COVID-19, Violence & The Need To Act with Urgency

Amidst the fear and uncertainty of the Covid19 lockdown in China, 26 year old Lele experienced something more terrifying than the virus itself. Her husband fashioned a weapon from a kitchen stool and beat her semi-conscious as she held her 11 month old baby in her arms. There was nowhere to go, no services to support, no possibility to flee. She had to spend several more weeks with her abuser before she could reach safety.

On the other side of the world in Greenland, the capital city banned alcohol sales to prevent growing child abuse during lockdown. In India the were 92,000 calls to a child abuse helpline in the first 11 days of lockdown. France experienced a 34% increase in abuse helpline calls by children and an even bigger increase in the number of peers and school mates calling on behalf of friends. . As closed schools and stay at home orders spread, so did the risk of abuse.This pattern played out across the world, in three ways:

The first is the way that lockdown piles pressure on households . Even the calmest, securely attached and ‘child development-aware’ parents are being tested by ‘pandemic-parenting’. Often they are working in uncertain jobs while teaching ‘cabin fever kids’ while adapting to loss of space and privacy. But most will not suddenly become abusive or neglectful. In more volatile families however, this stress can spill over into violence or exacerbate existing abuse patterns. The biggest beneficiaries of #StayAtHome are the serial abusers who practice coercive control and other forms of psychological aggression. the lockdown increase the likelihood of adverse childhood experiences.

Secondly, the means of reporting severe child abuse or neglect have been dramatically reduced. According to the US Department of Health & Human Services child protection interventions are initiated by reports from teachers, social workers or nurses. Social distancing measures have reduced reporting. From the 1980s onwards increased reporting of family violence was a major mark of success and progress in protecting the rights of women and children. Momentarily, reporting is in decline.

The third issue, is complex but equally serious. In normal circumstances less than 1 or 2 % of children are subject to interventions by social workers. Yet Adverse Childhood Experience (ACE) research across populations suggests between 15 and 20% of children are affected by chronic, multiple forms of abuse, neglect or dysfunctional parenting at home. This 15 to 20% of children are now in a state of isolation. Children have a biological imperative to have protective, soothing relationships with an adult and are simply not built to be isolated. When a positive relationship at home is absent, the child interprets it at risk. It over-activates their stress response system which wreaks havoc on all aspects of healthy development. Unaddressed it can lead to catastrophic health and wellbeing outcomes throughout life. But when the stress is buffered and soothed by a healthy relationship with a teacher, grandparent or friend and the child is made to feel they matter on an individual level-then the recovery can begin. Right now around the world, hundreds of millions of children have been cut off from those relationships.

This is deeply distressing. Accounts of childhood maltreatment often recall a despairing loneliness and unbearable slowness. Loneliness when the parent who should soothe the pain, is actually the source of that pain. Slowness during long pauses of waiting for a violent outburst or scarce moments of maybe feeling loved. The isolation of the pandemic amplifies this pain exponentially. It is malleable with no end in sight. Relationships with teachers, grandparents and friends were cut off suddenly with no date for restoration.

We need to act with urgency on all three issues. Governments and communities could appoint ministers or local leaders to coordinate child wellbeing during lockdown. A priority must be engagement with parents on managing stress, home schooling and positive discipline, tailored to lockdown conditions. Online and media platforms could be adapted to facilitate a conversation with families and disseminate pandemic-specific parenting tips, similar to the global UNICEF parenting hub. Social protection and housing support must be adapted to reduce the stress on vulnerable families. Behavioural insights and technology innovations should be used to understand how we can best support parents and protect children.

Expanded helplines and channels that enable neighbours and friends to report maltreatment anonymously need to be provided . Equally we need to encourage extended family and friends to maintain regular communication with children in lockdown with abusive or neglectful parents. One of the most moving stories of the pandemic so far is the upsurge in calls by friends of victims reporting maltreatment in France.

Innovation and adaptation could help teachers and social workers restore normal levels of communication with children, despite lockdown. If they are not giving lessons, can they call each child for five minutes? These measures need to be population-wide and not just targeted to 1-2% of children who are child protection cases.

Decades ago, it became normal to ensure every child was immunised against deadly disease with a vaccine. In the future we could hope for a world were every child is buffeted from trauma by a calm and predictable adult connection. A world in which we improve prospects for parenting in every family at the earliest possible stage and maltreatment is managed and prevented as a part of routine public health . All we can do now is demand protection for Lele, her baby and millions of abused children and women locked down, unreported and isolated around the world as part of our immediate and shared struggle to defeat Covid19

 

 

 

 

 

A Tale Of Two Pandemics

Will Covid19 Widen Inequality?

With Rugby & Football postponed and social gatherings replaced by social distancing-the only hope for an exhilarating weekend was a long bicycle ride. As Hudson suburbs gave way to inner city Bronx & Harlem before the more prosperous heartland of Manhattan- a simple bike ride shows how different income groups cope with Corona Virus. In prosperous neighbourhoods, cafe bars and barbers shop were half or three quarters empty. There was not a hipster to be seen. By contrast, poor migrant areas were bustling. It’s a bike ride-not a piece of scientific research. But do high rents, poor pay, insecure employment, no sick leave & “for profit” health systems prevent the poor from social distancing? Do they need to carry on as normal? Even when they are frightened of the virus?

We may all be frightened of getting sick. But the poor often fear the sickness itself less than the life consequences. One pay check away from homelessness, the potentially ruinous out of pocket hospitalisation costs or the direct relationship between todays work-shift & tonight’s family meal. Over time the secondary costs will hit the poor the most. If children are out of school, who will look after them? Online learning is a brilliant solution for social distancing, but those who already have the worse learning outcomes also have the worse connectivity: the poor. In the end, there will be job layoffs. Corona virus will break some businesses and the working poor will be the first to go.

27 million Americans don’t have health insurance. The world’s wealthiest country equals many middle and low income countries in having dramatically worse health outcomes for it’s poor. Brits shouldn’t be smug. Low income males in the UK die almost ten years earlier than the wealthy. Many of the non-communicable diseases and conditions that render Covid 19 lethal are much more prevalent for those in poverty. In the poorest countries on the planet, weak health systems may be overwhelmed by Corona Virus. This will divert resources from other child killers such as ebola, measles, cholera and pneumonia.

Child poverty is not the only driver of lifelong inequality. Adverse childhood experiences such as family violence and neglect also lead to serious inequality throughout adulthood . How do you think #StayAtHome sounds to a child who only feels safe when they are not at home? Whose only soothing & supportive relationship is with a teacher or a school deskmate. The pandemic will turn their already fragile world upside down and minimise their chances for recovery. When schools were closed during the Ebola crisis in West Africa increased rates of sexual abuse and exploitation of children were recorded.

Privileged cultures, wealth and education rightly equip children with skillsets to better navigate complex challenges in a way that often eludes the less well off. This is highly relevant in a pandemic. The ability to distill a stream of useful facts about the virus amidst an explosion of noisy fake news. The agility to regularly absorb and update ones knowledge and act up upon it. Adaptation to change and uncertainty and knowing where to seek help. When something goes wrong for a poor or high-adversity kid and they are knocked off course, it takes them much longer to get back on their feet.

In many countries including the US and UK, inequality seems to be expanding and social mobility declining. If you grow up without university educated parents, your future prospects seem to be in decline. It is rarely articulated, but deep in the sub-conscious of working class and poor people this trend has transformed voting trends. Growing inequality has created space for populist braggarts who shun science and international cooperation. The very people who now appear shrivelled and sheepish next to scientists with international networks of practice.

Covid 19 is not just a public health crisis. It will be an economic and social crisis, a jobs crisis, a housing crisis and it will certainly be a child crisis. It needs a social strategy as well as a public health strategy. Are we the Italian balcony Sopranos who celebrate our shared humanity by singing our hearts out together? Or the hysterical supermarket goers who elbow each other out the way to buy endless supplies of loo roll? I think time will show us to be more like the sopranos, but that social strategy needs to bring us together rather than build wedges to drive us even further apart.

Do the Academy Awards Point to an Awakening on Adversity?

I am unbearable company during the Oscars. Like most US-based Brits I can’t help but do football stadium style cheering every time someone from the UK wins anything. Worse still I can’t watch films like Judy or Rocketman without analysing the”underlying messages” on insecure attachment. Nor can I enjoy The Joker, Harriet or Honeyland without giving a droning commentary on how toxic stress ruins lives. The invitations are drying up.

In case you are not clued up on the lingo: Insecure attachment is the term used to describe how poor early parental attachment undermines our ability to form healthy and nourishing relationships . Toxic stress is when prolonged childhood trauma chronically activates our stress response systems. Robust recent research now shows how people with either do worse in education, employment, physical and mental health and inter-personal relations throughout life.

From a rough estimate, about a quarter of 2020 Oscar nominee productions feature a story line with the following formula: Child trauma – healing/soothing relationships = train wreck adulthoods. Does the proliferation of these story lines in films mean our recognition of the link between early trauma and poor life outcomes ? It is not just happening in Hollywood. In the sober UK BBC Question Time a couple of weeks ago. Decorated former Police Chief Mike Barton told a studio audience that we can only reverse the London drug and crime problem if we address adverse childhood experiences (ACEs). Research in the USA shows how media coverage on the theme has dramatically increased in recent years.

Our shared narratives should never be deterministic about the pathway from childhood trauma to adult dysfunction. Sometimes those with high childhood adversity flourish. But the most recent evidence suggests those with higher levels of trauma are much more likely to have poorer life outcomes. As Mike Barton may concur, they are the ones most likely to be targeted by criminals, groomers and radicalisers alike. As the US Centre for Disease Control has shown, they are also do much worse on almost every health and wellbeing indicator. The costs are huge and quantifiable. The UK Based Overseas Development Institute modestly estimated that violence against children alone (excluding the devastating global costs of child neglect) cost 8% of GDP. Conversely Nobel Prize winning economist James Heckman argues that if we invest in prevention in the very beginning of childhood-the return on investment through life is up to 13-fold.

Film scripts don’t always end with trauma. They can also inspire us with recovery and resilience. Gus van Sant’s Good Will Hunting had nine Oscar nominations and won two and is one of America’s most popular films. It is perhaps the most compelling cinematic representation of how a young adult overcomes debilitating childhood trauma through connection with an empathetic witness . When the film was made, recovery through connection was only a common sense proposition. Now that proposition is firmly backed up by science base. Human connection and a sense of belonging in family, school or community provides a buffer against toxic stress. It calms the stress response system and helps rebuild the attachment model. It enables the child to build the resilience to navigate future shocks and see a lifeline to a better future. We call this science of resilience.

The opposite of Good Will Hunting’s story of recovery is the inter-generational emotional neglect suffered and transmitted by Elton John’s father in RocketMan. Deep in middle age he sings: “I can’t love, shot full of holes, I don’t feel nothing, I just feel cold“. At the extreme end of this spectrum is the character played by Joachim Pheonix in The Joker. Severe childhood trauma with no empathetic witness on the path to adulthood is costly for the individual, their family and society as a whole.

Film and literature critics often tell us that fine writing gives a tangible narrative to feelings the viewer or reader has, but could never put into words. The research shows that between 50 and 80% of any given population have experienced one ACE and between 10 and 20% have experienced 4 or more. Everyone, everywhere is affected by childhood adversity. We don’t talk about it easily. We could assume it has been taboo for most of human history. But if we are not affected by it directly, our spouse, neighbour or colleague is. It is often manifested in their decisions and behaviour. It’s why we identify so much with these stories. It’s one of the reasons Good Will Hunting is held in such affection and why so much of our popular culture alludes to this theme. This is our story. Our broken childhoods and our struggle to overcome them are a central theme of human existence and spirit. But a marginal theme within our national and international conversations. Could that be changing?

From an advocacy perspective I hope so. More public openness to the theme could drive the political will and public demand needed. A good public policy start would be investment in 3 things. Trauma prevention though early parent outreach and support. Recovery and resilience through trauma-informed communities and schools. Open and taboo-busting public discussion on adverse childhood experiences. These interventions could close the costly gap between what we know and the policies we do. Imagine how much trouble could have been prevented if Gotham City had had better childhood policies. In Pinner and Philadelphia too.

And that brings us back to Elton and his Oscar nominated recovery anthem: “Find the wind to fill my sails, Rise above the broken rails, Unbound by any ties that break or bend, I’m gonna love me again” How rich our world would be with an opportunity for everyone to rise above those broken rails.

The Networking of Trauma

Preventing Organised Crime and Other Exploitation Groups Preying on Vulnerable Children

Violent extremists, gangsters and groomers have a simple recruitment strategy. They network trauma. They can spot a vulnerable teenager from 1000 yards. It can be easy to pull them in by sating a desire for belonging or through initial kindness. But the intention eventually is always exploitation.

An Irish security expert once shared three observations about the Northern Ireland conflict. Firstly that at any given moment during the conflict, there were only ever a few dozen people who could actually kill someone. Secondly that they usually came from traumatic homes with fathers who had also killed. He concluded that it seemed political extremists and organised criminals knew exactly how to identify and recruit such people. I have seen similar recruitment strategies in lawless or conflict-affected countries from Afghanistan to Bosnia. It always has devastating consequences.

It’s not black and white. There are economic and structural determinants of violence too. Most people affected by childhood trauma do not turn to crime or violence. But the world is waking up to the impact of childhood trauma as a driver of recurring violence. It occurs in cycles. Data from Wales show that adults affected by chronic childhood trauma were respectively 14, 15 and 16 times more likely to be a victim or perpetrator of violence or use crack cocaine than others. Data on consequences of chronic childhood trauma is similar across continents

There is an underpinning neurobiology to this cycle. Children are dependent on a strong attachment with a parent. If the attachment is absent due to neglect or violence, a child will see it as a serious threat. That threat chronically activates the stress response system. It distorts the way they perceive danger, they way they see themselves as well as their attachments to others. If families, schools or communities cannot provide soothing connections to heal the trauma, the child enters adolescence and adulthood with unresolved chronic trauma. This leaves them extremely vulnerable to exploitation and with limited prospects for learning or finding a lifeline to a better future.

All of this leads to an obvious question for anyone reading this blog. In my neighbourhood are there more forces trying to exploit or trying to prevent the inter-generational cycle of violence? Prevention services, usually delivered through the health system help new parents develop a secure attachment with their child. That attachment is the best weapon against neglect and violence. it can help heal the parent at the same time as protecting the child. In an ideal world these services would be provided globally. As noted elsewhere this type of prevention provides the greatest return on investment for the public purse. No other intervention does more to prevent poor life outcomes including in mental and physical health, crime and productivity.

Response services provide a second chance to children who have already been traumatised. In Trauma-informed schools for example, the teacher creates a calming environment and a caring connection. This ensures every child in school is safe, seen, secure….and most importantly soothed. The four Ss feature in the excellent “The Whole Brained Child” by Daniel Siegel and Tina Payne Bryson. In a Trauma-informed school, the teacher makes the child feel they matter as an individual. Many who come from traumatic childhoods have been rescued by a teacher who did exactly that. Positive relationships and connections build resilience that help teenagers navigate away from poor decisions that bring bad life outcomes. And if a child is approached by a Fagin type exploitation group, they feel they can tell the teacher

A second important question is what is being done in my neighbourhood to prevent the cynical “networking of trauma” by exploitation groups.

Both in the UK and the US, Trauma-informed practice is also being adapted to policing and justice sectors. One of my favourite champions of this is Detective Superintendent Stan Gilmore of Thames Valley Police in the UK. He observed those arrested for “County-Lines” drug trafficking were almost always in their mid teens. He started to see them as much as exploited and vulnerable youngsters as offenders . Instead of pursuing a custodial sentence, the emphasis was placed upon diversion from a potential life-cycle of crime. This included curfews and supervision orders that stopped the gangsters reaching the child . It cut off their source. It also referred the child to services to help address the underlying trauma. The whole approach switches the question to the child from “What did you do?” to “What happened to you?

To me this is intelligent and effective policing. It recognises that the foundations of organised crime are built on networking trauma and vulnerability and if you prevent that networking, you can break the cycle. Childhood trauma is not an excuse for crime, but to effectively reduce crime we need to be trauma-informed.

Just imagine how societies would flourish if we not only prevented the networking of trauma by exploitation groups, but also prevented or mitigated the trauma itself. We now have enough evidence and knowledge to work towards this goal. We just need the political will and the resources

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Ordinary People in Ordinary Places Talking about Violence and Neglect

“How can I help my child to be self confident when I do not feel self confident myself ?”
This is not an intimate conversation between friends. It is not a soul-searching parent in private counselling with a psychologist. It is one of many written questions delivered by a 400 strong audience to the stage of a provincial theatre in North Macedonia. Following dance and comedy, the audience engage with an expert panel on hirtherto taboo themes such as neglect & violence. And you can hear a pin drop.

As with most middle and low income countries, there is little public discussion on childhood adversity. Policy makers rarely prioritise investment to address its lifelong impact and costs. The “Parenting Is Always Learned” campaign has two aims. The first is to introduce the science of brain development to ordinary parents in ordinary places in simple language. The second is to break taboos on family crisis and Adverse Childhood Experiences.

We asked Sasko Kocev, a comedian and actor to moderate the event. We were amazed to the extent this created a conducive environment for discussing a taboo and difficult theme in a non-judgemental way.

It made sense later when we read research in the Power Of Moments by behavioural scientists Chip and Dan Heath. It suggests that laughter creates social bonds and synchronises audience engagement . We are all affected by Adverse Childhood Experiences. Most people have experienced them in their own childhood. Those who haven’t are likely to have their lives entwined with someone who has. Violence and neglect are not a “Them” problem, they are an “Us” problem. Comedy reminds us of our imperfections, at the very least, that we are all a bit broken.

A young dance troupe perform a powerful representation of themes such as alienation and domestic violence. The second half of the event is an interaction between the experts & the audience using anonymous questions.

Adverse Childhood Experiences are as present in North Macedonia as they are anywhere. A World health Organisation supported survey found that 64% of young adults had one adverse trauma in childhood and almost 1 in 10 had four or more. The most common was emotional neglect at 30%. I once asked the entire psychology faculty second grade if the data surprised them. It did not.

A campaign alone will not work. Parenting Is also Learned accompanies reforms of health, education and social protection systems. This includes home nursing visits that promote nurturing caregiving and universal pre-school education.

Often childhood trauma such as emotional neglect is transmitted from generation to generation. It is difficult to talk about neglect as we often have to examine our own behaviour or that of our parents. By acknowledging adversity is often transmitted unintentionally, we can discuss it without judgement. This is essential for breaking taboos and enabling consolidated action on childhood adversity.

The answer to the question posed at the beginning of the article is not easy. How do parents ensure they don’t transmit poor attachment, insecurity or anxiety on to their own children.” But senior British psychologist Peter Fonagy researched the way that being “reflective” prevents such transmission. The more parents become aware and reflective of their own feelings and the way they may impact others, the less likely they are to transmit negative models of care.

And as the name of the campaign suggests, we can learn parenting skills. As the curtains go down and we exit the stage there is a queue of parents and young people seeking to share their experience and ideas. Its 10pm, we have gone on for an hour longer than expected, yet many people don’t want to leave.

As Victor Hugo said, there is nothing more powerful than an idea whose time has come. The idea whose time has come is that we can nurture the first generation to grow without violence and neglect.

“Because I Grew Up In An Orphanage”

On Identity & Being Raised In Care of the State

I wouldn’t need a large abacus to count the number of times my experience as someone raised in care of the state has been well represented in a film. But one fleeting moment in Robert Altman’s 2001 murder mystery Gosford Park, an elegant pre-cursor to Dowton Abbey, nailed it.

During a large and free-flowing dinner table conversation about family, Mr Stockbridge (played by Clive Owen) stunned fellow diners when he answered a question with a simple “because I grew up in an orphanage“. The ensuing silence told more of our story than any scripted dialogue ever could.

Anyone from state care who had to describe their background because of a routine question about childhood in a polite conversation knows that silence. Until very recently and in middle age I still grimaced when such discussions arose at the diplomatic functions I attend with my job. If I am honest about it, at different stages of my life I have felt intrinsic shame, stigma and especially guilt for the discomfort it may cause to others and this has often fed into a deep, internal narrative that I am not really good enough to be here . But I also felt compelled never to hide who I am or where I come from. Being from state care is as important for my identity as being a Belgan or being a Hindu may be to someone else. It is where I spent my formative years, it is what shaped me and I want to be a good role model for kids in care today. It is at my core . I just would rather not talk about it.

6% of UK 18 year olds from state care go to university compared to around 27% of the general population. When I was 18 ( a very long time ago) it felt more like 0%. We were from a minority that was more likely than any other to end up in prison, a gang, trafficked, addicted or die early and very very unlikely to go to university. Unlike other marginalised minorities, we had no underpinning culture, flags or narrative to carry a sense of pride in our identity. I am so proud of the 6% of 18 year olds from care who end up in university today. It is mainly a testimony to their own resilience and brilliance, but also the fact that the system has been somewhat reformed in the past couple of decades. The odds are still stacked against them, they make it through anyway.

Like many of my generation, I left a children’s home aged 16 with a €200 leaving care allowance, a modest bag of life possessions and a complete absence of any form of love or belonging at all.

I have never complained about where I come from. This was the way my life was, it was normal to me. Coming from the bottom 1% of a society where identity was shaped by class and family, and then trying to advance though university & career etc often left me feeling unsteady on my feet and like an outsider or an imposter. I still feel like an outsider today to be honest, but I wouldn’t want to go back and change anything.

There are also things I am proud of. Because I had no parental support at all, I woke up at 4 am on weekends, when the other students were coming back from parties, and ran market stalls in Camden Town, I drove a mini-cab around London late at night and did shifts in an old peoples home and a college kitchen to pay my way through university. I really believed that a university education would help me escape the legacy of my childhood and I would do anything to reach that goal. I remember going to my first day of university, buying my own pens and books with money I had earned and not quite believing that I was lucky enough to be there. I was surrounded by people who seemed to take it all for granted. How much luckier I was then them, that this could feel like such a blessing in my life. I still feel blessed and privileged today.

But then there is love. In state care, one often grows up with this internalised sense of being unloveable, not even by one’s parents. Biologically all children are programmed to seek loving protection and nurture from parents, when it is absent they interpret it as danger. Adults from care backgrounds often have low self esteem, insecure attachment, post-traumatic stress and over-active fight or flight systems. This has a profound impact on your identity and sense of self.

You can strive to be a success on the outside as a young care leaver, but inside there are all these jagged edges and broken parts that, if you are aware of them, you would like to put together again. But because you are trying to escape extreme poverty and have an absence of support networks, you are just thinking about survival. Profound emotional insecurity can be a barrier to the relationships that the research now tells us are the single most most important determinants of both healing from trauma and building the resilience to overcome barriers and get on in life. Often the strategy the subconscious gives us is to separate the left and the right side of the brain-to run on the gas of the cognitive: job and education and forget the oil of love, emotion and belonging. But just like a car, you will break down in the end.

Nobody politically can articulate this. The main political discourses in our society don’t do emotional. They only do economic and power.

The left often argues that a care leaver is a victim of discrimination and poverty. But as Nimco Ali wrote recently about race & gender & being a refugee “The left wants to frame my life experience via the prism of helplessness and victimhood. I am meant to be consumed by all that has happened to me — to long for all that I have lost and wait to be rescued, but I have always refused to do that“. For me, it has taken me most of my adult life to feel really comfortable talking about being from care. But I can be shut down in a moment if someone tries to frame my narrative as a victim, and that often comes from the left.

Economic models from the right make life difficult for already marginalised care leavers. I know this from the rock face because I left care during Thatcherism. And then they argue that if an individual care leaver (actually a tiny fraction) can progress through hard work, then anyone can. But evidently they cannot and do not because the impact of trauma and neglect is very individual and complex and based upon the interaction of experience, resilience & biology. In 2019, policy makers should really know this, we shouldn’t have to explain it. And anyway, as Colin Powell once said, “how can you ask someone to pull themselves up by the bootstraps when they don’t have boots“. Care leavers badly need support networks.

Discrimination, poverty and hard work are high stakes challenges for any care leaver, but the main issue remains love, or the lack of it. There is a broader need for a politics that can talk about love, wellbeing, trauma, violence and hope. The social and emotional drivers of all of our behaviour and decisions. And this makes democratic sense because care leavers are not alone.

Until recently there was a common public perception that childhood trauma, neglect & violence were marginal issues addressed through the care, social work and juvenile justice systems dealing with maybe 1 or 2 % of a given child population. But the World Health Organisation and other bodies have undertaken surveys in multiple countries on general populations which reveal that on average, around 60% of adults in family settings were affected be one serious adverse childhood experience (ACEs) and around 15% by 4 or more. The 15% with 4 or more ACEs, like care leavers are much more likely to have really bad life outcomes in health, crime, education and all aspects of wellbeing. In psychology research, 42% of adults across countries are said to have insecure attachment due to absence or inconsistency of parental love in the first two years of life. Insecure attachment severely affects their ability to have quality relationships. The common perception about the marginality of trauma must have ran counter to people’s lived experience and their ability to articulate it. That is now changing.

I was raised in care of the state. I am neither proud of it or ashamed of it. But I would like to live in a world where future care leavers don’t suffer long silences & superficial victim or bootstraps narratives. Where investments are made to ensure those from public care & others affected by adversity everywhere-can reconnect, build and heal free from shame and public stigma. This would be socially just, fiscally prudent and frankly just plain easier and better for the whole of society.

Child Trauma-A Global Policy Agenda.

Parenting, education & environment in childhood drive wellbeing in adulthood everywhere.  Adverse Childhood Experiences (ACEs) including 1o different types of neglect, violence and dysfunctional parenting in the home during childhood, harm the economic, social & democratic development of any society.[1]

Recently global development collaboration efforts have expanded beyond the visible challenges of disease, hunger & illiteracy to also tackle the less visible emotional, social & psychological barriers to human development. The current UN sustainable development goals call for an end to all forms of violence in the lives of children everywhere by 2030.

Adverse Childhood Experiences (ACEs) are much more prevalent than policy makers previously imagined and are distributed within a similar range across continents, classes and races. They include emotional, physical or sexual abuse, emotional or physical neglect & chaos at home including domestic violence, mental health, addiction & crime .

There are ACE or similar Violence Against Children (VAC) surveys from at least 33 countries and 32 US States. These included the UK[2],, Canada[3], China[4], Russia[5], Brazil[6], Poland [7]and countries in Africa[8]and Asia[9]  [10]

Looking at the data from 11 European, 12 African, 6 Asian, the US, Brazil and Canada (the 1st, 2ndand 5thmost populous countries of the Americas)  and the Solomon Islands, the first thing that is striking is the similarity in prevalence of ACEs. On average about 60% of adult populations have experienced 1 ACE. Some countries such as Brazil and Russia are closer to 80% and some such as the Wales and Serbia are closer to 50%. But almost all countries fall somewhere between 50 and 80%, most hovering around the 60% mark, Similarly the prevalence of 4 or more ACEs is on average around 15%, though some countries have less than 10% such as the Czech Republic and some have more than 20% such as Vietnam. 

This is a relatively new form of research and relying on subjective responses to a questionnaire. ACE research  in the US shows little difference in prevalence of 1 ACE in social class or ethnic groups. However, a link between prevalence and poverty is clear when it comes to 4 or more ACEs.[11]

When we think about violence against children in the family often the first policy intervention we think of is a targeted social work response. But lets think again. . In a country like Wales, the prevalence rate for 1 ACE is 50%, the prevalence rate for 4 ACEs is 14%, yet the total number of children who are subject to targeted social work intervention for example on a register or in care, it is 1%[12]. To achieve the UN global target to end violence-we need to massively expand universal efforts through prevention & mitigation through health, education and policing working alongside social work.

There is no one reading this blog whose life is not affected by ACEs in some way. ACEs don’t just affect individuals, they affect societies

We know this because where ACE studies have been undertaken they always show a dose response correlation between the number of ACEs you have experienced and poor outcomes in almost every single wellbeing indicator in health, education, crime violence, mental health, addiction and much much more. throughout the entire life cycle

Perhaps the starkest illustration of the inter-generational transmission of violence, criminality and addiction is in the graph below from a 2015 study from Public Health Wales in collaboration with Liverpool John Moores University highlighted a high correlation between adults who experiences four or more ACEs and negative life outcomes[14]:

Compared with people with no ACEs, those with 4+ ACEs are:

4 times more likely to be a high-risk drinker
6 times more likely to have had or caused unintended teenage pregnancy
6 times more likely to smoke e-cigarettes or tobacco
6 times more likely to have had sex under the age of 16 years
11 times more likely to have smoked cannabis
14 times more likely to have been a victim of violence over the last 12 months
15 times more likely to have committed violence against another person in the last 12 months
16 times more likely to have used crack cocaine or heroin
20 times more likely to have been incarcerated at any point in their lifetime

The Wales data also show a much higher likelihood of becoming a victim of violence if you have higher ACEs. Recent work in England has revealed that grooming gangs have a tendency to go after young women with low self-esteem and what psychologists call “ambivalent attachment” as an outcome of inconsistent, neglectful and chaotic parenting in childhood.

The Welsh data is similar to what we see across societies globally. Health departments across US states reveal a similar dose-response correlation between higher aces and worse outcomes in health, wellbeing and decision making with regard to 40 different indicators[15]. The indicators include health outcomes but also behaviours related to addiction, criminality, mental health and unemployment.

Research from China shows a similarly graded link between ACEs and likelihood of alcohol abuse.[16]While ACE studies from Malawi[17] and the Solomon Islands [18]showed a similar graded link between risky behaviours, such as multiple sexual partners and high ACE scores.

Psychiatric evaluations of 1000 detainees at Cook County Juvenile Detention facility in Illinois revealed that 84% of offenders had experienced two or more ACEs and that the majority of offenders had experienced 6 forms of childhood trauma. [19]In a recent study in North Macedonia on ISIS recruitment all teachers, without exception, cited lack of parental care as a major factor for driving children toward radical extremism.[20]

Amongst children in school, if we take ACE data from WHO across Eastern and Central Europe and OECD data from the Pisa study, there is evidence of a correlation between higher than average ACEs and higher rates of school violence[21]. Coupled with the data from Wales showing a link between high ACEs and criminal and violent behaviour, this adds to a growing body of research showing the clear link between family and societal violence and criminal behaviour.

The American Academy of Paediatrics (AAP) suggest that periods of prolonged stress without respite in the home result in “toxic stress” or chronic activation of the stress response system[22]. Research shows that it is not just violence and chaos that creates toxic stress but also emotional coldness from the parent. This is because children are biologically programmed to seek strong bonds and attachments from birth for love and stimulation, but also for protection. As a species we are extremely dependent on parents for protection in early childhood. When the emotional attachment is absent, children see it is a threat and it activates the stress response system. This was also a finding of the prior research on attachment in psychology which revealed that while neglected children often stop showing outward signs of emotional need, their heart rate and cortisol levels are high [23]

Toxic stress derails normal development of all major systems of the fragile and evolving body and brain of the child. The impact affects the neurological, cardiovascular, immune and endocrinology systems and the way that genes are expressed. One of the impacts of toxic stress is that the body and brained is flooded with the stress hormone cortisol. Research showed that children who had been adopted in Canada but had spent their first year in a state of extreme neglect in children’s homes eastern Europe had much higher levels of cortisol than those who had been adopted earlier or who lived with their biological parents. This despite the fact that the high-cortisol children had spent most of their life in a secure adopted family.

Toxic stress also over-activates the amygdala region of the brain and the human fight or flight response and de-activates the executive function, impulse control and learning capacity of the brain. Children with high ACEs are likely to have problems with concentration, self-soothing and remaining calm and concentrated in the classroom. They are also likely to over-estimate the presence of danger and therefore are more prone to over react and make poor choices in the face of challenges such as perceived “disrespect” from peers or even adults.

This is particularly true during adolescent brain development-when personality and values begin to take shape and underpin individual identity, but also when there is a mismatch between mature impulse response and immature impulse control systems. All of this leads to poorer education outcomes and higher likelihood of

The UK Police are increasingly using ACEs to understand and prevent criminal behaviour such as drugs trafficking across country lines or urban knife crime.[24]It is widely assessed that criminal gangs or violent radical organisations on the one hand, and organised groomers and human-traffickers on the other-prey on young people from high ACE backgrounds. Knowing that there is a neurobiological pathway for high propensity for being a perpetrator or victim of violent crime has led to new levels of collaboration across police, health, social work and education sectors.

Some of the solutions to child trauma, adversity & violence are now known

The first is primary prevention.   Nursing visiting where the nurse can demonstrate secure attachment behaviours and positive parenting strategies can halt intergenerational transmission at the moment when the relationship and the parenting style if being formed. The importance of the parent practising the behaviours with the support and guidance of the nurse is crucial. Often for new parents with high ACEs , for example for young women from state care backgrounds,  having children in a supportive environment is the breakthrough which enables the parent to strengthen their attachment capability, self-soothe and overcome their own high ACEs background.  This is important because the first step to preventing intergenerational transmission of ACEs is ensuring that the parent is okay, calm and without anxiety Through longitudinal studies in Jamaica and the United States, Nobel prize winning economist Professor James Heckman demonstrated improved productivity, more health-seeking behaviour and reduced criminality amongst young adults who had received home visits decades earlier as babies yielded up to a $ 17 return for every public dollar invested, and that this was the biggest return on public investment that any government can make. [26] This correlates with research done by the Overseas Development Institute which conservatively suggests that 8% of global GDP is lost through the long term costs of violence against children.[27]

The World Bank, UNICEF & WHO now cite the Heckman research  to advocate for  governments to create fiscal space for investment in perinatal care, parenting and also pre-school for three to six year olds. The pre-school component is also important in combatting ACEs because the absence of stimulation and presence of toxic stress at home in early childhood derails language acquisition and other key learning and concentration attributes which cannot be caught up later and further diminish the prospects of progressing through school thus exacerbating the negative impact of ACEs on human flourishing. Universal pre-school is crucial to mitigate the long-term impacts of ACEs.

The second policy intervention is building resilience. Studies from child survivors of the holocaust to present-day conflicts and ACE-based research has pinpointed resilience as the main antidote to toxic stress or chronic trauma[28]. Resilience in childhood is about having “development assets which mitigate the impact of toxic on the brain and body. While the 2015 Welsh study had a dose response correlation between ACEs and poor life outcomes, it also had a dose response correlation of children with ACEs “bouncing back” from trauma if development assets were in place.[29]

There are many environmental factors, a lot of research of childhood survivors from the holocaust for example pinpoints ability to form and maintain relationships as a key determinant. Having at least one positive relationship is perhaps the one determinant of resilience across all research[30]. Other key aspects of resilience are things like belonging, purpose and a capacity to self-soothe. It has often been noted that children in state care or other high ACE situations are more likely to do better in life if they engage in sports. There are generations of bar stool pundits who have suggested that this is because such young people have had a chance to “channel their aggression positively” however through the research on resilience we probably now know that the positive correlation with sports and overcoming adversity is rather about positive relationships, belonging and purpose. Another myth that the resilience research bursts is the concept of the resilient individual overcoming adversity through sheer, individual perseverance. In reality where resilience occurs, it is normally because of relationships, not the rugged individual operating by themselves.

A good policy target for governments wishing to promote human flourishing would be to ensure that every child has at least one positive relationship with an adult in their lives. Sometimes this may need to be a teacher, a sports coach or social worker if the family is not able to provide such a relationship. The approach of trauma informed schools in which children are able to regulate, relate & reason…in order words calm down the stress response system, have a deep connection with a teacher and then begin to learn…are increasing being mainstreamed in education sector reform.

For the first time in history, the sustainable development goals provide policy space to make parenting, resilience and violence prevention systems available globally by 2030. To maximise this opportunity, we need to build a global movement that can harness this knowledge into action everywhere and create common understanding across societies whilst maintaining the flexibility to graft these interventions on to local cultures and value systems. Through this approach we can create a world in which all children can have the optimum opportunity to grow free from trauma and thrive in societies which flourish.


[1]https://www.cdc.gov/violenceprevention/acestudy/index.html

[2]http://www2.nphs.wales.nhs.uk:8080/PRIDDocs.nsf/7c21215d6d0c613e80256f490030c05a/d488a3852491bc1d80257f370038919e/$FILE/ACE%20Report%20FINAL%20(E).pdf

[3]https://www.albertafamilywellness.org/what-we-know/aces

[4]http://www.academia.edu/24121998/Association_Between_Adverse_Childhood_Experiences_ACEs_and_Preterm_Birth_a_Case_Control_Study_in_Chongqing_China

[5]http://www.euro.who.int/en/countries/russian-federation/publications/survey-on-the-prevalence-of-adverse-childhood-experiences-among-young-people-in-the-russian-federation

[6]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710615/

[7]http://www.euro.who.int/en/countries/poland/publications/survey-of-adverse-childhood-experiences-and-associated-health-harming-behaviours-among-polish-students-2018

[8]https://www.togetherforgirls.org/violence-children-surveys/

[9]https://www.cdc.gov/violenceprevention/childabuseandneglect/vacs/reports.html

[10]https://www.ncbi.nlm.nih.gov/pubmed/20888640

[11]  Gilbert et al. 2010 Childhood Adversity and Adult Chronic Disease: An Update from Ten States and the District of Columbia. American Journal of Preventative Medicine. 48(3): 345-349

[12]http://www2.nphs.wales.nhs.uk:8080/PubHObservatoryProjDocs.nsf/3653c00e7bb6259d80256f27004900db/fc57159cf0046a8a80257c28004aa6ea/$FILE/Children%20and%20YP%20Profile%20Wales%20report%20-%20low%20res%20(Eng).pdf

[13]https://press.princeton.edu/titles/9434.html

[14]http://www2.nphs.wales.nhs.uk:8080/PRIDDocs.nsf/7c21215d6d0c613e80256f490030c05a/d488a3852491bc1d80257f370038919e/$FILE/ACE%20Report%20FINAL%20(E).pdf

[15]https://www.cdc.gov/violenceprevention/acestudy/ace_brfss.html

[16]https://www.sciencedirect.com/science/article/pii/S0895398808600628

[17]https://www.researchgate.net/publication/325043095_Adverse_Childhood_Experiences_and_HIV_Sexual_Risk-Taking_Behaviors_Among_Young_Adults_in_Malawi

[18]https://www.researchgate.net/publication/327165969_Adverse_Childhood_Experiences_Mental_Health_and_Risk_Behaviors_Among_Men_in_the_Solomon_Islands

[19]Karen M./ Abram et al North Western University Post Traumatic Stress Disorder in Youth in Juvenile Detention Archives of general Psychiatry 61 April 2004

[20]http://www.analyticamk.org/images/2018/CVE-EN-FINAL-WEB_272e4.pdf

[21]Combining data from https://www.oecd.org/pisa/PISA-2015-Results-Students-Well-being-Volume-III-Overview.pdfand https://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/en/. The latter was compiled by the author for this paper

[22]https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/resilience/Pages/ACEs-and-Toxic-Stress.aspx

[23]http://alfredadler.edu/sites/default/files/Graham%20MP%202015.pdf

[24]https://www.standard.co.uk/news/crime/looking-behind-the-crime-isn-t-soft-it-s-intelligent-policing-a3966601.html

[25]  Expanding Circle Peter Singer 2011 Ethics, Evolution and Moral progress Princeton University press

[26]https://heckmanequation.org/resource/the-heckman-curve/

[27]https://www.childfund.org/uploadedFiles/public_site/media/ODI%20Report%20%20The%20cost%20and%20economic%20impact%20of%20violence%20against%20children.pdf

[28]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956753/

[29]http://www2.nphs.wales.nhs.uk:8080/PRIDDocs.nsf/7c21215d6d0c613e80256f490030c05a/d488a3852491bc1d80257f370038919e/$FILE/ACE%20Report%20FINAL%20(E).pdf

[30]https://www.apa.org/helpcenter/road-resilience.aspx

[31]https://uobschool.org.uk/wp-content/uploads/2017/08/Framework-for-Character-Education-2017-Jubilee-Centre.pdf