With 4 out of 10 children in North Carolina experiencing at least one adverse childhood experience (ACE), urgent action is needed to protect the well-being of children and families. This report from North Carolina's Essentials for Childhood Update Committee responds to this challenge by identifying strategic actions needed to prevent child maltreatment and other ACEs. The comprehensive report provides 15 recommendations and 43 actionable strategies designed to strengthen systems, promote early intervention, and ensure safe, stable, and nurturing environments for children across the state. Policymakers, stakeholders, and community leaders are urged to use the report as a blueprint to guide immediate and impactful action. The project was funded by the Centers for Disease Control and Prevention (CDC). It was completed in partnership with the North Carolina Department of Health and Human Services, Division of Public Health.
The report emphasizes the need for collaboration among state agencies, healthcare providers, philanthropic organizations, and community partners to implement sustainable solutions. Recommendations include increasing strategic investments in early screening, trauma-informed practices, and improved family support systems. Addressing barriers such as low Medicaid reimbursement rates, administrative burdens, and workforce shortages are also highlighted as critical steps toward meaningful progress. Other recommendations include enhancing child care subsidies to ensure a larger portion of eligible families receive subsidy payments, enhancing opportunities for cross-sector collaboration to improve quality of care and outcomes for parents or caregivers and their young children, and promoting the incorporation of positive childhood experiences (PCEs) throughout state and local initiatives.
The 35 committee members worked together to draw on research, data, and lived experience across multiple sectors—including public health, education, child welfare, early childhood, and community organizations—to ensure the recommendations were evidence-based and grounded in the realities facing North Carolina families. Their collaborative efforts reflect a shared commitment to building a coordinated, statewide response.
The NCIOM Essentials for Childhood update includes 15 evidence-based recommendations and 43 actionable strategies designed to foster thriving communities, promote positive childhood experiences, and strengthen cross-sector collaboration for North Carolina’s youngest residents and their families.
Chapter 1 offers an overview of the creation process for this report, background context on adverse childhood experiences (ACEs), and a look into how ACEs and positive childhood experiences (PCEs) are affecting children and families in North Carolina.
Recommendations in Chapter 2 focus on social norms, which are the shared beliefs, values, and expectations within a community. This chapter highlights the ways in which promoting positive community norms around parenting programs and behaviors encourages practices that prevent child maltreatment.
A working group should be established by NC DHHS to promote the incorporation of positive childhood experiences (PCEs) throughout state and local initiatives and identify gaps requiring additional investment. Strategies should maximize the impact of existing supports and identify additional resources needed to implement and raise awareness of existing infrastructure for PCEs. Strategies should include a focus on various audiences, including families, health care and service providers, local and state policymakers, faith communities, employers, schools, and others.
If adequate capacity and resources are available, the UNC School of Social Work will identify specific methods and measures to collect and share data on social norms related to economic supports for families. The approach should prioritize targeted data collection that can inform strategies to enhance financial stability and economic mobility in North Carolina communities.
North Carolina Early Childhood Foundation, Positive Childhood Alliance NC, MomsRising, and NC Child should continue the development and expansion of public awareness campaigns that focus on the role of economic supports in promoting positive childhood experiences (PCEs), preventing adverse childhood experiences (ACEs), and fostering financial stability.
Recommendations in Chapter 3 highlight families’ access to financial resources they need to thrive. An increasing number of studies show the value of economic and concrete supports in stabilizing families and reducing child maltreatment.
The Institute for Emerging Issues should establish a cross-sector task force to examine the factors affecting financial stability for families in North Carolina, with the goal of identifying actionable strategies to enhance financial resilience and create pathways to affordable, safe and stable housing for families.
The North Carolina Budget & Tax Center should conduct an economic analysis of the impact of policies including the Child Tax Credit, the commencement of a state refundable Earned Income Tax Credit (EITC), and paid leave on the financial stability and economic mobility of children and families. This analysis should identify disparities in how these policies affect different income levels, family structures, and historically marginalized populations.
DCDEE, North Carolina Partnership for Children/Smart Start, MomsRising, and North Carolina Early Childhood Foundation should lead a coordinated effort to convene leaders and employers across sectors to identify specific actions toward establishing concrete family-friendly workplace policies.
Recommendations in Chapter 4 focus on child care and the importance of accessible, high-quality, affordable child care for parents. There is also a child care crisis in North Carolina, with a dearth of providers due to various factors, including compensation. Additionally, child care issues often impact parents’ participation in the workforce.
The North Carolina General Assembly should enhance child care subsidies to ensure a larger portion of eligible families receive subsidy payments.
Child care workforce salaries should be increased and prioritized by using targeted investments to attract and retain skilled workers critical to delivering care.
State agencies should enhance opportunities for intentional cross-sector collaboration to improve quality of care and outcomes for parents or caregivers and their young children.
Recommendations in Chapter 5 highlight the importance of early screenings, trauma-informed care, and integrating children’s mental health into Medicaid. There is also an emphasis on reimbursement for providers, innovative care strategies, and expanding the available workforce.
NC Medicaid should create a strategy to integrate infant and children’s mental health into the Medicaid services and initiatives centered around social determinants of health.
Community Care of North Carolina, the Division of Child and Family Well-Being (DCFW), and others should establish guidelines for primary care clinicians to expand screening for social and emotional risk factors as well as family protective factors among families with children.
Chapter 6 targets the use of gathering and evaluating child well-being data to inform decision-making.
The North Carolina General Assembly should allocate funds to ensure the long-term sustainability of the newly developed surveillance system.
Utilize child care workforce data to inform strategies for improving family financial stability, employee retention, and overall economic development.
A Collaborative Action Council including NCDHHS Division of Child Development and Early Education,, NC Child, North Carolina Partnership for Children/Smart Start, NC Chamber Foundation, NC Department of Commerce, North Carolina Child Care Resource and Referral Council, Cape Fear Collective, child care employers, philanthropic organizations, business leaders, community organizations, and policymakers should establish shared goals, coordinate resources, and leverage data to mitigate child care workforce shortages.
The Cecil G. Sheps Center for Health Services Research (UNC Sheps) should collaborate with NC Medicaid to evaluate standard and tailored plans for their alignment with the goals of preventing Adverse Childhood Experiences (ACEs), growing Positive Childhood Experiences (PCEs), and promoting economic stability.