Adverse Childhood Experiences (ACEs) Report UK 2023

A Crisis of Parenting and Family Relationships

Adverse Childhood Experiences (ACEs) are stressful events occurring in childhood and have lifelong impacts on health and behaviour.

ACEs have been defined as: Sexual, Verbal, Physical abuse; Emotional, Physical neglect; A parent who is mentally ill, an alcoholic; A parent is a domestic violence victim, A family member is jailed, A loss of parent by divorce or abandonment.

People affected by several ACEs have much higher risk of poor health, educational failure, imprisonment, addiction, etc.  ACEs result in wasted lives and are a huge cost to society.

A report in the Lancet in September 2019 estimated these as follows, "Total annual costs attributable to ACEs were estimated to be US$581 billion in Europe and $748 billion in north America. More than 75% of these costs arose in individuals with two or more ACEs. Millions of adults across Europe and north America live with a legacy of ACEs. Our findings suggest that a 10% reduction in ACE prevalence could equate to annual savings of $105 billion."

Individuals, communities and society therefore pay a huge cost in dealing with the effect of ACEs - wasted lives, premature death, effect on communities e.g. anti-social behaviour, healthcare, justice, education, social services costs.

There is a lot of participation around ACEs by professionals – educators, academics, health services, social services, etc., but little focus on and involvement of parents and communities. This has led to a great deal of cost and effort on reducing the effect of ACEs once they have occurred rather than prevention in the first place i.e. dealing with the root causes.

Two surveys were conducted by My ACE Story across the UK from May to Sept 2023 to try to understand ACEs further.

One survey of 2000 individuals which was self-selecting and the results are very different than previous UK studies. One could argue they are voices of Lived Experience.

To counter the Lived Experience sample biases, a small National representative survey was also run using the same survey and the results compared to the Lived Experience results.

Many insights were identified, including:

1. The devastating effect of family instability on ACEs

In the Lived Experience sample, the median number of ACEs of those who did not experience their parents separating or divorcing is 3. This compares to 5 for those who did experience their parents separating and/or divorcing.

In the National sample, the median number of ACEs of those who did not experience their parents separating or divorcing is 1. This compares to 4 for those who did experience their parents separating and/or divorcing.

What ACEs increase?

In the Lived Experience sample:

• 35% of those whose parents separated or divorced experienced neglect vs 17% whose parents stayed together.
• 56% lived with a household member who misused alcohol or drugs vs 29%.
• 71% lived with a household member who was depressed, mentally ill or suicidal vs 54%.
• 81% saw or heard a parent in your home yelled at, insulted or humiliated or beaten vs 61%.
• 34% experienced unwanted sexual contact (not necessarily in the home) vs 23%.

In the National sample:

• 23% of those whose parents separated or divorced experienced neglect vs 9% whose parents stayed together.
• 45% lived with a household member who misused alcohol or drugs vs 19%.
• 47% lived with a household member who was depressed, mentally ill or suicidal vs 25%.
• 62% saw or heard a parent in your home yelled at, insulted or humiliated or beaten vs 37%.
• 13% experienced unwanted sexual contact (not necessarily in the home) vs 6%.

 2. The toxic, stressful family and home environment of those with a high number of ACEs. 

60%-72% of children in the Lived Experience sample have lived within a context of violence in the home.Three of the top four ACEs reflect violence in the home which is meant to be a safe, nuturing space. These were also the top ACEs in the National sample but to a lesser extent – 41%-45%.

44%-63% in the Lived Experience sample have faced drug or mental issues with a parent. This was also significant in the National sample but to a lesser extent – 28%-32%

53% in the Lived Experience sample experienced family breakdown. The comparative figure in the National sample was 40%.

31% of females and 16% of males in the Lived Experience sample have experienced unwanted sexual contact (not necessarily in the home). This is much lower in the National survey – 12% of females and 5% of males – 9% overall.

3. Mental health and drug issues in the household in both samples have increased over time.

4. Physical violence against the child in both samples has decreased over time.

5. In both samples, the more ACEs, the more visits to GP in a 12 month period and more medical conditions discussed.

Individuals with zero ACEs visited a GP on average once in the last 12 months. This increases to 3 times for those with 7-10 ACEs. The number of conditions discussed rises from 1 to 2.5.

6. In both samples, the more ACEs, the more that certain medical conditions increase.

The top conditions reported are; Anxiety, Depression, Allergies, Asthma and Heart Conditions. For example, in the Lived Experience sample, 23% of those with zero ACEs reported discussing Anxiety with a GP. This rose to 68% for those with 7-10 ACEs. In the National sample, the similar figures were 15% and 53%. Figures for Depression are 16% rising to 67% for the Lived Experience sample and 7% to 37%  for the National sample.

Some 'external to home' ACEs have been suggested and data was collected for three of these:

7. In both samples, bullying is rife regardless of sex (60% have experienced) but is more prevalent in White British populations (+7% to 11% vs Other Ethnicities). 

8. In both samples, 40%-45% of Other Ethnicities (excluding White British) have experienced racism. 
 
9. In both samples, Males (+5% to 12% vs Females) and Other Ethnicities (+6% vs White British) are more likely to have experienced violence in their communities.

Preventing ACEs

Thinking root causes, how do we successfully engage one of these groups in PREVENTING some ACEs in the first place, in a low-cost way?:

• youth (future parents),
• parents,
• caregivers e.g. grandparents

Thirteen ideas are presented for prevention (and reduction) of ACEs. A summary of these is as follows:

1. All new and expectant parents should be made aware about ACEs and their effects. 
2. Behavioural science nudges could be used to keep ACEs in focus and change behaviours e.g. like 5-a-day. 
3. The Oxford ‘SEEN: Secondary Education around Early Neurodevelopment’ curriculum for Key Stage 3 pupils should be extended for ACEs and rolled out to all secondary schools. 
4. Online Positive Parenting Courses should be offered free to all new and expectant parents. 
5. There has been a successful community initiative in the USA – Children’s Resilience Initiative (now Community Resilience Initiative) which has resulted in the whole community learning about ACEs and also agencies introducing trauma-informed practices. In one community, they have seen a 33% reduction in domestic violence, a 59% decrease in youth suicide attempts and a 62% decrease in secondary school drop-outs. Could that be replicated here via community champions? In that regard, open up the Resilience Challenge to any community organisation. 
6. Scotland are endeavouring to become a ‘trauma-informed nation’. This started by screenings across Scotland in 2017 of the film ‘Resilience’ along with a panel discussion. Could this film become free-to-view on a major channel in the UK with a lot of promotion as well? 
7. Could there be a mandatory parents’ assembly at primary schools on ACEs? 
8. Socially prescribe volunteering.A study in Australia has found that if a child is involved in volunteering before the age of 13, the odds of having poor mental health are reduced by around 28%. As well, children who demonstrate ‘prosocial’ behaviours, such as caring for others or doing acts of kindness, were 11% less likely to experience mental ill-health. 
9. Mandatory screening for ACEs of all children and adults up to 65 at GP level.“135,000 adults going through a US Health Appraisal with ACE screening with follow-up produced a 35% reduction in GP visits and an 11% reduction in Emergency Department visits over the following year compared with that group’s prior year utilization. We realized that asking with later follow up, coupled with listening and implicitly accepting the person who had just shared his or her dark secrets, is a powerful form of doing." In California, mandatory screening for ACEs of all children and adults up to 65 was introduced in 2020 and is administered by the Center for Youth Wellness. This has also led to fewer drugs given to children. 
10. Introduce self-help groups for ACE survivors to share experiences. "Self-Help Plus participants were significantly less likely to have any mental disorders at six-month follow-up compared to the ECAU group (22% versus 41%). The risk reduction appeared to be similar across the most common diagnoses of mental disorders – depression, post-traumatic stress disorder (PTSD) and anxiety disorders.”
11. Increase child-at-risk attachment to an independent adult. Scale initiatives such as TLG. 
12. What nudges/education could be introduced re family stability/relationships? Do policies incent family stability? There are various preventative aspects to consider here e.g. entering into safe and loving relationships, improving relationships between partners, splitting well. Improving such aspects is a complex and multifaceted process. Public policy should be to help people construct the foundations upon which a stable family life can be built - economic security, good incomes, the opportunity to acquire skills and education, reducing the time pressures on parents, and providing access to effective health care. Apart from policy considerations, relationship behaviours are key e.g. communication, expectations, showing appreciation, kindness, intimacy.
    There must be behavioural nudges to develop here which will help realignment of social norms.
13. Collect ACE scores at a local level and publish indices to help communities realise what issues are prevalent.