State Efforts to Reduce Adverse Childhood Experiences Should Include Programs to Strengthen Marriage

Last fall, the governor of Delaware signed an executive order directing state agencies to implement a number of programs aimed at raising awareness about adverse childhood experiences (or ACEs), including directing state employees to receive trauma-informed training and the creation of a state website with ACE resources. Delaware is one of a growing number of states to seek policies and programs aimed at preventing or mitigating the effects of ACEs, which are stressful or “potentially traumatic” childhood events that range from witnessing domestic violence to experiencing financial hardship.

As I reported on this blog, 45% of children in the U.S. have experienced at least one ACE and 21% have experienced two or more, according to Child Trends. A more recent study published in JAMA Pediatrics and based on data from the 2011-2014 Behavioral Risk Factor Surveillance System found that 62% of adults in 23 states report at least one ACE in their past, with 24% reporting three or more.

ACEs are linked to poor mental, physical, and emotional health in adulthood, with individuals who have experienced multiple ACEs more at risk for these and other negative effects. For example, one study of adults seeking treatment for opioid addiction found that 80% had experienced at least one childhood trauma, and two-thirds had witnessed domestic violence.

Children carry the impact of ACEs into their adult relationships, where they can repeat the trauma and dangerous behaviors that put them at risk in the first place, increasing the chances that the cycle will continue in the lives of their own children. The growing body of research on the negative and often cyclical effects of ACEs has inspired many states to seek policy solutions.

A recent report from the National Conference of State Legislatures (NCSL) highlights state efforts to address ACEs and offers legislative suggestions for other states wishing to do the same. In 2018, it reports that a total of 25 states considered at least 68 proposals incorporating ACEs through the following strategies: 1) expanding funding for early childhood education and home visiting programs for new parents; 2) implementing family-friendly economic policies (such as expanding the EITC or boosting the minimum wage); 3) increasing housing stability; and 4) instituting drug and mental illness screening and treatment programs for at-risk families and children, such as in-school screening for kids and specific treatment and support programs for opioid-addicted pregnant women.

What About Relationship Education?

All of these strategies are excellent but missing from the NCSL’s list is any mention of family life education, or healthy marriage and relationship education, as a way to combat ACEs. This is programming aimed at strengthening the bond between a child’s married or unmarried parents, helping youth form healthy relationships, and promoting the overall well-being of families. Although the NCSL does acknowledge that “[e]fforts that focus on building healthy families early in the life of a child are cited as among the most influential means of preventing ACEs and reducing their damaging effects,” it does not specifically include healthy marriage and relationship education in its list of suggested ACE-prevention strategies for states.

The omission is troubling considering that parental divorce or separation (including the breakup of cohabiting parents) is the most common ACE (along with financial hardship) and can increase the risk of experiencing others. We know that children raised by their own married parents are less likely to experience some of the most common ACEs, including being less likely to have their parents split up, to live in poverty, and to experience child abuse and witness domestic violence. Healthier parental bonds can also help families weather the storms of life that can put parents and their children at risk for other traumas, like drug use or depression.

According to BYU Professor Alan Hawkins, who has been involved with state- and community-level relationship education efforts, “family life education as a field is paying more attention to ACEs.” Hawkins, who is the author of The Forever Initiative, cites a program in Oklahoma as one example. The Family Expectations program—which is partially funded by the federal government’s Healthy Marriage and Responsible Fatherhood Initiative—provides support services to new and expectant, low-income, married and unmarried parents in the Oklahoma City area.

“Concepts of ACEs are integrated throughout our curriculum,” program director Julia Shannon-Phelan told me. “Although we don’t directly address ACE assessment or scoring in the workshops, we repeatedly touch on topics related to stress across the lifespan.” The program includes 12, three-hour long relationship skills and parenting workshops, as well as case management services for low-income couples, where a “Family Life Coach” is assigned to work with the families for one year following the workshop.

In a recent IFS blog post, Dr. Hawkins reported on the success of another community-level relationship education initiative that is funded by the Culture of Freedom Initiative (COFI) and worked through churches and the Live the Life organization in Jacksonville, Florida, to “saturate the area with relationship education services.” The programs offered by Live the Life Jacksonville include premarital counseling, marital enrichment seminars and programs, and weekend for couples considering divorce. According to one study, divorce rates in the Duval County area dropped by almost 30% in the first two years of the project (between 2015 and 2017), while divorce rates in the rest of Florida fell by only 8 percent.

Furthermore, recent research of government-funded healthy marriage and relationship education programs shows "modest but positive effects for low-income couples," including a reduction in physical violence. As Dr. Hawkins emphasized in a recent IFS blog post, “relationship education [is] an additional tool to help disadvantaged couples create stronger families and achieve their relationship aspirations.”

The good news is that healthy marriage and relationship education programming is already incorporated into the goals of federally-funded safety-net programs, including the Temporary Assistance for Needy Families (TANF) block grant. In a March 2018 “ Office of Family Assistance (OFA) Dear Colleague Letter,” OFA director Clarence Carter explained that TANF:

includes efforts to reduce the dependency of needy parents by promoting job preparation, work, and marriage (Purpose 2), and to encourage the formation and maintenance of two-parent families (Purpose 4) as two of its core purposes. As a result, TANF provides states with the funding and flexibility to support activities to promote healthy marriage… These programs provide services that combine marriage and relationship education and father-child involvement skills development and activities, with efforts to address participation barriers and the economic stability needs of their participants.

For states wishing to incorporate healthy marriage and relationship education into their existing safety net programs, the OFA letter cites a number of helpful resources, such as The National Center for Healthy Marriages and Families, which provides training, technical assistance, and webinars for safety-net program providers.

The Harvard Center on the Developing Child advises lawmakers seeking to strengthen families with young children through policy to follow three guiding principles: “enhancing responsive relationships, strengthening core life skills, and reducing sources of stress.” What better way to do all three than by bolstering the relationship between a child’s parents so they are more likely to stay together in a healthy union and to model a healthier relationship for their kids? Because family instability is one of the most common adverse childhood experiences today, it makes sense for states to include more of an emphasis on healthy marriage and relationship education in the arsenal of tools for reducing childhood trauma.

Alysse ElHage is Editor of the Institute for Family Studies blog.