• Matt Buttery
• 19 June 2018
• Posted in: Healthcare

The concept of Adverse Childhood Experiences (ACEs) has done much to further debate about the need to invest in children’s mental health.

But while ACEs can be helpful in identifying populations of children at risk of poor outcomes to inform resource allocation and service planning, moves to screen children for adverse experiences may not be so useful in an environment of stretched mental health services for children.

Some researchers point out being exposed to experiences does not define outcomes in every case, while others highlight that referring children at risk to services which may or may not exist might be ethically questionable.

Results from the first Welsh Adverse Childhood Experience (ACE) study suggest that children who experience four or more harmful experiences in childhood could be four times more likely to engage in high-risk drinking in adulthood, six times more likely to smoke and 14 times more likely of being involved in violence in the past year.

The survey revealed around one in every seven adults aged 18-69 years in Wales had experienced four or more ACEs during their childhood and just under half had experienced at least one.

However, in confronting ACEs it’s also critical to think of the way in which parenting and issues such as health, education, social mobility, life chances, and violent crime prevention intersect — they are all significantly impacted by what happens in the home.

The Home Office’s Serious Violence Strategy from April 2018 identified early intervention and prevention as one of the four key themes which are critical to tackling knife and gun crime. It stated: “This strategy stresses the importance of early intervention to tackle the root causes and provide young people with the skills and resilience to lead productive lives free from violence.”

The strategy also highlighted that ACEs are strong predictors of serious violence and that childhood abuse and the influence of parents can have a profound impact. It said: “Evidence highlights that there are a range of adverse childhood experiences (ACEs) which are significant predictors of at least one form of serious violence. These experiences can be diverse and complex and include childhood neglect, childhood abuse, parental criminality and parental substance misuse. They can be further complicated by their interlinked nature and may require a new approach … to address the full range of factors affecting those who experience them.”

A report published by the Sainsbury Centre for Mental Health, ‘The chance of a lifetime: preventing early conduct problems and reducing crime’, found that parenting is the single most important factor in shaping the emotional and behavioural development of children.

The report noted: “The most common childhood mental health difficulties are conduct problems. A very high proportion of those who have the most serious conduct problems during childhood will go on to become involved in criminal activity. Effective help for parents and families to prevent and manage conduct problems is extremely good value for public money and should be offered routinely across the UK.”

The Wales ACEs survey has done much to provoke policy debate about the best direction to take. However, Wales has moved quickly to respond with early intervention.

Professor Mark Bellis, Director of Policy, Research and International Development in Public Health Wales said:  "The report shows that providing safe and nurturing environments for every child in Wales is the best way to ensure we raise healthier and happier adults who contribute to their communities and the economy. This is one of the reasons why Public Health Wales is focusing on early years as a priority area for action with partners.

"By stopping abuse, neglect and other harmful experiences faced by children we could prevent around a third of all high-risk drinking, a quarter of smoking and as much as 60 per cent of violence in adults."

The US Centers for Disease Control and Prevention advocates that prevention of child abuse and neglect needs to incorporate an extensive public engagement campaign to change social norms in order to promote positive parenting and recommends behavioural parent training programs such as Triple P be used to lessen harms of abuse and neglect exposure and prevent problem behaviour and later involvement in violence.

Work by Triple P in rigorous evaluations around the world, and replicated in industry-level evaluations conducted by implementation partners, shows that, when implemented effectively, evidence-based parenting interventions can improve outcomes for children across the community.

Matt Buttery is CEO of Triple P UK, a social enterprise which takes a population-health approach to the delivery of evidence-based training and resources, including evidence-based digital interventions, to enhance the confidence and capacity of parents to promote the best outcomes for children.