The evidence base for routine enquiry into adverse childhood experiences: A scoping review

Ford, Kat; Hughes, Karen; Hardcastle, Katie; Lemma, Lisa Di; Davies, Alisha; Edwards, Sara; Bellis, Mark A

doi:10.1016/j.chiabu.2019.03.007

Cited by 84 publications

(72 citation statements)

References 41 publications

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“…As such, it is important not to assume that group differences in health measures across ACE scores are simply attributable to changes caused by the experience of ACEs. Third, the evidence that high ACE scores are associated with health outcomes is often interpreted to suggest that any individual with high ACEs will develop the outcome, thereby justifying the need for widespread screening for ACEs (Barry‐Jester, ; Ford et al, ; Hardcastle & Bellis, ; NHS Health Scotland, ). However, even the original ACE manuscript (see table 4 in Felitti et al ()) showed that most individuals with high ACEs (4 + ACEs) did not have any of the negative health outcomes measured and equally that most negative outcomes were observed in participants with no or low ACEs, given the higher prevalence of those groups.…”

Section: Resultsmentioning

confidence: 99%

Annual Research Review: Rethinking childhood trauma‐new research directions for measurement, study design and analytical strategies

Danese

2019

Child Psychology Psychiatry

121

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Childhood trauma is a key modifiable risk factor for psychopathology. Despite significant scientific advances, traumatised children still have poorer long‐term outcomes than nontraumatised children. New research paradigms are, thus, needed. To this end, the review examines three dominant assumptions about measurement, design and analytical strategies. Current research warns against using prospective and retrospective measures of childhood trauma interchangeably; against interpreting cross‐sectional differences in putative mediating mechanisms between adults with or without a history of childhood trauma as evidence of longitudinal changes from pre‐trauma conditions; and against directly applying explanatory models of resilience or vulnerability to psychopathology in traumatised children to forecast individual risk in unseen cases. The warnings equally apply to research on broader measures of adverse childhood experiences (ACEs). Further research examining these assumptions can generate new insights on how to prevent childhood trauma and its detrimental effects.

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Section: Resultsmentioning

confidence: 99%

Annual Research Review: Rethinking childhood trauma‐new research directions for measurement, study design and analytical strategies

Danese

2019

Child Psychology Psychiatry

121

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“…The rationale is that, since spontaneous disclosure of ACEs is uncommon, knowledge about ACEs can aid treatment (Read, Harper, Tucker, & Kennedy, ). There is little evidence in support of routine enquiry as yet (Ford et al, ), however various programmes now exist to encourage it, such as the Routine Enquiry into Adversity in Childhood (REACh) programme commissioned by Public Health Blackburn (RealLifeResearch, ). REACh trains practitioners, who have first line contact with adults presenting with risky behaviours and a range of health issues, to routinely conduct ACE questionnaires with their clients with the aim of responding appropriately and planning interventions.…”

Section: Application Of Aces Research To Clinical Work Public Policymentioning

confidence: 99%

Practitioner Review: Twenty years of research with adverse childhood experience scores – Advantages, disadvantages and applications to practice

Lacey

Minnis

2019

Child Psychology Psychiatry

256

220

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Background: Adverse childhood experience (ACE) scores have become a common approach for considering childhood adversities and are highly influential in public policy and clinical practice. Their use is also controversial. Other ways of measuring adversity -examining single adversities, or using theoretically or empirically driven methods -might have advantages over ACE scores. Methods: In this narrative review we critique the conceptualisation and measurement of ACEs in research, clinical practice, public health and public discourse. Results: The ACE score approach has the advantagesand limitationsof simplicity: its simplicity facilitates wide-ranging applications in public policy, public health and clinical settings but risks over-simplistic communication of risk/causality, determinism and stigma. The other common approachfocussing on single adversities -is also limited because adversities tend to co-occur. Researchers are using rapidly accruing datasets on ACEs to facilitate new theoretical and empirical approaches but this work is at an early stage, e.g. weighting ACEs and including severity, frequency, duration and timing. More research is needed to establish what should be included as an ACE, how individual ACEs should be weighted, how ACEs cluster, and the implications of these findings for clinical work and policy. New ways of conceptualising and measuring ACEs that incorporate this new knowledge, while maintaining some of the simplicity of the current ACE questionnaire, could be helpful for clinicians, practitioners, patients and the public. Conclusions: Although we welcome the current focus on ACEs, a more critical view of their conceptualisation, measurement, and application to practice settings is urgently needed. Researchers need to be clearer about their definitions of adversitywhat constitutes an adversity and what does not?Researchers should consider including additional ACEs other than the 10 frequently investigated ACEs from the Kaiser Permanente Study and justify these clearly.Researchers should explore the different ways in which ACEs tend to cluster cluster and, individually and together, predict outcomes Longitudinal studies are required, particularly those which are able to consider the co-occurrence, timing, frequency, duration and severity of ACEs, and which have high quality prospective ACEs data. Key practitioner messagesTwenty years of adverse childhood experiences (ACEs) research has shown a graded relationship between the number of adversities (ACE score) and health and other outcomes in many different populations, with important implications about the potential impact of ACEs in clinical practice, public policy and public health initiatives.

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“…Findings indicate initial support for the acceptability of ACE Enquiry among patients and practitioners, cautioning that further research and evaluation is needed before wider implementation due to a lack of supportive evidence (Hardcastle and Bellis, 2018), and concerns that it could be risky or unethical to use the approach with some patients (Quigg, Wallis and Butler, 2018). There is no evidential basis to support the wider rollout of ACE enquiry, with fundamental questions remaining about follow-up services being available for individuals affected, the limited scope of the standard ACE model, and whether the benefits of routine enquiry outweigh the financial costs (Finkelhor, 2017;Ford et al, 2019).…”

Section: Summary Of the Aces Model And Its Criticismsmentioning

confidence: 99%

The arrival of the ACEs movement in Scotland: Policy entrepreneurship and critical activist responses

Walsh¹

2020

Scottish Affairs

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This paper combines conceptual and documentary analysis to critique the recent introduction of ACEs (Adverse Childhood Experiences) in Scottish social policy, highlighting the role of the ACE-Aware Nation ‘movement’ and its positioning of the ACEs model through its campaigning activities. Consideration is given to the role of a sophisticated network of policy entrepreneurs and the commercial and political interests at play. Reflection is offered on the critical activist responses to this campaign that seek to highlight the socio-economic and political underpinnings of childhood trauma, which are largely absent in the ACEs model. The argument is that these policy developments amount to a recent turn to the ACEs model as a simplistic solution to complex social problems – a solution that is shown to be ultimately flawed in several respects. This analysis reveals the contradictions, conflicts and confusion that have emerged within the ACEs discourse, caused in the main by heuristic thinking and the conceptual inadequacies, misuses and misunderstandings of the ACEs model. The paper concludes that policy makers and practitioners should exercise caution in their appraisal of the ACEs model and the associated movement in Scotland.

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The evidence base for routine enquiry into adverse childhood experiences: A scoping review

Cited by 84 publications

References 41 publications

Annual Research Review: Rethinking childhood trauma‐new research directions for measurement, study design and analytical strategies

Annual Research Review: Rethinking childhood trauma‐new research directions for measurement, study design and analytical strategies

Practitioner Review: Twenty years of research with adverse childhood experience scores – Advantages, disadvantages and applications to practice

The arrival of the ACEs movement in Scotland: Policy entrepreneurship and critical activist responses

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