Introduction To Adverse Childhood Experiences

Introduction toAdverse Childhood ExperiencesJan BondHealth and Wellbeing Programme ManagerPublic Health EnglandSouth West CentreHealth and Wellbeing

Overview1. What are adverse childhood experiences2. Why do adverse childhood experiences matter3. What can we do about adverse childhood experiences Prevention (of future ACEs/vulnerability factors) Early intervention (for children in families with ACEs/vulnerabilityfactors currently) Mitigation for children/young people and adults already affected4. How do we implement this locally (discussion/activity).5. Summary2Introduction to Adverse Childhood Experiences

1. What are adverse childhood experiences? There are 3 direct and 6 indirect experiences that have animpact on childhood development. The more adversity a child experiences the more likely it isto impact upon their mental and physical health. Evidence suggests children exposed to 4 or more adverseexperiences are more likely to participate in risk takingbehaviours and find it more difficult to make changes. and consequently, have poorer health outcomes.3Introduction to Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs)Source: Centre for Public Health: Liverpool John Moore’s University 20164Introduction to Adverse Childhood Experiences

Child development and ‘toxic stress’Source: Harvard University, Centre for the Developing Child; Petchel and Pizzagalli, 2011.5Introduction to Adverse Childhood Experiences

Chronic/Toxic StressChronic traumatic stress in early life alters how a child’s brain developsit fundamentally alters nervous hormonal immunological system development.“This can result in individuals whose systems are ‘locked’ into a higherstate of alertness; permanently prepared for further trauma. Suchphysiological changes increase the wear and tear (allostatic load) ontheir body; increasing risks of premature ill health such as cancer, heartdisease and mental illness”Source: Public Health Wales and CPH, John Moore’s University 20166Introduction to Adverse Childhood Experiences

Toxic stress videoAccess below:https://www.youtube.com/watch?v rVwFkcOZHJw7Introduction to Adverse Childhood Experiences

We can learn new skills8Introduction to Adverse Childhood Experiences

2. Why ACEs matterSource: Bellis 2016 adapted from Felitti 1998, image credit to Warren Larkin Associates Limited9Introduction to Adverse Childhood Experiences

Who is at risk?Individuals reporting at least one ACEIndividuals reporting 4 ACEs or moreSource: Bellis, 2014.10Introduction to Adverse Childhood Experiences

Diet and obesity In the 1980s Felitti discovered that patients successfully losing weight in alocal Weight Programme were the most likely to drop out. Found that overeating and obesity were often being used unconsciously asprotective solutions to unrecognized problems dating back to childhood. Counterintuitively, obesity provided hidden benefits: it often was sexually,physically, or emotionally protective.Source: Felitti, 199811Introduction to Adverse Childhood Experiences

Health and wellbeing behavioursUK study suggests those with 4 ACEs are:2x more likely to have a poor diet 23x more likely to smoke 15x more likely to have had sex under 16 years 16x more likely to have been pregnantor got someone accidently pregnant Under 18 2Source: 1. Bellis et al. 2012 2. Bellis et al. 201312Introduction to Adverse Childhood Experiences

Social and community impactUK study suggests those with 4 ACEs are:2x more likely to binge drink7x more likely to be involved in recent violence11x more likely to have been incarcerated11x more likely to have used heroin or crackSource: Bellis et al. 2014, n 388513Introduction to Adverse Childhood Experiences

Health and wellbeing outcomesIndividuals never diagnosed with a major disease by age (%)Source: Bellis et al, 201414Introduction to Adverse Childhood Experiences

Impact on servicesPeople with 4 ACES compared with those with no ACESHealth care: 2.1 x more likely to have visited their GP in the last 12 months1 2.2 x more likely to have visited A&E in the last 12 months1 2.3 x more likely to have more than ten teeth removed1 2.5 x more likely to have stayed a night in hospital1 6.6 x more likely to have been diagnosed with an STD1Social Care: 64% of those in contact with substance misuse services had 4 ACE2 50% of homeless people had 4 ACES2Source: 1 Ford et al 2016152Bellis et al, 2014,2016Introduction to Adverse Childhood Experiences

OpportunitySource: tion to Adverse Childhood Experiences

Source: Early Intervention Foundation, 2016.17Introduction to Adverse Childhood Experiences

National responses1. There is a range of evidence of the impact of negative factors in childhoodon later life2. ‘ACEs’ is one way of describing these negative factors and helpfully‘quantifies’ them to some degree3. Some areas are looking to an ‘ACE Framework’ to describe local work4. Other national bodies are using ‘vulnerability’ as their framing – inparticular this is the focus of the Office of the Children’s Commissioner thisyear*5. Some local areas are also looking to a ‘vulnerability -vulnerability/18Introduction to Adverse Childhood Experiences

3. What can we do about ACEs?Working across the life-course19Introduction to Adverse Childhood Experiences

Policy and guidance1.PreventionBest start in lifeEmotional health and wellbeing in schools & collegesHousing for health2. Early InterventionSupporting mental health in schools & collegesCost of late interventionFuture in mind 5 / Year Forward View for mental health3. MitigationTackling child sexual exploitationHelping workless familiesFuture in Mind / 5 Year Forward View for mental health20Introduction to Adverse Childhood Experiences

3.1 Prevention Promote early attachment Universal and selective services – home visits, parenting/familyprogrammes Sexual abuse and violence prevention Community policing Schools – building resilience Social care system to prevent intergenerational neglect and abuse21Introduction to Adverse Childhood Experiences

Source: Perry & Pollard 1997 and 2005. /PerryPollard SocNeuro.pdf22Introduction to Adverse Childhood Experiences

3.2 Early interventionExamples of interventionsPerinatal mental healthEarly years support and educationWhole school/college interventionsBullying interventionsMindfulnessMental Health First AidConnect 5 TrainingCounsellingEarly intervention for self-harm23Introduction to Adverse Childhood Experiences

3.3 Mitigation for those with ACEs“You’re Welcome”Young people’s health services24Introduction to Adverse Childhood Experiences

Trauma informed services in schoolsTrauma informed care aims to develop different thinking process so that childrenand adults are less likely to ‘flip’ into the fight/flight type response that isassociated with threat and stress.Examples in the South West include: ‘Thrive Approach’ commissioned in Devon and Plymouth ‘Mindful Emotion Coaching’ commissioned inSomerset and North Somerset Emotion Coaching in Wiltshire, Swindon andBath and North East SomersetSources: oaching.co.uk25Introduction to Adverse Childhood Experiences

Trauma informed services – video linksClip 1 Emotion coaching and mindfulness introductionClip 2 Emotion coaching presentation and discussion for children’s servicesand tion to Adverse Childhood Experiences

Early Intervention Foundation27Introduction to Adverse Childhood Experiences

PC-Conference-London.pdf28Introduction to Adverse Childhood Experiences

Impacts of economic pressure29Introduction to Adverse Childhood Experiences

DWP pilotsSee EIF reference on previous slide30Introduction to Adverse Childhood Experiences

See EIF reference on previous slide31Introduction to Adverse Childhood Experiences

Routine enquiry into adversityBlackburn with Darwen Local Authority in partnership with Lancashire CareNHS Foundation Trust studied the barriers to early detection of ACEs.The findings:In response these findings the Routine Enquiry About Adversity in Childhoodmodel (REACh) was created. The model systematically screens for adversity.Source: www.lancashirecare.nhs.uk/REACh32Introduction to Adverse Childhood Experiences

Key findings of the REACh model Practitioners were not aware of the impact of adversity on later life outcomes. REACh helped to equip practitioners with the knowledge and skills to conductroutine enquiry with service users. The model is feasible and acceptable to staff and service users. There was no significant increases in service need following practice change. The REACh approach was the catalyst for increased frequency of disclosures,better therapeutic alliance and more targeted interventions. Practitioners considered the impact of ACEs in relation to their lives and that oftheir children.Source: www.lancashirecare.nhs.uk/REACh33Introduction to Adverse Childhood Experiences

4. ImplementationStrategic:Sustainability and Transformation Plans, Integrated CareSystems, CQUINS (NHS), JSNA’sPolice Early Intervention ProgrammesOperational:0-5years/health visiting, drug and alcohol services,violence prevention, sexual health,workforce development for routine enquiry34Introduction to Adverse Childhood Experiences

In a child’s wordsAccess video here:http://www.aces.me.uk/in-wales/35Introduction to Adverse Childhood Experiences

‘Sufficient evidence is already available forgovernments to prioritise and invest in ACEpreventing interventions. Too often thefocus is on addressing the consequencesof ACEs rather than preventing them in thefirst instance.’Bellis et al, 201436Introduction to Adverse Childhood Experiences

Service responsesEarly Intervention and preventionHow do you use data to you understand the need within your service?How do you develop and promote resilience?How do you respond when there are signs of vulnerability/adversity?Integrated workingHow do you work with other agencies such as criminal justice, education,health and other services?What opportunities do you have to forge stronger links?Proportional UniversalismChildren from all backgrounds can experience ACESAre staff working within universal services ACES aware/aware of thesevulnerability factors?Do staff know how to respond in a ‘trauma informed’ way?Have you got enough capacity in the system to scale up your responses wherethe need e-experiences-in-the-home.pdf37Introduction to Adverse Childhood Experiences

Discuss with your neighbour1.What local programmes are you involved in thatalign with ACE?2. What would a multi-agency ACE approach offeryour local area?3.What could you change in your work that wouldreduce the impact of ACES?38Introduction to Adverse Childhood Experiences

5. Summary There are nine key ACEs that can impact on a child's development and theirresponse to stress. The more ACEs a child experiences the more likely they are to experiencehealth implications as a result of poor health behaviours which can result inearly death. Early intervention and prevention work are cost saving in comparison to lateintervention programmes. Routine enquiry could help to identify those that may be at risk and those thathave already experienced ACEs and an opportunity to develop appropriatecare plans as required. Opportunity for services to become ACE aware and have a trauma informedresponse.39Introduction to Adverse Childhood Experiences

Contact:Jan BondHealth and Wellbeing Programme ManagerPublic Health England South WestJan.bond@phe.gov.uk40Introduction to Adverse Childhood Experiences

Nadine Burke Harris – TED talk.Access video here:https://www.youtube.com/watch?v 95ovIJ3dsNk41Introduction to Adverse Childhood Experiences

Mark Bellis – NHS England Lecture.Video can be accessed here (29 minutes)https://www.youtube.com/watch?v 7xuWzPRf0ro42Introduction to Adverse Childhood Experiences

Policy examplesExamples of Guidance:Best Start inLife’ andEmotionalHealth andWellbeing inSchools andCollegesSource: h-and-wellbeing43Introduction to Adverse Childhood Experiences