1032 Adverse childhood experiences (ACEs) awareness: a trust-level evaluation

Abstract

<h3>Background</h3> Adverse Childhood Experiences (ACEs) are events that can potentially cause lasting adverse impact in later life. By identifying ACEs early in the course of a child’s clinical encounter, healthcare members are in positions to help direct appropriate support to the child and family. <h3>Objectives</h3> To measure ACEs-awareness levels among healthcare staff dealing with children. To identify barriers preventing healthcare staff from identifying and proactively implementing interventions when encountering ACEs in clinical practice. <h3>Methods</h3> A questionnaire survey, held over 7 weeks, was sent to medical staff in acute paediatrics, neonatology, community paediatrics, emergency medicine, and acute maternity services. Email invitations to a GDPR-compliant survey platform was distributed, upon approval from various departmental safeguarding leads. Results were consolidated and analysed using Excel software. Respondents from CAMHS were excluded due to CAMHS operating under a different trust. Participants were asked about their current awareness of ACEs and their confidence levels using ACEs in their daily clinical practice; where they had received their ACEs-training; and whether they were keen to attend ACEs-training. They were also asked to select from a list, what would be classified as ACEs. <h3>Results</h3> 87 responders out of 283 invites (31% response rate) were received. 38 responders (44%) were Nursing staff, 7 (8.0%) were Midwifery staff, 16 (18.5%) Consultants, 2 (2.3%) associate specialists, 15 (17%) specialty registrars, 5 (5.7%) senior house officers, 1 (1.1%) foundation doctor, and 3 (3.4%) allied health professionals (dietician, health play specialist, and advanced nurse practitioner). Most respondents, 34 (39%) had never heard of ACEs. Only 12 (14%) respondents were confident in applying ACEs in clinical practice. When shown a list of social circumstances and asked to identify which were ACEs, 75 (86%) correctly identified all ACEs in the list. ACEs that were least recognised by responders were ‘Migration’ (78, 90% had correctly identified this ACE), ‘Parental mental ill-health’ and ‘Bereavement’ (82, 94%). 75 (86%) respondents were unaware of ACEs-training in the Trust. 71 (82%) had never attended ACEs-training before. Of those who did (16; 18%), cited ACEs-training were from Online modules, safeguarding training run by the Local Authority, Royal College of Paediatrics and Child Health Level 4 training, or regional paediatric study days, and trust induction. 79 (91%) respondents expressed eagerness to attend ACEs-training. Of the respondents who expressed ‘No,’ (8, 9%), reasons were: ‘Different priorities’, ‘Unsure of benefits,’ ‘Covered in safeguarding’, and ‘A trauma-informed approach rather than the ACEs model, is better.’ <h3>Conclusions</h3> ACEs-awareness among healthcare staff working with children is suboptimal, but staff showed eagerness to learn about ACEs. This positive attitude should be further developed by incorporating effective, relatable training sessions either through in-house training, leaflets and posters to raise awareness of intervening and preventing ACEs, or via online Trust or external continuing professional development (CPD) providers’ Learning Modules. As a result of our study, ACEs-training was introduced in Safeguarding induction and training. With more frontline awareness, it is hoped that protective, resilient factors that will help counteract the impact of ACEs can be implemented promptly, into the lives of affected children attending health services.