ACE guidelines ‘not a quick fix’ for treating trauma


Councils and other public services may be taking significant risks in supporting vulnerable children by oversimplifying the impact of childhood trauma, including abuse and neglect, a new report warns.

The report warns children affected by factors not covered by ACEs may not receive support. Picture: Adobe Stock
The report warns children affected by factors not covered by ACEs may not receive support. Picture: Adobe Stock

The Early Intervention Foundation (EIF) report details the 10 traumatic adverse childhood experiences (ACEs) that can provide useful predictors of poor health, mental health problems and contact with the criminal justice system in later life.

These ACEs are:

  • Physical abuse
  • Sexual abuse
  • Psychological abuse
  • Emotional neglect
  • Physical neglect
  • Domestic abuse
  • Mental illness in the family
  • Family substance abuse
  • Family member in prison
  • Losing a parent through divorce, separation or death

But the report warns that public services may be ignoring other factors and therefore missing children who need help.

The traumatic effect of poverty and neighbourhood crime are among wider social and economic factors that children’s professionals need to give greater focus to, the EIF says. Other factors include bullying, disability and discrimination.

This wider look at children’s lives would enable public services to better co-ordinate support and improve training for professionals about the links between childhood experiences and trauma, the report states.

“We know that people working in public services have found ACEs useful because they help make a set of serious, complex problems easier to understand and talk about,” said EIF chief executive Dr Jo Casebourne. 

“But our research makes clear that there are significant gaps in our understanding of how to identify, assess and really help children who suffer abuse, neglect or other adversities early in life.

“There are no quick fixes to prevent adversity or to help people overcome it. Although people are acting to tackle these serious issues, ultimately, by not intervening in the most effective way, they may not be doing what’s best for these children.”

The report is also critical of current practices around screening and testing of the impact of ACEs, with researchers warning that this could “retraumatise” children.

“Few evaluations to date have rigorously tested whether ACE screening is an effective method for identifying vulnerable children and making treatment decisions,” said the EIF.

Report lead author Dr Kirsten Asmussen added: “While some form of screening could be beneficial in some cases, there is also real potential that it could retraumatise people, especially if effective services are not available.

“More research is needed to understand whether ACE screening is actually helpful or whether it might just make things worse.”

Intensive home visits, school programmes around behaviour as well as mental health support are among interventions the report recommends are put in place to better support childhood impacted by trauma.

The report’s findings have been welcomed by chief social worker for children and families in England, Isabelle Trowler.

“It is definitely not saying that ACEs do not have value,” she said.

“In fact, it is saying the opposite. But it is also saying we need to understand the full value of ACEs and their application, before we go policy wild.”

The most recent report by Professor Sir Michael Marmot on health equity that a “clear impact” of living in poverty is the likelihood of experiencing ACEs.

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