Adverse childhood experiences (or ACEs) are traumatic events such as abuse, neglect, and household dysfunction that can have lifelong impacts on health and well-being.¹ Addressing ACEs is challenging in rural communities due to limited access to services, geographic barriers, and social stigma.²

Cross-sector networks, where multiple organizations collaborate, have emerged as a powerful community-scale approach to address ACEs.³ However, little research has examined how these networks change over time and how they respond to interventions to improve their partnership structure.

We are excited to share our newly published research, “Shifting connections: Assessing changes in a rural social network addressing adverse childhood experiences over time,” in the Journal of Public Health Management and Practice. This study provides critical insights into how community networks that address ACEs change following intervention in rural settings. It also builds on our previous research exploring the baseline structure of this network.⁴

Research Approach

Our study tracked changes in an ACEs-focused inter-organizational network of care in the San Luis Valley (SLV), Colorado over three years. Using a pre-post design, we examined how the partnership network changed from 2020 to 2023 with regard to members’ information exchange, tool-sharing and development, and general resource exchange.

Between our two data collection periods, we implemented a targeted network-building intervention to enhance collaboration among service organizations. This included:

• Creating a subcommittee focused on early childhood and information-sharing
• Hosting a networking event to bring together agencies working on ACEs
• Overall, strengthening partnerships between service providers

We collected and analyzed data using the PARTNER^TM Platform⁵ to assess changes in the information exchange, tool sharing, and resource sharing sub-networks from the first to second time point. We tracked several key metrics:

• Clustering: The tendency for one’s partners to be partners with each other. This is critical for developing trust and shared social norms.
• Centralization: How relationships concentrate around key organizations within a network. This is an indicator of centralized leadership and communication.
• Average path length: The average degrees of separation between members of the network. This measures how easily members of the network can reach each other.
• Density: Overall network connectivity. This tells us how many of the possible network connections exist.

Key Findings

We identified notable improvements in the network’s structure from the first to the second time point:

• Increased centralization: Key organizations played a stronger leadership role in improving network coordination
• Higher clustering and density: Organizations had more connections, and those connections were also connected to each other, creating an environment to support trust, shared social norms, and shared work.
• Shorter path lengths: Information and resources needed to cross a shorter distance to move through the network.

These findings demonstrate that intentional network-building efforts can enhance community collaboration in support of children and families experiencing ACEs. Other rural communities addressing ACEs may benefit from similar efforts to evaluate their networks, take action, and evaluate change.

What’s Next?

Next steps for this work include expanding this research to other rural communities and further investigating how network changes translate into real-world benefits for children and families.

To learn more, check out the full paper in the Journal of Public Health Management and Practice!

Funding and Acknowledgments

We’d like to acknowledge the co-authors of this article, Dr. Jamie Powers, Marlayna Martinez, and Dr. Danielle Varda without whom this manuscript would not have been possible.

This research was funded by the Centers for Disease Control and Prevention (CDC) under the Supporting Trauma Awareness and Nurturing Children’s Environments (STANCE) study (Grant: 6 U48DP006399-01-01).

We would like to thank our San Luis Valley (SLV) Community Advisory Board (CAB) members who were instrumental in identifying Adverse Childhood Experiences as a research topic for us to focus on, as well as the SLV community stakeholders who completed the social network analysis survey.

We also conducted this research with partners from the University of Colorado’s Rocky Mountain Prevention Research Center, whose skills and expertise were invaluable in advancing this work.

References

1. Danielson R, Saxena D. Connecting adverse childhood experiences and community health to promote equity. Soc Personal Psychol Compass. 2019;13. https://doi.org/10.1111/spc3.12486doi:10.1111/spc3.12457
2. Crouch E, Radcliff E, Probst JC, Bennett KJ, McKinney SH. Rural-Urban differences in adverse childhood experiences across a national sample of children. J Rural Health. 2020;36:55-64. doi:10.1111/jrh.12366
3. Rog DJ, Reidy MC, Manian N, Daley TC, Lieberman L. Opportunities for psychologists to enact community change through adverse childhood experiences, trauma, and resilience networks. Am Psychol. 2021;76:379-390. doi:10.1037/amp0000778
4. Lawlor JA, Puma J, Powers J, et al. Understanding rural social networks addressing adverse childhood experiences: A case study of the San Luis Valley. Fam Syst Health. Published online 2024. doi:10.1027/fsh0000894
5. PARTNER CPRM. Visible Network Labs. November 5, 2024. http://www.partnertool.net/