Better Normal March 26: Positive and Adverse Childhood Experiences (PACEs): What Happens in Childhood Matters

Join the Better Normal webinar about PACEs and HOPE at noon PT/ 3 pm ET, Friday, March 26.  This BN features Dr. Christina Bethell and Dr. Robert Sege. >>Click here to register<<

At PACEs Connection, we believe in following the research. The last 25 years have been rich with breakthroughs about the impacts of childhood adversity on health and well-being. Researchers have defined adverse childhood experiences (ACEs), explored their short- and long-term impacts on health, uncovered the biological mechanisms that mediate these processes, and discovered genetic changes that result from toxic stress. As a consequence of this work, pioneers in many sectors have made great progress in integrating ACEs to solve some of our most intractable problems, including domestic violence, school suspensions and expulsions, and child abuse.

Safe Babies Courts show that one year after participating, 99 percent of the children suffer no further abuse. In a community that integrated PACEs, youth suicide drops 98 percent. In a U.S. county where practices based on ACEs science are used, deaths from opioids drop 26 percent while deaths in an adjacent county that doesn’t integrate ACEs science increase 84 percent. Batterer intervention programs reduce recidivism from 30-60 percent to just one percent. Staff turnover in organizations decreases from 21 to 3 percent. Schools eliminate suspensions and expulsions.

Although there is still much to learn about ACEs and how to prevent and mitigate their effects, we also all know that childhood experiences are not limited to those that involve adversity. All childhood experiences matter. In the last few years, researchers have started to examine the impacts of positive childhood experiences (PCEs) on children and adults. We at PACEs Connection are particularly interested in the interplay between positive and adverse childhood experiences. Here’s some of the relevant research:

• Bethell et al (2019) found a dose-response association between positive childhood experiences — such as feeling like family stood by one during difficult times and feeling safe and protected by an adult in the home — and adult mental and relationship health among adults who had experienced ACEs, irrespective of how many ACEs they had. Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels (positiveexperience.org)
• Bethell, Gombojav, and Whitaker (2019) reported that at each level of ACEs, “the presence of flourishing increased in a graded fashion with increasing levels of family resilience and connection.” Family Resilience And Connection Promote Flourishing Among US Children, Even Amid Adversity | Health Affairs
• Bethell et al (2014) found that children with higher ACE scores were less likely to demonstrate resilience, live in a protective home environment, have a mother who was healthy, and live in safe and supportive neighborhoods. However, almost half of the children who had experienced ACEs also demonstrated resilience, and “resilience mitigated the impact of adverse childhood experiences on grade repetition and school engagement.” Adverse Childhood Experiences: Assessing The Impact On Health And School Engagement And The Mitigating Role Of Resilience | Health Affairs
• Whitaker, Dearth-Wesley, and Herman (2021) found that “greater childhood family connection was associated with greater flourishing in US adults across levels of childhood adversity.” Childhood family connection and adult flourishing: associations across levels of childhood adversity - Academic Pediatrics (academicpedsjnl.net)
• Yamaoka and Bard (2019) reported that “the number of adverse childhood experiences was associated with both social-emotional deficits and developmental delay risks in early childhood; however, positive parenting practices demonstrated robust protective effects independent of the number of adverse childhood experiences.” Positive Parenting Matters in the Face of Early Adversity - PubMed (nih.gov)
• Baglivio and Wolff (2020) discovered that among juvenile offenders, “high ACE scores were associated with increased reoffending, and high PCE scores were associated with decreased recidivism, as measured by both rearrest and reconviction. Further, among juveniles with four or more ACEs who have six or more PCEs, reconviction was 23% lower and rearrest 22% lower when compared to those youth with four or more ACEs and less than six PCEs, controlling for a host of demographic and criminal history measures.” Positive Childhood Experiences (PCE): Cumulative Resiliency in the Face of Adverse Childhood Experiences - Michael T. Baglivio, Kevin T. Wolff, 2021 (sagepub.com)
• Baxter et al (2017) discovered that higher ACEs scores were associated with lower hope in a study of caregivers who brought children in for a child abuse medical investigation at a child advocacy center. Exploring the Relationship Between Adverse Childhood Experiences and Hope: Journal of Child Sexual Abuse: Vol 26, No 8 (tandfonline.com)
• Crandall et al (2019) observed in a study of adults that “higher counter-ACEs scores [i.e., positive childhood experiences] were associated with improved adult health and that counter-ACEs neutralized the negative impact of ACEs on adult health.” ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health - ScienceDirect
• Whitaker et al (2020) showed that across levels of childhood adversity, greater childhood family connection was associated with greater flourishing among young adults with type 1 diabetes. Childhood Family Connection With Flourishing in Young Adulthood Among Those With Type 1 Diabetes | Pediatrics | JAMA Network Open | JAMA Network
• Bethell et al (2016) examined ACEs, resilience, family protective factors, and emotional, mental or behavioral conditions (EMB) in children and youth in the U.S. The authors found that children with ACEs had higher EMB than children without ACEs, but the presence of resilience was significantly associated with lower amounts of EMB for both children with and without ACEs. In addition, the prevalence of EMB was lower when family protective factors were present, even if the child had ACEs, although the presence of two or more ACEs decreased the effect. Adverse Childhood Experiences, Resilience and Mindfulness-Based Approaches: Common Denominator Issues for Children with Emotional, Mental, or Behavioral Problems (nih.gov)

In terms of research, these are still early days, says Dr. Robert Whitaker, director of Research and Research Education at the Columbia-Bassett Program and professor of Clinical Pediatrics in the Vagelos College of Physicians and Surgeons at Columbia University: “This area of PACEs research is emerging, but the boundaries of that research have not really been defined, particular as complement to the well-established body of research on resilience.”

From  “Brains: Journey to Resilience”, Alberta Family Wellness Initiative.

“PCEs may have lifelong consequences for mental and relational health despite co-occurring adversities such as ACEs,” noted Dr. Christina Bethell in Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. Bethell is professor at Johns Hopkins University in the Bloomberg School of Public Health and founding director of the Child and Adolescent Health Measurement Initiative. “In this way, they support application of the World Health Organization’s definition of health emphasizing that health is more than the absence of disease or adversity. The World Health Organization’s positive construct of health is aligned with the proactive promotion of positive experiences in childhood because they are foundational to optimal childhood development and adult flourishing.”

We’ll be addressing PACEs, flourishing, resilience and other topics during our next Better Normal webinar, PACEs and HOPE, which features Bethell and Dr. Robert Sege, professor of pediatrics and director of the HOPE National Resource Center at Tufts University. Please join Friday’s Better Normal at noon PT/ 3 pm ET, Friday, March 26. >>Click here to register<<

However, in terms of integrating what we know about PACEs, we have enough information to continue integrating the science into our work. If we want to change individuals, organizations, communities, and systems we need to talk about both positive and adverse childhood experiences — PACEs — and how they intertwine throughout our lives….

• At the individual level, learning about ACEs helps us understand why we behave the way we do, and that our coping behavior is normal…a normal response to abnormal circumstances. Learning about PCEs provides direction to heal. The key concept about PACEs is that learning about both, together, can help improve our health and well-being. It gives us hope.
• At the organizational level, staff and leaders can use knowledge of PACEs to create healing-centered work environments and programs in all sectors.
• At the community level, educating the public about PACEs can provide hope and foster the development of innovative ideas about how to support families, organizations and communities. Understanding the interplay between positive and adverse experiences offers opportunity for engagement with all sectors. Communities can use this new lens to create mindful, healing-centered, research-informed approaches to prevent adversity and encourage connection and healing.
• At the system level, policymakers and leaders can use research about PACEs to find common ground across fields and to support policies that promote the understanding of PACEs and how adversity and positive experiences work together.

At least two organizations are taking this approach and doing research to guide their actions:

• The Healthy Outcomes from Positive Experiences (HOPE) team at Tufts Medical Center have identified 4 building blocks that lessen the negative effects of ACEs: relationships, environments, engagement, and social emotional development. HOPE – Healthy Outcomes from Positive Experiences
• The Hope Research Center at the University of Oklahoma, Tulsa, focuses its research on the “science and power of hope as a psychological strength, especially among those experiencing trauma and adversity.” The Center defines hope as “the belief that the future will be better and you have the power to make it so.” Hope Research Center (ou.edu)
  
  

The HOPE project at Tufts is hosting its first annual summit April 9, 2021. The summit is virtual, free, and features morning livestream plenary sessions, with breakout groups in the afternoon. Sign up soon! Although the morning sessions have unlimited attendance, the afternoon breakouts can accommodate a limited number of people. They will be offered twice, so that people can attend at least two. 

Over the next few months, we’ll be doing more blog posts about PACEs, about the two Hope projects (HOPE and Hope) as well as more Better Normal webinars that address the topic. If you have any ideas or questions to address about PACEs, please join Friday’s Better Normal at noon PT/ 3 pm ET, Friday, March 26. >>Click here to register<<