Adverse Childhood Experiences in Wales

Introduction

This literature review aims to summarise prior existing research on adverse childhood experiences, identifying different topics and themes that will help structure my Dissertation on the topic of adverse childhood experiences in Wales. Researching existing material on the topic will provide an overview of key concepts and allow a better understanding of the subject. Its objectives are to survey the literature on adverse childhood experiences and to critically analyse the information gathered by identifying gaps in current knowledge, showing limitations of theories and points of view, and formulating areas of further research. Throughout this literature review, adverse childhood experiences will continue to be referred to as ACEs.

Adverse Childhood Experiences in Wales

Public Health Wales in collaboration with Liverpool John Moores University conducted the first Adverse Childhood Experience for Wales study in 2015, which consisted of 2,028 participants aged 18-69 years old. The initial analysis of the study was to identify how health-harming behaviours relate to ACEs experienced during childhood. The study concluded that a substantial proportion of the Welsh population has suffered various ACEs during their upbringing, with 47% reporting to have had experienced at least one ACE and 14% reporting to have experienced four or more ACEs during childhood. Growing evidence shows that negative childhood experiences affect health throughout adulthood, often caused by the self-inflicted development of health-harming behavioural habits. The greater the exposure to ACEs, the higher the risk of developing such behaviours (Bellis et al., 2015).

Children exposed to ACEs during their upbringing and poor quality childhoods are more likely to enter adulthood with the development of health-harming and anti-social behaviours. Children who experience multiple ACEs develop health-harming behaviours such as substance misuse, smoking, poor diet, and risky sexual behaviour. The same adverse experiences, often during adolescence, can inflict anti-social behaviour, including violence and aggressive behaviour. This highlights the critical need for early intervention and support systems to mitigate these risks (Felitti et al., 1998).

Statistical Analysis and Impact

Statistics published by Public Health Wales show that for every 100 adults in Wales, 47 have experienced at least one form of ACEs during their childhood, and 14 out of every 100 have experienced four or more ACEs. In comparison to those who have not experienced ACEs, those with 4 or more experiences are 4 times more likely to be a high-risk drinker, 6 times more likely to smoke, to have had underage sexual relations, or to have had or caused unintended teenage pregnancy. Those with multiple experiences of ACEs are also 11 times more likely to have smoked cannabis, 14 times more likely to have been either a perpetrator or victim of violence within the last 12 months and 20 times more likely to have been incarcerated at one point during adulthood (Public Health Wales, 2015).

According to Public Health Wales, preventing ACEs could reduce both the impact and influence of health-harming behaviour in Wales as well as improve the early years of children across Wales in future generations. Preventing ACEs could reduce the levels of ‘Class A’ substance misuse by 66%, incarceration by 65%, perpetration or victimisation of violence in the recent year by 60%, unintended teenage pregnancy by 41%, high risk and problematic drinking by 35%, underage sex by 31%, and the levels of smoking either tobacco or e-cigarettes by 24%.

Long-term Health Effects

The report by Public Health Wales also establishes that experiencing ACEs during childhood and adolescence can affect the development of the child, resulting in long-lasting effects on the individual during adulthood. Research shows that exposure to ACEs affects the development of a child’s brain as well as their immunological, nervous, and hormonal system. This relates the exposure of ACEs to a wide range of health problems in later years, including cancer, heart disease, and diabetes (Anda et al., 2006).

Recent evidence shows that chronic exposure to traumatic experiences in the early years of childhood can alter the development of the brain, fundamentally altering the nervous, hormonal, and immunological systems. Disturbances to the child’s neurological development, when exposed to routine ACEs, can result in the individual being “locked into a higher state of alertness, fundamentally preparing them for constant trauma”. This would have negative and long-lasting effects on their mental well-being (Shonkoff et al., 2012).

Relevance to My Research

This literature by Public Health Wales shows strong relevance to my intended research as it has the general knowledge on ACEs and the statistics to follow up. Having an understanding of the topic will allow me to further my knowledge on it, ultimately shaping my Dissertation question. The study conducted by Public Health Wales is beneficial for my research as it is recent and factual. It gathers an understanding on the topic in Wales as well as highlights themes appropriate for my research.

Educational and Social Implications

In terms of education, children eligible for free school meals are less likely to achieve higher GCSE grades and go on to further education. This is seen as a cycle. Children achieving lower GCSE grades are more likely to struggle with job prospects, ultimately affecting their income and life opportunities, therefore widening social inequality. Children eligible for free school meals are more commonly exposed to ACEs in comparison to those from higher-income families. “Individuals' engagement in education, their ability to gain qualifications and ultimately their contribution to the economy can all be affected by the combination of anti-social behaviours, difficulties with social adjustment, and ill-health” (Jones et al., 2013). The evidence relates child abuse and neglect to lower educational attainments, employment, and income.

Lower educational attainments result in poorer job prospects, ultimately affecting the individuals’ income. Household income would then determine the type of household the individual would occupy. In relation to social housing, those living in social housing are often the poorest and most vulnerable members of society. These individuals are more likely to be socially excluded than those in owner-occupied households. Because of this and my experience with a housing association, I intend to relate my research on adverse childhood experiences to social housing.

Prevention and Intervention Strategies

The goal for my Dissertation is to find the impact ACEs have and to find a prevention protocol that can work to minimise ACEs. In regards to successfully addressing the impact of ACEs, it would require a better understanding of the matter. This would require gathering data and assessing prevention needs. According to SAMSHA, building relationships with community organisations and partners through strong collaboration and having prevention efforts aligned with the widespread occurrence of ACEs would help to reduce the number of ACEs reported (SAMHSA, 2018). Combating ACEs in Wales relies on having “intelligence on how many individuals are exposed to ACEs, the characteristics of those most at risk and the consequences across the life course”. Prevention efforts would also require national policies and programmes that aim to identify and intervene where children may be victimised to ACEs, better equip parents and caregivers with necessary skills, and ensure that indirect harm from ACEs in families is identified and addressed.

Efforts to combat household adversity and parental and family risk factors would help towards building resilience and creating a wider awareness and understanding of ACEs. This would work to prevent ACEs and create better environments for children in future generations. Carl Sargeant, Secretary for Communities and Children, “wants to break the cycle of damaging childhood experiences. Providing access to a safe, secure home can play a crucial role in this” (Welsh Government, 2017).

Organisational and Community Roles

According to Public Health Wales, a strategic perspective on how to respond to ACEs would be to have ACE-informed organisations. Organisations with an ACE-informed strategy approach would require both staff and practice to assess all policies and services for the impact of ACEs on both parents and children. Developing a universal and proportionate approach to identifying, responding to ACEs, and recognising the prevalence of it will create understanding and the awareness needed to combat the issue. A better understanding of ACEs within organisations will encourage a wider understanding of it, creating an ACE-informed society. Interventions should focus on strengthening individual and community resilience rather than solely identifying and responding to individual ACE by strengthening communities and reducing resource disparity (Bellis et al., 2018).