Being ACE aware - a helpful or harmful approach?
Tuesday, March 26, 2019
I am passionate - as I know many people are - about relationship-based approaches to supporting and empowering children and young people. I'd heard of ACEs (Adverse Childhood Experiences) but hadn't explored it in detail. So, last year when our head of early years excitedly and enthusiastically reported back from a conference she'd attended, I was really interested in what she had to say and how it might inform our work in Derbyshire.
I was therefore very happy to accept an invitation to attend an event about the work of the Alberta Family Wellness Initiative. The event focussed on how Blackpool, as a Better Start area, is working closely with them, making use of brain science to transform their approach to early years and reframe early child development. My guess is that many of you reading this will also have heard of ACEs and some will know a lot about it. The rapidly increasing interest in the approach - if it is an approach - is being described by some as a ‘movement' or ‘campaign'. Scotland is even working on becoming the first ‘ACE aware nation'.
My initial response was one of real enthusiasm and a sense that much of what I'd previously understood about the impact of childhood trauma was brought together in a straightforward framework. In Derbyshire, our Future in Mind plan includes a programme of ACE awareness and we have a number of conferences planned. The consideration is whether there is scope for the development of an informed county wide approach across all partners. I'm aware some areas have already developed such an approach.
However, the more I have looked into the subject and read about it the more I realise that it's not quite as straightforward as I thought. As with most evidence-based approaches there can be very differing views!
ACEs are specified traumatic events that children can be exposed to during childhood. The original ACEs study (Felliti, V. J et al,1998) identified 10 kinds of adverse experiences; five that involved direct harm to a child (physical, sexual and emotional abuse; physical and emotional neglect) and five that affect the environment in which they grow up (domestic violence; substance misuse; parental separation; mental illness; incarceration of a family member). The question here would be, what about other adverse experiences such as loss and bereavement? And what about resilience - what makes one child more resilient to the impact of these experiences than others? My thinking is that there is nothing to say that adversity can't be viewed more widely than the original study, which I know others are doing.
The research concludes that the more ACEs a person experiences the higher the risk of poor outcomes in later life. The evidence shows that being exposed to ACEs in childhood can change the way the brain develops which can impact on a child's ability to navigate everyday demands and can increase the risk of developing health harming behaviours.
I don't suppose it's anything we didn't already know - that traumatic experiences occurring early in a child's life can have a lasting impact, but what I have found interesting and useful is the effect that toxic stress has on brain development. It's also fascinating to see the brain science and hope behind efforts to improve the impact of this stress.
What seems, however, to be a source of concern is the ACEs ‘scoring' tool which is a checklist of the experiences named above that produces an ACE score of 1-10. The research has shown that if a person has a score of four or more ACEs they will have a life expectancy of 20 years less than those with no ACEs. The notion of working through a clinical checklist of ACEs with a person, I agree would be a concern and could potentially add to a child's trauma. Any mechanistic way of trying to categorise human responses to events will have opponents and used badly could be destructive. Surely it's about appropriately skilled practitioners not reducing a child's lived experience to an ACE score, but instead using this awareness to reference the adversity in a constructive, person centred way in order to support positive change and build resilience?
So, I can't see the harm in understanding and talking more about the impact of adversity and the science of the brain. Neither can I see an issue with how this awareness can be used to inform practice and interventions that take into account the complexity of childhood trauma and toxic stress and support the development of resilience. If it leads to greater awareness among a wide range of multi-agency professionals, engenders increased compassion and care and opens up possibilities such as responses to behaviours that are often found to be a challenge, then surely this is a good thing?
There are many questions and this blog only lightly touches on the subject. However, for me, as with any model or approach, it's about ensuring that the intent and the application of it supports positive change and improved outcomes which is our ongoing strategic challenge.
Kathryn Boulton is deputy director of children's services in Derbyshire. This blog first appeared on the ADCS website