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Scales 246Policy recommendations re Adverse Childhood Experiences - 1


As the UK increasingly becomes ACE-aware through various initiatives by charities, NHS, local authorities, police, etc., I thought it would be good to share policies that have been enacted in USA and Canada since 2014.

Firstly, analysis of such legislation reveals a great awareness of the effect of ACEs. The following1 is a typical prelude to legal clauses:


WHEREAS, there have been recent significant advances in neuroscience with increased understanding of how emotional neglect and exposure to serious trauma affect the way children perceive and interact with their world both during childhood and into adulthood;

WHEREAS, post-traumatic stress disorder and other trauma-related disorders in children and adults can be caused both by exposure to a single severe traumatic incident or by exposure to a cumulative series of serious traumatic events;

WHEREAS, such traumatic incidents and events include emotional and physical abuse and neglect, sexual abuse, separation from or loss of a parent due to divorce or other reasons, serious injury or death of a parent, exposure to family discord, domestic violence, parental mental illness, substance abuse, criminal activity in the home, and other traumatic and nonnurturing experiences and environments;

WHEREAS, abuse, neglect, and traumatic events compose part of what has been described in the medical literature as "adverse childhood experiences" or "ACEs," and the cumulative potential impact to a child who has a significant history of exposure to neglect and trauma can be calculated using what is called an ACE score;

WHEREAS, it is now understood that significant exposure to severe traumatic events as outlined above can negatively affect the neurobiology and anatomy of a child's developing brain and result in a substantially impaired ability to absorb new information, develop healthy coping skills, and adapt to life's challenges as the child becomes locked into a "fight-flight-or-freeze" mode that becomes the child's and future adult's default approach when interacting with the world around them;

WHEREAS, children and adults whose brains have been negatively affected by exposure to severe or repeated serious trauma, often experience persistent and sometimes overwhelming dysfunctional emotions of fear, anxiety, depression, hopelessness, and anger, and may exhibit socially inappropriate labile and aggressive behaviors, or may exhibit socially inappropriate emotional detachment and avoidance behaviors;

WHEREAS, these negative coping behaviors and dysfunctional emotions limit a person's capacity to form healthy stable relationships, foster social capital, learn from experiences and mistakes, set and achieve short and long-term goals, and succeed in educational and vocational pursuits;

WHEREAS, in addition to the above negative outcomes, children and adults are more likely to attempt to self medicate trauma-related "fight-flight-or-freeze" anxiety and emotional dysfunction by using available substances such as tobacco, alcohol, prescription medications, and street drugs, including heroin, methamphetamine, cocaine, and cannabis;

WHEREAS, because of the cumulative adverse effects of the above negative outcomes on their physical health and emotional and cognitive capabilities, children and adults affected by severe traumatic events, despite their sincere and best efforts to succeed in life, are more likely to:

  • perform poorly in school and other academic pursuits;
  • struggle with work performance and sustainable employment;
  • become chronically unemployed as adults, resulting in financial stress, reduced quality of life, and increased risk of experiencing long-term disability, homelessness, and other personal and family traumatic experiences;
  • become dependent on and addicted to tobacco, alcohol, prescription medications, illicit drugs, and other substances;
  • become directly engaged with law enforcement and the criminal justice system;
  • suffer from significant mental illness including depression, psychosis, and severe anxiety leading to suicides and attempted suicides that otherwise would not have occurred;
  • suffer from serious physical health problems with poor long-term outcomes that otherwise would not have occurred;
  • engage in high-risk sexual behaviors as adolescents and adults, including onset of sexual activity at an early age and multiple sexual partners, resulting in increased risks of adolescent pregnancy and paternity, other unintended pregnancies, and sexually transmitted diseases;
  • experience significant problems and failures in marriage and other intimate partner relationships; become victims or perpetrators of intimate partner violence as adults;
  • struggle, despite their sincere efforts, to provide a stable and nurturing environment for their current and future children, resulting in increased likelihood of intergenerational trauma and intergenerational poverty; and
  • face a life expectancy shortened by as many as  years when compared to average life expectancy for adults who did not experience severe trauma as children;


WHEREAS, with an increase in understanding about the impacts of trauma has come the development of evidence-based questionnaires that identify behaviors and health-related disorders in children and adults that can be indicative of possible trauma-related exposures;

WHEREAS, using these questionnaires can provide the opportunity to identify and refer a child or adult for appropriate additional evaluation and treatment;

WHEREAS, the mental health profession can effectively diagnose and treat trauma-related disorders following evidence-based approaches that have been proven to be successful;

WHEREAS, one example of a well-studied, highly effective and widely available therapy is trauma-focused cognitive behavior therapy;

WHEREAS, early childhood offers an important window of elevated opportunity to prevent, treat, and heal the impacts of adverse childhood experiences and toxic stress on a child's brain and body;

WHEREAS, a critical factor in buffering a child from the negative effects of toxic stress and adverse childhood experiences is the existence of at least one stable, supportive relationship between the child and a nurturing adult;

WHEREAS, with the increase in scientific understanding and ability to identify, prevent, and treat trauma-related disorders, there is great hope for thousands of children and adults to begin healing from the negative effects of adverse childhood experiences, develop resiliency, and have brighter, more productive futures than was previously possible; and

WHEREAS, in order to maximize the potential for positive outcomes of evidence-based interventions in the treatment of severe trauma, it is imperative that employees of the state and other people who interface directly with vulnerable children and adults become informed regarding the effects of trauma on the human brain and available screening and assessment tools and treatment interventions that lead to increased resiliency in children and adults who struggle in life as the result of trauma-related disorders:

NOW, THEREFORE, BE IT RESOLVED


I think we can say they 'get it'!

But what are the policies they put into law? Read about these in the next blog.

1 https://le.utah.gov/~2017/bills/static/HCR010.html

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Geoff Knott, 27/11/2019

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