State and Territorial Caregiver Wellness Policies May Reduce Adverse Childhood Experiences

July 21, 2022 | Beth Giambrone, Maggie Davis

Smiling healthcare worker outside with her patient in a wheelchairPeople exposed to adverse childhood experiences (ACEs) are at risk for negative physical and/or mental health outcomes, substance use disorders, and unfavorable social outcomes in adulthood. Many people across the country may be exposed to ACEs, with nearly two-thirds of adults in the United States experiencing at least one ACE. The COVID-19 pandemic has also potentially increased the incidence of ACEs.

One known risk factor for ACEs is caregiver stress, including economic stress. The stress endured by caregivers can contribute to negative parenting which in turn can lead to ACEs. Recent studies also demonstrate the COVID pandemic’s impact on caregiver stress and ACEs and the need to improve caregiver wellness.

In recent years, state legislatures have considered several policies that can improve the overall health of caregivers and reduce ACEs. Several of these policies are outlined in a new ASTHOReport: State/Territorial Policy Considerations for Preventing Adverse Childhood Experiences. Created in collaboration with Jonathan Purtle, DrPH, at the NYU School of Global and Public Health, the report highlights several evidence-based policies that could prevent ACEs considered by state legislatures between 2019 and 2021.

Additionally, the report provides public health practitioners and policymakers considerations for adopting policies in their jurisdictions to prevent ACEs. In addition to the policies considered in the reports—such as improving housing security, expanding paid leave, and supporting positive parent education—states and territories have also considered policies that may improve caregiver wellness by increasing their economic supports and improving the built environment.

Increasing Minimum Wage

One way to reduce caregiver stress is through policies that strengthen economic supports for caregivers, such as improving caregiver incomes by increasing the minimum wage. There have been numerous studies on the impacts of increasing the minimum wage, with some finding that increases to the minimum wage over the course of a child’s lifetime decrease the probability of the child having poor health and increase the chances of a child having excellent health. Additionally, some researchers have found that increases in the minimum wage can reduce mortality rates from diseases such as diabetes and stroke, as well as increase doctor visits, which could diagnose health conditions at an earlier stage.

The first federal minimum wage was enacted in 1938 and has been increased 22 times since then. The current federal minimum wage of $7.25/hour was established in 2009. However, 30 states, Washington, D.C., Guam, and the U.S. Virgin Islands, have set their minimum wage above the federal rate. Thirteen states, CNMI, and Puerto Rico, have minimum wage laws equivalent to the federal minimum wage. Five states (Alabama, Louisiana, Mississippi, South Carolina, and Tennessee) do not have a state law establishing a minimum wage, making the federal minimum wage the minimum by default. Two states (Georgia and Wyoming) have state minimum wages below the federal rate, in which case the federal minimum wage applies.

During the 2022 state and territorial legislative sessions, at least eight states considered legislation relating to their state minimum wage laws. In addition, at least six states—Alabama (HB 185), Georgia (HB 116 and SB 24), Louisiana (HB 229 and SB 269), Mississippi (HB 191), South Carolina (H 3184), and Tennessee (HB 2793/SB 2670)—considered bills to establish a minimum wage higher than the national minimum. However, as of July 2022, none of the bills establishing a higher minimum wage have passed.

Beyond the general minimum wage, the Federal Fair Labors Standards Act (FLSA) allows states to pay people with disabilities employed in jobs as part of a “community rehabilitation program” below the $7.25/hour federal minimum wage. By some estimates, the people with disabilities in these programs were paid an average of only $2.15/hour. According to a study by Brandeis University, approximately one in ten parents with children at home have a disability, with 60% having a severe disability. Furthermore, parents with disabilities were more likely to have an income below the poverty line and more likely to experience food insecurity and experience housing insecurities.

In recent years, state legislatures have reconsidered allowing people with disabilities to be paid a subminimum wage under state law. During the 2022 legislative sessions, two states repealed their subminimum wage laws for people with disabilities. Rhode Island enacted HB 7511, which repealed an existing statute that allowed the state to set a lower minimum wage for people with mental or physical disabilities. Tennessee enacted HB 2078, prohibiting employers from paying employees below the federal minimum wage based on “age, physical or mental deficiency, or injury.”

Built Environment Improvements for Positive Caregiver Mental Health

Caregiver health is also improved by supporting policies that enhance the built environment, such as additional greenspaces and reducing exposure to ambient noise and light pollution. These improvements create fewer disruptions, increase sleep quality, and provide a less stressful environment overall. States have approached improvements to the built environment in a number of ways, including efforts to preserve greenspace and lower light and noise pollution.

As evidence shows that enhancing and maintaining greenspaces in communities can foster connectedness and reduce violence, several states are considering programs to promote and preserve greenspaces in developing communities. For example, South Carolina enacted S 152 in 2022, allowing coastal counties to implement a 1% sales tax to procure and preserve greenspaces in the community. The California legislature introduced AB 2114, which would create the California Pocket Forest Initiative and provide grants to cities, counties, and other organizations to create pocket forests and greenspace on public lands. The bill prioritizes disadvantaged communities and communities that lack publicly accessible green space for these grants.

Reducing light pollution caused by outdoor lighting fixtures in public places is being considered in several states. Currently, New Jersey is considering A 3080, which would lower light pollution in communities by establishing a maximum level of illuminance for any outdoor lighting fixture installed by the state, on behalf of the state, or using state funds. The Massachusetts legislature is considering S 2147, which provides requirements for outdoor lighting fixtures installed using state or municipal funds and directs the Department of Energy to promulgate regulations.

To help reduce exposure to ambient noise, Illinois enacted HB 106, which authorizes municipalities that implemented a Residential Sound Insulation Program to replace the windows and doors in a minimum of 750 residences per year. In 2021, New York enacted A 6265, mandating the New York City Transit Authority to produce an annual report on progress made to reduce subway noise, and planned noise abatement activities for the next year.

There is not a single policy solution that will prevent ACEs, but states and territories can consider layering multiple policies to support caregiver well-being, minimize chronic stress, and reduce the risk of ACEs among the children they care for. In the meantime, ASTHO will continue to monitor and report on this important public health issue.