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Engaging with children and young people
Engaging with children and young people

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3.3 Limitations of the ACEs model

It is important to note that while the concept of ACEs has proven itself to be very useful in terms of understanding subsequent behaviours, it should not be used as a way of assuming or predicting future challenges or anti-social behaviours.

As Bateson and colleagues (2020) emphasise:

Assessing risk of maltreating a child or committing a criminal offence is a complex issue thwarted with methodological challenges … Whilst the ACEs concept offers appealing simplicity, its predictive validity for child maltreatment, criminality or being taken into care has not been proven. For example, although four or more ACEs is associated with a 15 times greater likelihood of having committed violence against another person in the past 12 months … this cannot be used to predict future behaviour of an individual. In the same vein, statistical analysis of traffic trends can tell us the most likely time of day that an accident might occur on a given road but cannot tell us exactly which cars will be involved.

Individuals with a high ACE score, as a group, are more likely to be amongst society’s most high need populations so it would be easy to assume that an individual’s high ACE score also means they have high current need. However, an ACE score is retrospective and does not necessarily reflect a person’s current situation, needs or risks. For this reason, ACE scores are not a replacement for careful assessment of current needs, nor are they suitable to indicate whether someone meets the threshold for a particular service.

(Bateson et al., 2020, pp.4-5)

Activity 4 Applying the ACEs model

Timing: Allow 10 minutes

In this clip, Maria Morgan of SafeguardingNI discusses the key elements of the ACEs model and how it can be applied when dealing with children and young people.

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Transcript

pwc_3_a3_maria_morgan_new

MARIA MORGAN
My name is Maria Morgan, and I work for the Safeguarding Board for Northern Ireland. And I have a remit along with colleagues within my team to promote a better understanding about adverse childhood experiences and how we collectively work alongside to support organisations, to become more trauma-aware, more trauma-sensitive and responsive to children and adults who have experienced adversity.
ACEs stands for Adverse Childhood Experiences, and they have been defined as stressful experiences that occur during childhood that can directly harm a child or affect the environment in which they live. So some examples of ACES could be abuse, so that could be emotional, physical, or sexual abuse, neglect, either physical or emotional, domestic violence, substance misuse by a member of the household, divorce or separation of parents, mental illness, or maybe having a member of a family or a household go to prison.
It's really important for us to understand the relationship between adverse childhood experiences and the impact that they can have on an individual right across the lifespan. There's been a study done of the Welsh population that surveyed around 2,000 people aged between 18 and 69 years, and that study indicated that individuals who have experienced four or more ACEs are at a higher risk of developing physical and psychological ill health. And they're also at a higher risk of adopting health-harming behaviours.
So for example, people with four or more ACEs were six times more likely to smoke cigarettes, four times more likely to be a high-risk drinker, 11 times more likely to smoke cannabis, 16 times more likely to have used crack cocaine or heroin, and 20 times more likely to be incarcerated.
So if you think about a child growing up in a home that has been maybe chaotic and unpredictable, maybe through domestic violence, alcohol, drug abuse, it's probably not surprising to us that as that child grows into teenage, adulthood, when there hasn't been the help and support needed to mitigate some of the fear and distress that that child may have been exposed to, health-harming common behaviours such as abusing alcohol, drugs, may be used by that person to attempt, maybe, to lessen feelings of distress in relation to what they may have seen, maybe they've heard, or maybe what they've been a victim of in their life. And that can bring with it a degree of vulnerability. And when you're under the influence of alcohol and drugs, a person can be much more vulnerable to getting involved with criminal-type behaviour.
The Welsh research also tells us that individuals surveyed with four or more ACEs were four times more likely to have type two diabetes by the age of 49 years, three times more likely to have a respiratory and coronary disease by age 49, 14 times more likely to have been a victim of violence, six times more likely to have ever received treatment for mental illness, and nine times more likely to have felt suicidal or self-harmed.
Well, I suppose ideally we would like to prevent ACEs from happening in the first place, and it's also critically important that we intervene and offer the support that's needed as early on in a child's life as we can, as the evidence is very strong in telling us that adversities in childhood can overactivate a child's stress response system. So essentially this is where a child can be in a constant state of physical and psychological stress, and if that child isn't offered help and support that they need to create a sense of safety and security, the stress response may not really get a chance to switch off. So this over activation, as it's called, is referred to as toxic stress, and that's the primary way in which adversity damages a child's development and well-being, potentially leading to problems for the child with self-regulation, emotional management, and impulse control simply because the child may not have been given the nurturing support that they need for the healthy development in those areas.
The Welsh research, however, identified four resilient factors, and these are really important because we know that these help to mitigate and buffer the toxic stress that can develop as a result of adversities. The key resilience factor is children have an access to a consistent loving and nurturing caregiver, so an available adult that provides a sense of safety and security for the child to develop and grow in a healthy way. And if for whatever reason that available caring adult is not the parents, it could be a granny, a grandpa, an aunt, uncle, youth worker, nursery worker, teacher, health visitor, social worker, policeman, anyone involved with the child who can offer a sense of nurture that increases that child's sense of stability and security.
The second resilience factor identified is having a sense of being able to overcome hardship and guide your own destiny, and overcoming hardship a guiding your own destiny can be dependent, as we know, on our self-confidence, self-esteem, and a sense of self-worth and self-belief. And that available caring adult can nurture that sense of confidence and self-belief in a child.
So the research talks about a third resilience factor, which is about prepping children to manage their emotions and behaviour. And that's helping children with the ability to read and label not only their own emotions but the emotional states in others. And that's really important, as we know because-- as I say, as we all know, emotional intelligence is that sense of internal balance within us that enables us to keep our composure, make good decisions, communicate effectively, which all really aides us to develop and maintain healthy relationships. So being involved and connected is the last resilience factor of the Welsh research, and that's about having a sense of belonging and acceptance within our family community and wider society, free from exclusion, oppression, and discrimination for whatever reason.
Well, some of the approaches that we need to be taking into consideration is, for example, counting the number of ACEs a person has been exposed to. That potentially can be problematic because it is quite possible to consider that someone exposed to one ACE of a very severe and maybe enduring nature could be much more effective physically and psychologically than an individual who had exposure to four ACEs but of a much more mild to moderate nature.
We also need to consider mitigating factors might have been available to a child living in an adverse situation. So for example, a child may have had a lot of contact with a grandparent who was in a position to offer calm, loving, and supportive environment, which acted as a protective buffer against the toxic stress that the child may be experiencing as a result of what was going on at the home. We also need to consider in terms of the approaches how counting ACEs can introduce the potential risk to individuals defining themselves by various count and how that might, in turn, impact on how they see themselves, where they fit, and what they can achieve in general, in life. There may not be the same expectations, for example, of schoolchildren in terms of doing well in school because of the ACEs that maybe are going on in their lives when the evidence is very clear that mitigating factors can make all the difference.
I suppose the other consideration is how we are addressing the environmental factors that may contribute to adverse childhood experiences. So what role does poverty, discrimination, community violence, [INAUDIBLE], and so on play in exacerbating adversely for children and households? And we also need to think about, when we are asking people about ACEs and using checklists, are we in a position to do something with the information we've asked for? Can we offer referral pathways to support these individuals with the help that they need? Are the support pathways and interventions offered evidence-based to respond to what the child, the person may have experienced?
And we need to consider that the services are not readily available. For example, we have lists of three, six months. What's offered to the person in the meantime who has completed in these questionnaire and has talked maybe openly about their adversity?
Caring and nurturing relationships are a robust and protective factor against the impact of ACEs, and adversity in childhood can be mitigated against. I think that's really important to conclude with that key message, and it's all really important for us to consider across whatever sector we work in to think about what support we are offering or could offer to vulnerable kids who might be experiencing adversity.
The Safeguarding Board for Northern Ireland, on its website, has a lot of really good information and research reports, some of which I referred to in this conversation, and it also has developed a wide range of really healthy resources that practitioners can use in their daily practise to support vulnerable families. So it's definitely worth a visit to the Safeguarding Board of Northern Ireland website, and all of those resources can be accessed for free. Thank you very much.
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Having reflected on the comments made by Maria Morgan of Safeguarding NI, what do you think are the key benefits of the ACEs model and what are some of the limitations?

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Discussion

While the ACEs model provides a very strong framework for understanding the various adverse experiences that children and young people might encounter as they grow up, it is vitally important that the limitations of the model are clearly understood. No model or framework is ever perfect, but the ACEs model goes a long way toward helping those who engage with children and young people – be they police or others providing various services – to consider the impact and implications.

While the discussion so far has concentrated on the adverse experiences that children and young people might have, it should also be recognised that the process of growing up also entails a degree of risk taking and risky behaviour. Some key elements of this are discussed in the following section.