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RCGP Safeguarding toolkit

Part 2A: Identification of abuse and neglect

Adverse childhood experiences

Adverse childhood experiences (ACEs) are highly stressful and potentially traumatic events or situations that occur during childhood and/or adolescence. They can be single events, or prolonged threats to (and breaches of) the young person’s safety, security, trust or bodily integrity. These experiences directly affect the young person and their environment, and require significant social, emotional, neurobiological, psychological or behavioural adaption. In other words, ACEs can affect the way young people feel, behave and view the outside world. There are examples of ACEs below.

Experiencing trauma can result in a young person struggling with their mental health. A wide range of mental health conditions and symptoms can be linked to trauma, including, anxiety, depression, obsessive compulsive disorder (OCD), eating disorders and self-harming behaviours.

ACEs can have a significant negative impact on people’s lives. However, such experiences should not be seen as placing limits on someone’s aspirations and achievements. Individuals’ experience of and response to adversity and trauma depends on a range of factors, including the existence of supportive relationships, positive community experiences, access to financial resources and other forms of support. It’s therefore not possible to determine an individual’s longer-term outcomes (like their health or education) based on the number of ACEs they have experienced.

Scotland’s National Trauma Transformation Programme highlights that “adversity is not destiny”: many people may experience some form of traumatic event in their lives; the majority of people recover well, through supportive, positive relationships with family, friends, colleagues, people in their community, service professionals, and in some cases also receiving clinical psychological interventions or therapy.

Some examples of ACEs:

  • Abuse or neglect.
  • Violence and coercion, e.g. domestic abuse, gang membership, being a victim of crime.
  • Adjustment, e.g. migration, asylum or ending relationships.
  • Prejudice, e.g. anti-LGBTQIA+, sexism, racism or disablism.
  • Household or family adversity, e.g. substance misuse, intergenerational trauma, destitution or deprivation.
  • Inhumane treatment, e.g. torture, forced imprisonment or institutionalisation.
  • Adult responsibilities, e.g. being a young carer or involvement in child labour.
  • Bereavement and survivorship, e.g. traumatic deaths, surviving an illness or natural accident.
Impact of ACEs

Those who experience four or more ACEs are:

  • Two times more likely to binge drink and have a poor diet.
  • Three times more likely to be a current smoker.
  • Four times more likely to have low levels of mental wellbeing and life satisfaction.
  • Five times more likely to have had underage sex.
  • Six times more likely to have an unplanned pregnancy.
  • Seven times more likely to have been involved in violence.
  • 11 times more likely to have used illicit drugs.
  • 11 times more likely to have been incarcerated.
Protective factors against ACEs

There are some personal, structural and environmental factors which can protect children against adverse outcomes. Examples of these are:

  • Positive and supportive family environments.
  • Safe and mutual relationships with peers.
  • Access to a wider supportive and understanding community.
  • Ability to regulate emotions and manage emotional distress.
  • Acquisition of practical problem-solving skills.
  • Compassionate, attuned and supportive responses from professionals.
  • Early intervention from support, therapeutic or safeguarding services.
  • Trauma-informed policies & systems that address bullying, harassment or victimisation.
How can general practice support patients who have experienced adverse childhood experiences?
  • Be aware of adverse childhood experiences, how common they are and how they relate to health and wellbeing.
  • Be able to recognise the impact, short and long term, of adverse childhood experiences.
  • Be trauma informed and embed trauma informed practice routinely into your organisation and professional role. (More information on trauma informed practice is in Section 3 of the toolkit.)
  • Be able to respond compassionately and supportively to those who have experienced trauma.
  • Be mindful that colleagues may also have experienced adverse childhood experiences.
  • Take appropriate safeguarding action when needed.
References