Addressing adverse childhood experiences: implications for professional practice

INTRODUCTION

It has been over 20 years since the publication of seminal research by Felitti et al, highlighting the powerful relationship between adverse childhood experiences (ACEs) and a wide range of health and wellbeing outcomes.¹

Since the landmark ACE study was published, a compelling body of research has accumulated confirming the strong and proportionate relationship between experiences of childhood adversity and the manifestation of detrimental health and social outcomes later in life.^2,3 We have learnt that ACEs are relatively common and are amenable to detection. We have an evolving understanding of the neurodevelopmental links between adversity and poor mental and physical health outcomes. We have evidence that the negative effects of ACEs can be mitigated through psychosocial and resilience building interventions.⁴ However, despite this growing awareness, it is not obvious that ACEs have yet been approached as a significant public health problem in the UK.

ACE enquiry is becoming more common in the US primary care system and in paediatric medicine, with emerging evidence of significant human and financial payoff.² In the UK there is a growing interest in routine or targeted ACE enquiry, with early indications that this might offer opportunities for GPs to alleviate suffering via therapeutic relationships.⁵ Nonetheless, it is still relatively rare for healthcare professionals in the UK to routinely enquire about these experiences and their impact on a patient’s health. In this editorial we hope to explore some of the enablers and barriers related to implementing ACE enquiry in a UK primary care context.