Whilst acknowledged as not exhaustive, the list of experiences from a systematic review of the effect of childhood adversity is a useful tool.
Taken from Hughes et al 2017.
The Bradford ATR programme has a focus on prevention, early intervention, and mitigating the effects of adversity and trauma from preconception throughout a person's life.
We know that babies, children and young people who experience adversity and trauma are at high risk of poor health and wellbeing. We also know that adults who face multiple disadvantages as a result of adversity and trauma are also at risk of poor health and wellbeing outcomes.
The ATR programme is designed to drive the districts collective ambitions of working together to prevent adversity and trauma and to mitigate the existing harm across the lifespan; helping people who live and work in Bradford to understand the latest thinking around trauma, brain development, adverse childhood experiences and neuroscience research.
What are Adverse Childhood Experiences?
The term Adverse Childhood Experiences was introduced in the US by researchers Vincent Felitti, Robert Anda, and their colleagues in their original study conducted from 1995 to 1997. Since then there have been many other studies which have found similar findings including in Wales and England.
The definition used in the ATR Strategy is from Shared Language Paper from Blackpool and Cumbria (2019):
Adverse Childhood Experiences (ACEs) are stressful or traumatic events that happen in childhood and can affect people as adults. They include events that affect a child or young person directly, such as abuse or neglect. ACEs also include things that affect children indirectly through the environment they live in. This could be living with a parent or caregiver who has poor mental health, where there is domestic abuse, or where parents have divorced or separated. ACEs can be single events, long-term or repeated experiences.
Three types of ACEs
Environmental factors
Missing from the list are the impact of adverse environmental factors (such as deprivation, housing insecurity, racism and neighbourhood violence) which are also recognised as having a significant impact on development. This is illustrated well in the image below from Ellis and Dietz 2017.
What is trauma?
Adverse Childhood Experiences and trauma are often discussed interchangably. However, they are probably better considered on a continuum of experiences, what one person might experience as adverse another could find traumatic – leading to potentially more severe consequences for that individual.
A definition of trauma from ‘Shared lexicon for Lancashire and South Cumbria’
Trauma is a term for a wider set of experiences or events that can happen at any time of life and includes some of the adversities in childhood known as Adverse Childhood Experiences (ACEs). Trauma describes the psychological impact of experiencing or witnessing a physically or emotionally harmful or life-threatening event. It may be a single incident or prolonged or repeating experiences. Trauma can affect people long after the event(s) by causing anxiety, depression, or Post Traumatic Stress Disorder (PTSD). It may also affect the way people relate to others or deal with day-to-day stresses.
A definition of trauma from ‘Shared lexicon for Lancashire and South Cumbria’
What is stress?
Stress is an important and normal part of life and the body’s response to stress (release of stress hormones such as cortisol) is helpful in motivating us to handle a situation. Our bodies are designed to respond to brief stress but not ongoing or relentless stress. If a child has positive and supportive relationships with adults then temporary stress responses, even if serious, can be buffered and the child learns they can cope and their belief in themselves increase.
The following definitions have been shared by Center of Youth Wellness
Positive stress response is a normal and essential part of healthy development, characterised by brief increases in heart rate and mild elevations in hormone levels. Such as, first day at school, important exam, or job interview.
Tolerable stress response activates the body’s alert systems to a greater degree as a result of more severe, longer-lasting difficulties, such as the loss of a loved one, a natural disaster, or a frightening injury.
Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity — such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship.
What is resilience?
Research shows that some of us do not experience the negative outcomes. The capacity to overcome and adjust to the challenges of significant adversity is what is known as resilience.
Resilience is a complex and dynamic process and may include biological, psychological, or social factors which help to minimise the impact of stress associated with Adverse Childhood Experiences.
Some children and families may already have several resilience factors within their lives. Recognising and building on these factors is important. Factors that may promote resilience during childhood include:
- fostering a protective relationship with an adult caregiver where the adult recognises and responds to the child’s needs,
- developing social and emotional skills,
- accessing peer support,
- participating in communities/activities.
Prevalence of ACEs in Bradford
Why Adverse Childhood Experiences should matter to people living and working in Bradford.
The 2019 Health Needs Assessment (HNA) tells us that:
- Bradford has a young population,
- Bradford’s high level of deprivation puts its population at increased risk of Adverse Childhood Experiences,
- These early adverse experiences are a significant contribution to disease burden and are associated with numerous health inequalities.
The HNA discusses primary, secondary and tertiary prevention. These domains map well onto the main aims described in the Bradford ATR Strategy of reducing the impact of Adverse Childhood Experiences, promoting resilience and developing trauma-informed services and communities.
Key recommendations include:
- Make coping with and buffering the effects of Adverse Childhood Experiences a Bradford district priority;
- Create an active participatory programme with representation from a wide range of partners to lead the strategy and action plan and commission work that supports the ambitions of the strategy, including:
- Review and evaluate current services working to reduce the impact of Adverse Childhood Experiences, act on outcomes to improve service quality and share lessons learned;
- Identify gaps and opportunities in primary, secondary and tertiary prevention approaches;
- Endeavour to reduce silo working between organisations by improving links and referral pathways in order to maintain efficient use of expertise and resources across the district;
- Improve local routine data collection;
- Raise awareness of Adverse Childhood Experiences and their associated health outcomes, as well as resilience factors, in local communities and amongst professionals;
- Develop a district wide whole system trauma-informed approach in consultation with all relevant stakeholders, including children and their caregivers and people with lived experience of adversity and trauma;