By Caitlin Feasby, Statewide Coordinator, Ohio Infant-Toddler Court Team
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Note: This statement, written by Caitlin Feasby, was read by Susan Ackerman before the Ohio House Behavioral Health Committee on Tuesday, April 23, 2024. A recording of this testimony may be viewed here.
Chairwoman Pavliga, Vice Chair White, Ranking Member Brewer and members of the committee, my name is Caitlin Feasby and I am the Ohio Infant-Toddler Court Team and Policy Coordinator for Groundwork Ohio. As a master’s level social worker (MSW), trained mental health professional, and policy advocate on behalf of young children, I am pleased to have the opportunity to provide proponent testimony on House Bill 352 (HB352) to create a study committee on Adverse Childhood Experiences or ACEs.
Groundwork Ohio is a statewide, nonpartisan advocacy organization that champions high-quality early learning and healthy development strategies from the prenatal period to age five that lay a strong foundation for Ohio kids, families, and communities. Our vision is to make Ohio the best place to be a young child so that all children have the opportunity to reach their full potential.
Evidence is clear that the first few years of life are some of the most important for determining lifelong outcomes, as the most rapid period of brain development happens in the earliest years of life. With 80 percent of brain growth taking place by age 3 and 90 percent by age 5, a baby’s brain is forming more than a million neural connections every second. The development of Ohio’s youngest children is highly susceptible to influence from caregiving and environmental factors, where negative experiences can have just as much impact as positive ones. This creates an imperative that must be addressed.
What happens in childhood has immense authority over the course of our lives. Children who grow up in safe and loving environments may experience advantages in physical health outcomes, cognitive and social skills, language and literacy, setting the stage for academic, social, emotional and cognitive success. Unfortunately, we know that not all children grow up under positive circumstances. Children exposed to adversity without the advantage of a safe, stable, and loving home are more likely to experience negative long-term effects. Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur between the ages of 0-17 with potential to cause long-lasting negative effects. Exposure to ACEs can translate to increased problem behaviors across the lifespan, including excessive alcohol consumption, drug use, and violence victimization or perpetration. ACEs have health implications as well, including strong association with increased rates of cardiovascular disease, diabetes, cancer, and respiratory and liver diseases, and poorer mental health outcomes including increased rates of depression, anxiety, and higher risk of suicide.
Children in Ohio are experiencing adversity at an alarming rate, as Ohio ranks near the bottom of all 50 states and D.C. for children having two or more adverse childhood experiences. Using a scale of 0-10 where exposure to an adverse event equates to 1-point, a score of 4 or more is considered clinically significant with greater risk of negative outcomes throughout the lifespan. By age 5, nearly 1 in 5 Ohio children have been exposed to two or more ACEs.
While almost half of all children in the United States have experienced at least one ACE, a 2019 Ohio Medicaid Assessment Survey included in Groundwork Ohio’s Early Childhood Dashboard indicates nearly one in five Black and Hispanic/Latino children ages 0-5 were exposed to two or more ACEs, compared to one in six white children. This data tells us that some children are more likely to be left behind than others, and evidence suggests adversity differentially impacts vulnerable, marginalized, underrepresented, and at-risk people experiencing poverty, systemic racism, and other social factors. In 2018, our Early Childhood Race & Rural Equity Report illustrated how the color of your skin and where you live determine where you start in life, and often where you stay—children who start behind, stay behind. We must consider the broad range of environmental and systemic factors that prevent young children and families from succeeding by addressing issues like ACEs from a place of equity.
The Health Policy Institute of Ohio’s 2021 Health Value Dashboard notes key findings that if ACEs were eliminated, more than $10 billion a year in healthcare spending could be saved in Ohio and $319 million in lost wages could be eliminated each year in our state. In addition to this:
36% of depression diagnosis are potentially preventable
Smoking could be reduced by 33%
The inability to afford care could be reduced by 25%
Asthma could be 24% more preventable
COPD could be 20% more preventable
Heavy drinking could be reduced by 19%
We know that no single solution or intervention is sufficient to meet the needs and challenges faced by young children and families that lead to adverse childhood experiences. We furthermore acknowledge that even among our state systems serving some of Ohio’s most vulnerable children, there is room for improvement. Children engaged in the child welfare system are experiencing significant trauma, and those engaged in this system during the earliest years of life are particularly vulnerable. In Ohio, 0-3 year olds make up 29% of all children in state custody. Through a partnership including Groundwork Ohio, the Educational Service Center of Northeast Ohio (ESCNEO), Case Western Reserve University, and the Children’s Defense Fund of Ohio, we seek to expand the Safe Babies approach to Infant-Toddler Court Teams to prioritize a holistic, trauma-informed solution to child welfare practice for infants, toddlers, and their families involved in the child welfare system. Child welfare practice changes for families involved with the Safe Babies program have created a pathway to improve child welfare outcomes by decreasing time in care with increased rates of permanency placement or reunification and fewer foster care placements. Every baby served by this program inherently has at least once ACE score due to the trauma of removal, and we know from talking with their families and the professionals wrapping services around them that unmet needs remain, including lack of access to infant-early childhood mental health care, lack of affordable housing, challenges with service coordination, and timeliness of and access to substance use treatment.
Groundwork Ohio seeks to unravel and rebuild systems to apply early childhood brain science to policy and ensure our policies and investments are trauma-informed regardless of agency, service, program, or funding stream. While the statistics surrounding early childhood adversity are both staggering and daunting, there are strategies that have demonstrated efficacy in addressing ACEs if we shift our state culture to prioritize prevention through actions such as this study committee. I want to acknowledge the inclusion of two individuals with lived experience and one mental health professional serving children up to age five recommended by Groundwork Ohio, as essential members of the Adverse Childhood Experiences Study Committee alongside other uniquely qualified professionals. This study committee offers a unique opportunity for policy makers to connect the latest research and interventions to public policy with experts who bring a vast knowledge base to the table. This will allow the tenants of research to be embedded in the creation of laws and state programs and will increase the public’s knowledge of conditions caused by ACEs and bring attention to how trauma impacts disparate communities. Groundwork Ohio looks forward to being a partner to the ACEs Study Commission, we are pleased to see support for this proactive legislation and we ask for your support of the bill.