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Rural Health Information Hub

Considerations for Services Integration Programs for Children

There are several considerations for rural services integration programs serving children.

Adverse Childhood Experiences

Childhood trauma and adverse childhood experiences (ACEs) have been linked to brain development, the immune system, hormonal systems, and other health outcomes. ACEs include:

  • Physical, emotional, or sexual abuse
  • Neglect
  • Parental mental illness, substance dependence, incarceration
  • Parental separation
  • Domestic violence

The Adverse Childhood Experiences (ACE) Study, conducted from 1995 to 1997, explored the associations between childhood maltreatment and health and well-being later in life. The study found that 67% of the population has at least one ACE and 12.6% (one in eight) have four or more ACEs. Childhood ACEs are associated with developing health conditions later in life ranging from cancer to depression. These results reinforce the importance of services integration programs that can improve the lives of children and families.

One resource that may be useful to services integration programs is the National Child Traumatic Stress Network. This network contains information on creating a trauma-informed child- and family-service system, as well as a database of evidence-based treatments and promising practices and other resources for helping children and families who have experienced trauma.


Rural communities need to involve a wide range of stakeholders, gatekeepers, and partners when implementing a services integration program for children. These stakeholders can include:

  • Juvenile courts
  • Foster parents
  • Grandparents
  • Other caregivers
  • Schools
  • Social workers
  • Child welfare organizations

These stakeholders can offer expertise and access to networks that allow a services integration program to better meet the needs of children. Programs must build trust among parents and caregivers and involve them throughout the process.


Services integration programs that serve children must have consent from parents and guardians to provide treatment. One rural school-based services integration program included enrollment forms in the school's packet of back-to-school paperwork to increase the likelihood that parents would review the form. Other school-based programs may choose to obtain permission at the point of service.

Age-Appropriate Materials

Program staff should review all educational information provided to children to ensure that the content is age-appropriate and relevant for the targeted age group. For example, one rural services integration program developed a curriculum on healthy behaviors for fourth and fifth graders to ensure they understand the importance of healthy eating and physical activity.