Health services reluctant to ask about childhood trauma, study finds
Joe Lepper
Friday, June 1, 2018
Health workers are reluctant to routinely ask young people who access their services if they have been affected by adverse childhood experiences such as abuse or exploitation, a pilot study has found.
The pilot involved a child and adolescent mental health service (CAMHS), a drug and alcohol support team and a sexual violence support service in the north-west of England being asked to use the Routine Enquiry about Adversity in Childhood programme.
This involves routinely asking clients about any adverse childhood experiences, and for the pilot was carried out via a guide the Department of Health and Social Care asked Lancashire Care Foundation Trust to develop.
But during the pilot many health professionals taking part were reluctant to raise the issue with clients as a matter of routine.
A key factor cited was a lack of resources to provide specialist support if a traumatic experience was revealed.
Practitioners were also concerned that the questions posed through the programme's adverse child experience (ACE) and child sexual exploitation (CSE) questionnaire could be misinterpreted by young people.
They told the research team that for it to be used successfully with young people the questions posed need to be better tailored to their age group.
In addition, those taking part are worried about the appropriateness of asking questions about adverse experiences before they have been able to develop a rapport with clients.
In total 15 clients involved in the pilot were asked about adverse childhood experiences. Such questioning was "generally viewed as acceptable to both health workers and clients", states a report into the pilot by an evaluation team from Liverpool John Moores University's Public Health Institute. But in all cases the clients involved were aged over 18.
The drug and alcohol service failed to ask any clients, with senior managers wanting more support before taking part in the pilot.
In the two services covering CAMHS and sexual violence support that did take part, neither fully implemented the programme using the questionnaire provided, researchers found.
"Engagement in the pathfinder raised concerns across various practitioners around the rationale and appropriateness of implementing routine enquiry using the ACE-CSE questionnaire, within these types of services," states the evaluation report.
"For instance, implementing routine enquiry during the initial assessment was viewed as not being universally appropriate, as it is vital that a good client-practitioner rapport is developed and the client displays signs of resiliency, before exploring such traumas."
The evaluation report adds: "Significant concerns were raised about identifying adverse childhood experiences, without the required resources (both within and external to the service) to support the client appropriately."
