The people who are doing most of the pioneering work to integrate trauma-informed, resilience-building practices based on ACEs research (writ large) are doing so in cities and counties across the U.S. Now that more state agencies are learning about ACEs, many people in local communities are wondering what they can ask states for to help grow local efforts. 

Karen Clemmer, the maternal child adolescent health coordinator for Sonoma County’s Department of Health Services, and I were exchanging comments on a blog post, when we stumbled across a very useful “ask” applicable in any state. Here’s how this came about:

Karen asked if a health economist could help the Sonoma County community better articulate the return on investment of preventing/healing/treating ACEs across the life course. “Making a business case for ACEs might be one way to engage key leaders such as Chamber of Commerce, Rotary, key business sectors and even elected officials,” she noted.

So, I did a search through the blog posts on ACEsConnection to see what’s been done on this already. 

The Ella Baker Center did an analysis of the cost of incarceration on families. The federal government is starting to study the health benefits and screening and linking to social services.  Here's an article that refers to Washington State's calculation of savings by addressing childhood trauma. 

Oregon calculated what one year of child abuse -- all the cases in 2011 -- would cost the state over a lifetime -- $2.5 billion. Here's a report that an organization in Australia put together that shows a savings if $9.1 billion annually by addressing the impacts of unresolved childhood trauma and abuse in adults. Alaska calculated the cost for alcoholism and other drug abuse.

Economist James Heckman has done a LOT of work in this area. Check out his web site.

And there's this, from an article I wrote in 2012:

Case in point: Let’s look at only the children who were abused in the U.S. in 2008. Add up the total lifetime economic burden resulting from their maltreatment. It’s a whopping $124 billion. Include all the people who were abused each year even for just the last 10 years, and begin including every year from 2012, and the number rolls into the trillions.

The CDC’s National Center for Injury Prevention and Control, which did those calculations, broke down that unfathomably large number into this:

The lifetime cost for one child who was a victim of maltreatment is $210,012 in 2010 dollars. This includes:

• $32,648 in childhood health care costs;
• $10,530 in adult medical costs;
• $144,360 in productivity losses;
• $7,728 in child welfare costs;
• $6,747 in criminal justice costs;
• $7,999 in special education costs.

So, here’s the “ask”: a county-by-county breakdown of lifetime costs of the impacts of unresolved childhood trauma, and the cost savings if addressed. Perhaps this can also be done by sector within a county. Many communities are talking about obtaining local ACEs data. In California, for example, Gail Kennedy from our ACEs Connection Network team, is talking with people from California Essentials for Childhood Initiative and Kidsdata.org about developing a data dashboard that combines ACEs data from the state BRFSS, the Child and Adolescent Health Measurement Initiative (CAHMI), and from the Maternal Infant Health Assessment (MIHA). 

But some people ask: Then what? What’s the use of communities having local ACEs data? 

Answer: To develop analyses of the short- and long-term impact if ACEs aren’t addressed, and the cost-savings if they are. If communities have reliable numbers, and people can share this information from community to community, that would help support and accelerate the integration of this vital knowledge.  

So, what do you think? No doubt, some states that have done BRFSS surveys and their counties are probably already figuring this out, and we’d love to hear about it.