The high socio-economic cost of adverse childhood experiences

“There is an urgent need to better understand the cumulative impact of adverse childhood experiences (ACEs) on health outcomes across the life course, integrating epidemiology with fields including epigenetics, immunology and neurology. Equally, there is a critical need for knowledge on how services can become more trauma-informed, what impact trauma-informed service delivery can have, and how services for children and families affected by child maltreatment, substance abuse, domestic violence or incarceration, for instance, can be better integrated to provide a cohesive offer.” The Lancet Research Report, Volume 6, Number 11, November 2021

The annual cost associated with the nine health conditions, including violence and four health risks resulting from ACEs, has been estimated at £2.2 billion per annum in Wales.

In several service areas, notably education and youth offending, there is emerging awareness of the impact of trauma upon populations. However, there is limited evidence of the cost effectiveness of trauma informed service interventions and, therefore, there are difficulties in building and sustaining such services, including prevention. This is in part due to the variation in definitions and understandings of trauma and trauma informed practice. More work remains to be done on this emerging area of practice.

Further, there is a challenge in applying research to real lives. The 10 flat ACE categories fail to account for wider adverse experiences and the cumulative and dynamic effects of adversity and associated trauma, as noted by Dr Alex Chard in his 2021 paper, Punishing Abuse. Similarly, service assessment tools have typically failed to fully captured the age timeline details and context of historical adversity and trauma events. This adds to the difficulty of seeing where needs have not been identified earlier and where unmet needs interact with earlier vulnerabilities such as with universal service environments, decisions and outcomes.

Further, point in time screening and assessment tools do not allow an evaluation of the difference that can be made by applying trauma awareness, skills and approaches in support services as well as specialist interventions such as enhanced case management (ECM).

The findings from the recent public health research, Tackling ACEs: State of the Art and Options for Action, point to further adaptations that can be delivered to allow structured recording of adversity and trauma experiences to be more fully and consistently used to provide feedback to service leaders. Further, these arrangements can overcome the practical and ethical problems associated with ACE screening and enable routine reporting and evaluation of efforts to respond to adversity and trauma, for example in youth justice (and perhaps virtual schools) services. The same arrangements can also facilitate effective and sustained multi agency prevention around universal services in education.

However, it seems that children’s services at this time experience significant challenges in implementing statutory safeguarding and other statutory services for Children Looked After and Special Educational Needs. Many service areas are generating high costs without achieving better care or outcomes. Alongside this are workforce challenges of retention, sufficient stability and consistency of skills. Whilst these issues demand leadership time they can also draw attention away from developing the necessary longer term aligned service solutions.

So, what can be done against this backdrop? At CACI we accept that technology can make a significant contribution to the challenges, however, where and how information management is applied, implemented and supported can make a difference to facilitating and ameliorating outcomes or, in fact, becoming part of the problem, for example being overly focussed on process efficiencies to reduce staff and silo costs versus enabling aligned, coordinated and sustained effective multi professional relational helping capability.

The public health research makes evident the very significant long-term socio-economic costs that include:

• Avoidable costs of social care and health services
• Increased costs of special educational needs
• Harm to individuals and communities from anti-social behaviour, violence and other crime
• Loss of human capital and educational potential
• Lost cost from providing services not aligned to reducing adversity or ameliorating harm
• Lost taxes and productivity through lower economic activity, ill health and early death

Further, the recommendations are clear about the need to capture child development and real life adversity and trauma event data alongside service responses and child journeys. The overarching goal will be to use this data operationally to discover where tailored multi service practice responses to individual, familial and local community issues and contexts deliver a sustainable positive impact.

“Increasing the methodological consistency of data collection, particularly in children, would help to promote early prevention, inform the provision of support, evidence the impact of prevention, and evaluate progress.” Tackling ACEs: State of the Art and Options for Action

A key challenge is achieving the alignment of universal services, effective multi professional prevention and early help responses.

Population data is increasingly available about the high costs of adversity and trauma accrued over the life course and could be considered in guidance, oversight and regulation of individual service decisions and options. This can be the next challenge for information system designers.