Addressing Adverse Childhood Experiences Through the Affordable Care Act: Promising Advances and Missed Opportunities

Abstract

Adverse childhood experiences (ACEs) occur when children are exposed to trauma and/or toxic stress and may have a lifelong effect. Studies have shown that ACEs are linked with poor adult health outcomes and could eventually raise already high health care costs. National policy interest in ACEs has recently increased, as many key players are engaged in community-, state-, and hospital-based efforts to reduce factors that contribute to childhood trauma and/or toxic stress in children. The Affordable Care Act (ACA) has provided a promising foundation for advancing the prevention, diagnosis, and management of ACEs and their consequences. Although the ACA's future is unclear and it does not adequately address the needs of the pediatric population, many of the changes it spurred will continue regardless of legislative action (or inaction), and it therefore remains an important component of our health care system and national strategy to reduce ACEs. We review ways in which some of the current health care policy initiatives launched as part of the implementation of the ACA could accelerate progress in addressing ACEs by fully engaging and aligning various health care stakeholders while recognizing limitations in the law that may cause challenges in our attempts to improve child health and well-being. Specifically, we discuss coverage expansion, investments in the health workforce, a family-centered care approach, increased access to care, emphasis on preventive services, new population models, and improved provider payment models.

Health Status of Adolescents Reporting Experiences of Adversity

“…Identification of reimbursement structures to support investment in screening is needed. 69 Collaboration with family and community partners to identify acceptable ways of asking about adversity and modeling relevant responses to a range of screening results is essential. 70,71…”

Safe, Stable, and Nurtured: Protective Factors against Poor Physical and Mental Health Outcomes Following Exposure to Adverse Childhood Experiences (ACEs)

“…ACEs have been acknowledged as a public health crisis given their association with diseases and illnesses that are linked to early mortality and contribute to rising healthcare costs (Srivastav et al 2017). Approximately 35 million children nationally have experienced one or more types of childhood trauma and well over half of South Carolina's adults (62%) report experiencing ACEs (Morse et al 2016;National Survey of Children's Health: NSCH 2011/12, n.d.).…”

The Empower Action Model: A Framework for Preventing Adverse Childhood Experiences by Promoting Health, Equity, and Well-Being Across the Life Span

“…ACEs can also affect life potential such as academic achievement, employment, and wealth, all of which are also linked to health outcomes (Larkin, Shields, & Anda, 2012). The consequences of ACEs have lasting impacts on our already overburdened health care system (Srivastav, Fairbrother, & Simpson, 2017). Taken together, ACEs demonstrate the importance of taking a social determinants of health perspective—understanding that adult health and social outcomes are the product of the complex interplay of experiences in early childhood and inequities (Braveman & Barclay, 2009; Larkin et al, 2012).…”