Meryl Schulman, MPH

November 15, 2018

Over the past year, the Center for Health Care Strategies (CHCS) has been monitoring state and federal policymakers’ interest in addressing early adversity, toxic stress, and trauma to promote overall health and wellbeing. To date, states and the federal government have employed a variety of policy levers to prevent and address trauma experienced by children, adults, and communities, and to encourage the adoption of trauma-informed approaches to care. The developments below highlight continued policymaker interest in addressing adverse childhood experiences (ACEs) and trauma, and promoting trauma-informed care.

State-Level Efforts Raise Awareness on ACEs and Advance Trauma-Informed Care

This summer, Governor Bill Walker of Alaska signed Senate Bill (S.B.) 105 into law which declares: “It is the policy of the state to acknowledge and take into account the principles of early childhood and youth brain development and, whenever possible, consider the concepts of early adversity, toxic stress, childhood trauma, and the promotion of resilience through protective relationships, supports, self-regulation, and services.” The bill’s language is the result of years of work by advocates such as the Alaska Resilience Initiative. The state is currently determining how to implement the amendment, which is intended to accelerate trauma-informed programs in the state and promote future trauma-informed policymaking.

Similarly, Governor John Carney of Delaware recently signed Executive Order 24 requiring Delaware to become a trauma-informed state. The order states that the Family Services Cabinet Council, which coordinates private and public services for Delaware families, must:

  • Develop a trauma-informed care toolkit for use within state agencies and organizations;
  • Declare a trauma awareness month that includes appropriate events across the state;
  • Share information about educational and professional development opportunities related to ACEs and resilience with state employees and community partners;
  • Create a recognition program for trauma-informed care champions to support community partners and those working within state agencies;
  • Identify gaps in prevention services and early intervention programs for children and their caregivers;
  • Develop a comprehensive early intervention strategy for children and families exposed to ACEs; and
  • Coordinate the collection, evaluation, and reporting of ACEs data across the state.

In addition, the Executive Order also requires state agencies that serve children and adults to hold trainings on the health impact of ACEs and toxic stress, promote strategies that encourage staff self-care and resilience, and incorporate a variety of other approaches that are critical to trauma-informed care.

Trauma-Informed Care Provisions Included in Federal Opioid Legislation

At the federal level, exciting progress has been made toward advancing trauma-informed care on a national scale. One example is the inclusion of language related to trauma-informed care practices within policy proposals aimed at addressing the nationwide opioid epidemic. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (H.R.6), which focuses on changing provisions to state Medicaid programs and Medicare requirements to address substance use disorders (SUDs), incorporates language related to trauma-informed care in the health, early childhood, and education sectors, including:

  • Authorization of the Centers for Disease Control and Prevention to support states in collecting and reporting data on ACEs for children and adults;
  • Creation of an interagency task force to recommend best practices related to the identification, prevention, and mitigation of trauma across the lifespan, and to better coordinate the federal government’s response;
  • Authorization of increased funding for the National Child Traumatic Stress Initiative to provide technical assistance, direct service, evaluation, and dissemination of best practices related to trauma-informed care for children and families;
  • Creation of grants to connect education and mental health agencies to increase students’ access to evidence-based trauma treatments and services with learnings disseminated by the Secretary of Education; and
  • Recognition of the relationship between early adversity and SUDs by requiring the Secretary of Health and Human Services to disseminate information and resources to early childhood programs and educators on how to recognize and respond to early childhood trauma.

Recently signed into effect by the President, H.R.6 represents an important step at the federal level to expand access to trauma-informed services.

Looking Ahead

The above examples represent growing interest from policymakers in addressing the impact of trauma across the life course, and the importance of taking a trauma-informed approach to building resilience and supporting people with trauma histories. Moving forward, it will be important that both states and the federal government make a concerted effort to invest in trauma-informed care and the systems that serve children, families, and those who have experienced trauma. To stay informed about legislation related to ACEs, trauma, and trauma-informed care, check out ACEs Connection’s new “Mapping the Movement” feature, and the Campaign for Trauma-Informed Policy and Practice for relevant resources and webinars.


Upcoming Trauma-Informed Care Implementation Resource Center

Health care providers looking to explore trauma-informed approaches should stay tuned for a new resource center from CHCS, made possible through support from the Robert Wood Johnson Foundation, that will launch this fall, TraumaInformedCare.chcs.org.

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