At IIMHL and IIDL 2018, The Mental Health Foundation (Scotland) and The Scottish ACEs Hub hosted an inspiring leadership match: Transforming public mental health and wellbeing with Adverse Childhood Experiences (ACEs) related innovation. Denise Aylward of Pathways shares her experience.

Sara Dodds, adviser on adverse childhood experiences for the Scottish Government, with Dr Michael Smith and Sharon Doherty of NHS Scotland at the IIMHL leadership match in Glasgow.

 

The match

This exchange was a small leadership match with two people from England, two from New Zealand (Denise Aylward from Pathways and Fiona Trevellyn from Odyssey), and one from the United States. The host was Dr Michael Smith, associate medical director for the Greater Glasgow and Clyde region of NHS Scotland.

On the first day of the match, the local workforce from around Glasgow interested in ACE also joined the group for a day of presentations. Dr Smith started with a recap of the evidence from a Scottish point of view. 

About ACEs

Adverse Childhood Experiences (ACEs) are stressful or traumatic experiences that can have a significant impact on children and young people throughout their lives.

People with six or more ACEs die, on average, 20 years earlier than their peers. 

ACEs carry throughout the lifespan.

The 10 widely recognised ACEs, as identified in a United States study from the 1990s, are:

Abuse:

  • physical
  • sexual
  • verbal.

Neglect:

  • emotional
  • physical.

Growing up in a household where:

  • there are adults with alcohol and drug use problems
  • there are adults with mental health problems
  • there is domestic violence
  • there are adults who have spent time in prison
  • parents have separated.

The 10 original ACEs above now have an additional 10:

  • bereavement
  • bullying
  • discrimination
  • witnessing violence
  • lack of neighbourhood safety
  • frequent family money problems
  • food insecurity
  • homelessness
  • prolonged parental absence
  • parents always arguing and no good friends.

One of the strongest protective factors identified is the presence of a readily-available, trusted adult.

In Scotland, one in four children live in poverty and the Scottish Government has embraced ACEs research, developing national policy in this area. For them, the evidence is compelling – the case for action is a moral and financial imperative.

Actions needed for Scotland

Scotland has taken the following actions:

  • Integrated ACEs into the policy landscape.
  • Taken a multidisciplinary approach - the Scottish ACEs Hub includes Government, health, education, justice, police and local councils.
  • Engaged with elected members to win the commitment to change. A ministerial event was attended by first minister Nicola Sturgeon and her ministers and heads of government agencies to watch the film Resilience. For some, including the head of police, the reaction was profound and career-changing. The Scottish Prime Minister has also seen the film.

‘Getting it right every time, every child, every chance’

 

ACEs and the Scottish Government’s agenda for training

Dr Sharon Doherty at NHS Scotland is responsible for trauma training and is developing a knowledge and skills framework for the Scottish workforce called 'Transforming Psychological Trauma' within Government services to determine who should be doing what.

There are plans to develop and implement national and local training including training for leaders, publishing a training plan to support agencies and ensuring ongoing dialogue between Government and national and regional leaders.

Dr Doherty says all related workforces need to be cognisant of trauma and trained in varying levels of practice, depending on their work category. In addition she says support and supervision is also required for the various workforces. 

Policy documents

'Polishing the Diamonds': Addressing Adverse Childhood Experiences in Scotland, was Scotland's first major report on ACEs, published in 2016.

The Scottish ACEs Hub was established by NHS Health Scotland "to help inform and shape the actions identified in this report.”

A Nation with Ambition: The Government’s Programme for Scotland 2017-2018 was published last year.

The programme states, "Our focus on prevention and early intervention will:  target the earliest years of a child’s life to build strong foundations and reduce the number of adverse childhood experiences that we know have lasting impacts on our children and shape their lives as adults” (p. 12).

For more information, read the Scottish Government's factsheet on ACEs.

Next steps for Pathways in New Zealand

Denise reports that several years ago Pathways was one of the first NGOs in New Zealand to implement trauma-informed care, and is actively training staff on the subject.

During the past year, Pathways staff have participated in a number of workshops and conferences to promote and understand current trauma-informed care practice.

She says further review by the new Pathways clinical director and its business operations unit will strengthen the rollout of trauma-informed care nationally at Pathways.

The IIMHL and IIDL Leadership Exchange is supported by the Ministry of Health and Te Pou o te Whakaaro Nui.