Health policy experts increasingly recognize that exposure to adverse experiences during the first 1,000 days of life dramatically increases the likelihood of poor health and social outcomes later in life. The cumulative burden of such exposure is associated with substantially increased health care costs across an individual’s life span. Adverse childhood experiences (ACEs) are also associated with a variety of negative social outcomes — ranging from poor school performance to involvement with the juvenile justice system — that frequently precede the onset of the poor health outcomes.

Many of the challenges that low-income, high-risk families face are essentially multi-generation issues rooted in poverty; low educational attainment; mental illness and substance use; unsafe neighborhoods; violence; and criminal justice involvement. With Medicaid covering nearly half of all births and 40 percent of children nationwide, Medicaid-driven strategies offer valuable potential for identifying problems and connecting at-risk infants, young children, and their families with needed services. Efforts to reduce early childhood trauma and ACEs could have major long-term payoffs, for individuals and the states and health care systems serving them as adolescents and into adulthood.

Over the past few years, the Center for Health Care Strategies (CHCS) has convened leading-edge Medicaid plans and provider organizations in its Complex Care Innovation Lab, in which participants recognized that failure to address early childhood adversity too often creates a socially constructed pathway to super-utilization. CHCS’ exploratory work evolved into new efforts in states across the country to identify and test ground-level strategies:

Learning Group

Under a planning grant from the David and Lucile Packard Foundation, CHCS convened leaders hailing from six states — Connecticut, Maryland, Minnesota, New York, Oregon, and Washington — to identify and spread strategies to support high-risk, low-income families, prevent ACEs, and improve the life chances, social determinants, and educational prospects of children. The following topics emerged as key priority areas to support this work:

  • Integrating cross-sector data;
  • Using data analytics and predictive modeling to target interventions to the highest-risk infants, families, and neighborhoods;
  • Identifying assessment tools and shared metrics (e.g., kindergarten readiness);
  • Building state and community level cross-agency partnerships (e.g., across health, early childhood, child welfare, housing, etc.); and
  • Creating new clinical models and community linkages to medical practices.

Innovation Lab

With support from the Robert Wood Johnson Foundation and the Packard Foundation, CHCS launched the Medicaid Early Childhood Innovation Lab in August 2017 to convene a learning group of state Medicaid agencies (Connecticut, Maryland, and New York) and regional health systems (Hennepin County, Minnesota and Health Share of Oregon) to catalyze upstream innovations in Medicaid. These sites designed Medicaid-driven strategies to: (a) create optimal conditions for early childhood (prenatal and ages 0-3) health and development; and (b) intervene with at-risk families to prevent trauma and improve the life chances of these children.

CHCS worked closely with the participants to design interventions, often targeting specific high-need communities and families that are more likely to yield quicker and more significant returns than would population-wide approaches. At the same time, the Innovation Lab supported efforts that make the case for broader investments in creating optimal conditions for healthy childhood development of all children.