My daughter knows over 21 people that have died from drug overdose or suicide: cross-sector rural provider perspectives on adverse childhood experiences

Background Cumulative exposure to adverse childhood experiences (ACEs) is associated with an increased risk of substance use, overdose, and suicide. Rural children are more likely to experience most ACEs. There is limited literature contextualizing rural individuals’ experiences with ACEs. Public Health 3.0 calls for multisector partner engagement to generate collective impact. The purpose of this study was to evaluate rural providers’ perspectives on challenges and recommendations for ACEs mitigation in their community from a cross-sector context. Participants and setting Participants were 74 providers enrolled in an online ACEs training. Participants lived and/or worked in five rural Missouri counties with high drug overdose death rates. Methods This was a conventional content analysis of written responses to structured discussion prompts from three training modules. Analysis included familiarization, inductive identification of major codes, and refinement of codes, followed by independent coding by two authors until consensus, and reporting major patterns. Artificial intelligence supported preliminary code development. An adapted Sequential Intercept Model (SIM) framework organized challenges and recommendations by setting. Results Results included personal stories about how ACEs impacted their communities through overdose, suicide, homelessness, unemployment, and adverse health effects. Settings included schools, government, healthcare, daycares, criminal justice, Extension, fire departments, libraries, and nonprofits. Participants recommended expanding the ACEs definition to include satanic abuse, bullying, incest, war, genocide, military family stressors, and death of a loved one. Intervention recommendations included whole-family interventions, community-wide training, trauma-informed training, expanded access to treatment, classes in prison/jails, and fostering positive childhood experiences. Conclusion Community voice is necessary to contextualize setting-specific insights that inform development of upstream interventions appropriate for and tailored to the community. Participants identified both strategies that could be incorporated into everyday practice—including empathy, listening, providing judgment-free and safe spaces, providing food for children experiencing hunger, encouraging positive childhood experiences, mentoring, and connecting individuals with resources for food, shelter, clothing, and mental health—and broader structural changes that may require policy-level action. The adapted SIM organizes these concepts.