Welcome to the 30th edition of our A Better Start Southend Research Bulletin, bringing you the latest on ‘what works’ in early years’ around our outcomes: Social and Emotional Development, Diet and Nutrition, Communications and Language, Community Resilience and Systems Change.

Your regular update, edited by Rachel Wood, also shows how we’re using these findings to influence our work in Southend. In addition, we invite you to help shape our ‘test and learn’ projects and innovations in prevention and early intervention.

This edition includes an editorial from Guest Editor Dr Sarah Sivers from Southend Educational Psychology Service (SEPS). This also shows the types of responses to the COVID-19 pandemic that Southend is undertaking in this area. We would also like to thank our partner Catherine Rushforth for her support and contribution to the development of this edition.

If you would like to suggest or contribute an article, or would like to sign up to receive these updates, or have a question, please e-mail: abssresearch@eyalliance.org.uk

Contents:

Editorial
ACES and Early Intervention
ACES and Social Policy
ACES Review in Lambeth
Shifting to a Trauma Informed Care Approach
Trauma Informated Care in Northern Ireland
ACES, Prevention and the Life Course
The Workforce and Working with Trauma Information Practice (Guest Editorial from Dr Sarah Sivers)
Trauma Informed Approached in Schools
Trauma Informed Care Research


Editorial:

The aims in this edition is to show how Southend is exploring, scoping and responding to:

  • what we are learning in the UK about ACES and Trauma Informed and responsive Practice
  • working together with our workforce and the communities in which we work in ABSS to support our social and emotional, and community resilience outcomes
  • what the likely risk factors are in the areas in which we work
  • Gathering the views and collaborating with our partners as to how we might respond in terms of systems change

 

The definition of ACES emerged in a US Study [1] which linked obesity and childhood sexual abuse.

It is however important to note that ACES through the evidence we know that they are not just linked to health and are also likely to impact significantly on early child development, and transitions to school among others.

ACES or Adverse Childhood Experiences are commonly understood to be stressful or traumatic experiences that impact on children and throughout their lives.

The number of ACES experienced, and for how long is also a critical consideration in terms of potential protective factors e.g. prevention activities as well as early intervention (e.g. supporting resilience).

[1] Felitti et al 1998

The most commonly used ten ACES are as follows:

Abuse: physical, verbal and sexual
Neglect: physical and emotional
Household adversities: Mental illness, imprisonment of a relative, domestic abuse, parental separation, substance abuse

However, it is important to note that there are others which also have an impact:

  • Poverty
  • Bereavement
  • Bullying

Since this study a standardised questionnaire ACE-IQ has been developed by the World Health Organisation, and at the Centre for Disease Control and Prevention (CDC) who found that of those surveyed that 64% has 1 ACES and 25% had 2. It also found that those who had experienced 4 or more were 4 to 12 times more likely to experience alcohol and substance misuse, smoking and poor emotional wellbeing.

An English study in 2013[1] found that 47% had experienced at least one ACE. On this basis the authors employed modelling to propose that the following were likely attributable to the prevalence of:

  • 9% of binge drinking
  • 6% of poor diet
  • 7% of smoking
  • 6% of unintended teenage pregnancy
  • 52% of violence
  • 7% of substance use (heroin/crack cocaine)

Why do they matter in the Early Years?

In early years practice it is therefore critical that we support the attachment and developmental needs of young children in our care, and no more so than in terms of our responses to trauma and adverse experiences.

It is also critical as the known lifetime cost of child-abuse is likely to be £89,390 or more (Conti et al 2017) and that the absence of childhood adversity could lead to a reduction in mental health issues by a third (Kessler and Mclaughlin, KA. 2010) in the population.

[2]ACES across the life course

Evidence has shown that trauma can have a significant life course impact and can develop in the following way:

Adverse Childhood Experience (ACES) ➟ disrupted nervous, hormonal and immune development ➟ social, emotional and learning problems ➟ adopt health harming behaviours and crime ➟ non-communicable disease, disability, social problems, low productivity ➟ early death


[2]
Felitti et al, 1998[1] Bellis et al 2014

What is Trauma Informed Practice?

Moving from a “what is wrong with you?” approach to “what happened to you?”

Is a strength-based way of working that supports physical, psychological and emotional safety of everyone. SAMHSA[1] definition of trauma is as follows:

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being.

They also advocate the following 6 guiding principles in terms of practice:

  • Safety
  • Trust worthiness and transparency
  • Peer support
  • Collaboration and mutuality
  • Empowerment voice and choice
  • Cultural, historical and gender issues

In order to do this those that deliver services and promote organisational change should be supported to create environments and relationships that promote resilience, recovery as well as reducing the risk of re-traumatisation.

How can I learn more about ACES and Trauma Informed Practice?

There is a Free on-line learning resources which looks at both ACES and Trauma Informed Practice:

https://www.acesonlinelearning.com/

[1] SAMHSA, 2014, p7

The learning module takes approximately 50 minutes and if you complete all the knowledge elements you can obtain a certificate.

The main areas of learning in the module are as follows:

  • Introduction
  • Brain Development
  • Impact of Childhood Adversity
  • Social, Health and Community Impact of ACES Early Trauma
  • Protective Factors
  • Looking at ACES through a Trauma Informed Lens
  • Building Resilience

Another resource that you could try is the Brain Story certification:

This is an in-depth FREE on-line learning developed by 30 leading experts in mental health and neurobiology:

https://www.albertafamilywellness.org/training

If you would like to let us know your thoughts in terms of the learning resource(s) please feel free to let us know at abssresearch@eyalliance.org.uk

A Better Start Southend and Trauma Informed Practice (‘Five to Thrive’)

In 2016 we supported a large number of the early years workforce to attend a ‘Five to Thrive’ attachment-based approach workshop. If you came along, we would also be interested to hear from you how this might have impacted your approach to trauma informed practice and ACES.

 

Other useful resources:

YouTube (43:17) video conversation on how ACES impact on health across the life-course (with Dr Nadine Burke Harris)

ACES and Toxic Stress Factsheet (Centre on the Developing Child – Harvard University)

National Mental Health Implementation Plan

References for Editorial:

  • Bellis, MA. Hughes, K. Leckenby, N. Perkins, C. and Lowey, H. (2014), National Household Survey of Adverse Childhood Experiences and their Relationship with Resilience to Health Harming Behaviours in England, BMC Medicine, 12 (72)
  • Conti, G. Morris, S. Melnychuk, M. Pizzo, E. (2017), The Economic Cost of Child Maltreatment in the UK, NSPCC
  • Substance Abuse and Mental Health Services Administration (2014,) SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (HHS Publication No. (SMA) 14-4884), SAMHSA

 


ACES and Early Intervention

Title: Asmussen, K. Fischer, F. Drayton, E. and McBride, T. (2020), Adverse Childhood Experiences: What We Know, What We Don’t Know, and What Should Happen Next, Early Intervention Foundation

Research source: https://www.eif.org.uk/report/adverse-childhood-experiences-what-we-know-what-we-dont-know-and-what-should-happen-next

Publication Date: February 2020

Our Summary:

The authors from the Early Intervention Foundation (EIF) summarise their report as follows:

  • ACES have generated a powerful and accessible narrative which has helped increase awareness. However, there has been several misconceptions in terms of policy and public service
  • There still remains limitations in the current evidence base, and the risk of an illusion that so-called quick fixes can resolve the issues
  •  There is currently a real enthusiasm for tackling ACES in the public health arena built on evidence that improves outcomes

It argues that Public Health responses need to be system wide e.g. workforce and service development, commissioning and leadership. Also, that there needs to be a “significant investment into research on childhood adversity” (p5).

Based on their review the authors argue that the risks associated with ACES are as follows:

  • doubles the rate of obesity, physical inactivity and diabetes
  • triples the risk of smoking, cancer, heart disease or respiratory disease
  • quadruples the risk of sexual risk-taking, mental health problems and problematic alcohol use
  • increases the risk of problematic drug use and interpersonal and self-directed violence by seven-fold.

They summarise what we know, don’t know yet abut ACES and what should happen next is as follows:

What we know:

  • They are harmful
  • They are prevalent
  • Commonly occur in predictable clusters
  • Are strongly associated with an increased risk of alcohol and substance misuse
  • Are strongly associated with mental health and behavioral problems
  • That there are other circumstances that predict poor adult outcomes other than the original ACES categories
  • That there is a strong association with social inequalities
  • ACES increase children’s vulnerability to adult problems in ways which may not be evident during childhood
  • They are perpetuated through social processes
  • ACES research and policies have dramatically increased awareness of the negative abuse and neglect of children’s development

What we don’t know yet:

  • The true prevalence of ACES
  • The prevalence of differing ACES clusters
  • The extent to which they predict physical health outcomes
  • The implications of neurophysiological evidence for preventing and reducing ACES
  • The benefits of ACE screening practice
  • The potential for trauma-informed care for reducing ACE related trauma and improving child and family outcomes

What should happen next:

  • Activities that prevent ACES (e.g. family-based interventions)
  • Activities that reverse social processes that perpetuate ACES (e.g. increasing resilience)
  • Prevent or reduce health harming behaviours universally
  • Therapies that treat trauma

The EIF outline 33 services and activities that would support prevention and early intervention in terms of ACES and Trauma Informed Practice:

The following table shows 17 interventions[1] from the report which are suitable for children 0-4 years and their carers. They have also been shown by the EIF to have achieved evidence of causality (e.g. been through a randomised controlled trial) [Level 3 evidence] or a series of trials and evidence of longer-term outcomes [Level 4 evidence]:

Universal

  • Perinatal Mental Health Screening: 2-9% reduction in depression (3-5 months) 34% reduction in depression when referred to CBT
  • Domestic Violence Screening: Increased maternal safety and improved childbirth outcomes
  • Family Foundations (for couples expecting their first child): Level 4 medium evidence for infant soothability, reduction in maternal depression and anxiety and medium to large in co-parenting and relationship satisfaction
  • Schoolchildren and their families (for couples with a child entering primary school): Level 3 improved parenting behaviours, parental mood and child behaviour among others
  • PATHS Preschool (a preschool based curriculum promoting emotional and social competencies): Level 3+ small improvements in work-related skills, problem-solving skills and emotions

Selective

  • Family Nurse Partnership: level 4 e.g. 91% decreased rate of child maltreatment in international studies

Targeted

  • Empowering Parents / Empowering Communities (EPEC) (Parenting programme for families with children aged 2-11): Level 3 moderate reductions in coercive parenting and small in problematic child behaviour
  • Triple P Group and Standard (Level 4) and Enhanced Level 5 (Level 5 is a supplement to group- based support that addresses family factors): Level 3 significant reductions in coercive parenting, and improvement in child behaviour (lasting for over 3 years) and increasing parenting competence
  • Family Check-up for Children (Supports parenting practices): Level 3 reduction in aggressive and destructive behaviour (sustained at 1 year) along with other benefits
  • Helping the Non-Compliant Child (Supporting parents to manage unwanted child behaviours): Level 3 reductions in ADHD symptoms and improved behaviours
  • Hitkashrut (Co-parenting intervention designed to reduce conduct problems): Level 3 reduction in conduct problems etc.
  • The Incredible Years Preschool Basic (Parenting programme): Level 4 of medium to large reductions in conduct problems, also improvements in reading
  • Family Transitions Triple P (FTTP): (Intensive parenting programme following divorce): Level 3 significant reductions in behavioural problems, as well as coercive parenting
  • New Beginnings (Programme for separated parents): Evidenced reduction in externalising and internalising problems post intervention. 15 year follow up shows continued in internalising.
  • Trauma-focused Cognitive Behavioural Therapy (Cognitive strategies for managing negative emotions and beliefs stemming from ACES): Level 3 suggesting moderate to strong reductions in PTSB, anxiety and depression
  • Child-Parent Psychotherapy (Targeting mothers and pre-school school who have experienced ACES or at risk of them): Level 4 evidence of reducing externalising symptoms and substance dependence
  • Child First (A 12-month home visiting intervention psychotherapy with social support): Level 3 reductions in child behavioural problems, reports of child maltreatment and parenting stress

Felitti, VJ. Anda, RF. Nordenberg, D. Williamson, DF. Spitz, AM. Edwards, V. Koss, MP. And Marks, JS (1998), Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, American Journal of Preventative Medicine, 14, 245-258References:

How we’re applying this in Southend

  • Family Nurse Partnership (Adapt) is just one of the projects that we are delivering in Southend through our partner organisation that support ACES

Help us help Southend

  • What evidence based, or informed programmes do you feel could make an impact on outcomes for children in Southend?
    Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


ACES and Social Policy

Title: Steptoe, A. Marteau, T. Fonagy, P. and Abel, K. (2019), ACES: Evidence, Gaps, Evaluation and Future Priorities, Social Policy and Society, 18(3), 415-424

Research source: https://www.cambridge.org/core/journals/social-policy-and-society/article/aces-evidence-gaps-evaluation-and-future-priorities/9327F00FF5E422E9B5C44E23B87E24C4

Publication Date: July 2019

Our Summary:

The authors argue that although some is known about ACES that there are still gaps (many of the studies are of small populations) in the evidence base and areas in which collaborative and coordinated research is still needed. This includes the screening and assessment of children, along with robust evaluation of activities which seek to support such families. There is also seen to be a lack of knowledge as to possible ‘sensitive periods’ in development, as well as the role of risk and protective factors, and the causal mechanisms (e.g. social economic status and biological pathways) which may lead to negative outcomes e.g. reduced life expectancy.

For their review it would seem that long term adversity is likely to be more of a risk than single events e.g. lacking in provision of protective and resilience factors. It is also argued that there is currently limited provision for those in high risk groups, and the ways that they may engage in such provision.

In terms of Trauma Informed Practice/Care and Psychologically Informed Environments the authors advocate intervention personalisation where possible, particularly as “not all interventions are good for all children.” It is also argued that such approaches can also benefit the workforce themselves.

References:

Bethell, C. D., Carle, A., Hudziak, J., Gombojav, N., Powers, K., Wade, R. and Braveman, P. (2017a) Methods to assess adverse childhood experiences of children and families: toward approaches to promote child well-being in policy and practice. Academic Pediatrics, 17, 7S, S51–69
Bryson, S. A., Gauvin, E., Jamieson, A., Rathgeber, M., Faulkner-Gibson, L., Bell, S., Davidson, J., Russel, J. and Burke, S. (2017) What are the strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. International Journal of Mental Health Systems, 11, 36, doi: 10.1186/s13033-017-0137-3

How we’re applying this in Southend

  • As part of our service design process we co-produce and review known protective and risk factors for the groups that we are looking to support. We also consider personalisation at all stages of development and delivery.

Help us help Southend

  • In what ways can we ensure that all of our workforce benefit from such approaches?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


ACES Review in Lambeth

Title: McCormick, G. (2019), Adverse Childhood Experiences (ACES): An Evidence Review for Lambeth (Summary), HMac Consultants Ltd

Research source: https://www.leaplambeth.org.uk/sites/default/files/2020-02/ACEsSummaryReportFINAL.pdf

Publication Date:  June 2019

 

Our Summary:

Lambeth (LEAP) is one of the five A Better Start sites across England, and the site which is most close to us geographically.

This review sets out not only to assess the existing research base for ACES and Trauma Informed Practice, but to also review collaborative provision across the London Borough.

The authors draw attention to some useful resources (including a free E-Book) for those who are interested in ACES and supporting children who are facing adversity. This draws attention to the early years as a critical period in which there are long terms risks in terms of outcomes. They also draw attention to that 72%[1] of such impacts will be on the child, rather than the mother or main carer. This highlights the importance of “scaffolding child development by supporting families”[2].

Also highlighted is that there is a REACh (Routine Enquiry about Adversity in Childhood) programme developed by Dr Warren Larkin which has been piloted in some areas in the UK. This aims to raise awareness in the workforce about the long-term impacts of ACES and to embed practice in terms of the ACE-IQ. An important part of the training is to help teams to enquire safely and sensitively. This is offered in five stages: 1. Scoping (co-produced audit of readiness) 2. Operational Readiness Checklist and Action Plan (OR-CAP) including review of change management processes 3. Workforce Training (1 or 2 days) 4. Time-limited follow-up support and monitoring 5. Evaluation of implementation. As it currently stands according to the authors evidence of effectiveness is currently limited, and at the time of writing not all sites had achieved full embedding. Learning from Scotland[3] in this area is seen to be as follows:

  • Organisational readiness is critical
  • Practitioners must understand the rationale and have prior knowledge in this area before the training
  • The routine enquiry should be personalised and not ‘tick box’
  • Adequate support for the service user and team member should be in place
  • Rapport building is an essential part of the process

As part of the report the authors utilise the study to model the following for Lambeth to be in the population (Adult population 18-64 years):

One ACE (Lambeth Borough): 23%; 55.984
Four or more ACES (Lambeth Borough): 9%; 21,907


[2]
Page 5[1] Bush, 2018 p143

[3] P7

Statistical modelling for A Better Start Southend areas (Total adult population – 16-64 years)

One ACE (ABSS): 23%; 10,218
Four or more ACES (ABSS): 9%; 3998

They also propose that the House of Commons Science and Technology Committee – Evidence-based Early Years Intervention Inquiry recommends the following strategic responses:

  • Define and train the early years workforce
  • Make use of ‘implementation science’
  • Support for Local Authorities
  • Better use of data
  • Funding

On this basis Lambeth asked local stakeholders fifteen ACE related questions[1] that are summarised as follows:

  • Many of the stakeholders said they have knowledge and experience of working with adversity. However, they said that they were not necessarily using the language of ACES
  • In Lambeth poverty, deprivation, poor housing, overcrowding, homelessness, austerity, racism, refugee status, gang affiliation, youth violence and witness violence were seen as important contextual issue
  • No-one was using routine inquiry (or screening method) about the 10 ACES
  • All services said that it was important to obtain information on ACES. However, there were concerns raised about using routine inquiry
  • Only one service was offering limited training in the area
  • The importance of a Trauma Informed Approach (TIA) was prioritised
  • Most services said they had reflective practice, clinical and well as line management supervision (but due to workload were not always able to access it
  • Most stakeholders had services in place to help workers themselves if they have had, or were experiencing trauma
  • To build a more resilient way of working the following approaches were seen to be prioritised: multi-agency working, using lived experience, building on Children’s Centres, having services that reflect demographics, enhancing Early Help, and offering mental health wellbeing support
  • That there should be a focus on prevention, and a long-term approach
  • Other suggestions were basing implementation on alternatives to top down approaches, agreeing strength-based language, and for this work not to be used as a threshold or as a stigmatising method

[1] Pages 9-13

References:

Bush, M. (2018), Addressing Adversity: Prioritising Adversity: Prioritising Adversity and Trauma-Informed Care for Children and Young People, Young Minds

How we’re applying this in Southend

  •  We work closely with all the national A Better Start and learn together through Communities of Practice. We are indebted to LEAP Lambeth who have shared the experiences of the development of the report with us.

Help us help Southend

  •  In what ways might Lambeth’s experience by similar to that of Southend and how might it be different?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Shifting to a Trauma Informed Care Approach

Title: Middleton, JS. Bloom, SL. Stolin-Goltzman, J. and Caring, J. (2019), Trauma-informed Care and the Public Child Welfare System – The Challenges of Shifting Paradigms: Introduction to the Special Issue on Trauma-Informed Care, Journal of Public Child Welfare, 13:3, 235-244

Research source: https://www.tandfonline.com/doi/full/10.1080/15548732.2019.1603602

Publication Date: June 2019

Our Summary:

The authors argue that what is needed is a move from a trauma informed framework to a trauma responsive organisational culture. This it is said is critical in supporting community resilience. Part of the issue with moving towards this transformation is coming to an agreement on the language that is used in this area. In addition, it is seen that focus needs to be on implementing policy, strategy and the corresponding systems change that needs to be made[1].

It is important to note that this is a US review and so it must be taken into consideration that the policy environment is not always the same. The authors always highlight that even making the move towards ‘trauma informed’ cannot be resolved with just the provision of workforce development training that is short in length.

[1] P235-236

How we’re applying this in Southend

  • We are currently reviewing the results of our previous workforce development survey, and will be including specific questions about Trauma Informed Practice.

Help us help Southend

  •  In what ways do you think that Southend has a trauma responsive organisational culture, and how could this be further developed?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Trauma Informed Practice in Northern Ireland

Title: Bunting, L. Montgomery, L. Mooney, S. MacDonald, M. Coulter, M. Hayes, S. Hayes, D. Davidson, G. Forbes, T. (2018), Evidence Review – Developing Trauma Informed Practice in Northern Ireland, Safeguarding Board for Northern Ireland


Research source:
https://www.safeguardingni.org/sites/default/files/sites/default/files/imce/ACEs%20Report%20A4%20Feb%202019%20The%20Justice%20System.pdf

Publication Date: September 2018

Our Summary:

In 2017 the Northern Ireland Safeguarding Board adopted a Trauma Informed Approach to its safeguarding. As part of this process it undertook a systematic review to understand the way that better outcomes for children could be made to changes in policy and practice. This was with a specific focus on organisational change.

Some of the negative impacts that can be seen in children are seen to be as follows:

  • Lack of trust
  • Inability to cope or form healthy relationships
  • Poor memory and concentration
  • Difficulties with new learning
  • Inability to control emotions or assess safety
  • More prone to heart disease, obesity, addiction and other physical health disorders

In terms of resilience the authors argue that certain protective factors can mitigate the effects that this can have. The authors emphasise that this is not an issue of individual capability, it can be through attachment, relationships and the community.

The system responses in terms of policy and procedure that are highlighted are as follows:

  • Not expecting a child or adult to continually retell their story
  • Not treating children or adults as if they are a number
  • Not using labels or diagnoses to define
  • Not providing choices in services or interventions
  • Not giving opportunities to give feedback or experiences

The review then examined a series of activity and intervention models including:

  • Attachment, Self-Regulation and Competency (ARC) Framework – a menu of activities and interventions
  • Sanctuary – use of trauma theory, therapeutic communities, and a toolkit of responses
  • Risking Connection – focus on the therapeutic communities and a toolkit of responses
  • 6 Core Strategies – e.g. workforce development
  • Fairy Tale Model – emphasis on families, parenting education and trauma informed case management
  • Care model – improving leadership and organisational support

On this basis a range of organisational change components are recommended as follows:

  • Workforce Development – training and staff safety and wellbeing
  • Services – screening and evidence-based activities
  • Organisational change – leadership buy in, collaboration, welcoming environments, co-production, monitoring, review and evaluation

How we’re applying this in Southend

  •  Safeguarding is a critical part in all the services that we deliver in partnership. We also ensure that we consider all known risk factors and unintended consequences of all of our projects and services through our test and learn processes and criteria

Help us help Southend

  •  What do you think that we could learn from Northern Ireland’s approach?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


ACES, prevention and the Life Course

Title: Di Lemma, LCG. Davies, AR. Ford, K. Hughes, K. Homolova, L. Gray, B. and Richardson, G. (2019), Responding to Adverse Childhood Experiences: An Evidence Review of Interventions to Prevent and Address Adversity across the Life Course, Bangor University and Public Health Wales NHS Trust

Research source: https://www.bangor.ac.uk/news/documents/RespondingToACEs-PHW2019-english.pdf

Publication Date: 2019

Our Summary:

The percentage of ACES in Wales are as follows:

  • Parental Separation – 25%
  • Mental illness – 18%
  • Domestic violence – 17%
  • Alcohol abuse – 13%
  • Drug abuse – 6%
  • Incarceration – 4%

This evidence review aims to examine the actions to prevent ACES and their associated harms[1] in terms of Wales. It is argued that many organisations are responding in particular areas e.g. domestic abuse that a systems approach is required in order to support communities in their own resilience. In order to do this the authors reviewed 100 interventions (Inc. Circle of Security, Child Parent Psychotherapy – CPP, Family Nurse Partnership – FNP, and 1-2-3 Magic):

  • Supporting parenting e.g. attachment and positive parenting
  • Building relationships and resilience e.g. mentoring, life skills and community-based wellbeing programmes
  • Early identification of adversity
  • Responding to trauma and specific ACES

The authors present the four overall messages:

  • ACES are stressful events occurring in childhood
  • ACES are common
  • ACES can have a detrimental impact on health across the life course
  • ACES and their negative effects can extend beyond a single generation

They go onto highlight that resilience is a crucial factor to protect and prevent ACES. In order to tip the balance, they argue for[2]:

  • Perceived financial security
  • Trusted adult relationships
  • Community engagement
  • Participation in sports groups

This also confirms that evidence-based parenting support in the early years has a great deal of potential for long term cost savings[3].

As a summary the authors identify the following preventative routes to resilience:

  • Promoting social development and building positive relationships
  • Promoting cognitive skills and emotional development
  • Promoting self-identity and confidence
  • Developing skills and strategies to cope with adversity
  • Building knowledge and awareness about the causes and consequences
  • Early identification
  • A collaboration multi-sectoral approach

The limitations in the evidence base were found to be in the areas of parental separation and incarceration across non-health sectors e.g. housing.

References:

Hughes K, Ford K, Davies AR, Homolova L, Bellis MA. (2018), Sources of resilience and their moderating relationships with harms from adverse childhood experiences. Report 1: mental illness: Welsh Adverse Childhood Experience (ACE) and Resilience Study. Cardiff: Public Health Wales.

Stevens M. (2014), The cost-effectiveness of UK parenting programmes for preventing children’s behaviour problems–a review of the evidence, Child & Family Social Work; 19(1): 109-118

[1] Page 5

[2] Hughes et al 2018

[3] Stevens 2014

How we’re applying this in Southend

  •  A Better Start Southend’s focus in on prevention and early intervention in all of its projects and services.

Help us help Southend

  •  What interventions and activities do you feel could help the prevention of ACES?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


The Workforce and Working with Trauma Informed Practice (Guest Editorial from Dr Sarah Sivers)

Title: Brennan, R., Bush, M. and Trickey, D. (2019) Adversity and Trauma-Informed Practice: A Short Guide for Professionals Working on the Frontline. Young Minds

 

Research Source: https://youngminds.org.uk/media/3091/adversity-and-trauma-informed-practice-guide-for-professionals.pdf

Publication Date: June 2019

Many thanks to Guest Editor Dr Sarah Sivers, Educational Psychologist, Southend Borough Council for the editorial on this article

Our Summary

The authors explain in detail what Adverse Childhood Experiences (ACEs) are as well as the signs and potential impact of ACEs. The aim is to provide a guide for professionals in supporting and reducing the negative impact of ACEs within a local community.

Research has defined ACEs as highly stressful events or situations that occur in childhood or adolescence. These events can be one-off incidents or prolonged experiences of trauma. The guide encourages us to reflect on the fact that ACEs are not just physical in nature, but a range of social, emotional and environmental experiences that merge and overlap.

As we write this summary, we are living through an event which will cause many people trauma in a wide range of ways, some of which we do not even understand or know about in the present moment. This event is the Coronavirus (COVID-19) pandemic, which has completely changed everyone’s lives and will also lead to vulnerability and trauma on many different levels.

This guide will help inform the way we manage and work through the COVID-19 pandemic as a traumatic event, as well as the other life events that individuals have already experienced or may go on to experience. It will help understanding and reflection on impact and ways in which we can move forward to a safer future and reduce any potential long-term impact on a child’s future wellbeing.

The guide also highlights the need to acknowledge the impact working with individuals who have experienced trauma has on the professionals supporting them. Research suggests that it is important for these professionals to have ongoing access to spaces to reflect and active forms of support to reduce secondary traumatic stress or compassion fatigue.

The authors suggest six evidence- and practice-based principles for adversity and trauma-informed practice as a guide. These principles are:

  • Prepared – Addressing and anticipating the impact of adversity and trauma.
  • Aware – Common frameworks known and used by all.
  • Flexible – Variety of interventions to suit needs.
  • Safe & Responsible – Safeguarding and prevention.
  • Collaborative & Enhancing – Person-centred and strength-based approaches.
  • Integrated – Joined-up working

How were applying this in Southend:

Southend Educational Psychology Service (SEPS) has provided training to Early Years staff, which predominately focuses on the prepared and aware principles. This includes:

  • Safe to Learn training course, which focuses on raising awareness of trauma-informed practice. This course is delivered as part of the Advanced Healthy Schools programme
  • Training provided via the Early Years SENCo borough meetings
  • Workshops using Virtual Reality equipment, which raises awareness of and empathy for individuals who may have experienced neglect and ACEs. The Virtual Reality kits are part of a pilot project set up by a charity named Cornerstone. The Southend Fostering and Adoption team signed up for the project in 2018; SEPS and the Virtual School team have been part of an integrated approach to developing this project
  • Training offered to all members of staff in a local primary school in collaboration with the Adoption Service and Cornerstone, including to all Early Years staff
  • All of the Southend Educational Psychology Service are trained in trauma-informed practices; it informs our day to day work with children, young people, families and professionals
  • professionals

Help us help Southend

  •  What other ways could we collaborate on Trauma Informed Practice?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Trauma Informed Approaches in Schools

Title:  Maynard, BR. Farina, A. Dell, NA. and Kelly, MS. (2019), Effects of Trauma-informed Approaches in Schools: A Systematic Review, Campbell Systematic Reviews, 15 (1-2)

Research source: https://onlinelibrary.wiley.com/doi/full/10.1002/cl2.1018

Publication Date: July 2019

Our Summary:

The aim of this US systematic review is to examine how trauma informed approaches (e.g. programmes, organisations, systems and workforce development) can impact on behaviour, social and emotional development and educational performance in schools. The authors were unable to locate any current research literature that matched their search criteria in order to describe the impact that such work maybe having. This is set against a background in which 17 US states have identified that they are taking a trauma-informed approach.

The authors refer to the position in the UK is that the Department for Education (DfE) and the NHS has undertaken[1] is in undertaking multiple surveys and pilot projects in this area. Indeed, the DfE have identified that school settings have expressed that trauma, attachment and post-traumatic stress are areas in which they would like the most support.

It is also argued that 1 out of every 4 children in schools have been exposed to traumatic events which can affect their responses to learning. The sorts of responses that they believe can be drawn upon are[2]:

  • Modifying disciplinary practices
  • Establishing protocols for communication between carers, the schools and the voluntary and community sector
  • Modifying the physical environment to promote safety
  • Developing partnerships with those that deliver health and mental health services
  • Considering the implementation of screening or referring to screening

In summary the authors advocate a cautious approach in terms of trauma informed schools.  This they believe is due to the limited nature of the available research evidence, and that there could potentially be unintended negative consequences as the result. It is also unknown as to whether the potential costs e.g. economic and academic could potentially outweigh any such benefits.

[1] Page 4

[2] Page 7

How we’re applying this in Southend

  •  Our Early Years Specialist Teachers support pre-schools and nurseries in various ways including supporting transitions, and the communication and language environment

Help us help Southend

  •  In what ways can we further develop partnerships that support this environment in our settings and community spaces?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Trauma Informed Care Research

Title: Gatwiri, K. McPherson, L. Cameron, N. and Parmenter, N. (2019), Research Briefing: Trauma Informed Care, Southern Cross University

Research source: https://www.safeguardingni.org/sites/default/files/sites/default/files/imce/ACEs%20Report%20A4%20Feb%202019%20Developing%20a%20Trauma%20Informed%20Approach%20-%20Full%20Evidence%20Review.pdf

Publication Date: January 2019

Our Summary:

This Australian research briefing focuses on Trauma Informed Care. It focuses on the following areas:

  • Attachment – e.g. boundary issues, distrust and withdrawal
  • Biology – e.g. problems with coordination, posture, balance, skin problems, and sensitivity to light, sound, smell and touch
  • Affect regulation e.g. difficulty with emotional self-regulation, and labelling emotions
  • Disassociation: alterations in consciousness – e.g. impaired memory and depersonalisation
  • Behavioural regulation e.g. cannot control impulses, insomnia, and addictive behaviours
  • Cognition e.g. difficulties in holding attention, lack of creativity, learning and language development
  • Self-concept e.g. low self-esteem, feeling unlovable and self-blaming

The authors bring to the fore the issue that there is the common definition of trauma informed care. They propose that 9 principles[1]  be used to summarise the messages[2]:

  • Trauma significantly alters physiological arousal levels and affect mood and emotions
  • Trauma reduces cortical capacity which affects behavioural modification
  • Trauma disrupts memory
  • Trauma disconnects children from trusting attachments
  • Trauma restricts attention and may become stuck in past experiences
  • Trauma based behaviour is functional and a coping mechanism
  • Trauma limits children’s flexibility and adaptability
  • Trauma disrupts identity formation and self-esteem
  • Trauma reduces social skills and isolates children from their friends

They also argue that based on the evidence all trauma informed care should have the following components to support:

  • Safety
  • Self-regulation
  • Self-reflection
  • Traumatic experiences integration (containing or processing)
  • Relational engagement and empathy
  • Positive self-worth

References:

Tucci, J. & Mitchell, J. (2015), 9 plain English principles of trauma informed care. Retrieved from <www.childhood.org.au/blog/home/2015/april/trauma-informed-care>.

[1] Tucci and Mitchell, 2015

[2] Page 17

How we’re applying this in Southend

  •  We ensure that all our communications and messaging support the positive messaging using these principles

Help us help Southend

  • What other ways can we encourage the use of these principles?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk

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