Early Action Together Conference - The impact of ACEs on individuals, families and communities

The impact of ACEs on individuals, families and communities #EarlyActionTogether #CamauCynnarGydanGilydd

Professor Gordon Harold Andrew and Virginia Rudd Chair and Professor of Psychology, University of Sussex

Adverse Childhood Experiences and Young People's Mental Health Putting the Evidence in Perspective Gordon Harold

Gordon Harold Andrew and Virginia Rudd Professor of Psychology School of Psychology, University of Sussex Gordon Harold

MRC Centre for Neuropsychiatric Genetics and Genomics Cardiff University Gordon Harold

Early Action Together: Taking a Public Health Approach to Policing and Criminal Justice

Mental Health, Costs and ‘Causes’ • Mental health (UK and international) – – – – –

Depression and Anxiety Aggression, Conduct Problems, Criminality Social competence Academic attainment Physical health

• Medical/social care/production – England: £105.2 billion; Scotland: £8.6 billion; N. Ireland: £2.8 billion; Wales: 7.2 billion

• Correlates/Causes of poor mental health – ACEs (birth – 18 years; 10+ ‘Experiences’) • Family stress (poverty/econ press)** • Parent mental health/substance misuse** • Parenting behaviour/practices (neglect)** • Inter-parental conflict (DV)** • Divorce/Family transition (LAC)** • Peer relationships/bullying • New ‘environments’/ACEs – The digital world

Cascading Processes versus Additive?

Paternal Depression

Economic Stress/High Pressure

Interparental Conflict

ParentChild Neglect

Child Problems

Maternal Depression

Conger and colleagues 1989-2017+

Challenges to Past Research • Salience of the family environment ?

– Predominantly conducted with biologically related parents and children

• What if it is all in the genes?

– Associations between parental behaviour (e.g. negative parenting) and child behaviour is BECAUSE children share genes with their parents??

• Disentangling genetic factors (nature) from rearing environment factors (nurture) – Relevance to intervention/prevention – What we target, when we target, for who?

The Nature of Nurture (ACE ‘Perspective’) • Two novel research designs (US, UK) – Early Growth and Development Study (US) – Cardiff In vitro fertilisation Study (UK)

• What can we NOW conclude?

– Associations between parental behaviours (e.g. parent-child conflict) and child behaviour CANNOT be due to common genes shared between rearing parents and children – Re-Booting the significance of ACEs (Nurture) for youth mental health – Gene – environment interplay

• The environments children experience affect long-term outcomes – Poor trajectories are malleable – EFFECTIVE intervention – Intergenerational transmission (costs …)

Moving the Debate Forward: From Evidence to Intervention • UK Youth Mental Health – 1:10 to 1:5 (report source) – Among worst in OECD (18+ years) – Assessing the problem or assessing the outcomes of earlier problems??

• Effective assessment of BOTH

• Adverse Youth Experiences (AYE) – Parental neglect, E/P/S abuse, poverty, IPC, bullying, online risks, substance misuse, others

• Building ‘front-line’ Capacity and Confidence – Working with ALL professionals – a public health crisis (charities, schools, local authorities, NGOs, PARENTS/CARERS) – Standardised assessment of ‘causes’ – Alignment with evidenced programmes – Correct measurement of ‘outcomes’

UK Government Investment in Supporting Families and Children (DWP) • Evidence Review – Economic pressure/Worklessness, adult mental health, Parenting, Inter-Parental relations, child mental health – Supporting the inter-adult/parent relationship improves parenting AND child outcomes – Breaking Intergenerational ‘cascades’

• DWP (£42M; April 2017) – Inter-parental and parenting focused support – Child Outcomes (intergenerational)

• Provider/Practitioner – – – – –

Assessment of need (questionnaire) Training – programme fidelity Evaluation Programme alignment Lessons for ACE informed training??

Opportunities for REAL Change • Recognising the link between poor mental health and early ‘environmental’ influences (ACEs) – Not new messages (nurture), BUT new evidence (nature of nurture)

– Family, school, peer, new digital world REALLY matters for children • Anxiety, depression, aggression, conduct problems, academic failure, criminality, substance misuse, suicidality, employability, DV, divorce – Inter-generational cycles/transmission – COSTS (lifecourse; they repeat)

• Early environmental adversity is a public health issue (Government) – Investment in front-line training; Harnessing/developing existing capacity – Parents/carers, teachers, social care professionals, mental health specialists, the police, law, charities, NGOs, Government/Policy makers – Beware of eminence-led versus evidence-led recommendations

• Constructive progression from current mental health catastrophe – Robust evidence; what puts children’s present and futures at risk – We have the resources to equip professionals to help EARLY (WALES**) • CAFCASS Cymru (MP), Barnardos Cymru (LB), PHW/EAT (JR) – ACE = AAE = APE = ACE (cycle continues) – Time/opportunity for change/difference – EVIDENCE LED £££ PLEASE!