A new report from Early Intervention Foundation suggests services using the Adverse Childhood Experiences (ACEs) approach may be overlooking vulnerable children and calls for services to exercise caution.
Independent research charity, the Early Intervention Foundation (EIF), has put out a warning in a new report – Adverse childhood experiences: What we know, what we don’t know, and what should happen next. Released today, the report warns that public services may be taking significant risks by being overly focussed on the popular Adverse Childhood Experiences (ACEs) approach used to identify and support vulnerable children at risk of poor health and other problems such as mental health issues, chronic diseases and involvement in crime later in life.
The ACEs framework is a set of 10 traumatic childhood circumstances which are consistently shown to increase the risk of adult mental health problems and physical diseases.
Although precise data on prevalence is lacking, 80% of the children in England who were formally classed as being “in need” last year had experienced at least one of these ACEs, and 10% of the population experience four or more ACEs before the age of 18.
Risking oversimplification of abuse markers
EIF says that ACEs have been useful for raising awareness around the negative impact of childhood adversity and galvanising action. However, the report makes clear that there is a risk of oversimplification and that there are major gaps in the evidence on how to identify and support the most vulnerable children.
Dr Jo Casebourne, chief executive at EIF, said: “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. 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.”
ACE screening concerns
The report finds that many other adversities in childhood – beyond the 10 original ACEs – also increase the risk of serious adult problems. These adversities include economic disadvantage, discrimination, peer victimisation and individual factors, such as low birth weight or disability. A focus on the original 10 ACEs, to the exclusion of these other factors, risks missing many children who need help as much or more than those currently being identified.
The report raises serious concerns about the value of some popular practices based on the ACEs framework. ACE screening, or routine inquiry, is increasingly being used to identify children who may be experiencing ACE-related trauma, as a result of current or recent adversity. However, few evaluations to date have rigorously tested whether ACE screening is an effective method for identifying vulnerable children and making treatment decisions.
Dr Kirsten Asmussen, lead author of the report and Head of What Works Child Development at EIF, added: “Our research shows that it’s clear that ACEs themselves are harmful and must be stopped. However, the evidence supporting some of the assumptions about ACEs is less clear. This includes the claim that ACEs are the root cause of many life-threatening diseases. The truth is, the best evidence does not fully substantiate this claim.
“We also don’t know whether common practices, such as ACE screening, really work to identify people who need help or lead to effective treatment. 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.”
Responding to the report, Isabelle Trowler, Chief Social Worker for Children and Families in England, said: “EIF is offering something much more than a critique of ACEs. It is offering a way forward. It is definitely not saying that ACEs do not have value – 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. I hope the report might build a bridge between those on either side of the debate.”
The report calls for more data and evidence to be collected. With this, it will be possible for public services to put in place better ways of identifying and supporting children affected by childhood adversity.
EIF has identified 33 interventions with robust evidence of either preventing ACEs or reducing ACE-related trauma. These include intensive home visiting interventions for vulnerable parents, schools-based programmes aimed at preventing health harming behaviours, or psychotherapeutic treatments designed to reduce the symptoms of trauma. These services are not currently widely available.
Report recommendations to improve screening
To improve the situation EIF recommends, a wider, whole-system approach to preventing and reducing ACEs. This includes:
- National and local policies designed to address the wider social and economic conditions that can increase the likelihood of children being exposed to adversity, such as poverty and community crime;
- Strengthening local systems for preventing childhood adversity and providing supporting, including through effective and coordinated local leadership, developing the skills to practitioners to respond to and support parents and children, and strong services providing evidence-based interventions; and
- Significant investment into research on childhood adversity, including the rigorous evaluation of a comprehensive public health response to tackling adversity.