Effects of State Paid Family Leave Policies on Preventing Household Adverse Childhood Experiences (ACEs) in Early Childhood in the United States, 2011-2019.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that can predict a wide range of short- and long-term negative health outcomes. More research is needed on policies that may reduce ACEs. Paid Family Leave (PFL) is a state-level policy that provides economic support for employees to care for a newborn or a recently adopted child. This study evaluated effects of PFL on reduction in household challenge ACEs. To investigate whether PFL implementation reduced the occurrence of household challenge ACEs among young children in Rhode Island and New York relative to other states without PFL implementation. This study used 2011-2019 population-based National Survey of Children's Health (NSCH) data to compare the proportion of household challenge ACEs experienced in intervention versus control states. Bayesian Additive Regression Tree (BART) and two-way fixed effects (TWFE) methods estimated post-intervention average treatment effects. United States (U.S.) Census covariates controlled for variation between states. Placebo checks bolstered the robustness of inference. Rhode Island and New York (intervention states) implemented PFL in 2014 and 2018, respectively. Control states included states that did not implement PFL as of 2019. The NSCH surveys included a 9-item ACEs questionnaire in which caregivers reported on whether their children ages 0-2 experienced various forms of abuse, and potentially traumatic household challenges (i.e., caregiver divorce, domestic violence, caregiver incarceration, caregiver mental health problems, caregiver substance use). This study focused on five household challenge ACEs and the occurrence of any household challenge ACE as primary outcomes. A treatment indicator identified intervention and control states. State-level covariates were median household income, unemployment rate, and percent uninsured.  Results suggest that PFL implementation was associated with significant 4% reduction in caregiver separation and 2% reduction in caregiver incarceration ACEs in the intervention states post-PFL adoption and a significant 4% reduction in the proportion of young children experiencing any household challenge ACE relative to no PFL implementation in control states. This study adds rigorous scientific support for the public health benefits of PFL for young children and their families. Existing evidence indicates caregiver incarceration and separation may affect children's short- and long-term mental health, substance use, and school related outcomes. Support through PFL may help reduce the occurrence of household challenge ACEs and promote children's well-being.