In recent years, many states have focused on addressing adverse childhood experiences (ACEs) — stressful and potentially traumatic events, such as violence, abuse, or neglect, that occur prior to age 18. Some states have adopted cross-sector statewide plans to address ACEs. In other states, governors’ executive orders have put a priority on mitigating the effects of ACEs.

California and New Jersey are leading examples of states pursuing groundbreaking efforts and making substantial investments to address ACEs. California is the first state to prioritize mitigating the effects of ACEs and toxic stress across its programs, and New Jersey is the first state to stand up an Office of Resilience to coordinate statewide ACEs-related efforts. This blog post highlights these two states’ approaches for preventing and mitigating the effects of early adversity on children and families as well as supporting resilience-building in their communities.

Encouraging Providers to Screen for ACEs and Adopt Trauma-Informed Care in California

In 2019, California appointed its first Surgeon General, Nadine Burke Harris, MD, MPH, FAAP — a longtime champion for promoting strategies that address ACEs and toxic stress. With this announcement, it came as no surprise that the Office of the California Surgeon General emphasized early childhood, health equity, and ACEs and toxic stress as key priority areas for the state. These priority areas align with the Surgeon General’s overarching and ambitious goal of reducing ACEs and toxic stress in half in one generation.

To support this effort, the Office of the California Surgeon General and the Department of Health Care Services launched ACEs Aware, a first-in-the-nation effort focused on encouraging Medi-Cal (Medicaid) providers to screen for ACEs in children and adults, provide appropriate follow-up services and supports, and embrace trauma-informed care. Through ACEs Aware, a variety of supports have been made available to providers and their care teams to encourage ACE screening and response, including training materials, implementation tools, information on supplemental payment for implementing select screening tools, and guidance on how to build trauma-informed networks of care to support patients and families. The state also supported stakeholders to develop resources and create learning networks to facilitate peer-to-peer exchange and spread best practices. For information related to implementation of ACE screening under ACEs Aware, check out a recent Center for Health Care Strategies (CHCS) report that details perspectives from Medi-Cal providers.

Of note, ACEs Aware recently transitioned to a new organizational home within the University of California. The  University of California ACEs Aware Family Resilience Network (UCAAN) is co-led by the Department of Pediatrics at the David Geffen School of Medicine at University of California, Los Angeles and the Center to Advance Trauma-Informed Health Care at the University of California, San Francisco. UCAAN will build on the investments made through ACEs Aware and related efforts and will focus on supporting health professionals in understanding and addressing toxic stress and promoting resilience in clinical and community settings.

Building a Trauma-Informed, Healing-Centered New Jersey

New Jersey is paving a different path to address, prevent, and mitigate the effects of ACEs with a focus on prioritizing community voice in the state’s healing-centered efforts. The statewide coordination of ACEs-related efforts aims to cultivate a sustainable cadre of community leaders who are empowered to create a better future for people across the state.

In 2019, the New Jersey ACEs Collaborative engaged CHCS to facilitate a human-centered, information-gathering process to understand the priorities of state residents related to ACEs. CHCS hosted focus groups, interviews, and learning sessions that culminated in the creation of the New Jersey ACEs Statewide Action Plan. The Action Plan, launched in February 2021 by New Jersey’s Governor Phil Murphy, outlines five core strategies: (1) achieve trauma-informed and healing-centered state designation; (2) conduct an ACEs public awareness and mobilization campaign; (3) maintain community-driven policy and funding priorities; (4) provide cross-sector ACEs training; and (5) promote trauma-informed, healing-centered services and supports.

In June 2020, with support from the New Jersey ACEs Collaborative, New Jersey established the nation’s first Office of Resilience, housed within the New Jersey Department of Children and Families. After a national search, the Collaborative selected Dave Ellis as the Office’s first Executive on Loan and Executive Director, financially supported through public-private partnership among members of the ACEs Collaborative. The Office of Resilience is committed to centering community voice and improving quality of life, particularly for individuals who are most impacted by ACEs. The Office builds awareness about the effects of ACEs, ACE prevention efforts, and trauma-informed, healing-centered initiatives across the state. It conducts outreach to public and private entities, maintains a virtual learning community to connect people interested in ACEs-related efforts, and developed a statewide awareness campaign. Additionally, the Office established Healing New Jersey Together, a technical assistance entity dedicated to engaging communities to co-create opportunities for healing, supportive, and thriving futures. The Office also coordinates a train-the-trainer program that educates community members on the brain-body connection of trauma and strategies to improve well-being for children and their families. To reduce siloed efforts, the Office stood up an ACEs Interagency Team comprised of 11 state agencies that are committed to supporting the state’s children and families experiencing adversity.

More recently with support from the Center for Disease Control and Prevention, CHCS — working in partnership with state agencies, local regional health hubs, and non-profit organizations — is leading a two-year statewide collaborative effort to enhance New Jersey ACEs surveillance infrastructure by leveraging existing data systems. This work involves partnering with a variety of New Jersey stakeholders to implement effective strategies to prevent ACEs and to inform program and policy changes that are responsive to local needs.

Moving Forward

While California and New Jersey have unique approaches to addressing, preventing, and mitigating the effects of ACEs, both share the same end goal: to help children and families heal from trauma, to support communities in unique ways, and to prevent future ACEs. It is heartening to see such deep investment reaching from the east to west coasts of the country, particularly at a time when so many children and families have lost loved ones due to COVID-19, children and adolescents are experiencing higher rates of depression and anxiety, and social support systems have been disrupted. States interested in determining a path forward have great examples to learn from. CHCS looks forward to following and supporting new developments in these and other states and sharing information to help advance additional state-based efforts to address ACEs.

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