Policy Considerations

Policymakers across the country increasingly recognize the profound effects of trauma and toxic stress on the health and wellbeing of people and their communities. Policy initiatives can be focused on mitigating the effects of trauma and adverse childhood experiences (ACEs), as well as on upstream prevention strategies.

Following are considerations for state and federal policymakers interested in supporting trauma-informed approaches to care, as well as examples from states and organizations across the country.

Identify opportunities for collaboration to increase adoption across sectors and within systems.

People with histories of trauma are often served by multiple sectors, highlighting the importance of cross-sector collaboration when advancing a trauma-informed approach. In Philadelphia, more than 100 representatives from the health, legal, and education sectors participate in the Philadelphia ACE Task Force to ensure a comprehensive, unified strategy for addressing ACEs across public sectors. In Wisconsin, Fostering Futures, a cross-sector, state-wide initiative supports children, families, and communities through trauma-informed, strength-based policies and programs. At the federal level, for example, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (H.R.6), signed into law in October 2018, supports grants to connect education and mental health agencies to increase students’ access to evidence-based trauma services.

While philanthropic partners often have an important early role in advancing these types of initiatives, policymakers can facilitate collaboration and provide funding to sustain cross-sector trauma-informed efforts.

Measure the impact and return on investment for trauma-informed care to accelerate broad adoption.

To date, research has primarily focused on the implementation of trauma-informed care and the cost of inaction related to traumatic experiences. Further evaluation of trauma-informed models is needed, as well as research on the relationship between trauma and negative social and health outcomes.

Encourage the inclusion of trauma-informed screening, treatment, and referral services in delivery system and payment reform models.

Creating financial incentives and regulatory structures that encourage integrated care, prevention, early intervention, and cross-sector collaboration could increase support for implementing trauma-informed care. While few such reforms are currently in place, innovators, such as the Center for Youth Wellness in San Francisco, are advocating for such opportunities. For example, through its National Pediatric Practice Community on ACEs, the Center for Youth Wellness explains how pediatricians can begin to address trauma by screening for ACEs and toxic stress within their practices and adopting a trauma-informed approach to care. Such screening could potentially be linked with payment incentives.

Engage families and communities with lived trauma experience to support the design and implementation of trauma-informed policies.

It is important to engage patients in designing effective approaches to address trauma and ensure that individuals with lived experience have a strong voice in the policy development process. Many providers have incorporated patient voice and choice through patient advisory boards, and many city- and/or community-wide efforts to become trauma-informed have actively recruited community representatives to participate in governing bodies and decision-making processes.

Invest in upstream prevention to reduce early adversity, identify problems sooner, and connect at-risk infants, young children, and families with needed services.

Early childhood (ages 0-3) is a critical time for brain development, when experiences shape lifelong health and how a person learns and behaves. However, in the absence of protective factors (e.g., a supportive relationship), prolonged or frequent exposure to trauma can cause a toxic stress response that negatively impacts a child’s developing brain and body. Policymakers across the country are examining how various policy levers (including Medicaid) can be used to reduce children’s exposure to ACEs, foster resilience, and increase the odds that children get a good start in life. One example is New York’s First 1,000 Days on Medicaid initiative, which aims to improve access to services and health outcomes for children served by Medicaid. The statewide initiative is supporting development of a preventive pediatric clinical advisory group that, among many other objectives, will identify ways to incorporate trauma-informed care into practice, including how to identify and address ACEs.

Future Without Violence’s Changing Minds: Preventing and Healing Childhood Trauma State Policy Guide outlines approaches that health, education, child welfare, justice, and child development organizations can use to further the prevention and healing of childhood trauma at the state level.

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