National roadmap to ACE recovery

The All-Party Parliamentary Group on a Fit and Healthy Childhood’s latest report discusses an issue habitually shrouded in secrecy – adverse childhood experiences (ACEs).

It has long been accepted that the incidents that blight an individual child’s life are for them to resolve – with, or without the help of their family. The new report draws on a wealth of professional and personal expertise and argues that the solution lies with the government. Getting this right will benefit society and the time is ripe for a “population-wide strategy” or national “roadmap to recovery”.

Economic insecurity is a breeding ground for ACEs and the government must re-commit to eradicate child poverty, requiring all policy choices to address low wages, inadequate housing and a benefit system designed to promote stigma and low take up.

A population approach would ensure that children’s centres and mental health hubs were not located in “problem areas” but available for all regardless of their income, family circumstances or geographical neighbourhood. There would be an obligation on all Whitehall departments to “road-test” policy proposals for their impact on children and families and for departments and service providers to share data to ensure effective cooperation so that those in need feel supported rather than judged.

Early intervention

Making early intervention and prevention a reality can make the difference in combating ACEs and avoiding them devastating future generations – as evidenced by existing local projects (see case studies). It means ensuring that the NHS has a population-wide preconception and inter-conception strategy and services to match; health and education professionals who are fully trained and equipped to deliver it and a revised school curriculum that places personal, social and emotional education at its core.

Preventive mental health services must be readily accessible, embracing the needs of the entire family from early years settings onwards and complemented by government investment in research and training and new statutory measures that strengthen such an approach instead of minor alterations to clinical procedures. Child and adolescent mental health services cannot manage the weight of work and many potentially serious issues could be averted with proactive intervention.

Repeated patterns

Individuals whose lives are scarred because of ACEs – often of a violent and abusive nature – are likely to repeat the patterns in adult life and the economic and health bill is charged to every section of society; including the cost of treating illness directly derived from ACEs, lack of economic productivity, a collapsing criminal justice system and the price of rehabilitating entire neighbourhoods.

Above all, a new policy of openness will champion evidence-based campaigns so that ACEs are understood by all sections of society and sources of help made available without stigma.

ACEs wreck individual lives but we can all benefit from the recovery. It’s in all of our interests to demand that the government acts on ACEs.

Preventative commissioning in Birmingham

ACEs Birmingham was developed by the UK Birmingham Health and Wellbeing Board with the aim of introducing a routine enquiry about ACEs into frontline specialist practice in services supporting adults, children, young people and families.

It aims to alter the history of ACE impact in three ways:

Tertiary prevention: using routine enquiry to identify past or present experiences and encouraging people to make changes with the aim of improving future therapeutic responses and outcomes.

Secondary prevention: using routine enquiry earlier in the development of responses to concerning behaviour in school. The development of an emotional health early help system for school students, families and staff is intended to enable access to early help before problems become embedded.

Primary preventions: these extend the principles and understanding to the physical, policy, disciplinary and cultural environment of the whole school. The intention is to create a safe space that will reduce the impact of previous experiences and to practice ways to enhance all individuals’ resilience.

The scheme is administered by Birmingham City Council and includes health, education and social care providers.

Trace-informed assessments in Wales

The Cwm Taf Youth Offending Service (YOS) has embedded a trauma- and ACEs- (TrACE) informed approach to working with children. It receives referrals from several agencies, including self-referrals, for children aged eight to 17 where there is a risk their behaviour might be judged as antisocial or later offending.

They take a developmental and relationship-based approach, responding to the needs of individual children and families. They have police officers, a substance misuse worker, health visitor and speech and language therapist seconded to the YOS. They have found the trauma-informed work has changed how they work with families and improved engagement. However, some families refuse interventions, even where this is a youth caution disposal.

The early assessment and close work of the YOS often highlights risks for the child that may lead to further offending such as poor school attachment and children’s services involvement. The YOS team report that at the end of the voluntary three-month intervention, many children ask for longer-term support.

An evaluation of the approach found mixed evidence for impact on offending, with nine out of 21 not reoffending, seven committing an offence of the same or lesser seriousness, and four committing an offence of greater seriousness.

Helen Clark is the lead author on APPG report on ACEs. Report from https://fhcappg.org.uk/