Rationale and design for a community-engaged intervention addressing the intergenerational transmission of adverse childhood experiences (ACEs): a hybrid implementation-effectiveness study protocol.

Background: Adverse childhood experiences (ACEs) are traumatic experiences (e.g., abuse) that can have a profound negative effect on a child's developing brain and body with lasting deleterious impacts on a person's mental health and chronic disease risk throughout the lifespan. Exposure to ACEs is often repeated generation to generation. STANCE (Supporting Trauma Awareness and Nurturing Children's Environments) was developed, in partnership with a rural community in Colorado, to prevent the intergenerational transmission of ACEs. STANCE is employing community-based participatory research (CBPR) principles to develop and test a multi-level community intervention to promote socioemotional development in young children, enhance parenting skills, and strengthen a comprehensive system of care to meet the needs of young families who have experienced ACEs.

Methods: An effectiveness-implementation hybrid study of STANCE is being conducted in the San Luis Valley of Colorado, a rural community with a majority Hispanic population. The primary effectiveness outcomes are being evaluated in a pragmatic public health trial using a stepped-wedge cluster randomized design that includes 16 early childhood education centers. A mixed-methods, prospective case study with a social network analysis approach will inform the primary implementation outcomes which were drawn from the Consolidated Framework for Implementation Research (CFIR).

Discussion: This study evaluates the effectiveness and implementation of an ACEs prevention intervention for young children and families living in a rural community. If successful, this trial will inform the use of evidence-based intervention strategies to address ACEs and provide a framework for dissemination and implementation to other rural communities.