**Background:** Adverse childhood experiences (ACEs) are prevalent stressors linked to poor health outcomes across the lifespan, including cancer, heart disease, depression, and substance abuse. Nearly 60% of the US population has been exposed to at least one ACE, with disproportionate burden among low-income and racial/ethnic minority populations. Despite well-documented associations, few interventions target secondary prevention by building resilience in children exposed to ACEs who have not yet developed behavioral or health problems. School-based delivery offers potential for broad reach, but implementation evidence is limited. The Reaching Out to Kids with Emotional Trauma (ROcKET) intervention was designed as a healthy-lifestyle, resilience-building program for this population.
**Methods:** This single-arm, single-centre feasibility study was conducted between October 2018 and May 2019 at a K-4th grade charter school in Nashville, TN, where 96.1% of students are children of colour and 100% qualify for free or reduced lunch. Children were eligible if parents reported at least one ACE on a screening questionnaire. The ROcKET intervention comprised three levels: (1) 12 weekly 30-minute in-school child sessions led by the school psychologist, focusing on health behaviours, goal setting, and mindfulness; (2) 12 weekly 60-minute afterschool family sessions led by trained teachers, covering nutrition, physical activity, sleep, media limits, and parenting styles; and (3) a school-wide social-emotional learning curriculum based on the CASEL framework. Teacher facilitators were required to score ≥90% on training module quizzes. Outcomes were assessed using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative data included participation rates, fidelity observations, and attendance records. Qualitative data were collected via focus groups with 13 parents who attended at least one session; transcripts were analysed using an inductive, theoretically driven approach.
**Key Results:** Of 105 eligible children, 57 (54%) enrolled with their parents. Enrolled children had a median age of 6.6 years (IQR 3.8); 54% were female; 82% were Black/African American, 9% Hispanic, and 9% white. Among participants, 46% had 1 ACE, 26.5% had 2 ACEs, 14.3% had 3 ACEs, and 1.2% had ≥4 ACEs. The school staff implemented all planned sessions with >90% fidelity. Average attendance at in-school child sessions was 87% (57 students). Among parents, 61% attended at least one family session, and 44% attended at least half. Of children who completed the final intervention session, 91% (52 of 57) completed 6-month follow-up assessments. Attrition was 9%. Qualitative data from 13 focus group participants (23% of enrolled parents) indicated high satisfaction, uptake of positive health behaviours (e.g., consistent bedtimes, family meals without TV, reduced screen time, increased water intake), and perceived improvements in quality of life, including stronger family relationships and increased community connection with other parents and school staff. Facilitators of participation included the reputation of Vanderbilt University Medical Center, provision of dinner during sessions, convenient timing (5:30–7:00 pm Tuesdays), and gift card incentives. Barriers included lengthy initial surveys, transportation challenges for bus riders, work schedules, and fear of child welfare involvement.
**Clinical Implications:** This feasibility study demonstrates that a multilevel, school-based resilience intervention for children exposed to ACEs can be implemented with high fidelity and acceptability in a low-resource, minority-majority school setting. Key organisational enablers included engaged school leadership, alignment with perceived community needs, and the perceived legitimacy of the intervention source. The findings support the potential for schools to serve as platforms for health disparity interventions, though barriers such as survey burden, transportation, and parental mistrust must be addressed. The authors plan to use these results to inform a larger pilot randomised controlled trial. Limitations include the single setting (a charter school with high autonomy), lack of quantitative effectiveness outcomes, no cost analysis, and absence of follow-up interviews with children or non-participating families.