Evidence
Alert

What support do young people affected by adverse childhood experiences need?

Adverse childhood experiences include physical or sexual abuse, neglect, and living in a household with domestic violence or substance misuse. A key public health priority is to reduce the long-lasting and negative impact of these experiences on someone’s mental and physical health.

To help inform future policy in this area, the Department of Health and Social Care (DHSC) commissioned a review of the services currently available. The DHSC review also gathered research on people’s experiences of the services. This part of the review, in which people describe the support they received and they support they needed, is reported here. 

Researchers analysed information from 20 studies. People were looking for emotional and practical support to fill the gaps left by their childhood experiences. They valued service providers who displayed empathy, were non-judgmental, and were active listeners. Supportive relationships, especially with adults, were a key factor in feeling understood.

The findings underline the importance of improved understanding of the types of support this group of people require and should receive. Satisfactory support encourages people to have meaningful long-term engagement with services. 

This research will be of interest to policymakers and practitioners working across education, health and social care. It provides a set of guiding principles that inform future best practice.

What’s the issue?

Adverse childhood experiences cause direct harm to the child or affect the environment they live in. They include physical, sexual or emotional abuse; neglect; domestic violence at home; homelessness or living in care; parental mental health problems or substance abuse; and a parent who had died. 

Almost one in two adults in the UK has been exposed to at least one adversity during their childhood. Many have experienced different types of adversity. 

These adverse experiences affect people differently and their impact is complex. But young people who experience them are at higher risk of poor mental and physical health outcomes, and even early death, compared with those who have no such experience. One large study suggests that almost one in three mental health conditions diagnosed in adults is directly related to an adverse experience in childhood

This study explored the kinds of services that these young people feel they need. This understanding will inform future public health policy with the aim of reducing the long-term harmful consequences of these experiences on people’s lives.

What’s new?

The new study reviewed evidence from UK qualitative studies, published since 2008. The studies included young people exposed to adverse childhood experiences when they were between three and 18 years old. They may not have accessed services until later.

A total of 20 studies exploring the views of young people on their support needs were included. Each study focused on a specific adverse experience, with almost half involving young people who were fostered or cared for.

The synthesised findings were grouped into three themes, according to the types of services needed, and how best they could be delivered. 

1. Emotional support

    • Interactions with other young people gave rise to a shared sense of solidarity and for some was an invaluable source of support. But stigma and shame prevented some young people from building relationships with their peers.
    • Supportive relationships with adults helped them engage effectively with services. Adults could be foster carers, health and social care workers, therapists, teachers, or other professionals. The adults needed to display empathy, be non-judgmental and an active listener. Some young people said professional adults need a genuine sense of caring and ‘not just some act they’re putting on’.

2. Practical support

    • Information about the services available, including details of professionals they could approach, was valued. This included services for their parents’ mental illness where applicable. Or, for those who had lost a parent, information about how they might experience grief.
    • Practical advice to help them manage everyday challenges such as housing and money, completing forms sent to families by schools, and the benefits agency. 
    • Respite from the challenges they faced through recreation (music, sport, and doing something completely different) relieved stress and provided opportunities for socialising.

3. Service delivery

    • Continuity and a dependable service helped young people to trust professionals, which was essential for them to develop effective relationships. Many had been let down repeatedly, and experienced rejection and abandonment. They did not want to describe their experiences to a stream of new workers.
    • Flexibility and control over how they were supported helped young people engage with services and manage challenges. For example, they appreciated services using texts, as this allowed them to stay in touch on their own terms. They wanted to be involved in decisions, especially about where they were going to live. They criticised services for being process-driven and not designed with service users’ needs at heart. 

Why is this important?

These findings will help to inform the design of services to better meet the needs of people who have had adverse childhood experiences. There was wide variation in the nature of the childhood experiences, but the young people affected had common needs from services.

The larger study included an evaluation of the effectiveness of interventions to support this group. It highlights areas of mismatch between people’s needs and the types of support they are offered. It points to the need for emotional support from a trusted adult or through peer support, for example via group therapy. Adequate time, flexibility and control over how and when they engage with service providers are important in gaining the trust of young people. 

Many interventions are short-term, lasting just a few weeks, and focus on addressing individual mental health outcomes. However, people affected by these adverse experiences describe the importance of stability and continuity in the support they receive. 

What’s next?

It will be important to evaluate longer term interventions to empower young people who have had adverse childhood experiences. They need early support and help to build life skills.

Future research could examine how to encourage meaningful engagement with services. For example, exploring the service needs of young people living in poverty and affected by adverse childhood experiences. This is particularly relevant considering the known health inequalities in the UK, which are likely to have widened during the COVID-19 pandemic.

You may be interested to read

The full paper: Lester S, and others. Service needs of young people affected by adverse childhood experiences (ACEs): A systematic review of UK qualitative evidence. Children and Youth Services Review 2020; 118:105429  

The report commissioned by the Department of Health and Social Care (DHSC): What helps to support people affected by Adverse Childhood Experiences? A review of evidence

A blog from the Evidence for Policy and Practice Information and Co-ordinating Centre: Involving young people with lived experience of adverse childhood experience (ACEs) in a systematic review

A handbook produced by Young Minds: Addressing Adversity: Prioritising adversity and trauma-informed care for children and young people in England

 

Funding: This research was funded  by the NIHR Policy Research Programme (PRP) for the Department of Health and Social Care (DHSC).

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Commentaries

Study author

Young people who have had adverse experiences in childhood value support from somewhere beyond their household or care. The opportunity to talk to other people going through similar experiences, or with someone a bit older cannot be underestimated. It can provide them with more perspective and help them to cope better. Without someone to turn to for guidance or to talk about these serious issues with, these problems can become much worse.

Most of this is around building trust – it’s about the nature of the relationship and allowing the time for it to develop.

Sarah Lester, Research Officer, Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre), UCL Institute of Education, University College London 

Action for Children 

We want every child to get the best start in life but sadly our frontline workers see too many young people for whom that is not the case. Whether they are living in poverty or living in a home with domestic abuse, struggling with their own mental health or seeing their parents struggle it’s deeply worrying that so many are not having the safe and happy childhoods we would all want them to have.

Adverse childhood experiences can cast a lasting shadow over the lives of children and young people, that is why it is crucial they receive early help and support. As the pandemic eases, the Government must urgently invest in children’s centres, family hubs and other services to give children the support they need.

Imran Hussain, Director of Policy and Campaigns, Action for Children

Lived Experience 

As a service user with a significant trauma history and Complex Emotional Needs (CEN) myself, I recognise a lot of parallels between these findings and important features of services for people with CEN, where continuity and flexibility are paramount. Regardless of diagnosis, almost all service users benefit greatly from a compassionate, non-judgmental approach to care in addition to support for their practical needs. However, especially considering the basic nature of such care needs, it is really disappointing to see that services continue to struggle to meet them.

All care must be individualised, as there simply is no one-size-fits-all approach. Two people with the exact same diagnosis or whose adverse childhood experiences (ACEs) would fall under the same category can have completely different experiences and resulting needs.

This research highlights the crucial role that flexible, person-centred approaches and a trusting therapeutic relationship that is carefully developed over time play in mental health care. Problems arising from years of adversity can’t possibly be expected to be ‘cured’ overnight, but need time and compassion to heal.

I hope this study will help shape policy and ultimately improve the care and support that services provide for people who have had ACEs.

Eva Broeckelmann, Public Contributor, London 

Psychologist

I hope these findings will increase understanding of the needs of this neglected group. We need to make more determined efforts to provide ongoing support and continuity of care.

Young people in this position desperately need help from someone they trust who is prepared to continue the relationship for as long as they need support. This is likely to be for years, rather than weeks or months. So it might help to consider setting up a system of volunteers with suitable backgrounds who are prepared to make this sort of commitment. They should have their expenses covered and be supervised by the statutory services.

Chris Bennett, Independent Research Psychologist