ACE Support Hub Annual Report English

ACE SUPPORT HUB ANNUAL REPORT 2018 – 19

WELCOME Welcome to our 2018-19 annual report, celebrating highlights, impact and achievement from over the past year.

The surge of energy and passion in applying the ACE knowledge to practice in public and third sector services over the last year motivates us at the ACE Support Hub to further challenge attitudes, hearts and minds to push this trauma informed and citizen focused revolution as far as we can take it.

Education, youth work, housing and the police are leading the charge, examples of which are highlighted in this report. As facilitators of learning, we have been continually inspired and led by the feedback from across sectors and communities to hone the relevance of the agenda to the wellbeing of the people of Wales.

There is much to do, but this report gives us a chance to think about how far we’ve come and on the shoulders of some giant strides taken by those highlighted here we go on.

We are proud to say we are making Wales a world leader in tackling, mitigating and preventing ACEs.

Jo Hopkins Director of the ACE Support Hub I have immensely enjoyed my first six months as Director of the ACE Support Hub, and am delighted to publish an annual report that reflects the good work that has gone before, but also gives a sense of our direction, priorities and impact as we move into delivering our plan for 2019/20. I have been impressed by the commitment, drive and passion that so many of you have for taking this agenda forward, not just to increase awareness of Adverse Childhood Experiences, but making the transformational systems changes that will have the real impact on peoples’ lives. I am constantly inspired by the amazing stories of trauma informed practice, leadership, inclusivity and compassion.

I hope we have captured some of that here, but do have a look at our website for more information on campaigns, events and the evidence that supports the impact our work is having.

I am proud of our small team of eight committed individuals who are helping to transform the housing, education, sport and youth sectors and embed the approaches for future generations. I look forward to working with established and new partners, including the police and Early Action Together programme. The social movement is gaining strength and momentum and I look forward to continuing that this year and into the next phase of this work.

Matt Jukes Chair of the Advisory Board As Chair of the ACE Support Hub Advisory Group, I am delighted to introduce this annual report and reflect on just how much progress the ACE Hub has been made this year in delivering against the plans for delivery that had been set out. This is not just a question of checking off points on a programme. We’re now seeing the real meaning of this work on people’s lives. The education training you can read about at page 8 has helped achieve a reduction in exclusions where it has been rolled out.

Across a range of services, awareness of ACEs is already leading to more engaged and emphatic policy and practice.

But the evidence of the harm caused by ACEs shows how far we have travel. We must continue to work collaboratively with partners such as the Early Action Together programme towards our joint vision around ACEs in Wales. The ACE Hub’s role in offering strategic direction, influencing and enabling sectors is now coupled with the Early Action Together programme, operationalising ACEs knowledge and research within the policing and criminal justice sectors. Several other sectors have seized their own opportunities, as reflected here in examples such as the housing sector. For example, through implementing a psychologically informed environment, Taf Housing have seen a 33% reduction in violent incidents and an 84% reduction in the number of incidents requiring police intervention.

The message of this report, despite its focus on trauma is optimistic. We can make a change. We can focus not just on having responsive services but on growing resilience and preventing harm to future generations.

www.wlga.wales @Welshlga

Cymdeithas Llywodraeth Leol Cymru Chris Llewelyn Tracey Cooper Chief Executive of Welsh Local Chief Executive of Public Welsh Local Government Association Health Wales

Government Association

We are delighted to introduce the ACE Support Hub’s Annual Report, reflecting on what has been a fantastic year of trailblazing work to progress the creation of an ACE-informed Wales. The ACE Hub has led the way in facilitating learning across sectors in our public and third sector services, applying the ACE knowledge to practice to improve the health and wellbeing of people in Wales.

Through the ACE Support Hub’s collaborative partnerships with the First 1000 Day programme, and with the Early Action Together Programme to create an ACE-informed policing and criminal justice Dr Chris Llewelyn system in Wales, we have seen fantastic momentum to improve our early years and give children the Prif Weithredwr | Chief Executive best start in life. Whilst as a nation we are young in our action on ACEs, it is humbling to already see the results highlighted in this report.

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Fe gafodd Chris Llewelyn ei eni a'i fagu yng Nglanaman, Sir Gaerfyrddin. Mae e'n byw bellach mewn pentref cyfagos, Garnant, gyda'i wraig Julie a'u tri mab, Morgan, Macsen ac

Chris Llewelyn was born and brought up in the village of Glanaman in Carmarthenshire. He now lives in the neighbouring village of Garnant with his wife Julie and

ALL ABOUT ADVERSE CHILDHOOD EXPERIENCES Adverse Childhood Experiences (ACEs) are traumatic experiences that occur in childhood and are remembered throughout adulthood.

These experiences range from suffering verbal, mental, sexual and physical abuse, to being raised in a household where domestic violence, alcohol abuse, hostile parental separation or drug abuse is present.

WHAT IS THE ACE SUPPORT HUB FOR? The ACE hub has been established to help tackle ACEs. We help create the environment for change and support individuals, communities and organisations to help create an ACE aware society.

PREVENT ACEs from occurring in children’s lives

SUPPORT EARLY INTERVENTION when children are experiencing ACEs to minimise their impacts

THINGS THAT WE BELIEVE IN ARE:

1

PROMOTING AND BUILDING RESILIENCE

2

CHALLENGING STRUCTURAL INEQUALITIES

3

THE POWER OF RELATIONSHIPS

4

BEING INCLUSIVE TO ALL COMMUNITIES

5

PROMOTING KIND AND COMPASSIONATE SERVICES AND SOCIETY

BUILD RESILIENCE in adults who have experienced ACEs to stop them being passed on through generations.

OUR FOCUS: Spreading information and knowledge about ACEs

Sharing evidence about what organisations can do differently to help prevent and mitigate ACEs

Developing knowledge and skills amongst professionals

Pull learning from individuals, communities and organisations and share it

Drive change and system transformation at local and National levels.

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HOUSING STRIDES TOWARDS A TRAUMA-INFORMED SECTOR

With on-going funding from Welsh Government, the support of Cymorth Cymru and some amazing trainers, to date nearly 1600 Housing and Homelessness staff across Wales have been trained in PATH (Prevention, ACEs, Trauma, and Homelessness).

The training teaches staff about the impact of attachment and trauma, helping them to create and discover how to be psychologically informed in their practice and how their organisation can be trauma informed so as to prevent homelessness.

Welsh Government support PATH, which is recognised as contributing to the prevention of homelessness both through reductions in evictions and helping exercise the duty to prevent under the Homelessness Prevention Act.

The work is beginning to have a tangible impact on the sector, changing language and attitudes, from blaming and shaming, to compassion and curiosity, even influencing other sectors, such as substance misuse, mental health and children’s services who are asking for similar input.

Most impressively, commissioners and leaders are using the knowledge to transform the system of service delivery, describing it as “completely amazing and transformational” and “ really useful and insightful, we now have a reference point to ensure Psychologically Informed Environments (PIEs) is a benchmark*” (*leaders and commissioners interviewed at least 6months post training)

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ACE PRACTICE IN HOUSING: Jackie Amos, Executive Director of People and Places, Taf Housing – “The creation of PIEs in our supported accommodation for homeless young women has transformed our service delivery.

60% Nearly 60% of the young women we work with have 4 or more ACEs and so we knew that we had to take a trauma-informed approach if we really wanted to be serious about helping to make a difference in their lives.

We undertook PATH training, reviewed our staffing structures, policies and procedures, stripped out our house rules and warnings processes and began working with a psychotherapist to ensure that our staff are also emotionally safe and well.

33% Within 3 months of implementation, we saw a 33% reduction in violent incidents

84% and an 84% reduction in the number of incidents requiring police intervention.

Of course, this can fluctuate as young women move in with us and begin to trust and feel safe enough to begin to change behaviour that has helped them survive, however harmful that behaviour was, but we know now that this approach is the one that will help get them there in the end.

We have decided as an organisation that a psychologically informed approach isn’t something you do, it has to be something you are that informs all our decisions and relationships. We have now begun to implement it right across the organisation and are already seeing the benefits that it brings, beginning with a review of our approach to dealing with anti-social behaviour in our general needs housing which is now seeing satisfaction levels at 95%”.

WALES & WEST HOUSING Sarah* has been a resident with Wales & West Housing (WWH) since 2015. She was living in a one bedroom general needs flat. With no close family or friends, she displayed behaviour that some found challenging. She spoke openly about her life to anyone who would listen. The abuse that still pains her was difficult for many to hear. She was often avoided by residents who didn’t or couldn’t listen to her. She didn’t trust men.

Concerns about Sarah’s welfare grew after Christmas 2015. On return to work following the 2-week Christmas break, Sarah appeared to have lost weight and was anxious and agitated.

She hadn’t enjoyed Christmas, and had spent it alone. WWH staff didn’t know what to do; they were not ‘experts’ and referred Sarah to the GP and other services that might help, as had been done many times before. Sarah was well known to the services. Even following staff concerns, the GP was unable to help, and the situation seemed to be going around in circles.

So, WWH staff regrouped. By understanding Sarah’s journey so far, they realised that although they knew all about the presenting issues, the problems, the complaints, they really didn’t know Sarah very well – if at all. What was life like, looking through Sarah’s eyes?

They set about having a conversation with Sarah – no forms, no structure and no agenda, building rapport and asking different questions. Sarah spoke openly about her troubled life – this was no different, but at one point, Sarah addressed a time in her childhood that wasn’t so painful; the staff asked about that time:

Tell us more about this? What was it that made you feel good?”

Were there any other times that made you feel like this, that made you happy?”

Sarah’s happier times helped establish the beginnings of ‘What Mattered’.

• “I want to feel safe” • “I want to be in X area – somewhere I am familiar with” • “I want to be with other people, and share meals and activities with them” • “I want to enjoy going outdoors, in the garden” WWH explored options to help Sarah achieve what mattered to her. Heads of Services were sceptical at the start, but reassured when staff shared Sarah’s journey and what mattered.

Sarah was introduced to a retirement scheme that would give her everything that mattered. It was difficult at first and it took residents a while to get used to Sarah, within a year however, Sarah had settled well, she had developed good relationships with the other residents. Sarah put on weight and was less agitated - she even laughs now.

(*names have been changed)

Changing the focus from the presenting issues/problems to concentrating on the person and ‘what matters’ brought many learns and lightbulb moments for staff at all levels.

• Staff assumptions that bringing in an ‘expert’ is the solution • Referrals/Assessments were not necessarily the fix for Sarah • Staff taking/having time to listen • Getting better at asking good questions • Active listening skills • Confidence in having the right conversation • Understanding the right problem to fix WWH realised they may not be able to ‘fix’ people’s mental health, but by understanding what matters to a person, helping them to realise their goals/actions, they can solve management problems. This can then turn off failure demand and be cost effective for the business.

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EDUCATION STRONG, INCLUSIVE, TRAUMA-INFORMED SCHOOLS

Our ambition is for every school in Wales to be a strong, inclusive and trauma-informed, helping children to flourish and have the best start in life.

We are supporting this by delivering training to make the school environment ACE aware, and then able to confidently respond to trauma, in line with the Welsh Government aim to ensure pupil inclusion, well-being, behaviour and attendance, directly supporting the development of the whole school approach.

Q

A

So far, over 309 ACE Ambassadors (champions for driving the ACE agenda forward in schools), teachers and schools leads have been trained, 140 Estyn inspectors and challenge advisors, and 95 ‘Train the Trainers’.

This is having a substantial impact on the sector, leading them to create more nurturing environments in schools, transforming processes to reduce exclusions and improve well-being.

Children are feeling happier, included and welcome, with kindness and compassion are at the forefront of school practice and behaviours.

What’s more, Estyn have started visiting schools for thematic reviews on trauma informed practice, which will further drive systems change and embed traumainformed culture.

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ACE PRACTICE: SHINING A LIGHT ON TRAUMA-INFORMED SCHOOLS

PENCOED COMPREHENSIVE Pencoed Comprehensive in Bridgend recently reported a drop of the number of days lost due to exclusion. In the school year immediately post training this was a 57% reduction (but there may have been exclusions in year prior to the training completion); the following year it is 48% (compared with pre training exclusion days).

Pencoed Comprehensive consider themselves to be on a journey to becoming a trauma-informed school, and are taking all school staff with them. They feel that the training has strengthened the empathy, professional knowledge and practice of a core group of staff towards their learners.

Pencoed have established a number of projects and practices alongside their increasing confidence as a school in responding to the needs of learners impacted by ACEs, including a much sharper focus on building and supporting learner resilience. The biggest change is the strengthening of the pastoral team which is planned for September 2019, along with the implementation of the ‘Pastoral Hub’ for the summer term. This will be a revolving door for pupils who, because of pastoral issues (ACE’s), are struggling to access the curriculum. Pupils can be self-referred or referred by the pastoral team. All of Pencoed’s feeder schools and selected governors are ACE Informed also.

LLWYN YR E OS PRIMAR Y SCHOOL

Llwyn Yr Eos Primary Scho ol in Aberyst school demon wyth is a strating a who le school appr doing amazin oach, and g things with limited reso have on-site urces. They nurture unit based in a st funded thro atic caravan ugh the scho ol budget, an unit funded d a sensory through dona tions. Many have worked of the staff at the school for many year through the s funded Pupil Depriva tion Grant, an invested in su d are heavily pporting the children and in the comm their families unity to ensu re that child supported an ren attend, ar d are given th e e best start in life.

Everything ab out the scho ol is focused The staff are on wellbeing aware of the . si tuations the face – the re children cognised ACE S as well as th community e wider context and some of the social factor challenging s. This year, they have se recognised an en their effor d rewarded ts

by Estyn insp gave given th ectors who em ‘excellent ’ for wellbeing and guidance and support categories (a ll other catego still good!) W ries are hat the repo rt does not sa is that their y still though ethos and tr auma inform working over ed way of the last 17 ye ars, their incl engagement usivity, their with parents and the com meant that de munity, has spite taking ex cluded child have not had ren, they one exclusio n in the 17 ye head teache ars that the r has been in post.

They do not single out th ose in care, or been previous who have ly excluded; they include children in w all of the hat they do an d base their the needs of approach on the child. It is a fantastic exam trauma resp ple of a onsive enviro nment.

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YOUTH CREATING AN ACE AWARE YOUTH WORKFORCE FOR WALES

For the youth services sector, the principles and learning of the ACEs agenda isn’t necessarily new. This workforce is often at the forefront of dealing with and responding to trauma, and has long recognised the links. Our aim within this sector was to raise awareness of the ACEs research to build a shared language and approach to traumainformed care, and to create a community and work force that is ACE aware.

In partnership with the Youth Justice Board, Theatre Director Jain Boon and The Council for Wales of Voluntary Youth Service (CWVYS) the ACE Support Hub has developed a free ACE Awareness training course for practitioners working in youth and youth justice services across Wales.

The training aims to raise awareness of ACEs, their impact on behaviour, and provides practitioners with a range of tools to support resilience and self-regulation, to enable staff to train others.

Our youth workforce advisory group brings greater depth to youth work and the youth offending workforce in relation to ACE focused work. It also provides sector knowledge and expertise and support the hub to engage and communicate with these sectors.

Training days were attended by 100 participants (25 people at each session) and targeted at a range of youth work professionals from across Wales. With increased knowledge and confidence, youth workers feel more able to incorporate ACE principles into their services.

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Youth workers feel an increased value and recognition for their existing experience and knowledge in supporting ACEs, and feel that ACEs knowledge has given them a common language and approach to trauma informed care and a desire to further link services.

Participants valued being introduced to a toolkit to practically apply their learning to take an informed strength-based approach to responding to trauma. The next step is to ensure buy-in from senior management is necessary to implement significant systemic change to an organisation.

SPORT BUILDING RESILIENCE AND MENTAL WELLBEING IN INDIVIDUALS, AND COMMUNITIES

Sport is key to building community for those who may feel isolated, and supporting resilience and protective factors. The Wales ACEs research specifically commends the impact of sport on friendship opportunities, benefits to mental health and access to role models.

We have been working with a number of the National Governing Bodies and key partners across the sports sector in Wales such as Wales Rugby Union and Sport Wales to further consolidate its role in supporting people and being inclusive for everyone to realise the benefits of sports participation, regardless of ability.

Thanks to the appetite from the sport sector to link up with the ACEs agenda, we have delivered an ACE awareness session to Sport Wales Mid and West Wales, and we co-facilitated training for Street Games Wales and members of national governing bodies.

We have held an ACE awareness day in conjunction with the Wales Rugby Union for sports sector leads and interested partners to develop collaborative working around ACES, sport and resilience.

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TRANSFORMING SYSTEMS CHANGE Public Services Boards (PSBs) have a pivotal role in driving systems change as set out in the Wellbeing of Future Generations Act (2015).

19 PSBs were established to bring together local organisations and strengthen the way they work together to improve the well-being of the people in each local authority.

Each of the 19 PSBs have ACEs as a priority in their wellbeing plans and are making the shift from being aware of ACEs, to embedding trauma-informed practice.

We held a national event, attended by 60 PSB members from 14 PSBs from across Wales.

The objective was to introduce them to systems thinking so as to apply this to how they are seeking to achieve the objectives set out in their wellbeing plans to tackle ACEs.

ACE PRACTICE: MONMOUTHSHIRE PSB This work enabled us to think differently about what we are doing:

1

We have since scrutinised the impact our current services are having on people who may have experienced ACEs

2

Where we know people have ACEs and we have services in place, we have thought about what more can we do to connect people to the right service at the right time?

This ignited many great ideas and instead of new services, it was about different, trauma informed services and ways of working

3

What was most striking was the impact the whole community can have in mitigating and tackling ACEs and we have plans to raise awareness and skill levels across ALL communities in Monmouthshire so they can make a difference (without necessarily the need for service involvement)

This exercise was hugely helpful in the revolution happening in Monmouthshire� at the bottom of the PSB page

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“

We drew together PSB members and a mix of strategic and operational leads from across the county to a ‘systems thinking event’ where we were challenged to apply an ACEs lens to our current ways of working to help us develop a robust plan for tackling ACEs locally”

FINANCIAL STATEMENT The Hub is a key contributor in helping the Welsh Government to deliver on its commitment to develop ACE aware public services, which take a more preventative approach to ACEs. Welsh Government has provided three-year funding, totalling £1.2m for the establishment of the Hub. 2018/19 was the second year of this funding. Indirect funding of £116k also comes from Health and Social Services via Public Health Wales.

£

£

£ £

£1.2 MILLION for the establishment of the Hub.

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SKILLS AND KNOWLEDGE ACES: KNOWLEDGE IS POWER

Wales has big ambitions to become a world leader in tackling, mitigating and preventing Adverse Childhood Experiences (ACEs). To achieve this, we must all be aware of ACEs, what they mean for us as individuals and everyone around us, and understanding our unique role in tackling them, both in our professional and personal lives.

Our skills and knowledge workstream is ever-evolving, and we have developed a range of products for organisations to implement into their work, learning from the needs of sectors we work with and evaluation of our work as we go.

The ACE Support Hub has coproduced a Skills and Knowledge Framework that will help all of us in Wales to understand our part in tackling and preventing ACEs, alongside an ACE training prospectus.

It will help us to challenge ourselves to think, “What can I do differently?”, and recognise what we’re already doing. The framework relates to everyone, not just frontline workers

and practitioners supporting people affected by trauma, to recognise that the impact of ACEs is widespread and affects people at all ages, across all walks of life.

Our vision for the ACE Skills and Knowledge is for it to be part of an organisation toolkit; a suite of resources which support organisations to become ACEinformed, or become more ACEinformed.

OUR LEARNING One of the great things about the ACE Hub’s evaluation methodology is its ability to adapt, recognising the need to change when something isn’t working. We are moving away from generic training in favour of the sector-led approach, a more sustainable approach for training delivery that is co-produced by the sector and generates improvement activity relevant to their services and the system in which they operate in order to be fully embedded into their sectors and organisations.

EDUCATION

HOUSING PATH TRAINING

• 1

ACE recognition

• 1

Foundation

• 2

Recognising trauma, responding appropriately, developing resistance

• 2

3-days

• 3

PATH approach to becoming an ACEInformed school

• 3

Leadership

YOUTH

MULTI-AGENCY

• 1

Creating an ACE Aware Youth Workforce

• 1

Introduction to ACEs (E-learning package) Under development

Creating an ACE Aware Youth Workforce Train the Trainer

• 2

ACE Awareness presentation

• 3

1-day ACE Informed (Train the Trainer)

• 4

ACE-Skilled Under development

2

•

CULTURE AND LEADERSHIP

CLARITY AND CONFIDENCE

RECOGNITION AND RESPONSE

FOLLOW UP AND MONITORING

• Principles for ACEInformed organisations

• ACE Skills and Knowledge framework

• Training / Professional Learning

• Readiness toolkit

• Skills Audit / LNA tools

• Implementation Action Plan

• Peer review, monitoring and improvement

• Training / Professional Learning

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COMMUNICATIONS Our communications ethos has always been about positive, continuous, inspiring, and motivational messaging around ACEs and what helps to build resilience, capturing the momentum of the work happening in Wales.

We publish, promote and encourage information exchange, and have created online spaces for people to connect and share. By converting evidence into shareable content, we strive to help people and organisations learn and understand what truly ACE aware and trauma-informed organisations look like.

In March 2019 alone,

4,565 different people logged onto our site. In the last year, resources from our Knowledge Hub have been downloaded over

5,000 WEBSITE We launched our ACE Support Hub website: www.aceawarewales.com in July 2018.

Nine months on, our website plays a vital role in ACE Hub communications.

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times, our Blog has become one of our most visited pages, with over

8,000

views.

OUR PRINCIPLES

TWITTER Our Twitter account plays a vital role in the spreading and sharing of messaging surrounding the work happening in Wales. Followers feel that it is a useful, positive, inspiring and motivational account to follow, with a phenomenal growth of 3,400 followers within 12 months* (*Taken from a sample surveyed in October 2018.)

RESOURCES

FACEBOOK Our closed group Facebook forum has 250 members from both general public and professionals. It is, for many, a space for connecting with other individuals who are passionate about tackling ACEs in Wales.

There is a consistent, high demand for resources, video and articles from a growing number of website visitors. And there’s still scope for improvement, we want to keep improving the design and functionality, making our website a more personalised experience for its visitors.

We’re human, social and helpful

We’re visual, using imagery and video to tell stories and build emotional connections

EVENTS INSTAGRAM We’re on Instagram @acehubwales

We have held ACEs in Practice events across Wales which have been open to attend across sectors with a varied and diverse agenda to suit all needs. These events helped us to demonstrate the impact of the ACE Hub by showcasing the sectors we have worked within.

96% At our Mid- West Wales event, 96% of attendees felt that the event had inspired them to take action going forward.

PR AND MEDIA Coverage from BBC Wales Good Morning Wales dedicated more than 17 minutes to ACEs, including live interviews from our Education Sector Lead Sian Griffiths and Hub Director Jo Hopkins, plus a pre-record interview with Professor Mark Bellis.

We celebrate success stories

We talk about serious issues but we are optimistic and excited for change

We’re positive, we inspire and motivate

We’re inclusive, building a team, a movement. We start a conversation and encourage the sharing of ideas

SUSTAINABILITY

1 Embedding ACEs learning into youth work qualifications and professional learning for teachers.

2 We will continue to explore broader opportunities for embedding learning about ACEs and ACE-informed practice through work planned with creating ACE aware higher education, further education and other ‘post 16 education and training’ settings.

3 We will work with key areas of policy to embed ACES in the critical strategies and Welsh Government.

LOOKING TO THE FUTURE Public awareness campaign launching in June 2019

Engagement with wider experiences of communities

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Sports sector co-produced training

Sector specific work with health (NHS) and social care to identify key areas of focus to support, and aligning with key developments around integrated services.

ACE informed organisations implementation / Becoming ACE-informed toolkit

National baseline survey of ACE awareness mapping among professionals

An integrated approach to developing the higher education / further education sector to be trauma informed and support skills development and course content

Inform public policy and process development and work with key areas of policy to embed ACES in the critical strategies and Welsh Government.

ACE specific work to strengthen work to tackle adverse experiences in adulthood that impacts on children

Roundtable events to focus shifting the narrative from awareness to institutional and societal change

ACE Support Hub: Get in touch ACE@wales.nhs.uk @acehubwales /acehubwales/ @acehubwales