Children and Families Network Routine Enquiry About Adversity in Childhood (REACh) REACh Project Lead Lesley M. Banner

Routine Enquiry about Adversity in Childhood What is it? The process by which we routinely ask individuals about traumatic/adverse experiences during the assessment process with the intent to respond appropriately and plan interventions which in the longer term will reduce the impact of the experiences on later health and wellbeing Why is it important? Robust evidence of a causal relationship between adversity in childhood and poor emotional, mental and physical health

Adverse Childhood Experiences (ACEs) Having: Parents who misuse substances A mother who is a victim of domestic violence A family member incarcerated A family member diagnosed with a mental illness Or Experiencing: The disappearance of a parent through divorce, death or abandonment

Adverse Childhood Experiences (A.C.E.’s) also include: Growing up (prior to age 18) in a household where there is: Physical abuse Verbal abuse Sexual abuse Physical or Emotional Neglect Recurrent Emotional Abuse including Bullying

U.S. Studies: Four or more adverse childhood exposures significantly increase the odds of a person: developing cancer (by nearly two times); being a current smoker (just over two times); having sexually transmitted infections (by two and a half times); using illicit drugs (by nearly 5 times increased risk); being addicted to alcohol (over seven times increased risk); attempting suicide (over 12 times increased risk).

Felitti et al 2003 Adverse childhood experiences are surprisingly common, although typically concealed, unrecognised and rarely routinely enquired about ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness Adverse childhood experiences are the main determinant of the health and social well-being of the nation

Bellis et. al 2013 Adverse Childhood Experiences Retrospective study to determine their impact on adult health behaviours in a UK population Blackburn with Darwen Increasing ACEs were strongly related to adverse behavioural, health and social outcomes Individuals with 4+ ACES’s were: – 3.96 times more likely to smoke – 3.72 times more likely to drink heavily – 8.83 times more likely to be incarcerated – 3.02 times more likely to be morbidly obese

Blackburn with Darwen ACE Study They also had greater risk of: Poor educational and employment outcomes Low mental wellbeing and life satisfaction Involvement in recent violence Recent inpatient hospital care Chronic health conditions Higher ACEs were also associated with having caused/been unintentionally pregnant aged under18 years and having been born to a mother aged less than 20 years.

They Conclude That The Evidence Suggests: Many chronic diseases in adults are determined decades earlier, by experiences in childhood Risk factors for these diseases are initiated during childhood or adolescence and continue into adult life It can take 10 years before an individual discloses adverse experiences – if we don’t ask we are at risk of repeating interventions which will not improve outcomes in the longer term

REACh Project – Where did the idea come from? Within the mental health field the relationship between A.C.E. and later ill health was well researched (Larkin & Morrison 2006, Read et al 2005) We initially trained 100 staff within the Early Intervention Service in Routine Enquiry Based on the findings from this exercise we sought funding to share the learning, expand the training to other sectors and raise awareness about the impacts of early adverse experiences

REACh Team Meet Norman Lamb

REACh Project – What did it set out to achieve? Identify best practice in routine enquiry and response which can be developed and shared locally and nationally Develop and trial training in routine enquiry Raise the understanding and confidence of staff in the pilot areas about routine enquiry, childhood adversity and poor emotional, health and wellbeing outcomes for children and families

REACh Project – What did it set out to achieve? Provide support in the organisational implementation of routine enquiry Identify any risks or challenges in making enquiry routine Identify and understand the impact of the approach on demand for services or gaps in service provision

Pilot sites for this project: Chosen to reflect a cross section of sectors: LCFT South East Team, Health Visitor and School Nurses Blackburn with Darwen Children’s Services Family Support Team Child Action North West, Familywise Team Lifeline, Substance Misuse Practitioners

What did we do: Trial and develop training in Routine Enquiry Support Managers in implementing systems to embed and support routine enquiry Offer drop-in sessions for staff and managers in the pilot groups to discuss and feedback on their enquiries (capturing reflections)

This work is early and ongoing but indications are that: It has not been difficult to change systems and processes to enable routine enquiry Professionals are embracing routine enquiry Individuals are disclosing adverse experiences which they have not previously disclosed despite previous contact with services Gaps in provision have been identified for early help in relation to bereavement and loss particularly for children and young people No upsurge in demand for higher levels of intervention following disclosure

What needs to happen to make enquiry routine?

The ‘So What’…….. Routine enquiry about Adversity in Childhood should become routine and embedded Enabling right help at the earliest opportunity In the long term enquiring early and responding appropriately is preventative reducing costly interventions which only focus on symptoms