Discussing ACEs with families and next steps
Emerging Minds and ANU, Australia, February
General Practitioners have skills in discussing sensitive personal and family health issues, and are well-placed to constructively discuss children’s adverse experiences and help parents/carers plan the support they need. An ACEs discussion is most successfully initiated and continued when it is sensitive to certain considerations and is guided by a number of principles, which are outlined in the resources contained in this toolkit.
Principles to guide an ACEs discussion
- Assessing a child’s safety and wellbeing is paramount. It is important to remain aware of mandatory reporting obligations;
- Awareness of the parents’/carers’ health and wellbeing is important, given the potential impact on the child;
- ACEs discussions will be most successful when based on a collaborative, respectful and non-judgmental relationship with the family;
- The aim in an ACEs discussion is to help families build their capacity to withstand recent adversity and prevent their children’s exposure to future adversities;
- Family circumstances can be complex, and it is important to allow the time for families to be secure in discussing ACEs.
Considerations when initiating an ACEs discussion
- Parents/carers can sometimes feel shame about their child’s adversities. It can be helpful to reassure them that, as a physician, your concern is not to judge but to support their child’s health and wellbeing. Providing parents/carers with accessible information about ACEs impacts is useful here;
- Parents’/carers’ own possible experiences of childhood adversity may make it difficult for them to speak about their child’s experiences. GP advice and referral should consider the health of adults in the child’s life, and appropriate consultations arranged as needed;
- A physical examination of the child can reveal somatic complaints without apparent cause. These might indicate other causes, such as anxiety or stress;
- Allow the parent/carer to expand on their family circumstances at their own pace. Non-judgemental, empathic listening is important;
- With parents/carers who are uncomfortable talking about ACEs, acknowledge the difficulty, let them know you can still provide some information and advice, and arrange another time to talk about how their child is going.
Read an example scenario for initiating an ACEs discussion.
Considerations when continuing an ACEs discussion
- In some cases, a full ACEs discussion may require a number of family consultations
- Knowing the particular ACEs a child has experienced, and determining any associated health symptoms, will help with the advice and support you provide;
- Inviting the child into the discussion at an appropriate level can be helpful, to gain their perspectives. Children may not always see family circumstances in the same way as their parents;
- In some cases, it may be necessary to talk with parents/carers about child-protection issues regarding their child.
Listen to a podcast on supporting child mental health in general practice.
View our online course Engaging with Children: A Foundation.
Next steps: GP advice and referral
General Practitioners can provide information, advice and referral options that support parents’ and carers’ ability to promote their children’s resilience and capacity to recover from stressful experiences.
Children’s resilience can be strengthened by having safe, stable and nurturing relationships with adults and others in their lives. Parents and carers are best able to provide these relationships when they have:
- practical support for the daily practicalities of parenting
- information and skills support regarding their children’s health and wellbeing and how to parent well
- personal support through friendships and relationships that strengthen their own personal wellbeing
In many cases, General Practitioners can assist parents and carers with these supports through providing information and preventive advice on, for example:
- the nature and impacts of adverse childhood experiences, and the benefits of building resilience;
- how to promote the child’s health and parents’ or carers’ health and health-related behaviours;
- how to lower the risks of future stressful events in the child’s life;
- community groups and activities suitable for the child (and those for parents/carers)
- parenting skills information and courses
View our online course Supporting children’s resilience in General Practice.
In some cases, formal referral of the child, or parent/carer, to specialist health or welfare services may be appropriate. These can include paediatricians, developmental psychologists, alcohol and other drug services, and family violence counselling and support, etc.
Whether advice and information is sufficient, or referral to specialist services, will depend on the particular circumstances of each case, including the ACEs score on the Kindergarten Health Check, any concerning symptomatology (e.g., lack of sleep, constant crying of the child), the particular adverse experiences disclosed, and their frequency.