6th February 2017
Dr Kat Ford is a researcher at Public Health Wales. In this blog, she talks about the importance of considering adverse childhood experiences (ACEs) when responding to domestic violence.
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Growing up in an environment where domestic violence and abuse (DVA) occurs is likely to be a traumatic and stressful negative experience. Children growing up in these environments can experience feelings of blame and responsibility, and negative impact on their social development and relationships that can lead to lasting harms such as the uptake of risk taking behaviours (e.g. smoking and alcohol use). Yet children exposed to DVA may have also experienced other stressful adversities in their lifetime.
An increasing number of studies around the world have identified that certain adverse experiences during childhood can have long-term negative impacts on our health and wellbeing. The term adverse childhood experiences (ACEs) is used to describe these and includes experiences that directly hurt a child (e.g. physical, sexual or emotional abuse) or affect them through the environment in which they live. This includes growing up in a household where: domestic violence, parental separation, mental illness, alcohol abuse, or drug abuse is present, or where someone has been incarcerated.
The early years of our lives are critical for our development, including brain development and how we learn empathy and trust. If children experience chronic stress and trauma, the way their brain develops is altered as they become ‘locked’ into a higher state of alertness in preparation for experiencing future trauma. This can result in: a ‘wear and tear’ effect on their body thus increasing risks of disease; psychological problems such as anxiety; and the adoption of harmful behaviours such as smoking, heavy alcohol consumption and early sexual activity. Children raised in environments where violence, assault and abuse are common will often come to believe this behaviour is normal and therefore find it difficult to establish and maintain healthy relationships.
In 2016 Public Health Wales conducted the first survey of ACEs in Wales. It highlighted that ACEs are common, with almost half the population in Wales experiencing one and 14% experiencing four or more ACEs. Figure 1 shows the prevalence of ACEs among adults in Wales.
FIGURE 1: Prevalence of ACEs in Wales
There is a cumulative impact of ACEs. Compared to someone with no ACEs, someone with 4 or more is more likely to experience a range of negative outcomes in adulthood. For example, they are 16 times more likely to perpetrate violence and 20 times more likely to be incarcerated at some point in their lifetime.
Many people experience ACEs but go on to lead productive and healthy lives. Protective factors (i.e. that mitigate risks), such as one or more stable caring child-adult relationship, feeling you can overcome hardship and guide your own destiny, feeling involved and connected with others, and having the skills to manage your own behaviour and emotions can build resilience, which allows individuals to grow and endure crisis and stress. Enhancing these protective factors, and taking a trauma-informed approach (i.e. understanding and integrating knowledge on the trauma a person has experienced) in response to individuals experiencing ACEs including DVA, has been shown to mitigate and prevent negative outcomes.
Preventing ACEs or reducing their impacts in one generation can also benefit future generations. The Welsh Government has prioritised tackling ACEs, defining them as a major threat to well-being and economic prosperity in Wales. In South Wales a unique collaboration has been developed to use the research evidence surrounding ACEs to develop policies for prevention and early intervention, aimed at reducing ACEs and supporting those affected by them. Public Health Wales, the Police and Crime Commissioner for South Wales, South Wales Police (SWP), National Society for the Prevention of Cruelty to Children (NSPCC) Cymru, Barnardos and Bridgend County Borough Council are partners on the Early Intervention and Prevention Project; a two year project funded through the Police Innovation Fund.
By viewing the policies and strategies for DVA through an ACE lens we would be able to not just treat the symptoms, but hopefully break the generational cycle of harm and adversity.
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 Safelives 2015
 Bellis, M.A., et al. (2016). Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population. Cardiff: Public Health Wales NHS Trust. Available from http://www.wales.nhs.uk/sitesplus/888/page/88504