Trauma-Informed Practice

ACE (Adverse Childhood Experiences) and Trauma-Informed Practice

Trauma informed practices

It is the understanding that exposure to trauma can impact an individual’s neurological, biological, psychological and social development. Being trauma-informed means assuming that people are more likely than not to have a history of traumatic experiences and that these experiences may impact on their ability to feel safe within or develop trusting relationships, or their ability to live happy and fulfilled lives.

This seeks to remove the barriers that those affected by trauma can experience by using the principles of trauma informed practice: 

  • Safety
  • Trust
  • Choice
  • Collaboration
  • Empowerment
  • Inclusivity and Cultural Consideration

It also seeks to avoid re-traumatisation which is the re-experiencing of thoughts, feelings or sensations experienced at the time of initial trauma. This is generally triggered by reminders of previous trauma.

Trauma results from an event or circumstances which is harmful or life-threatening. Trauma is when an individual experiences something that is very stressful, frightening or distressing. It could be one incident, or an ongoing event which happens over a period of time.

Adverse Childhood Experiences are highly stressful and potentially traumatic negative events that occur in childhood. These could be direct harm perpetuated on a young person, or indirect such as witnessing domestic abuse. Some examples of ACEs can be seen below. Some other important examples to note are gang membership, bereavement, living in care, criminal exploitation, health issues, being a young carer, being a refugee and so much more.

Preventing ACE’s is a wider problem, such as tackling social inequality. While they are found across the population, it is highest in areas of high deprivation. There are many long-term health-related outcomes, as well as reduced educational attainment, worklessness, diminished social mobility, lower socioeconomic status and involvement in the criminal justice system. People who experience ACE’s often develop coping strategies. Whilst these can be health-harming, it is also shown that people with no health-harming coping strategies still had increased risk of non-communicable diseases.

When a young person has been exposed to stressful situations, there are three types of responses.

  • Positive
  • Tolerable
  • Toxic

These terms refer to the stress response systems’ effects on the body, not to the event or experience itself. Positive stress response is a normal part of a healthy child development. This may be characterised by increase in heart rate and mild elevations in hormone levels. An example of this could be getting an injection, or meeting a new caregiver. Tolerable is stress of a much higher degree, stemming from a severe longer-lasting difficulty. This could be a bereavement, or a frightening injury. If there is the correct support in place, the mind recovers from what could otherwise be a traumatising event. Toxic stress occurs when a child experiences strong, frequent or prolonged damaging incidents, such as abuse and neglect. Without support, this prolonged activation of stress response can disrupt development of the brain, and increase the risk of stress-related diseases. 

There are 4 common ways to prevent and mitigate the impacts of ACEs.

  • Supporting Parenting
  • Building Relationships and Resilience
  • Early Identification of Adversity
  • Responding to Trauma and Specific ACEs

There are things that we can all do, both in life and in the workplace:

  • Keep in mind that a person’s behaviour might be related to ACEs
  • To make sense of a child/young person’s current difficulties by considering “what happened to you?” instead of “what’s wrong with you?” And go on to ask, “how has this affected you?” and “who is there to support you?”
  • Use protective factors to build resilience e.g. secure attachment, opportunities for positive activities and supportive networks.
  • Continue to raise awareness

Some protective factors are:

  • Being around people with a positive attitude
  • Experiences of success and achievement
  • Good communication pathways
  • Secure attachments with trusted adults
  • Positive relationships

The role of resilience to mitigate the impact of ACEs is increasingly evident. Resilience resources in childhood and adulthood can reduce the negative outcomes associated with ACEs and show protective effects on mental ill health, childhood health and educational attendance. Childhood resilience resources which help prevent the negative impact of ACEs include having a stable trusted relationship with an adult, participating in sport clubs and strengthening social and emotional competency (protective skills).

It is important that we remember that trauma is extremely common, and is likely to have happened to the majority of individuals we speak to on a daily basis. Often, when a person is exposed to one ACE, they are exposed to many. Support requires a whole system approach which extends across sectors including health, social care, policing, education, housing and community from childhood to adulthood.

  • Thank them for trusting you
  • Listen, be non-judgemental and compassionate
  • Let them know you will be passing this information on
  • Follow your Safeguarding Procedures
  • Write everything that was said down, to the time, place, exact wording etc

The ACE Index: mapping childhood adversity in England:

Trauma-Informed Practice Framework, BNSSG:

Contextual Safeguarding:

Brene Brown on Empathy:

E-Learning: Introduction to Adverse Childhood Experiences:

Keeping Bristol Safe Partnership: