About a year ago I became aware of an exposure that, when experienced in high doses, has a significant influence on the life course of an individual. It is a level of exposure that about 14% of the adult population have experienced.
If this exposure were eradicated it could reduce;
- Heroin and crack cocaine use by 66%
- Incarceration by 65%
- Violence victimisation by 57%
- Unintended teenage pregnancy by 41%
- Smoking tobacco or e-cigarettes by 24%
- High risk drinking by 35%
Yet there is no routine identification of or screening for this exposure.
The exposure to which I refer is childhood trauma. Trauma that ranges from sexual, physical or emotional abuse or neglect, dealing with mental illness or drug or alcohol issues in the home, or being separated from a parent by death, divorce or incarceration.
These are experiences in childhood that are so significant they can change the hormonal and physiological development of a child. They create a heightened state of alertness that influences how they react to any given situation, and so set in course a life trajectory that is ultimately 20 times more likely to result in imprisonment and will end in death on average 20 years earlier than those who have not had these experiences.
Whether we work in Policing, health, social care, housing, education, youth support or prisons, we will all recognise the outcomes that arise from childhood trauma.
I can recall many conversations with colleagues within my Policing career, walking away from incidents involving young people, where instinctively we already know where their life course is likely to take them. We feel down beat at the lack of ability to change things for that young person, still so impressionable in a positive way if only given the right influences. I am sure that colleagues from across the public sector have had similar reflections.
So imagine my delight a year ago when I encountered the evidence relating to Adverse Childhood Experiences (ACEs). Finally, the evidence to support my instincts, we must now be able to do something about this. To truly focus on the root causes of so many of the problems we spend so much of our time trying to manage.
Yet the more I looked, the more I realised how, as a system, we continue to focus on the outcomes or behaviour created by ACEs, seeking to filter different behaviour into different agencies or areas of business where we can best hope to manage it.
If it’s a health problem, give it to health; if it’s a social problem, give it to social care; if it’s a criminal problem, give it to the police.
Don’t get me wrong, there are some excellent partnerships that come together to help bridge gaps between agencies and ensure we are all working together. However, more often than not I find these are still focused on behaviours and outcomes. And if we do talk about root causes, we tend to think about issues such as drugs and alcohol as a cause of crime, but these are not truly root causes.
Yet the evidence in relation to ACEs paints one picture. It paints a picture in which the outcomes that each agency seeks to manage are inextricably linked by the same root causes.
When I view this picture I see an elephant. Just one elephant, not multiple elephants. An elephant that causes havoc wherever it walks.
 Public Health Wales, “Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population”, 2015.
I see one big elephant, the limbs of which we all seek to manage; you take the tail, we’ll take the left leg, someone else can take the right ear, and so on. Yet the body still exists and is unlikely to change its general direction, so the best we can really hope to do is disorientate, slow down or temporarily knock over the elephant by each focusing on our own limb, even if we get together on a regular basis to discuss how we are managing our allocated limbs.
ACEs gives us the opportunity to recognise the same elephant, and that if we want to rid ourselves of the elephant then we need to tackle it as one elephant, all willing to take a hold wherever we are able to, recognising that whilst traditionally my remit may have been the tail, if I can bite a chunk out of the leg then that will contribute to our collective aim.
When I see this elephant, I see ACEs.
So, how do we collaborate to prevent ACEs? How do we work together, recognising we are all part of the same society where lives are complex and multi-faceted and not lived in silo. Acknowledging that so many of the problems that drive the demand experienced by public services can only be prevented if we all unite around the same cause.
It is going to be a difficult journey with no single right answer, but the great starting point is that every partner I have spoken to so far has seen the benefit and relevance of taking an ACE informed approach.
The evidence tells us that we should be asking about ACEs, which in turn gives the professional and the individual concerned a common understanding of root causes, and a common approach to being able to tackle them. Sounds to me a bit like Restorative Practice – working ‘with’ people rather than doing ‘to’ or ‘for’ them?
So we have started to give a few things a go . . .
Here in Gloucestershire Constabulary, we have been working with an existing partnership already focused on prevention and early intervention, known as Great Expectations & Aston Project.
The Great Expectations & Aston Project partnership is centred around work with young people who are considered at risk of future or escalated involvement in harmful behaviour, and includes local councils, housing, youth support team, families first, social care, fire & rescue, crimestoppers, prisons, infobuzz, education and most recently public health.
We have changed the information captured at referral to move the focus away from behaviour onto root causes, enabling us to ACE score at the point of referral and continually throughout their engagement, keeping ACE on the forefront of everyone’s minds.
We have delivered ACE awareness sessions to a wide range of staff, with staff in Great Expectations & Aston Project team in particular now starting to have conversations with young people and their parents related to ACEs.
Supervision within the team now focuses on root causes and how we are working to tackle them.
Our outcomes tool is based on the wider determinants of wellbeing and offending behaviour.
A new approach to diverting young offenders from the criminal justice system is incorporating ACEs into its decision making process.
People across the system are starting to talk about ACEs.
And Gloucestershire’s first ACEs summit took place on Tuesday 28th November.
I am starting to feel confident that, so long as we continue the momentum, we will one day manage to defeat this elephant.
Insp Tim Wood – Community Harm Reduction, Gloucestershire Constabulary – to find out more, contact Tim via email
I am married with two young children. I have become particularly passionate about the role prevention and early intervention can play in making Gloucestershire a great place in which to grow up.
I have over 15 years’ service as a Police Officer with Gloucestershire Constabulary and am currently Inspector within the Community Harm Reduction Team (CHRT).
The CHRT’s focus is on prevention and early intervention, and includes award winning work such as Great Expectations, Aston Project and Project Solace.
My work also includes a current pilot initiative which incorporates a two year research plan into community building and how the development of social cohesion contributes to community safety and wellbeing.