The COVID-19 pandemic has exacerbated adverse childhood experiences (ACEs), and children could be facing a surge of poor physical and mental health outcomes without adequate investment and focus to reduce the effects of ACEs. This is especially important because Black, Latinx, and Native American children, who already disproportionately experience higher levels of ACEs, have also been impacted by the COVID-19 pandemic, in part due to longstanding inequities. A number of states are taking action. States like California and New Jersey have launched statewide initiatives to mitigate the long-term effect of traumatic events, and several state legislatures have introduced bills to identify and address ACEs in partnership with systems such as Medicaid and education.

[av_two_third first min_height=” vertical_alignment=” space=” custom_margin=” margin=’0px’ row_boxshadow=” row_boxshadow_color=” row_boxshadow_width=’10’ link=” linktarget=” link_hover=” padding=’0px’ highlight=” highlight_size=” border=” border_color=” radius=’0px’ column_boxshadow=” column_boxshadow_color=” column_boxshadow_width=’10’ background=’bg_color’ background_color=” background_gradient_color1=” background_gradient_color2=” background_gradient_direction=’vertical’ src=” background_position=’top left’ background_repeat=’no-repeat’ animation=” mobile_breaking=” mobile_display=” av_uid=’av-jx8vhgm’]

[av_textblock size=” font_color=” color=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” av_uid=’av-kpwqsjug’ custom_class=” admin_preview_bg=”]
State Initiatives to Address ACEs

In California, the ACEs Aware Initiative focuses on screening children for ACEs and working to address the impact of toxic stress, as NASHP has previously highlighted. California set a goal of reducing ACEs by one half in a generation and is working towards this goal in a multi-faceted, community-oriented approach. Through the ACEs Aware Initiative, and in collaboration with the California Department of Health Care Services, the state has distributed nearly $45 million in grants to more than 120 communities. Grantees work to educate providers and community members to recognize exposure to racism as a risk factor for toxic stress and ACEs. Grantees also highlight the importance of prevention, treatment, and healing. For example, several grantee sites assess children for resilience as well as trauma. Individuals who are racially marginalized (Black, Latinx, Native American, or multi-racial) are more likely to experience confounding ACEs and toxic stress in childhood, including lack of access to quality health care or education, or disproportionate involvement in the criminal justice or welfare systems. Because new crises like COVID-19 are more likely to disproportionately affect racially marginalized populations, the ACEs Aware Initiative centers equity as a core component of the program.
[/av_textblock]

[/av_two_third][av_one_third min_height=” vertical_alignment=” space=” custom_margin=” margin=’0px’ row_boxshadow=” row_boxshadow_color=” row_boxshadow_width=’10’ link=” linktarget=” link_hover=” padding=’0px’ highlight=” highlight_size=” border=” border_color=” radius=’0px’ column_boxshadow=” column_boxshadow_color=” column_boxshadow_width=’10’ background=’bg_color’ background_color=” background_gradient_color1=” background_gradient_color2=” background_gradient_direction=’vertical’ src=” background_position=’top left’ background_repeat=’no-repeat’ animation=” mobile_breaking=” mobile_display=” av_uid=’av-hahdp5y’]

[av_promobox button=’no’ label=’Click me’ link=’manually,http://’ link_target=” color=’theme-color’ custom_bg=’#444444′ custom_font=’#ffffff’ size=’large’ label_display=” icon_select=’no’ icon=’ue800′ font=’entypo-fontello’ box_color=” box_custom_font=’#ffffff’ box_custom_bg=’#444444′ box_custom_border=’#333333′ av_uid=’av-kpwqrvc3′ custom_class=” admin_preview_bg=”]
“Through ACEs Aware, we can realize a more just and equitable reality where we can truly prevent and provide healing from childhood adversity for all Californians.”  California Surgeon General Dr. Nadine Burke Harris
[/av_promobox]

[/av_one_third][av_textblock size=” font_color=” color=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” av_uid=’av-kpwqsbxm’ custom_class=” admin_preview_bg=”]
In New Jersey, the Department of Children and Families’ (DCF) Office of Resilience released a statewide action plan in 2021 with a goal of helping children and families in New Jersey reach their full potential by focusing on prevention and reduction of childhood trauma and adversity in future generations. The DCF Office of Resilience was created in June 2020 during the pandemic, to host, coordinate, and facilitate statewide initiatives with the purpose of raising awareness of and creating opportunities to eradicate ACEs through grassroots and community-led efforts. Key components to implementing the new action plan include:

• Conducting a statewide literature and programmatic review to assess current efforts to address ACEs in the state,
• Meeting with non-governmental organizations to ensure actions are community-led and centered, and collaboration to highlight and promote an online community, and;
• Making data from the New Jersey Population Health Cohort study publicly available.

Both state strategies center community voices and highlight resilience as a protective factor against trauma, and both plans work in stages by first identifying the breadth and depth of trauma in children through screenings, and then using this information to create appropriate resilience-focused programs. Both California and New Jersey strive to proactively address the impact of ACEs, especially as children are exposed to compounding trauma living through a pandemic and help build a healthier future.

Proposed State Legislative Strategies

COVID-19 has exacerbated existing stressors and the trauma from the pandemic has created new ones, and states have been having active discussions about how best to serve the needs of children during the pandemic.  Against this backdrop, legislators across states are considering new strategies to address ACEs. Most states’ legislative cycles are reaching their end and bills are at various point in the legislative cycle, but common themes in proposed legislation include:

• Publicly acknowledging the impact of trauma and importance of trauma-informed care. Illinois  SR 212 declared May 25, 2021 “Trauma-Informed Awareness Day,” to, among other things, encourage all employees of the State to become informed regarding the generational impacts of ACEs, toxic stress, and systemic racism.
• Creating entities to identify areas of need and recommendations. A bill in Georgia seeks to create a House Study Committee on ACEs to improve the health of women and children. The bill was introduced after data from the U.S. Health Resources and Services Administration showed that in 2019, 23.6% of Georgia children lived in economic hardship, that economic insecurity is the most common ACE, and non-Hispanic Black children are nearly twice as likely to experience one or more ACEs. Similarly, a Maryland bill proposes establishing a “Workgroup on Screening Related to Adverse Childhood Experiences,” tasked with updating and developing screening tools, submitting the screening tools to the Department of Health, studying best practices, and making recommendations to the Governor and General Assembly.
• Increasing ACE and social determinant of health screening for children by Medicaid and education agency stakeholders. State legislatures are exploring:
  • Requiring home health care professionals to use ACE questionnaires to assess patient health risk with reimbursement by Medicaid (NY).
  • Requiring school district board of directors to conduct ACEs screenings for any child before taking disciplinary action and including the results in any reports explaining the disciplinary results (AR).
  • Screening students for ACEs or traumatic events (CT, MD, PA). Pennsylvania’s bill requests a comprehensive analysis to identify an age-appropriate measuring tool that can be used by school districts to measure childhood trauma. Maryland’s bill requires the Secretary of Health to approve ACE training programs that providers can complete, to be reimbursed by Medicaid.

Next Steps

Unfortunately, nearly 40,000 children lost parents to COVID-19, and sustained investments will be critical to mitigate the effects of the trauma experienced during the pandemic. States are at different stages of promoting ACE awareness and addressing the effects of ACEs–identification and screenings are just the first steps toward improving long term health outcomes. Ongoing efforts to shine a light on this issue are moving ACEs towards mainstream consciousness at a critical juncture.  As strategies in California, New Jersey, and other states demonstrate, awareness, community engagement, provider training, and critical partnerships are the first steps toward ensuring that children’s needs are considered and met. NASHP will continue to monitor state action including use of American Rescue Plan Act Funds to address ACEs. See related NASHP resources.
[/av_textblock]