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A harsh spotlight: how the ACEs narrative lays bare the cost of doing nothing


27 Feb 2020

Rachel Dickinson, ADCS president and executive director people at Barnsley Metropolitan Council, calls for ACE-awareness in policymaking at all levels and the resources to follow through with early intervention and support.

The adverse childhood experiences (or ACEs) movement has seen a surge in both profile and uptake in recent years, with Scotland actively working towards being the world’s first ‘ACE-aware nation.’ For some people, the concept of ACEs offers a clear roadmap for thinking and talking about the lifelong impact of early childhood experiences on outcomes, which can be helpful. But we know that no two people, or their experiences, are ever the same. So, rather like the mantra of ‘Get Brexit Done’, could we be in danger of oversimplifying something very complex?

The concept of ACEs originated in the US over 20 years ago, and the theory is that the greater the adversity experienced in childhood, the higher the risk of poor outcomes in adulthood, including drug use, obesity or even suicide. The ACE framework encompasses 10 traumatic events or circumstances, including poor parental mental health, domestic abuse, divorce and bereavement. But given its growing usage, I worry that some key determinants of poor health and wellbeing, such as low birth weight, bullying at school and social inequality, are not considered in the framework.

A huge body of research and experience tells us that what happens in our childhood, particularly in the early years, shapes who we will become in later life. But we also know with great certainty that strong, consistent and loving relationships mitigate the worst effects of childhood adversity. People’s lives, their individual vulnerabilities as well as their personal resilience and support networks, cannot easily be captured via screening tools that result in a ‘score’. Divorce can be amicable, or surely preferable to growing up in a volatile and abusive household, and the love and support of siblings, step-parents, grandparents, a teacher or foster carer can help children to not only to cope with adversity but to thrive.

EIF’s latest report identifies 33 interventions with robust evidence of preventing ACEs or reducing the symptoms of trauma, including intensive work with parents in the home and school-based programmes. So we do know ‘what works’. But the capacity of local services, including CAMHS, schools and local authority children’s services, to offer this much-needed support continues to be curtailed by a decade of austerity. The ongoing use of grant funding by a whole host of government departments to tackle entrenched social issues, such as alcohol-dependent parents, parental conflict and exploitation, adds to these pressures.

ACEs should not be used to label or stigmatise individuals or groups, but there is real value in raising awareness of childhood distress among the public, professionals, politicians and policymakers. I have to believe that the architects of welfare reforms could not have considered the impact of sanctions, caps, subsidies, limits and freezes on children’s lives, nor the suffering that would be caused by hunger, cold homes, overcrowding, and seeing parents and carers struggle to make ends meet. ‘ACE-awareness’ by the UK government when developing new policies would be a significant step forward, as would the prioritisation of early help and support when and where it is needed. There is a real human cost to doing nothing. Our children deserve better.