At a two-day conference on adverse childhood experiences (ACE) last September, Scotland set out a vision to become an "ACE Aware Nation". The Scottish government has committed to preventing and mitigating ACEs, and has funded the creation of Health Scotland's ACE Hub to raise awareness and understanding about ACE, increase the evidence base and develop policy and practice approaches to prevent them, and mitigate their negative impacts.
The use of ACEs is commonplace in the United States, where the research originated. It has since gained ground internationally.
In Wales, public health and policing have become linked around an agenda to better prevent ACEs and support those affected to build resilience.
In England, the science and technology select committee's recent inquiry on evidence-based early years interventions heard evidence of how the ACE framework is being used to help early years and health practitioners to identify children at risk.
National strategy
The committee called for the government to "match the ambition of the Scottish and Welsh governments, and build on the example set by certain English councils, to make early intervention and childhood adversity a priority, and set out a clear, new national strategy by the end of this parliamentary session to empower and encourage local authorities to deliver effective, sustainable, evidence-based early intervention".
While the moral and economic argument for better early intervention is compelling, the case for more support for affected people is not so straightforward.
Last November, we brought together international speakers and participants from a range of academic, practice and policy fields to explore some of the challenging ethical and practical issues associated with using ACEs. What did we learn?
We heard that some issues are missing or hidden. Child Bereavement UK highlighted the significant impact of child grief and how this is so often overlooked. Similarly, research on bullying seems to be absent from the ACE debate, and professor Mike Lucas set out the case for better understanding the impact of early childhood nutrition on later life health - another aspect missing from discussions on ACE.
We also learned that we should remember that uncritical, enthusiastic use of tools such as this can lead us down a dark path in stigmatising those most in need and pathologising families. Professor Sue White's work at the University of Sheffield has shown how families can feel further excluded by overzealous state interventions.
Perhaps of most importance, we learned that tools alone will not fix the problem. A tool that tells you the number of things that went wrong in your childhood does nothing more than identify some potential problems.
We should all be more sensitive to early warning signs - but of more importance should be a better focus on building resilience. We achieve this not by focusing on deficits but on positive factors.
Positive approach
Examples from Canada and Australia resonated with us (see case studies). We have long been concerned about the wider issue of how we support children to thrive, particularly at a time of austerity.
Our takeaway message is that ACEs alone are unlikely to add much to what we know and do already, and if we're not careful, could potentially do more harm.
They can only be useful if situated in a broader positive approach to supporting children and young people's social and emotional development within an economic and socio-political context that truly values them.
For this to happen, policymakers need to sit up and take notice - and start to put children and young people's wellbeing at the heart of health, education and wider policy.
INTERNATIONAL EXAMPLES OF GOOD PRACTICE
AUSTRALIA
Samantha Donovan, the inspirational principal of Norfolk Village State School in Queensland, spoke at the event. She explained that her school is built on the principle that every child can flourish - academically, socially and emotionally. The proof of this is in the way it has been put into practice. Children are encouraged early on to recognise and articulate and build their own behaviours, emotional needs and social connections within an extremely supportive environment. The impact is outstanding: for some of those most challenged children, the school is seeing positive results in engagement and attainment. The environment matters, but so too does positive leadership and faith in every child's capacity to thrive.
CANADA
The Human Early Learning Partnership (HELP) in Vancouver offers an exciting model for us to learn from. Based at the University of British Columbia, HELP brings together its diverse scientific community to address complex early childhood development issues with a mission to make a direct impact on children's lives. It works in partnership with local services, providing them with data about the state of wellbeing for families on their doorstep. There is a commitment to gaining as much insight into the personal problems individuals might face, and also the wider socio-economic challenges they are growing up into. This approach recognises that communities need to be equipped to help children grow up in the best environment possible.
By Professor Sir Al Aynsley-Green and Dr Jason Pandya-Wood, Nottingham Trent University
Further reading
Evidence-based early years intervention inquiry, science and technology select committee, October 2018
The British Betrayal of Childhood, Al Aynsley-Green, Routledge, September 2018
Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population, Mark A Bellis, Helen Lowey, Nicola Leckenby, Karen Hughes, Dominic Harrison, Journal of Public Health, April 2013
