Helping prevent Adverse Childhood Experiences (ACEs) and their long-term impacts

Adverse Childhood Experiences (ACEs) have emerged as an important population-level indicator of disadvantage across the community since a ground-breaking study in the US by Felitti et al (19981). The British Psychological Society defines Adverse Childhood Experiences (ACEs) as “highly stressful events or situations that happen during childhood and/or adolescence,” which can “be a single event, or prolonged threats to, and/or breaches of a young person’s safety, security, trust or bodily integrity.”2

It’s now well established that children who experience adversities or adverse childhood experiences (ACEs) are 6 to 10 times more likely to develop mental and physical health problems in later life.

A 2018 report by the House of Commons Science and Technology Commission confirmed this, concluding that there is now sufficient evidence to demonstrate “a correlation between adversity suffered during childhood and an increased prevalence of health and social problems in later life.”3

Increased awareness of how early intervention can help prevent ACEs has prompted calls for greater access to wide-ranging parenting and family support. The Early Intervention Foundation’s 2020 report offered clear guidance on what should happen next: “The current enthusiasm for tackling ACEs should be channelled into creating comprehensive public health approaches in local communities, built on the evidence of what works to improve outcomes for children.”4

The role of parenting interventions in reducing ACE’s is well established. However, as the Social Mobility Commission pointed out in their 2017 ‘Time for Change’ report, the availability of parenting support has barely changed since 1997, due to real-terms cuts to parenting programmes. Greater funding for evidenced based approaches is needed.5

Triple P have always understood that investing in parenting support at a community and population level strengthens families and significantly reduces some of the key risk factors associated with ACEs. As a result, the likelihood of mental health issues, negative family environments, serious violence, and youth crime is also reduced.

Triple P programmes tackle the issues which are closely associated with ACEs. Demonstrated improvements include:

  • Improved child emotional wellbeing
  • Reduced hyperactivity
  • Reduced rates of child abuse and neglect
  • Improved attendance; Fewer child academic problem behaviours
  • Greater parental confidence and use of positive parenting
  • Less parental stress, depression, and anger
  • Reduced parental conflict; Improved parental engagement
  • Improved work satisfaction and reduced work-family conflict.

Triple P is also one of only two evidence-based programmes recommended by NICE as an appropriate intervention where risk factors for ACE’s are predicted or present, for example:

  • As early help for families showing possible signs of child abuse and neglect
  • Conduct disorder in children under eleven
  • First-line treatment for ADHD in children under five
  • For parents of children aged under 12 years with a learning disability and conduct disorder / behaviour difficulties

Evidence rating ‘very high’ for Triple P in prevention/reduction of ACE’s negative effects

Triple P is also one of only two interventions rated “very high” in a 2020 report, prepared by the Australian-based Centre of Research Excellence in Childhood Adversity and Mental Health6, reviewing the available evidence on interventions that aim to prevent or reduce the negative effects of ACEs on children’s mental health.

The authors examined 26 interventions, across six broad categories including, community-wide initiatives, parenting programmes, home visiting programmes, economic and social service interventions, psychological therapies and school-based programmes. Both the programmes that were rated as having a very high level of supporting evidence were parenting programmes.

“Data from meta-analyses of RCTs show that Triple P has led to…Short-term improvements in children's social, emotional and behavioural outcomes and parenting practice/s; Long-term improvements in children's social, emotional and behavioural outcomes and parenting practice/s behaviour; Long-term reductions in substantiated child maltreatment, out-of-home placements, hospitalization, or emergency room visits for child maltreatment injuries.”

The report also said the data showed Triple P as “effective across different settings including schools, community-settings or households” and “there is evidence of cost-effectiveness at reducing child behavioural and emotional problems and promoting effective parenting.”

This aligns with the Early Intervention Foundation’s 2020 report confirming the key role of early intervention in reducing ACEs:

“There is strong and consistent evidence showing that parenting interventions [including specific mention of the Triple P system] can reduce coercive family interactions contributing to child abuse and neglect.”

“Interventions offered to divorcing[/separating] couples [including specific mention of Family Transitions Triple P] have the potential to reduce family conflict and the stress associated with family breakdown”

This is the exact response to ACEs that Felitti et al suggested in 1998, saying at that time that prevention and reduction of adverse childhood experiences, “will ultimately require societal changes that improve the quality of family and household environments during childhood”1

Triple P is disseminated extensively across the UK and Ireland in services seeking to tackle ACEs. You can read more detail in the case studies below:

1. Felitti, V. J., Anda, R.F., Nordenberg, D., Williamson D.F., Spitz, A.M., Edwards, v., Koss, M.P. & Marks, J.S. 1998. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine. 14(4):245-58. doi: 10.1016/S0749-3797 (98)00017-8

2. The British Psychological Foundation, Adverse Childhood Experiences (ACEs), 18 June 2019.

3. Science and Technology Committee, House of Commons, ‘Evidence-based early years intervention’, 14 November 2018.

4. The Early Intervention Foundation (EIF), ‘Adverse childhood experiences: What we know, what we don't know, and what should happen next’, 26 February 2020.

5. The Social Mobility Commission, ‘Social mobility policies between 1997 and 2017: time for change’, 28 June 2017.

6. The Centre of Research Excellence in Childhood Adversity and Mental Health, ‘Summary of interventions to prevent adverse childhood experiences and reduce their negative impact on children’s mental health: An evidence-based review’, December 2020.