Preventing adverse childhood experiences: what we can learn from specialist services

Eleri Butler sets out the importance of specialist services and prevention in tackling adverse childhood experiences






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The impact on the 1 in 5 children who experience domestic abuse in their childhood and the 1 in 20 children who have been sexually abused is well documented, and can last well into adulthood. Children impacted by abuse risk mental and physical health difficulties through their lives, poorer educational outcomes, involvement in crime, and difficulties in their own future relationships.

This is supported by research in Wales into how future health and well-being can be profoundly affected by the co-existence of adverse childhood experiences (ACEs), such as direct experiences of abuse (sexual, emotional, physical), physical and emotional neglect, and family circumstances like parental separation and divorce, exposure to substance misuse, mental ill-health, experiencing domestic abuse, or imprisonment of a family member.

This research reinforces the decades of experience in third sector domestic and sexual violence services.

When domestic or sexual violence features in children’s lives, we know there’s a high probability that some or many of these other adversities will be present. We know many survivors of abuse develop chronic illnesses, depression, anxiety, obesity, self-harming behaviour including suicide attempts, alcohol or drug abuse, and suffer premature death. We understand that adverse childhood experiences in families is exacerbated by their experience of multiple disadvantage like homelessness, poverty, and involvement in the justice system, created in part by poor access to support, structural discrimination and the response of services and society.

We also know the gender of victims and perpetrators impacts the risk, severity and harm caused. Many women and girls experience cumulative abuse through their life, including outside the home where girls face intolerable levels of sexual harassment and abuse in schools and colleges. The correlation between  violence, abuse and health outcomes, at any age, is significant. Over half of those who experience abuse self-harm, they are 15 times more likely to attempt suicide, and there are clear links between abuse and being disabled, alcohol dependent, drug dependent, and with obesity. For many women and girls the abuse is fatal. Between January and August 2017 at least 93 UK women were killed by men: 93 women in 243 days is one woman dead every 2.6 days.

Whilst the number of adversities present in a child’s life helps us understand the connection between health, relationships and parenting, counting ACEs gives us only part of the picture.

Specialist services know we can’t assume that a child living with domestic abuse with 4+ associated adversities is having a harder time than a child with 3, 2 or only 1 adversity. The child who has 1 ACE because their father is seriously harming and coercively controlling their mother, who because of the abuse is unable to function, will likely suffer more from their father’s abuse, than the child who has 4 ACEs associated with domestic abuse and being homeless, but who has access to outside services and support with their mother.

We also know that children will be impacted differently depending on the context of the adversity being experienced. Imprisoning the sexually abusive parent will likely reduce the violence and abuse experienced and lead to a chance of more positive outcomes. In contrast, imprisoning non-abusive mothers on successive short sentences for debt and poverty caused by domestic abuse will reduce their access to protective factors and likely increase the child’s trauma.

The reality is that women and children will often experience abuse in combination. Where coercive control is a feature, children are also being harmed by the continual monitoring, isolation, verbal, emotional, psychological and financial abuse. Recent evidence highlights that children and women can also resist coercive control and actively support one another, which enhances their well-being and recovery. This reinforces much earlier reviews into children’s experiences of domestic abuse, which drew attention to the abuser’s intent to undermine the relationship between women and children, and advocated that supporting and protecting the non-abusive parent, usually the mother, is the most effective way of improving outcomes for children.

So adversities in childhood are part of a child’s story but it isn’t their whole story.

Just as experiences of abuse and other adversities is gendered, so too is children’s response and ability to recover from adversities dependent on factors such as their age, sex, ethnicity, ability, their access to protective factors and the support network around them. We know that a boy who has witnessed domestic abuse does not have to grow up to be an abuser and a girl does not have to become a victim of domestic abuse later in life.

Specialist services have in-depth knowledge of how best to support survivors to prevent further harm, increase their well-being and can significantly mitigate the trauma associated with abuse. Support that is trauma-informed promotes well-being as a right for every child and adult and focusses on safety, trustworthiness, advocates choice, collaboration and empowerment, and places survivors at the centre of their approach. This can include individual and group support, play therapy, recreational and educational activities and advocacy. Programmes delivered by specialist services, like STAR (Safety Trust and Respect) groupwork for mothers and children, support women to protect and support children and helps children understand what has happened.

So it’s a travesty that children and young people impacted by adversities and trauma face a post-code lottery when accessing specialist support from domestic and sexual abuse services. Specialist services spend much time and effort fundraising to secure donations and charitable trust funding for this life-changing support, which is rarely funded by Governments and the public sector. There is at least one area in Wales where funding cuts have left a whole county without any specialist provision for children and young people affected by abuse and violence.

When 25% of young women have experienced physical violence and 72% have experienced emotional abuse in their own relationships, and 70% of girls aged 11–21 say sexism is so widespread it affects most areas of their lives, something clearly needs to change.

Investment into specialist services to support children must be accompanied by a greater focus on prevention. Prevention, early help, and a change in behaviour and approach by public services and in communities also lies at the heart of our cross-sector model for achieving real ‘Change that Lasts’. We know that domestic abuse and sexual violence is a cause and consequence of inequality between women and men and, as such, is predictable and preventable.

Programmes and education to create gender equality, and social and cultural change in communities, must play a pivotal, alongside compulsory Sexualities and Relationships Education and a whole education approach to preventing violence against women, domestic abuse and sexual violence. And to achieve long term change, specialist services, and the survivors they support, must be central to work underway in Wales to mitigate ACEs. Only by working together will be achieve a safe, equal, violence-free world for our children and young people.

 

All articles published on Click on Wales are subject to IWA’s disclaimer.

Eleri Butler is CEO of Welsh Women’s Aid