16 Pages • Read Time 27 Minutes

Adverse Childhood Experiences (ACEs):

A strategic approach to prevent ACEs in Ohio


Safe, stable environments and nurturing relationships are essential for children’s healthy growth and development. Children in families that are stressed and that do not have access to necessary supports are more likely to be exposed to adversity and trauma or Adverse Childhood Experiences (ACEs). Exposure to ACEs can cause serious and long-lasting health and economic harms that persist across generations.1

ACEs are common. In Ohio, one in five children were exposed to ACEs in 2018-2019.2  However, ACEs are not inevitable and Ohioans are resilient. Exposure to ACEs does not have to determine future hardship. There are strategies that state policymakers and others can deploy to prevent ACEs and safeguard the well-being of Ohio children and families who have experienced adversity and trauma.

Ensuring that all children have a fair opportunity to thrive is a value shared by many Ohioans. Leaders across both the public and private sector have expressed a strong commitment to this value and have taken actions to lay a solid foundation for families and children. This brief, the third in HPIO’s Ohio ACEs Impact Project, provides insights to build upon these successes and support a comprehensive and strategic approach that maximizes resources to prevent ACEs and advance equitable outcomes.


3 Key findings for policymakers

  • Focusing action on key strategies can have a powerful impact. State policymakers and other partners can maximize the effectiveness of public and private spending to prevent ACEs by focusing on 12 cost-beneficial strategies.
  • ACEs are not inevitable. Significantly reducing the number of children in Ohio who are exposed to ACEs requires getting ahead of potential harms, creating safe, stable and nurturing environments and fostering resilience.
  • ACEs prevention efforts must reach children and families most at risk. Ohio’s public and private leaders should equip communities to support children and families that are most at risk for experiencing adversity and trauma, such as Ohioans of color and Ohioans with low incomes, disabilities and/or who live in urban and Appalachian areas.

Ohio ACEs Impact project

Led by the Health Policy Institute of Ohio (HPIO) and informed by a multi-sector advisory group, the Ohio ACEs Impact project includes a series of three policy briefs and an online resource page to build on and amplify current efforts to address ACEs in Ohio.

Since August 2020, HPIO has published two policy briefs as part of this project, Adverse Childhood Experiences: Health Impact of ACEs in Ohio and Adverse Childhood Experiences: Economic Impact of ACEs in Ohio. This brief, the third in the series, builds on the previous two briefs by identifying evidence-informed and cost-beneficial strategies to mitigate the impacts of ACEs.

This project is funded by the Harmony Project, the Ohio Children’s Hospital Association and HPIO’s core funders.


  • Adverse Childhood Experiences (ACEs): Health Impact of ACEs in Ohio. Health Policy Institute of Ohio (HPIO), August 2020, and Adverse Childhood Experiences (ACEs): Economic Impact of ACEs in Ohio. Health Policy Institute of Ohio (HPIO), February 2021.
  • Health Policy Institute of Ohio. 2021 Health Value Dashboard™. April 2021.


Carrie Almasi, MPA

Reem Aly, JD, MHA

Stephen Listisen, MPA

Zach Reat, MPA, HPIO

Published On

August 20, 2021

Table of Contents

  1. Overview
  3. 3 Key findings for policymakers
  4. Ohio ACEs Impact project
  5. Notes
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