Parental Adverse Childhood Experiences and Mental Health


  • Adverse Childhood Experiences
  • Understanding of, and working with mental health concerns
  • Engagement
  • Was Not Brought approach
  • Inter-agency working and communication


A Practitioner Learning Event was undertaken to consider the multi-agency response to families where there are parental Adverse Childhood Experiences and ongoing mental health issues. Levels of engagement and attendance at appointments were also considered.

Good Practice

Adverse Childhood Experiences

  • Ongoing liaison and information sharing between practitioners allows for all practitioners to have a good understanding of an individual’s history
  • Provision of detailed information at the point of referral to a service provides a rich history of an individual’s circumstances and supports practitioners / services in their response
  • Good, detailed record keeping (for example on electronic systems) provides a fuller picture
  • Use of an Adverse Childhood Experience template or prompt can  encourage a practitioner to think about the impact of adverse childhood experiences for an individual and their family
  • Adverse childhood experiences should be considered within a Think Family, Work Family Approach; what is the impact both for the individual but also their wider family?

 Understanding of and working with mental health concerns

  • Continual consideration of referrals to mental health services where there are known mental health concerns provides opportunities for the individual to receive appropriate support in a timely way
  • Continual offer of secondary support services in relation to mental health provides opportunities for an individual to opt into receiving additional support should they choose
  • Continually asking the question in relation to how an individual feels, and routinely exploring a person’s feelings and statements allows for consideration of any mental health concerns
  • Within the Child in Need Plan (CIN) consideration should be given, as appropriate to referrals to the Infant Mental Health Team.


  • Offering to make appointments on behalf of an individual and / or attend with them can help to increase engagement with services and overcome any potential barriers.
  • Cross agency reiteration, and support with regards to the need to attend appointments demonstrates a united approach and supports engagement.
  • Engagement can be enhanced by providing an individual the space to talk about what was important to them as well as the main purpose of the contact.

Was Not Brought approach

  • Parent / carer engagement with services can be enhanced through the rearrangement of missed appointments, and the use of different methods of trying to engage when unable to make contact

Inter-agency working and communication

  • Regular conversations between practitioners who have on-going relationships with the individual / family allows for concerns to be shared, relevant agencies to be contacted and everyone to know what is happening
  • Good relationships between practitioners supports good interagency working and communication. This is increased and aided when working in localities / “community patches”
  • The mapping of practitioners and their involvement with a family ensures appropriate support for all staff following a traumatic event.

Key learning and practice improvements  

  • Feedback from adults has identified that the use of ACE as an acronym was not welcomed as experiences were not “ace”
  • The point of referral to a service is an opportunity to highlight any specific information / history for an individual or family
  • The offer of a follow up meeting / discussion after a multi-agency meeting provides an opportunity for an individual to explore the views and information provided and aide understanding of conversations and decisions
  • Awareness and understanding of the Leeds Was Not Brought Approach, or the expansion of it beyond the health application within Leeds, is varied amongst practitioners
  • Due to multiple systems used in health GPs are unable to interrogate all records to establish a full picture, therefore practitioner’s communication / information sharing with a GP supports their understanding of issues
  • Midwives who work in specialist teams and are not linked to a GP surgery do not have access to system one, hindering their ability to access all available information available within health systems
  • Services need to have in place systems which ensure that all practitioners involved with a family are made aware of any traumatic events within a family.

Your Next Steps

Share and discuss the identified good practice and learning points with colleagues, and ensure the following is embedded in your practice:

  • Have regular conversations with other practitioners known to a family. Share information as appropriate. Keep good, detailed records to aid information sharing and provide a clear history
  • Take time to get to know practitioners within your locality and build relationships with them
  • Consider the use of the acronym ACE when discussing adverse childhood experiences; speak to the individual about how they feel about you using it; consider how you use it within records
  • Consider adopting an Adverse Childhood Experience template / prompt sheet to encourage consideration of the impact of these. Ensure adverse childhood experiences are considered within a Think Family, Work Family approach.
  • Ensure referrals are detailed within records and any specific information or history is highlighted appropriately
  • Where mental health concerns are known continue to ask how an individual is feeling, explore their responses with them and consider referrals to services or offers of additional support as appropriate.
  • Consider any potential barriers to an individual’s engagement and how you can support it, for example make appointments for them, accompanying them to appointments, reiterate the need to attend appointments, allowing space and time for an individual to discuss what is important to them even if it’s not the main purpose of the contact
  • Check out an individual / families understanding following meetings, do they know the concerns and understand why decisions were made? Offer to meet to explore with them.
  • If a traumatic event occurs as an agency consider who has had involvement with the individual / family, how they will be informed and what support they may need and how this can be provided.

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