Health and Wellbeing Board Development Session: Adverse Childhood Experiences (ACEs) · 2018-02-08 · •Child and family support services •Parenting programmes, where they have

Health and Wellbeing Board

Development Session:

Adverse Childhood Experiences (ACEs)

Welcome

Councillor Sylvia Hughes

Chair

Northamptonshire Health &

Wellbeing Board

Northamptonshire Health and Wellbeing Board:Making It Real

Cllr Sylvia Hughes, Northamptonshire County Council

Chair of Northamptonshire Health and Wellbeing Board

Health and Wellbeing Executive Board

Cllr Sylvia HughesChair

Prof Nick PetfordVice Chair

Dr Darin SeigerVice Chair

Cllr Chris Millar Vice Chair

Lucy WightmanDirector of Public Health

The Board Development Sessions

• Health and Wellbeing Board meet six times a year.

• Board Development Sessions include the opportunity of extending the reach of the Board

• Each session hosted by the Chair or a Vice Chair, with invitations relating to the theme of the session

Purpose of Event

Setting the Scene

Chief Constable Simon Edens

Northamptonshire Police

ACE Workstream Update

Nicci Marzec

Director for Early Intervention

Office Police Crime Commissioner

Rajwinder Gangotra

Public Health Principal

Northamptonshire County Council

What can we do about ACEs?

Working across the life-course

8 Introduction to Adverse Childhood Experiences

Policy and guidance


1.Prevention

Best start in lifeEmotional health and wellbeing in schools & collegesHousing for health 2. Early Intervention

Supporting mental health in schools & collegesCost of late interventionFuture in mind 5 / Year Forward View for mental health

3. MitigationTackling child sexual exploitationHelping workless familiesFuture in Mind / 5 Year Forward View for mental health

Prevention


• Promote early attachment

• Universal and selective services – home visits, parenting/family

programmes

• Sexual abuse and violence prevention

• Community policing

• Schools – building resilience

• Social care system to prevent intergenerational neglect and abuse


Source: Perry & Pollard 1997 and 2005. https://childtrauma.org/wp-content/uploads/2013/12/PerryPollard_SocNeuro.pdf

https://childtrauma.org/wp-content/uploads/2013/12/PerryPollard_SocNeuro.pdf

Early intervention

Examples of interventions

Perinatal mental health

Early years support and education

Whole school/college interventions

Bullying interventions

Mindfulness

Mental Health First Aid

Connect 5 Training

Counselling

Early intervention for self-harm


Mitigation for those with ACEs


“You’re Welcome” Young people’s health services

Trauma informed services in schools

Trauma informed care aims to develop different thinking process so that children

and adults are less likely to ‘flip’ into the fight/flight type response that is

associated with threat and stress.

Examples in the South West include:

• ‘Thrive Approach’ commissioned in Devon and Plymouth

• ‘Mindful Emotion Coaching’ commissioned in

Somerset and North Somerset

• Emotion Coaching in Wiltshire, Swindon and

Bath and North East Somerset


Sources: https://www.thriveapproach.com/

http://www.emotioncoaching.co.uk

Adults who have experienced ACEs

• Routine enquiry has started in a number of LAs

• Key areas for piloting adult enquiry – police, drug and alcohol services, mental health.

• Opportunity for better collaborative integrated working


MEAM – model for integrated working


Source: http://meam.org.uk/

Making Every Adult

Matter

“In every local area

people with multiple

needs and exclusions are

living chaotic lives and

facing premature death

because as a society we

fail to understand and

coordinate the support

they need”.

1. Mental Health – To review mental health pathways to ensure that our mental services are ACE informed and all interventions include ACE screening. Enabling mental health practitioners to have a clear dialogue on ACEs and the services that are available.

NHFT

CCG

NCC

General

PracticePolice/

OPCC

VCS

NGH/KGH

2. High Risk/Need Families - To analyze the impact of school exclusions, crime and other key indicators of high need on individuals and the wider family. To review current services, identifying gaps and influencing future commissioning.

Police/OPCC & CFE

CCG

NHFT

General Practice

Probation

VCS

NGH/KGH

3. Partners to actively adopt strategies and training programs to ensure that their staff and services are ACE aware.

All Health and Wellbeing Board member organisations should be

involved

4. To use the principles of ‘Five to Thrive’ to address ACEs - equipping parents to be more mindful about the needs of children and how their behaviour impacts on them.

CCG

NHFT

NCC

General Practic

ePolice/

OPCC

VCS

NGH/KGH

5. Countywide social marketing campaign aimed at parents and families.

Public Health

NHFT

PHE

General Practice

Police/

OPCC

VCS

NGH/KGH

Next Steps

1. Quarterly steering group meetings – identification of the right person with decision-making responsibility

2. Commitment to three task and finish groups

3. ACE Health and Wellbeing Board Development Day – Thursday 8th

February 2018

Header (optional)

Adverse Childhood Experiences: The Critical Factors

Mark Evans & Sean Scannell 08-02-2018

Header (optional)

Number of ACE style factors

Prevalence (%) in YOS ASSET cohort

Prevalence (%) in YOS ASSET cohort with 5+ convictions

Prevalence (%) in Northamptonshire population (LiverpoolJohn Moore’s University study)

0 33.5 13.4 52.5

1 19.5 17.9 19.3

2-3 28.3 28.4 17.9

4+ 17.2 40.3 10.4

Prevalence of ACEs in YOS

Header (optional)

Individual ACE style factor

Prevalence (%) in Northants population (Liverpool John Moore’s University)

Prevalence (%) in YOS ASSET cohort

Prevalence (%) in YOS ASSET cohort with 5+ convictions

Abuse 23 (verbal)14 (physical)

6 (sexual)39.1 63.9

Domestic Violence 16.4 37.3 55.9

Drug abuse 4.2 14.2 22.2

Alcohol abuse 11.6 13.4 25

Living with known offenders / Incarceration

3.2 38.4 60.5

YOS: Prevalence of Individual ACEs

Header (optional)

• Northamptonshire Police Target Nominal Matrix (TNM) used to prioritise nominals in order of risk

• Incorporates recency, frequency and severity of offending

• Drives operational tasking

• Top 200 18-24 year olds responsible for 26% of all crime by this age group where there is a named suspect

• Top 200 10-17 year olds responsible for 32.2% of crime by this age group where there is a named suspect

Police Target Nominal Matrix

Header (optional)TNM: 18 – 24 Cohort

Analysis of the top 200 identified 156 who had attended school in the county:

• 22% had a permanent exclusion

• 83% had at least one fixed term exclusion

• 55% had at least one special educational need

• 64% of that 156 (99) were allocated to Children’s Social Care as a Child in Need

• 26% previously LAC (looked after)

Header (optional)

56 of the top 200 have a child relationship on the Social Care system:

• 82 children in total

• 79 allocated to Children’s Social Care

• 72 with an assessment that highlights Factors of Concern

TNM: 18 – 24 Cohort

Header (optional)ACE Factors of Concern: Children of 18-24

0% 10% 20% 30% 40% 50% 60% 70% 80%

Emotional Abuse

Domestic Violence – Parent/Carer

Mental Health – Parent/Carer

Drugs – Parent/Carer

Neglect

Physical Abuse

All assessments, 2014-15

TNM Cohort assessments

Header (optional)TNM 10-17 Factors of Concern: ACE

0% 10% 20% 30% 40% 50% 60%

Alcohol – Parent/carer

Drug – Parent/carer

Sexual Abuse

Physical Abuse

Mental Health - Parent/carer

DV against Parent/carer

Neglect

DV against child

Emotional Abuse

All Assessments 2014-15

Top 200 Young Offenders

Header (optional)TNM: Numbers of ACEs

0% 10% 20% 30% 40% 50% 60%

0

1

2

3

4+

10-17 Top 200 Suspects

18-24 Top 200 Suspects' Children

Header (optional)

Header (optional)

• 29% of those with alcohol risk factor also have parental alcohol use as a risk factor

• 27% of the with drug risk factor also have parental drug use as a risk factor

• 68% of those with domestic violence risk factor also have domestic violence against parent as a risk factor

• 55% of those with mental health as a risk factor also have parental mental health as a risk factor

Intergenerational ACEs

Top 200 TNM 10-17 Year Olds

Header (optional)

Header (optional)

• Police TNM highest ACE rich cohort

• Generational and family based

Living with Offenders

Domestic Abuse

Mental Health

School Exclusions

• Highly Predictable

• Locality Prevalence

Conclusions

Header (optional)Inter-parental Conflict (EIF)

Family Stress Model

Header (optional)

Broadly Supportive Services

• Child and family support services

• Parenting programmes, where they have a specific component that looks to improve child outcomes in the context of inter-parental conflict

• Health services, such as Improving Access to Psychological Therapies (IAPT) or Health Visiting.

Relationship Support Services

• Relationship counselling and therapy

• Marriage and relationship education, including new parenthood programmes

• Family mediation

• Online information and advice.

Inter-parental Conflict

What Works (EIF)

Header (optional)

NE Northampton 12 month pilot from April

Multi agency setting

Agreed Exec Support Group + SDM Board

Police and CC resources committed

Shared information and powers upstream

Evaluation and analytics

Shared outcomes

Commissioning?

One year ago we said . . .

Early Intervention Hub

Header (optional)Now . . .

Header (optional)Sample Achievements

Referral Issues ACEs Partners Current Position

School to PCSO

Behavioural; Emotional; ASB; SEN

DA; Parental Separation; Mental Health

NDAS; CAMHS; ASB Unit; Young Carers; Street Sports Mentoring; Early Help; DWP; PCSO

Family working with 0-19 service; Protective Behaviours work by school; Likely to be able to disengage in a couple of weeks

PPN Child -Anxiety; Mother -self-harm

DA; Parental Separation; Mental Health

School (counselling); Lowdown; NDAS; First for Wellbeing; Campbell House

Lowdown counselling complete – child coping with anxiety; Mother has first appointment at Campbell House –more positive that will get help she needs

Workshop 1 –

the business case for action

• What are the improved outcomes that could be achieved

through focusing on these critical ACEs?

• How does your organisation contribute to identifying and

tackling these vulnerabilities?

Workshop 2 –

A single view of the truth

• What do we need to do to effectively identify the

“vulnerable/at risk”?

• What information do we need to share to identify vulnerable

individuals for intervention, and trends to identify preventative

commissioning opportunities?

• What information/data should we monitor and hold ourselves

accountable for delivery?

Workshop 3 –

• What will we do differently to act on this understanding, in

improving outcomes and preventing harm?

• Identify 4 priority things that can be done and who would

need to be involved. How will we coordinate our efforts across

partnership governance?

Assistant Chief Constable James Andronov


Feedback

Chief Constable Simon Edens


Plenary, Next Steps & Closing Remarks

Health and Wellbeing Board Development Session: Adverse Childhood Experiences (ACEs) · 2018-02-08 · •Child and family support services •Parenting programmes, where they have

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