Good intentions but the right approach? The case of ACEs

Andy Turner
11 min readApr 8, 2021

Adverse Childhood Experiences (ACEs) are traumatic events that children can be exposed to while growing up. These include the direct impact of suffering abuse or neglect, or the indirect effects of living in a household affected by domestic violence, substance misuse or mental illness. The original ACEs study found that those with a higher number of ACEs were more likely to have physical and mental health difficulties and to engage in health-related risk-taking behaviours than those with less traumatic childhoods. In the 20 years since the study was published the ‘ACEs movement’ has steadily expanded, particularly in the United States.

It took much longer for the first UK ACEs study to be published and it is only really in the last few years that awareness of ACEs has grown on these shores. England is currently lagging behind Wales and Scotland in recognising ACEs in national policy, though many local areas are developing their own ACEs strategies.

I only heard about ACEs two or three years ago. I was aware of each of the individual experiences that the authors had termed ACEs, but not of their being grouped together and counted. There was something about the idea that nagged away at me right from the start, but I couldn’t articulate it. Then I came across a concrete example of good intentions causing harm in a charity I was working alongside. The organisation helps vulnerable people with a range of problems, from domestic violence to involvement with the criminal justice system. Staff had received training on ‘ACE-awareness’ and how to incorporate routine enquiry about ACEs into their work with service users, apparently to offer more tailored support. Many of the staff had faced the same issues as those they were now trying to help, and several reported finding the training distressing. They were told of the potential damage ACEs can cause, which caused them to worry about the impact it had had on themselves. Several reported feeling guilty about having ‘passed on’ their own ACEs to their children. They were taught all about the (potential) negative impacts of ACEs, but offered no reassurance that you can have a high number of ACEs and still be totally fine. I posted this issue in an online ACES forum and found that it was not an uncommon issue. I’ve since worked on various ACEs projects and think my…

Andy Turner

Public Health Specialty Registrar