TO: HEADS OF ALL STATE DEPARTMENTS AND AGENCIES
RE: MAKING DELAWARE A TRAUMA–INFORMED STATE
WHEREAS, the Kaiser Permanente Adverse Childhood Experiences (ACEs) Study identified that childhood exposure to traumatic experiences increases the likelihood of physical and psychological illness later in life. Those childhood experiences are: physical, emotional, or sexual abuse; physical or emotional neglect; household dysfunction, including substance abuse, untreated mental illness, or incarceration of a household member; domestic violence; and separation/divorce involving household members; and
WHEREAS, a study published in September 2018 in the Journal of the American Medical Association Pediatrics – the largest ACEs study ever conducted, sampling over 200,000 adults across 23 states – documented that 25% of the respondents reported exposure to 3 or more ACEs and 16% were exposed to 4 or more ACEs, with higher exposures noted among: people of color; those who identified as gay, lesbian, or bisexual; those of lower economic means; and those with less than a high school education; and
WHEREAS, a 2015 survey of Delaware adults indicated that 14% were exposed to 4 or more ACEs and were: 8 times more likely to have been diagnosed with a mental health condition; nearly 7 times more likely to have been diagnosed with a substance abuse problem; and 4.6 times more likely to be in fair or poor health; and
WHEREAS, Delaware’s ACEs data indicated that 23% of children from birth to age 18 were exposed to 2 or more ACEs, and that those children were 5 times more likely to be reported in fair or poor health; and
WHEREAS, a recent study by the Centers for Disease Control and Prevention found that the average lifetime cost for each victim of abuse and neglect was $210,012, including child and adult healthcare costs, and productivity losses. The lifetime costs associated with just one year of confirmed cases of child maltreatment was approximately $124 billion; and
WHEREAS, research has shown that prevention of prolonged exposure to toxic stress, early intervention, trauma-specific treatment, and building resilience of children and families – which can be promoted through trauma-responsive care – can mitigate the impact of ACEs and produce better health, educational, and community outcomes; and
WHEREAS, a core component of resilience is promoting healthy social-emotional development in children and families; and
WHEREAS, creating trauma-responsive communities, organizations, and schools will help Delaware become a healthier state, which may help reduce healthcare costs and emergency room visits.
NOW, THEREFORE, I, JOHN C. CARNEY, by virtue of the authority vested in me as Governor of the State of Delaware, do hereby DECLARE and ORDER the following:
1. The Family Services Cabinet Council shall lead efforts to ensure that Delaware becomes a trauma-informed state by:
a. Developing a Trauma-Informed Care toolkit of resources that: provide trauma awareness and self-care education for state employees; increase recognition of signs of ACEs exposure; and offer effective interventions to mitigate trauma and build resilience to be shared across all state agencies and organizations for use at service delivery access points.
b. Promoting a Trauma Awareness Month in Delaware with appropriate events to be held across the state.
c. Sharing information with state employees and community partners on educational and professional development opportunities related to ACEs and building resilience.
d. Creating a recognition program for champions of this work, which may include individuals, divisions within an agency, and community partners, such as schools and school districts.
e. Identifying gaps in available services or service capacity along the prevention and early intervention-treatment continuum for children and their caregivers statewide.
f. Developing a comprehensive plan focused on early intervention for children and their caregivers exposed to adverse childhood experiences in order to help prevent abuse and neglect, and remedy the impact of it.
g. Coordinating the collection, evaluation, and reporting of Delaware ACEs data.
2. All state agencies that provide services for children and adults shall integrate trauma-informed best practices, which will include (but are not limited to):
a. Offering regularly scheduled training to staff to increase their knowledge about the impact of ACEs and toxic stress on short-term and long-term health outcomes.
b. Promoting strategies to enhance staff resilience and self-care.
c. Using trauma-specific language in requests for proposals and in service contracts with providers, when appropriate.
d. Implementing evidence-informed services to prevent and respond to toxic stress and build resilience in children, adults, and communities.
APPROVED this 17th day of October, 2018.
John C. Carney
Secretary of State