An ACEs Life Course Health Development Framework to Guide Prevention and Mitigation.

Prevention of Adverse Childhood Experiences (ACEs) and mitigation of their impacts on lifelong health and wellbeing are public health priorities. Current prevention and mitigation efforts lack a comprehensive, actionable and widely adopted conceptual framework to guide research, policy and practice. To address this shortcoming we propose an ACEs Life Course Health Development (ACEs LCHD) framework that integrates Bronfenbrenner's Bioecological Model, the Family Stress Model, the Stress Continuum and other relational development theories. A life course framework is especially pertinent because it explains and specifies mechanisms linking early life adversity and later life physical and mental health challenges. It incorporates intergenerational and historic cultural factors including parents' own life histories that can play a powerful role in either perpetuating and compounding or resisting adversity. It demonstrates how ACEs occur in the context of developmental ecosystems - multi-layered family, community and societal milieu in which children live, learn, play and grow. Strengths and vulnerabilities in each level of these ecosystems across the life course can either buffer or amplify the effects of adversity. Unlike previous ACEs or trauma informed frameworks, the ACEs LCHD framework unites developmental timing, intergenerational influences and ecological context within one integrative systems approach. It points to four action-step priorities: (1) Create developmental ecosystems maps and apply a complex systems science approach to their analysis; (2) Address root causes and mitigate the impact of ACEs on health development trajectories; (3) Identify and act on leverage points; and (4) Enable collaborative action. Child health providers cannot do all this alone but can contribute to local cross-sector coalitions to co-develop interdisciplinary multi-level action, advocate for trauma informed practice and connect children and families to evidence-based interventions to prevent and mitigate ACEs.