Every child deserves to thrive

The New Hampshire Children’s Health Foundation is engaged in a long-term, multi-prong effort to prevent and reduce childhood trauma. Our focus is to effect change in New Hampshire policies, systems, and environments through strategies that can prevent and reduce the risk for adverse childhood experiences.

Adverse Childhood Experiences, or ACEs, are experiences or events witnessed by children that can have lifelong implications for physical, social and emotional health. These experiences can include physical, emotional and sexual abuse as well as living in a home with domestic violence perpetrated against a parent or caregiver, with someone engaged in substance misuse or experiencing mental health problems, having an incarcerated parent, or household instability due to parent separation. ACEs impact “aspects of the child’s environment that can undermine their sense of safety, stability, and bonding.1

The common term for the impact of ACEs is toxic stress.

In New Hampshire, more than 20% of children ages 0-17 have experienced one ACE and nearly 16% have experienced two or more ACEs.Fifty percent of New Hampshire adults, ages 18-64, report experiencing one or more adverse childhood experiences,4 increasing their risk for the health and mental health conditions associated with ACEs.1

These potentially traumatic events impact a child’s brain development or “architecture” which in turn can have negative implications for a child’s overall development and well-being. 2

Children are resilient

Children experiencing ACEs have higher rates of chronic health conditions such as asthma, diabetes, and cancer, are associated with higher rates of poor mental health and substance misuse, are at higher risk for overweight and obesity and are less engaged in school. In New Hampshire, children with ACEs experience poor social, emotional and physical health at higher rates than the national average.3

Conversely, we know that children are deeply influenced by and/or build resilience when they have a supportive adult in their life, have places to play and explore in nature whether on a trail or at a park, can access mental and physical health services in a timely manner from healthy providers knowledgeable about ACEs5, and whose parents and caregivers get the support they need to build and strengthen their ability to nurture.

In 2016, New Hampshire Children’s Health Foundation initiated grantmaking to prevent and reduce the impact of ACEs. We learned a lot from those who were interacting with — and supporting children and caregivers impacted by ACEs.

Pilot projects

The foundation’s early investments included building capacity for evidence based models like Child Parent Psychotherapy, a therapeutic modality that works with parents and caregivers to strengthen their attachment and ability to bond with their children.

We piloted a concept developed by the Manchester Police Department and Amoskeag Health, the Adverse Childhood Experience Response Team (ACERT), to educate police about ACEs and in partnership with social service staff to guide families with children to available resources following a domestic police intervention.

We’re building knowledge and changing systems in pediatric practices to screen for ACEs and where indicated, refer to local services to help families with young children get the support they need.  In addition, our assessments and reports have had a positive impact on increasing state resources to prevent and respond to ACEs.

Children benefit from a community of supports

Following these early investments, the foundation remains committed to supporting environments that create positive experiences for children, builds resilience for children and families and invests in systematic changes that assure children experience safe, stable relationships, foundational for positive childhood development.

New Hampshire Children’s Health Foundation continues to pilot and invest in models that strengthen communities’ ability to provide positive childhood experiences, family support services and those who make services available so that children can thrive.  We will keep you posted about work being done throughout the state and will update you about our learning and impact from time to time.

Grantmaking investment examples

  • Childhood Adversity Systems Change - Introducing Trauma Responsive Communities

    New Hampshire Children’s Health Foundation (NHCHF) continues to invest in pilot models that have the opportunity to strengthen community resources to screen, refer and support children who may benefit from resilience enhancing, trauma informed services. In late 2022, the Foundation awarded multi-year funding to four communities to initiate a Trauma Responsive Communities (TRC) model. This work is intended to build on previous community investments to implement trauma informed pediatric screening and referral for Adverse Childhood Experiences (ACEs).

    The four communities engaged in the TRC initiative include Coos County, Nashua, Monadnock Region and Concord. Each of these communities was the site of a trauma informed pediatric screening pilot led by the University of New Hampshire. In addition to trauma informed pediatric screening, the TRC communities have demonstrated knowledge, resources, capacity and available family support services to prevent, inform and serve children and families exposed to ACEs..

    Working together

    In a trauma responsive community, families, service providers and community leaders work together to address the impact of ACEs and reduce the conditions that lead to trauma and toxic stress. The model includes five components that can be addressed individually or in conjunction with one another. The TRC components are: prevention, community collaboration, trauma informed services, access to services for child and caregivers and informed decision and policy makers.

    TRC funding is not intended to initiate a new program or service. Rather, the community will determine which existing practices within prevention services, mental health, social services, schools/education, local government or across multiple disciplines will be the focus of activities. Inherent in the selection of the strategy is the application of a policy, system or environment change (PSE) approach to strengthen and sustain the practice.

    The approach varies

    Capacity building, assessment, policy development and implementation are examples of eligible use for funding. Activities vary among each community. Some are conducting an inventory of ACEs related services, activities and resources. The inventory is the first step toward identifying a practice whose impact would benefit from a establishing a PSE to assure long term sustainability. Other communities are working to deepen earlier work to build stronger inter-organizational relationships and systems. NHCHF will provide support for communities to maximize their ACEs assets and impact while building on community resources and existing networks that further enhance a TRC.

    A variety of supports beyond grant funds will be offered by NHCHF to participating communities including technical assistance, evaluation and communication. Grantee and partner convenings will be held throughout the project for learning and to share knowledge, to engage around particular topics or issues and provide overall input to the pilot project. Keep an eye out for upcoming communication about the ACEs support community inventories, stories from the TRC communities and more about what the Foundation is learning from our community partners. Also, please visit the NHCHF website for podcasts, workforce assessments, project pilots and other work to date to prevent and reduce childhood trauma.

    For more information

    To stay informed about upcoming NHCHF funding opportunities and our newsletter which includes updates and new stories about our work, sign up here.

  • Podcast: Pediatricians are Key for Screening and Referring to Address Childhood Adversity

    Read an overview of the Pediatric Trauma Informed Care Screening  project and listen to a podcast with  project director, Felicity Bernard, hosted by the NH Power of Prevention Partnership.

  • New Resource: Trauma-Informed Care Toolkit

    Based on their research and lessons from the field, the NH Pediatric Improvement Partnership is excited to share a new Trauma-Informed Care Toolkit. The toolkit offers an array of resources, tools and educational materials for any medical setting interested in the implementation of trauma-informed care.

    Click here for more information about the toolkit

  • Child Parent Psychotherapy

    Child-Parent Psychotherapy (CPP) is family therapy for young children and their parents or caregivers. It’s a nationally recognized, evidence-based intervention model for children who have experienced at least one traumatic event. What separates it from other family or behavioral therapies is that it requires significant involvement by parents or caregivers.

    CPP works specifically with caregivers and children up to age five, and is supported by the New Hampshire Children’s Health Foundation, which has funded the training of practitioners in its use in New Hampshire.

    Rather than seeking to simply modify behavior through rewards or other modification techniques, CPP first works with a caregiver to understand the “story” behind the child’s behavior. Once this occurs the caregiver can work with the child to also understand that story and to begin healing by establishing safety and creating a new one.

    Read more >

  • Adverse Childhood Experiences Response Team (ACERT)

    Police departments throughout the country respond to thousands of troubling incidents at residences each year where young children are present. These include domestic violence situations, overdoses, sexual assaults and suicide threats.

    A growing body of evidence indicates that children exposed to prolonged and excessive traumatic experiences like these may suffer life-long effects.

    A ground-breaking project in Manchester, N.H. brought the local police department and health and human service agencies together to help prevent and reduce trauma in children exposed to violence.

    The Adverse Childhood Experiences Response Team, or ACERT as it is called, is comprised of staff members of the Manchester Police Department, YWCA New Hampshire and the local community health center Amoskeag Health — among other community partners.

    These organizations work in tandem to connect hundreds of children and families in Manchester affected by violence to counseling, home visiting, therapeutic services, art therapy and other social services to help children understand and develop strategies to cope effectively with trauma.

    The ACERT model has received significant national attention and is likely to expand nationwide. As the project’s initial funder, the New Hampshire Children’s Health Foundation, commissioned a case study outlining how the ACERT model works and what the Manchester ACERT leadership team has learned since the project’s inception.

    ACERT Case Study Executive Summary

    Full ACERT Case Study

  • Screening for Childhood Adversity in Primary Care

    In 2012, the American Academy of Pediatrics released a policy statement outlining the critical role of the medical home in identifying and responding to ACEs. In 2018, the New Hampshire Pediatric Improvement Partnership released a report that identified challenges to implementing this recommendation in New Hampshire pediatric clinics, and recommendations for clinics to address them.

    Recommendations included:

    1. Providing clinician training on trauma-informed care.
    2. Increasing public awareness about ACEs and Social Determinants of Health.
    3. Conducting research to help clinics operationalize team-based care to address ACEs.

    The Childhood Adversity Screening in Primary Care project created and implemented by the New Hampshire Pediatric Improvement Partnership and funded by the New Hampshire Children’s Health Foundation was designed to advance these three recommendations.

    Read more >

  • New Hampshire Contraceptive Access Assessment

    In 2019, the New Hampshire Children’s Health Foundation implemented a strategic grantmaking model aimed at strengthening protective factors and early intervention practices to prevent or ameliorate adverse childhood experiences (ACEs).

    One component of the model is the reduction of unintended pregnancy through increasing awareness and availability of all contraceptive methods so that people are empowered to confidently decide if and when they want to parent. To inform the development of this work, the Foundation, joined by a funding partner, supported an assessment of the current landscape of sexual and reproductive health care services in New Hampshire. The overarching objectives of the assessment were to:

    • Understand the current landscape of access to and education about contraceptive methods in New Hampshire; and
    • Examine the barriers that individual patients face in accessing contraceptives and other sexual and reproductive health care.

    Read more >

  • Assessment of NH’s Early Childhood and Family Mental Health Workforce

    While mental health services have historically been targeted towards adolescents and adults, there is growing recognition of the need for increasing the availability and capacity of services and programs to promote healthy social, emotional development for young children and their families. The Endowment for Health and the New Hampshire Children’s Health Foundation commissioned an assessment of the capacity of the workforce serving this population in the New Hampshire. The objectives of the assessment were:

    • To identify who is providing early childhood and family mental health services, where, how, and with what training and credentials.
    • To identify barriers, beyond those of financing, to providing and accessing early childhood mental health services.

    Read more >

1Centers for Disease Control and Prevention, Fast Facts: Preventing Adverse Childhood Experiences (reviewed 4/6/22)
2National Scientific Council on the Developing Child. (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain; Working Paper 3;  Updated Edition. http://www.developingchild.harvard.edu
3National Survey of Children’s Health, 2018-19
4NH Behavioral Risk Factor Surveillance Survey, 2016
5ACEs Aware, Clinical Care and Treatment, State of California Department of Health Care Services (2022)