Lessons in Advancing Policy to Prevent Adverse Childhood Experiences

June 29, 2026 | Juno Dolan

Adverse childhood experiences (ACEs) are traumatic events (e.g., abuse, neglect, and household substance misuse) and linked to lasting health challenges, including chronic disease and mental health concerns. Jurisdictions can take policy actions to prevent ACEs by shaping economic, social, and institutional conditions.

Between January and March of 2026, ASTHO engaged health agency leaders and staff in Kansas, Oregon, and Indiana to discuss policy successes, including how strategy and implementation decisions supported the state’s overall goals of ACEs prevention.

State Approaches to ACEs Policy

Indiana: Elevating Family and Youth Voices

Indiana operates the Commission on Improving the Status of Children (CISC) and, in 2025, enacted legislation requiring CISC to create and staff the Youth, Family, and Engagement Initiative, with recommendations from youth, families, and caregivers. The legislation passed unanimously, sparking seven additional bills to embed lived-experience voices across other state agencies. By centering those with direct system experience in policy design, Indiana aims to advance effective policies informed by individuals affected by ACEs.

Kansas: Building Partnerships to Support Working Families

Kansas’ Child Daycare Assistance Tax Credit is for employers who support their employees’ child care costs. The bill was promoted as a measure that would strengthen employers’ economic stability and enhance workforce retention. Supporters, including the Child Death Review Board, connected quality child care access to reductions in child abuse and neglect. A coalition between Chambers of Commerce, business leaders, Child Care Resource and Referral and Early Childhood Agencies, and the Child Death Review Board advanced the bill. In 2026, the tax credit was updated to increase the credit amount, streamline eligibility criteria, and offer businesses the option to contribute to a third party that expands community child care options. By tying child care access to employer incentives, Kansas improves the chances of relieving a key economic stressor linked to child abuse and neglect.

Oregon: Supporting All Families with Universal Home Visiting

Home visiting reduces child protective service involvement and improves maternal mental health. It also reduces barriers to support children and families, normalizes seeking help, and targets early risk factors for ACEs across all families. In 2019, Oregon passed Senate Bill 526, mandating an evidence-based, universally-offered statewide home visiting program, with state-regulated health benefit plans reimbursing the full cost of the service (see state law). Responsive to the mandate, the state adopted the Family Connects model, naming it Family Connects Oregon, which is backed by Duke University’s randomized controlled trials. The program aims to normalize seeking and providing postpartum support to all families, regardless of income. It works to strengthen connections between families with newborns and support services including the broader home visiting system.

Key Themes Across State Efforts

Champions and Leadership

Developing and implementing effective ACEs prevention policies in all three states required dedicated champions who could navigate complex political environments, secure resources, and sustain momentum amid budget cuts, political shifts, and the challenges of launching new programs. Their roles varied, including state legislators, agency directors, community advocates, and individuals with lived experience. Effective champions used strategic actions to bridge gaps, move initiatives forward, and ensure affected communities had a voice in decision-making:

Securing stakeholder buy-in: Oregon engaged commercial health payers prior to the legislative session to lay the groundwork for a sustainable reimbursement model. By securing voluntary agreements beforehand, Oregon ensured the program's coverage by commercial insurers.
Engaging diverse voices: Kansas relied on a diverse coalition of champions, each bringing distinct resources, and arranged critical meetings between the partners and legislators. Discussions involved Child Daycare Assistance Tax Credit bill improvements to expand beyond large corporations and include smaller employers. Meanwhile, Indiana actively included youth and caregivers with lived experience by creating a large volunteer network that reviewed recommendations, ensuring that ground-level realities informed policy proposals before reaching CISC.

Cross-Sector Partnerships

States brought together government agencies, private industry, advocacy organizations, and community members. This called for creating new alliances and leaning into long-standing institutional relationships. While all states faced structural and operational barriers, they were able to leverage cross-sector collaboration and reduce duplication.

Leveraging established networks: Family Connects Oregon partners with Oregon’s Department of Early Learning and Care and its 16 Early Learning Hubs. Various agencies (i.e., local public health) can serve as both newborn nurse home visiting providers and community leads, key implementation roles. Community-based organizations and other family supports (e.g., WIC and 211 hotline) expand Family Connects Oregon’s reach, serving as key access points for home visiting programs. Indiana’s Youth, Family, and Engagement Initiative relied on CISC, a formal body comprising 20 members from all three branches of government. The commission has more than 100 volunteers to support policy recommendations and changes to agency practice.
Working through coalitions: Existing coalitions were utilized in Kansas, and each partner contributed to the passage of the Child Daycare Assistance Tax Credit. The Chambers of Commerce mobilized critical political backing, while Child Care Resource and Referral and Early Childhood Agencies supplied the operational infrastructure needed to mitigate liability concerns for participating businesses. The Child Death Review Board added urgency by directly linking quality child care to improved child safety outcomes.

Monitoring and Evaluation

Monitoring and evaluation approaches across the three jurisdictions vary in maturity. Some initiatives relied on rigorous, pre-existing evidence bases to guide policy strategy and evaluation, while others had to define and measure success for newer or more innovative models. All states recognized that evaluation must evolve alongside the program, balancing immediate accountability with long-term objectives such as:

Informing evaluation frameworks with existing evidence and novel metrics: Oregon benefits from Duke University’s randomized controlled trials on the Family Connects model and the ongoing research from Family Connects International, which demonstrate significant reductions in child protective services engagement and improvements in maternal mental health for universal home visiting. Meanwhile, Indiana recognized that traditional metrics would not capture meaningful engagement and is developing indicators to ensure that community voices are driving decision-making.
Integrating epidemiological data into action planning: Kansas is implementing a "data-to-action" workgroup to bridge the gap between implementing solutions and measuring success by integrating epidemiological data into their action planning. This model ensures that future interventions are not only implemented but also rigorously evaluated for success.
Expanding data collection efforts: Oregon extends beyond clinical metrics to include communications data and tracking of the strategic plan to assess the model's state-wide adoption as a standard of care, with an external evaluator engaged to provide an independent layer of oversight. Indiana is moving beyond superficial indicators (e.g., attendance) to assess whether community members feel empowered and influence outcomes. Data collection is being designed to track both output and process metrics, including the number of recommendations vetted annually, the extent of outreach to other state agencies, and the adoption of best practices by partner agencies.

Conclusion

Despite differences in policy environments and implementation strategies, Kansas, Oregon, and Indiana have shown that effective ACEs prevention policy requires leadership, coordination, and ongoing evaluations. Future success centers on institutionalizing lessons learned, such as ensuring inclusive engagement, fostering cross-sector collaboration, and measuring outputs and process quality. As these states refine their strategies, they provide a strong model for integrating primary prevention into public health and child welfare, shifting the focus from risk mitigation to collective resilience.