ACEs in Wales and preliminary findings from a review into routine enquiry. Dr Kat Ford, Bangor University

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1 ACEs in Wales and preliminary findings from a review into routine enquiry Dr Kat Ford, Bangor University

objectives; Link into academic networks; Provide opportunities for the development of both

2 The Public Health Research, Evaluation and Development Hot House Funded by Public Health Wales Dedicated resource to respond to emerging research needs in line with PHWs strategic objectives; Link into academic networks; Provide opportunities for the development of both research capacity and high quality research programmes. Based in Wrexham Campus, Bangor University, North Wales.

3 Adverse Childhood Experiences (ACEs) Stressful events occurring in childhood that affect a child directly (e.g. child maltreatment) or affect the environment in which they grow up (e.g. family substance abuse, mental illness, domestic violence) Among the strongest predictors of poor outcomes across the life course ACEs are preventable Impacts can be avoided Multi-agency framework for action

4 Nationally representative household survey 2,000 adult residents aged Exposure to 9 ACEs Welsh ACE Survey 2015

5 Welsh ACE Survey 2015

6 Welsh ACE Survey 2015

8 PHYSICAL HEALTH WEIGHT & EXERCISE SEXUAL HEALTH Cancer 2.1 Heart disease Poor self-rated health Liver/digestive disease Respiratory disease 4.4 Anxiety Depression 4.4 Low life satisfaction 1.5 Diabetes Victimisation Violence perpetration Physical inactivity Obesity Smoking 2.8 Heavy alcohol use Multiple 3.6 sexual partners Global review of ACE studies Increased risk in adults with 4+ ACEs Suicide attempt Problem drug use 10.2 Early sexual initiation Teenage pregnancy STIs Illicit drug use Problem alcohol use Hughes et al, 2017 MENTAL ILLNESS VIOLENCE SUBSTANCE USE

9 Resilience: the ability to overcome serious hardship What factors may protect against impacts of ACEs in Wales? Factors building resilience: Feel you can guide own destiny Equipped to manage behaviour and emotions Socially connected, grounded in cultural traditions Having at least one stable, caring child-adult relationship

10 ACE Resilience Study 2017 National household survey 2, year olds 2,005 general population 492 boost in Welsh speaking communities Exposure to 11 ACEs

Current mental illness Currently treated for depression, anxiety or other

11 Proportion of adults reporting each ACE in 2017 Mental Illness Lifetime mental illness Ever treated for depression, anxiety or other mental illness Current mental illness Currently treated for depression, anxiety or other mental illness Felt suicidal or self-harmed Ever having felt suicidal or self-harmed

12 Relationship between ACEs and mental illness Increased risk with 4+ ACEs (v 0 ACEs)

13 Childhood resilience was associated with lower mental illness across all ACE levels 60% 29% 39% 41% 17% 14% Lifetime mental illness Current mental illness Felt suicidal / self harmed

14 An ACE-informed Wales Population 3 million Devolved Government Education, health, housing, local government, social services We will create ACE-aware public services which take a more preventative approach to avoid ACEs and improve the resilience of children and young people"

15 Breaking the cycle Recognise and Support Build resilience Prevent ACEs

16 ACE-informed Policing Exploring police knowledge and practice relating to vulnerability Evaluating training to improve understanding of trauma and increase confidence in responding Evaluating the impact of changes in practice to identify and respond to vulnerability ACEs and Prisons Measuring the prevalence of ACEs in the offender population Exploring staff knowledge and perceptions of ACEs

17 ACE-informed Health Services General Practice Evaluation of pilot study in England Staff training Routine enquiry via questionnaire waiting room Discussion with GP Feasibility, acceptability and impact Health visitors Exploration of current practice Staff training Routine enquiry during initial assessment Feasibility, acceptability and impact

18 Routine enquiry for ACEs What Importance of developing is of trauma-informed the public services and increasingly, the possibility of routine enquiry for ACEs (Burke et al., 2011; Clarkson Freeman, 2014; Dube, 2018; Loria & Caught, 2018; McGavock & Spratt, 2017; Waite et al., 2010). Routine enquiry seeks to move beyond professionals responding to the disclosure of evidence? abuse, enabling them to proactively and sensitively enquire about past childhood experiences Opportunity to identify individuals who are at high-risk of developing poor health outcomes Assist in informing treatment options Research indicated that enquiry, as part of standard medical assessment, held a therapeutic benefit associated with a reported 35% reduction in visits to the doctor s office and 11% reduction in visits to the ED (Felitti & Anda, 2014) A number of researchers have called for professionals to be ACE informed and adequately trained to routinely enquire about ACEs during their service user assessments/interactions

19 Thank you Kat Ford with thanks to Professor Mark Bellis, Professor Karen Hughes, Katie Hardcastle, Dr Lisa Di Lemma, Dr Alisha Davies, Sara Edwards.

Adverse childhood experiences, mental illness and the protective effects of resilience in Wales. Karen Hughes, Public Health Wales

Adverse childhood experiences, mental illness and the protective effects of resilience in Wales Karen Hughes, Public Health Wales Adverse Childhood Experiences (ACEs) Stressful events occurring in childhood