ACEs: The rationale for long-term and systemic therapeutic interventions

All the children, young people, and families whom KidsAid are involved with have experienced trauma. Trauma is very individual; it may be a one-off trauma, such as a road accident, or chronic and cumulative, such as neglect and abuse.

ACEs: The rationale for long-term and systemic therapeutic interventions

The ability and resilience to cope with trauma are not generally innate, although sometimes people’s personalities and perspectives are a protective factor. It is influenced by other facets, such as the context, previous experience, secure family relationships, the ‘system’ around the individual, and the age or developmental stage in which the trauma is experienced. 1

When trauma occurs during childhood whilst the brain is still developing, there is a potential for lifelong implications. Studies have evidenced a link between adverse childhood experiences and poor health and life outcomes in adulthood. Children who have experienced four or more ACEs (Adverse Childhood Experiences) are considerably more likely to experience significant physical health problems and other social, emotional, and mental health difficulties in adulthood. 2 It has been reported that one in three adult mental health conditions are directly related to trauma experienced as a child. 3 Studies on child maltreatment have shown that experiencing ACEs in childhood can alter the epigenetics and biological processes in the body, which can trigger predispositions to poor mental health for the individual and future generations. 4 and 5

While children’s brains develop, they make sense of the world through their experiences and attachment relationships. If these are positive, reciprocal, and supportive, the child grows up expecting all relationships and experiences to be the same. They will have experienced responsive caregivers who have met their emotional needs and are more likely to be resilient as they will have developed coping mechanisms modelled by their caregivers. To provide this parenting experience, caregivers will have had these positive experiences as a child themselves.

Unfortunately, this is not the reality for many of the families supported by KidsAid. The parents and carers of the children and young people we work with often struggle with their own experiences of trauma and poor mental health. This is usually due to their own childhood experiences and not developing adequate coping mechanisms at a young age. As a result, parents cannot always support their children’s emotional needs effectively, and families experience significant strain.

The number of referrals received by KidsAid has tripled since 2020 which demonstrates the growing difficulties families are facing. This is largely due to the impact of the pandemic, barriers to accessing services, and the rising cost-of-living. These factors have the potential to affect the number of ACEs that young people experience during their childhood.

The demographic of the clients KidsAid supports are wide and varied, and as increasing numbers of clients are struggling with complex trauma, we have re-modelled our way of working to meet needs effectively. Though we no longer provide early intervention through short-term provision, we are preventing future ACEs, and addressing generational trauma patterns, therefore reducing demand on other services by creating sustainable change.

Why do KidsAid only work long-term and systemically?

The families we work with have often experienced years of barriers to services or inadequate support. Social Determinants of Health demonstrate that there are strong links between high levels of deprivation and consequent high ACE scores. 6 This, in addition to young people and their families suffering from isolation, ACEs and cumulative trauma, often requires long-term and systemic intervention to ensure positive and sustainable change.

Working at an individual’s pace in therapy allows them to remain within their ‘window of tolerance’ and not become overwhelmed. Working too quickly through an individual’s trauma could potentially re-traumatise individuals by making them process situations they are not psychologically or emotionally ready for. Children and adults who have experienced significant trauma and ACEs are likely to have developed suspicion and distrust of the world and people around them due to disrupted and damaged attachment. It is therefore important that relationships are built slowly and led by individual clients to ensure they develop feelings of safety which allows them to process their experiences within their therapy sessions. 7

An individual needs to develop a sense of security and emotional safety within the relationship with their therapist to feel safe enough to explore upsetting and disturbing experiences. Individuals need to know and trust that their therapist can help ‘contain’ big, challenging emotions and support them by co-regulating them. It is through this co-regulation that an individual learns the skill of self-regulation and develops appropriate coping mechanisms. Experiencing ACEs during childhood can affect our neuroception (an automatic brain function), which is the ability for our brains to sense danger within our environment. Highly traumatised children and adults will likely perceive danger where there is none and be in a state of hyperarousal, making it difficult to regulate their emotions. 8

Working systemically allows KidsAid the ability to support all the members of the family. Where a child is struggling, in our experience, the parent/carer, and family are struggling too. Parents and carers need to feel empowered to be able to support their child through life’s experiences whilst recognising and being able to seek help when they themselves are triggered too. Many studies have highlighted that children have a greater chance of recovery when they have stable, supportive parents able to assist them in navigating adverse circumstances. 9

KidsAid supports families to identify ACEs and their mental health needs, and we put therapeutic provision in place for children and young people to meet those needs. We also provide therapeutic parenting, parent therapy and attachment interventions to strengthen and repair ruptured relationships.

KidsAid believes that ACEs should not be seen as someone’s destiny. In our work, we regularly see that much can be done to support the impact of ACEs on children, young people, and their parents/carers. However, to address an individual’s prolonged and negatively impactful experience, our practice informs us that short-term therapy will not pose a suitable solution.

The efficacy of working in this way is proven to be effective from our outcomes.

In 2021-22, our outcomes evidenced the following impact:

  • We improved the emotional symptoms of 89% of parents and young people we worked with, who shared that they had reduced feelings of anxiety and depression following their intervention.
  • An improvement to the conduct symptoms of 76% of our beneficiaries was reported, with a reduction in troublesome, risk taking and disruptive behaviours.
  • We improved the relationships of 91% of the families we worked with. These parents and young people shared that because of their intervention, they experienced improved relationships and reduced isolation.
  • Prosocial behaviours, including caregiving behaviours improved for 81% of the parents and young people we worked with.

Cathryn Hicks MSc, B.Ed (Hons)
Play Therapist
Clinical Lead


  1. Treisman, K., (2017), Working with Relational and Developmental Trauma in Children and Adolescents. Abingdon: Taylor and Francis.
  2. Felitti, M. D., Anda, R. F., Nordenberg, M. D. et al (1998) ‘Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study’ American Journal of Preventative Medicine. 
  3. Adebowale, V., (2018), Addressing Adversity. London: Young Minds Trust.
  4. Mehta, D. et al. (2013) ‘Childhood maltreatment is associated with distinct genomic and epigenetic profiles in posttraumatic stress disorder’ Proceedings of the National Academy of Sciences 110(20): 8302–8307: 58
  5. McGowan, P.O., Szyf, M., (2010) ‘The Epigenetics of Social Adversity in Early Life: implications for mental health outcomes’ Neurobiology of Disease 39(1): 66–72.
  6. Public Health England, (2017), Health Profile for England: 2017 – Chapter 6: Social Determinants of Health. Accessed 20/02/2023
  7. Niven, H., (2021), Overcoming overwhelming childhood experiences (ACEs), Accessed 20/02/2023.
  8. Greenwald, R., (2015), Child Trauma Handbook: A guide for helping trauma-exposed children and adolescents. London: Routledge.
  9. Thierry, B. (2015) Teaching the Child on the Trauma Continuum. London: Grosvenor House Publishing.

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Monday 13th March 2023