations between childhood adversity and health and behavioural outcomes (Basto-Pereira et al., 2022; Dube et al., 2003; Fergusson et al., 2013; Hughes et al., 2017; McLennan et al., 2021). This includes emergency service research, including associations with law enforcement mental health outcomes (McDonald et al., 2022; Violanti et al., 2021), stress-related effects (Komarovskaya et al., 2014; Otte et al., 2005; Rabichuk et al., 2025; Violanti et al., 2021), moral injury (Battaglia et al., 2019; Roth et al., 2022; Yeterian et al., 2019) and police misconduct (Halford, 2025).

Although ACE measures have been useful in policing research for linking officers’ formative histories to some in-service outcomes, they do not capture the substantial adversity encountered during policing careers. Estimated exposure ranges from 170 to 900 adverse incidents across a full career (Chopko et al., 2015; Patterson, 2001; Rudofossi and Lund, 2017). Research has therefore tended to examine operational trauma via specific incident types, roles or investigative features (Foley et al., 2022, 2024; Miller et al., 2023). More broadly, policing well-being measurement remains dominated by outcome-focused instruments assessing PTSD symptoms, stress, burnout, anxiety, depression or general well-being, often relating these outcomes retrospectively to functions or incident exposure (Foley et al., 2022; Houdmont et al., 2012; McCarty et al., 2019; Sherwood et al., 2019; Wellington, 2021). While these tools are valuable for identifying current psychological states, they are inherently downstream and indicate harm without specifying the cumulative or patterned career exposures that preceded it. Reliance on outcomes and diagnosis alone can therefore encourage a reactive evidence base that supports post-hoc intervention but offers limited leverage for upstream prevention.

This article argues that an exposure-focused approach can provide a complementary, more preventive lens. Rather than measuring outcomes or symptoms alone, an exposure tool can quantify cumulative burdens of recurrent career adversities and support systematic testing of associations with both health outcomes and non-health organisational outcomes. This matters because policing harms extend beyond clinical well-being and include organisational and career outcomes such as presenteeism, leaveism, turnover intentions and resignation, and adverse conduct or performance trajectories, which are widely discussed but rarely examined using a consistent exposure measurement framework (Drew et al., 2025; Wellington, 2021).

At present, exposure measurement in policing is fragmented. While some studies assess operational trauma exposure, others focus on outcomes alone and many treat operational, investigative and organisational contexts as discrete domains (Boag-Munroe, 2017; Foley et al., 2024; Purba and Demou, 2019). This fragmentation has two consequences. Firstly, it limits understanding of how adverse career experiences interact across domains over time. Secondly, the absence of a standardised exposure instrument reduces comparability across studies and constrains scalable organisational learning, including benchmarking exposure patterns across units, roles and time periods.

To address this gap, and building on the utility of the ACE framework, this article extends exposure–outcome logic to in-service adversity across the policing career life course and develops a practical screening survey of police adverse career experiences (PACEs). The instrument is intentionally an exposure checklist rather than a diagnostic tool and is designed to complement, not replace, validated outcome measures. By spanning operational, investigative and organisational domains, it provides a foundation to examine exposure–outcome associations for both health and occupational outcomes at individual and organisational levels.

The survey is developed via a scoping review guided by the Population–Exposure–Outcome (PEO) model (Bettany-Saltikov, 2016; Khan et al., 2011) to identify PACEs that are common, measurable and impactful, and that can be feasibly assessed through retrospective self-report, consistent with the pragmatic logic of ACEs. The discussion distinguishes PACEs from existing measurement approaches, outlines potential applications for trauma-informed policy and practice, and notes limitations, including the absence of empirical validation and the need for future research to test reliability, validity and exposure–outcome associations.

Exposure to adverse experiences in policing is substantial, with officers regularly encountering emotionally and psychologically distressing situations. Patterson (2001) estimated an average of 3.5 traumatic incidents every six months, which extrapolates to more than 170 events across a 30-year career. Other estimates are higher, approaching 900 incidents when indirect trauma (e.g. secondary exposure to victims’ suffering or graphic materials) is included (Chopko et al., 2015; Rudofossi and Lund, 2017). This frequency and intensity distinguish policing from many occupational settings and is reflected in UK survey findings where over 80% of officers report stress, low mood or anxiety and more than 90% report that work caused or worsened these problems (Wellington, 2021). Consequently, well-being assessment, particularly trauma exposure and its relationship to policing-related outcomes, has become a central concern, prompting the development and use of a wide range of tools.

Most instruments, however, remain outcome-led, relying on general and policing-adapted measures assessing stress (Gerber et al., 2010; Gomes et al., 2016; Cohen et al., 1994; Parkitny and McAuley, 2010; Cooper et al., 1988; Anunciação et al., 2022; Gershon et al., 2009; Spielberger and Reheiser, 2020; McCarty et al., 2019; McCreary and Thompson, 2006), burnout (Maslach et al., 2001; Montero-Marín & García-Campayo, 2010; Feldt et al., 2014; Goodman, 1990; Vuorensyrjä & Mälkiä, 2011) and PTSD symptoms (Foley et al., 2022; Weathers et al., 2018; Cloitre et al., 2021; Weiss et al., 2010), including applications to occupational outcomes such as resignation intentions and workforce well-being monitoring (Drew et al., 2024, 2025; Houdmont and Elliot-Davies, 2016). Where exposure is measured, it is often fragmented across general trauma checklists, policing incident inventories and organisational hazard measures (Gray et al., 2004; Carlier et al., 1997; Weiss et al., 2010; Houdmont and Elliot-Davies, 2016; Miller et al., 2023) and can be constrained by scalability (e.g. clinician-administered formats), operational or frequency emphasis, and ‘worst-event’ framing, with less consistent coverage of investigative and organisational adversity (Weathers et al., 2018; Carlier et al., 1997; Weiss et al., 2010; Miller et al., 2023). Collectively, this supports the need for a simplified, standardised, policing-specific exposure instrument capable of capturing adverse career experiences across operational, investigative and organisational domains to enable consistent exposure–outcome testing for both health and occupational outcomes.

Inspired by the original ACEs tool, this article develops a framework to capture PACEs and assesses whether police-specific in-service adversities can be systematically identified and linked to measurable negative outcomes among police personnel. If so, this provides a basis for a scalable screening tool that can establish baseline PACE exposure among UK officers and support examination of associations with a wide range of officer- and organisational-level outcomes, including common health issues, promotion, misconduct and resignation. The study is guided by the following research question:

To address this question, the article synthesises existing literature to develop a PACEs taxonomy, which is then translated into a survey instrument. Consistent with the ACE approach, the tool is designed as a brief self-report checklist using binary (yes/no) responses that contribute to a cumulative score; higher ACE scores have been reliably associated with elevated risk of adverse outcomes (Hughes et al., 2017). The intention is to replicate this pragmatic format to support feasible, scalable exposure assessment in policing.

To develop the PACEs survey, principles of scale construction outlined by DeVellis and Thorpe (2021) and the best-practice framework from Boateng et al. (2018) were used to inform early-stage instrument development. Specifically, the construct definition and item generation stages (DeVellis and Thorpe, 2021; Boateng et al., 2018) were addressed through a scoping review followed by thematic analysis to identify and select candidate items. The resulting survey is explicitly positioned as a preliminary instrument, pending empirical testing of reliability, structural validity, and broader construct validation.

The author’s professional policing background and academic role informed the identification and interpretation of PACEs. To mitigate potential bias, items were derived from published empirical, theoretical, and policy sources; analysis was iterative and transparent; and inclusion criteria were intentionally broad to avoid privileging particular experiences or outcomes. PACEs therefore represents a synthesis of the evidence base rather than professional experience alone, while acknowledging the interpretive judgement inherent in early-stage construct development.

To develop the survey, the scoping review methodology proposed by Arksey and O’Malley (2005) was adopted. A systematic review and meta-analysis were not appropriate because the study aim was not to estimate pooled effect sizes or identify statistically dominant predictors, but to define and operationalise PACEs and generate an initial item pool for a scalable screening instrument. Given the heterogeneity in how policing adversities and outcomes are conceptualised and measured, statistical synthesis was not meaningful and a scoping approach was better suited to mapping a broad evidence base spanning quantitative, qualitative and grey literature, including practitioner and Police Federation surveys.

Qualitative studies were included to capture adverse career experiences that are poorly represented or inconsistently labelled in quantitative research, particularly organisational and cultural adversities such as procedural injustice, moral injury, bullying and negative leadership, and to ensure item generation reflected officer-identified experiences. This aligns with early-stage construct development, where coverage and construct clarity are prioritised over effect estimation, and provides a foundation for subsequent validation once the construct and instrument are established.

A limitation of scoping reviews is the absence of formal critical appraisal, which may increase the risk of incorporating lower-quality studies (Grant and Booth, 2009). To mitigate this, the review followed Arksey and O’Malley’s (2005) five-stage framework for question identification, study identification and selection, data charting and results synthesis and reporting.

As outlined in the “Current Study” section, the research question informed stage two of the scoping review (identifying studies). A preliminary review was undertaken to develop an iterative keyword strategy grounded in the PEO model, which is commonly used in reviews focusing on health-related outcomes (Bettany-Saltikov, 2016; Khan et al., 2011) and is well suited to capturing adverse experiences across policing careers.

Because “frontline” is variably defined across research and policy, the population scope was defined using Her Majesty’s Inspectorate of Constabulary (HMIC) criteria. HMIC defines frontline policing as everyday contact with the public and direct delivery of policing services, encompassing “visible” functions (e.g. response and neighbourhood policing) and “specialist” functions delivering policing services through crime investigation and operational activity, while excluding back-office and purely support roles with materially different demands and exposure profiles (HMIC, 2011, p. 12).

Using this definition, population keywords included terms such as “police”, “police officer” and “law enforcement”. Exposure keywords were organised into two domains (operational and occupational) and outcome keywords into two domains (health and occupational). Consistent with scoping review conventions, terms were refined iteratively during screening, charting and thematic analysis to maximise coverage and minimise omission risk where occupational titles and role labels vary. The full keyword list was compiled in an Excel datasheet and is provided in  Appendix.

The search process was conducted in accordance with PRISMA-ScR guidelines. Searches were conducted across Web of Science and Google Scholar between 1st and 20th July 2025. Study selection (stage three) followed predefined inclusion criteria: (1) studies focused on law enforcement personnel or police officers; (2) addressed at least one exposure and/or outcome as defined in the keywords; (3) included official governmental or policing reports, meta-analyses, and systematic reviews, and where not covered by these, individual empirical studies; and (4) imposed no restrictions on methodological design.

Study selection followed the “sifting, charting, and sorting” process described by Arksey and O’Malley (2005), with initial screening based on titles, abstracts and conclusions. Figure 1 presents the PRISMA flow diagram and summarises records identified, screened and included. In total, 523 records were identified, and 66 met the inclusion criteria and were retained for full-text review and data extraction.

Following selection and charting, thematic analysis was conducted using Braun and Clarke’s (2006) six-phase framework. Studies were read in full, with PACEs and associated outcomes highlighted and manually coded to extract recurring concepts. Codes were reviewed iteratively, grouped into provisional categories and refined into overarching domains capturing commonalities across the evidence base. This process identified 13 PACEs across three domains, which were synthesised narratively and are reported in the Findings section.

The scoping review identified three domains of PACEs: Operational, Investigative and Organisational. Table 1 summarises the 13 most commonly reported adverse experiences within these domains and the outcomes attributed to them in the literature. The item selection process aligns with early-stage scale construction principles concerning construct definition and item pool generation (DeVellis and Thorpe, 2021; Boateng et al., 2018).

Operational Adverse Experiences arise from core policing duties and are often characterised in the literature as traumatic exposures that exceed routine demands. One of the most traumatic is witnessing a violent or traumatic death (Violanti, 1999), which is associated with increased risk of PTSD, anxiety, prolonged grief and chronic stress (Violanti and Gehrke, 2004; Violanti et al., 2007; Papazoglou et al., 2020; Sherwood et al., 2019; Violanti et al., 2006). Impacts may be intensified where organisational expectations require rapid return to duty, limiting opportunities for psychological processing and contributing to disturbed sleep and intrusive thoughts or imagery (Hartley et al., 2013; Henry, 2004).

Serious assaults in the line of duty also represent a significant operational adversity (Miller et al., 2023; Sherwood et al., 2019). In the UK, Police Federation of England and Wales (PFEW) findings indicate persistent violence, with 55% of officers reporting physical attacks and 13% reporting attacks with deadly weapons, resulting in injuries requiring medical treatment and longer-term physical and psychological strain (Wellington, 2021). Such experiences are linked to higher risks of PTSD and anxiety and to enduring fear of future victimisation (Sherwood et al., 2019; Wellington, 2021), which is associated with reduced job satisfaction and disengagement from duties and community interaction (Davidson et al., 2023; Ellrich and Baier, 2017; Mueller and Tschan, 2011). Repeated assaults may compound these effects by eroding perceived safety and control over time.

Attendance at fatal road traffic collisions (RTCs) was also identified (Miller et al., 2023). Officers responding to RTCs, particularly those involving children or multiple fatalities, report visual and emotional shock linked to sleep disturbance, intrusive memories and symptoms consistent with depression and PTSD (Backteman-Erlanson et al., 2011; Foley et al., 2022; Ramos-Galarza et al., 2025). The unpredictability and graphic nature of these scenes can produce lingering psychological effects beyond incident closure (Stephens and Miller, 1998). Relatedly, repeated exposure to and handling of human remains (e.g. incident response, scene or post-mortem attendance), especially involving children or decomposed, dismembered or severely burnt bodies, was also classified as an operational adversity (Foley et al., 2022; Greene, 2001; Karlsson and Christianson, 2003; Liberman et al., 2002; Sherwood et al., 2019; Violanti and Gehrke, 2004). Such exposures are associated with long-lasting intrusive thoughts and with reduced empathy and emotional withdrawal, potentially affecting victim care and public interactions (Greene, 2001; Karlsson and Christianson, 2003; Liberman et al., 2002; Violanti and Gehrke, 2004).

Finally, responding to suicides and/or experiencing the loss of a colleague to suicide was identified as an operational adverse experience. In the UK, the issue has prompted national attention, with the College of Policing (2024) highlighting suicide exposure as a major source of psychological distress. Officers attending suicides may retain intrusive mental images that disrupt sleep and provoke complex responses, including survivor guilt, particularly where the deceased is known to the officer or is a colleague (Aldrich and Cerel, 2022; Cerel et al., 2019). In cases of colleague suicide, harms may extend across teams, families and the wider policing community, contributing to grief, trauma, and longer-term emotional impacts (College of Policing, 2024).

Investigative Adverse Experiences are distinct from operational ones in that impacts are often vicarious, but no less consequential. The literature identifies investigation of sexual offences, particularly those involving children, as one of the most psychologically taxing functions in policing. Although not exclusive to detectives, they often carry the bulk of these cases, requiring repeated exposure to traumatic material including graphic images, videos and victim accounts of abuse and exploitation (Foley et al., 2022, 2024). In the 2017 PFEW detective survey, 72% of UK detectives reported frequent exposure to such material, associated with heightened stress and reduced well-being (Boag-Munroe, 2017; Sherwood et al., 2019). Reported effects include emotional exhaustion, sleep disturbance, PTSD symptoms and elevated risk of secondary vicarious trauma (Foley et al., 2024; Hurrell et al., 2018; MacEachern et al., 2019; Miller et al., 2023; Turgoose et al., 2017).

Investigating the death of a child was also identified as an Investigative Adverse Experience. Officers assigned to these cases report intense emotional strain and symptoms including anxiety, burnout and emotional exhaustion (Carpenter et al., 2016; Miller et al., 2023; Roach et al., 2018). The moral and emotional burden, alongside case uncertainty and complexity, can undermine psychological resilience even among experienced officers (Holmes et al., 2022).

Organisational Adverse Experiences arise within the police service itself and reflect embedded structures, practices, policies, leadership dynamics and culture. One of the most psychologically corrosive is self-perceived procedural injustice, encompassing perceived unfairness, disproportionate scrutiny or lack of recognition (Sherwood et al., 2019; Tyson and Charman, 2025). In the 2020 PFEW survey, fewer than 30% of UK officers believed organisational decisions, particularly staffing decisions, were effective or fair (Police Federation of England and Wales Social Market Foundation, 2025). Only 25% reported feeling treated fairly and 10% reported feeling valued (Police Federation of England and Wales Social Market Foundation, 2025). Perceived injustice is linked to burnout, betrayal, declining organisational trust, institutional abandonment, reduced commitment and resignation (Papazoglou and Chopko, 2017; Police Federation of England and Wales Social Market Foundation, 2025; Regehr et al., 2003; Sherwood et al., 2019; Tyson and Charman, 2025).

Being subject to misconduct proceedings or an official inquiry was also identified, given the potential to damage professional integrity and generate lasting psychological harms, including increased PTSD risk and diminished trust in the organisation (Lavis, 2025; Regehr et al., 2003). Impacts are amplified in prolonged cases, which the Police Federation has raised with parliament due to reported emotional and psychological harms to officers, colleagues and families (Police Federation of England and Wales, 2021). Where officers perceive limited support, punitive oversight or leadership indifference, vulnerability intensifies (Police Federation of England and Wales, 2021; Sherwood et al., 2019). The issue is sufficiently pronounced that the UK College of Policing cites professional standards investigations as a risk factor for police suicide, due to isolation, anxiety and despair among those affected (College of Policing, 2024).

Moral injury (MI) was included as an additional adverse career experience. MI has been defined as “traumatic events wherein one perpetrates, fails to prevent or witnesses’ actions that transgress deeply held moral beliefs and expectations” (Litz et al., 2009, p1; Papazoglou et al., 2020). Although historically associated with the military, a growing literature now links MI to policing (Blumberg et al., 2018, 2020; Blumberg and Papazoglou, 2019; Komarovskaya et al., 2011; Papazoglou, 2017; Papazoglou et al., 2019a, 2019b; Papazoglou et al., 2020). The politicisation of policing may heighten MI risk; following the introduction of elected police and crime commissioners in 2012, it has been argued that there has been an “opening the door for party political ideological dominance” within UK policing (Grieve, 2024). In this context, police services and officers increasingly face moral accusations, including claims of ideologically driven two-tier policing (Chouliaraki and Higgins, 2024). Such accusations are often linked to protest policing (Chouliaraki and Higgins, 2024), but debates around non-crime hate incidents and arrests for ‘online speech’ also contribute. Regardless of the validity of such claims, this polarised environment may increase exposure to moral conflict, including pressures to operate in ways that contradict personal values. This is consequential because MI is associated with depression, compassion fatigue, PTSD and increased suicide risk (Nash et al., 2013; Papazoglou and Chopko, 2017).

Bullying and harassment were also identified as cultural manifestations of organisational adversity and are associated with heightened stress, reduced well-being and increased suicide risk (College of Policing, 2024). This is particularly salient for minority and female officers navigating environments shaped by racism, sexism, misogyny or hyper-masculine norms (Casey, 2023). These dynamics can compound harms from other exposures, reduce workplace cohesion (Wellington, 2021) and are associated with depression, exclusion, psychological distress, burnout, anxiety, emotional exhaustion and disengagement (Acquadro Maran et al., 2022; Demou et al., 2020; Dextras-Gauthier and Marchand, 2018; Foley et al., 2022; Rabe-Hemp, 2008; Sherwood et al., 2019; Wellington, 2021). Such contexts can also foster mental health stigma, discouraging disclosure and treatment-seeking, increasing isolation and limiting opportunities for intervention (Santa Maria et al., 2018; Gutschmidt and Vera, 2021).

Negative leadership and oversight practices represent a further organisational adversity, including micromanagement and intrusive performance surveillance. In this framing, negative leadership is directed at individuals and occurs under the guise of performance management, often protected by policy and therefore difficult to challenge. It is commonly underpinned by poor communication or decision-making perceived as arbitrary, punitive or exclusionary (Jackman et al., 2021; Domingues and Machado, 2017). The issue is widespread, with up to 70% of officers reporting it as a key factor reducing morale and organisational commitment (Wellington, 2021). Persistently negative leadership and intrusive oversight can erode autonomy, initiative, job satisfaction and internal trust, and exacerbate mental health vulnerabilities, including anxiety linked to suicide risk (College of Policing, 2024; Sherwood et al., 2019). It is also associated with reduced productivity and a range of occupational outcomes, including leaveism, absenteeism, presenteeism and increased intention to leave (Kim et al., 2016; Mouzelis, 2017; Olsen et al., 2006; McCreary and Thompson, 2006).

Following the scoping review and thematic analysis, the identified domains and adverse career experiences were translated into a scalable survey instrument. Table 2 details this operationalisation, showing how each adverse career experience was converted into a single item intended to indicate exposure only. This reflects the PACEs survey’s purpose as an exposure screening tool rather than a diagnostic or symptom-based assessment. Consistent with the ACE framework, items were phrased as direct dichotomous (yes/no) questions (e.g. “Have you ever […]”), to minimise respondent burden and support accessibility and scalability across operational settings. The final instrument comprises 13 items across three domains, with cumulative scoring representing overall exposure burden rather than domain-specific severity.

A central aim of this study was to replicate the methodological principles underpinning the ACE framework by identifying common, measurable, high-impact experiences suitable for retrospective self-reporting (Felitti et al., 1998; Dube et al., 2003). This has been achieved using a scoping review and thematic analysis to complete the early stages of construct definition and item pool generation for preliminary scale construction (DeVellis and Thorpe, 2021; Boateng et al., 2018), identifying recurrent and consequential adverse career experiences within policing. In line with the ACE approach, the PACE survey prioritises simplicity, measurability and generalisability over comprehensiveness, and is positioned as a scalable screening tool rather than a diagnostic instrument. Thus, it provides an exposure tool spanning operational, investigative and organisational domains, enabling exposure–outcome testing for both health and non-health outcomes through a brief, binary, self-administered format requiring no specialist training. This improves accessibility for organisations without capacity for intensive clinical assessment while retaining analytic utility.

It should be noted however that the PACEs survey is not intended to replace validated clinical instruments and cannot provide the diagnostic precision of PTSD or complex trauma measures. Its value lies in scalable screening. Furthermore, as with ACEs, PACEs focuses on adverse exposures rather than protective or mitigating factors; future work could identify such factors and assess whether combining PACEs with mitigation measures provides a more holistic understanding. Despite these restrictions, the tool addresses the gap in policing measurement by focusing on exposure rather than outcomes.

The PACEs survey is best used as an exposure checklist rather than a measure of well-being or psychological state, and is most valuable upstream of health, organisational and career outcomes. It can capture both first-time and cumulative exposure (through repeated or clustered events), which life course and cumulative risk perspectives associate with harm (Ben-Shlomo and Kuh, 2002; Evans et al., 2013; McEwen, 1998) and which the ACEs literature links to negative outcomes (Felitti et al., 1998; Hughes et al., 2017). This enables systematic cross-referencing of exposure patterns against outcomes across domains, including health outcomes (e.g. ill-health retirement, sickness absence, suicide), organisational outcomes (e.g. misconduct and disciplinary proceedings, public complaints, workplace grievances) and career outcomes (e.g. performance, promotion, transfers). By foregrounding exposures rather than symptoms, the PACEs survey offers a means to identify patterns that may clarify exposure–outcome relationships and support primary prevention by identifying roles/units with concentrated exposure burdens, and secondary prevention by triggering proportionate supportive follow-up for sustained or clustered exposure before distress becomes entrenched.

In practice, the PACE survey achieves this by being deployed as an exposure-based screening mechanism to flag officers, units or roles that warrant further assessment, including follow-up using validated outcome measures and integration with well-being, HR and leadership processes. Where embedded, it will enable both policy and practice to shift towards a trauma-informed approach, where PACEs data could help target evidence-based interventions that buffer against PACE-related outcomes (Raver and McElheran, 2022). Examples include cognitive behavioural therapy for moral injury and trauma-related symptoms (Steenkamp et al., 2011), mindfulness-based interventions for psychological well-being including anxiety and depression (Kukucska et al., 2023), structured stress management and resilience training (Patterson et al., 2012; Lees et al., 2019), shift-scheduling reforms to reduce fatigue risk and improve sleep (Amendola et al., 2011), heart rate variability feedback and physiological regulation training (Cox et al., 2024; Goessl et al., 2017), peer-support and structured post-incident support models (Hunt et al., 2013; Lynch et al., 2025) and organisational justice and leadership reforms associated with improved well-being (Trinkner et al., 2016). Embedding such interventions within a proactive organisational response may also reduce stigma associated with help-seeking by shifting responsibility from the individual to the organisation (Craddock and Telesco, 2022).

Given its simplicity, PACEs could be administered at scale locally or organisation-wide and repeated periodically (e.g. annually or biannually) to support monitoring and evaluation. Repeated measurement could help identify changes in exposure patterns following interventions, training, policy or procedural reform, enabling stronger assessment of preventive impact. For example, reductions in organisational PACEs following leadership training or cultural reform would be expected to align with improved outcomes, while increases in operational or investigative PACEs could indicate emerging risks requiring enhanced welfare provision. In all cases, PACEs should be used to guide supportive intervention rather than punitive monitoring or decision-making.

At this stage, specific PACEs, cumulative score thresholds and exposure ‘profiles’ are not specified. These parameters should be determined empirically through future validation and exposure–outcome studies rather than assumed a priori.

The primary limitation is the absence of empirical testing. This article is confined to initial instrument development via scoping review and thematic analysis and PACEs has not yet been evaluated against defined outcome groups. Establishing predictive capacity and practical utility therefore requires subsequent validation studies. Planned work will test survey performance and inform iterative refinement of the tool.

The PACEs design also imposes constraints. Although it deliberately mirrors the brevity and binary structure of the ACE framework, this simplicity limits measurement of severity, frequency and duration of exposures. It also does not capture contextual or moderating factors shaping how officers experience and process events, or whether exposures translate into outcomes. For such nuance, established diagnostic and clinical instruments remain more appropriate.

Methodologically, the review was conducted by a single reviewer without formal dual screening. While consistent with exploratory construct development and mitigated through inclusive screening, this may introduce selection bias; future validation studies could incorporate dual screening and agreement procedures to enhance reproducibility. Formal quality appraisal was also not undertaken because the purpose was constructing mapping rather than effect estimation, meaning the PACE taxonomy may reflect evidence of variable rigour. Future iterations could therefore incorporate systematic review or meta-analytic approaches where feasible to strengthen the evidential foundation and improve defensibility.

This study provides an initial attempt to systematically identify and categorise PACEs and translate them into a preliminary screening tool modelled on the ACE framework. By synthesising evidence across operational, investigative, and organisational domains, PACEs offers a simple, scalable approach to capturing cumulative policing adversity and supporting exposure–outcome examination across health and non-health outcomes. The tool is not intended to replace validated clinical instruments; rather, it is designed to complement them by enabling accessible exposure screening to inform trauma-informed policy and welfare interventions. Empirical validation is now required to test predictive value and refine application, but this study establishes a foundation for advancing understanding of policing adversity and strengthening organisational resilience.

• Flags cumulative exposure before health, performance or conduct issues emerge.

• Brief yes/no format supports routine, large-scale use.

• Complementary: Adds exposure context to well-being, OH and HR metrics; not a diagnostic tool.

• Supports exposure-informed understanding of well-being and outcomes over time.

• Aggregated results can identify higher-exposure roles, units and practices to guide support and reform.

• Repeat use can track exposure trends following leadership, cultural, investigative or operational change.

• Enables future dose–response, mitigation and protective-factor analyses.