Entry Category
Program Entry – Overall Social Marketing
Name of Intervention/ Program
Live Beyond
Background and Situation Analysis
Adverse Childhood Experiences, or ACEs, are traumatic events children and youth experience before age 18, such as experiencing abuse, neglect, or household challenges such as living with a caregiver who has mental illness or substance abuse challenges. Almost two-thirds of US adults have experienced at least 1 ACE, and 17% have experienced 4 or more. ACEs are a risk factor for toxic stress — the prolonged, severe, or chronic activation of the body’s stress response systems. Children are particularly sensitive to toxic stress as their brains and bodies are still developing, and without buffering support from a parent or caregiver, toxic stress can affect their brains and immune and hormonal systems. Left unaddressed, toxic stress can impact mental, emotional, and physical health into adulthood, increasing the risk of depression, anxiety, substance abuse, chronic disease, and more. Additionally, the economic impact is staggering, with ACEs-related adult health conditions costing the U.S. an estimated $14.1 trillion annually. Understanding ACEs, and the physiology of toxic stress, along with evidence-based strategies on what to do to heal and get support, is a first step in helping reduce their effects for current and future generations. In 2023, the Office of the California Surgeon General hired Civilian to create a campaign to raise awareness and support healing from ACEs and toxic stress, with the goal of reducing ACEs by half in one generation — driven by the bold vision of Dr. Nadine Burke Harris, the first California Surgeon General. While many studies have looked at adult rates of ACEs, few have looked at rates among teens and young adults. Focusing on adolescence is important, given that adolescence is an important time of development and a prime time to build an understanding of past experiences alongside skills to manage stress, strengthen relationships, and obtain support in the near and long term. To that end, Civilian worked with RAND to conduct a statewide pre-campaign baseline survey of 1,200 transition-age Californians to assess knowledge, skills, and rates of ACEs. The survey found that 3 in 5 young people ages 16–25 have experienced an ACE, and 1 in 5 have experienced 4 or more; and, similar to national trends, exposure to ACEs is inequitably distributed by race, ethnicity, and income. Despite the enormity of this public health challenge, only 10% of youth and young adults surveyed had ever heard of the term ACEs, indicating a pressing need to educate Californians about ACEs and help build skills for them to heal — for themselves, and for future generations.
Priority Audiences(s)
California youth and young adults ages 16–25 were our priority audience. Knowing that BIPOC communities, youth impacted by the foster or justice systems, and Native and rural communities in California are disproportionately impacted by ACEs and experience a dearth of support, we segmented our youth audiences accordingly. Secondarily, we focused on parents of youth ages 8–16, given that parental ACEs and toxic stress can affect the health of subsequent generations. We overlaid counties in California with high rates of ACEs scores of 4+ based on Medicaid provider screening data as an additional geographic focus.
Behavioral Objectives
Understanding ACEs and their impact is the first step toward breaking cycles of trauma and subsequent toxic stress that can lead to long-term health problems. By increasing awareness and knowledge of ACEs, promoting the belief that healing is possible, and providing practical tools and resources for healing from the effects of toxic stress, the campaign empowered those impacted to Understanding ACEs and their impact is the first step toward breaking cycles of trauma and subsequent toxic stress that can lead Understanding ACEs and their impact is the first step toward breaking cycles of trauma and subsequent toxic stress that can lead to long-term health problems. By increasing awareness and knowledge of ACEs, promoting the belief that healing is possible, and providing practical tools and resources for healing from the effects of toxic stress, the campaign empowered those impacted to take action through evidence-based stress-busting tips and guidance in seeking additional help. Given that our statewide survey showed very low levels (10%) of awareness of ACEs, despite 3 in 5 youth and young adults in California experiencing at least 1 or more, our approach to move our audiences from awareness to action was built on the following objectives: 1. Build knowledge: Build knowledge and awareness on ACEs, toxic stress, and their impacts on physical and mental health, and relationships 2. Shift attitudes and beliefs: Upon learning about one’s ACEs and toxic stress, foster a hopeful outlook that healing is possible and that one is not defined by one’s ACEs. 3. Create skills: Providing easy-to-implement, free-of-cost, evidence-based practical strategies and tips for managing the effects of ACEs and toxic stress. 4. Support further help-seeking: Promoting healing from ACEs and toxic stress through additional help-seeking behaviors and community connections, such a mental health provider, primary care provider, or peer support specialist.
Description of Strategy/Intervention
Understanding behavior change starts with understanding the beliefs and emotions that prepare people to take action. For our social marketing campaign to succeed, we needed to know how our audiences — specifically young people — would feel when they came into contact with it. This would be instrumental in opening their minds to new facts about ACEs and toxic stress. We asked ourselves, How do young people, parents, and caregivers talk about and understand issues like childhood adversity, trauma, healing, and resilience? From there, we took the following steps to develop our campaign: 1. Campaign planning and discovery: Communicating about a complex topic with low public awareness was a key challenge in developing our ACEs and toxic stress awareness campaign. We conducted extensive research through a literature review, landscape scan of national and international campaigns, and consultations to identify best practices, as our campaign would be the first of its kind to focus its messaging on youth and young adults. 2. Campaign advisory: We also assembled a subject-matter expert advisory group, including clinicians, researchers, and the current and former California Surgeons General, to inform and provide regular input on the campaign. In addition, we also partnered with ACEs Aware to assemble youth/young adult and parent/caregiver advisory boards. Board members are diverse and from across California, with lived experiences of ACEs, toxic stress, and interaction with the justice and foster care systems. We met with them monthly and offered paid opportunities for campaign content creation, activations, and speaking engagements across the state. 3. Statewide listening sessions: We held in-person and virtual statewide listening sessions with youth, caregivers, and community partners serving families to solicit input on current knowledge, perceptions, and barriers, along with our campaign’s creative, messaging, outreach tactics, and more. Based on these listening sessions we uncovered barriers that we needed to address in our campaign’s behavior change strategy. These barriers included: – Stigma and shame about past experiences and ACEs; – Varied stages of willingness to seek support for ACEs, toxic stress, and their effects. Some audience members had only just learned about the term and were understanding their childhood experiences in new ways; -Relationships matter; how ACEs and toxic stress show up in young people’s relationships (familial, platonic, and romantic) was just as important as the effects on their physical and mental health. Our campaign needed to emphasize how ACEs can shape our responses to adversity, including when it involves people we care about — coupled with positive, healthy ways to manage stress. This is a different approach than that of prior ACEs campaigns and initiatives, which focus on the longer-term health effects with calls to action centered around talking to a doctor. – Mistrust towards support services and inability to find culturally responsive care; and – An unclear path, with many sharing that healing is not linear and everyone’s journey is unique and often lengthy. Our youth audiences let the Civilian team know, in their own words, how they wanted the campaign to make them feel, and used the descriptions of hopeful, safe, deserving, supported, understood, empowered, and driven to take action. These emotions guided how the campaign looked and felt. Our formative research culminated in our grounding strategic insight we heard time and time again: healing isn’t linear. It’s a journey and means many different things for different people. But there are small things you can do today and big things you can build up to in the future to heal and grow from the effects of ACEs and toxic stress. Based on these insights, we developed our creative concepts and embarked on our creative testing plan, speaking to nearly 200 English- and Spanish-speaking youth and caregivers, inclusive of special focus groups with Native communities. We landed on a resounding winning campaign concept, Live Beyond, which evoked feelings of “hope, optimism, positivity, assurance, promise, encouragement, and empowerment.” Live Beyond created an emotional connection with clear, straightforward, genuine, and future-focused messaging. Our creative’s color palette with lavender and peach tones were perceived as “soothing, hopeful, and warm” among our audiences, who also appreciated our handwritten note elements and sunburst motif symbolizing rays of light and hope. A curved line woven throughout embodies our grounding insight: “healing isn’t linear.”
Implementation
Our collaborative youth- and audience-driven development process played a crucial role in securing state-level approvals from the California State Governor’s Office and the Office of the California Surgeon General. With our finalized campaign creative, we began implementation, which included the following: Amplifying Reach Through Trusted Voices – Youth storytelling and user-generated content: Our diverse campaign advisors were offered paid opportunities to create authentic, relatable user-generated content (UGC) — unedited videos, photos, and artwork — showcasing their healing journeys and stress management tips. Prompts included: “How I heal,” “My ‘aha’ moment,” and “My hopes for the future.” In addition, we filmed conversations on how to seek additional help — pairing youth with a provider or mental health professional — and worked with our advisors to create a patient guide and toolkit for healthcare providers. – Native youth ambassadors: Native communities are disproportionately impacted by ACEs and intergenerational trauma, and it was important for our campaign to reach them authentically. We worked with Native youth from different nations and tribes to indigenize campaign resources, with photography of local community members, a sticker sheet designed by a Native artist, and a bookmark and curated list with books that spoke to the Native experience. These youth later served as campaign ambassadors, speaking at events and leading activations. A Multi-Channel, Multilingual Strategy That Delivered Impact – The campaign website, designed with a mobile-first approach, was a hub for learning about ACEs. It featured concise, engaging content tailored to young adults without discounting the complexity of these topics. Livebeyondca.org is full of real stories reflecting our “healing isn’t linear” ethos, told by youth in their own voices with their own photos. The site was translated into Spanish and many resources were translated into AAPI languages, Arabic, and more. – A comprehensive paid media campaign was designed to reach our primary audience of transition-age youth (16–25) alongside parents and caregivers. Using consumer insight data, we strategically placed ads across digital and traditional platforms to guide people through the audience journey: increasing understanding, shifting the dialogue, building skills, and, finally, inspiring action. Ads were developed in English, Spanish, and additional languages to maximize reach. We met audiences where they lived, placing customized media in high schools, murals on community walls, and ads on community college campuses, in movie theaters, and in concert venues across the state with Live Nation. – Robust campaign toolkits featured stickers, posters, bookmarks linking to a youth- and expert-curated booklist, palm cards, a Live Beyond healing journal, tip sheets on how to bring the campaign to life locally, and a stress-busting foldable “pocket card.” They were created in digital and print formats and translated into 7 additional languages. These toolkits, along with the subsequent healthcare provider toolkit, have been mailed to hundreds of community-based organizations, healthcare provider offices, and local government partners across California. Reaching Youth Where They Are, on Their Terms – We invested in social media, in particular TikTok, recognizing it as the best platform to engage with transition-age youth. Tailored TikTok content featured the voices of youth, experts, and advocates, blending educational messages with the platform’s signature humor and trends. Instagram featured interactive stories, calming videos, and strategic reposts from trusted sources. This approach allowed us to effectively reach target demographics, with TikTok and Instagram aligning with younger audiences and Facebook engaging slightly older audiences. – We partnered with South Central Los Angeles’s renowned Drew League, a basketball league and organization that provides mentorship and basketball coaching for at-risk youth. Live Beyond sponsored their 2024 season with the support of high-profile NBA and WNBA coaches and players at interactive community events. We also worked with prominent Drew League talent to curate and share videos about ACEs, toxic stress, and healing in organic and authentic ways. This collaboration yielded over 1 million hyper-targeted impressions and significant word-of-mouth promotion from celebrities and community members alike. Sparked Conversations in New Spaces – Given that 90% of Gen Z are online gamers, we partnered with Valkyrae — YouTube’s most-streamed female gamer and a top influencer — to amplify our message across her channels, resulting in more than 260K views. – We also pursued high-impact collaborations, including one with Twitch and Refinery29 for three episodes of Good Game, a hit show engaging BIPOC, non-binary, and female gamers. Each episode featured influential gamers and subject-matter experts candidly discussing ACEs — generating nearly 1.3 million views, significantly broadening our reach and engagement.
Evaluation Methods and Results
Civilian’s Live Beyond campaign is a testament to the power of healing through authentic storytelling in the places and spaces our audiences spend time in. Since its launch in May 2024, Live Beyond has sparked a statewide conversation about ACEs and toxic stress, resilience, and collective healing. To date, the campaign has achieved: – 740 million+ paid and organic social media impressions – 18 unique earned media placements resulting in 700 million+ potential earned impressions – 1.7 million users accessing campaign resources on the Live Beyond website, with 22% choosing Spanish-language resources – 6,500+ engagements across organic social channels, with an average monthly follower growth rate of 44%, indicating that the content is both attracting new followers and successfully retaining their interest – $2.47 million in additional media value through earned media, sponsorships, and bonus placements — ensuring critical messages reached even more young people – 200,000+ unique viewers of the Valkyrae livestream event – Nearly 300 partners utilizing campaign resources through our campaign toolkits in community activations across the state Our campaign’s evaluation will conclude with a statewide post-campaign survey, conducted by RAND, and a robust process evaluation to measure shifts and changes in awareness, knowledge, attitudes, and behaviors related to healing from ACEs and toxic stress. Results are expected in early summer 2025.
Entry Letter: C