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Objectives Adversity during childhood remains an inadequately addressed common risk factor for worse outcomes across physical, mental and social health.1–3Child-facing practitioners (CfPs) are well placed to identify and intervene on adversity.4 Despite growing evidence and policy around preventing adversity and it's sequalae, the incidence of adversity in childhood remains high. This study investigates child-facing practitioners (n=113) understanding of adversity via an online survey. Methods Participants were recruited via volunteer sampling. Organisations from Health and Social Care, the Education system and the Voluntary sector in England were contacted by email and requested to disseminate the survey to staff. An online survey was developed, and the survey link was distributed by email. Participants were presented with a participant information sheet before being asked to consent to take part in the survey. Participants then completed the 17 survey questions anonymously online. Results A total of 120 responses were received. Data are reported for 113 respondents, of which 50 were healthcare staff; data from participants working in voluntary services were removed (n=7). Responses to 'do your assessments ask about the following issues' demonstrated on average over 1 in 5 healthcare professionals 'never' asked about; whether a family member has a diagnosed mental illness (16%), substance addiction (20%), incarceration (34%), whether the child has witnessed domestic abuse (24%) or if there has been significant family disruption (10%). Participants in all sectors felt confident in their understanding of adversity. However, 29% of healthcare staff 'disagreed, felt this was not part of their role or did not know' if they felt confident to raise concerns about a caregiver's emotional or behavioural responses to their child (figure 1). Respondents were asked 'which aspect(s) of a child's development is/are most affected by negative experiences related to a child's health and well-being?' with less than a third providing a correct answer, out of the following possible responses, table 1: A) Emotional development B) Cognitive development C) Language development D) Auditory and visual development E) Gross motor skills development F) I don't know Conclusion Child-facing professionals did not consistently assess adversity, a significant proportion of healthcare professionals 'never' screen for some aspects. There was low confidence in raising concerns about a caregiver's emotional or behavioural responses to their child. Gaps in knowledge about how adversity affects child development were identified. These results should feed into discussions about assessing and acting on adversity as part of preventative community health strategies. References Shonkoff, et al. The lifelong effects of early childhood adversity and toxic stress, Pediatrics. 2012. Sahle, et al. The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systemic reviews and meta – analyses. European Child & Adolescent Psychiatry. 2021. Reading R. The enduring effects of abuse and related experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Child:Care Health Dev. 2006. Read, et al. Why, when and how to ask about childhood abuse. Advances in Psychiatric Treatment. 2007.
Smout et al. (Tue,) studied this question.