Adverse Childhood Experiences

– in the Scottish Parliament on 24th January 2018.

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Photo of Linda Fabiani Linda Fabiani Scottish National Party

The final item of business is a members’ business debate on motion S5M-09381, in the name of Gail Ross, on adverse childhood experiences. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that in Caithness, Sutherland and Ross, and across Scotland, there are still many children who are growing up with adverse childhood experiences (ACE), a term that covers abuse, neglect and household adversity, the effects of which can cause chronic stress responses and have a lasting impact on children as they grow into adults; notes research, which suggests that instances of ACE rise with the level of deprivation that a child is living in; understands that there are no published studies to date of the prevalence specifically of ACE among the general population of Scotland; notes what it sees as the benefits of early intervention and addressing ACE; considers that such an approach has a positive impact on the person as well as society as a whole, and notes the view that, in order to mitigate against these experiences, a greater understanding must be achieved among policy makers and that focus should lie on prevention, resilience and enquiry.

Photo of Gail Ross Gail Ross Scottish National Party

I thank everyone who has come to the chamber tonight; everyone who has supported us with briefings and advice, including the WAVE Trust, Barnardo’s, the National Society for the Prevention of Cruelty to Children Scotland and Children 1st; all the people who have been in touch on social media; and everyone who has signed the motion, which has gained support from members from all sides of the chamber. I ask anyone who is interested in ACEs to support the WAVE Trust’s 70/30 campaign, which aims to reduce adverse childhood experiences by 70 per cent by 2030. This is the first time that I have ever done this but, if people are following the debate on Twitter, we have a hashtag, which is preventACEs.

Presiding Officer, ACEs might be a relatively recent term in our social discourse, but childhood trauma is far from a new phenomenon. For many decades, psychologists, social scientists and educational experts have insisted that events that we experience in our early years can go on to form how we think, act and form relationships in adulthood.

I was first introduced to the concept in 2013, when psychologist and attachment expert Suzanne Zeedyk came to Highland Council and gave us a talk about childhood trauma. It really got to me. My son was very small at that point, and I had recently completed a course in child development. I think that most of the councillors who were present that day would agree that it was one of the best discussions that we had. It opened our eyes to the way that childhood trauma affects lives.

Suzanne Zeedyk was one of the first people to talk to Highland Council about love. Those of us who have been in a council chamber will understand that that was a welcome change. She told us about the importance of the very early years—how attachment or insecure attachment to a loved one or a caregiver can mould us, not just emotionally and socially, but physically, in the way that our brains develop. She showed us two brain scans: one of an infant who had been loved and nurtured and had good attachment, and one who had not. The difference was stark.

I met Suzanne again last October at an event, and I pledged to help in any way that I could to raise awareness and initiate action on ACEs. I think that we have begun that today.

There are no statistics on ACEs in Scotland. I hope that the minister can address that in her closing remarks. A prevalence study that was conducted by NHS Scotland would give us a baseline from which to work and let us see the scale of the issue that we are dealing with.

Statistics from the 70/30 campaign tell us that 67 per cent of the population might have at least one ACE. I do not know how many people here in the chamber have used the ACEs tool provided by Barnardo’s on the ACESTooHigh website, but a massive 87 per cent of people who have taken that test have at least one ACE.

What are ACEs? They basically sit in three categories: abuse, neglect and household dysfunction. The 10 indicators are physical, sexual or emotional abuse; physical or emotional neglect; mental illness; mother treated violently; substance abuse; divorce; and incarcerated relative.

Research has shown that, compared to people with fewer ACEs, people with four or more have three times the levels of lung disease and adult smoking, 11 times the level of intravenous drug use and 14 times the number of suicide attempts. They are four times as likely to have had sexual intercourse by the age of 15 and four and a half times as likely to develop depression. They have two times the level of liver disease. People with six or more ACEs can die 20 years earlier than those who have none.

ACEs can lead to disrupted neurological development; social, emotional and cognitive impairment; the adoption of health risk behaviours; disease, disability and social problems; and early death. They can lead to a life of drug and alcohol addiction, homelessness, mental health problems, long-term unemployment, aggression and criminality.

Studies also show that preventative spend to invest in our early years can save millions of pounds of public money. In Highland Council, Suzanne Zeedyk gave us an analogy of a baby in a stream: do the hard work at the source and you will not be fishing them out further down the stream in later years when they are playing up in school or are in prison, are homeless or worse. We could avoid not just the physical cost but the social and emotional cost to individuals and families all across the country.

We know that the best thing to do is to try to prevent ACEs from occurring in the first place, but we have to be realistic and recognise that in every instance that may not be possible. Therefore, we need to help build resilience in people with trauma so that they can deal with it. A lot of those people have never been shown love and affection, and in turn they find it difficult to show those things when they become parents. That is why schemes such as the family nurse partnership are hugely important to breaking the cycle. Our professionals, teachers, social workers, health workers and organisations such as the police need to be fully aware of, and trained and equipped to spot, the signs of trauma and to deal with the resulting behaviours and other consequences.

The sectors of education, health care, justice, social security and housing all need to work together to ensure a trauma-informed approach to the way that they work. We also need to embed a trauma-informed approach in our teacher training. I believe that Strathclyde university is already doing that, and may well be the first university in the United Kingdom to do so.

I know a teacher who set up a social enterprise that encouraged school refusers and young people from disadvantaged backgrounds to learn new skills and, in turn, to raise money for the school. I will never forget the time that she had 30 kids in the school on a Saturday morning, learning how to knit. She never apportioned blame, always tried to understand the backgrounds of the children, asked them questions, rewarded good behaviour and attendance, and cared about the kids. They rewarded her with increased attendance, attainment and confidence, because they trusted her.

We do things well in Highland. We were the first to integrate health and social care back in 2012 with the lead agency model—the only one currently operating in Scotland. We have led on many children and young people initiatives, such as the named person scheme, which—no matter if you do not agree with it—was working. So it comes as no surprise that I am putting on record my request to the WAVE Trust to use Highland as the area for its pioneer community project and my asking the Scottish Government to consider becoming a third partner in that initiative.

In Scotland, we pride ourselves on the way that we look after our children, we strive to get it right for every child and we want Scotland to be the best place in the world to grow up in. Let us get an assurance here tonight to work together across all sectors to make Scotland an ACE-aware nation, and to fulfil our United Nations Convention on the Rights of the Child commitment to protect children against all forms of neglect, cruelty and exploitation. There are a lot of people out there with the knowledge and drive to make things better.

We are never going to close the attainment gap until we address ACEs. Children cannot learn properly when they are suffering from trauma. Let us get them talking about feelings, and teach them to be kind and loving individuals who matter. ACEs have been cited as the single greatest unaddressed public health threat that we face. We need action from Government and in society, and the time for that action is now.

The Deputy Presiding Officer:

We move to the open debate, which is heavily oversubscribed, so I will be very strict with times. Contributions should be absolutely no more than four minutes, and less in some cases would be appreciated.

Photo of Rona Mackay Rona Mackay Scottish National Party

I thank Gail Ross for bringing this vital and timely debate to the chamber. Earlier this month I hosted an event to screen a film called “Resilience”, which highlights the ACEs initiative. It was my second time of viewing the film and it probably hit me even harder than the first time, as I picked up on more and more of its astonishing content.

That sell-out film took Scotland by storm in 2017. It features the research of a pioneering doctor called Nadine Burke Harris, who works in America with children who are primarily, but not always, from disadvantaged backgrounds. As a former children’s panel member, I have seen children thrive when they were taken out of hostile environments. I knew that it happened, but I did not really know why. Now I know, and it is like finding the final piece of a jigsaw.

It is important to remember that the ACEs initiative is based on scientific evidence, not academic theories. Altered responses to stress lead to physical changes in the way that the brain develops, as Gail Ross described. I urge everyone to examine the evidence and the research that has been done on the subject; it is truly revolutionary and could shape the way that we deal with disadvantaged young people for generations to come.

The psychological and scientific communities are in agreement about the harmful impact of ACEs. When someone is subjected to any kind of abuse, neglect or household adversity through their childhood, they often continue to suffer the consequences far into adulthood. In other words, for each traumatic experience that a child has, such as domestic violence, physical or sexual abuse, addicted parents, neglect and more, the higher their ACE score is and the more they will be affected.

Early traumatic experiences condition children to normalise stress and terror. That is called toxic stress. Children who experience ACEs are more likely to self-harm or attempt to commit suicide as adults. Unlike other children of their age, children with multiple ACEs are not worried about an upcoming exam—they are worried about how they will get their next meal or whether they will be safe at home. In short, they are worried about their own survival, day to day.

The eminent research scientist and ACEs pioneer Dr Suzanne Zeedyk, who Gail Ross mentioned, reports that those prolonged emotions

“change the way the body functions.”

That impacts on the quality of their lives and their overall life expectancy.

We want Scotland to be the best place in the world for children to grow up in, so we need to take action to get all our young people, whatever they have experienced, help and emotional healing. Children with a high ACE score are not doomed if they receive the correct care and understanding. In the film “Resilience”, we hear from a professional who says:

“If we want to improve the lives of our children we have to transform the lives of those caring for them.”

A lot of knowledge is already out there about ACEs. As ever, Scotland’s wonderful children’s organisations, such as Children 1st and Barnardo’s, among many others, are right at the forefront of how we deal with affected youngsters. However, we need to ensure that teachers and social workers receive training about ACEs, how to recognise the behaviour of a child who is affected, and how to respond to their needs.

We can also begin to spread awareness about the commonality of ACEs in childhood so that those who are suffering do not feel isolated. A major conference that will take place in Glasgow in September will be an amazing forum in which to spread the word. That is testament to the will and determination of all those who work passionately in the field.

Any efforts to help those children and adults are an investment in the future of Scotland. Let us make Scotland a beacon for the rest of the world in dealing with ACEs, because we can do that.

Photo of Elaine Smith Elaine Smith Labour

I congratulate Gail Ross on securing this debate.

I apologise to members and to the Minister for Mental Health in particular for having to leave early, I am afraid, as I have a meeting to go to.

I recently attended the showing of the “Resilience” documentary that was hosted by Rona Mackay, which she mentioned. It was interesting. It explained the ACE score sheet, how it works and its origins. As Gail Ross outlined, research has found a direct link between childhood trauma and adult onset of chronic disease as well as depression, suicide, being violent and, indeed, being a victim of violence. It also found that the risk of health, social and emotional problems increased with the more types of trauma that were experienced.

As Rona Mackay mentioned, a copy of an ACE questionnaire was sent with the Barnardo’s briefing that we received. I was surprised to see that bereavement was not one of the categories. Other traumas can affect health and wellbeing but, apparently, the 10 factors that are used are the most common.

Although divorce and separation are included in the 10 ACE factors, we must take care to ensure that the approach does not stigmatise any child or any parent in a one-parent family, whether that is by choice, divorce or bereavement. Sometimes separation can protect children from trauma from difficult or abusive parental relationships. Across Scotland, there are many parents, grandparents and carers who are doing a great job in providing a secure home and giving the children in their care the best start in life in many different family settings, and we should recognise that.

One concern that I want to raise is the apparent absence of any equalities and discrimination analysis from the study and the development of the ACE scores. Racism and racist abuse, for example, can blight a child’s life from the outset. We have a responsibility to continue to tackle all discrimination head on.

In many cases, childhood trauma has its roots in poverty and deprivation, of course. Many parents who live in poverty provide security and stability for their children despite massive challenges, but there is no doubt that poverty puts a strain on family finances and therefore relationships. We know that children who grow up in low-income households have, on average, poorer mental and physical health. A Joseph Rowntree Foundation report on poverty tells us:

“At age five, children who have had high-quality childcare for two to three years are nearly eight months ahead in their literacy development than children who have not been in pre-school.”

I welcome the cross-party commitment in the Parliament to increasing quality childcare provision in Scotland. However, to go back to the impact of poverty on families and children, it is shameful that the UK end child poverty campaign coalition reported yesterday on a significant increase in child poverty across the UK. The report highlights that 45 per cent of children in one Glasgow constituency now live in poverty. That is unacceptable.

There is no doubt that many people who experience trauma and abuse are resilient, but others are not. Suffering traumatic events and adverse childhood experiences undoubtedly increases the risk of inequalities, disadvantage and poorer physical and mental health. That means that building resilience and coping strategies in children and young people is clearly necessary to help to prevent negative outcomes. Family support is also important, as is ensuring that those who care for and look after children are properly supported and trained.

We have the tools to diagnose the problems and we know what some of the answers are, but all that has budgetary implications for the Government, local authorities and, indeed, the third sector. That includes the pay and conditions of staff. Earlier this week, the Jimmy Reid Foundation published a report, commissioned by Unison, that highlights the vital contribution made by local government to local services and communities. The experience of children and families living in poverty will undoubtedly be worsened by continuing cuts to local government budgets and essential services. On the other hand, increasing wages and investment to provide high-quality public services will improve children’s life chances and help reduce those ACE scores for many children. It is clearly an area where preventative spending will be of great benefit in the long term, not only to individuals but to society as a whole.

Again, I congratulate Gail Ross on securing a debate on this important issue.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I thank Gail Ross for bringing this important debate to the chamber. I remind members of my entry in the register of members’ interests, which shows that I am currently registered with the Scottish Social Services Council.

I have eight years’ experience of working in a busy child protection social work office. As Gail Ross highlighted, trauma is prevalent in the lives of children who are referred to that service. One of the issues that I encountered most often was domestic violence—an issue that leads to many child protection referrals and interventions. I am glad that the Government is taking forward the Domestic Abuse (Scotland) Bill. In debates on that bill, I have highlighted the gap in child protection, and I am glad that there is cross-party support for the gap to be addressed.

Earlier today, I talked about child sexual abuse with people from the cross-party group on adult survivors of childhood sexual abuse, of which I am a member. For most people, there is little that is more harrowing than such abuse, but it is something that there is still mainly silence about. I remember the number of times that I had to go out and deal with such cases. Unfortunately, people still do not want to talk about that issue—we still have a lot to do.

What Elaine Smith said about poverty and deprivation is right. There is no doubt in my mind that, in more deprived areas, more child protection referrals were likely, as parents became more stressed and so on. I take this opportunity to welcome John Finnie’s proposed member’s bill on giving children equal protection from assault.

I think that we have made a lot of progress over the past few years. I have mentioned before in the chamber that I started in social work in 2004. I was in the child protection team between 2004 and 2012, and over those years I noticed a lot of changes, particularly in relation to agencies sharing information, which became much more common. We need to do even more collaborative working. As I remember it, at first everybody was just in their own wee groups, but then we trained with the police and health visitors, for example, and shared training became more common. I know that local authorities in different areas have different ways of doing that, but it was heartening to hear what is happening in the Highland area in that regard.

Everybody knows that we need to prioritise early intervention, but everybody would also accept—Elaine Smith touched on this—that that is easier said than done. When a child protection case comes in, that becomes the priority for agencies, and we should ensure that resources exist to tackle both child protection and early intervention issues across all services, including social work. I ask the minister, in winding up the debate, to respond to that point. Incidentally, I note that it is a health minister rather than a minister for young people who will wind up the debate, so I should probably declare that I am the parliamentary liaison officer to the Cabinet Secretary for Health and Sport.

Policy is also important. I was very proud of some of the Scottish Government’s policies when I worked in social work, particularly the getting it right for every child policy and framework, which has really had an impact. Like Gail Ross, I will not get in into the controversy around the issue, but I support the named person scheme and think that it can make a difference as well.

I am a very big fan of the nurture approach. A lot of good work is going on in that area in schools in my constituency and in organisations—too many to mention, as I see that I am running out of time. Play is also important—we can use play and other approaches to support children. I finish with the point that it is never too late for the nurture approach. I dealt with a number of teenagers who, in the end, just wanted to feel secure—we would see coming out of them a wee child of only four or five, which was amazing.

Photo of Jeremy Balfour Jeremy Balfour Conservative

I thank Gail Ross for bringing the important issue of adverse childhood experiences to the Scottish Parliament’s attention—and, to be honest, to my attention, as I was ignorant of the issue until the motion was lodged.

Adverse childhood experiences are stressful events. Gail Ross outlined many of them as well as the different categories. A survey of adults in Wales found that those with four or more ACEs were more likely to have been in prison, to develop heart disease, to visit their general practitioner frequently, to develop type 2 diabetes, to have committed violence in the past 12 months or to have health-harming behaviours such as smoking or high-risk drinking or drug use.

When we talk about ACEs, we are talking about developmental trauma. Children who have experienced trauma and ACEs often struggle to develop the skills that are required for learning and for developing social relationships, resulting in high levels of tension and anxiety. The behaviours often manifest themselves in the school environment and can be misconstrued by teachers as bad behaviour and as requiring discipline rather than support.

However, research has found that a relationship with one trusted adult during childhood can mitigate the impacts of ACEs on mental and physical wellbeing. The children’s charity Barnardo’s, which works with children, young people and parents who have experienced trauma and abuse, has identified that, in areas where their staff have specific training in trauma-informed practice, they see changes in lifestyle. Professionals are identifying trauma in multi-agency meetings and in assessments, and schools are flagging trauma in the same way that they flag autism or attention deficit hyperactivity disorder.

Just this week, I spoke to a primary headteacher in the Lothians who welcomes the increased awareness of ACEs among professionals. She believes it is important that information is available to professionals to ensure that plans are in place to counterbalance the trauma experienced by children and to allow nurturing adult and child relationships to develop. However, she feels that care should be taken to ensure that we do not unintentionally place additional labels on vulnerable children.

It is important that we support those who care for children with ACEs and that the root causes of the issues that are being presented are dealt with. It is crucial that those who work with children who have experienced trauma are adequately supported through supervision and training.

I agree with Fulton MacGregor that children can often be helped by play and other such activities. The Scottish Government has made 2018 the year of young people, and the importance of the early years is reflected in many areas of the Scottish Government’s work. However, as Gail Ross said, unlike England and Wales, Scotland does not have an ACE survey. I encourage the Scottish Government and the Minister for Mental Health to consider whether such a survey would provide greater evidence for and put more emphasis on the need for action and, as has been mentioned, give us the baseline that we require.

ACEs should not be seen as deciding someone’s destiny or as defining someone for the whole of their life. Much can be done to offer hope and build resilience in children, young people and adults who have experienced adversity in early life. I welcome the steps that are being taken to raise awareness and understanding, but we still have a long way to go. It is incumbent on all of us, whether in local or national Government or in the third sector, to play our part.

The Deputy Presiding Officer:

I notice that speeches are gradually creeping past four minutes and then past the next five or 10-second mark. Can we have a bit of care, please?

Photo of Emma Harper Emma Harper Scottish National Party

I congratulate my colleague Gail Ross on bringing this difficult subject to the chamber today. She described ACEs with commendable detail, and I welcome that.

Gail Ross’s motion describes adverse childhood experiences as

“abuse, neglect and household adversity”.

My first experience of witnessing child abuse occurred when I was a student nurse. As part of my training, I did a clinical rotation in paediatrics. I was part of a team that was looking after an 18-month-old girl who had been admitted for a respiratory illness. That was when the cigarette burns were discovered—cigarette burns on her arms, her chest and her back. She was 18 months old and I was 18 years old at the time.

I have thought about that case a lot over the past 30-odd years, especially when I hear stories of weans in California and children from Smyllum Park in Lanarkshire, and when I hear stories from constituents when they come to my office. I understand that there are no published studies in Scotland on the prevalence of ACEs. I agree with Gail Ross that further investigation of the nature and prevalence of ACEs in our country should be a priority.

I am a member of the Health and Sport Committee, which recently took evidence from Sir Harry Burns, Scotland’s former chief medical officer, who emphasised the correlation between deprivation and adverse childhood experiences. There is an excellent TED talk by Sir Harry Burns online, in which he talks about the work of the American psychologist Professor Aaron Antonovsky, who interviewed hundreds of concentration camp and Holocaust survivors—I highlight that this week is Holocaust education week.

As a result of his research, Professor Antonovsky began to fill the space in scientific understanding between social circumstances and molecular physical events—or, as Sir Harry Burns puts it, the biological consequences of social chaos. Professor Antonovsky found that although 70 per cent of interviewees were unhealthy, 30 per cent survived. The common denominator found among the 30 per cent was an understanding that the world is comprehensible, manageable and meaningful. That provided those individuals with a resilience that helped combat chronic stress.

One of the biological consequences of social chaos is the way in which stressful events in early life affect the development of brain structures. The longer a child has been looked after away from a single significant parent, the greater their stress hormone levels are. The hippocampus in the brain, which enables us to suppress the stress response, is less developed in those with a chaotic early life, as a result of exposure to those hormones.

We are already doing things in Scotland to address ACEs and stop abusive cycles. For example, we are encouraging parents to tell their children bedtime stories to improve the cognitive attachment between child and guardian. We are enabling smoking cessation and the promotion of breastfeeding and of baby boxes—524 were given out in Dumfries and Galloway between their introduction and the end of December last year. The children who received a baby box last year will also be among the first to receive more than 1,000 hours of fully funded early learning and childcare from 2020. That support is available to all families, building on the principle established by the baby box that all children are born equal.

When I spoke to the minister early this morning, she told me that the interim review of the care sector would address any problems as soon as they were identified and that immediate action would take place—there would be no waiting, because the issue is so important.

In the words of Harry Burns,

“let’s not spend a fortune trying to find drugs to fix these problems—let’s change the chaotic and difficult circumstances.”

I am sure that the Scottish Government will need to spend some money—wisely, though—on sorting these problems.

In Scotland we are on the way to breaking the cycle of ACEs and their consequences in later life. I look forward to being part of that work and, once again, I thank my colleague Gail Ross.

The Deputy Presiding Officer:

I told members earlier that the debate is heavily oversubscribed. Due to the number of members who wish to speak, I will accept a motion without notice, under rule 8.14.3, to extend the debate by up to 30 minutes. I invite Gail Ross to move such a motion.

Motion moved,

That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[

Gail Ross

]

Motion agreed to.

I will say it again: please come in under four minutes. It is a very important subject and I do not want to cut anybody off when they are making an important statement, so please have a care.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I thank Gail Ross for securing time for us to debate the subject and for her excellent speech to start off proceedings. I remind members of my interests, given my career in residential childcare and the voluntary sector for children.

In that career, I came to know a little boy in one of our care homes who, at the age of 9, had been through 37 failed foster and residential placements.

That a boy who was the age of my eldest son could have endured such a fractured existence kept me awake at night: it should keep us all awake at night. The trauma that the boy had suffered in early life had created in him such a profound attachment disorder that he went into every new foster placement expecting it to fail. In a desperate attempt to exert some control in his life, he would, through challenging behaviour, seek to bring the placement crashing down on his terms, rather than wait for what he saw as the inevitable rejection by his foster family. Every failed placement represented, for that child, an adverse childhood experience. Failed placements were just one kind of ACE in a catalogue of ACEs that he had suffered by that young age, which ranged from bereavement and desertion to abuse and neglect.

Understanding adverse childhood experiences is critical to our deliberations in Parliament, because such experiences lie at the root of so many negative life outcomes. As Barnardo’s informs us, they are not determinants that there will be negative outcomes, but they severely hamper a person’s ability to cope with adversity, and negative outcomes stem from that. People who have experienced four or more ACEs are 20 times more likely to be incarcerated and 14 times more likely to have been a victim of violence in the past year, compared with people who have had no such experience.

It is small wonder, then, that, as we heard in Emma Harper’s excellent speech, a recommendation of Sir Harry Burns’s review of targets in the NHS was that we should routinely capture the extent and nature of adverse childhood events, so that we can form a holistic response to that reality. Sir Harry Burns’s work beyond the review addresses the internationally recognised fact that adverse events in early life have a physiological effect on the brain at genetic level, which can inhibit serotonin receptors and, thereby, the brain’s ability to cope with stress and anxiety or to experience joy.

Simply by recording adverse events for every child, we can begin to target resources effectively. However, we are certainly not meeting that challenge right now. A 2017 report by the National Society for the Prevention of Cruelty to Children found that only two of 15 local authorities that were considered provided dedicated trauma-recovery services for children.

We are not equipping our educationists with a trauma-informed approach, as we have heard. It has been 10 years since I started campaigning with others in the sector for student teachers to receive training in attachment disorder, trauma and loss, and their impact on behaviour. The issue is a key reason why educational attainment is so poor and school exclusion so high among the 15,000 young people who are in the care of the state in any given year. I therefore agree with the call from Barnardo’s Scotland and Children 1st for a trauma-informed approach for everyone who works with children and young people.

We cannot limit trauma recovery to children. We need to remember that adverse life events are multigenerational and that neglect or abuse by a parent might well stem from unresolved trauma in the parent’s life.

As we have heard, 2018 is the year of young people. What better time could there be to do more for young people who have been handed the worst start in life? It feels as though we are on the edge of a long-overdue period of revelation and revolution in the field of trauma recovery. We need to start here, in Parliament, which is why I am so grateful to Gail Ross for securing the debate. If we do not start collecting data on the prevalence of adverse experience in Scotland, we cannot begin to help the children who have such experiences, each of whom is fighting an individual battle that we might otherwise know nothing about.

The Deputy Presiding Officer:

I am afraid that this is the final warning that I am able to give. We are now in a position in which I might have to cut members’ speaking times.

Photo of Jenny Gilruth Jenny Gilruth Scottish National Party

I congratulate my friend and colleague Gail Ross MSP on securing the debate, and I remind members that I am parliamentary liaison officer to the Cabinet Secretary for Education and Skills.

As Emma Harper said, the former chief medical officer for Scotland, Sir Harry Burns, gave evidence last month to the Parliament’s Health and Sport Committee, on which I, too, sit. In response to a question that I asked, he said:

“The link is absolutely cast-iron: adversity before someone goes to school leads to failure when they get to school. If we are serious about having a flourishing, inclusive economy, we have to get that link built more strongly. Well-meaning policies such as GIRFEC have arrived, but it is time someone came up with a system to create success at school and pulled all of that together.”—[

Official Report

,

Health and Sport Committee

, 5 December 2017; c 42-3.]

The getting it right for every child policy has not just arrived: the policy can be traced back to 2004 and the review of the children’s hearings system under the previous Lab-Lib Administration. We are 14 years on.

I think back to my time working in the classroom, which was not that long ago. I look at the list of adverse childhood experiences—abuse, neglect and violence—and I can think of pupils whom I taught who experienced a range of adverse experiences before they even crossed the school gates. How was that information communicated to me as a professional? Sometimes, it was not, because the school was not informed. Sometimes, I would catch the guidance teacher after a staff meeting. Often, however, teachers simply would not know about the adverse experiences that were impacting on their pupils before the school day had even begun.

“No homework today? Detention for you.” “Can’t complete today’s task? Stay in over lunch.” “Don’t have a tie on? Go to the headie.” More restorative approaches to discipline are to be welcomed, but there is still a draconian hangover in many Scottish schools, which creates a culture of fear when it comes to discipline. That is not healthy, and it is fundamentally detrimental to pupils’ wellbeing.

Week in, week out in the Health and Sport Committee, I am struck by the disconnect between the rhetoric of the health portfolio and the rhetoric that is espoused in education. We talk about closing a poverty-related attainment gap, but the language of adverse childhood experiences rarely features in that discourse. The trauma is often caused by abuse or neglect, and abuse and neglect often arise from the conditions that are created by poverty.

What do we already know? In 2015, 159 children were on the child protection register in Fife. Parental substance misuse was a concern in 91 cases, domestic abuse was a concern in 102 cases and parental mental health was a concern in 77 cases. Who is aware of that information? Classroom teachers are not, deputy heads rarely are, guidance teachers occasionally are, as I have mentioned, but social workers often are. There is therefore a disconnect not just between health and education—a disconnect is also apparent between education and social work.

The 1997 ACEs study, in which the term “adverse child experiences” was coined, was carried out in America. I welcome Gail Ross’s proposal that the Government commit to a similar piece of qualitative research in the Scottish context. I make my own additional suggestion that the research should not be carried out exclusively by NHS Scotland, but should be done in conjunction with Education Scotland, thereby forcing those two disparate Scottish Government departments not only to work together, but to focus on agreeing a common approach to tackling adverse childhood experiences, because our schools cannot be expected to be trauma informed if we do not have a full understanding of the national picture.

On page 18 of Professor Burns’s recent report to the Government, he recommends that

“Analysis of school attainment rates should routinely consider the effect of adverse circumstances arising from socioeconomic deprivation on attainment.”

He supplemented that view in committee, saying that

“There are ways of achieving success that we should collect data on. We should try to have a more consistent approach, because if we have a piecemeal approach, everything just gets fragmented.”—[

Official Report, Health and Sport Committee

, 5 December 2017; c 43.]

This is the situation that we have: a fragmented approach to gathering information on adverse childhood experiences, and one that does not link effectively to the Government’s aspiration to close the poverty-related attainment gap. I hope that the Government will commit to challenging that fragmentation for the health and the wellbeing of children who are yet to be born.

Photo of Alison Johnstone Alison Johnstone Green

I, too, thank Gail Ross for bringing the debate to the chamber this evening.

We have heard that Children 1st considers that adverse childhood experiences are the single biggest health and social care issue affecting children and families in Scotland. Last night, I hosted an event with the Royal College of Paediatrics and Child Health, which published yesterday its scorecard on the state of child health. The college is calling on MSPs to prioritise child health and to ensure that the health and wellbeing of children are put at the centre of every decision that we take here. Its scorecard shows that we are not doing enough to shape our health and social care services around children’s needs. Doing all that we can to prevent adversity in early childhood is fundamental to that.

John Carnochan, who is a retired director of the violence reduction unit, wrote an insightful piece on adverse childhood experiences for

Holyrood magazine on Kirsty the Holyrood baby, which urged us to

“consider all our public policy within the context of prevention and develop our strategic planning through the lens of adverse childhood experiences and if we do this, we won’t have to imagine a Scotland that is less unequal, it will be a reality.”

As Emma Harper and Jenny Gilruth have shared, the Health and Sport Committee recently heard evidence from Professor Sir Harry Burns on his health and social care targets. He advocates renewing the focus on the early years. He was clear about the evidence base around the long-term impact of ACEs, and stressed:

“we had better start getting it right in the early years if we want to have a flourishing population.”—[

Official Report, Health and Sport Committee

, 5 December 2017; c 39.]

We know that experiencing a number of adverse events can affect children’s brain development and capacity to develop healthy and meaningful relationships. With that comes an impact on their ability to learn, to cope with stress and to manage difficult decisions. Down the line, children who have been through significant adverse experiences are eight times more likely to struggle with alcoholism or substance misuse, or to be arrested for violent offences, and are much more likely to develop chronic illnesses as they go through life.

I recently visited the Edinburgh access practice a couple of times to learn more about the fantastic work that it does. I have met people who are in recovery from addiction, and it could not be clearer that the one thing that those inspiring people have in common is that they have experienced adverse events in childhood. Meeting people who have been exposed to shocking circumstances that I would struggle to cope with today—I cannot imagine coping with them today, let alone as a vulnerable child—has left me in no doubt about the impact of ACEs. What is worse is that it was not until some of those people had been through years and years of insecurity, poverty and trauma and had developed chronic health issues and addiction problems that they got the support that they had needed since childhood.

As part of her work with the violence reduction unit, Karyn McCluskey has a presentation and a film—I do not know whether members have seen them—about David, who found himself being sentenced for culpable homicide at the age of 16. She went back and researched his life story, in which she found alcoholism, domestic abuse, constant house moves and family members with more than 100 convictions between them. There was a real pattern there, and Karyn McCluskey could not be clearer about the need for intervention at the earliest possible stage.

It is right that our NHS is leading work to develop our understanding of the long-term impact of adverse childhood experiences in Scotland, and it is right that we foster a trauma-informed approach to care and treatment. It is time for us to shift the focus of care from an approach that involves asking, “What’s wrong with you?”, to one that involves asking, “What happened to you?”

In 2016, there was an important conference on the impact of ACEs across our lives, the report on which was called, “Polishing our Gems: A Call for Action on Childhood Adversity”. Before the Presiding Officer asks me to wind up, I ask members who have not had the opportunity to read it to do so, because it will be really helpful as we take forward our work on the issue.

Photo of Christina McKelvie Christina McKelvie Scottish National Party

I pay tribute to Gail Ross for bringing such an important issue—one that is sometimes overlooked—to the chamber for debate.

It is not a sign of weakness to recognise an adverse childhood experience. I make it clear that the study of such experiences is not pseudo-science, that it is not an unfathomable, abstract concept, and that we are not talking about the nanny state or political correctness gone too far. No shame or disdain should be cast on someone for admitting to being a victim of an adverse childhood experience. In fact, it is the realisation of victimhood that can sometimes help us all to come to terms with the impact of such an experience in later adult life.

Victims can carry the pain for many years, silently, alone and in solitude. That might lead to the communication of chronic stress through lashing out, self-harming, truancy and many of the other things that we have heard about today. Acting out in distress can escalate into criminal behaviour or more severe episodes of mental ill health. The Scottish Government’s seriousness of purpose on mental health and wellbeing should not be forgotten. That is demonstrated at the national level by our 10-year mental health strategy, but it extends to the local level, where inspiring organisations in my constituency such as Wholistic Life do all that they can to help young people through the tribulations of an adverse childhood experience. They are doing such work in schools as we speak.

Last year, I had the privilege of introducing the award-winning video “Never too late to tell”, which is an NHS Lanarkshire training video that has been designed to help people to spot the signs of childhood sexual abuse, which is an adverse childhood experience in its most reprehensible form. I pay tribute to the NHS Lanarkshire gender-based violence service and to the survivors of childhood sexual abuse who bravely shared their experiences so that the professionals would know what they were looking for and other victims would not suffer the same adverse trauma.

That adverse trauma can manifest itself in many ways. Although the repression of ACEs might have little impact on people’s daily lives, minor incidents can in later life trigger behaviour that is much more damaging not just for the person concerned but for those around them. Their reactions to small things may be more violent than the experience may warrant, and those extreme reactions can be devastating to individuals, families, friends and the people they work with.

To get to the key crux of ACEs, we have to look at deprivation, inequality and the lack of sustainable opportunities, and those need to be recognised. The negative pressures of rising inequality are driving feelings of powerlessness and anger in situations in which people feel shame and feel compelled to lash out. Intervention, support and a global understanding of wellbeing are critical to effectively treating the harm caused to victims of adverse childhood experiences. That means addressing bigger issues for our localities, such as poverty, unemployment, housing and education, because they are all part of an agenda for equality that could help to interrupt the cyclical nature of an adverse childhood experience.

Photo of Kezia Dugdale Kezia Dugdale Labour

I congratulate Gail Ross on securing the debate and I commend her for an excellent speech that laid out much of the context for why ACEs matter and why we are talking about them tonight.

One of my first meetings as an MSP was with Barnardo’s, at which SallyAnn Kelly talked about toxic stress. She gave us a lesson on what it meant, which I was profoundly struck by and which had a lasting impact on me.

We have heard that there are 10 indicators of adverse childhood experiences. Domestic abuse is one, and I will concentrate my comments on it. The Barnardo’s survey, which was mentioned by Gail Ross, is about how a person can identify whether they have experienced an ACE. It includes a question on domestic abuse as it relates to a child’s mother. It asks:

“Was your mother ...

Often pushed, grabbed, slapped, or had something thrown at her? or

Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or

Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?“

If the answer to that question is yes, that is one ACE point in the Barnardo’s scoring system.

We have heard from a number of speakers that there is not enough data. We do not count the number of ACEs in Scotland as they do in Wales. I add my support to Gail Ross’s call for the Scottish Government to look at that. However, just because we do not count ACEs, it does not mean that we do not know what is going on—a point that was made by Jenny Gilruth.

I have spent most of the afternoon looking at the Government social work statistics. I started with a random year, 2013, when there were 2,681 children on the child protection register, of whom 700 had experienced domestic abuse. Back in 2013, that was the seventh highest reason for being on the register. The most recent statistics, which were published last year, for 2016, show that the number of children who were on the child protection register was slightly higher at 2,723 kids. However, more than 1,000 of those children had domestic abuse marked as one indicator for being on the register, and it was now the second most dominant issue on the register, preceded only by alcohol abuse. Therefore, we have a rising prevalence of domestic abuse impacting on children.

It is worth reflecting quickly on how we approach domestic abuse law. It is often approached from a gendered perspective, being about women, and rightly so. A by-product of that is that we do not always consider the impact on children. In the history of domestic abuse law as it impacts on the access of a parent to their child after being convicted, section 11 of the Children (Scotland) Act 1995 dealt with it; it was reviewed again in 2006 in this place by the Family Law (Scotland) Bill; and in 2008, it was reviewed again by the Scottish Government’s national domestic abuse action plan, priority 5 of which was to review the issue properly. In portfolio questions this week, I received an answer from Annabelle Ewing that said that the Government is now starting that review, 10 years after it was promised.

It is important to recognise that the new Domestic Abuse (Scotland) Bill, which I hope will come into law next week, has made huge progress in that regard, particularly around coercive control. The Government’s equally safe strategy says that the physical abuse of a mother is coercive control of the entire family. I understand that the bill’s measures on non-harassment orders are entirely down to the work of Mairi Gougeon, for which she should be recognised and commended. The bill would not include those measures if it were not for her work in the Justice Committee.

We have come a long way, but we need to look specifically at domestic abuse as it impacts on children in the context of the law if we are going to achieve the fundamental goal of reducing ACEs by 70 per cent by 2030.

Photo of Clare Haughey Clare Haughey Scottish National Party

I refer members to my entry in the register of interests, in that I am a registered mental health nurse and currently hold an honorary contract with NHS Greater Glasgow and Clyde. I, too, thank Gail Ross for bringing this very important issue to the chamber to be debated.

I argue that addressing ACEs is the biggest challenge that is faced by public health—not just here in Scotland but across the whole of human society. Our childhood experiences shape who we are and how we respond to the situations that life presents to us—even more so if they are the negative experiences of neglect, harm, violence, poverty or abuse.

The correlation between ACEs and future negative outcomes is supported in study after study. The Scottish Government itself highlights research that shows that, compared with people with no ACEs, those experiencing four or more were 15 times more likely to have committed violence against another person in the past year. Do we really need any more evidence to prove how vital early intervention is?

Crucially, ACEs do not need to be a determinant of future poor outcomes, as the right support and interventions can and do make a difference. Taking steps to prevent occurrences of ACEs is essential. However, prevention alone is, sadly, not enough. Some ACEs, such as parental separation or parental mental illness, are unavoidable, which is why we must have a focus on resilience and early intervention, too.

For many years, I worked as a perinatal mental health nurse. Ensuring the early detection and treatment of maternal mental distress and illness is critical in helping to secure better outcomes not only for a mother’s mental health but for the baby and the family as whole. Promoting, developing and maintaining good attachment between mother and baby will foster a healthy and happy relationship between them, and it will substantially assist with the infant’s mental health, too.

If people who have had an ACE have little support when entering parenthood, the development of a good relationship with their child is often difficult to achieve. Parenting programmes such as the Solihull parenting approach help parents to develop skills that they may not have or recognise in themselves. The Solihull approach—in which I declare that I am trained—has been adopted by health and social care professionals across the UK and beyond. It promotes knowledge and understanding of emotional processing for both babies and parents, which is known as containment, and it promotes sensitive, attuned reading of babies’ own cues and language, which is known as reciprocity. Being attuned and responsive to a baby’s needs helps to promote the resilience that each child requires. Other programmes, such as triple P and mellow parenting, which are used across Scotland and beyond also provide essential building blocks for healthy attachment and therefore resilient families. Evidence, as well as my experience, shows that parent education and family support programmes can help to provide a secure attachment between mother and baby. In turn, that forms the basis of the child’s wider relationships and is a protective factor against the impact of ACEs throughout their lives.

In doing some research for writing this speech, I came across a Scottish public health network report that was published in May 2016. The wording in its foreword struck me as getting to the heart of why early intervention and addressing ACEs are so crucially important:

“A very wise ... Health Visitor used the analogy, when talking about children that they are like diamonds: their potential is inherent, but they need to be polished with care and attention. Sadly, not all of our children in Scotland are ... ‘polished’ with enough care and attention”.

We need to be bold in our ambition for our children’s future, innovative in our support of parents and carers and challenging of the barriers that prevent our children from being those polished gems.

The Deputy Presiding Officer:

I call Gillian Martin, and then we will have what I hope will be a very small contribution from Mairi Gougeon.

Photo of Gillian Martin Gillian Martin Scottish National Party

I thank Gail Ross for allowing us to debate this hugely important subject.

I want to use my opportunity to speak on it to concentrate on the word “resilience”, which features in the motion.

I recognise that most members have talked about early years trauma. However, now—more than any other modern time—is the most challenging time to be a teenager. The freedom of expression that we all enjoy as a result of the rise of social media gives many opportunities to our young people, but it also puts tremendous pressure on teenagers. My biggest worry is that, in recent years, the abuse, coercion and intimidation that are perpetrated online are having a serious effect on the mental health of young people and how they form adult relationships.

Members will be aware that I keep coming back to this subject. I have been campaigning on better awareness of the dangers of the sharing and unsolicited receiving of intimate images, as well as so-called sexting between young people. There has been a rise in the crime rate of sexual abuse of young people by other young people and it is my belief that social media might be one of the causes of that. Right now, young people are being swept up in activity that could put them at risk of offending under the Abusive Behaviour and Sexual Harm (Scotland) Act 2016.

Apps such as Snapchat, Instagram, Messenger and so on liberate and connect young people, but they can also be channels for abuse of a sexual nature. There are too many examples of that to go into in the short time that I have available. The answer is to promote resilience and care around social media use. Parents and teachers have a role in that, but young people themselves have the biggest role, and I commend to everyone Young Scot’s digi, aye? programme, which is working with me and the students of North East Scotland College who are, as we speak, designing a range of films to highlight the all-too-common misuses of social media that can lead to the types of sexual abuse that can have a lasting negative effect on the recipient and the perpetrator.

Children who are recovering from ACEs are at particular risk. The extra pressure on children who have suffered ACEs and are entering their teens can be acute. I appreciate that I have concentrated on the other end of the childhood experience, but Gail Ross’s motion has led me to discover a new aspect of childhood trauma that makes work on resilience as teenagers, with all the pressures that they face, ever more urgent. Children who have experienced trauma can become vulnerable young adults and a healthy approach to relationships is particularly important in the face of the online pressures that teens face. As Emma Harper said, let us break the cycle of ACEs.

The Deputy Presiding Officer:

That is the way to do it. I can now allow Mairi Gougeon up to three minutes.

Photo of Mairi Gougeon Mairi Gougeon Scottish National Party

I was away to ask if I get an extra minute’s grace.

I start by adding my thanks to that of my colleagues across the chamber to Gail Ross for bringing up such an important issue. The reason why the debate has been so popular that it is oversubscribed is that everybody realises what a hugely important issue it is and the impact that it has.

I also thank Rona Mackay for sponsoring the screening of “Resilience” in Parliament the other week. I attended that and I am genuinely glad that I did. I left the screening itching to do something, because it is an issue that we need to tackle.

First, we need to do something about preventing ACEs, because we know all about the impact that they can have. Kezia Dugdale talked about the toxic stress that they can cause in a child’s life and how that can continue into adulthood.

I add my support to the 70/30 campaign. Preventing ACEs means attacking the issue from all sides. This is not just a health issue and it is not just an education issue. It is about health, education, social work, justice, welfare and many other elements all working together to challenge the myriad issues that children face.

As the motion says, we know that the level of ACEs rises with the level of deprivation that a child lives in. However, when I watched the screening of “Resilience”, I was surprised at how ACEs impact on people from right across the spectrum. That was also found when audiences at the screenings were interviewed.

We know about ACEs and we can try to prevent them as far as possible, but what can we do to help children and young people who have suffered ACEs so that they do not go on to suffer later in life? At the screening, it was great to see some of the methods that are being used in certain schools in the US and how they are working. One such technique is the Miss Kendra technique, which provides an environment in which children discuss their thoughts and feelings.

That brings me to the real reason why I wanted to speak in tonight’s debate: to highlight the work of Maisondieu primary school in Brechin, in my constituency. There, staff recognise the importance of the positive mental wellbeing of our children and the fact that early intervention and building resilience is vital. The school has developed a long-term strategy involving parents, the Scottish Association for Mental Health and specialists who work in the area of mental health in young people. Last week, the school held its first wellbeing event, which I was unfortunately unable to attend. It had workshops for children, yoga, relaxation, mindfulness and reading workshops for parents and their children. The school recognises that there is no mental health part to the curriculum, so it is actively trying to do something about it. From nursery through to primary 7, it is helping children to explore their feelings and develop coping strategies, and, as part of the roll-out of its programme, it will be looking at nurture and attachment.

Our schools cannot solve all the problems or challenges that a child faces when they are at home, but they can play a key role in helping to develop resilience and build coping mechanisms to ensure that the ACEs that children have do not hold them back or have a lasting impact on the rest of their lives.

The Deputy Presiding Officer:

It seems to me that some members were determined that the minister was not going to be able to conclude the debate. I call Maureen Watt.

Photo of Maureen Watt Maureen Watt Scottish National Party

I am very pleased to have the opportunity to close today’s debate on the crucial agenda of addressing adverse childhood experiences. I thank Gail Ross for bringing the important issue to the chamber and thank all members present for their valuable contributions—including that of Alex Cole-Hamilton, who has first-hand experience in the area.

We all know that what happens to us as children shapes who we are and can have a huge impact on us throughout out lives, especially on those who have adverse experiences involving abuse, neglect, harm, violence and poverty.

Kezia Dugdale talked about the profound effect that meeting someone from Barnardo’s had on her. I will always remember how, when I was Minister for Schools and Skills and we worked jointly across ministerial portfolios to produce “Equally Well”, Harry Burns—who is very modest and does not tell people that he has done a lot of work himself in the area—talked about research on identifying holes in children’s brains during pregnancy and how that can be prevented, partly by the good nurturing of babies in the womb and of children in every possible way.

Last year, we made a commitment in the programme for government to reduce ACEs and to promote resilience in those children and adults who are affected. It is about building on positive policy developments to date and placing the rights and wellbeing of children and young people at the heart and centre of all that we do. ACEs impact on all areas of life and we have a truly cross-cutting agenda for physical and mental health, education, social work, the justice system, employers and many more areas. It requires working jointly across services and sectors. A number of ministers wanted to reply to the debate, which shows how we are all involved.

As the Minister for Mental Health, I am concerned about the impact that early-life adversity has on people’s future mental health, wellbeing and lives overall. As members will know, we published our ambitious 10-year mental health strategy, which highlights the impact of ACEs—there is a whole paragraph on it. The key focus of the strategy is on prevention and early intervention. A wide range of actions that are currently being implemented will help to reduce the incidence and impact of ACEs. Those actions include improving the identification of mental health problems during pregnancy, reviewing pastoral guidance in school and counselling services for children and young people, and supporting the mental and emotional health of young people on the edges of, and in, secure care—people who we know will experience ACEs.

Although ACEs surveys usually look at the 10 key types of childhood adversity that many members have mentioned, the Scottish Government’s focus is on all types of childhood adversity. A few weeks ago, I visited Polmont young offenders institution and met a young offender who told me that he had been seriously adversely affected by a number of traumatic bereavements in his life. I also think about the adversities that many child refugees and asylum seekers who have arrived in Scotland have experienced, particularly those who have arrived from war-torn countries. Therefore I use the term ACEs in the broadest sense to encompass all stressful and traumatic experiences that negatively impact on children’s development.

We can already see awareness of ACEs increasing across Scotland. NHS Education Scotland has facilitated screenings across the country of the “Resilience” documentary that many members have mentioned. The screenings have attracted huge audiences, which have included Scottish Government ministers and officials, who have engaged in this agenda.

I have been struck by the way in which ACEs evidence is providing a shared language that we can use to engage in debate and discussion. It is telling us about what we can collectively do to improve our children’s lives and how we can better understand the lives of adults and young people who have lived through the most challenging circumstances. The contributions of members tonight have been really important. We must continue to raise awareness of the impact of ACEs, drive forward progress in preventing ACEs from happening in the first place and, when they cannot be prevented, mitigate their negative impact as effectively as possible.

We know that, with the right support at the right time, people can develop coping strategies and resilience in overcoming adversity, and I thank all the members who have stressed the importance of promoting resilience.

Our commitment to addressing ACEs is part of our on-going national approach to getting it right for every child. Alison Johnstone mentioned the event that was held last night by the Royal College of Paediatrics and Child Health and the scorecard that Scotland got that showed that we have enacted more policies to improve children’s health than have been enacted in the rest of the UK. We are steadfast in our commitment to children and young people. That is particularly evident this year, which is the year of young people. That will give young people a stronger voice on social issues and will celebrate and showcase their talents and ideas, as the event last night did.

The best start for children begins before they are born, which is why implementation of the best-start review of maternity and neonatal services maximises opportunities for early intervention and support from the early stages of pregnancy. We are expanding the family nurse partnership across Scotland and are extending the offer to vulnerable mothers up to the age of 24. That means that more first-time young mothers will be supported to develop and strengthen their parenting capacity and skills. We are increasing home visits through the universal health visitor pathway. That offers an opportunity to identify and provide the right support at the right time for all families to prevent and reduce the impact of ACEs.

We know that ACEs occur across all incomes and can impact all members of society. However, we also know that those living in poverty have an increased risk of experiencing ACEs and are less able to access resources to support them in the face of adversity. In that regard, it was interesting to hear from Christina McKelvie about what is happening in Lanarkshire. The Government’s action on reducing childhood poverty is crucial in this area, because we know that poverty and ACEs both impact on children’s long-term health and life outcomes, so we need to address both in order to reduce inequalities in Scotland.

I am optimistic that much of the work that we are taking forward across education, health and justice is taking us in the right direction with regard to addressing ACEs. The pupil equity fund enables teachers to best meet the needs of children who are living in poverty and who are experiencing other types of adversity. Minimum unit pricing might well have a positive impact on reducing ACEs. The move to a presumption against short prison sentences might also reduce the number of children experiencing parental imprisonment. Further, we are increasing our investment in the provision of good visitor centres to help to reduce the negative impact on children with family members in prison.

Gail Ross, Jeremy Balfour and Emma Harper asked about collecting data. We are looking at the best options for obtaining data on ACEs in Scotland. Work is under way to test the inclusion of ACEs questions in the 2019 Scottish health survey. Scottish data on ACEs will inform our understanding, but there is a lot of positive action that we can take now.

We have a good understanding of the impact of ACEs from the evidence from the US and closer to home in Wales and England. Health staff, police officers, social workers, teachers and many more people across Scotland speak to me of the sometimes devastating impact of ACEs that they see day to day in their work. Many are already driving progress in creating ACE-informed places and services, and there are many positive examples in the third sector as well as in public services. The Scottish Government and our partner organisations are working to build on their learning and good practice, as well as exploring new areas of development.

For example, we are testing out approaches that involve routinely asking adults who come into contact with services about their experiences of early life adversity. Such routine inquiry about ACEs can help people to better understand how their childhood experiences are affecting their lives and how best they can be supported. Importantly, in the case of parents, that can help them to prevent the cycle of ACEs from being repeated with their children.

Routine inquiry into ACEs is being considered as part of the wider work on taking forward the national trauma training framework, which aims to help all of Scotland’s workforce develop services that respond appropriately to people’s experiences of early life adversity and trauma in adulthood. It is part of an overall movement towards trauma-informed services. As Alison Johnstone said, it involves a shift from asking, “What’s wrong with you?” to asking, “What’s happened to you?”

I assure Jenny Gilruth and others that my ministerial colleagues and I are absolutely determined that Scotland’s children should get the best start in life. The disconnect that she highlighted at local level is certainly not my experience in Government. We are focused on making Scotland the best country in the world for all children to grow up in, so that all children and young people can achieve their full potential in a safe and supportive environment. The Government is whole-heartedly committed to continuing to work across all sectors and services to do all that we can to prevent ACEs and, where they occur, to support the resilience of children and adults in overcoming that early life adversity.

Meeting closed at 18:22.