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ACEs: COVID-19's social and economic impact looms large over children

In December of 2019, the odds that a child in the United States would experience trauma were already high. In the wake of a global pandemic, those odds have risen sharply. That’s serious cause for concern, and it requires urgent action.

Before they reach adolescence, many children face household challenges including poverty; parental or caregiver separation, divorce, substance use disorder, mental illness or incarceration; discrimination; abuse; neglect or other forms of adversity. These traumatic circumstances are known as adverse childhood experiences, or ACEs.

According to Child Trends, economic hardship and separation or divorce are the most common adverse childhood experiences. In the United States, 61% of Black children, 51% of Hispanic children and 40% of White children have experienced at least one ACE.

Too often, ACEs disrupt young lives that have barely just begun. While ACEs don’t predetermine any child’s fate, the experience can jeopardize prospects for a healthy, fulfilling life. Many children who suffer trauma become hypersensitive to the needs of others and withhold their own emotions. Students who face trauma often find it more difficult to engage with their school work (PDF) and may seem detached or distant.

Trauma is a full body experience. Data show a clear relationship between ACEs and mental and physical health problems that often continue well into adulthood. ACEs are linked to anxiety, depression and disruptive behavior, which can eventually undermine family and employment prospects, not to mention overall well-being. In fact, the average life expectancy of someone who has experienced six or more ACEs is twenty years shorter than someone with none.

Tragically, ACEs have been on the rise (PDF) during the pandemic, and their impact has grown more intense.

In the past year and a half, more American families have faced job loss, food insecurity and housing insecurity. Although these may seem like adult issues, the resulting fears and anxieties are also experienced by children, both directly and indirectly. As the stress inside the household accumulates, the ACEs begin to multiply.

Without strategic intervention now, the growing rate of ACEs will have dire consequences on both individual and community well-being. And the effects could extend for generations.

Modest steps today can have a bold impact tomorrow

Minimizing ACEs and their impact requires a multi-pronged approach.

Investment in preventative measures is critical if we want to stop ACEs before they begin. Home visits to pregnant women and parent-training programs can prepare expecting families for the challenges that lie ahead. Violence prevention programs and social support for parents can help families develop healthy strategies for navigating life’s inevitable stresses.

Preventative measures can also include work to address other drivers of health that contribute to ACEs.

For example, research suggests that household food insecurity increases the risk of childhood trauma. Our work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to promote food security demonstrates how strategic cross-sector collaboration can drive relatively low-cost measures to prevent the toxic stress that often leads to ACEs. Helping one family at a time can make a difference in a child’s life and reduce ACEs’ downstream effects on health and well-being.

Early childhood education can support children and parents alike. According to the Centers for Disease Control and Research, access to quality childcare can help reduce child behavior problems (PDF). It can also relieve parental stress and depression and cut rates of child abuse and neglect.

Similarly, preschool enrichment programs that engage and support parents can improve student math, language, and social skills as they enter school. This increases the odds that young students will eventually graduate from high school and attend college. For example, federally funded Child Parent Centers provide educational and family support in underserved communities. Evidence suggests they can help lower rates of abuse and neglect, depression, substance use and risky behavior.

Finally, we also need to strengthen our infrastructure so that health care professionals, social services providers, educators and community-based organizations are better equipped to help children at risk. Often children experiencing ACEs are mislabeled, unfairly disciplined and written off. With proper training, those in the best position to help would recognize that these children need treatment, resources, support, compassion and redirection.

For example, North Carolina’s Mountain Area Heath Education Center (MAHEC), with the support of Healthy Blue, Blue Cross NC’s Medicaid program, has expanded its ACE Learning Collaborative and is helping other regions in the state replicate it at home. Through monthly virtual ECHO training sessions and biennial summits, the learning collaborative brings together national experts in the field and participants from across the state who can help North Carolina’s providers gain a greater understanding of the role they can play interrupting the cycle of intergenerational trauma. The program and the summits have reached medical staff and clinicians, educators, social service workers, law enforcement, first responders, church staff and many others. By taking a collaborative approach to ACEs education, MAHEC is helping to build a state-wide network that will foster a “culture of resiliency.”

Modest steps today can have a bold impact tomorrow

Investing to prevent childhood trauma isn’t just the right thing to do. It also makes good financial sense. ACEs take an economic toll on communities in the form of productivity loss and costs associated with health care, special education, child welfare and criminal justice. According to the Centers for Disease Control and Prevention, Americans spend $748 billion on illnesses related to ACEs. Even a 10% reduction in ACEs would result in $56 billion in annual savings.

The good news is that a broad awareness of ACEs is growing. Vital work is unfolding at the federal and state levels to address their impact. In the wake of a pandemic that has magnified the deep inequities in our economic and health care systems, this work is more urgent than ever before.

With a more compassionate approach and more strategic investment, we can help ensure that children who have accumulated ACEs break the cycle of poverty and adversity.  With early intervention and redirection, even children with multiple ACEs can emerge healthy and successful. In the long run, this will help disrupt intergenerational trauma and shatter barriers that prevent children from reaching their full potential.

authors photo

John Lumpkin, MD, MPH

John Lumpkin, MD, MPH

John is president of the Blue Cross and Blue Shield of North Carolina Foundation, a position he has held since April 2019. He also serves as vice president, drivers of health strategy for Blue Cross since September 2019. In his role, he's responsible for innovations addressing social needs and drivers of health for Blue Cross NC members and communities across North Carolina.

The Blue Cross NC Foundation seeks to improve the health and well-being of all North Carolinians through a focus on transforming the health care system (including oral health), expanding access to healthy food, supporting a healthy start in life for children, improving the physical conditions where people live, and strengthening the ability of communities to improve health. 

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