State Actions to Prevent and Mitigate Adverse Childhood Experiences

Preventing and mitigating adverse childhood experiences and toxic stress and promoting resilience are increasingly priorities for Governors. To mount an effective response to ACEs, states may consider a holistic approach to promoting resilience for children and their families and adopt approaches that combine universal training, access to screening and treatment, improved data collection and reporting, and also a commitment to transformative, cross-agency cultural change.


Executive Summary

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).


NGA Center and the National Academy for State Health Policy thank the state officials from the Delaware, Maryland, Pennsylvania, Virginia, and Wyoming teams for their engagement in this project and for allowing us to highlight their work in this publication. In addition, we thank the state officials in California, Tennessee, New Jersey, and Alaska for sharing their experiences and lessons learned as models for this project. We would also like to thank Sandra Wilkniss and Lauren Block for their contributions to this project during their tenure at NGA. Finally, NGA Center and the National Academy for State Health Policy also thank the Robert Wood Johnson Foundation for its generous support of this publication and the project that made it possible.