Tackling Adverse Childhood Experiences (ACEs) is prominent on the policy agenda in Wales and indicates a desire to intervene early in order to save later. But will policy conservatism elsewhere undermine the laudable efforts to invest in future generations?
When the demise of the Communities First programme in Wales was first mooted in October 2016 an interesting new approach was included in the announcement: tackling Adverse Childhood Experiences (ACEs). It threw up several questions:
- Why did it not figure in the ‘Welsh’ Labour election manifesto only five months earlier?
- Did the simultaneous phasing out of Communities First and advent of tackling ACEs reflect a continued shift away from supporting collective, community action to shaping individual pathologies and behaviours?
- Indeed, are they being pitched into competition against each other?
- What had happened to the word ‘poverty’ in political discourse in Wales?
- What was the theoretical and academic basis to ACEs?
- Does a future focus on children mean adults in need of support now are being ‘written off’?
Within a month Public Health Wales (PHW) helped answer some of these questions with a two day conference and report that shed a light on the academic underpinning to ACES; two further reports have followed. They assert that:
Adults in Wales who were physically or sexually abused as children or brought up in households where there was domestic violence, alcohol or drug abuse are more likely to adopt health-harming and anti-social behaviours in adult life.
PHW asserts that these behaviours are costly to the NHS and other services and this burden could be greatly reduced had the ACEs been prevented. Multiple ACEs experienced during childhood can have an aggravating effect in later life.
An ACE is defined as a traumatic experience that occur before the age of 18 and are remembered throughout adulthood. The specific ACEs are:
Sexual abuse Physical abuse
Verbal abuse Domestic violence
Parental separation Mental illness
Alcohol abuse Drug abuse
Incarceration
Page 9 of the full report outlines what answers to which questions asked of adults qualified someone as having experienced an ACE.
The report suggests that 47% of the adult population in Wales experienced at least one ACE with the pivotal number of ACEs being four: in comparison with someone who experienced no ACEs those with 4 or more are several more times likely to, among other things, become a high-risk drinker, be incarcerated, use crack or heroin or to smoke.
The research is compelling and would, frankly, chime with a great number of people with a community development and Communities First background.
In addition to further reports, a national resilience survey around ACEs will be carried out, and an ACE Hub has been developed that will:
help organisations, communities and individuals across Wales to tackle ACEs by bringing together people who are knowledgeable, skilled and experienced in this area.
The broader policy approach appears to have at its heart a desire to collaborate, learn from each otehr and experience and take risks in a manner that the Wellbeing of Future Generations Act asks of statutory agencies.
It is hard to argue against the approach. But I have had a recent focus on and interest in prisons inspired by the prospect of a forthcoming podcast about empowering prisoners through education with Prisoners’ Education Trust, and by an excellent discussion on Desolation Radio about prisons and criminal justice in Wales, And something continues to niggle me, compounded by the new UK government drug strategy launched recently.
A so-called ‘super’ prison recently opened in Wrecsam/Wrexham in north Wales. It is Wales’s biggest with over 2000 berths in it, 50% more capacious than the next biggest (Parc). That a centre-right government will respond to a record and overcrowded prison population by merely building more prisons will come as little surprise. HMP Berwyn also follows an increasingly well-trodden path in marketisation of and private investment in a traditionally statutory public sector service. Curiously, debate about the suitability of the proposed location was dominated by the prison’s supposed benefit as an economic driver to north Wales; and discussion about the effectiveness of prison, of any size, on rehabilitation was barely heard. HMP Berwyn is deconstructed and made accessible quite deftly and effectively in the Desolation Radio podcast.
What’s more the appetite for super prisons – an oxymoron if ever there was one – appeared to be growing with one mooted for Port Talbot.
Surely, HMP Berwyn will need to be filled to justify its size and existence. A 2000 berth prison whose population barely ever scrapes into four figures will be considered a vast white elephant. In this way we are worryingly following the American model of industrialising prisons to generate profits for the private sector, whose pursuit for never-ending growth will create a hunger for more prisoners that will never be sated.
Much of the decisions around HMP Berwyn and criminal justice are not devolved to Wales. In this way I have a degree of sympathy with the Welsh Government. I would hope we in Wales would take a more progressive approach to crime if the powers were devolved, but it is academic at present and does not appear to be a situation likely to change any time soon.
Health is devolved however and the focus on ACEs is a reflection of this and it is very much in keeping with the Wellbeing of Future Generations Act in emphasising early intervention and prevention as a way of guaranteeing greater wellbeing in communities further down the line. But herein lies the possible policy contradictions: in one corner we have robust evidence about ACEs informing a policy approach, around which a consensus as rapidly formed, articulating the corrosive familial harm of incarcerating someone; and in the other corner the construction of the country’s biggest prison (and maybe a second one on the way) that will need to be filled.
That we seek to tackle the impact on children of, among other ACEs, incarceration while consciously making it an imperative to imprison ever greater numbers of people appears ridiculous. Likewise the new drug strategy. Although it suggests a slight change of position on some issues, the strategy demonstrates little in ideological shift away from the use of the criminal justice system, instead of health services, to tackle drug use. Sadly, the strategy continues to suggest that drug users will be sent to prison for punishment, rather than clinics for treatment; and children will continue to be adversely affected by the related experiences.
Again, Welsh Government has little room for policy manoeuvre here due to the devolution settlement, but putting constitutional complexity to one side, as morally justifiable as it is to tackle ACEs, a policy emphasis on limiting the adversity of an experience of parental drug use or incarceration, would be better replaced by a progressive supply-side policy approach that prevents the cause of the experience in the first place.
Without an ideological shift in treating addiction as a health issue and recognising incarceration’s limited impact on rehabilitation, we will continue to be exposing children to the pernicious impacts. The conveyor belt will continue to produce ACEs that will need to be tackled.
Featured image courtesy of wrexham.com
