State Actions to Prevent and Mitigate Adverse Childhood Experiences

Experiencing adversity early in life can affect a person’s health, well-being, and success into adulthood. A groundbreaking study by the Centers for Disease Control and Prevention and Kaiser Permanente, released in 1998, found that adults who experienced adverse childhood experiences (ACEs), ranging from physical
and emotional abuse, and neglect to various forms of household dysfunction, in sufficient duration and intensity, had significantly elevated risk of heart disease, diabetes, substance use disorder, smoking, poor academic achievement, and early death. COVID-19 has brought additional attention to the impact of ACEs and trauma across the lifespan, which may be exacerbated by disruption in the lives of families; increased family stressors; income, food, and housing insecurity; social isolation; and school closures. Recognizing the critical role that Governors and their staff can play in implementing policies that can prevent and mitigate ACEs, the National Governors Association Center for Best Practices, in partnership with the Duke-Margolis Center for Health Policy and the National Academy for State Health Policy, conducted an intensive, multi-state technical assistance project on statewide approaches to address ACEs across the lifespan, starting in June 2020. Across the work with the selected five states, the following areas of focus emerged: Establishing trauma-informed states by creating a holistic, cross-agency vision for cultural change; Developing a common, statewide language and lens around trauma and ACEs and implementing universal trauma awareness communications and/or training; Improving the quality of ACEs surveillance data; and Increasing access to ACEs screening and developing a comprehensive, trauma-informed system of care. As a capstone of this project, this paper highlights lessons learned from states that served as models for statewide approaches that prevent and address ACEs and the development of trauma-informed policies (Alaska, California, New Jersey, and Tennessee). The paper also addresses the goals, policy, and programs developed and launched by states that were selected for the project (Delaware, Maryland, Pennsylvania, Virginia, and Wyoming).

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