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Screening Childhood Trauma
ONC Editorial

Sep 15, 2023

A three-point plan to address childhood trauma through funding, screening and awareness. (The opinions expressed in this piece are those of the individual authors, Madeline Leung and Alexander Sejas, whose information can be found below.)

Big Picture

Not all public health crises are physically obvious. Childhood trauma, often called Adverse Childhood Experience (ACE), is common in the United States. To combat this problem, states must construct ACE screening tools, continue receiving federal funds for childhood trauma programs, and continue promoting trauma-informed care. 

Operative Definitions

  1. Traumatic Event: An event with lasting psychological impacts that severely threatens one's sense of safety and one's ability to cope. 
  2. Adverse Childhood Experience (ACE): Childhood trauma, occurring between zero and 17 years old. There’s one than more kind of ACE. 
  3. Trauma-Informed Care: Healthcare and psychotherapeutic practices that recognize and response to the impact of trauma. This includes systems that promote trauma awareness. 

Important Facts and Statistics

  1. Among surveyed adults across 25 states, around 61 percent reported to have experienced at least one type of ACE. Around 16 percent reported to have experienced four or more ACE types. 
  2. ACEs are linked to chronic health problems, mental illness and substance abuse and can negatively impact education, job opportunities and earning potential. They can also increase risk of injury, maternal and child health issues and sex trafficking. 
  3. Children who grow up with ACEs can experience trouble forming healthy relationships, stifled brain development, etc. 
  4. In 2016, almost half of American children, or 34 million, had at least one type of ACE. 
  5. In 2019, California launched ACEs Aware to give Medi-Cal providers the training and payment for a screening tool that screened children in their routine care visits. California allocated over $105 million to promote the screening. Some funding includes $50 million for training doctors, $45 million to reimburse doctors. 
  6. The National Child Traumatic Stress Network (NCTSN) was created by Congress in 2000. It is composed of providers, family members, researchers and national partners. The network works to raise the standard of care and increase access to resources for children and families who experience trauma. It is funded by the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), and U.S. Department of Health and Human Services. 
  7. Wisconsin is the first trauma-informed state. This development was driven by Fostering Futures, a public-private partnership to increase trauma-informed care and awareness for trauma. Fostering Futures has trained over 10,000 people on trauma-informed practices and pushed for federal recognition of trauma-informed care.

Three-Point Plan

(1) Allocate between $50 million and $100 million (depending on size) to each state for ACE screening tools. This initiative should be funded in every state to promote ACE screening. These funds will be dispersed for training, technology, analysis, etc. The screening will identify ACEs in children during their routine visits, allowing providers and families to address them early on. 

(2) Continue federal funds for programs that support children and families and mitigate trauma. Federal agencies such as the CDC, Substance Abuse and Mental Health Services Administration (SAMHSA), and Administration for Children and Families in the Department of Health and Human can augment state actions. These federal programs should continue funding other and/or smaller programs that work toward supporting state and local families, mitigating trauma and providing resources and research to better future policies. The National Child Traumatic Stress Network, for example, is currently funded by federal agencies. 

(3) Continue the movement for trauma-informed states. Create and support more partnerships, programs and organizations like Fostering Futures to make states more trauma-informed, like Wisconsin. This includes raising awareness for ACEs and their impacts, developing resilience, and trauma-informed change. Trauma-informed states should have comprehensive approaches to addressing trauma by training staff, urging change at the federal level, and an overall recognition of trauma-informed care (TIC). 

Why This Initiative Important

Childhood trauma is highly associated with some of the leading causes of death and poor quality of life: chronic health problems, mental illness, substance abuse, increase risk of injury, maternal and child health issues and sex trafficking. ACEs can negatively impact education, job opportunities and earning potential. Children who grow up with ACEs can experience trouble forming healthy relationships, effects on brain development, etc. It is important to act early on to prevent chronic conditions and complex needs for future older adults. We must look upstream, which includes addressing childhood trauma now. 


The following student(s) worked on this nonpartisan proposal: Madeline Leung, The University of North Carolina at Chapel Hill; Alexander Sejas, University of Miami. 


“Fast Facts: Preventing Adverse Childhood Experiences |Violence Prevention|injury Center|CDC.” Centers for Disease Control and Prevention, 6 Apr. 2022,

“The Important Role of Policy in Addressing Childhood Trauma during Covid-19 and Beyond.” Kaiser Permanente Institute for Health Policy, 27 May 2020,

Peterson, Sarah. “Creating Trauma-Informed Systems.” The National Child Traumatic Stress Network, 20 Sept. 2018,

Walker, Tonette. “Becoming a Trauma-Informed State.” Kaiser Permanente Institute for Health Policy, 27 May 2020,


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