A United Kingdom that considered adverse childhood experiences (ACEs) a public health priority would be a very different place.

If ACEs were prevented where possible, trauma-informed knowledge was integrated into all frontline services and communities were geared towards building resilience in each new generation, we would see an enormous decrease in many social issues and health problems.

 

Preventing adverse childhood experiences

Following a study in 2015, Public Health Wales estimated how far a selection of social issues and phenomenons could be reduced if the ACEs contributing towards them had been prevented. They estimated reductions to the tune of:

  • Poor diet (current, less than 2 fruit & veg portions per day): 16%
  • Smoking tobacco or e-cigarettes (current): 24%
  • Early sex (before age 16): 31%
  • High-risk drinking (current): 35%
  • Unintended teen pregnancy: 41%
  • Cannabis use: 42%
  • Violence victimisation (past year): 57%
  • Violence perpetration (past year): 60%
  • Incarceration (lifetime): 65%
  • Heroin or crack cocaine use (lifetime): 66%

Given the far wider range of outcomes that could be affected by ACEs, this list could extend for much longer.

 

Trauma-informed approaches


Trauma-informed approaches (i.e. a reactive approach to ACEs) also have the potential to achieve substantial reductions across many sectors, as the following examples show:

 

  • Lincoln High School in Walla Walla, Washington saw its graduation rate rise from just 44% to nearly 80% over 5 years.
  • In San Francisco, the Healthy Environments and Response to Trauma in Schools (HEARTS) programme led to incidents involving physical aggression falling by 43% after 1 year and 86% after 5 years.
  • The Menominee Indian tribe of Wisconsin saw marijuana, cigarette and alcohol use fall among high school students by 30%, 49% and 64% over a decade.
  • Iceland’s teenagers used to be among the heaviest drinkers in Europe. Using the latest in neuroscience, alongside other measures, between 1998 and 2016 rates of drinking among 15- to 16-year-olds dropped by 42% to 5%. Cannabis use and smoking also plummeted.
  • A women’s prison in Framingham, Massachusetts saw prisoner-on-staff assaults drop by 62% and the number of suicide attempts by 60% in just one year.
  • Norway’s prison system is trauma-informed in all but name. From a 2005 cohort of released prisoners, only 22.6% were reconvicted within 1 year, less than half of the amount for a similar cohort in England and Wales (2000, 51.4%).
  • Among other changes, Bridgend Council’s decision to make its children’s services ACE-aware contributed towards child protection plans falling from 179 to 120 in a year and the number of looked-after children leaving school with no qualifications being reduced from 21% to zero.

  

Trauma-informed communities


Following an Act introduced in 1994 to improve the state’s seven major social problems related to youth and families, Washington state created a series of networks across its communities aimed at reducing youth violence and “at-risk” youth behaviours. Following the ACE study’s publication in 2002, the Family Policy Council overseeing these networks decided that addressing ACEs would be its main priority. This helped contribute to major reductions achieved across multiple social issues.

Cowlitz County benefitted significantly from this initiative, having started in a bad place:

“In the 1980s, when the timber and fishing industries declined, and in 2003, when the aluminium reduction manufacturing plant went bankrupt, Cowlitz County residents lost more than jobs—they lost their ways of life. Compounding problems, the region was also devastated by the volcanic eruption of Mount St. Helens in 1980 and the second largest urban landslide in U.S. history in 1998. Through the 1980s and 1990s the county experienced chronic underemployment (over 15 percent), and many health and social problems—infant mortality, births to mothers ages 10 to 17, violence against self and others, chronic disease, youth hospitalizations for suicide attempts, and dropping out of school, for example—were occurring at rates in the worst quartile of county rates throughout the state.”

 

The following sample graphs compare rates for Cowlitz County (purple) and Washington state as a whole (turquoise), showing the astounding improvements they achieved over the years:

Other potential benefits of establishing trauma-informed communities include:

  • Fostering community relationships
  • Promoting more physical activity
  • Promoting positive family interactions
  • Promoting better physical and mental health
  • Decreasing isolation
  • Combatting the effects of stress and trauma
  • Improving school academic performances
  • Reducing flow of entrants into the criminal justice system
  • Reducing flow of children on a pathway to homelessness, drug and alcohol addiction, sexual promiscuity, teen pregnancy, long-term unemployment
  • Creating thriving, sustainable neighbourhoods
  • Major budget savings across various Government sectors and a boost to the economy, notably through improved productivity levels