A dverse C hildhood E xperiences

1. Adverse Childhood Experiences Dr Sandra Roper Ashley McCormac

2. What we will cover today • What are ACEs • Some background and context • What counts as an ACE • Potential areas of impact of ACEs • Risk and resilience • ACEs and offending behaviour • From theory to practice

3. What are ACEs Adverse Childhood Experiences But what do we mean by adversity?

4. Some background and context We have long understood that early experience can impact on later life: Sigmund Freud

5. Some background and context Harry Harlow and his monkeys John Bowlby and his 44 thieves

6. Some background and context https://www.youtube.com/watch?v=FOCTxcaNHeg&feature=youtu.be

7. Some background and context Study by Felitti et al in 1998 Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study

8. What counts as an ACE In the Felitti study seven categories of adverse childhood experiences were studied: • Psychological abuse • Physical abuse • Sexual abuse • violence against mother • living with household members who were substance abusers • living with household members who were mentally ill or suicidal • living with household members who were ever imprisoned

9. Potential areas of impact Potential influences throughout the lifespan of adverse childhood experiences. (From Felitti et al, 1998)

10. Risk and resilience • Can those who struggle in the context of risk be supported to achieve better outcomes? • … resilience??

11. What is resilience? • "...the positive end of the distribution of developmental outcomes among individuals at high risk.“ (Rutter, 1987) • "...the maintenance of positive adjustment under challenging life conditions.” (Masten, 2001) • “resilience is both the capacity of individuals to navigate their way to the psychological, social, cultural, and physical resources that sustain their well-being, and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways” (Ungar, 2007)

12. Protective factors The presence of protective factors explain why some young people appear resilient while others do not. Resilience interventions focus on increasing the amount of protective factors in order to improve mental health and well-being Internal factors – features of the child External factors – supportive relationships and structures

13. ACEs and offending behaviour A number of studies have found a relationship between ACEs and offending behaviour. Can we use the concept of ACEs to identify young people at most risk of offending? How does this fit with approaches to risk and assessment (e.g. AssetPlus)

14. A practitioners perspective of working with children with ACE’s Ash McCormac Senior Lecturer University of Bedfordshire

16. A quick look at a number of perspectives that are a useful resources when considering meaning interventions when working with young people from toxic environments • My practitioner experiences include: • Working with the homeless (childhood trauma) • Working in the USA on a young offenders programme (abuse, abandonment and boundaries – exposure to violence) • Residential Rehab for young people with addictions (avoidance) • Working with families re: sexual abuse investigations, assessments and interventions

17. Secure/optimal development David Howe Age Sub-optimal/ Insecure/trauma etc

18. Secure/optimal development Intervention Intervention Age Intervention Sub-optimal/ Insecure/trauma etc

19. Public perceptions • The victim / threat paradox (simultaneously scared FOR and Scared OF children). • A public conflicted by emotions manipulated by politicised concepts of victimology (Warner 2015) and • a preoccupation of risk and future victims (McNeil 2009) • the emergence of “the pre pubescent super predator in purgatory” (Pitts, J. 2001) • Public ‘prurience disguised as outrage’ (Blackener) • The need to explicitly separate the episodic from the life long (Colemen); the static from the dynamic

20. Prentky (2002) re: development of sexually abusive behaviours

21. Gail Ryan Trauma model

22. Our strongest emotions are felt in relationship to other people • Emotions override thoughts and cognition • Whereas emotions can outbid thought, it is more difficult for thought to outbid feelings • Emotions influence What we see and HOW we see it…

23. THE TOOLS OF THE MIND BECOME BURDENS WHEN THE ENVIRONMENT WHICH MADE THEM NECESSARY NO LONGER EXISTS - HENRI BERGSON

24. Life space • Taken from Trieschman et al (1969) in the book “the other 23 hours” – what happens to the children for the rest of the day when they are not in the ‘one hour of treatment’ or their appointment with you! • While planned interventions have their place, they are only one aspect of work with children. Providing consistency, reassurance and perhaps the monotony of predictable living

25. Maier (1979) The Core of Care • Starts with ‘bodily comfort’ and basic care • ‘human radars’ and ‘go-go kids’ – the first are active ‘scanners’ (hypervigilant) the second are those who make sense of the world by ‘bumping into it’ • So interventions that may suit one may not suit the other – needing individualised responses

26. Livesley’s “Integrated model” (2005) • Assessment followed by • Formulation and • Applied to intervention • Rehabilitation • Reintegration • The formulation is pivotal here - perhaps the most essential element to getting intervention right but can only be based on the viability and integrity the information from the assessment

27. “It is patience, thoroughness and persistence in this process, rather than any diagnostic or interviewing brilliance that produces results” (P.D Scott; Assessing Dangerousness in Criminals. 1977: p129)

28. References • Baglivio, M.T.,Wolff, K.T.,Piquero, A.R. & Epps, N. (2015) The Relationship between Adverse Childhood Experiences (ACE) and Juvenile Offending Trajectories in a Juvenile Offender Sample. Journal of Criminal Justice 43,3,229-241 • Callaghan, J.E.M. (2018) Trauma informed practice and ACES: Critical perspectives on children’s mental health and domestic abuse Children’s wellbeing, safety and relationships: A one day conference Stirling, 24 May 2018. • Hahn Fox, B., Perez, B., Cassm E.,Baglivio, M.T. & Epps, N.(2105). Trauma changes everything: Examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders. Child Abuse & Neglect 46, 163-173 • Hunt, T.K.A., Slack, K.S., & Berger, L. M. (2017) Adverse childhood experiences and behavioral problems in middle childhood. Child Abuse & Neglect 67, 391–402 • Masten, A. S. & Garmezy, N. (1985) Risk, vulnerability and protective factors in developmental psychopathology. In: Advances in Clinical Child Psychology, Vol. 8, Lahey, B. B. & Kazdin, A. E. (eds). New York: Plenum  • Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American psychologist, 56(3), 227. • Rutter, M. (1985). Resilience in the face of adversity: Protective factors and resistance to psychiatric disorder. The British Journal of Psychiatry, 147(6), 598-611. • Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American journal of orthopsychiatry, 57(3), 316-331. • Ungar, M. (2012). Social ecologies and their contribution to resilience. In The social ecology of resilience (pp. 13-31). Springer, New York, NY.