‘When washing your hands will not break the chain of infection’

‘When washing your hands will not break the chain of infection’ – what is our response to ACEs in COVID 19?

As we all become accustomed to a new way of life, now being termed by many as a ‘new normal’, most of us are thinking that this is the first, and hopefully the only time we experience a pandemic in our lifetime; lack of freedom to move, confined to our houses, limited access to services or support are all things that we are now experiencing. But we are also proving that kindness and compassion is something that can be awakened in our communities. Or perhaps it was always there but just needed a pandemic to kick start it into systemic action; volunteers and communities are pulling together across Wales to identify and reach the most vulnerable in a number of ways. Social media is playing a huge part of course but so are more traditional methods of leaflet dropping, phone calls and in my case yelling over my garden fence ‘I know we haven’t met yet but my name is Jo….’in 10 minutes I learnt more about my neighbour than I think I would have ever done in a year in different circumstances.

But many of us are not only thinking of COVID 19 as a medical emergency related to the spread of a flu. With services geared up to dealing with ‘high risk’ rather than need, and in many cases reliant on grant funding to deliver, the system is not as yet configured to deal with the things that are already of epidemic proportions in our society and all others across the globe, or perhaps to respond to the change in need/demand when we come out the other side. We are already seeing evidence from China, Australia and France that domestic abuse will increase whilst we are confined to our homes. Given that prior to this we know that 1 in 4 women and 1 in 6 men will experience domestic abuse in their lifetime, we are already at epidemic proportions and have been for many years; underpinned by systemic structural inequality. In November last year the BBC reported that there had been an 83% rise in domestic abuse-related crimes recorded in Wales over the past four years 1 and although attributable to better recording and confidence to report the message is clear – this is bigger than we know. Our response to the COVID19 pandemic is bringing to the fore the other pre-existing pandemics in our society that we do not have a ’20 second hand wash’ to break the chain.

And it’s not just domestic abuse, although that seems to be where there is initial evidence to support the assertion of a rise2. Calls to ‘Childline’ have also increased; children are anxious

1 https://www.bbc.co.uk/news/uk-wales-50565513 2 https://www.theguardian.com/society/2020/mar/28/lockdowns-world-rise-domestic-violence

and looking for support3. Initial numbers suggest that girls aged between 12 and 16 are calling the most with concerns for their emotional wellbeing. It is unclear whether they are looking for support because they can no longer access services they had previously relied on, or at a time of heightened fear, the confinement with family is exacerbating their experience. Children growing up in households where there are Adverse Childhood Experiences may see these intensify as we all try and cope. Taken away from supportive structures such as schools, friends and confined with adults trying to manage their own coping strategies for increased financial concerns, relationships that are coming under strain or existing issues that are becoming more difficult to manage. Food poverty as families struggle to cope to feed their children4 is still something people find hard to ask for help with, ashamed that they are unable to provide for their children without free school meals.

Single parents, juggling the care arrangements for children or finding themselves 24/7 with children with additional needs that would otherwise have access to school or support. And young carers often holding the family together in environments that now have become significantly more challenging, taking an adult role as a child. We have not experienced this before – we need to look at what the evidence is telling us about what’s happening.

But the incredible social movement that has emerged in many of our communities, far faster it seems than government responses and now integral to them, brings an opportunity to look for ways to break these enduring chains that mean that over half the population of Wales will have at least one Adverse Childhood Experience in their lifetime 5. The ACE Hub has worked with a range of incredible people in Wales; third sector and charities, influencers and leaders from the community, a range of public and private sector organisations and individuals who can pull together to make transformative things happen.

As we do all we can to stay home, support the NHS and our most vulnerable, we are also turning our minds to what we need to do to respond to the increased adversity and removal of protective factors such as trusted adults, such as grandparents who are being shielded, to cultural and community connections through faith or sport, or emotional self-regulation at a time of heightened fear. We are seeing an immediate response to the expected increase in DA – strong messages have already been sent by the police that they will come through the door if they are called in domestic abuse cases. We need to build on what we know from developing ACE aware, trauma informed services across Wales to understand what we need to do; and we need to keep learning and listening to the needs of people and the evidence of what is working in our communities. What will the longer term impact be on health, wellbeing and how we live?

Here are some of things that we in the ACE hub are thinking about; it’s not an exhaustive list, but we want to use the time we have to think more about what we can do; and then work with our partners to do it. Your thoughts on the below are most welcome.

3 https://www.theguardian.com/world/2020/mar/27/sharp-rise-in-number-of-calls-to-childline-overcoronavirus 4 https://www.theguardian.com/society/2020/mar/28/families-borrowing-buy-food-week-of-lockdown 5https://common.bangor.ac.uk/system/files/uploaded_files/news/School%20of%20Healthcare %20Sciences/2018/01/ace_resilience_report_en_pdf_11162.pdf

1. The numbers that we see in China, France and Australia are police reported cases of Domestic Abuse. Confined to our homes it may be even more difficult to ask for help, or reach for social media. Many elderly people, those in controlling relationships, those who are dependent on others who just don’t do this form of communication.

How will they gain knowledge that what they may be experiencing is not normal, or acceptable? How do we facilitate that information? Often the workplace or contact with others is the sanctuary or lifeline people need to ask for help.

2. We are telling the elderly and those with specific conditions that they must shield themselves from the outside world, but what if abuse is happening in these relationships, and how will increased isolation and loneliness impact on those who already feel alone?

3. Hard to reach groups – just got harder! We don’t subscribe to this term at the hub, we say we are not reaching people in the right way – so how do we look out for the elderly and most vulnerable who are in the shielding group to ensure that they are not experiencing abuse within the home or from those that want to exploit them. Or support people for whom English is not their first language, or communities who felt marginalised before this happened?

4. Working from home – is not as easy as it looks with children, partners and pets! But if home is not a safe place to be then then what should employers be thinking about in terms of information, support and protocols to keep in touch with staff and recognise if something is wrong? Everyone is using the internet more but are our children safe from online abuse? We have seen evidence that this may be increasing 6 5. ‘Don’t be a bystander’ is the message we give, but how can we safely intervene? We have an army of volunteers in the community response calling people, leafletting, dropping off prescriptions or food and interacting with people who otherwise would not see anyone. Should we leaflet other information? How can we use existing community ambassadors? What should people look for and what should they do if alarm bells ring? An unsafe intervention may cause more harm than good, how do you judge what is safe?

6. Deserving compassion: how do we ensure that the compassion extends as much to the person struggling with alcohol dependency and mental ill health as the young family who need a prescription collecting from the pharmacist for their children’s medication?

7. Data. Children are telling us that via ‘Childline’ that they are worried. They are seeking and accessing this external resource as access to youth workers is more difficult and school support taken away. They may not be getting that in the home.

What evidence do we have that tells us what people NEED in this new and different context, and where we should focus effort?

8. Clear and coordinated messaging developed collectively to address the immediate need but also look forward to how we support people as the lockdown is lifted. What different or additional support will be needed in schools when children return? How will the experience affect people and what/who will they turn to to cope? How can we plan now for what we might need in the coming months to ensure kindness and 6 https://www.bbc.co.uk/news/technology-52067507

compassion endures beyond COVID19, to understand the impact on health and wellbeing and where we can intervene early to reduce demands on services in future (and what that demand looks like).

9. #TimetobeKind – now more than ever we must think about what we could do as an individual to make a difference to someone’s life. Communities are showing us the power of collective action. What can we do to support them?

Joanne Hopkins Director, Adverse Childhood Experiences Support Hub Programme Director, Early Action Together Programme

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