Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are stressful or traumatic experiences, including abuse, neglect and a range of household dysfunction such as witnessing domestic violence, or growing up with substance abuse, mental illness, parental discord, or crime in the home.

Living with ACEs results in individuals developing coping and lifestyle strategies that are based on poor parental attachment and the effects of trauma.

The Department of Health in England commissioned the Institute of Health Equity to build on the work of the Marmot review, to develop the evidence base around the wider social factors that shape health outcomes and contribute to health inequalities, and to support programmes and policy making at local, national and international level; in 2015 they found:

“Acting to prevent ACEs could improve health, reduce inequalities and save money. Taking action on the causes, prevalence and impacts of ACEs is therefore necessary in order to improve health, reduce inequalities within generations, prevent the transmission of disadvantage and inequality across generations and improve the quality of children, young people and adult’s lives.”

ACEs include:

rockpool family training Physical, sexual and verbal abuse.

rockpool family training Physical and emotional neglect.

rockpool family training Witnessing a mother being abused.

rockpool family training Losing a parent to separation, divorce or other reason.

rockpool family training A family member who is:

> depressed or diagnosed with other mental illness;
> addicted to alcohol or another substance;
> in prison.

Children and Young People

Why are they important?

ACEs are common…The Adverse Childhood Experiences Study* tell us that nearly two-thirds (64%) of adults have at least one.

They cause adult onset of chronic disease, such as cancer and heart disease, as well as mental illness, violence and being a victim of violence

ACEs don’t occur alone…. if you have one, there’s an 87% chance that you have two or more.

The more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence.

People have an ACE score of 0 to 10. Each type of trauma counts as one, no matter how many times it occurs. You can think of an ACE score as a cholesterol score for childhood trauma.

For example, people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic.

Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and suicide by 1200 percent.

People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases.

People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years.

ACEs are responsible for a big chunk of workplace absenteeism, and for costs in health care, emergency response, mental health and criminal justice.

So, the fifth finding from the ACE Study is that childhood adversity contributes to most of our major chronic health, mental health, economic health and social health issues.

What work are we doing with ACEs?

Our ACEs Recovery Toolkit for Adults and ACEs Recovery Toolkit for Children and Young People programmes are rolling out across the United Kingdom.

We have a number of training days to support practitioners to better understand ACEs and toxic stress and how this can impact on individuals. This training explores how we can support clients to build resilience and protective factors to mitigate ACEs and help practitioners to better understand trauma informed practice and how they can apply this to their work.

Sue has been working with South Wales Public Health and South Wales Police for the last 18 months developing training for front line police officers.

In May 2017, she travelled to America with a delegation from Wales to visit American and Canadian centres of excellence where they are using a trauma informed ACE lens approach. Among these was the Lincoln high school in Walla Walla where Paper Tigers was filmed which chronicles a year in the life of Lincoln High School who have adopted an ACE lens approach to tackle bullying, truancy, anti-social behaviour and school refusal.

Trauma Specific Training

Our ACEs Training in Harpurhey, Manchester

Manchester City Council and Rock Pool are working together on a year long place-based pilot to help staff from all public, voluntary and community sector services, better understand Adverse Childhood Experiences.

We are delivering 16 full-day ACE Awareness and Routine Enquiry Training courses, and 8 half-day ACE Awareness and Impact Training courses to about 600 staff who provide operational frontline delivery in Harpurhey.

They are being trained, coached and developed to offer a trauma-informed approach to engaging with current and future service users/people with lived experience.

Find out more about our work in Harpurhey.

Harpurhey ACEs Trainers


*The Adverse Childhood Experiences Study

Vincent J Felitti MD, FACPCorrespondence information about the author Vincent J Felitti

Robert F Anda MD, MSDale Nordenberg MDDavid F Williamson MS, PhD, Alison M Spitz MS, MPH, Valerie Edwards BA, Mary P Koss PhD, James S Marks MD, MPH