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A Future Without Adverse Childhood Experiences

By Caitlin Feasby, Statewide Coordinator, Ohio Infant-Toddler Court Team

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Ohio ranks 46th in the nation for children having three or more Adverse Childhood Experiences (ACEs). Although common, ACEs are not inevitable. As one of a three-part policy brief and resource page, the Health Policy Institute of Ohio’s (HPIO) most recent publication offers insight into the ways state policymakers and local-level partners can strategically reduce the long-term individual and societal impact of ACEs in Ohio. Our proactive response promotes healthier and happier children while drastically improving outcomes across their lifespan, helping Ohio become the best place to be a child and raise a family.


The Impact of ACEs in Ohio

Early life experiences associated with safe and stable housing, and responsive, nurturing caregivers help an infant to form strong attachments and develop a sense of safety and belonging. As a baby matures into childhood, those strong foundations carve a path for healthy development in domains such as physical health, cognitive and social skills, language, and literacy. For children without a strong foundation or for those exposed to certain traumas during vital developmental years, negative impacts on physical health, mental health, and poorer educational outcomes emerge as barriers throughout childhood and into adulthood. A well-balanced structure between an infant’s environment, consistent caregivers, and enriching experiences is the ideal, but not the reality for many of Ohio’s children.

ACEs are potentially traumatic events that occur between the ages of 0-17. Using a simple questionnaire, adverse experiences fall under four primary categories (included in the picture to the left) in which exposure to an adverse experience equates to one point. A score of 4+ on a scale of 0-10 is considered clinically significant with greater risk of negative outcomes throughout the lifespan of a child. By age 5, nearly 1 in 5 Ohio children have been exposed to two or more ACEs.

The scope of this issue is enormous. While some individual factors can influence ACE scores, more complex issues such as poverty, poor educational outcomes, and social/environmental factors are the most blatant contributors and point to colossal systemic barriers outside individual control.


Deep racial inequities in housing access, poverty, and the gross over-representation of Black and other POC in child welfare and criminal justice systems substantially increase the likelihood of ACEs in children of color. Groundwork Ohio published a factsheet noting that while 40% of white children have at least one ACE, 51% of Hispanic children and 61% of Black children have at least one ACE.


What happens in childhood has immense authority over the course of our lives. A 2017 meta-analysis shows higher ACE scores can translate to increased problem behaviors across the lifespan, including excessive alcohol consumption, drug use, and violence victimization or perpetration. ACEs have physical health implications as well, and a high ACE score is strongly associated with cardiovascular disease, diabetes, cancer, and respiratory and liver diseases, and are closely associated with poor mental health outcomes including increased rates of depression, anxiety, and higher risk of suicide.


The data is clear: ACEs result in lower life satisfaction scores and shorter life expectancies. They have a deleterious impact on individual, community, and state levels and come at a significant cost to state infrastructure and individual out-of-pocket expenses. If exposure to ACEs were eliminated, an estimated $10 billion in annual healthcare spending could be avoided along with more than $4.5 billion in annual spending to treat depression attributed to ACEs exposure.


A Systematic Approach to Change

Although this data is alarming, there is a corrective path forward and many meaningful solutions are already available throughout Ohio. HPIO recommends 12 key strategies to prevent and mitigate the impacts of ACEs, ranging from trauma-informed care to family income supports. While some strategies are costly to implement, the individuals and communities most at risk of ACEs exposure are worthy of our investment.


Using a cost-benefit ratio, HPIO explains the up-front cost of financial investment in these strategies is outweighed by substantial social benefit returns. Any strategy with an estimated cost-benefit greater than $1 demonstrates meaningful social benefit. For example, by expanding the Ohio Earned Income Tax Credit to 30%, the cost-benefit ratio is $1.75. Comparatively, Dating Matters, a comprehensive teen dating violence prevention program, has a cost-benefit ratio of $34.90. For more information on the cost-benefit analysis of HPIO’s 12 key strategies, click here.


Building Skills and Strengthening Connections to Caring Adults

HPIO’s most recent brief expands on strategies that build skills and strengthen connections to caring adults. By focusing on skills enhancement, parents and youth are better able to manage stress in the face of everyday challenges. These skills training programs offer a benefit to children and their caregivers by strengthening relationships, increasing caregivers’ understanding of child development, and promoting healthy behavioral management. Skills training has been shown to effectively reduce the cycle of generational trauma, promoting healthier relationships across the lifespan, and lessening ACEs exposure.


School-based Violence, Bullying, and Intimate Partner Violence Prevention Programs

Online and school-based bullying, sexual dating violence, and physical fights impact millions of children each year. School-based intimate partner violence prevention programs aim to curb exposure to violence by promoting healthy relationship development through education and skills training. Dating Matters is one such program available in Ohio and has illustrated effectiveness in promoting healthy relationships while enhancing awareness of unhealthy relationships. Evidence shows Dating Matters is successful in reducing incidents of sexual violence perpetration and victimization, bullying, cyberbullying, and physical violence.

These programs focus on teaching life skills and emotional and behavioral management to navigate challenging situations. Skills such as cultivating healthy relationships, understanding and managing stress, and making good decisions are shown to increase positive social interactions and demonstrate positive results in education performance, employment outcomes, and overall life satisfaction.


While Ohio law does not require teaching these skills in K-12 education, funding is available to Ohio schools to invest in a variety of wellness activities, which can include teaching life skills and emotional and behavioral management, early childhood mental health initiatives, and substance use prevention to name a few. Although not required, 81% of Ohio schools offered prevention-focused programming during the 2020-2021 school year.


Mentoring Programs

Finally, mentoring programs are designed to match youth with volunteers to develop supportive relationships and promote the child’s personal growth. Mentoring relationships have been shown to reduce delinquent behavior, aggression, and drug use for youth who are at risk. An array of mentoring programs are available in Ohio, including Big Brothers Big Sisters of America and MENTOR. Although there is no state funding available for mentoring programs, federal grant funding is available to expand these services and increase accessibility to mentorship.


A Challenge Worth Taking

Each of these strategies comes with a unique set of strengths and challenges. For example, Dating Matters is most effective when the curriculum is tailored to the needs of individual communities while making the program engaging and personal for students. HPIO notes funding constraints are an implementation barrier for parents and caregivers to receive family skills training, school-based social and emotional instruction programs, and mentoring programs. Workforce shortages create an additional barrier for all but volunteer mentoring programs.


Exciting efforts to expand Ohio’s capacity to provide improved care are happening every day. In addition to the programs and strategies outlined by the HPIO’s ACEs series, Groundwork Ohio is also dedicated to ACEs reduction strategies and is housing the statewide expansion of the Safe Babies approach for Ohio Infant-Toddler Court Teams. The Safe Babies approach is designed to improve child welfare outcomes for children ages 0-3 and their families by employing a holistic and family-centered approach. By enhancing oversight and interdisciplinary problem-solving, expediting effective services, providing trauma-responsive support, and prioritizing continuous quality improvement, Safe Babies is a revolutionary approach to child welfare for system-involved children and families who rely on our state systems to work well.


To continue following these conversations:

  • Stay informed on the HPIO’s continued work on ACEs prevention strategies and learn how you can advocate to policymakers.

  • Read more about the Safe Babies approach

  • Follow Groundwork Ohio for developing information on the Safe Babies approach and its expansion in Ohio.

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