2018 NACo Legislative Conference Workshop Review: The Impacts of Adverse Childhood Experiences and Childhood Poverty

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The Adverse Childhood Experience Study, known to many as “ACEs,” was conducted between 1995 and 1997 by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC). It asked participants a series of questions related to childhood trauma and found that individuals who reported incidences of adverse experiences also suffered poor health outcomes later in their adult lives. 

As compared to those with no adverse experiences in early childhood, individuals who indicated 4 or more adverse experiences were:

  • 2.2 times more likely to be smokers;
  • 4.6 times more likely to be depressed;
  • 12.2 times more likely to attempt suicide;
  • 7.2 times more likely to be alcoholics;
  • 4.5 times more likely to be drug users; and
  • 5.5 times more likely to abuse their partners.[1] 

On Monday, March 5, 2018, the National Association of Counties (NACo) hosted a workshop during its 2018 Legislative Conference on the scientific impacts of childhood trauma on the developing brain. Dr. Brenda Jones Harden, Professor at the University of Maryland and Chair of the Committee of the Board at ZERO TO THREE, presented information about this critical time in a child’s development to county leaders.  Sharing research conducted by Dr. Jack P. Shonkoff, renowned Professor and Founding Director of the Center on the Developing Child at Harvard University, she described three levels of stress: positive, tolerable and toxic. Dr. Shonkoff defines toxic stress as the, “Prolonged activation of stress response systems in the absence of protective relationships,” and proclaims, “When toxic stress response occurs continually, or is triggered by multiple sources, it can have a cumulative toll on an individual’s physical and mental health – for a lifetime.”[2] 

Brain science demonstrates that the development of language, cognitive function and sensory pathways is at its greatest during our earliest years.[3] Since this period of rapid brain development is such a critical time for young children, exposure to toxic stress can disrupt brain architecture and functioning, relaying into undesirable physiological and psychological outcomes which may include: developmental delays, academic challenges, lack of impulse control, difficulty concentrating, the internalization or externalization of problems, and harm to other organs resulting in asthmatic or inflammatory issues.[4] Although ACEs tend to predict the 10 leading causes of adult death and disability, Dr. Jones Harden had good news to share – the existence of toxic stress can be, “Mediated with positive caregiving.” 

Following Dr. Jones Harden’s engaging presentation, Uma Ahluwalia, the Director of the Department of Health and Human Services in Montgomery County, Maryland, moderated a panel of two counties that have applied a trauma-informed lens to their programs and services. Trauma-informed systems offer routine screenings and culturally responsive assessments; evidence-based parent and child interventions; resources; staff support to prevent secondary traumatic stress; and an emphasis on the continuity of care and coordination with other service delivery systems.[5]

Commissioner Jasmine Beach-Ferrara from Buncombe County, North Carolina, shared how they began to implement a trauma-informed lens to their programs and services for young children approximately 5 years ago, starting with the recognition that they must engage the whole family unit. Today, Buncombe County is working to move beyond trauma-informed programs and towards a trauma-informed system. Two ways they have begun to work systematically are through service mapping to assess the need for coordination within the county and by using positioned navigators who help to coordinate programs, similar to a pop-up farmers market model.    

This year, the Buncombe County Board of Commissioners committed to, “Ensuring that every child in Buncombe County has an equal opportunity to thrive during their first 2,000 days, including access to quality early childhood education,” as one of their strategic priorities. As they work to expand equal access to early education, in alignment with the NC Pre-K state policy, they will continue to use their trauma-informed framework to support the development of their youngest residents.

Commissioner Tammy Baney from Deschutes County, Oregon, concluded the workshop by sharing how her county is working regionally with neighboring jurisdictions, Jefferson and Crook, to deploy Trauma, Resilience, and Adverse Childhood Experiences (TRACEs).  TRACEs works at the system level to ensure that each individual in the region has the strength, connections, and support needed to thrive by supporting various local priorities and utilizing a trauma-informed approach across the community, which has been integrated into the county services, schools districts, child care centers, health service centers, and non-profit organizations.

According to the U.S. Department of Health and Human Services’ Administration for Children and Families, the youngest children are the most vulnerable to child maltreatment, with more than one-quarter of victims younger than three years old in FY 2016.[6]  Local findings estimate that the annual economic toll of child maltreatment is anywhere from $38 million to $81 million in Central Oregon, based on loss of productively, medical costs, child welfare costs, special education costs, and criminal justice costs.  Consequently, the implementation of TRACEs is a crucial component to the health of their regional economy.

Understanding the significance of a child’s first experiences and the practical application of how counties can implement trauma-informed models and foster resiliency in their youngest residents is critical to the role they play in administering programs and services to children and families.  Early strategic investments are a fundamental solution to a thriving community and county leaders can help  mitigate some of these early challenges by working to decrease poverty; fostering community and social well-being; reducing environmental risks for toxic stress, offering comprehensive programming for quality early care and education, parent education, family support and income support; and implementing intervention programs for children and families exposed to adverse experiences and toxic stress.  During the ACE’s workshop, Commissioner Jasmine Beach-Ferrara, shared the following quote by Nelson Mandela, “There can be no keener revelation of a society’s soul than the way in which it treats its children.”  Nelson Mandela’s quote resonated with the audience, reminding us of the importance of investing in young children early and supporting strong family networks.


[1] Anda, R.F., Felitti, V.J., Bremner, J.D. et al. Eur Arch Psychiatry Clin Neurosci (2006) 256: 174.  

[2] Harvard University Center on the Developing Child.  Toxic Stress (2017). Available from:

[3] Institute of Medicine. 2000. From Neurons to Neighborhoods: The Science of Early Childhood Development.  Washington, D.C.: The National Academies Press.

[4] Shonkoff et al. “Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention.” JAMA The Journal of the American Medical Association, 2009; 301 (21): 2252 DOI: 10.1001/jama.2009.754  

[5] “What is a Trauma-Informed Child and Family Service System?” The National Child Traumatic Stress Network.  Available from

[6] U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2018). Child Maltreatment 2016. Available from

About Tracy Steffek (Full Bio)

Program Manager for Human Services

Tracy Steffek is the Program Manager for Human Services in the County Solutions and Innovation (CSI) department. In this role, she is responsible for educating and assisting county officials across the United States on human services issues and for the development and implementation of an early childhood project.

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