Charlotte Waite

Hyb Cymorth ACE Cymru: ACE Support Hub Wales

Amanda Protheroe

Housing Consultant

Housing and ACEs: the Welsh Response

Champion & Challenge

for Change

Hyrwyddo a

Herio dros Newid

ACE Study – Wales

• Over 2,000 adults aged 18-69 years participated in two ACE’s Studies for Wales

• Provided information on their exposure to ACEs before the age of 18 years and their health and lifestyles as adults.

• The study achieved a compliance rate of 49.1%

• The sample was designed to be representative of the general population in Wales

• Data were collected using an established questionnaire incorporating the short ACE tool developed by the US Centre for Disease Control based on work by Felitti et al (1998)

ACE Study – Wales

Welsh ACE study - Prevalence

• ACEs don’t occur alone….if you have one, there’s an 87% chance that you have two or more.

ACEs: What we know

Champion & Challenge

for Change

Herwyddo &

Herio am Newid

Prevalence

ACEs – The Increased Risks

.

ACE Support Hub

• Established by Cymru Well Wales (CWW)

• Funded by Welsh Government (cross portfolio funding) and supported in kind by CWW partners

• Vision – to reduce ACEs in Wales, minimise their impact, increase resilience.

• Aim – to develop ACE informed organisations and professionals AND create an ACE aware society

• Key principle – long term sustainability – not another ‘thing’

ACE Support Hub – Strategic Approach

Strategic Engagement

and organisational

readiness

ACE Informed Framework

Tools and Resources

Support from Sector

Relationship Leads

Consistent Awareness

Sector specific training

Opportunities for Policy Development, identification of barriers

Co

mm

un

ity

Aw

aren

ess

and

En

gage

men

t

Impact of stress

Positive Stress –

Mild and short lived stress response required for healthy development

Tolerable Stress –

More severe stress response but limited in time and

allows for recovery

Toxic Stress –

Extreme, frequent or extended activation of body's

stress response without buffering of supported adult

Positive role model, emotional buffering, resilience Intense, repeated, unaddressed

Trauma response and the impact on brain development

Toxic Stress from trauma will over-develop ‘life-preserving’ part of the brain.

At Rest

Threat

Fight – Flight - Freeze

Exhausted

RecoveryAt Rest

Healthy response

trauma

FixedAllostatic load

Tau et al, 2010; Mercy, Butchart, Bellis et al, 2014

Chemicals flood in

Trauma – Brain Development

• Understands the impact of toxic stress on service users and on staff

• Recognises that stress causes us to revert back to old habits that may have been overcome in the past.

• Learning about the psychobiology of toxic stress is liberating...it provides an explanation for some puzzling, often destructive behaviours we engage in and the feelings that can come to dominate us.

A system that understands toxic stress

In one area of South Wales between 4th June 2015 and 18th November 2015 (24 weeks) 1,484

Public Protection Notifications were received by social services

from the police

89% (1,317) Public Protection Notifications logged and closed

11% (167) Public Protection Notifications progressed

Verbal Abuse

Physical Abuse

Separation

Domestic Violence

Alcohol Abuse

Incarceration

Drug UseMental Health

Sexual abuse

Operational example: Police and ACEs

Tenants who have unmet support needs which interfere with their ability to pay their rent and engage with their landlord to resolve the issue.

25% go on to commit crime

16% go on to use A & E

4% have an ‘unwanted’

sexual partner in order to

secure accommodation

Verbal

Abuse

Physical

Abuse

Separation

Domestic

Violence

Alcohol

Abuse

Mental Health

Housing and ACEs In 2015-2016, social landlords

undertook 914 evictions,

including 301 evictions of

families with children, making

approximately 512 children

homeless.

Incarceration

Drug Use

Sexual Abuse

ACEs and Homelessness

‘‘multiple exclusion homelessness’ (MEH) –a form of ‘deep’ social exclusion involving not just homelessness but also substance misuse, institutional care and/or involvement in ‘street culture’ activities.’

‘Most MEH service users had experienced troubled childhoods marred by school and/or family problems, with many also reporting traumatic experiences such as sexual or physical

abuse, homelessness or neglect.

In adulthood, the incidence of

self-harm and suicide attempts

is notable.’

Fitzpatrick, Bramley and Johnsen

(2012)

• The Housing (Wales) Act was passed by the National

Assembly in 2014 and aimed to ensure that people who

are homeless or facing homelessness receive help as

early as possible.

• Third sector support providers, housing associations and

local authorities all play crucial roles in supporting people

to avoid homelessness, access housing and maintain

their tenancies.

• These organisations frequently support people with

experiences of trauma and want to deliver high quality,

psychologically informed services that enable people to

avoid homelessness and live independently in their

communities.

Housing and ACEs

Arguing with mum Going missing

Drug use Offending

Mental health

difficulties

Truanting

Anxiety

CSE

Night terrors

Mothers mental

health difficultiesParental separation

Death of parent

Witnessing domestic

violence

Victim of domestic

violence

Neglect

Physical abuse

Sexual abuse Verbal abuse

Homelessness

SYSTEM RETRAUMATISING THE INDIVIDUAL

1. Relationships2. Physical Environment and Social Spaces3. Psychological Framework4. Staff Support and Training5. Evidence Generating Practice

The nature and quality of relationships between participants would be recognised and highly valued

participants share some measure of responsibility for the environment as a whole, and especially for their own part in it where all participants – staff, volunteers and

service users alike –are equally valued and supported in their particular contribution

engagement and purposeful activity is encouraged

opportunities for creativity and initiative, whether spontaneous or

shared and planned

A PIE is an Enabling Environment

Champion & Challenge

for Change

Hyrwyddo a

Herio dros Newid

Where behaviour, even when disruptive, is seen as meaningful and as communication to be understood.

Formal rules or informal expectations of behaviour are clear; or if unclear, there is good reason for it

Where power or authority is clearly accountable and open

to discussion

Where decision-making is transparent and both formal and informal leadership roles

are acknowledged

A PIE is an Enabling Environment

Champion & Challenge

for Change

Hyrwyddo a

Herio dros Newid

• Understands the impact of toxic stress on service users and on staff

• Recognises that stress causes us to revert back to old habits that may have been overcome in the past.

• Learning about the psychobiology of toxic stress is liberating...

it provides an explanation for

some puzzling, often destructive

behaviours we engage in and the

feelings that can come to dominate us.

A system that understands toxic stress

Service users Staff Organisation

Feel unsafe Feel unsafe Is unsafe

Aggressive Punitve Punitive

Helpless Helpless Stuck

Hopeless Hopeless Missionless

Hyperaroused Hyperaroused Crisis Driven

Fragmented Fragmented Fragmented

Overwhelmed Overwhelmed Overwhelmed

Confused Confused Valueless

Depressed Demoralized Directionless

Trauma Organised Systems

•Vicarious trauma: can occur when you hear about and see the effects of trauma on the lives of others

•Compassion fatigue: Can cause errors in judgment, detachment from work, avoidance

• Burnout : Usually characterised by: lack of enthusiasm; sense of stagnation; feelings of frustration; apathy toward your job and the people there

You can be affected indirectly by trauma

• @charlotwaite

• charlottewaite@wales.nhs.uk