Improbable Few

(in celebration of healing)
Improbable people
Always lay low
They take short sips
And never throw fits
There are things that only they know
Like, love is real
Yet hard to feel
When the screen was so blank
And only God to thank
For that nightlight hung on the soul
Research would say
They shouldn’t be this way
But love sprung out
Their improbable out-spout
Until eventually, even they run dry
Improbably then
The real journey begins
Held down with a howl
An in-spout installed
Pain rising up to be skimmed
So they start having fits
And taking long sips
And people smile wide
God beams with pride
Held strong in the love that they grew
From that place that already knew
These the improbable few
(may the improbable few become the improbable many)
Author:  Christina Bethell,  January, 2011

Childhood Trauma and Positive Health

The mission of the CAHMI is to promote the early and lifelong health of children, youth and families. Part of fulfilling this mission it to disseminate data, information and ideas to understand and address social determinants of health, like adverse childhood experiences and the trauma and chronic and toxic stress that can result and impact lifelong health.  A primary focus is on promoting the development of positive health, such as resilience, engagement in life and the safe, stable and nurturing relationships most essential to child development and well being.

October 19, 2017: Our new issue brief on ACEs and well-being is now available! This issue brief builds on the fact sheet below, and includes national and state-level data on the prevalence of ACEs as well as health effects and protective factors that mitigate the effects of trauma.

October 6, 2017: As a part of the Sesame Workshop’s “Sesame Street in Communities” initiative on helping children cope with traumatic experiences, the CAHMI has developed a fact sheet on the prevalence of Adverse Childhood Experiences (ACEs) among US children and youth, using newly released data from the 2016 National Survey of Children’s Health. This fact sheet is the first in a series of briefs that will explore ACEs along with factors that can mitigate the effects of trauma and toxic stress, including family relationships & resilience, social & emotional skills, and family-centered care. Additionally, we have created a high-level summary that gives an overview of the National Agenda to Address ACEs, recently published in Academic Pediatrics.

The agenda overview and fact sheet, along with additional upcoming briefs, can also be found below on this page’s Focus Area #3, under Data Briefs and Reports.

September 5, 2017: A new special issue of Academic Pediatrics, “Child Well-being and Adverse Childhood Experiences in the US,” is now available! See below for links to articles by CAHMI and other JHU staff (Focus Area #3, Peer-reviewed Publications) as well as the JHU press release and blogs by Dr. Christina Bethell (Focus Area #2, September 5, 2017).

The above video is taken from a national meeting sponsored by the CAHMI to begin the design of a national resesarch and action agenda on adverse childhood experiences (ACEs).

What are ACEs?

The term Adverse Childhood experience (ACEs) refers to a range of events that a child can experience, which leads to stress and can result in trauma and chronic stress responses. Multiple, chronic or persistent stress can impact a child’s developing brain and has been linked in numerous studies to a variety of high-risk behaviors, chronic diseases and negative health outcomes in adulthood such as smoking, diabetes and heart disease. According to the CDC, Adverse childhood experiences are broken down into three groups including abuse, household challenges, and neglect. The presence of adverse childhood experiences can lead to risky health behaviors, chronic health conditions, and low life potential or early death.

The CDC’s ACE Pyramid represents the conceptual framework for the ACE Study. The ACE Study has uncovered how ACEs are strongly related to development of risk factors for disease, and well-being throughout the life course.
Image from: https://www.cdc.gov/violenceprevention/acestudy/about.html

Focus Area #1: Support Research, Education, and Advocacy

The CAHMI supports the use of available national, state and local data to fast track research and educational applications of available data and tools to prevent and mitigate the impact of adverse childhood experiences and promote positive health. As part of this, we provide “point and click” access to micro-data findings on childhood trauma and positive health from the NSCH as well as “ready to run” NSCH datasets and codebooks, and helpful technical assistance through our National Data Resource Center for Child and Adolescent Health (www.childhealthdata.org)

  • ACEs Resource Packet: This packet is intended for use by clinicians, health care professionals, and health care students to open and enhance dialogue with patients, families, colleagues, friends, and community leaders about ACEs and resiliency. It contains four information sheets: ACEs Basics, The Science Behind ACEs, What Can We Do?, and Resources on ACEs and Resilience.
  • Click here to search the NSCH for data on ACEs (NSCH 2016/17 -> Survey Sections -> Family Health & Activities -> Indicator 6.13 Adverse Childhood Experiences)
  • Explore your state’s findings on ACEs using the 2016-2017 combined NSCH data.
  • Request a cleaned and coded dataset from the CAHMI’s Data Resource Center
  • Ask Technical Assistance Questions to the expert staff of the Data Resource Center
  • Link for providers wanting to translate this learning into practice

Focus Area #2: Facilitating a Research and Policy Agenda

As a part of a larger commitment to facilitate a whole-child, whole-family and whole-community health model of well-being, the CAHMI has partnered with AcademyHealth and many others to specify a child health services research and policy agenda to advance knowledge and action in addressing childhood trauma, toxic stress and promote positive health.

CAHMI work in this area with AcademyHealth and a wide range of other partners will continue throughout 2015 and result in a research and action agenda, communications toolkit and a series of research papers

More information can be found on the AcademyHealth website here or by contacting Dr. Christina Bethell, Director of CAHMI or Dr. Lisa Simpson, CEO of Academy Health

Learn more:

September 5, 2017, Academic Pediatrics special journal issue (Publication and promotion of national agenda)

April 25-28, 2015, Advancing the agenda & increasing participation through co-digital software (Pediatric Academic Societies Annual Meeting)

March 28-29, 2016, HOPE and the New Science of Thriving Summit

    • In March 2016, the CAHMI and Health Resources in Action collaborated to coordinate and host a summit on “Hope and the New Science of Thriving,” with participants from many fields, including research, health care, health systems, policy, philanthropy, and more.
    • Summary proceedings: includes pre-meeting survey results, summit presentations and discussions, and agreed-upon next steps

Focus Area #3: Building a Knowledge Base and Putting Data into Action

The CAHMI envisions the development of a clearinghouse of publications and resources to advance and translate into practice and policy, and seeks to contribute to this knowledge base through papers and resources developed by our team and partners.The CAHMI is also dedicated to the development and actionable use and dissemination of data to inform evidence based programs and policies. Below are examples of publications, presentations, newsletters, data briefs, and reports the CAHMI has developed or contributed to that draw on information on adverse childhood experiences and related factors from the 2011/2012 National Survey of Children’s Health (NSCH):

Learn more:

Peer-reviewed Publications

Data Briefs and Reports

Presentations and Posters

Emerging Collaborations

The Center for Human Thriving and Child Well-Being: Prioritizing Possibility

The science of human development opens the door to unprecedented advances in human health and well-being.   Breakthrough findings in neuroscience, epigenetics, biology, psychology, sociology and humanities point to a new science of thriving that illuminates largely untapped capacities for self-healing and squarely places the locus of human health and development within the social, emotional and environmental context we create and live within.  We seek to bring together existing capacities and partners in research, education, innovation, advocacy and leadership capacity to catalyze and advance a new integrated science of thriving into the everyday lives of all Americans. Our work will bring awareness to the requirements for well-being and the critical need to build resilience, mindfulness and thriving skills to promote health. It will also address the early life adversities and trauma science shows become biologically embedded, resulting in devastating losses in human potential and life expectancy. Sectors of impact include public health and health care systems, education and community-based organizations, business and economics and arts and entertainment.


Additional Resources

ACEs Resources from Other Organizations and Individuals


In Partnership With: AcademyHealth / The California Endowment/National Committee and Advisors; and you!