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Maternal and Child HealthMental Health and Well-Being

Adverse Childhood Experiences and Trauma-Informed Policy Approaches

October 24, 2017


Guided by a growing body of multidisciplinary research, policymakers are increasingly recognizing the role that adverse childhood experiences play in health and well-being, and are beginning to champion a burgeoning number of trauma-informed policy approaches across the nation.  

An adverse childhood experience (ACE) refers to a “traumatic experience in a person’s life occurring before the age of 18 that the person remembers as an adult.” Examples of ACEs may include (but are not limited to): physical, emotional, or sexual abuse; domestic violence toward a parent; mental illness of a household member; substance abuse of a household member; incarceration of a household member; divorce or separation of a parent; and lack of basic necessities. The latest 2016 National Survey of Children’s Health revealed that over 46 percent of children in the United States have experienced at least one ACE.

The landmark 1998 Adverse Childhood Experiences Study established the correlation between the accumulation of adversity during childhood and poor health outcomes. Advances in neurobiology since then have helped to explain the connection: Exposure to extreme or prolonged patterns of stress during childhood can cause a variety of changes in brain structure and function, leading to enduring neurobehavioral consequences. If unrecognized and untreated, ACEs may negatively affect health and well-being throughout the life span and can be a powerful determinant of health outcomes.

However, not all ACEs cause lifelong problems for a child. Trauma-informed practices, such as early childhood interventions that mitigate social and environment risks for the family, can promote resilience and better developmental outcomes. Promising community-level approaches can also ameliorate the impact of ACEs, especially in communities that have suffered generations of poverty or historical trauma culminating in toxic stress and poor health outcomes.

The research on ACEs has continued to evolve and deepen over the years, and has been influencing policy and practice in an increasingly diverse array of sectors—from pediatrics to public education to juvenile criminal justice systems, to name a few. This fall, the journal of the Academic Pediatric Association, Academic Pediatrics, dedicated an entire special issue to Child Well-Being and Adverse Childhood Experiences in the United States, which represented the culmination of a four-year effort to engage stakeholders across multiple sectors.

Policymakers have taken note of the growing body of ACE research, and there has been a promising surge in proposed policies that recognize the impact of ACEs and incorporate trauma-informed approaches. In March of 2017, the National Conference of State Legislatures (NCSL) identified almost 40 bills proposed in 18 states that specifically include language on ACEs. This represents a dramatic increase from the handful of bills that NCSL identified in 2016.

The NCSL noted several trends in the proposed bills that specifically mention ACEs. Some of the policy approaches presented in these bills include:

ACEs Connection has also been tracking proposed bills and enacted statutes that include references to trauma-informed policy or would have the effect of mitigating ACEs (with or without a specific mention of ACEs or trauma-informed practices). This scan revealed 20 enacted statutes in 15 states that aim to mitigate ACEs.

The momentum to integrate trauma-informed practice into state policy approaches is very encouraging. There have also been a number of innovative non-profit initiatives aimed at promoting trauma-informed practices at the community level and across sectors. For example, Mobilizing Action for Resilient Communities is working with communities to pilot trauma-informed programs and to promote best practices. Innovative community approaches, such as the Building Community Resilience (BCR) model, aim to create an integrated network of partners across child health and community-based agencies to address the root causes of toxic stress and childhood adversity. Advancing Trauma-Informed Care, led by the Center for Health Care Strategies, is also overseeing trauma-informed pilot projects in the health care sector. Collaboration and engagement with local communities and across different sectors will be critical to effectively serve people with histories of trauma.

This area is ripe for ongoing policy surveillance and analysis of how different policy approaches are affecting trauma-informed practice and populations with high ACE scores. The Network plans to continue to focus on legal and policy issues relating to ACEs and trauma-informed practice. If you have questions about these issues and would benefit from legal technical assistance, please feel free to contact the Network.

This post was developed by Brittney Crock Bauerly, J.D., Staff Attorney for the Network for Public Health Law–Northern Region.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult an attorney in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.