Adverse Childhood Experiences (ACEs) toolkit

This toolkit contains information, advice and practical tools for individuals and professionals who work with, or care for, children who have had adverse childhood experiences (ACEs). The toolkit includes:

• resources and tools to support practitioners
• information specific to the ACEs questions in the Australian Capital Territory (ACT) Kindergarten Health Check
• information to support GPs navigating ACEs in the Australian Capital Territory (ACT) Kindergarten Health Check, and
• information for parents and carers about ACEs.

ACEs is a term used to describe very stressful events or circumstances that children may experience during their childhood. The term was introduced in a seminal 1998 US study on the impact of childhood abuse and neglect and household challenges on later-life health and wellbeing (Felitti et al., 1998). This early study showed an association between adverse experiences in childhood and potentially profound impacts on later health and social functioning.

Twenty years of extensive international research has since shown a strong predictive relationship between the number of ACEs one is exposed to as a child, and the probability of physical health, mental health and social and behavioural problems occurring through childhood into adult life, and being passed on to the next generation (Hughes et al., 2017). The most widely recognised and researched ACEs relate to abuse, neglect and household adversities, and include:

• childhood physical, sexual and emotional abuse
• physical neglect and emotional neglect
• exposure to family violence
• parental substance use
• parental mental illness
• parental separation or divorce, and
• parental incarceration.

There is a misconception that these adversities are experienced only, or predominantly, by certain population sub-groups. While children from lower socioeconomic positions have a greater risk of experiencing ACEs (Walsh, McCartney, Smith & Armour, 2019), research consistently shows that individuals across all demographics can be exposed to ACEs.

An estimated 72% of Australian children have been exposed to at least one ACE, with this rate being higher in some vulnerable Australian populations e.g. Aboriginal and Torres Strait Islanders (Zubrick et al., 2005), juvenile offenders (Baglivio et al., 2014), and children involved in welfare services (Kerker et al., 2015).

Follow the links below for a range of ACEs information, tools and resources.

^{Baglivio, M. T., Epps, N., Swartz, K., Sayedul Huq, M., Sheer, A., & Hardt, M. S. (2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2).}

^{Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … 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 Preventive Medicine, 14(4), 245-258. doi: 10.1016/s0749-3797(98)00017-8}

^{Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., … Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health, 2(8), e356-e366. doi: 10.1016/S2468- 2667(17)30118-4}

^{Kerker, B.D., Zhang, J., Nadeem, E., Stein, R. E. K., Hurlburt, M. S., Heneghan, A., … McCue Horwitz, S. (2015). Adverse childhood experiences and mental health, chronic medical conditions, and development in young children. Academic Pediatrics, 15(5), 510-517. doi: 10.1016/j.acap.2015.05.005}

^{Walsh, D., McCartney, G., Smith, M., & Armour, G. (2019). Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review. Journal of Epidemiology and Community Health, 73(12), 1087-1093. doi: 10.1136/jech-2019-212738}

^{Zubrick, S., Silburn, S. R., Lawrence, D., Mitrou, F. G., Dalby, R. B., Blair, E., … Li, J. (2005). The Western Australian Aboriginal Child Health Survey: The social and emotional wellbeing of Aboriginal children and young people. Perth, Western Australia: Curtin University of Technology and the Telethon Institute for Child Health Research.}