By Rochelle Sharpe For The New York Times Not far from the scenic San Diego coastline, a local internist discovered an unsettling truth nearly 30 years ago: Childhood trauma could lead to lifelong health damage. Abuse victims often felt devastated when they learned about the landmark research, known as the 1998 adverse childhood experience (ACE) study, which showed that childhood trauma could significantly increase risks of cancer, heart disease, stroke, alcoholism and suicide. But research now points to ways of mitigating these long-term effects and has led to a framework that is being adopted by educators, health care workers and social service providers around the world. In his research, Dr. Robert Sege sought to understand how trauma victims could avoid lifelong suffering. (Gabriella Angotti-Jones / The New York Times) Nowhere is it being embraced more enthusiastically than in San Diego, home of the original ACE research, where a local university, the county welfare department and the nation’s largest YMCA are all banding together to transform the community’s health. “The change is so profound,” said Dr. Pradeep Gidwani, medical director of the American Academy of Pediatrics’ San Diego area chapter. “It shifts the paradigm from ‘What is the problem’ to ‘What can I do about it.’ ” The 7-year-old framework, called Healthy Outcomes from Positive Experiences (HOPE), is the brainchild of Dr. Robert Sege, a Massachusetts pediatrician. As evidence emerged showing the brain rewires itself after good as well as bad events, Sege spent years exploring why some people manage to emerge unscathed from horrific childhoods. After figuring out the protective value of key positive experiences, he devised a way to translate his insights into action. “We are not the sum of all of our problems,” said Sege, director of HOPE’s National Resource Center at Tufts Medical Center, in Boston. HOPE presents four broad pillars that can promote healing: supportive relationships, safe environments, opportunities for emotional growth and social engagement that promotes a sense of belonging. More than 100,000 health and social service providers have been trained on the framework, which helps them identify people’s strengths rather than focus primarily on their deficits — a shift that fosters resilience and agency. “It has transformed my life — my communication with my patients and their parents, my parenting of my own children, my approach to cultivating my own well-being and how I look at my community,” said Dr. Wendy D. Pavlovich, a San Diego pediatrician. One of the big challenges of adversity work is that clinicians can’t take adversity away, Pavlovich said, adding that, with HOPE, “I really have an evidence-informed plan to amplify what the family is already doing and cheerlead on that.” Pediatricians who use the framework say that highlighting positives in people’s lives bolsters trust. The doctors work, in part, as family advocates, helping marginalized patients believe in themselves, Gidwani said. “We heal through relationships. That’s how we really make change.” Some public health scholars question whether the framework is too broad. “People are looking for that checklist,” said Dr. Andrew Garner, a pediatrics professor at Case Western Reserve University, in Cleveland, who has written several position papers on child adversity for the American Academy of Pediatrics. “Its strength is also its weakness.” But checklists can be rigid. Pavlovich worked for years with a California initiative that encouraged pediatricians to screen all patients for trauma. Now she starts each appointment asking patients about what’s going well for them or to describe recent moments of pride. When a pediatric resident at Stanford University asked a young mother about her strengths, Sege said the woman burst into tears, saying, “No one has ever told me I’m doing something right before.” It’s a significant change from the 1980s, when Dr. Vincent J. Felitti discovered the pervasive, lifelong effects of child trauma. He was running a radical weight loss program at Kaiser Permanente, when one of his patients, who had dropped from 409 to 132 pounds in less than a year, then regained all her weight at a rate that he had not considered physiologically possible. Felitti learned that the patient had started eating in her sleep after an older married man propositioned her at work. She also had eaten in her sleep as a child, when her grandfather began sexually abusing her at age 10. Felitti’s study initiated new avenues of research and screening tests to assess childhood trauma damage on a 10-point scale. But Sege began questioning why the majority of people who endured child trauma did not suffer dire health consequences. Having devoted much of his career to examining ways to build resilience, he often recalled an insight from Dr. Carl Bell, a psychiatrist in Chicago who became an international leader in youth violence prevention: “Risk factors are not predictive factors because of protective factors.” Sege analyzed dozens of studies, searching for common elements of programs that helped children overcome health and behavioral challenges. Some colleagues dismissed this work as fuzzy. “It’s not fuzzy at all,” he rebutted. “It’s just unexplored.” Using the same methods as the landmark ACE study, Sege partnered with other researchers to design a survey that examined positive childhood experiences. The research showed that trauma victims who escaped lifelong suffering shared many common experiences in childhood, such as enjoying supportive relationships. The effects were quite potent. Alondra Diaz Ruiz hugs a student while playing during a preschool class at Copley-Price Family YMCA in San Diego, Jan. 9, 2026. The HOPE framework outlines four building blocks that can guard against trauma: supportive relationships, safe environments, opportunities for emotional growth and social engagement that promotes a sense of belonging. (Gabriella Angotti-Jones / The New York Times) Those who had the most positive childhood experiences were 72% less likely to suffer from poor mental health than those who had the fewest, the research found. In fact, children who endured the most trauma but had strong support from families and communities fared better than children who had rarely experienced adversity but lacked similar relationships. Since Sege published his initial findings in 2017, there have been more than 50 other retrospective studies and five longitudinal studies correlating these experiences with lower risks of mental illness and cardiovascular disease, less alcohol use, and rates of teen pregnancy and recidivism. Some studies also found reductions in persistent insomnia and C-reactive protein, a clinical marker for inflammation. In 2024, the Centers for Disease Control and Prevention gave local health groups more than $5 million to reduce child trauma, including strategies that boost positive childhood experiences. “They have such a strong protective effect,” said Phyllis Niolon, a senior adviser for the agency’s National Center for Injury Prevention and Control. “They can improve health outcomes for the entire population in a relatively inexpensive way.” *** Jamillah Johnson was recovering from opioid addiction when she gave birth to a severely premature boy. Tufts Medical Center in Boston treated the infant for a heart condition and a partially developed lung. But within a few years, it became clear that the boy also had autism and attention-deficit/hyperactivity disorder, said Dr. Shirley Huang, chief of general pediatrics at the medical center. Johnson and her son were both completely overwhelmed, Huang said, with the mother struggling to handle her child’s physical and behavioral troubles. Dr. Shirley Huang uses HOPE principles in her work at Tufts Medical Center in Boston. (Gabriella Angotti-Jones / The New York Times) Huang said she used HOPE principles to go beyond just tending to their immediate problems. Her first priority: safety. Johnson and her son were under threat from a relationship that had turned abusive, so Huang helped them move to a new neighborhood. To make sure the family would not feel isolated in their new home, Huang and the clinic’s social workers connected them with organizations in their community, such as the Special Olympics. The medical team also referred them to therapy, aiming not only to help them with their individual problems but also to deepen their relationship. Johnson said the staff’s unwavering attentiveness made all the difference. “I didn’t feel alone,” she said. Huang is amazed by the progress of both mother and son. “She’s stepped up in a way that I could not have predicted,” she said. During a recent doctor’s visit, Johnson’s son, then 6, was having an uncharacteristically bad day. He threw shoes at his mother’s head and screamed profanities. But Johnson gently reminded him to use polite words. When he ran out of the exam room, she retrieved him with a smile and used chitchat and distraction to get him to cooperate with the doctor. Now 7, her son is so much calmer that his school moved him from a special education classroom to an inclusive one, and in 2024, he was able to start attending summer camp. HOPE is now being used in ways that Sege never envisioned. A preschool class at the Copley-Price Family YMCA in San Diego, where officials have embraced the HOPE framework. (Gabriella Angotti-Jones / The New York Times) In Harford County, Md., Bernard Hennigan, an assistant school superintendent, began including HOPE materials in bags distributed in maternity wards so parents could learn about the framework before their children are school-age. Hennigan goes to libraries, day care centers and parent-teacher association meetings to explain how schools can amplify HOPE’s four building blocks — encouraging extracurricular activities for all grades to foster social engagement and provide safe environments after classes. Related Articles Minnesota sues to block Trump administration’s withholding of Medicaid funds Do energy drinks offer benefits beyond caffeine? All the News That’s Fit: The ultraprocessed angle, cabbage crunching and discontinued body parts Trump’s Medicaid work mandates are meant to save money. But first states will have to spend millions He got sober. Now he wants to help others do the same through a new UCSD program. “Parents are really receptive to this because it’s easy,” Hennigan said. They also like the focus on family strengths, which “helps them see how they can use them to fix problems.” In San Diego, officials are trying to make the entire county HOPE-informed. Managers from the welfare department, the YMCA, San Diego State University and Rady Children’s Hospital meet regularly to discuss their efforts. Aiming to keep children out of foster care, the welfare department — now renamed the Department of Child and Family Well-Being — recently opened an office that offers families extensive support. After investigating abuse allegations, the department refers closed cases to this office, where the staff helps clients with housing, mental health services or other needs. To build resilience, the staff requires families to create their own “well-being plans,” which could include trying therapy or possibly starting weekly movie nights to boost parent-child bonds. SDSU is now taking the framework beyond clinical services to become the nation’s first HOPE-informed university. Bubbles filled with smoke, meant to emulate snow, float above students during a winter wonderland fair at Ocean View Hills Elementary School in the San Ysidro School District. (Gabriella Angotti-Jones / The New York Times) Through students, HOPE principles can become self-replicating and possibly disrupt intergenerational cycles of abuse, said Lori Clarke, director of the Social Policy Institute at SDSU. Shelly Paule, an SDSU lecturer and former social worker, encountered the same person twice as a client, decades apart — first as an abused child and later as a mother abusing her child. Paule helped the university pilot a project during the last academic year, infusing the principles into her social work course. Students developed closer relationships with their peers and felt more satisfaction helping distressed clients, a project evaluation showed. This year, the university began more pilots to improve gender equity, integrate ex-prisoners into college classes and help developmentally disabled students develop plans after high school. As Sege continues his work, he’s more convinced than ever that the effects of child trauma need not last a lifetime. “We’re perfectly capable of healing,” he said. ...read more read less