Positive experiences can help people recover from negative ones that occurred during childhood, also known as ACEs.
Photo by DisobeyArt, courtesy iStockphoto
“We are working to build communities where we shift the focus from ‘what's wrong' to ‘what's strong,' and building on that.”
— Crystal Charbonneau
Jada Imani's childhood was marked by a parental split, an angry and unpredictable father who struggled with substance use, and multiple family moves that uprooted her life.
“I think it caused me to be very anxious and depressed from a very young age,” Imani, a 27-year-old California resident, told The Nation's Health. “My proximity to ACEs gave me very low stress tolerance, getting easily overwhelmed and a hyper- sensitive nervous system.”
ACEs, or adverse childhood experiences, are traumatic events —such as abuse, neglect and household substance misuse —that occur before adult- hood. People who experience ACEs have higher risks for chronic illness, mental health issues and risky behaviors as adults.
Public health professionals work to prevent ACEs and support people who have experienced them.
In the past, people who had experienced ACEs were treated mainly through behavioral counseling and psychiatric care to address depression, anxiety and other negative emotions, with mixed results. But in recent years, a third and sometimes misunderstood element of treatment has occupied more space and shown promise in effecting resilience and recovery.
Programs led by educators, health care workers, and social service and training providers offer ACEs recovery approaches that de-emphasize trauma to focus on the positives of what can be done about it.
Behavioral counseling can help address depression, anxiety and other negative emotions associated with ACEs, but positive family and peer support can also be beneficial, new recovery methods show.
Photo by Mikolette, courtesy iStockphoto
“We are working to build communities where we shift the focus from ‘what's wrong' to ‘what's strong,' and building on that,” Crystal Charbonneau, MAT, parenting education coordinator at the Child Abuse and Neglect Council in Saginaw, Michigan, told The Nation's Health.
While the seminal study showing the lasting health effects of childhood trauma from ACEs was published in 1998, it took about 20 years for an approach to develop that many community health and social services leaders say they were comfortable embracing.
Pediatrician Robert Sege, MD, PhD, noticed that some people who experienced childhood adversity emerged as adults without long-term trauma. In the late 2010s, Sege and colleagues examined a survey on ACEs and positive childhood experiences, finding resilient people tended to share social and environmental factors that buffered or shielded them from toxic trauma.
People with multiple positive childhood experiences were 72% less likely to experience physical and mental ailments as adults compared to those with lower PCEs scores, their study found. Positive experiences included having a non-parental mentor, open communication, support from siblings or friends, a feeling of belonging at school, and community acceptance.
Based on PCEs research, Sege and his team developed the framework for Healthy Outcomes from Positive Experiences, or HOPE.
“We were able to see a strong correlation between positive childhood experiences and adult mental health outcomes,” said Amanda Winn, MSW, HOPE director of training and technical assistance at Tufts Medical Center.
With over 700 certified facilitators, HOPE trains health and social workers on its four-prong framework: supportive relationships, safe environments, opportunities for emotional growth and social engagement that promotes a sense of belonging.
“What this science shows us is that even after trauma has occurred, if we can get access to these key types of positive childhood experiences into the lives of the kids and families that have been impacted, we can change their health trajectory,” Winn told The Nation's Health. “We think of PCEs as kind of the ‘now what' to ACEs.”
With support from Children Trust Michigan and the AmeriHealth Caritas Foundation, health and social service groups in 19 Michigan counties adopted the HOPE initiative.
The Child Abuse and Neglect Council in Saginaw County has about 25 staffers who offer education, intervention and advocacy for families. Charbonneau leads a primary prevention program involving expectant and new parents at high risk for household adversity.
When talking to parents, Charbonneau tells them they have control of their own emotional growth. That can help them understand that parental stress needs a release valve to keep it from being a shadow in the household, she said.
Another HOPE pillar is fostering a healthy relationship with a caring adult other than parents. Charbonneau helps parents understand how such a relationship benefits a child emotionally and how it can be achieved.
The CAN Council surveyed parents in the HOPE program after one year, finding that about 90% of them said HOPE initiatives helped them better see their children's strengths. HOPE also helped the parents handle stress more effectively and gain parental knowledge to support their children emotionally and socially.
“We're no longer talking about the adversities,” Charbonneau said. “We're talking about the things that we see that are positive.”
California works to ‘live beyond' ACEs
In 2020, California began a statewide ACEs initiative led by the Office of the California Surgeon General and the Department of Health Care Services. Two years ago, the state established Live Beyond, a public awareness campaign aimed at teens and young adults. The campaign tells people that “It is never too late to heal from adverse childhood experiences.”
One in five California youth and young adults have three or more ACEs, with people from marginalized groups disproportionately impacted, a state report found. Multiple ACEs can lower lifelong earning potential and result in chronic physical and mental health issues.
Live Beyond set out to increase discussion and understanding of ACEs and toxic stress. In 2024-2025, the campaign's webpage received over 2 million visits, according to a report.
Diana Ramos, MD, MPH, MBA, California's surgeon general, whose office leads the Live Beyond ACEs campaign, said she has a personal commitment to the efforts.
Ramos experienced extreme adversity as a child, but also had a healthy, safe relationship with her aunt and other family members that protected her from toxic stress as an adult, she said.
“It's a dose response, if you want to think about it that way,” Ramos told The Nation's Health. “The higher the ACEs, the higher the positive childhood experiences that you need to have. That is so critically important.”
A California screening initiative known as ACEs Aware, overseen in part by Ramos' office, is working to reduce toxic stress by 50% in one generation. Co-led with the California Department of Health Care Services, it trains and reimburses Medicaid providers on trauma screening for their patients.
Following the HOPE framework, ACEs Aware promotes supportive relationships and environments, while being more specific on self-care approaches, emphasizing sufficient sleep, balanced diet, physical activity, and mindfulness or meditation.
For Jada Imani, ACEs Aware has helped her process her childhood experiences and focus on her skills and talents. She also enjoys being a Live Beyond advisor for youths and young adults. Among her stress busters are exercise, mindfulness, nature walks and getting together with like-minded friends.
“ACEs are not destiny,” Imani said. “You can reverse toxic stress through different interventions. Also, my experiences working in the community with peers who are grappling with or healing from these sorts of things has been really healing.”
For more information, visit www.acesaware.org, https://livebeyondca.org, and https://positiveexperience.org.
- Copyright The Nation’s Health, American Public Health Association
