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.
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.
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.