New voices bring promise to challenge of childhood adversity

Serena Clayton
Serena Clayton

By Serena Clayton at

At the Center for Youth Wellness policy convening on childhood adversity in San Diego last Thursday, I kept asking myself if we were having a new conversation or an old conversation, but with different people at the table.

The fact that children who experience adverse events (e.g., domestic violence, or a mentally ill or incarcerated parent) have worse health outcomes hardly seems like news. In public health, we know that environmental, economic and social factors lead to health disparities. In education, we know that poverty is connected to lower achievement, and there is a strong correlation between poverty and adverse childhood experiences (ACEs).

To address ACEs, new “trauma-informed practices” are moving the focus off of “fixing” individuals to understanding their experiences and building resiliency and safe, supportive environments. All of this sounds a lot like youth development, protective factors and strength-based approaches.

There is no doubt that we are seeing some of the same ideas come back in a new package. But something is different now, and it is the very fact that different people are now at the table—juvenile justice advocates, educators and health care providers. What this demonstrates is that the concept of childhood trauma has succeeded in uniting various sectors in a way that I have not seen before.

Juvenile and criminal justice advocates see themselves in this issue because so many youth who have experienced trauma end up in the correctional system. Educators have a stake because childhood trauma shows up in the classroom in the form of poor attendance, behavioral challenges, or learning difficulties.

Even the healthcare industry is beginning to take note. We now have not only epidemiological evidence of the impact of social stressors on health, but also biological evidence. ACEs or chronic stress raise the level of cortisol in the body, which affects many physiological processes and, ultimately, increases the risk of poor health outcomes. Just like poor diet or physical inactivity, ACEs are a risk factor that can lead to increased healthcare costs down the road.

As a public health professional with 20 years in various aspects of adolescent health, I am encouraged by the way that new science is creating new bedfellows. The concept of adverse childhood experiences provides an explanation for so many outcomes in different sectors: health disparities, the achievement gap, multi-generational poverty and cycles of violence.

As a school-based health advocate, I am intrigued by the possibilities. How can school-based health providers best use their unique position at the intersection of health and education to respond to childhood adversity, or to prevent it in the first place? As health care (slowly) begins to take prevention more seriously, what approaches to childhood trauma could become part of pediatric care or patient-centered health homes?

As educators strive to improve school climate, what alternatives to suspension will become standard practice? How can the public health and educator sectors support criminal justice reform as a health issue? And how can justice reform advocates help increase resources for health and education?

I look forward to exploring potential answers to these questions. 

Serena Clayton is the executive director of the California School-Based Health Alliance.



  1. I am so glad that this change is happening. But, I am incredibly saddened that for people who are 40+ years of age, I have spent half of my life feeling disconnected, lost, and am now starting to have health issues. I have seen 12 therapists in my lifetime and although at age 20, I was diagnosed with PTSD and dysthymia, really, no one has addressed my issues. It’s all about fixing my brain to stop living in the past. Nothing about healing my sexual trauma at age 4, the mental/emotional/physical abuse I endured growing up in my home. I have now been cast out, they would argue and say that I walked away from them. I know the honest truth. The last therapist I saw, said I might have C-PTSD and severe depression. I have had an incredibly difficult time trying to find someone who, !. believes me, 2. who can actually help me to grieve and process my pain. I feel like people of my age have fallen through the cracks. I have no joy, no hope.


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