A Roadmap to Shared Strategies that Promote Well-Being and Resilience

July 08, 2026

Adverse childhood experiences (ACEs), suicide, overdose, and mental health concerns are not isolated challenges; they are linked across the life course. ACEs can increase the risk of suicidal behavior, substance use, overdose, mental health concerns, and violent acts later in life. This means that efforts to prevent ACEs from ever occurring can also prevent subsequent negative individual, intergenerational, and societal outcomes. These strategies are often referred to as intersectional.

To support state, territorial, and freely associated state health agencies in their intersection work, ASTHO — with CDC funding — developed resources that detail these evidence-informed strategies and provide additional relevant resources and examples.

Summary of Strategies to Address Intersecting Health Concerns

Strategies to address the intersection of ACEs, suicide, overdose, and mental health concerns must incorporate the comprehensive and unique needs of communities. The “Swiss Cheese Model” (Image 1) shows how these intersecting strategies address multiple health concerns: When evidence-informed strategies are layered like a stack of Swiss cheese, most holes are eventually blocked by another slice, reducing the likelihood that any single hole remains all the way through. Similarly, layering multiple prevention strategies in communities prevents someone from falling through the cracks and experiencing multiple traumatic events. Table 1 further details these intersecting strategies and how they work together.

Table 1: Strategies and Specific Approaches to Address the Intersection

Strategy	Importance	Specific Approaches
Strengthening Economic Supports for Families	Strengthening economic supports for families enables them to better afford housing, child care, healthy food, and medical care. It can also help stabilize families by protecting their jobs/income and reducing stress while they care for themselves, children, or family members.	Bolstering Household Financial Security Enhancing Work-Related Family Supports Building Employment Opportunities Supporting Stable and Affordable Housing
Strengthening Community and Home Environments	Where people live shapes their health and well-being. Ensuring that household and neighborhood environments are safe and nurturing is critical for helping all ages thrive.	Promoting Modifications to Community Environments Advancing Safe Home Environments
Ensuring Strong Foundational Supports for Children and Families	Early childhood experiences set the foundation for lifelong health and well-being, as children’s environments and relationships shape how their brains and bodies develop. As children and adolescents enter school, they also benefit from ongoing resources and support within or attached to the school system, including opportunities to build skills to navigate life challenges.	Enhancing Early Childhood Supports Enhancing Programs and Supports for School-aged Children Providing Skill Development Training
Strengthening Supports to Lessen the Impact of and Prevent Future Traumatic Experiences	When traumatic experiences occur, it is critical to ensure that effective interventions are in place to address those experiences and reduce the likelihood of future risk — for these individuals and their children (i.e., any potential generational trauma).	Supporting Behavioral Health Integration into Primary Care Enhancing Access to Behavioral Health Treatment and Services Improving Civil Protections to Prevent Traumatic Experiences Enhancing Responses After Traumatic Events

The Health Agency’s Role

To implement and improve these intersecting strategies, health agencies play critical roles:

• Convene and partner with multisector organizations that can facilitate implementation efforts locally.
• Support cohesive, coordinated strategies that maximize existing resources and reduce duplication of efforts.
• Ensure adequate data infrastructure to collect and disseminate data on the current state of local efforts, and opportunities for improvement and benefits of these efforts for families and communities.
• Explore where policy levers might enable or hinder efforts, and where flexible funding across sectors or organizations can enhance local efforts. This is often best done in collaboration with partners.
• Provide education and raise awareness among the public and decision-makers about the importance of implementing these efforts to address health concerns.
• Reduce barriers for local agencies and organizations that support these strategies to be able to improve their services for families and communities, including efforts to support workforce capacity in these areas.

Additional ASTHO Resources

• Addressing the Intersection of ACEs, Suicide, Overdose, and Mental Health Concerns: Detailed practical guidance and resources to support implementation of intersectional strategies.
• Voices from the Field: A collection of stories demonstrating how jurisdictions are implementing these strategies.
• Suicide, Overdose, and Adverse Childhood Experiences Prevention Capacity Assessment Tool: An internal collaborative self-assessment to enhance current capacity to strengthen prevention efforts.

This resource reflects the collective efforts of many contributors, including ASTHO staff Alison Maffey, MSW, Vice President, Social and Behavioral Health; Caitlin Langhorne-Griffith, Director, Injury, Suicide, & Violence Prevention; Rachel Scheckman, Senior Analyst, Intersection of ACEs, Suicide & Overdose Prevention; and Erin Wright-Kelly, DrPH, MA, of Community Impact Partners, LLC.