IF I TOLD you that one in four New Hampshire children would experience serious, negative health outcomes later in life unless we put in place a proven system of prevention today, would you support investing in that prevention?

This is actually an urgent question for New Hampshire, as a state, to respond to, as a recent survey of New Hampshire adults found that those who had experienced early adversity are in poorer physical and mental health than their peers who did not experience adversity.

This survey of Adverse Childhood Experiences, or “ACEs”, asked New Hampshire adults whether they, as children, experienced conditions that have been shown to negatively affect both short- and long-term health and social outcomes. These ACEs include witnessing or experiencing physical violence, living with an adult with a substance use problem or a mental health issue, and other factors that disrupt stability in the parent-child relationship. Nearly half of adults in New Hampshire report having experienced one or more ACEs.

What the research on ACEs has made clear is that not all stress is good for you. In fact, some forms of adversity can produce toxic stress in children when they don’t have caring adults who can respond to and support them through the adversity. Toxic stress is dangerous because it damages the brain’s architecture and leads to lifelong problems in learning, behavior, and both physical and mental health.

This new research on the number of New Hampshire adults who report that they, as children, experienced this kind of early adversity suggests we should be doing more to turn the tide in our state. New Hampshire adults with one or more ACEs were three times as likely to report having significant numbers of bad mental health days, compared to adults without ACEs. The good news is that while we know how to treat toxic stress, we also know how to prevent it. And we all know that preventing something from happening in the first place is much more effective, and less costly, than trying to fix a complex problem later.

How do we do that? We put in place a preventive system that can catch children before they fall. Research suggests that there are three critical pillars of support in such a preventive system.

The first pillar is voluntary, evidence-based, home visiting. These programs provide professionally trained home visitors who work in partnership with expectant parents and parents of babies and toddlers to ensure safe home environments, promote healthy growth and development, and provide key connections for families to needed services in their communities. It isn’t surprising that these programs have been shown to improve child and maternal health and protect against the causes of toxic stress in children.

Unfortunately, New Hampshire’s home visiting services reach only a fraction of families with young children who could benefit. An estimated nine times as many families could benefit as currently receive services.

The second pillar would be support for Family Resource Centers. Family Resource Centers work in communities to create the conditions that promote healthy development and family well-being. They are built on a research-based framework of family support, which focuses on helping families build their own strengths as well as access resources in their communities. These are community- based organizations whose services reflect the needs of the community, but which tend to include home visiting, parenting classes, financial literacy and workplace supports, and early care and education. Family Resource Centers make it easier for families to do the hard work of raising children.

Finally, making effective early childhood education more available is key to the stability of our state today and tomorrow. In 2017, 70 percent of New Hampshire children under the age of 6 had all parents in the workforce. That’s 52,000 kids. What would it mean for us if we ignored their early environments? If we provide access to effective early learning experiences to these children while their parents are working, we have a more stable economy today AND tomorrow. We know what works, it’s just a question of making it happen. Both economic and developmental science have been telling us for years that investments in early care and education programs produce some of the greatest returns on investment that we can make. When we choose to ignore what children need for healthy development today, there will be serious consequences later.

While ACEs have been researched for decades, and their health impacts well established, this is the first study of ACEs in New Hampshire. It should serve as both a warning flag and a call to action. If we want New Hampshire to thrive into the future, we must create the conditions that our youngest generation needs for healthy learning and development. If we were to invest in these three proven supports — home visiting, Family Resource Centers, and early care and education — we could prevent the negative effects of ACEs and strengthen families’ abilities to promote their children’s health and well-being.

Ardis Olson, MD, is a pediatrician and a leader in studies of rural pediatric care. She directs Clinicians Enhancing Child Health (CECH) and Dartmouth COOP practice based research networks, with more than 100 rural pediatric and family medicine practices engaged in clinical research. Dr. Olson has also published some of the most frequently cited studies of pediatricians’ attitudes toward their role in the management of child mental health problems. She has implemented the Dartmouth Teen Mental Health program of adolescent depression screening and depression management in primary care in 14 practices in northern New England.

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