Adverse Childhood Experiences (ACEs) – what can we do? Welcome Adverse Childhood Experiences (ACEs) – what can we do?

ADVERSE CHILDHOOD EXPERIENCES Sara Dodds Adviser on Adverse Childhood Experiences Scottish Government Sara.dodds@gov.scot Katy Hetherington Child & Adolescent Health Lead NHS Health Scotland Katy.hetherington@nhs.net ADVERSE CHILDHOOD EXPERIENCES

Programme for Government September 2017 “What happens to us as children can have a huge impact on us throughout our lives... We will embed a focus on preventing ACEs and supporting the resilience of children and adults in overcoming early life adversity across all areas of public service, including education, health, justice and social work.” http://www.gov.scot/Resource/0052/00524214.pdf

Resilience Documentary Screenings

Five minute film about the ACEs study: https://vimeo.com/139998006

ADVERSE CHILDHOOD EXPERIENCES (ACEs) HOUSEHOLD DIFFICULTIES ABUSE NEGLECT HOUSEHOLD DIFFICULTIES

http://www. healthscotland. scot/media/1267/2_mark-bellis-presentation http://www.healthscotland.scot/media/1267/2_mark-bellis-presentation.pdf

THREE CORE CONCEPTS IN EARLY DEVELOPMENT Experiences Build Brain Architecture ‘Serve & Return’ Shapes Brain Circuitry Toxic Stress Derails Healthy Development http://developingchild.harvard.edu/

Three Types of Stress Response

Communications & Engagement Group Scottish Government ACEs Policy Network Practitioner Network Communications & Engagement Group

Increase understanding of ACEs in Scotland Purpose: Increase understanding of ACEs in Scotland Develop actions to better prevent ACEs, and support the resilience of children and adults affected to mitigate the negative impacts of ACEs http://www.healthscotland.scot/population-groups/children/adverse-childhood-experiences

Scottish Public Health Network Report May 2016 “The evidence of impact of adverse childhood experiences is compelling, as is the case for action from a moral and financial perspective at an individual level and to prevent the repeated cycle of intergenerational transmission.” https://www.scotphn.net/projects/adverse-childhood-experiences/introduction/

Source: Scottish Government (2017) 2015/16 Poverty and Income Inequality in Scotland: 2015/16

Paper on ACEs and Attainment June 2017 “Schools are in a fantastic position to help support children and mitigate some of the effects that ACEs may have by recognising the factors which might affect children, building trusting relationships with them…and responding in a psychologically informed manner.” http://www.healthscotland.scot/publications/tackling-the-attainment-gap-by-preventing-and-responding-to-adverse-childhood-experiences

“What’s wrong with you?” Blame Shame Punishment “What happened to you?” Understanding Nurturing Healing

Thank you

June McGill Partnership, Improvement and Data Officer Midlothian Council Early Learning and Childcare Team Impact on parents with 4 or more ACE’s though the Big Bedtime Read Intro – Hello my name is and intro everyone else Health & Safety – Fire Drill Toilets Tweet – Using #CYPIC Link to the session via ‘insert title of app’

Where: Woodburn Family Learning Centre Woodburn is an area of high deprivation – top 15% I delivered ‘Big Bedtime Read’ to a group of 20 individual parents over a 2 year period. Between them they had 44 children, age ranging from 0 to 15 Big Bedtime Read - a great way to get parents understanding the importance of their role in their child’s early learning, improving sleep routines, bonding and attachment, developing mathematical, scientific and literate brain functions (research) Conversation a lot bigger than just BBR! Child development Managing behaviours Empathic listening Importance of singing, rhymes and stories Play Sleep Relationships Attachment Bonding Childhood and impact on parenting style Mental health and coping Intro – Hello my name is and intro everyone else Health & Safety – Fire Drill Toilets Tweet – Using #CYPIC Link to the session via ‘insert title of app’

Why? As I got to know the parents – evident that there were long standing difficulties with relationships, parenting, self esteem & poor mental health in some. I wondered if they could use the model to improve their parenting, resilience and sustainability - started a new ‘group’ Aim: Parents will show improved understanding with regard to their role in their children's learning by March 17 (17 weeks)

Measures: I asked myself ‘if I do this what do I expect to see, feel and hear’ – I measured that! Very subjective tho! I expected to see improvements in… Behaviours – less confrontational, aggressive, dismissive Attitudes – parents role as important, ‘good enough’ Questions – those they asked me to be more relevant to their child and their learning Involvement in the group – less time on phone, less time chatting about other things understanding of their child’s developmental needs, their role in this and the ideas they had

Measures continues: No sign of understanding or interest in their child's development; no engagement in the group discussions; chatting throughout the session; on phone the whole session not related to the discussion; using negative language about their child; talking about their childhood experiences but no understanding of the impact on their own parenting style; showing no sign of the impact of their parenting/behaviour on their child 1 Some indication of understanding of age and stage of child's development; showing signs of reasonable expectations; some understanding of their role in their child's learning; some understanding of the importance of learning through play and what their role in supporting this is; interested in engaging with the group but sporadic; 2 High levels of engagement in the group; lots of ideas shared; lots of support offered to others; understanding of their childhood experiences on their own parenting style; very involved in their child's learning though reading, playing, going out and about; using language that expresses their feelings without dismissing them; willing to support their child's learning and interested in tools/courses they can use 3

The group 11 mum’s joined my more in-depth group looking at difficulties parenting. All with 4 or more ACE’s. 4 fully engaged over 17 weeks Between the 4, 16 children. All with SW & FS involvement or referred by HV Some ‘A good time to be 2’ children Stayed in paernts room unless they asked for a 1:1

Theory of change – 4 core pillars By talking conversationally with parents about all elements of child development and learning I will be able to improve their: understanding of child development, age and stage capacity to managing child’s ‘difficult’ behaviour resilience and ability to better manage own emotions interest in becoming their child’s most important keyperson

Recording They updated their impact wheels and completed their PDSA’s I made a point of having a direct chat with each one of them each time I saw them. I used little 5 bar gates and notes but also my memory and gut feeling I made note of the discussions we’d had each week relating to child dev, sleep, experiences etc etc

Testing – mum’s Each engaging parent had their own area of improvement they wanted to make. Measured this on an ‘impact wheel’. Mum 1 – Leopard Impact wheel identified what areas for a PDSA

Leopard - Bedtime Routine Northwest Improvement Initiative Reminders: Small changes Act on ideas Don’t give up - You can do it! Leopard - Bedtime Routine PDSA 5: Day 5 Task: turned phone off, had the conversation about no TV (no tantrum – yet) Plan – Start routine at 5. try no TV, bedtime routine activity, bed by 7pm, read a book with funny voices. Do – felt a right eejit but did voices and he loved them…had to read the book 3 times! Only started at 6 because mum called. Turned phone off after that. Was happy to go to sleep without TV. Was really loving. Really enjoyed it. Study/Act – tell everyone I’m starting this at 5. remind myself to turn phone off somehow! I’m quite emotional at how easy it’s been and how lovely and calm I feel. PDSA 4: Day 4 Task – sent texts to everyone Plan – Use routine tool again. Bed for 7. Read 1 page of book. Do – used routine tool – went really well. Phone rang and rang! Managed to keep him on task tho. Read a whole book! He wasn’t that interested, looking for something, he eventually snuggled down but wanted the TV on. Gave in to it for tonight. Got to bed at 7.30. Study/Act – prepare him for no TV. Put more effort into the reading! Turn phone off! Things take longer than I expected so start at 5. PDSA 3: Day 3 Do - Mum popped in and messed up my plan for today – really annoyed. Bed at 11.30pm. Nightmare. Study/Act - Tell everyone what I’m doing and to not come round after 5 till further notice. PDSA 2: Day 2 Task - made a routine chart. Plan – Use the new routine thingy. Try again for 7pm. Hold the book! Do - Tried the routine, nightmare! Managed to read and get him to bed for 8 tho! whoop PDSA 1: Day 1 Plan - Bedtime as per usual – try for 7pm, read a book Do - Spoke to A about importance of good sleep to learning, managed to get to bed at 9.30 (usually 11pm), never got to read book as too stressed. Study/Act - Tomorrow I’m going to try making a bedtime routine with him © R. Scoville & I.H.I. 31

Learning Not for the feint hearted – very resource intensive and lots of responsibility – ones you’re in your can’t just walk away Using the model definitely focused the mum’s minds but I had to keep it simple simple simple! Using the impact wheel helped them visualise their own journey and realise all the impact they had had Started with my own example when teaching them about MfI – very simply Needed a lot of support during the PDSA with what to try next Things with a clear process – like a bedtime routine that they were in control of - worked better. When others got involved it got more difficult for them

Progress 19 parents (1 dad) – all showing huge impact on their parenting and understand of their child’s learning and their role in this Project ran for 2 years – 18 months before my relationship with the mum’s allowed me to take it to this level – lots of trust issues – resource intensive – 1 whole day per week in centre. Recorded what I saw/heard/felt through chatting in group. Used my gut…a lot! Now stopped going to the centre but mum’s still very attached to me Every single parent in the group (11 of the 19) showed signs of improvement in all their chosen areas – some have gone on to make further improvement I may do a follow up.

Spread and Scale What next? I’ve started at another centre so at the relationship building stage. Will I continue? Not taking the same approach here as I don't have the same dedicated time to offer Less deprived area however still issues with mental health and parenting evident

Question for table discussion How can we work together to address ACES in Scotland?

Thank you and close