Injury and violence Prevention (IVP) Branch

Child Adversity Prevention Programs

The Child Adversity Prevention Programs focus on preventing Adverse Childhood Experiences (ACEs) and promoting Positive Childhood Experiences (PCEs) to improve health and well-being across the lifespan.

By reducing and preventing exposure to ACEs and strengthening protective factors, including PCEs, the Child Adversity Prevention Program engage community members in efforts to educate about the need for trauma-informed policies, early childhood interventions (e.g., Strengthen Economic Supports to Families, Change Social Norms to Support Parents and Positive Parenting, Provide Quality Care and Education Early in Life, Enhance Parenting Skills to Promote Healthy Child Development, and Intervene to Lessen Harms and Prevent Future Risk)[1], and cross-sector partnerships to foster safe, stable, and nurturing environments. Recognizing the interconnected nature of childhood adversity and lifelong health, Child Adversity Prevention Programs work to prevent harm before it occurs while equipping communities with resources that can promote well-being and resilience. 

Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences (ACEs) are traumatic events that occur before the age of 18. These events may disrupt healthy brain development, alter the immune and endocrine systems and change how the body responds to stress.[2] Experiencing ACEs can negatively impact education, employment, earnings and health over a person’s lifetime and can extend to future generations.[3] Types of ACEs include abuse, neglect, household challenges, and other forms of adversity (Figure 1).

Figure 1: Types of ACEs and ACE categories. Image adapted from the Robert Wood Johnson Foundation.[4],[5], [6], [7], [8], [9], [10], [11], [12]

Experiencing four or more ACEs has a strong relationship with increased risk for several leading causes of death in adulthood, including:

Heart disease
Cancer
Chronic obstructive pulmonary disease (COPD)
Alzheimer's
Suicide[2],[4]

Since the first ACE study was published, other studies have identified additional childhood adversities across the socioecological model including witnessing violence, experiencing discrimination, feeling unsafe outside the home, being bullied, experiences of living in poverty, or being in foster care.[8]

Positive Childhood Experiences (PCEs)

Positive Childhood Experiences (PCEs) are experiences that engage the child, a caregiver and the caregiver-child relationship to achieve positive child health outcomes. PCEs, such as supportive relationships and safe environments, have been shown to enhance resilience, helping to buffer the negative effects of ACEs.[13], [14], [15] There are four types of PCEs that support lifelong well-being and encourage children to thrive and grow into resilient adults.[16] The Healthy Outcomes from Positive Experiences (HOPE) Framework describes these four key types of PCEs - Relationships, Environments, Engagement, and Emotional Growth - as the Four Building Blocks of HOPE. (Figure 2).[17], [18] For more information about PCEs, please visit the Positive Adverse Childhood Experiences Resources Webpage.

Figure 2: The Four Buildung Blocks of the HOPE Framework[17], [18]

References

[1] Fortson, B. L., Klevens, J., Merrick, M. T., Gilbert, L. K., & Alexander, S. P. (2016). Child Abuse and Neglect Prevention Resource for Action: A Compilation of the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

[2] Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. About Adverse Childhood Experiences. Accessed June 20, 2023 on the Center for Disease Control and Prevention About Adverse Childhood Experiences webpage  

[3] Bhushan D, Kotz K, McCall J, Wirtz S, Gilgoff R, Dube SR, Powers C, Olson-Morgan J, Galeste M, Patterson K, Harris L, Mills A, Bethell C, Burke Harris N, Office of the California Surgeon General. Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Office of the California Surgeon General, 2020. DOI: 10.48019/PEAM8812.

[4] Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine. 1998;14(4):245-258. doi:https://doi.org/10.1016/s0749-3797(98)00017-8

[5] Robert Wood Johnson Foundation. The truth about ACEs infographic. Accessed May 5, 2022. https://www.rwjf.org/en/library/infographics/the-truth-about-aces.html

[6] Cronholm PF, Forke CM, Wade R, Bair-Merritt MH, Davis M, Harkins-Schwarz M, Pachter LM, Fein JA. Adverse Childhood Experiences: Expanding the Concept of Adversity. Am J Prev Med. 2015 Sep;49(3):354-61. doi: 10.1016/j.amepre.2015.02.001. PMID: 26296440.

[7] Walsh D, McCartney G, Smith M, Armour G. Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review. Journal of Epidemiology and Community Health. 2019;73(12):jech-2019-212738. doi:https://doi.org/10.1136/jech-2019- 212738

[8] Choi KR, Stewart T, Fein E, et al. The Impact of Attachment-Disrupting Adverse Childhood Experiences on Child Behavioral Health. The Journal of Pediatrics. 2020;221:224-229. doi:https://doi.org/10.1016/j.jpeds.2020.03.006

[9] Bernard DL, Smith Q, Lanier P. Racial discrimination and other adverse childhood experiences as risk factors for internalizing mental health concerns among Black youth. Journal of Traumatic Stress. Published online November 20, 2021. doi:https://doi.org/10.1002/jts.22760

[10] Lemon ED, Vu M, Roche KM, Hall KS, Berg CJ. Depressive Symptoms in Relation to Adverse Childhood Experiences, Discrimination, Hope, and Social Support in a Diverse Sample of College Students. Journal of Racial and Ethnic Health Disparities. Published online April 9, 2021. doi:https://doi.org/10.1007/s40615-021-01038-z

[11] Choi KR, McCreary M, Ford JD, Koushkaki SR, Kenan KN, Zima BT. Validation of the Traumatic Events Screening Inventory for ACEs. Pediatrics. 2019;143(4). doi:https://doi.org/10.1542/peds.2018-2546

[12] Bernard DL, Calhoun CD, Banks DE, Halliday CA, Hughes-Halbert C, Danielson CK. Making the “CACE” for a culturally-informed adverse childhood experiences framework to understand the pervasive mental health impact of racism on Black youth. Journal of Child & Adolescent Trauma. 2020;14. doi:https://doi.org/10.1007/s40653-020-00319-9

[13] Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R. Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatr. 2019;173(11):e193007. doi:10.1001/jamapediatrics.2019.3007

[14] Han D, Dieujuste N, Doom JR, Narayan AJ. A systematic review of positive childhood experiences and adult outcomes: Promotive and protective processes for resilience in the context of childhood adversity. Child Abuse Negl. 2023 Oct; 144:106346. doi: 10.1016/j.chiabu.2023.106346. Epub 2023 Jul 18. PMID: 37473619; PMCID: PMC10528145.

[15] Hinojosa, M. S., & Hinojosa, R. (2024). Positive and adverse childhood experiences and mental health outcomes of children. Child Abuse & Neglect, 149, 106603.

[16] Huang CX, Halfon N, Sastry N, Chung PJ, Schickedanz A. Positive Childhood Experiences and Adult Health Outcomes. Pediatrics. 2023 Jul 1;152(1):e2022060951. doi: 10.1542/peds.2022-060951. PMID: 37337829; PMCID: PMC10312234.

[17] Tufts HOPE – Healthy Outcomes from Positive Experiences. (n.d.). Tufts Hope. https://positiveexperience.org/

[18] Sege, R. D., & Browne, C. H. (2017). Responding to ACEs with HOPE: Health outcomes from positive experiences. Academic pediatrics, 17(7), S79-S85.

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