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2021 State of the Child Report delves into how adverse experiences, trauma impact kids long-term

State of the Child

TML Communications Specialist

One in five Tennessee children are affected by at least two adverse experiences that could negatively direct their future health and well-being as well as impact their communities, according to a new report looking into the welfare of children in the state of Tennessee.

The Tennessee Commission on Children and Youth’s 2021 “State of the Child Report” delved into how adverse childhood experiences (ACEs) and resulting trauma and stress can affect everything from future health outcomes to economic success in adulthood. One in five Tennessee children has experienced at least two ACEs, higher than the national average.

“These experiences can often be connected to a lack of community resources or threats to mental and physical health or economic success that occur at a community level,” the report found. “Known as Adverse Community Environments such as lack of economic mobility or opportunity, poor housing, systemic poverty, and discrimination can increase the likelihood of Adverse Childhood Experiences. ACEs can cause poor health outcomes, increase risky behaviors and decrease future earnings creating a cyclical issue. Many of the issues we look at in the State of the Child relate back to Adverse Childhood Experiences, Adverse Community Environments and the long-term impacts of both. They create multi-generational issues that require systemic efforts to combat.”

There were 10 adverse childhood experiences originally identified in a study conducted by Kaiser Permanente: physical abuse, emotional abuse, sexual abuse, mental illness, substance abuse, incarcerated relatives, divorce, violence towards mothers, physical neglect, and emotional neglect. These experiences are often connected to adverse community environment, identified as living in an unsafe neighborhood, discrimination, living in foster care, witnessing violence or bullying.


In 2019, Tennessee had the highest rate of foster care instability in the nation. Foster care instability is defined as children having three or more placement, and Tennessee recorded the nation’s highest rate at 31%.  

State custody facts
Foster care instability is an ongoing issue for many children in Tennessee.

Of children placed into state custody in Tennessee, 88% of children were placed due to neglect. Children age 13 and older make up the highest number of children in state custody at 5,702 followed by children ages five to 12 at 5,371, and infants to age 4 at 4,025.

“Safe, stable and nurturing homes help support child development,” the report said. “Being removed from your home can be potentially traumatic for a child, making the need to have safe, stable and nurturing options while in custody critical. Relative caregiver placements can provide a sense of comfort and familiarity or the child. Currently 5% of Tennessee children are in kinship care. Reducing the number of placements and the time in state custody can help in minimizing the trauma a child experiences. In FY2020, approximately one in three children in custody were there for more than a year.  In 2019, 42% of children in Tennessee foster care had more than two placements.”

Pandemic benefits have helped those who have graduated out of the foster care system. Tennessee received $7.4 million in federal funding to support former foster youth and there are an estimated 29,782 youth between the ages of 14 and 26 in the state who were eligible for these funds. 

The recent extension by the state legislature of benefits to children aging out of the foster care system also allows students a $5,000 a year education and training voucher for post-secondary education, placement support or independent living allowances, and support services including life skills classes and leadership opportunity.

Human trafficking
While sex trafficking is the most common type of trafficking experienced by child victims in Tennessee, labor-related trafficking is also a significant issue.

One in 10 victims of domestic violence in Tennessee are children with 8.1% of reported domestic violence victims being a child who experienced violence from a parent or step-parent. Tennessee also had the highest rate of dating violence for teen girls in the nation with more than one in six Tennessee high school girls reporting at least one incidence of physical dating violence in the past year. This is twice the national rate.

The report noted that youth who experience or witness domestic violence can suffer both short and long-term behavioral effects.

“In the short-term, children may struggle with anxiety, withdrawal from activities or show physical symptoms such as headaches and stomach aches,” the report said. “Teens may engage in risky behaviors and are more likely to experience legal trouble. In the long-term, children become more likely to engage in abusive behavior or become victims of abuse themselves. A boy who sees the abuse of his mother is 10 times more likely to abuse his female partner as an adult. A girl that grows up in a home where her father abuses her mother is more than 6 times as likely to be sexually abused than a girl who grows up in a non-abusive home.”

There were 53 known cases of human trafficking involving a child reported in Tennessee in 2019 with sexual trafficking making up the highest percentage of human trafficking cases reported in the state. In 2021, the state received a “D” grade from Shared Hope International’s state report card on human trafficking, the lowest grade the state has ever received. However, Tennessee still ranks among the top 10 states for Child and Youth Sex Trafficking protections.

“Many myths surround human trafficking, but we know certain risk factors increase the likelihood of someone becoming a victim,” the report said. “Factors include recent migration or relocation, substance use, mental health concerns, involvement with the child welfare system and being a runaway or homeless youth. Most victims have a relationship with their trafficker, and the victims’ vulnerabilities are taken advantage of to obtain control”


Tennessee’s rate of youth substance abuse continues to decline and remains below the national average. However, the state has seen an increase in youth and young adult fatal overdose deaths between 2019 and 2020 with fentanyl involved in 80% of fatal overdoses – roughly a 230% increase in the past five years. Additionally, there were nearly 4,300 non-fatal overdoses among youth age 15 to 24 in that same period.

One in 15 students age 12 to 17 in the state reported using drugs and 15% reported that they had ridden in a car where the driver had been drinking alcohol. Of illicit substances, marijuana was the most commonly abused at 10.65% among youth followed by alcohol at 9.1%, pain relievers or opioids at 2.32%, cocaine at 0.39%, and meth at 0.19%.

The use of vapor products is outpacing traditional cigarettes for nicotine consumption among teenagers. More than half of high school students reported having used vapor products but only 7% reported using cigarettes. Smoking among high school students has decreased by almost 80% in the state over the last 24 years, but Tennessee’s amount of youth tobacco use is higher than the national average – unlike its rates of drug and alcohol abuse.


A disproportionate amount of black and disabled students were suspended or expelled from schools, limiting their future long-term academic and social success.

Students who were disabled had an out-of-school suspension rate of 9.2% compared to 5.7% of abled children while disabled children had an in-school suspension rate of 9.6% compared to 6.8% of able-bodied students. The report found that often these issues were the result of children experiencing ACEs including learning disabilities, poverty, a lack of health care, homelessness and food insecurity.

Youth Justice
Detaining youth in juvenile facilities is less cost effective and is less likely to divert youth out of the adult justice system than other non-incarceration-based programs. A lack of consistent state data on youth justice also makes it difficult to track real progress. 

“While schools simultaneously adopted strict policies on minor offenses and relied more heavily on school resource officers in an attempt to deter more serious offenses, students became more likely to become involved in the justice system for offenses that would previously been handled by the school,” the report said. “Although, zero-tolerance policies have been widely regarded as a failure, and are not in place in many schools, the repercussions remain. Differential treatment in the classroom begins in prekindergarten and the pattern continues throughout their education.”

The report noted the rate of Tennessee’s suspensions and expulsions has been steadily dropping over the decade, reaching a new low this year. This decrease can be attributed to a reduction of in-person education as well as shifting away from zero tolerance policies to policies that work to find what is causing disruptive behavior and find positive, equitable solutions.

Students who experience discipline in school are also more likely to have early encounters with the criminal justice system.

“Once in the youth justice system, they are more likely to receive harsher sentences,” the report found. “Early involvement in the justice system leads to an increased likelihood of being incarcerated as an adult and a lower likelihood of graduating high school. Additionally, being in the youth or adult justice system can exacerbate trauma. Those with more serious charges may face challenges finding future employment, housing or receiving social support.”

One of the reasons it can be hard to solve issues related to youth incarceration is because of a lack of reliable data in the state. Not all juvenile courts report data – despite being required by state law – and data is often different between counties, creating misleading statistics. Only 78 of the state’s 98 juvenile courts reports data regularly.

What is evident is early intervention programs are more cost-effective in the short and long-term and provide more positive outcomes for youth than incarceration. The average annual cost to detain a juvenile a secure facility in Tennessee comes in at $180,675 per juvenile or $495 per day.

By contrast, custody prevention programs cost the state $7.09 per child per day with a 97.8% diversion rate, child and family intervention programs cost $1.42 per child per day with a 98.8% diversion rate, truancy prevention programs cost $0.91 per child per day with a 100% diversion rate, and three-day treatment/education programs cost $21.62 per day with a 99.4% diversion rate. Programs providing aftercare to prevent re-entry into the system also cost $15.62 per day with a 95% diversion rate.

Work is being done to address the negative impact of ACEs on Tennessee youth. impacts. The Tennessee General Assembly has recently enacted evidence-based training programs for school leaders and teachers on ACEs and their impact as well as required LEAs and public charter schools to adopt trauma-informed discipline policies. Parents attending educational seminars must also watch a video on ACEs.

“Tennessee has begun this effort though policy change, community and business partners, educators and caregivers, but we must continue to push forward to create a safe, prosperous, and healthy Tennessee,” the report found.

To read the full report, visit this link. For more information on how Tennessee is tackling ACEs and related issues, visit this link.