A Public Health Approach to Adverse Childhood Experiences

Key points

  • Addressing conditions that cause adversity and meeting the needs of children and parents are essential for preventing adverse childhood experiences.
  • Strategies to prevent adverse childhood experiences focus on changing norms, environments, and behaviors to prevent adversity from occurring.
  • Effectively preventing adverse childhood experiences requires collaboration between sectors like public health, government, education, and social services.

Overview

Preventing adverse childhood experiences (ACEs) requires collaboration among public health, government, education, and social services to implement comprehensive strategies.

Comprehensive violence prevention means addressing risk and protective factors and how these factors affect people, communities, and society. Effective strategies include changing norms, environments, and behaviors to create safe, stable, nurturing relationships and environments for children and families. In this way, we can address the conditions that increase the risk of experiencing adversity while also meeting the more immediate needs of families.

CDC's Adverse Childhood Experiences Prevention Resource for Action represents a select group of strategies based on the best available evidence. Below are the recommended strategies, or preventive directions, to achieve the goal of preventing adverse childhood experiences. Within each strategy, example approaches are provided that describe specific ways to advance the strategy.

Prevention strategies

Policies that strengthen household financial security and family-friendly work policies prevent ACEs by increasing economic stability, income, and employment. These policies also reduce parental stress and help parents better meet children’s basic needs and obtain high-quality childcare. Example approaches include:

  • Strengthen household financial security through tax credits, childcare subsidies, and livable wages.
  • Family-friendly work policies like paid leave and flexible and consistent work schedules.

Changing social norms that accept or tolerate violence and adversity is crucial in preventing ACEs. This includes promoting shared responsibility for child well-being, positive parenting, healthy gender norms, and reducing stigma around help-seeking. This can also include strengthening social connections and support systems to help people and communities better cope with and overcome adversity. Example approaches include:

  • Public education campaigns can help reframe how people think and talk about ACEs and who is responsible for preventing them.
  • Legislative approaches to reduce corporal punishment can establish norms for safer discipline, reducing harms from physical punishment.
  • Bystander approaches can teach skills to intervene safely and reinforce norms that reduce the risk of future harm.
  • Mobilizing men and boys as allies in prevention can foster healthy norms around gender, masculinity, and violence.

Home-based support programs provide information, caregiver training, and support to build a safe and nurturing home environment. They also enhance children's development, school readiness, and future opportunities as well as reduce rates of child abuse and neglect. Example approaches include:

  • Early childhood home visitation programs can provide caregiver support and child development training.
  • High-quality childcare can reduce child behavior problems and parental stress and depression.
  • Preschool enrichment with family engagement can build a strong foundation for learning and strengthen the connection between home and school.

Teaching children skills to handle stress, resolve conflicts, and manage emotions can prevent violence, substance misuse, and other negative health outcomes. Strengthening parenting skills and promoting nurturing family environments protect children from various forms of harm as they develop into adults. Example approaches include:

  • Social-emotional learning can be used to enhance skills related to communication, problem-solving, conflict management, and emotional regulation.
  • Safe dating and healthy relationship skill programs can foster caring, respectful, and non-violent relationships.
  • Parenting skills and family relationship approaches can teach behavior management and discipline, foster healthy relationships, and can improve parent-child communication.

Positive relationships with caring adults prevent ACEs and improve outcomes for young people. These adults can be teachers, coaches, family members, neighbors, or community volunteers. Connecting youth to caring adults and activities enhances their engagement in school and establishes positive networks. Example approaches include:

  • Mentoring programs pair youth with adult volunteers to foster relationships that contribute to their growth, skill development, academic success, and future outcomes.
  • After-school programs offer opportunities for youth to develop behavioral, leadership, and academic skills through positive school and community activities.

Providing timely access to intervention and effective care can help reduce the health and behavioral effects of ACEs. It also strengthens children's resilience and breaks the cycle of adversity for families affected by ACEs. Example approaches include:

  • Enhanced primary care can help address ACE exposures with referrals to intervention services and supports.
  • Victim-centered services like crisis intervention and access to housing support can be lifesaving and helpful in reducing the harms of violence.
  • Treatment to lessen the harms of ACEs can address depression, anxiety, post-traumatic stress disorder, and other distress symptoms.
  • Treatment to prevent problem behavior and future involvement in violence includes therapy and support to address the social, emotional, and behavioral risks linked to ACEs.
  • Family-centered treatment for substance use disorders can address substance misuse by parents and the needs of their children.

Implementation guidance

CDC's Violence Prevention in Practice tool provides guidance on how to implement the strategies in the Prevention Resources for Action. The tool is designed to support state and local health agencies and others who have a role in planning, implementing, and evaluating violence prevention efforts.

Working together

Public health plays a crucial role in preventing ACEs by leading prevention efforts, coordinating partnerships, collecting data, and evaluating programs. However, successful implementation of prevention strategies and approaches requires collaboration from multiple sectors including education, government, social services and more.

Schools can:

  • Create a safe and supportive school environment where students feel connected to caring individuals.
  • Offer professional development on classroom management, including reinforcing positive behavior and establishing rules, routines, and expectations.
  • Support student-led clubs, providing a safe space for socializing, support, and connection.
  • Facilitate positive youth development through mentoring, community volunteering, and connecting students to supportive community-based programs.
  • Provide resources for positive parenting practices, including open communication and parental supervision.
  • Encourage school staff to take CDC’s free Preventing ACEs for Educators training to better understand their role in preventing ACEs.

Healthcare providers can:

Mental health providers can:

  • Integrate trauma-informed care principles into their practice.
  • Consider trauma-focused modalities like trauma-focused cognitive behavioral therapy when treating children and families impacted by ACEs.
  • Take CDC's free Preventing ACEs for Mental Health Providers training to better understand their role in preventing ACEs.

Public health can:

  • Use public health surveillance systems to describe the burden of ACEs and changes over time.
  • Triangulate data to integrate information from multiple sources and create a more comprehensive understanding of ACEs.
  • Identify populations at disproportionate risk of ACEs to inform tailored prevention and intervention strategies.
  • Monitor and evaluate the effectiveness of ACEs prevention and intervention strategies.
  • Monitor efforts to reduce the disproportionate burden of ACEs and achieve health equity.

Take advantage of the best available evidence and join CDC in efforts to prevent ACEs. Everyone has a role to play.

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Content Source:
National Center for Injury Prevention and Control