Policymakers need to recognize the long-term health, social, and economic benefits of upstream investments for children, including those who have experienced trauma, violence or severe adversity, and fully include children in health care payment and delivery system reform. This paper – a joint effort of Futures Without Violence and Families USA — examines the reasons children have been left out of current delivery system reform efforts, discusses existing and promising payment reform models, and recommends policymakers investment in evidence-based interventions in early childhood that drive long-term health outcomes.