Actions to Build Capacity for ACEs Prevention

The Association of State and Territorial Health Officials (ASTHO), in collaboration with CDC, developed the Adverse Childhood Experiences Prevention Capacity Assessment Tool (ACECAT) to help state, territorial, and local health agency staff 1) describe how they address adverse childhood experiences (ACEs) in their jurisdiction and 2) identify opportunities to maximize resources and impact. ACECAT is designed for health agency leadership and staff focused on child maltreatment prevention and/or addressing risk and protective factors for ACEs (e.g., economic mobility, community connectedness).

Using the data from jurisdictions about gaps and challenges in ACEs prevention, ASTHO developed these action ideas and resources for teams to build additional infrastructure and topical capacity for ACEs prevention. It includes beginner, intermediate, and advanced action ideas, health equity considerations, and additional resources for each section of ACECAT. Please note that this does not follow the exact order of ACECAT but rather the order in which an agency might approach enhancing their ACEs prevention capacity.

Infrastructure Capacity

Infrastructure capacity includes multiple components affecting program capacity, implementation, and sustainability. Key components are data and surveillance, risk and protective factors, networked partnerships, responsive planning, multilevel leadership, and managed resources.

Capacity Elements

Beginner

Explore whether your agency collects ACEs surveillance in the Youth Risk Behavior Surveillance System (YRBSS), Behavioral Risk Factor Surveillance System (BRFSS), and other data for your state.
Determine whether your agency collects data about ACEs from the community and ACEs surveillance data.
Identify which surveillance data sources your agency uses for ACEs prevention.
Explore existing data dashboards available within your jurisdiction.
Research data reports from national, state, and local organizations that focus on ACEs data.
Identify potential data sources for information about shared risk and protective factors (SRPF) that are connected to ACEs outcomes (see the Risk and Protective Factors section).

Intermediate

Evaluate and gain an understanding of how your agency uses ACEs surveillance data and how your state can assess the SRPF that helps mitigate ACEs outcomes.
Seek to add more questions/modules about ACEs, positive childhood experiences (PCEs), and SRPFs in existing data surveillance sources.
Explore trainings on storytelling and framing data to learn how to present data in an impactful way to a wide variety of audiences.
Identify geographic areas or populations with a high prevalence of ACEs or their risk factors or a lower prevalence of protective factors or PCEs.
Participate in ACEs data sharing/ dissemination.
Create an evaluation plan that includes indicators across the shared risk and protective factors for ACEs.
Establish an understanding that many social determinants of health (SDOH) are also risk factors for ACEs and identify existing data about SDOH.

Advanced

Analyze administrative data on indicators of ACEs (e.g., program administration for child welfare, food, and economic support) to understand service and program needs.
Gain access (e.g., funding or collaborative relationship) to your own epidemiologist to analyze community-level data on SDOH to understand SRPF for ACEs and/or PCEs.
Analyze community-level data regarding access to social support.
Analyze SRPF, ACEs, and PCEs from YRBSS and/or BRFSS results. Run cross tabs to connect to related health outcomes.
Conduct annual surveillance updates to prior analyses.
Develop and maintain a jurisdictional ACEs data dashboard.
Conduct ongoing program evaluation.
Explore using data to determine the return on investment for resource allocation for ACEs.
Train agency staff on storytelling and framing SRPF and ACEs data.

Health Equity Considerations

Advocate for analyzing data through a health equity lens within your program and across your agency.
Ensure that data is representative to all people, accessible to the public, and helps identify priority populations.

Resources

Beginner

Determine team members’ knowledge of SRPF approaches to address ACEs.
Create a self-assessment for team members.
Create a list of available trainings about SRPF approaches and offer trainings to team members.
Identify existing work already in place that aligns with an SRPF framework.
Determine which SRPFs your health department can influence to achieve multiple outcomes.
Determine where outcome-focused programs are working in siloes and, instead, where they could collaborate on one SRPF.
Convene your internal team and facilitate discussions around SRPF approaches.

Intermediate

Determine which programs within your organization are working to address one or more SRPFs. Review work to enhance alignment and collaboration, where possible.
Develop or host a training for internal staff and stakeholders on SRPF.
Review funding sources that support work on upstream approaches that address SRPFs.
Identify opportunities for braiding and sharing outcome-focused funding sources to support evaluation regarding SRPFs. Also, consider braiding or sharing evaluation costs across.
Complete stakeholder mapping to identify external programs. Then, create a shared dictionary for internal and/or external use with upstream prevention language and definitions between SRPF sectors and disciplines.
Determine how external programs relate to internal programs.
Discuss possible collaborations based on shared priorities.
Convene your cross-sector team and facilitate discussions around SRPF approaches.

Advanced

Working with partners, develop shared internal and external strategies for addressing SRPFs within your agency and community.
Review existing funding sources to identify opportunities to braid or layer funding to offer sustainability and maximize the impact of the selected approach.
Apply for grant funding to support SRPF approaches.
Evaluate how changes in SRPF indicators influence multiple public health outcome areas.

Health Equity Considerations

Use risk and protective factors to guide the identification focus on priority populations and guide upstream ACEs prevention strategies.

Resources

Beginner

Conduct an informal scan of your agency or program's partnerships.
Determine if there are gaps in your current programming that would benefit from new partnerships.
Identify potential partners and establish priorities.
Examine the importance and role of non-traditional partners (e.g., homeless shelters, schools) in your work.
Support your local health departments in connecting with community champions or leaders to help engage with disproportionately impacted populations and gain trust in the community.
Encourage your staff to partner with other departments/organizations to advance shared priorities.

Intermediate

Engage with your team in stakeholder mapping, both internal and external stakeholders.
Identify the level of coordination with your internal or external partners and your agency.
Examine non-traditional partnerships (e.g., business partners, pharmacies, schools/universities, and homeless shelters) and how they might be helpful.
Develop roles for potential partners and determine what each program or organization will bring to the partnership.

Advanced

Involve people with lived experiences and partners who work with underserved populations in your ACEs prevention work.
Work with partners to share and coordinate data that represents all populations within your communities.

Health Equity Considerations

Advocate for analyzing data through a health equity lens within your program and across your agency.
Ensure that data is representative to all people, accessible to the public, and helps identify priority populations.

Resources

Beginner

Explore the ACEs Prevention – Best Available Evidence section below for additional strategy ideas.
Determine how ACEs and related SRPFs prevention strategies are included in your strategic plan/state health improvement plan.
Identify SRPFs that partner organizations prioritized in their planning.
Identify SRPFs that your agency would like to prioritize in partnership with other agencies in the jurisdiction.
Discuss your agency's priorities, objectives, and goals for SRPFs and ACEs prevention.
Determine whether your agency carries out shared planning and coordinates within your agency to inform SRPF and ACEs prevention strategies.
Assess multiple program work plans for potential areas of alignment.

Intermediate

Create or update your agency's strategic plan to represent SRPF and ACEs prevention and implementation goals.
Review your agency's strategic plan with internal and external stakeholders to ensure coordination and receive feedback from those connected to the plan.
Begin shared planning and regular collaboration within your agency.
Create an implementation plan for the strategic plan. Design a measurement plan for strategic plans and/or priorities.
Review the strategic plan regularly to ensure continuous quality improvement.
Revise the strategic plan based on outcome and performance outcome results.

Advanced

Establish a common work plan to guide ongoing shared planning and collaboration across all networked partnerships, internal and external to your agency.
Assess multiple program work plans for potential areas for alignment.
Create a shared plan across all partners to represent SRPFs and ACEs prevention and implementation goals.
Review your shared plan with all of your partners to ensure coordination.
Work with your partners to create an implementation plan for the shared plan.
Design a measurement plan for the shared plan.
Regularly work with partners to review the shared plan to ensure continuous quality improvement.
Revise the shared plan with your partners based on outcome and performance outcome results.

Health Equity Considerations

Incorporate health equity, community-level shared risk and protective factors, and prevention strategies that represent the diversity of your communities in your agency's strategic plan.
Collaborate with partners to identify shared priorities in addressing health inequities.

Resources

Beginner

Assess the levels of leadership represented in your agency’s current network and identify which partners you might need more leadership support from.
Support your local health departments in connecting with community champions or leaders to help engage different populations and gain trust in the community.
Learn about effective communication styles and determine your communication style as a leader.
Create a culture of collaboration with staff and set clear expectations for relationship building within and outside your organization.

Intermediate

Connect with different leaders and partner organizations.
Strengthen existing relationships.
Develop organizational mentorship opportunities for team members within and across departments.
Attend leadership trainings to strengthen leadership skills, such as communication, vision, and systems thinking, which will support an environment of diversity, equity, and inclusion.

Advanced

Establish new collaborations and formal memorandums of understanding between your agency and leaders of other partner organizations.
Create a leadership council that meets regularly to collaborate on SRPF work.
Practice collective leadership. Determine ways to leverage networks to bring together communities and systems.
Convene your leadership team and establish collaboration expectations across departments to engage in SRPF approaches.
Create a plan for sustaining collaborative relationships despite things like personnel turnover.

Health Equity Considerations

Engage with community leaders and implement inclusive leadership practices within your agency.

Resources

Beginner

Review current funding and budgets going towards SRPF work that impacts ACEs and determine gaps.
Sign up to receive federal funding announcement notifications from grants.gov.
Determine whether your agency's ACEs prevention program engages in resource sharing with other internal program areas.

Intermediate

Identify ways to begin braiding and layering funding. Divide the SRPF approach into multiple components and action areas required for each funding source. Identify whether diverse funding sources can each contribute resources (e.g., staff time, funding toward a contract, diverse funding sources supporting separate communities) toward the effort separately.
Determine whether your agency directs specific funding sources toward SRPF.
Identify possible shared positions internally that can support multiple SRPF efforts with specific expertise, like social norms change communication, program evaluation, data analysis, etc.
Research future funding opportunities that align with ACEs priorities.
Research potential business partnerships that may be able to provide funding or other resources.
Develop a plan to share resources with other internal program areas.

Advanced

Coordinate with other internal program areas to engage in further efforts to share resources.
Explore options for intra- or inter-agency arrangements for shared staffing, contracting, and/or resources to work on SRPFs that impact ACEs.
Research non-traditional partnerships with internal and external organizations for funding, contracting, and other activities and resources.
Implement braiding and layering across multiple sources for your ACEs program.
Reassess existing funding for additional areas for future SRPF alignment. Strategically identify SRPFs across public health outcomes and apply for multiple funding sources that help address one shared approach in complementary ways.

Health Equity Considerations

Identify funding opportunities your agency can use to address health equity and ensure your agency has processes or standards in place for equitable management of funding resources.
Consider ways to support and/or fund partners or community organizations in addressing health inequities.

Resources

Topical Capacity

Topical capacity refers to multiple strategies that work together to form a comprehensive response for addressing ACEs. A comprehensive response includes primary, secondary, and tertiary prevention components. This section covers the best available evidence to prevent ACEs, health disparities, and workforce capacity.

Capacity Elements

Beginner

Identify best available evidence for other SRPF prevention strategies and policies.
Conduct a scan and list current policies that strengthen economic support to families through financial security and family-friendly work. Keep track of policies not currently legislated in your jurisdiction.
Identify jurisdictional programs that promote social norms that protect against violence and adversity. Keep track of policies not currently legislated in your jurisdiction.
Research the benefits of protective factors and compile a list of programs in your jurisdiction that connect youth to caring adults and activities.
Create a list of programs that teach skills (e.g., social-emotional learning, healthy relationship skill programs, parenting skills, and family relationship approaches).
Research examples of interventions like improved access to care and effective treatment options that lessen immediate and long-term harms to determine your jurisdiction's current interventions.

Intermediate

Research the benefits of policies that strengthen economic support to families through financial security and family-friendly work that are not currently legislated in your jurisdiction.
Review research on the importance of promoting social norms that protect against violence and adversity and the programs that support positive social norms.
Collaborate with partner organizations leading programs that ensure a strong start for children and identify ways to support their efforts.
Create factsheets or infographics that convey the importance of connectedness to caring adults and activities as a protective factor.
Build relationships with jurisdictional programs that teach skills.
Look into long-term health implications and return on investment for interventions that lessen immediate and long-term harms.

Advanced

Coordinate efforts to educate your jurisdiction's legislators about the benefits of policies that strengthen economic support to families and create factsheets or infographics to support your case.
Launch public education campaigns that convey the importance of promoting social norms that protect against violence and adversity.
Identify funding sources and policy changes that ensure a strong start for children.
Promote the importance of connectedness (e.g., mentoring programs, after-school programs) as a protective factor for children's physical and mental health to leadership in your jurisdiction.
Develop communication and social media marketing strategies that stress the importance and support the funding for and encourage adoption of evidence-based programs that teach skills and connect community members to local organizations.
Produce content, including factsheets and blogs, that stress the importance of interventions that lessen immediate and long-term harm on long-term health outcomes for children.
Collaborate with your agency’s partners and plan the approach for your agency’s selected interventions and work in relevant infrastructure areas (see the Networked Partnerships and Responsive Planning section for more action ideas).

Health Equity Considerations

Align your agency's ACEs prevention strategies to address inequities, engage in equitable approaches, reach certain communities to ensure equitable care, and create awareness of intergenerational trauma in ACEs.

Resources

Beginner

Determine whether your jurisdiction has completed a population analysis (e.g., a needs assessment) to identify priority populations for ACEs prevention.
Create a list of current partnerships that focus on reaching populations disproportionately affected by ACEs.
Research examples of culturally and linguistically responsive communication and health promotion materials.
Ascertain how often the perspectives of people with lived experiences inform programmatic decisions and your agency's overall work.
Determine whether your jurisdiction has a clear definition and standardized language around health equity.

Intermediate

If a population analysis that identifies priority populations for ACEs prevention exists, investigate how the information is currently being used to prioritize initiatives based on the need.
If a population analysis identifies priority populations for ACEs prevention does not exist, research examples of needs assessments used to identify priority populations in other states.
Reach out to and collaborate with organizations that serve populations disproportionately affected by ACEs and identify ways to support their efforts.
Review your agency's communication and health promotion materials. Assess whether materials are culturally and linguistically responsive, and determine gaps.
Build relationships with community organizations that work with people with lived experience.
Research examples of definitions of health equity and determine which definition and language make the most sense to use in your jurisdiction.

Advanced

If a population analysis identifies priority populations for ACEs prevention exists, determine how current state programs can incorporate this information to better target initiatives to those most in need.
If a population analysis identifies priority populations for ACEs prevention does not exist, use examples found to create one that will help your state identify priority populations for ACEs prevention.
Actively support the efforts of organizations to serve populations disproportionately affected by ACEs through identifying funding sources and data sharing agreements.
Update your agency's current communication and health promotion materials to make them more culturally and linguistically responsive.
Partner with community organizations that work with people with lived experience. Create opportunities to connect with people with lived experience and incorporate their perspectives into programmatic decisions and your overall work.
Update your agency's current communication and health promotion materials to include standardized language and a definition of health equity.

Health Equity Considerations

Address health disparities within targeted initiatives for ACEs prevention and establish a position dedicated to eliminating health disparities within your agency's ACEs prevention work.

Resources

Methods and Emerging Strategies to Engage People with Lived Experience | HHS
Equity in Injury and Violence Prevention | Safe States Alliance (PDF)
Creating Materials and Approaches to Training that are Culturally and Linguistically Appropriate for the Intended Audience | National Center for Cultural Competence
How to Identify and Plan for At-Risk Populations | NACCHO
Diversity, Equity & Inclusion | International Association for Public Participation

Beginner

Create a self-assessment for staff to identify strengths and gaps in knowledge.
Identify internal training gaps and provide focus groups with staff to determine what would be most valuable for them.
Identify staff who work on ACEs prevention strategies or are invested in the health outcomes connected to ACEs across the health agency and partnering agencies to support collaborative work and reduce capacity concerns.
Determine whether your agency provides training on trauma-informed care for health agency staff.
Ascertain the level of knowledge and skills health agency staff currently hold to address health equity.

Intermediate

Look into resources and trainings that focus on evidence-based prevention strategies and how they could be implemented to close gaps in knowledge.
Connect colleagues from across programmatic areas and partnering agencies who work on issues related to ACEs.
Compile a list of internal resources staff can engage with to better support them when they are experiencing anything from lack of motivation or burnout to a crisis that needs more immediate attention.
Research available resources and trainings on trauma-informed care and determine which training would be suitable for staff in your health agency. If trauma-informed care training already exists, determine which resources would best supplement the training already in place to move the workforce from knowledge to skills.
Identify internal and external resources on health equity and its impact on health outcomes, including ACE.

Advanced

Book and conduct additional training on evidence-based prevention strategies for health agency staff and partners.
Train health agency staff and partners on ACEs and create a plan for future collaboration across programmatic areas and partnering agencies.
Build health agency and partner staff on policy change approaches to create systemic and lasting change.
Provide wellness and stigma reduction workshops that focus on self-care for staff and employee wellness topics.
Set up and implement trauma-informed care training for health agency staff.
Conduct a health equity workshop with health agency staff.
Engage partners in educating and training mental/behavioral health providers and health agency staff that help prevent, identify, treat, and mitigate the harms of ACEs.

Health Equity Considerations

Employ strategies to onboard and retain staff who recognize and implement a health equity lens, regularly train staff on prioritizing a health equity approach, and regularly assess your staff’s knowledge of health equity.