What do we want to know?
Adverse Childhood Experiences (ACEs) include physical, sexual or emotional abuse; neglect; domestic violence in the home; homelessness or living in care; parental mental health problems or substance abuse; and parents who are absent through imprisonment, separation or death. We sought to understand how people affected by ACEs can best be supported. In order to address this, we conducted a review of evidence which involved three components: a qualitative synthesis of UK views studies; a systematic review of reviews which measured the effectiveness of interventions to support people affected by ACEs; and a stakeholder workshop with young people with lived experience of ACEs.
Who wants to know?
The review was commissioned by the Department of Health and Social Care and will be of interest to a range of policymakers and practitioners working across education, health and social care.
What did we find?
We identified 21 qualitative studies (UK only), and 98 systematic reviews, of which 31 were included in our best evidence synthesis (OECD countries).
The qualitative synthesis revealed that ACEs impacted people’s well-being in numerous ways. People affected by ACEs described feeling a compromised sense of self, experiencing issues around trust and forming and maintaining healthy relationships, and a lack of stability owing to financial insecurity, and inconsistent school and care placements. Services were conceived as needing to ‘fill the gaps’ left by ACEs through emotional and practical support. Relationships with trusted adults, regardless of professional background, were highlighted as a key factor in feeling supported. Effective and valued service providers were described as displaying empathy, being non-judgemental, and being active listeners.
The 98 reviews covered all ACE populations, with most evidence on looked-after children and young people, and children who have been sexually abused. Most reviews focused on individual psychological interventions and on mental health or behaviour outcomes. These data indicate that there is good evidence for the effectiveness of the following for at least some populations: cognitive behavioural therapy and other psychological therapies for mental health outcomes; psychoeducation for mental health outcomes; and parent or foster carer training for behaviour outcomes. Evidence is limited and findings are mixed for other interventions which address the broader contexts of children’s and young people’s lives.
At the stakeholder workshop young people described how the impact of ACEs varies depending on factors such as: gender, stage of life, family structure, geographic location, socio-economic and ethnic background. They described the negative effects of an inflexible school system and teachers’ lack of understanding of their problems. Community recreational activities held potential to improve confidence and build identities. Many wanted the opportunity to learn practical life skills and highlighted the importance of support at key transition points, such as leaving school.
What are the conclusions?
Although the impacts of ACEs are complex and affect people differently, people described common needs and experiences across the different ACE populations. However, there were areas of discordance between the evidence on people’s needs and experiences and the evidence on the effectiveness of interventions.
A focus on addressing mental health outcomes among the effectiveness evidence overlooks the multifaceted and ongoing needs identified by the young people in the views synthesis and in the stakeholder work. This suggests a need for evaluations of interventions aimed at empowering young people through offering early support and building life skills.
Many interventions were short-term, lasting just a few weeks, whereas people affected by ACEs described the importance of stability and continuity in the support they receive which would allow the necessary time to build up trust.
Although we included interventions to address the impact of ACEs at any point in life, few reviews took this approach. Future research should evaluate interventions which adopt a lifecourse approach to understand how people affected by ACEs can be supported to thrive in adult life. Our review of evidence also shows that ACE populations tend to be studied in isolation, there is a need for research which explores how ACEs co-occur and how interventions may address the impact of multiple ACEs.
How did we get these results?
Comprehensive searching of electronic databases and websites was carried out. A review of reviews approach was used to bring together the systematic reviews of intervention effectiveness and an AMSTAR quality rating was applied to conduct a best evidence synthesis. Using the same searches, systematic reviews of qualitative evidence were used to procure primary views studies conducted in the UK. Qualitative studies were appraised using quality and relevance criteria, only studies which received a ‘high’ or ‘gold standard’ usefulness rating were included in the synthesis.
This report should be cited as:
Lester S, Lorenc T, Sutcliffe K, Khatwa M, Stansfield C, Sowden A, Thomas J (2019) What helps to support people affected by Adverse Childhood Experiences? A Review of Evidence. London: EPPI Centre, Social Science Research Unit, UCL Institute of Education, University College London.