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Talking about childhood experiences with health visitor enriches relationships and gives health improvement for whole family

Published: 3 June 2021

A new report, published by Public Health Wales today (03.06.21) suggests that when Health Visitors enquire about caregiver’s adverse childhood experiences (ACE’s) as part of their routine visits, a series of positive benefits are found by all parties.

These include supporting the mental and physical health of the caregiver, and developing an enriched relationship between health visitor and caregiver that results in the caregiver being more likely to feel comfortable discussing other issues in the future.    

Key findings from the study were:  

Despite health visitors’ initial concerns over a potential negative response, the offer of ACE enquiry was very well received, with 9 out of every 10  caregivers agreeing to participate in the pilot, across all three health boards 

Over 40% of caregivers with any ACEs said the ACE enquiry pilot was the first time they had told a professional or service about these experiences, with first disclosure most common among male caregivers (55.1% of males with ACEs). 

4 in every 5 caregivers that provided feedback agreed that their Health Visitor got to know them better by asking about their childhood experiences and 85% suggested the intervention had made them more likely to discuss other issues with their Health Visitor in the future. So the quality of their relationships and service they received had improved. 

Caregivers who received ACE enquiry were significantly less likely to report experiencing parental stress (at six months post-partum), when compared with those who had not taken part in ACE enquiry. 

Commissioned by the Welsh Government and evaluated by Public Health Wales, a ‘Health visitor enquiry about caregivers’ adverse childhood experiences (ACEs): Key findings from a pilot evaluation’ builds on a previous, smaller pilot scheme conducted in Anglesey in 2018. This study was substantially larger with more than 1,000 caregivers involved, across three Welsh Health boards.  

Katie Hardcastle, Senior Public Health Researcher at Public Health Wales, said: “The original, pilot study focused on a much smaller area and predominantly just mothers as the primary caregiver, but showed potential for having a real benefit to both families and the Health Visitors themselves. 

“By expanding the study we were able to evaluate this model of ACE enquiry with a more ethnically diverse sample and across geographical areas such as more rural locations, and importantly look at the experiences of fathers alongside mothers, as the caregivers. 

“While there was initially caution that asking people to reflect on difficult childhood experiences could have a negative effect, evidence from this evaluation suggests that for first time parents the opposite was actually true. So this has been a very useful insight into how an ACE informed approach could help health visitors support families to improve their health and wellbeing. 

“This study paves the way for further work to understand why such benefits may materialise and how services can ensure such benefits are experienced by all parents and families.”  

Commissioned by the Welsh Government, this report builds on a previous pilot scheme conducted in Anglesey. This larger scale report used a trainer-facilitator to work with Health Visitors (HVs) at Aneurin Bevan University Health Board, Hywel Dda University Health Board and Swansea Bay University Health Board to design and deliver an approach to asking, mothers and fathers about adverse childhood experiences (ACEs) within routine health visiting contacts (known as ‘ACE enquiry’). Public Health Wales was commissioned to evaluate this mid-scale pilot programme.  

The report summarises learning from the pilot programme by exploring both the practitioner and the service user perspective and considering the potential impacts of ACE enquiry on families’ health and wellbeing.