Year: 2023
Type: book
Abstract: Tackling Adverse Childhood Experiences State of the Art and Options for Action Executive summaryAdverse Childhood Experiences (ACEs) refer to sources of stress that children may suffer whilst growing up.Although there is no standardised definition of ACEs, they have historically included multiple forms of physical, sexual and emotional abuse and neglect, exposure to violence between parents or caregivers, and other serious household stressors such as parental substance abuse or mental illness 1 .This state of the art report brings together current research on ACEs, their immediate and life-long impacts and the evidence on how to tackle ACEs through prevention, mitigation and trauma-informed practice (TIP).It is intended as an evidence-based guide for those developing policy, practice or other interventions to reduce the prevalence and harmful impacts of ACEs.This report identifies that: ACEs are common in populations (Section 3).In Europe, around four in ten adults are thought to have suffered at least one ACE whilst growing up, and two in ten are thought to have suffered more than one.The prevalence of ACEs varies geographically, and is affected by socio-demographics such as gender, ethnicity, race and socio-economic status or deprivation.Importantly, children that suffer one type of ACE are at increased risk of suffering other types of ACEs, reflecting a need to address ACEs collectively rather than only focusing on individual adversities.The risk of children suffering ACEs can be affected by a wide range of individual, family, community and societal circumstances.Whilst many people with ACEs are resilient to the harmful effects, for others, ACEs can have long lasting impacts across the life course (Section 4).ACEs can increase risks relating to:• Early child development, e.g.increased risk of developmental delays.• Education, e.g.increased risk of school absence, low engagement and low achievement.• Health and behaviour, e.g.increased risk of injury, health-harming behaviours and poor mental health.• Involvement in violence and criminal justice systems, e.g.increased risk of offending.• Socio-economics, e.g.increased risk of poverty, unemployment and homelessness.• Chronic illness, e.g. earlier development of illnesses such as cancer or cardiovascular disease.• The health and development of offspring, e.g.increased risk of developmental, mental health and physical health problems for the children of those with ACEs.ACEs and other stressful experiences can result in biological changes in the body that become embedded in behaviour (Section 5).Some biological changes may have been adaptive developments aimed at improving short-term survival within an adverse childhood environment.However, in contemporary societies, these changes often result in negative health and behavioural consequences across the life course.Biological changes include those relating to:• The developing brain, affecting early development in brain structure and function.• Stress regulation, leaving those affected with greater difficulty controlling responses to, and recovering from, stressors.• The immune system, increasing vulnerability to infection, chronic inflammation and autoimmunity.• The endocrine/metabolic systems, leading to a number of issues including high blood pressure, insulin resistance and risk of chronic diseases.• Epigenetic changes, impacting on brain development, cognition, behaviour and health.The financial costs of ACEs to society are vast (Section 6).ACEs can impose major costs on a range of services and systems, including health, social care, education and criminal justice.The annual health burden of ACEs in 2017 has been estimated at 24.6 million Disability-Adjusted Life Years 2 (DALYs) in the WHO European region and 12.9 million DALYs in North America.The financial costs associated with this were estimated to be $581 billion for the European region (equivalent to 2.7% of Gross Domestic Product [GDP]) and $748 billion in North America (equivalent to 3.6% of GDP).1 ACEs can include other childhood adversities such as peer violence, community violence, and exposure to collective violence and war.However, in this document, we focus predominantly on ACEs that affect children in the home environment, including child maltreatment.2 Sum of the years of life lost due to premature mortality and years lived with a disability, due to prevalent cases of a health condition or disease. Tackling Adverse Childhood Experiences State of the Art and Options for ActionA broad range of approaches can prevent or mitigate the impacts of ACEs (Section 7).These approaches are effective across multiple types of ACE through addressing common risk factors.It is also likely that additional health and well-being benefits and cost-savings elsewhere will be derived from the implementation of ACErelated measures.Strategies include:Policies, legislation and strategies that promote the social determinants of health and human rights, address inequalities in health and gender, and aim to alter norms, behaviours and environments that promote ACEs.E.g. legislation to prohibit corporal punishment of children or criminalise intimate partner violence (IPV), public awareness-raising and education programmes on ACEs, empowerment programmes for women and girls, and programmes to alter harmful social and cultural norms that promote ACEs.Strengthening families and developing/maintaining safe, stable, nurturing relationships and environments for children, families and wider communities.E.g. parenting programmes that educate and support parents and caregivers and strengthening economic support for families.Provision of education and opportunities to develop life skills that help deal with stress, negative emotions and conflict.E.g. pre-school enrichment programmes, school-based violence prevention or life skills development programmes, and training of professionals to raise awareness of child maltreatment.Response and support services that aim to reduce the impact that adversity has on children and adults.E.g. counselling and therapeutic approaches, pharmacological treatment, interventions to counter toxic stress and improve biological functioning, and support for specific ACEs such as child sexual exploitation response programmes, support for survivors / perpetrators of IPV, screening and brief intervention for parental substance use.Multi-component programmes that combine different strategies to address multiple risk factors at the same time.E.g.Multi-component family programmes that combine parental, youth and family skills building.Building resilience is an important part of work to mitigate the impact of ACEs (Section 7.10).Many individuals with ACEs avoid adverse outcomes; a characteristic referred to as resilience.This is an ability to withstand, cope or recover from the effects of adverse circumstances.Individual resilience is the product of an interaction between internal (child predispositions) and external (social) factors.Types of resilience that can be developed include those relating to:• Individuals, such as having a sense of control over one's life circumstances, hope, and skills in selfregulation and executive functioning.• Relationships, such as a trusted, supportive relationship with an adult.• Communities, such as supportive social networks.• Cultures, such as mobilisation of cultural traditions.• Systems, such as the capacity of a system (e.g.health system) to recover from adverse events and maintain function.Strategies that can help to build resilience are often similar to those used to prevent ACEs from occurring.E.g. parenting programmes, mentoring interventions, school-based programmes that develop life skills, psychological support to deal with the negative impacts of ACEs and community-based programmes that strengthen local resources and relationships.Box 3.3: ACEs across Europe WHO European Region has worked with a number of countries to identify the prevalence of ACEs and relationships with health-harming behaviours among young adults in secondary or higher education.Studies have been conducted in Albania, Czech Republic, Latvia, Lithuania, Moldova, Montenegro, North Macedonia, Poland, Romania, Russian Federation, Serbia, Turkey and Ukraine.Each study has used the Family Health History Questionnaire 6 used in the US ACE survey to collect information on childhood adversities.The questions used to measure each ACE are below*.While you were growing up, in the first 18 years of life… Physical abuse How often did a household member: † • push, grab, shove or throw something at you? • hit you so hard you had marks or were injured?(ever) • spank you (sometimes at hard severity, or often at medium to hard severity)?Emotional abuse How often did a parent or household member: † • swear at you, insult you, or put you down (more than sometimes)?• act in a way that made you think that you might be physically hurt?(more than once or twice) Sexual abuse How often did an adult or someone at least 5 years older than you: †~ • touch or fondle your body in a sexual way?• have you touch or fondle their body in a sexual way?• attempt to have any type of sex with you?• have any type of sexual intercourse with you? Parental separationWere your parents ever separated or divorced?Household alcohol abuse Did you live with a household member who was a problem drinker or alcoholic?Exposure to caregiver IPV How often did your father (or stepfather) or mother's boyfriend do any these things to your mother (or stepmother): †#• kick, bite, hit her with a fist or hit her with something hard?(more than once or twice)• push, grab or slap her or throw something at her? (more than once or twice)• repeatedly hit her for a few minutes or more?• threaten her with a knife or gun?Household mental illness Did you live with a household member who was depressed, mentally ill or suicidal? Household member incarceratedDid you live with a household member who went to prison?/Was anyon
Source: Liverpool John Moores University
Language: English
Topic: Child Abuse and Trauma
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7135881560