ACEs: The Science of Positive Childhood Experiences (Part 2)

Can you outrun a traumatic childhood? Dr. Christina Bethell returns for Part 2 to explain why an Adverse Childhood Experience (ACE) score is an indicator of risk, not a predictor of destiny. As a national leader in population health and systems measurement, Dr. Bethell has reshaped how we understand the "toxic stress" that accumulates in the nervous system when childhood trauma is experienced without buffers.

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In this episode, we dive into the "Positivity Paradox" and the breakthrough research on Positive Childhood Experiences (PCEs). Dr. Bethell explains that the absence of positive experiences—feeling loved, supported, and heard—can be as detrimental to long-term health as the presence of trauma itself. We discuss why healthcare systems are often slow to screen for trauma and how the "medicine" of presence and connection can rewire the brain even decades later.

Our guest, Dr. Christina Bethell (PhD, MPH, MBA), is a Professor at Johns Hopkins University and the Director of the Child and Adolescent Health Measurement Initiative (CAHMI). Her work proves that healing is a life process and that "more likely is not most"—meaning a high trauma score does not guarantee a future of illness or addiction. Whether you are struggling with your own past or trying to build a resilient future for your children, this conversation offers a roadmap for shifting from "fixing" to "connecting".

⏱️ Chapters:

00:00 – Recap: How ACEs and PCEs intersect

05:03 – What does an ACE score actually mean?

08;23 – Are you "broken" if you have a high score?

10;43 – How do we get more positive experiences (PCEs)?

13;27 – Why don’t doctors ask about childhood trauma?

16;36 – Is the absence of "good" worse than the "bad"?

23;16 – The 4 indicators of family resilience

34;42 – Is it ever too late for adults to heal?

44;16 – Healing your relationship with your teenager

53;14 – A magic wand for society: Connecting vs. Fixing

❓ Questions the Video Answers:

What is an ACE score? 

Does a high ACEs score mean I will get sick? 

What is the difference between an event and toxic stress? 

How do positive childhood experiences buffer trauma? 

Why is emotional neglect so common and harmful? 

Can I heal my nervous system as an adult? 

What is the "positivity paradox"? 

Why don't insurance companies cover trauma screening? 

Can I build resilience with my teenager now? 

What is "biobehavioral synchrony" in parenting? 

How does trauma affect the immune system? 

What are the 7 key PCEs for healing? 

How do I reparent my inner child? 

Why is "feeling heard" a public health priority? 

How can I find safety if I grew up not trusting people? 

#childhoodtrauma #mentalhealth #resilience

Transcript

SPEAKER_00 0:00

Having a negative reaction to something that's painful and negative is healthy.

SPEAKER_01 0:05

Dr. Christina Bethel is a professor at Johns Hopkins University in the Bloomberg School of Public Health. Dr. Bethel's research has shaped the conversations on adverse and positive childhood experiences, advancing public health outcomes for children, families, and communities. If there was a magic wand and you could change one thing about how our society treats children, what would it be? Well, I would treat them as welcome back to part two of our discussion about childhood experiences, both the negative and the positive that impact our lives well into adulthood. I'm Terry McGuire, your host. We are joined again today by Dr. Christina Bethel, whose work has fundamentally reshaped how we measure and improve health outcomes from childhood forward. Welcome back.

SPEAKER_00 0:55

Thank you. It's great to be here.

SPEAKER_01 0:57

So last week we laid the groundwork for today's dive into the most searched internet questions about these topics, the childhood experiences that impact us. But for anyone who missed that or needs a refresher, could you just remind us what ACEs are and what PCEs are and how they intersect?

SPEAKER_00 1:14

Okay. So adverse childhood experiences were identified in the late 90s through a study that the CDC did with Kaiser Permanente out of the observation that many adults who were being treated for smoking cessation and obesity recovered but then reverted. And they did some analyses to find out that a lot of the people who didn't end up keeping their gains had adverse experiences in childhood. So they took it further to create a tool that is actually useful for clinical purposes and public health, looking at the types of childhood experiences that create adversity and impact our well-being and health, health behaviors, chronic illness, and things like that. So there were 10 of them that had enough evidence and that really were distinct enough from each other to be included. And it looks like the more you have of these 10, the bigger impact negatively on your health, mental health, physical health, immune health, and health behaviors. And they include three categories. One is abuse, physical, emotional, or sexual, neglect, physical, emotional neglect. So not having needs met, being neglected, not being bathed, not having clothes that are clean, not having food, warmth, things like that. And emotional neglect, which is huge and common, actually. And then household dysfunction, which also interrupt the safety and security and nurturance in a home, things like mental health problems, alcohol and drug use, imprisonment, involvement in the justice system and imprisonment or loss of a parent through divorce or separation. And so these are events that co-occur. They're 85% co-occurring. So usually if you have one, you have another. And it's the accumulative toxic stress of those events as they are experienced. So it's not the event, it's how it was experienced. And when you experience it in a way without buffers, um, it becomes toxic stress and you can get stuck on on or off and your whole system and impacts all of your health. Stuck in fight or flight, just stuck in stuck on on, stuck on off, or going in between the two. And we often define mental illness and things like that as stuck on on, being hyper, or but the usually it's going both between the two where you can't regulate in that window of tolerance what's happening even when you're outside of the trauma. You start to react to life as if it's a trauma-big one trauma.

SPEAKER_01 3:37

Okay, and the buffers or positive childhood experiences.

SPEAKER_00 3:40

So positive childhood experiences is not exactly the other side of the coin because they can co-occur with ACEs. And when they do, they can buffer ACEs hugely. And there's something all of us can engage in with ourselves and each other, and there's positive adult experiences. So the positive experiences really have to do with family, community, and school and community environments and the roles and that each of those environments can play. So the family has to do with whether you as an adult, looking back on your childhood, felt safe to talk about, to talk with your family about things that were hard. Did you feel safe? Did you feel that when things were hard, you were supported? Did you feel protected by at least one adult in your home? Um, for school, did you feel a sense of belonging? Did you feel that your friends supported you? And the common denominator word is feel. So it's not necessarily that if a helicopter came down and observed that you had those things, that that would have been enough. It's did you experience it? Just like with ACEs, did you experience it based on all of the confluence of factors? And for the positive, it's the same. So the positive experiences are often what I call a par the positivity paradox. They're how thing how you were cared about or how you felt you could connect with others when things were hard.

SPEAKER_01 4:58

Okay. We're going to start with the ACEs, because that was the number one question on the internet. And you hear people talk about their trauma score. And the ACEs questionnaire is where that comes from, you know. What does an ACE score actually mean?

SPEAKER_00 5:13

So there's a phenomenon called cumulative risk, and it's well studied that the more you have of things that are hard, the worse you do. It's like it accumulates in your nervous system like a boiling water, and it gets to a breaking point at some point. So basically, the score is a way to start to give a general sense of how much that happened. It's not always the case, but basically it's a linear relationship between zero, one, two, and four or more, and the more the worse. Um, between that and having illness and alcohol or drug abuse or mental health problems, and even also all the chronic conditions, heart disease, um, all of it. So basically every condition you can think of diabetes, heart disease, asthma, um, or the behavioral issues are all associated with the more ACEs you have, the higher. And that's really the breakthrough in the science was to show that. However, I always like to say, more likely is not most. So many with high ACEs do not have those problems. And that's really, you know, what the opportunity for healing and prevention is. So it is uh an indicator, but not a predictor. It's especially not a predictor at an individual level. It really is more of a predictor at a population level. We have a lot of reliability in that data, that the more ACEs in a population, the more that population is going to have a higher rate of something. But again, because more likely is not most, at an individual level, you have to look at a lot more than that. And you really want to look at um the factor, their toxic stress, their self-regulation, their flourishing, their positive health in order to find out if those ACEs really are having a negative impact.

SPEAKER_01 6:56

What specific illnesses, and you've named some of them, are most linked to ACE. And does a high score mean I will get them?

SPEAKER_00 7:02

Okay. No, it doesn't. So even in the case of substance abuse, which is like drug abuse, is like a thousand times more likely if you have highly high ACEs.

SPEAKER_01 7:13

Do you mean you when you say that you're not being hyperbolic, you you mean research?

SPEAKER_00 7:17

Yeah, no, the odds are that much more. If you think of odds as 100, it's 10 times more likely, but a thousand times greater odds. So it's just a math thing. But yes, but most don't. Okay. So if you have hi aces, most don't go on to have substance use and addiction. It's just you're more likely to. So no, it doesn't mean that. It means you're more likely, but not necessarily. Not destined. No destiny at all. In fact, most who have hiaces do not go on to have any of those problems one by one. If you add it all up, though, and you say, if you have hi aces, do you have at least one of a number of things? Usually it's starting to get up there. You're going to have something. But um, for any given condition or any given level of aces, they're not predictive at the individual level. You have to look at the individual. It's a risk, but the solution to the risk is to create uh resilience and healing trauma and things like that. And many people have found out a way to do that when they did have high ACEs and they don't go on to have the problems.

SPEAKER_01 8:19

Another of the top questions is I have a high ACE score. Am I broken?

SPEAKER_00 8:24

No, you're not broken. So in many ways, having a negative reaction to something that's painful and negative is healthy. It means you're healthy if you are broken by what it breaks. And so the issue is what do we do about it? And what we need to know is we can do a lot. Um, first of all, we can acknowledge that we're suffering and reach out and get support and start to open the door to integrate the pain, to build the skills that we often didn't build when we were locked down in it, like learning to breathe and move the body and open and receive care and start to come back into life. So we can shut down under trauma in ways that prevent us from actually living well and healthy. We can also gain, you know, kind of numbing techniques. The nervous system always wins. If you are dysregulated, you're gonna do something. Shut down, act out, or numb. And so it's you're definitely not broken. And in fact, the fact that you're suffering is a sign that you know what's right and possible and true and you need to work on healing and getting it.

SPEAKER_01 9:26

What are the biggest misconceptions about ACE scores?

SPEAKER_00 9:30

I think the biggest one is a little bit of what we're talking about, that um, if you didn't have the ACE ACE's, you'd be fine. Yeah. Is one. And what we know is that it's really about proactive nurturance that is what we need to be healthy. And many without ACEs didn't have what we're gonna talk about positive childhood experiences. And when they didn't, that actually is also a risk. So the absence of the positive is the negative. So one of the biggest mistakes is if you didn't have ACEs, you're fine. The other is if you have it, you're going to be sick. There are many people who have high ACEs who nonetheless had those positive experiences and other buffers who don't have the problem. So I think we need to really be careful to not um think about in either way of those extremes, that having it's always bad, or that not having it is means you're fine. Um, and also that it's a population health indicator and that at the individual level, you have to get a much more complex and look at the whole person and their own each case.

SPEAKER_01 10:30

And you have looked at that. Yes, we have. And your groundbreaking research proves the value of positive experiences and supportive connections in countering the effects of ACES. How do we get positive experiences?

SPEAKER_00 10:43

Yeah. I mean, well, first of all, I want to say what our research did was look at child level or adult level data. So it's one adult with all the data at the same time. So when you have that, you can start to look at variation. So a lot of individuals with the same ACES risk are doing better than others. Why? So it allows us to look at that level. And that's really more what in public health we call population-based research that's needed to complement the scientific research, like the biological research that comes up. So, what we did was look at a population level adults with ACEs and adults with what we call positive childhood experiences as a way to help understand how some are doing better than others based on the buffering that they get. And so positive childhood experiences. Um, I think your question was um, make sure I how do we get them? How do we get them? Uh, well, they are relational primarily. And they're dependent. And so we need each other in positive ways in our independent society. We nonetheless need each other. And the positive childhood experiences come through homes and families and how families relate to each other and mostly through nurturing, being a safe place when things are hard, proactively being supportive when things are hard. These are some of the most positive experiences are how we're hand, how we are met when things are hard ends up being the buffering. And then also in the community, feeling like you belong, you're part of a community that cares about each other. Seeing that we're in a culture that cares about each other is a big part of flourishing when they do the happiness surveys of different countries. America doesn't do so well. And one of the biggest predictors is a sense that we're not in a culture that cares about each other. That maybe we don't either if you feel like you're being if your leadership or your community doesn't care about each other, it's very diminishing of your own sense of well-being, even if you don't think you're directly affected. So we care about being in communities that care about each other and that come together. So one of the positive experiences is enjoying participating in rituals and community events and where people, lots of people come together to connect with each other. And then the other is in school where there's a sense of belonging. So, how can schools create a sense of belonging? You don't have to be the most popular kid or get straight A's. It's not about that. It's about everyone matters in this school. Everyone belongs here and matters. And in a lot of schools, that's not necessarily the case. Like you matter and you belong if XYZ. So there's a whole movement in schools on how can we make sure every child feels seen, heard, and matters.

SPEAKER_01 13:19

Another of the top questions is if adverse childhood experiences can impact our health and overall well-being, why don't doctors ask about them?

SPEAKER_00 13:27

Yeah. Well, I mean, first of all, the studies originally were on small enough samples that it didn't get public health attention and therefore wasn't paid for. So a lot of screenings that happen are covered by health insurance.

SPEAKER_02 13:43

Okay.

SPEAKER_00 13:44

And so the time involved in doing it, the time involved in responding to it has at least some reimbursement. So a lot of this has to do with economics and how do you get the attention of policymakers and health plans and insurance plans around risks? And this one is tricky. Um, it can be documented and it has been documented, but it hasn't reached a level with our research to be able to mandate it. And so in California, I've worked with um Nadine Burcaris, who you've interviewed. They have ACEs Aware, which actually is reimbursing doctors for people who receive care through Medicaid, because the state can control that. They're reimbursing for ACES screening. Of course, screening doesn't do much if you don't do anything with it. So they're also allowing supports to come in. Um, and you know, we're studying how that affects things. And in some ways, you have to do it and show it works before it can become broad. So I think that it's very variable. The other is being afraid of offending your patients, making them feel that you're getting in their business. So we have to really understand that um our inner well-being and trauma affects our health. It is a matter of health to talk about heart disease and you talk about stress, that's safe to talk about stress, but what's driving the stress? What's underneath it? So I think there's a lot of fear of being personal, even though it's what's personal that's driving all of our problems.

SPEAKER_01 15:08

If the policy is not to ask and to not explore ACEs, but if we know our score, that's right, whether it's a number or just that we have experienced things, should we say, hey, listen, you should know some of this might be related to I mean, I I actually have done a lot of work on developing uh patient-facing, family-facing IT little apps that people can self-assess.

SPEAKER_00 15:31

So most of what the doctor's gonna ask you anyway, you can self-assess, get it scored with resource links. So we have something called the Well Visit Planner that allows families to do that. And we they can choose to look at ACEs and they can get that if they want to. You could also just assess the positive, positive experiences, if that's easier. The absence of the positive is a risk. And in fact, it's probably more of a risk because without ACEs and without the positive, you're still at risk. So if we don't like asking about trauma and or trauma, things that can cause trauma like ACEs, we can ask about the positive experiences as a way to focus on strengths, celebrate them, and just keep promoting the positive because it's actually not as common as we think. You know, our studies show that only about half of adults looking back on their childhood had high levels of positive childhood experiences. Because we have a culture that hasn't necessarily prioritized proactive care and nurturance. Maybe uh parents think that's not being authorit, you know, authoritative and and you can be both caring and warm and have authority as a parent. And that's important. There's a lot of studies on that.

SPEAKER_01 16:36

I want to reiterate that. I want to go back. It's so even if you haven't had bad things, adverse childhood experiences, if you haven't had good ones, if you haven't been supported and loved and shown to be of value and cared for, that is as bad, as harmful or more than having Well, it's actually why ACEs are a problem.

SPEAKER_00 16:59

Because it was the absence of positive. If you have aces and you had nurturance nonetheless through um other adults that made you feel safe or it was highly buffered, you know, in some way, you don't see the negative effects so much. And also being taught how to regulate your own emotions, how to reach out when you're when you're suffering and all of the things, um, then you don't end up with all those problems. So there's a lot who have high ACEs that don't go on to have problems. And when you look and peer into side why, it points to these positive childhood experiences. But even without aces, without high positive experiences, you are at risk. And so we can start with the positive. We can actually assess flourishing and positive health, like resilience, um, having and having intentional goals in life and pursuing them, staying connected to other people, being able to have relationships, all meaning and purpose for adults, flourishing is well defined. Having flourishing, you can still have illness. But if you foster flourishing and foster positive experiences, because you just don't want to like deal with the negative because you think that's invasive, we will go a long way. You'll run into the negative though. Yeah. But through the lens of what's possible. So if you start talking about positive experiences and they weren't there, and you ask people like Vincent Fletti, who did the original ACE study, how do you think that's impacted your life? People know. Yeah. They'll tell you. And then you've opened the door. What do you think you might want or need? They usually know something about that too. And you, as a doctor or a health professional, has a lot of authority encouraging that. Yes, I think that would be a good, good idea. Here's some other things. Can I mention some other things? But letting it come from people, asking them, what do you know about how that might have affected you? Do you think it's important? Almost always somebody's gonna say, Well, of course it's important. I just didn't know it was an issue I could talk to you about. Right. Except for you should care about it if you're a doctor, because so many of the health issues, even within a health condition, asthma, let's take for kids or adults, there's huge variation in how people do. And it's not all about whether they're taking their meds or not. First of all, we know asthma attacks are very triggered by stress. If you have regulation capacities around stress, your asthma is going to be less difficult. There really isn't a condition that isn't impacted by toxic stress. And there isn't really a condition, therefore, that's not going to be benefited by having the positive experiences that regulate that.

SPEAKER_01 19:28

And that's where you keep saying we are the medicine. We are the medicine. Literally, and it's me.

SPEAKER_00 19:32

When I say we are the medicine, it's it's not just me with me. I think it does start once you're of a certain age, you have to be open to connect. And that's the big danger point is when adverse childhood experiences shut us down. And that's if you start alcohol or drug use at an early age, you shut down. How we know lots of ideas about how you niji in there and help remap the beliefs that are driving that use of substances from really when you're young. If you can start to help somebody remap their own beliefs about I matter, life can be safe, I can heal, I can do something to improve my life, people will start to do that, but that's often harder. So, but if you can get in there and start to help people um build their own capacities to self-heal, it's huge.

SPEAKER_01 20:19

Another of the top questions is what positive experiences protect children? What specific experiences?

SPEAKER_00 20:25

Yeah. Well, I mean, obviously we need food, shelter, clothing, right? Absolutely. And, you know, Maslow's hierarchy talks about that. You need these basic things. And then at the top, you can get to self-actualization and all that. I think we need to rewire Maslow's hierarchy to center in the middle care and belonging, because that's what kind of opens us up neurobiologically and otherwise to be an open system that can learn, reach out when you're suffering and that sort of thing. And somehow that actually ends up enabling us to um evolve, to maybe look for opportunities to get help if we don't have our enough food or housing and that kind of thing. So, but ultimately, if we're talking about from childhood, it's safe, stable nurturing relationships in the home. But with half of half of adults in the country not having had their own nurturance, not because we're bad, just it it's cultural in many ways. You know, we don't really understand the power of love or how to have love with boundaries. Having love for your child doesn't mean not having boundaries, not helping guide them in their behaviors, but it's a skill. And so really helping families and parents heal themselves, build the skills so we can promote nurturing relationships, build those skills, and then we can also reduce the sources of stress in the environment if we can, you know, through addressing access to food and housing and clean air and all the other things that impact our health.

SPEAKER_01 21:52

I remember as a pregnant with my first child forever ago reading a book. I don't know how it came to me that loving your child is not enough. was the title. And I was stunned. I was just, I was on a plane, just reading it as fast as I could. And then started it all over from the beginning. And I was like, if you don't know, you don't know. If you didn't have it put into you, you have to learn it somewhere else to be able to give it.

SPEAKER_00 22:16

No, I think that's true, especially if you didn't have it. And so obviously feeling love is common for your child. Even I believe my mom felt love, but she couldn't actualize it through her behavior or through relating to me. So loving your child also means really connecting with them, this connect fixing to connecting kind of concept, which is you don't just give them the food and all the parenting behaviors. We measure that actually we look at all the parenting behaviors like limiting screen time, having bedtime routines, sharing meals, not smoking in the home, all the things. If you're a perfect parent in that, but you don't have family resilience and parent-child connection, they don't really do that much. I can show you the data on that. They really don't do that much when it comes to predicting school readiness, school engagement, health of a child, flourishing of a child. So you can get away without being a perfect parent in many ways if we can find a way to create that parent just positive childhood experiences. And part of family resilience is feeling hopeful about your future, knowing you have strengths to draw on, being willing to reach out for help when you're struggling. And only about half of kids live in families that are positive on all four of our indicators of family resilience, where families report high levels of feeling hopeful, even when things are hard, feeling they have strengths to draw on when things are hard, reaching out and staying connected as a family to solve problems when they have them and feeling like they can reach out to others. And so if your response to difficulty is to shut down and shut down from each other and not reach out, that's not resilient. And when you don't have that, you're not likely to have the positive childhood experiences either. So helping families is key, but we've got half of families and half of adults looking back on their childhood not feeling they had high positive experiences and half of kids living in homes with families that on a survey that's a strength-based survey, meaning you're going to report it's good if it's good, if it even if it's bad, we have about half not living in homes with high levels of resilience. So we have opportunities culturally to just normalize and and really own the power we have through our daily moment by moment interactions and beliefs about having hope, seeing we have strengths, looking for them, building them and caring about each other.

SPEAKER_01 24:33

Are some of the positive childhood experiences more powerful or more essential than others or are they all?

SPEAKER_00 24:39

Yeah I mean if you look at the data, I have a nice diagram I could show you that looks at each one individually as it relates to predicting certain things. If it's looking at adults reporting back on their childhood like the original ACES study, I can show you that some of the factors have a bigger impact on preventing course they're co-occurring as well. But the family ones tend to be stronger than the just school or community factors that we measure. However, if you have all the school and community factors, those together can start to equal that. So it's all it's all linear. It all makes a difference but the definitely the family factors are the most essential.

SPEAKER_01 25:20

Is there some math to the balance? You know if you have uh X, I'll say, because you can tell me what it is on the ACES questionnaire and X on the positive experiences, where does it start to make a real difference?

SPEAKER_00 25:35

You mean in terms of the score? Yes. Or okay. Yeah. I mean this is really interesting. So first of all there's a lot of people who try to take the ACEs and PCs and see if one didn't before the if one if one matters more than the other. And it's really the cumulation that is the biggest impact. You can pick it apart a little bit and say well it's mental health and alcoholism and the abuse that's worse, but it really doesn't pan out in the end or if mathematically feasible to even do in a in a screener. But the score is really it the cumulative positive the cumulative negative is what we're looking at. And for positive experiences there's what we call a ceiling effect. You need to have high positive it you don't sort of feel safe. You don't sort I mean you can be on your journey but it's almost like if you check it out for yourself, you either do or don't. And that doesn't mean it's never not safe. If you feel safe in your home, it doesn't mean it's always safe. It means you trust that it's going to be it's going to be right. So it's really six to seven positive experiences. And also same thing on family resilience. If a if a family doesn't say we pretty much all the time feel hopeful when things are hard, all the time we can identify strengths to draw on all the time we stay connected during difficulties to try to problem solve together and not just go to our corners and shut down you know if if you say most of the time in my research most of the time isn't really enough. It usually means more like some of the time. And same thing on flourishing if you look at your child and say is your child able to stay calm and in control when they face daily challenges if you say usually and you do the interviews or you look at the math usually isn't enough. Very strong. So usually is more like sometimes or never where always so it's a positivity bias on the positive things. You want to kind of strength based measures require strength based scoring. On the negative side any level of that negative is a linear related it's a cumulative thing. It's a little bit more smooth. So the more the worse in that way and it can actually be even one ace could be enough for some people if it reverberates and has been consistent and caused enough stress. On the positive side it seems to be high. We need the high. And what does it actually look like?

SPEAKER_01 27:52

So in a family and I obviously don't didn't have this um tried to create it for my own children but kind of winging it when someone has been through a difficult time as you keep saying and they come for support you say let's sit down let's talk this through how we're going to get through this together.

SPEAKER_00 28:08

I'm here is that the conversation well first of all if your child will come to you with a difficult issue because we we do measure something called parent-child connection and we have to figure out how to measure using very few items because on a national survey the real estate space is like$2500 or more per item. So if you have something you want to measure that you would need 20 items, you get like two. So we've had to do a lot of item reduction and identifying so the one parent-child connection item we have which is for school age children is whether or not the parent feels that they can talk with their child about um things that really matter, share ideas and talk to their child about things that really matter. And when they say very well, that is hugely protective even if every other thing is positive in the family if that's not strong and families parents know if that's happening actually. So if they don't say very well to that, that's a risk in and of itself. So it's talking with your child about ideas, their ideas, your ideas, and about things that really matter, which is always something that's hard that when you do the research talking about things that really matter is usually about things that are a little bit maybe too vulnerable to talk about with just anybody. So being available for that, but your relationship with your own self and whether you're connected to yourself, whether children observe that you are comfortable with your own vulnerability is going to say a lot about whether they're going to be comfortable with theirs with you. So I always say your being is their well being so how you are with yourself. If we're locked down in ourselves are kind to ourselves or are shut down, don't honor our own emotions because children can feel they can feel you and if if you if they notice you're not well and ask and you say I'm fine that disconnect with yourself is going to send some kind of signal that they're not going to be fine to come to you with what's difficult for them. So it's very important that we be that safe space but it has a lot to do with also then feeling our own vulnerability. And so that's trick that's tricky. But yes, you're basically right like being a safe place to share ideas and talk about things that really matter, no matter what they are, because all roads lead to Rome. Maybe a child wants to talk about clothes and you just keep asking you know um well what is it that you care about about that you know I have um an exercise that I do called finding the jewel. It's one of the positivity paradox exercises, which is if your child is um clearly suffering, but maybe shut down. You can maybe ask, you know, if they are willing to talk about the bad like that's hard for me. I'm mad at that child that other kid or whatever. You can ask them what is it that you really care about that makes that so hard for you?

SPEAKER_01 30:55

Oh great question.

SPEAKER_00 30:56

What is it that you really care about that makes that so hard for you? And what that reminds us of is that we get upset because there's something good and right and true that we know is important that was violated. It could be well I want to matter I want to belong I want to be included I want peace I want justice. Those are good things to want and so even in the midst of difficulties you can remind your child that what they're upset about speaks to their goodness speaks to the fact that it is true and right and good to know that you belong you should belong you do belong you matter how does it make you feel what is it you care about and then when you can reconnect with the positive that is underlying every negative experience all pain comes because you know there's something good that's deeper and more right. And when you somehow can tap into that I think it opens a portal for new ideas to say, well now that we've noticed that what do you think you could do? Sometimes it's like I could ask them to stop. I could tell them you're hurting me. Please stop now that may be too bone vulnerable but in some cases ideas come. I could um ask the tell the teacher and ask other kids and maybe we can do something to help that person that's bullying me. Almost all kids who bully were bullied. So it's a it's a tricky thing but it's really common for kids. So there's exercises that you can do to try to make it safe to talk about um what's hard. And those skills are really important for parents to learn.

SPEAKER_01 32:23

I think I can say this without getting in trouble with my son. He was he was bullied by a kid at school and I asked him what do you want to do? What do you want me to do? What do you what do you want to have happen now? And he said, I think he needs some of what we have and he wanted him to come over to to bake cookies. That's right. I'm going to get teary because I was so surprised I thought he was going to say I want you to get him kicked out of school or whatever it was. And that's right even in second grade he recognized that that kid needed what we had.

SPEAKER_00 32:50

And and that's beautiful. So I just want to say whatever you did, that's beautiful because that's love and action. That's love and action. A lot of kids who are bullied don't want to retaliate because they actually care. They know that these are instinctive things like even little tiny babies have empathy. They're built to care for their own parents in many ways, right? Not like I'm not trying to no right but they're you know whether or not a child reaches out to their parent with care when their parents clearly suffering at a very young age is a sign of healthy development.

SPEAKER_02 33:20

Good.

SPEAKER_00 33:20

It's normal. And so you know kids had any kind of healthy parenting they're going to have that. And so we need to figure out at a population level how not to just you know people who hurt were hurt. And the school at a school level needs to create a culture and environment to make it safe for kids who are hurt and bullied to heal and restore as well. So this is why we talk in my work about systems transformation and making belonging mattering and nurturance a matter of public health for everyone and then looking at where we can restore it. And if we all work together, there's always opportunities. But that's beautiful that your son did that.

SPEAKER_01 33:57

He did say don't leave us alone stay in the kitchen which is smart.

SPEAKER_00 34:00

Of course and if you asked them what is it you really care about that um makes that painful for you if you can help that your son connect with that it is hard for them because you don't want to just bypass it, um, they're going to say well I care about peace and that we all matter and that this child doesn't feel like they have to obviously you know so I think it's really remembering that underneath all our pain is our instinctive knowing of what's good. Now when people are mean and they can't answer that question, they say, well what I really want is to get back at them then if they're a little farther gone. Right. But most people really understand what's possible, but we don't talk about it and we don't know how to foster it and we can. It's a skill.

SPEAKER_01 34:41

Those are my questions. I'll go back to the internet questions. Is it ever too late can an adult who experienced and was deeply affected by adverse childhood experiences still heal and flourish?

SPEAKER_00 34:51

Absolutely um you know I think a lot of people who had high adverse childhood experiences may always need to may meet may need to make a space for um a part of them that will always take and to be the loving adult to yourself and to start to set boundaries and make choices that can help keep you out of a perpetuation of the trauma because it's very common to somehow when we have trauma we tend to attract things I don't know mean to get woo. I don't really mean that but somehow our perceptual lenses or the way we hold ourselves is somehow we're receptive to behavior and abuse that can help perpetuate it. And then we can keep trying to fix it, right? Like when we wanted to as a child. So I do think that it is absolutely possible, but we have to open up to the pain from a place of capacity. So building our capacity in our physical container to hold our emotion, then have the emotion so it can be integrated and start to build new behaviors. For some people it's boundary setting where we can say what we mean, mean what we say, but not say it mean boundary setting is not slamming a door in someone's face. It's how can we grow ourselves up emotionally to have healthy boundaries it's difficult to do that when you had a lot of abuse or neglect and you have aces. So we kind of have to work the process and there's a lot of pathways and things like that to healing, but they almost all involve becoming a, you know, working with your nervous system, sort of growing up your nervous system and your capacities to regulate emotion, then being able to have emotion, meet what's in the pit that's hard in an empowered way rewire our belief systems, our behaviors and start to make new empowering choices for ourselves. So it it's a pathway for sure and it's absolutely possible happening all the time.

SPEAKER_01 36:49

Say what you mean mean what you say I've heard a hundred times I've never heard that third element but don't say it mean that's brilliant. I love that so how do adults find safety support and nurturing if they grew up not trusting people.

SPEAKER_00 37:04

Yeah I mean again I'm going to say by the time you're an adult, you know, the first uh first focus on self, you know, being aware of how we are with ourselves and being able to reach out if we can't be that loving adult to ourselves, we may need to hire people or reach out to others. I think 12-step programs and recovery programs often can do that for each other where we can somebody who can hold the space of the loving adult sort of languaging back to us. So inner bonding is a process that can be used where you notice you're triggered, you identify what's triggering and you actually literally have a dialogue with yourself to help nurture yourself. So internal family systems, inner bonding all of these processes do that. But that's a skill that can often need to be developed in in relation to a therapist. Yes. But if you can't have a therapist it's really common for groups to be able to come together reading books, listening to tapes, going through being guided through exercises that can help restore those pathways I personally think those pathways are what we're originally built for. And that the positive gets disrupted and so we're just restoring something we're not creating something that was not we can't do. We're built for this we're built for this life we're built to face suffering and challenge. I mean we're the ancestors of people who went through that right yes like is there any lineage of time where it wasn't hard yeah so we can do this but if we can't get into that relationship with ourselves and tolerate our own feelings start to practice as a daily practice you know reflection seeing how the meaning we make out of what happens ends up perpetuating it. How can we get up underneath that through journaling and these different exercises all of which are evidence-based practices. How have you done it with an ACES score of 10? Yeah I mean I think I learned early my grandmother taught me how to go into my own body when I was scared um she's told me to hide in the closet and do body scans basically which I learned later because I'm a mindfulness based stress reduction teacher as well that she was basically teaching me to go into the moment that I was safe in that closet by myself and being able to dive into it like my toe is safe my big toe is safe my next one and connect with myself and calm my nervous system which then could help my brain stay connected and develop and not just go offline where I you know I still had a lot of physical things. That's been my big thing I mean I had a lot of physical things but I was able to keep my mind present and through that skills building and I also got permission to reach out. I when you're impressionable when you're young I she basically gave me permission go knock on a door tell a teacher speak people care. People out there care when you're you know let them help you. And so I think those were the two big things but I've also been involved I mean I could have written a book about this when I was 14 because I was an allate and all the things but I hadn't really met my body impact. I was still in my mind and so I think there's a natural progression. There's only so much you can do until you're actually safe it have to you have to have be gone. And so the trauma didn't end for me until well my mom died from it. So it never really went away. So it's a life it's a life process but it turns out the things I have to do to be well are the things you're all supposed to be doing anyway whether you had trauma or not. So I just have to do it. I can't get away without it.

SPEAKER_01 40:40

So this next question is one of the top ones on TikTok searches and actually made me kind of sad because it says what does feeling safe and protected actually look like I have um I write a lot of poetry or it writes me and I also when I work with young people or children they often write them.

SPEAKER_00 40:58

And one of the poems um is about a young girl who basically said she never knew what feeling safe was like. And so if you don't know what feeling safe is like you can't titrate against it. And so you have to have some sense of that in your own body which is some of these practices can do is actually create a sense of safety in your body. It's a process it's an iterative process but once you have a sense of what it could feel like then you'll notice what isn't it. So the whole immune system functions by being able to detect what is and isn't you. Okay. So your immune system recognizes a virus and when it recognizes it, it can attack it. Autoimmunity often is where you don't do that. Something comes in that's bad and you don't fight it. Something comes in that's good and you do fight it. Right. Your body attacks itself. I think it's similar with trauma that if you never knew it's like having autoimmunity of your mind where you're attacking good things you're not really giving yourself the um you're not noticing the good or pushing away the bad. And it's very common. We don't have boundaries we let things in that we should say no to and we're not nurturing ourselves. And so it's like this getting stuck. So I think restoring through trauma healing practices and um seeking out if you can help and being very vulnerable to believe you can restore this. And once you know what it feels like to feel safe, which can take a long time in your body, but it can also go quicker there's a lot more practices now that people are doing that are making it go quicker. Then you can then start to make choices where you prioritize feeling safe not in a shutdown way, because life is hard, but in a real how do you keep yourself safe in a healthy way? But if you don't ever have it, it's very hard to create it.

SPEAKER_01 42:51

What are some of the practices that you were mentioning that make it happen quicker?

SPEAKER_00 42:55

Yeah I mean I think having a daily practice where you reflect, journal, um, spend some time with yourself in either um just quiet breathing where you're feeling your body and you're noticing you're okay in that moment, like just noticing when you are okay and taking making it a point to to relish that like being able to find a place that's safe in your home and be with yourself and notice that you do feel safe actually the chairs supporting you. Let nothing bad's happening now there is a there is a way you do feel safe sometimes and getting used to what that feels like. If for some reason your mind is going crazy and you don't can't access that, then you write down what is it that's happening? What am I noticing? What are my fears? What are my resentments? What are the things that are going on in me that's making it hard for me to feel safe and then what are the beliefs I have? What am I believing is true? What could I believe instead? Is there something I could do? And it kind of unfurls it comes fairly naturally so doing some like structured journaling reflection Reflection on, you know, being with your body, and it starts to really pick up steam. But having um that pathway, that roadmap, and those skills is really critical.

SPEAKER_01 44:10

Another of the internet questions is Is it too late to start building positive childhood experiences with my teenager?

SPEAKER_00 44:16

Oh, not at all. Not at all. I mean, the trouble is that if it hasn't been there, they may not be very receptive. Um, so you have to sort of think about well, how am I going to communicate or attract them to me to as a safe place now that I am. And so I think the best thing to do is, you know, there's a book called Parenting from the Inside Out that Dan Siegel wrote, who's one of my heroes in this whole space. And it's really where you look at your own childhood, your own sense of safety, being that safe space with yourself becomes an attractor field for your child. They'll notice. And so there's things you can say, even in your own vulnerability. You know, I'm learning about something called positive childhood experiences. And I'm aware that I would like, I wish I had that, and I would like you to have more of that. So, and you can say vulnerably your intentions and just may that may be enough to attract it, but you have to create a sacred space for it. You can't just um expect it's gonna happen overnight to not be, don't go back into shut down yourself or I'm never gonna reach my kid, they don't like me. You know, try to really grow yourself into a space where you can hold the container no matter what and have them um hopefully start to come to you when things are hard. But saying I want to be a safe place for you to come to when things are hard can do you and they may have some ideas about how to do that. Do you have any, you know, they may or may not, but it's worth asking. You know, is there anything you need or want or how could I do that? You know, to kind of make it a topic.

SPEAKER_01 45:54

Yeah. Like you said, ask them what they need, ask them what they want as opposed to impose.

SPEAKER_00 45:59

Yes, and also take it upon yourself to learn the skills, which is often going to have to do with healing yourself. Because if that didn't happen, it's not your fault. It's again, it's not what's wrong with you. It's it's what you knew or didn't know, it's what you got. And so getting on your own side and being willing to practice and experiment. Um, but you know, definitely taking a shot at asking you're letting them know what you want to do. And one of the first things that can come out when you start to restore trust is the anger. Okay. And so having to hold a space for that, it's natural. You probably notice if you're in a relationship and somebody's been really difficult and they apologize, then that's when your anger comes out. You're like, well, thank God you apologized. Let me tell you what it was like. And so having to hold space for that without then yourself shutting down as a parent and just, you know, really being a good listener. I hear what you're saying. Is there any more? Tell me more. And I can understand why you feel that way. I hear that you feel that way. Really showing up for being able to talk about things that are hard. Because sometimes when kids come to you to talk about things that are hard, what's hard for them is you. And that's okay too. Because we're always growing.

SPEAKER_01 47:08

What is the single most important safe, stable, and nurturing relationship that a child needs? I'm guessing the parent. Oh, oh, you're talking about a person.

SPEAKER_00 47:17

Yeah, I mean, I do think it's the parent ultimately, but if it's not, we all matter. It's really more that the consistency, that there's somebody that's there consistently. There's something magical about a parent obviously caring about you. And I will, I still have to remind myself that it's not my fault, that they were suffering, that they had their own. You know, my father was in World War II and was shut down at a very young age. My mother, who attracted these other people, and it was a hard time. Half of them were in the Vietnam War. I mean, it was really harsh. So I can look and see and understand what happened, but there's still a piece that can go into, I didn't matter. I wasn't worth it. You know, I was dispensable. And so when that happens, I help, I just listen. And then I try to bring in my own self-nurturing. So it's very difficult. Aside from a parent, who are the most key factors for providing a sense of security and safety to a well, I will say we just did a study um looking at teachers versus family and whether children felt heard. So first we had to define what does it mean to feel heard from a child's point of view. So this is actually in the World Health Organization Convention on the Rights of a Child that children are have the right to feel heard, have their values, wishes, and thoughts heard and matter. Wow. It's actually one of the things. Okay.

SPEAKER_01 48:41

Wow.

SPEAKER_00 48:41

So we define that. Well, what does it mean to be heard? Well, it was two things. One is the adults ask you what you feel, think, wish for, and you respond. You consider it. So it doesn't mean you go along with what they wish or want or feel or try to fix it, but they feel that you considered it. You didn't just ask, you know, kind of and then ignore them. And so we created a measure to ask you children themselves, whether they feel heard at home or at school. And it turns out that if you don't have it at home, but you have it at school, it's hugely protective. And there's a lot of research showing that teacher care and the environment and the daily life of children at school matters a lot. Um, also grandparents and other people, but it's really where you the more you it the most important people are the people you're around the most. I hear coaches, aunties, uncles. That's right. I hear a lot of people. But it's really the people you're around the most. And that every person around a child needs to take every opportunity they have to be that safe, stable, nurturing space. And if it all adds up, sometimes it's not anyone, it's a little bit of a bunch. And I think that was the case for me. I mean, I didn't see the grocery club ever every day, and I didn't see the bus driver every day, and only for a couple seconds, really. But it adds up. So even if you can't have one that is constantly there, it does add up. I mean, that's a theory of mine. I would love to test that. Yeah. But I think I mean, there's so many questions here, really. If we took it seriously, just like we did nutrition, or we hardly take nutrition seriously. But if we really want to understand something, we have to unpack it. And so I think that having positive experiences that accumulate to being protective can come through many avenues. It can be one or two uh intensive experiences of safety and nurturance. It can be a lot of maybe a lot of not the same person. I I'm not sure for me, that's what it was. Um, but I think every adult in a child's life needs to understand how much they matter and how important this is.

SPEAKER_01 50:41

So I want to flip that, even though I've probably asked this uh several times already and I don't care because I want to hear it again. So the people who can help, how can we be those people?

SPEAKER_00 50:50

Yeah, I think the first thing is can you be that for yourself and your own inner child? I know that sounds crazy. And inner child sounds like a funny term, but it's pretty intuitive for people that we have voices and places and emotional segments of our being that hold certain emotions and beliefs. Um, and if you identify inside as not being tolerant of your own emotions, your own pain, shutting down to it, it's unlikely that you're gonna be a safe place for your child's pain and difficulties as well. Especially if those pain and difficulties are about you as a parent. So there's a lot of restoration of self, that parenting from the inside out, healing yourself, being able to have the qualities of flourishing, having a sense of meaning and purpose in life. And so many of the flourishing qualities are about how can we meet what's difficult with a sense of meaning and purpose, staying engaged, seeking relationships, looking for possibilities in the midst of adversity, wanting to contribute. So it's not about getting rid of bad so much as how we show up with it. So if you look at your own flourishing, like if we looked at the flourishing scale, which is a survey you can share with people too, and they assess themselves if they're low on their own flourishing, they're probably gonna be less likely to be able to be that force for their kids.

SPEAKER_03 52:10

Yeah.

SPEAKER_00 52:11

And so, really, in many ways, you know, if they say physician, heal thyself. I think there's always that possibility. And that's at least a really important place to start.

SPEAKER_01 52:20

And after doing that and being there for your kids, I found it very healing for me. That's right.

SPEAKER_00 52:27

So they call it direction in the research, they call it biobehavioral synchrony. So when you're attaching with a child, they're attaching to you and they're regulating you and you're regulating them. Now, co-regulation is pretty much all we got. Like we say self-regulation, but even that's relating to a part of you that you're soothing. So it's still like co-regulation to another part of yourself. So really co-regulation is good for you. So there's a lot of merging evidence that when you do, when you do this with your child, it helps the health of the parent hugely. I believe that. Yeah. And so it's important to your own well-being that you're you're connecting with your kids.

SPEAKER_01 53:05

So, Dr. Bethel, if there was a magic wand and you could change one thing about how our society treats children, what would it be?

SPEAKER_00 53:14

Well, I would treat them as um full human beings that have thoughts, feelings, and wishes and wisdom and knowing. And I would engage them explicitly in a self-reflect, I would teach them how to how to own that and give them opportunities to express that in a healthy way. Because I think a lot of the unhealthy outbreaks that we get are a sense that, you know, there's something happening that I don't know what it is. We don't educate children about their own emotions. So the first thing would be to regard them through presence and connection and listening and curiosity, involving them. You know, even healthy parenting, you may not be able to let a child do whatever they want, but you can give them choices, right? You can say you can have the blue shirt or the red shirt, which do you want? You can at least start to engage their agency, engage their sense that they matter, that they have capacity, and then help nurture that capacity. But if there was one thing at a systems level that I would do is we have a lot of evidence about early childhood development and what we could be doing right now in pediatric primary care, the first 15 well visits are designed to promote safe, stable nurturing relationships. Most parents don't know that. Most physicians don't have time to do that because they're too busy screening and or they're running around. And so there's a lot of solutions we have at a systems transformation level so that there's this through-in-y-door approach, whether a child is in early care and education or at church or at the doctor's office, there's a way that everyone understands what we're talking about, looks for the avenues through which they can promote it and work together to make sure families and kids get the support they need. Um, so there's systems transformation frameworks that we've created that go down to the nitty-gritty of like policies and measures of performance and things like that. So at a systems level, we do need transformation. And um, we have a recent National Academies of Science report called launching lifelong health that came out in 2024 that is a roadmap for that. And then also recognizing the lack of well-being and the need for transforming the systems. And there was one in 2025, at the end of 2025, that was just on early relational health. So, how do we promote early relational health as a public health priority so that we can start to create um healthy society?

SPEAKER_01 55:38

It has to be frustrating to know all that and to have proven it all and to have documentation and tons of anecdotal material and know the world could be a different place.

SPEAKER_00 55:50

Yeah. Especially since we actually have system strengths, we have the systems there. We actually in primary care, we pay for all those well visits already. We have performance measures to them. We're just not doing them the way that we say we want to do them. We have national guidelines, we have knowledge, we've had knowledge. So it is frustrating. But, you know, the translation of knowledge and science of healthy development into policy and practice is a long road. It's longer because we actually, you know, don't value children in our country the way that we need to by the way our policies go. If we we know how important it is now, we can't deny it. You know, our current administration is very clear about the diseases of despair, adult disease, adult death is going up in our country from alcoholism, suicide, um, you know, smoking, all of it's up. We're like one of the most unhealthy countries in the in the world. Any industrialized country, we're like 39 out of 41, and we have been for decades because we're not prioritizing what we know we need to be well. You know, 70% of young people are not qualified to join the military because of their health, mental health, physical health. We do not have, even if all you cared about was war, we're not healthy enough. And so you have to care about what we're talking about because that's how health happens. Otherwise, what you get is young people who don't even want to go to college, don't want to have kids, and that we're seeing that. And so we're at a breaking point. And I think that the accumulated trauma of our society, that's endemic, has created these conditions where we're almost blind to the possibilities. So we're trying to shake that up. It's growing, but it's really important that we lean into the strengths and possibilities we have to turn the tide, which we know what to do. And I remember I'm a link in the chain. I honestly thought once we got the science, we have performance measures that incentivize, you know, best practice, early childhood pro health promotion, and all these issues. And we had all the measures and all that it would just fix, and it's not true, it's not true. We've had that in place and nothing's improved in 10 years. But we are not done and things take time. And I think we're the people who can help get it over the hump. That and the people the kids behind us. I think they're pretty amazing, the young people I see today. They're they're they're awake to what's happening, and I think they want something different. So we'll see how it shakes out. But I I have um ongoing faith and humility.

SPEAKER_01 58:17

I have more faith knowing that you're a link in the chain. Yeah. And I appreciate the work you do. I appreciate you bringing this to light and and proving it, not saying it'd be great if you'd, you know, it's like this matters. Yeah. And I'm great.

SPEAKER_00 58:30

And since we did that first study, there's just so much research going on because people know. So once you break, it's like the hundredth monkey, once you get something through the door, which was not easy to get a paper in the Journal of the American Medical Association, they thought PCEs were the opposite of ACEs. We had to show over and over that's not the case. You know, even though the data showed it, it was like a resistance. So we're breaking through, the research is growing, translating it into policy and practice is key, but I say free the people in the meantime. Because any adult, any parent can start this on their own, whether their healthcare provider is bringing it up or not. You we have the power because ultimately what needs to be done is within and between us.

SPEAKER_01 59:13

Amen. We will be back next week and do a deep dive into another topic. I want to just say thank you, thank you, thank you for the work you do for being here and for sharing it with you.

SPEAKER_00 59:24

Absolutely. Thank you.