Interventions to support people exposed to adverse childhood experiences: systematic review of systematic reviews

Abstract

Background: Adverse Childhood Experiences (ACEs) such as abuse, neglect or household adversity may have a range of serious negative impacts. There is a need to understand what interventions are effective to improve outcomes for people who have experienced ACEs. Methods: Systematic review of systematic reviews. We searched 18 database sources from 2007 to 2018 for systematic reviews of effectiveness data on people who experienced ACEs aged 3-18, on any intervention and any outcome except incidence of ACEs. We included reviews with a summary quality score (AMSTAR) of 5.5 or above. Results: Twenty-five reviews were included. Most reviews focus on psychological interventions and mental health outcomes. The strongest evidence is for cognitive-behavioural therapy for people exposed to abuse. For other interventionsincluding psychological therapies, parent training, and broader support interventionsthe findings overall are inconclusive, although there are some positive results. Conclusions: There are significant gaps in the evidence on interventions for ACEs. Most approaches focus on mitigating individual psychological harms, and do not address the social pathways which may mediate the negative impacts of ACEs. Many negative impacts of ACEs (e.g. on health behaviours, social relationships and life circumstances) have also not been widely addressed by intervention studies.

Factors Associated with Adult Mental Health Treatment Among Youth with and without Adverse Childhood Experiences from the 1997 National Longitudinal Survey of Youth

“…Importantly, our results suggest that adults who are seeking greater MH treatment are significantly more likely to have had adolescent ACEs. These findings support ongoing preventive efforts to identify and support children at risk for emotional problems, in addition to the provision of trauma-informed care to children and adolescents who have experienced or are at risk for ACEs (33). Our findings point to the need to evaluate policy efforts aimed at maintaining funding for public programs that support the healthy development of children and adolescents, especially those most at risk for mental illness and in need of treatment at an early age.…”

Forgotten Variables and Older Men in Custody: Negative Childhood Events, Forgiveness, and Religiosity

“…They advocated for interventions to be informed by neuroscience (e.g., trauma-focused cognitive-behavioral therapy). Lorenc et al (2020) analyzed 25 reviews of the effectiveness of interventions designed for participants aged 3–18 years and highlighted the value of additional research investigating mediating pathways that might mitigate the influence of negative childhood experiences. Thus, this study's findings provide additional evidence of potential targets for interventions aimed at improved well-being among incarcerated individuals, including self-forgiveness, social support, and religiosity.…”

Intersectionality: Social Marginalisation and Self-Reported Health Status in Young People

“…Multiple adverse events in childhood (ACEs) are associated with poorer long-term health outcomes, with a direct relationship between the number of adverse experiences and likelihood of inferior health outcomes [32,33] Many interventions to improve outcomes for people who have experienced ACEs focus on mitigating individual psychological harms [34]. Although adverse experiences in childhood and belonging to marginalised groups are clearly separate concepts, it is likely that adverse experiences occur as a result of being marginalised.…”

“…A shift in focus from individual harms-to disadvantage experienced by groups-may also shift the focus for the level of interventions. While addressing psychological harms commonly focusses on individual therapies [34], interventions for reducing social disadvantage and/or addressing its effects are more likely to involve public health approaches. For example, public health interventions to improve outcomes for gender and /or sexuality diverse young people may involve addressing homophobia and transphobia in communities, rather than providing individuals with psychological support [39].…”