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 thisresource pageto 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 nearlyhalf 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.
This policy brief provides recommendations to lessen the healthcare disparities that exist in rural communities by addressing ACEs.
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study
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).
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
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
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)
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.
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)
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.
The Helping Children with Loss (HCWL) program is based on the general principles of the Grief Recovery Method, an evidence-informed, action-based program to help people recover from grief. The HCWL program teaches adults how to help children talk about their losses and the feelings they experience. Parents, caregivers and any adults who work with children and youth (e.g., teachers, coaches, counselors, youth pastors, juvenile justice staff, daycare providers) can participate.
Transforming Practice with HOPE (Healthy Outcomes from Positive Experiences)
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
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
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)
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)
These systematic reviews offer healthcare professionals evidence-based recommendations for clinical preventive services, such as screenings, counseling services and preventive medications.
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
This tool provides strategic objectives on ACEs-related data, policy, financing, messaging and cross-sector partnerships for community and state health agencies.
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
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
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
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
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
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)
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
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
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
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
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
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
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)
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
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)
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)
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
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)
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
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
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)
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
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.