Ohio ACEs Resources

Ohio ACEs Impact project

Led by the Health Policy Institute of Ohio and informed by a multi-sector advisory group, this project includes a series of six policy briefs and this resource page to build on and amplify current efforts to address ACEs in Ohio. Exposure to ACEs is a pervasive problem in Ohio and across the nation. More than two-thirds of Ohioans have been exposed to an ACE, with nearly half of Ohioans exposed to two or more ACEs.

In August 2020, HPIO released the first brief in this project, Health impact of ACEs in Ohio, which summarizes current research and provides new analysis on the health impacts of ACEs on Ohioans. The second brief, Economic impact of ACEs in Ohio, released in February 2021, summarizes national research and provides Ohio-specific analysis on healthcare and other costs attributable to ACEs in Ohio. The third brief, A strategic approach to prevent ACEs in Ohio, builds on previous briefs by identifying evidence-informed and cost-effective strategies to prevent and mitigate the impacts of ACEs. The final three briefs analyze the extent to which those evidence-informed strategies are being utilized across the state, describe implementation considerations, and make recommendations for how implementation could be enhanced or expanded across Ohio.

This resource page provides links to data, research and other information to further understanding of the health and economic impacts of ACEs and will be updated throughout the duration of this project.

The conceptual framework below illustrates the project’s expected outcomes. For more information, or to see all phases of the project, click here.

 

Resources

If you have a resource you would like HPIO to consider adding to this page, please email Becky Carroll (bcarroll@hpio.net)

Adverse Childhood Experiences (ACEs)

Exploring the Rural Context for Adverse Childhood Experiences (ACEs)

National Advisory Committee on Rural Health and Human Services, U.S. Department of Health and Human Services
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This policy brief provides recommendations to lessen the healthcare disparities that exist in rural communities by addressing ACEs.

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Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study

Download

This groundbreaking study brought light to the relationship between exposure to adverse childhood experiences and health in adulthood. It considered seven categories of adverse childhood experiences (psychological, physical or sexual abuse; violence against the mother; or living with household members who abused substances, were mentally ill or suicidal, or were ever imprisoned) and found a graded relationship between the number of categories of childhood exposure and many different adult health risk behaviors (e.g., smoking, alcoholism, drug use) and diseases (e.g., heart disease, cancer, diabetes).

Adverse Childhood Experiences (ACEs)

Centers for Disease Control and Prevention (CDC)
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The CDC provides ACEs fast facts, research, resources, prevention strategies and data on this page.

Understanding Child Trauma

Substance Abuse and Mental Health Services Administration (SAMHSA)
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This page provides resources, learning materials and research related to child trauma and stress.

ACE Resources, ACEs Aware, an initiative of the Office of the California Surgeon General and the California Department of Health Care Services

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This page provides an aggregation of resources to advance the standard of care for ACEs and toxic stress.

Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study

American Journal of Preventive Medicine
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This study, published in 1998, serves as a foundation for how ACEs are talked about and understood today.

Health Impacts of ACEs

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Long-Term Consequences of Child Abuse and Neglect

Children’s Bureau, U.S. Department of Health and Human Services
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This publication details the long-term physical, psychological, behavioral and societal consequences of child abuse and neglect.

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention

Centers for Disease Control and Prevention (CDC)
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This article highlights the adverse health and socioeconomic impacts of ACEs on adults using the same Behavioral Risk Factor Surveillance System data as the first policy brief in HPIO’s ACEs Impact Project, Health Impact of ACEs in Ohio.

ACEs and Toxic Stress: Frequently Asked Questions

Center on the Developing Child, Harvard University
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This guide discusses how ACEs can lead to toxic stress and how to mitigate the effects of toxic stress.

Childhood Trauma Has Lifelong Health Consequences for Women

Population Reference Bureau
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This article highlights the effects of ACEs on women’s lifelong health.

Racism is an Adverse Childhood Experience

Jordan Institute for Families, University of North Carolina at Chapel Hill
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This webpage examines the exposure to institutional/systematic racism as a child can impact future health outcomes.

Toxic Stress and Children’s Outcomes

Economic Policy Institute
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This webpage reviews the variation of toxic stress amongst different races and social classes and how it can have negative health outcomes.

Economic Impact of ACEs

Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis  (2019)

The Lancet Public Health
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This study calculated the combined annual costs of depression and anxiety attributed to ACEs in North America at approximately $82 billion. The study estimated that a 10% reduction in ACEs in North America would lead to annual savings of $56 billion. 

The Economic Cost of ACEs in Tennessee (2019)

The Sycamore Institute
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This study calculated that, in 2017, ACEs experienced by Tennessee adults led to an estimated $5.2 billion in medical costs and lost productivity. This cost was associated with eight ACE-related health outcomes in which cigarette smoking ($2.1 billion) and depression ($923 million) were the highest.

The Economics of Child Abuse: A Study of California (2019)

Safe & Sound
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This report found that the cumulative financial impact on California for 71,289 verified claims of child maltreatment in 2017 was $19.31 billion. The report also estimates that the individual lifetime cost of child maltreatment for survivors was $268,544 in 2017.

Protective Factors

Transforming Practice with HOPE (Healthy Outcomes from Positive Experiences)

Maternal Child and Health Journal

Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience

National Scientific Council on the Developing Child
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This report highlights the importance of protective factors in building resilience and combatting the negative effects of ACEs for children.

Strengthening Families

Center for the Study of Social Policy
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This framework developed by The Center for the Study of Social Policy focuses on developing protective factors to proactively address ACEs.

Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
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Those who are interested in addressing child abuse and neglect can use these strategies outlined by the National Center for Injury Prevention and Control.

Preventing Adverse Childhood Experiences

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
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This series of trainings was created by VetoViolence to provide information about ACEs and how to prevent them.

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Protective Factors Approaches in Child Welfare

Children’s Bureau, U.S. Department of Health and Human Services
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Using this guide, individuals can learn more about protective factors and how to put them into practice.

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Risk and Protective Factors

Substance Abuse and Mental Health Services Administration (SAMHSA)
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This publication describes risk factors, protective factors and types of interventions.

Strategies to prevent and mitigate ACEs 

General

Hi-5 (Health Impacts in Five Years)

Centers for Disease Control and Prevention
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This resource offers details on CDC-recommended strategies that have evidence of positive, cost-effective health impacts that produce results within five years.

California Evidence-Based Clearinghouse (CEBC) for Child Welfare

California Department of Social Services
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This evidence registry provides information regarding evidence-based practices relevant to child welfare.

Social Programs that Work (SPTW)

Arnold Ventures
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This evidence registry reviews rigorous randomized control trials of social programs to determine their impact and effectiveness to inform policymakers.

The Guide to Community Preventive Services (Community Guide)

CDC
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These systematic reviews provide evidence-based recommendations, identified by the Community Preventive Services Task Force, to improve health and prevent disease.

U.S. Preventive Services Task Force Recommendations (USPSTF)

USPSTF
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These systematic reviews offer healthcare professionals evidence-based recommendations for clinical preventive services, such as screenings, counseling services and preventive medications.

What Works for Health (WWFH)

County Health Rankings and Roadmaps
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This evidence registry lists evidence-informed policies, programs and system changes that can improve factors that affect health.

Community Health Advisor

Health Partners Institute
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This calculator helps determine which policies will most effectively decrease health and medical costs in a community.

Return on Investment (ROI) Calculator for Partnerships to Address the Social Determinants of Health

The Commonwealth Fund
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This calculator explores the ROI of the delivery of social services to high-need, high-cost patients.

Benefit-Cost Results

Washington State Institute for Public Policy (WSIPP)
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This database assesses and compares the benefits and costs of evidence-informed policy options. Although the analysis is focused on Washington State, the benefit-cost research may be applicable to people in other states.

Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence

Centers for Disease Control and Prevention
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This "Prevention Resources for Action" report identifies evidence-informed ACEs prevention strategies with the greatest potential for impact.

Preventing Adverse Childhood Experiences Framework

Association of State and Territorial Health Officials
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This tool provides strategic objectives on ACEs-related data, policy, financing, messaging and cross-sector partnerships for community and state health agencies.

Healing Iowa

Iowa ACEs 360 Coalition
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This report discusses the different response strategies and policy options Iowa is considering or implementing to address ACEs.

Preventing and Mitigating the Effects of ACEs by Building Community Capacity and Resilience: APPI Cross-Site Evaluation Findings

Mathematica Policy Research
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This report analyzes efforts of communities in Washington State to prevent child maltreatment, decrease exposure to toxic stress and improve development outcomes.

Strategies to ensure a strong start for children and strengthen economic supports for families

Early Childhood Finance Toolkit: A curated resource to support state leaders in a mixed delivery system

HHS Administration for Children & Families, Office of Child Care
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This toolkit provides a collection of resources to guide and support state leaders as they develop and/or refine a comprehensive and aligned fiscal system across multiple early childhood settings, including child care, Early Head Start/Head Start, health, home visiting, mental health, Part B, Part C and state-funded prekindergarten. (2021)

Early Childhood Governance: A toolkit of curated resources to assist state leaders

HHS Administration for Children & Families, Office of Child Care
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This toolkit provides state leaders with information and guidance on the governance structure of early childhood programs. This includes early childhood organizational structures, authority and accountability for program policy, financing, and implementation decisions for publicly funded early care and education for children birth to age 5. (2021)

A Conceptual Framework for Family Engagement in Early Childhood Home Visiting

HHS Administration for Children & Families
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This resource presents a framework that describes family engagement in the context of early childhood home visiting and presents strategies that programs can use to encourage family engagement. (2023)

Home Visiting Evidence of Effectiveness: Model Search

HHS Administration for Children & Families
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This database provides a thorough and transparent review of effectiveness and implementation for home visiting program models.

A Conceptual Framework for Implementation Quality in Home Visiting

HHS Health Resources & Services Administration
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This report provides a conceptual framework to identify, evaluate and strengthen implementation quality in home visiting. (2021)

Toolkit: A planning, implementation, and practice guide for building and sustaining a health center-based MLP

National Center for Medical-Legal Partnership
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This toolkit provides guidance for community health centers to develop, strengthen and sustain a medical-legal partnership. (2020)

Financing Medical-Legal Partnerships: View from the Field

National Center for Medical-Legal Partnership
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This brief draws on data from organizations who have implemented MLPs to provide guidance on funding MLPs. (2019)

Medical-Legal Partnership Interventions and Child Development: Cross-Sector Partnerships to Address Social Determinants of Health

Institute for Child Success
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This publication outlines the structure, services and outcomes associated with MPLs; highlights the impact of social drivers on health and child development; provides case studies; and identifies opportunities to strengthen MLP service delivery. (2018)

Improving Health Equity Through Medical-Legal Partnerships

American Hospital Association
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This issue brief discusses how medical-legal partnerships can support vulnerable populations and highlights implementation resources. (2020)

Income Support Associated with Improved Health Outcomes for Children, Many Studies Show

Center on Budget and Policy Priorities
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This report summarizes the connection between economic security programs and improved health development. (2021)

Earned Income Tax Credit Overview

National Conference of State Legislatures
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This resource compares eligibility requirements for EITC among states. (2023)

Earned Income Tax Credit Enactments

National Conference of State Legislatures
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This source compares enacted legislation for state earned income tax credits from 2009-present. (2023)

Policy Basics: State Earned Income Tax Credits

Center on Budget and Policy Priorities
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This brief on EITC provides policy tools states can use to lower barriers in claiming the EITC. (2021)

State Child Tax Credits and Child Poverty: A 50-State Analysis

Institute on Taxation and Economic Policy
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This report provides recommendations and design principles for policymakers on how to set up an effective child tax credit. (2022)

The Child Tax Credit: The Impact of the American Rescue Plan Act (ARPA; P.L. 117-2) Expansion on Income and Poverty

Congressional Research Service
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This report provides an overview of the American Rescue Plan Act (ARPA) changes to the child tax credit and the impact this had on the financial well-being of families and the prevalence of child poverty. (2021)

Child Tax Credit Enactments

National Conference of State Legislatures
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This resource summarizes legislation for the 12 states that have enacted a state child tax credit. (2023)

Report: Measuring the Child Tax Credit’s Economic and Community Impact

Niskanen Center
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This report analyzes the effect of the Child Tax Credit on stimulating economic activity, including a state-by-state comparison for policymakers. (2021)

Strategies to build skills and connect youth to caring adults

Guide to implementing family skills training programmes for drug abuse prevention

United Nations Office on Drugs and Crime
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This document provides basic information and guidance for policymakers and program managers interested in implementing a family skills training program. It describes best practices, challenges and how to overcome them, cultural adaptation of evidence-informed programs, tips to improve recruitment and retention and other basic implementation issues. (2009)

Elements of Effective Parenting Programs and Strategies for Increasing Program Participation and Retention

National Academies of Sciences, Engineering and Medicine
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Chapter 6 of Parenting Matters: Supporting Parents of Children Ages 0-8

This chapter describes elements of family skills training programs that have been found to be effective through evaluation. These include treating parents as partners, tailoring interventions to unique needs, service integration and collaboration across agencies, peer support, trauma-informed services, cultural relevance and inclusion of fathers. (2016)

Compilation of Evidence-Based Family Skills Training Programmes

United Nations Office on Drugs and Crime
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This document includes thorough descriptions of 23 family skills training programs with evidence of effectiveness. It includes an overview of program content, groups of focus, materials and training for each. (2010)

Preventing Bullying Through Science, Policy, and Practice

The National Academies of Sciences, Engineering, and Medicine
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This policy brief provides ways to strengthen laws against bullying, areas for further research, and federal resources for policymakers. There is also a link to a more comprehensive research report. (2016)

Importance of Anti-Bullying Laws: Understanding Anti-Bullying Laws and Policies

U.S. Department of Health and Human Services, stopbullying.gov
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This webpage identifies guiding principles for schools to develop and implement comprehensive anti-bullying policies. (2021)

Dating Matters Toolkit: Guide to Informing Policy

Centers for Disease Control and Prevention
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This interactive guide provides an overview of teen dating violence prevention policy approaches, considerations for informing policy, guidance for developing a policy plan, and additional resources. (2023)

School-based violence prevention: a practical handbook

World Health Organization
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This handbook outlines important elements in establishing a comprehensive approach to violence prevention in schools. It promotes a “whole school approach” to preventing violence. (2019)

Recommended Process for Developing State Policies and Guidelines to Support Social and Emotional Learning

Collaborative for Academic, Social, and Emotional Learning (CASEL) and American Institutes for Research (AIR)
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This document offers guidance for state and local education agencies to develop, implement, and sustain social and emotional learning (SEL) policies and practices. (2022)

Key Features of High-Quality Policies and Guidelines to Support Social and Emotional Learning: Recommendations and examples for state policy leaders

CASEL and AIR
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This document outlines six key features of a high-quality, comprehensive package of policies and guidance to support SEL. (2022)

Navigating SEL From the Inside Out

Harvard Graduate School of Education
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This report examines key features of 25 leading SEL programs for elementary-age children to support education administrators in fitting SEL programs to their context and needs. (2017)

Resources for Mentoring Programs

National Mentoring Resource Center
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The website provides a variety of resources for mentoring programs such as mentor training, program management, program policies and procedures, and marketing and recruitment tools

Elements of Effective Practice for Mentoring (4th edition)

MENTOR
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This report provides best practices for creating and sustaining impactful mentoring relationships and programs, informed by research and practitioner experience. (2015)

Generic Mentoring Program Policy and Procedure Manual: Effective strategies for providing quality youth mentoring in schools and communities

National Mentoring Resource Center
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This resource provides a template for a mentoring program to create a customized manual with policies and day-to-day procedures. (2007)

Strategies to promote positive social norms and intervene to lessen harm

Creating Safe Environments: Violence Prevention Strategies and Programs

Prevention Institute
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This report discusses various approaches to community violence prevention programs, best practices and challenges. (2006)

Designing Equitable Community Violence Intervention Strategies with Employment and Workforce Supports

The Center for Law and Social Policy
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This report provides recommendations for developing community violence prevention programs with a focus on equity and inclusion. (2022)

Implementing Outreach-Based Community Violence Intervention Programs

Local Initiatives Support Corporation
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This report details how community-based programs can prevent violence and best practices for program implementation, support and sustainability. (2022)

Adult Treatment Court Best Practice Standards

All Rise (formerly the National Association of Drug Court Professionals)
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These widely-used best practice standards are based on research, are culturally sensitive and were developed with input from many practitioners and subject matter experts. This second edition is an update of the 2013-2015 edition. (2023)

Family Treatment Court Best Practice Standards

Center for Children and Family Futures and National Association of Drug Court Professionals
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This report outlines eight best practice quality standards, each with clear practice guidance. (2019)

Family Treatment Court Planning Guide

National Drug Court Institute and Center for Children and Family Futures
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This planning guide presents the critical topics and decisions groups will encounter when beginning to implement a family treatment court. (2018)

Essential Readings

National Treatment Court Resource Center
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This website includes an array of useful resources on drug courts.

SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach

Substance Abuse and Mental Health Services Administration
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This report provides background information on trauma as well as a framework for a trauma-informed approach that can be implemented in sectors such as behavioral health, child welfare, education, criminal and juvenile justice, primary care and the military. (2014)

Ohio’s Trauma-Competent Care Initiative Resource Library

Ohio Department of Mental Health and Addiction Services
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This webpage offers links to a wide variety of resources on trauma and trauma-informed care, divided by age group, subject and other categories.

Key Ingredients for Successful Trauma-Informed Care Implementation

Center for Health Care Strategies
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This brief describes best practices for trauma-informed health care, including both organizational and clinical changes. It also highlights payment, policy and educational opportunities to acknowledge trauma’s impact. (2016)

Become a trauma-informed district or school

Ohio Department of Education and Workforce
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This webpage offers links to many resources for schools and districts wanting to be trauma-informed.

Increasing Access to Behavioral Health Services: Opportunities at the State and Federal Level

National Academy for State Health Policy
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This report outlines the seven most pressing behavioral health treatment priorities among state policymakers. (2023)

National Guidelines for Behavioral Health Crisis Care: Best Practices Toolkit

SAMHSA
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This toolkit outlines key elements of a comprehensive and integrated crisis care system. It also assists with estimating crisis system resource needs, the number of people who can be served within a system, costs of crisis services, workforce demands and other important development and implementation considerations. (2020)

Promoting Health and Safety Through a Behavioral Health Continuum of Care

National Association of Counties
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This report outlines how counties can help residents with behavioral health conditions before, during and after a behavioral health emergency and provides examples from around the U.S. (2022)

Last updated 1/29/2024

 

This project is funded by the Ohio Department of Mental Health and Addiction Services (OhioMHAS) supported by Ohio’s 2020-2021 SAMHSA Community Mental Health Block Grant, the Harmony Project, the Ohio Children’s Hospital Association, Interact for Health and HPIO’s core funders