In the two decades since the original ACE study, many publications have added to the body of research on childhood trauma, including effective strategies to prevent and manage negative consequences. For example, many of the recommendations for achieving strong physical health—adequate sleep, good nutrition and regular exercise—are also useful for protecting children from the harms of ACEs. Efforts that focus on building healthy families early in life are cited as significant means to prevent ACEs and reduce their damaging effects. Social support and stress reduction strategies, such as mindfulness and psychotherapy, are also well supported.
The CDC developed a resource tool focused on preventing ACEs that highlights evidence-based approaches. These approaches include strengthening economic supports for families; promoting social norms that protect against violence and adversity; ensuring a strong start for children; teaching skills; connecting youth to caring adults and activities; and intervening to lessen immediate and long-term harms. Many of these strategies are explored below. State policies may include strategies to help parents reduce stress, build resilience in children and families, and increase screening and treatment for ACEs.
Know the Data
The Behavioral Risk Factor Surveillance System (BRFSS), an annual phone survey administered by the CDC, collects state data on health-related risk behaviors, chronic health conditions and the use of preventive services. Each year, residents in 50 states, the District of Columbia and three U.S. territories complete the survey. Since 2009, 48 states and the District of Columbia. have included ACEs questions in their BRFSS survey for at least one year, making it a tool for identifying state-specific trends in ACEs.
Support Parental Stress Reduction
Nearly a quarter of U.S. children live below the federal poverty level, and in almost every U.S. state, economic hardship is one of the most common ACEs. Economic hardship affects children because it can cause high parental stress and increase the likelihood of kids experiencing abuse or neglect. Efforts to strengthen families’ economic security may help reduce parental stress, establish greater household stability and protect children. Policies such as earned income tax credits, minimum wage increases and full pass-through child support payments, according to research, are some mechanisms for reducing ACEs.
Some strategies may include:
Earned Income Tax Credit (EITC)
The EITC is a policy the federal government, some states, the District of Columbia and some municipalities have implemented to support the economic security of low-income working families, especially those with children. Learn more about the EITC and state examples on NCSL’s webpage Tax Credits for Working Families: Earned Income Tax Credit.
NCSL tracks state minimum wages and legislation.
Child support is the payment by a parent to support a child or children of whom he or she does not have full custody. All states and territories operate a child support enforcement program.
Two-generation strategies simultaneously address the needs of parents and children to improve outcomes for the whole family. States approach two-generation strategies through programs focused on children, on parents and on supporting family economic success (for example, New England's Whole Family Approach to Jobs initiative).
Federal Nutrition Programs
The U.S. Department of Agriculture administers various programs and services that increase food security and reduce hunger through access to nutrition education and affordable, healthy food, such as:
Paid Family or Sick Leave
Paid family leave provides compensation for extended time away from work for specified family and medical reasons, such as the birth of a child or to care for a family member with a serious health condition. Paid sick leave provides compensation for time off related to personal medical care.
The Center on the Developing Child at Harvard University offers three principles for policymakers to consider in helping families with young children thrive: enhancing responsive relationships, strengthening core life skills and reducing sources of stress. These principles target characteristics of the individual, family and community that are associated with physical health. Strategies that expand access to quality early child care and education, and that increase positive parenting skills and safe, stable and nurturing relationships, can strengthen protective factors and improve lifelong health.
Home visiting programs employ nurses, social workers, early childhood educators and other trained professionals to visit families in their homes during pregnancy and early childhood. These programs teach positive parenting skills (including best practices for coping with stress), provide health education and connect families to supportive services.
Home visiting is linked to improved school readiness, higher quality parenting, more positive child-parent interactions and improvements in parents’ mental health as they develop more responsive connections to their children. Home visiting reduces the likelihood of abuse and neglect.
The Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, a federal initiative, provides states with substantial resources for home visiting.
In 2019, Oregon enacted SB 526
to direct the state Health Authority to design, implement and maintain a voluntary statewide program to provide universal newborn nurse home-visiting services to all families to support healthy child development and strengthen families.
Utah passed the Nurse Home Visiting Pay-for-Success Program (SB 161
) in 2018 to create an evidence-based nurse home-visiting program.
Quality Early Child Care and Education
In addition to building secure attachments with caring adults, access to early childhood education is a promising pathway to resilience. Early learning opportunities allow children to think, play and explore, which exercise critical executive functions such as “working memory” and self-regulation. Early childhood education supports social and emotional development, which includes building self-confidence and positive relationships. It also instills in children the motivation, persistence and other life skills necessary to be inventive, flexible and functional adults, and to be resilient in the face of life’s challenges.
Increase Screening and Treatment
Approximately 27 percent of U.S. children experience a diagnosable mental or behavioral disorder, such as depression, anxiety or attention-deficit/hyperactivity disorder (ADHD). For people with ACEs, the likelihood of developing one or more of these disorders is significantly greater. Frequent classroom interruptions, aggression, underperformance, truancy, poor attitude, bullying and social withdrawal are symptoms commonly expressed by children struggling to manage a learning or behavioral issue.
Schools and child care centers are uniquely positioned to detect these issues early and link children to supportive services and formal assessments. Early interventions may mitigate the direst consequences of childhood trauma and frequently demonstrate positive effects on long-term health. Specifically, efforts by schools and child care settings to consider a child’s history of trauma and subsequent coping strategies—an approach commonly called trauma-informed care—are likely to be highly valuable in mitigating some of the consequences of ACEs.
Children who grow up in households with family members with an untreated substance use disorder (SUD) or mental illness often witness significant dysfunction. Efforts to provide comprehensive health services may support better SUD treatment, mental health and child welfare outcomes.
- In 2019, Hawaii lawmakers implemented a task force to evaluate certain students experiencing challenges using an ACEs assessment protocol and to make recommendations regarding a statewide implementation of that protocol.
- In 2018, Missouri passed a law to establish the Trauma Informed Care Task Force to promote comprehensive trauma-informed support systems and interagency cooperation.
- In 2017, Indiana lawmakers established an opioid addiction recovery pilot program to assist expectant mothers with an opioid addiction. The program provides treatment in a residential care facility and home visitation services following discharge from the facility.
- Nineteen states have either created or funded drug treatment programs specifically for pregnant women, and 17 states and the District of Columbia provide pregnant women with priority access to state-funded drug treatment programs.