Significant adverse childhood experiences (ACEs) impact health, socialization, academics, engagement in education, and behavior outcomes in elementary students. ACE researchers have identified protective factors, which mitigate the deleterious effects of significant ACEs. One of those protective factors is the positive teacher-student teacher relationship. This qualitative case study examined how elementary teachers build positive relationships with students who have significant ACEs in a medium-sized school district in central Pennsylvania. The study examined teacher factors contributing to positive relationships with students who have significant ACEs. The study also examined the challenges involved and how teachers overcome those challenges. Data were collected through online surveys, online interviews, and philosophy of education documents. Conclusions derived from the findings included that elementary teachers use a multi-faceted approach comprised of motivations, intentions, interactions, environment, and classroom practices to build positive relationships with students who have significant ACEs and that elementary teachers benefit from a support network as the build and foster positive relationships with students who have significant ACEs. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]