1. What are ACEs?
2. What does the research on ACEs tell us?
Dr Vincent Felitti, head of Kaiser Permanente’s Department of Preventative Medicine, and Dr Robert Anda, an epidemiologist from the CDC, surveyed over 17,000 patients for their experiences of childhood trauma. Participants were asked about different types of childhood trauma which they referred to as ACEs. Key findings showed that:
- 60% of participants had experienced at least one ACE and 1 in 8 had experienced 4 or more ACEs.
- The higher the ACEs score, the higher the likelihood of developing long-term health problems like heart disease, stroke, cancer and Type 2 diabetes (a dose-dependence relationship).
Since the original ACE research many other studies have been conducted internationally, including here in the UK. Most of these studies uncover similar findings which increases the validity and robustness of the theory.
3. How do ACEs affect people in adulthood?
ACEs are not only associated with poorer health outcomes but a range of social and economic ones too. People with ACEs are more likely to under-perform in school, develop high-risk behaviours, and be on lower incomes. Deprivation, health, and social factors are closely related and perpetuate an inter-generational cycle of adversity.
4. Are some ACEs worse than others?
5. What about other types of adversity?
6. What can be done to tackle ACEs?
People can be protected from the effects of their ACEs by building resilience. The most important mitigating factor is the buffering effect of a supportive relationship with at least one trusted adult. Evidence shows that ‘5 ways to wellbeing’ is also a useful tool for building resilience. It encourages individuals to connect with others, give back to their communities, be active, take notice of what’s around them, and keep learning.
The public sector, as well as voluntary and community organisations, can work together in partnership to better support individuals and families who are struggling to cope with the causes and impacts of ACEs. This means thinking about the person’s needs more holistically, looking beyond the symptoms, and making the best use of assets and services available.
7. How do we effectively engage parents around ACEs?
8. Should I ask clients/service users about ACEs?
If you are frontline practitioner who has a relationship with a client, completing the ACEs questionnaire may be a good way to start the conversation. There is quite a lot of evidence showing that talking about trauma can contribute to recovery. It is important to ensure that those asking the questions are prepared for the response are in a position to help, and are supported themselves.
Tools are being developed in Gloucestershire and further information can be found at the www.actionaces.org website.
9. Aren’t we already doing this?
There is a lot of good work going on to reduce the impact of harm on children, prevent, and intervene early. Mitigating the effects of ACEs needs to work alongside the traditional approaches and strengthen what is already available. Being ACE aware will complement existing services, by giving all services a common language to talk about adversity and to adopt a more holistic, trauma-informed way of working. It is not about doing new things but connecting them in different ways, seeing the big picture, and treating people with compassion (staff and clients). Empowering people involves a shift in the power dynamic.
10. Where can I find out more about ACEs?
Gloucestershire’s Action on ACEs website includes information about the background research and resources for tackling ACEs. Signing up as an ACEs Ambassador will give you access to our regular newsletter containing the latest updates on action in Gloucestershire. The original ACEs study by Dr Vincent Felitti and Dr Robert Anda, as well as videos and publications by Dr Nadine Burke Harris give a good introduction to the ACEs journey in the US. In the UK, Public Health Wales have conducted a significant amount of research and are beginning to design models of good practice. Numerous areas across England are tackling ACEs in local communities using whole –system approaches similar to the work underway in Gloucestershire.