When Andrew Bennet, a public health consultant, approached us about working on an awareness campaign about ACEs, commissioned by Public Health Wales and Blackburn and Darwen Council - we had to admit - we had no idea what the client was talking about. So time to fire up the search engines and log in to youtube.

Scoping out and researching a subject online can sometimes be tedious - there are only so many graphs, tables and contradictory opinions you can take before you start yearning for the halcyon days of a trip to the local reference library. But bear with us, the theory behind ACEs is interesting and some of the work being done around them is fascinating.

What are ACE's, and what did we find out?

ACE's is an acronym for Adverse Childhood Experiences. During the mid to late 90s Kaiser Permanente, a health care consortium in America, conducted the first study into ACEs. It was groundbreaking research that looked at how ten types of childhood trauma affected long-term health.

Traumas included: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s in jail, and witnessing a parent being abused.

How do ACEs affect the physical and mental health of children?

It's important to realise that learning how to cope with adversity and stress is an integral part of healthy childhood development.

When threatened and in a stressed state, our bodies prepare us to respond by increasing our heart rate, blood pressure, and stress hormones, such as cortisol. When this happens within an environment of a supportive relationship with adults, these physiological effects are mitigated and brought back down to baseline. The result is the development of healthy stress response systems.

However, if the stress response is extreme, repeated and long-lasting, and those relationships are unavailable to the child, the result can be damaged, vulnerable systems and brain architecture, which can cause lifelong damage.

The scientific explanation of how early adversity affects brain architecture is way above our pay grade, but there is an interesting article in Psychology Today if neural pruning and epigenetic shifts are your thing.

Repeated ACEs cause chronic ill health in later life: like cancer, heart disease, diabetes, and health-harming behaviours such as problem alcohol use, smoking, poor diets and violent behaviour - and ultimately premature death.

A recent study from our client, Public Health Wales, on adverse childhood experiences and their impact on the Welsh adult population, has found that people who reported experiencing four or more ACES are:

• 4 x more likely to be a high-risk drinker
• 6 x times more likely to have had or caused unintended teenage pregnancy
• 6 x times more likely to smoke e-cigarettes or tobacco
• 6 x times more likely to have had sex under the age of 16 years
• 11 x times more likely to have smoked cannabis
• 14 x times more likely to have been a victim of violence over the last 12 months
• 15 x times more likely to have committed violence against another person in the last 12 months
• 16 x times more likely to have used crack cocaine or heroin
• 20 x times more likely to have been incarcerated at any point in their lifetime

Further research suggested ACEs can be passed across the generations, which reminded of the saying about apples not falling far from the tree - got to love the old granny wisdom.

Admittedly the outlook may look pretty grim. A positive message about ACEs - how are we going to do that? But all is not lost. Studies form Public Health Wales and Bangor University suggested that supportive adult relationships and early interventions can help to reduce the damaging effects of ACEs.

The Welsh Adverse Childhood Experience (ACE) and Resilience Survey by Bangor University and Public Health Wales says that while teaching children to be resilient 'does not entirely counter the risks associated with exposure to multiple ACEs', a combination of 'high resilience and low ACEs provided the lowest risks of a lifetime and current mental illness'. It went on to say that 'focus should continue to be placed on strengthening early years, parenting and family programmes', and that these 'programmes can both reduce ACEs and support the development of resilience in children.'

ACEs - target audience and core message

A clear message, communicated to the correct audience is vital to encouraging behaviour change. It was clear from the research that early intervention was one of the most effective tools in preventing or mitigating the damaging effects of ACEs.

It followed that the target audience should be people and organisations who came into contact with young children and families, could identify problems in an early-years setting and be able to use resources to stage interventions.

The audience could include health visitors, social care services, teachers, GPs, midwives and police - amongst others. The message we eventually used - 'We all need to be ACE aware' - had practically written itself.

To deliver this message and navigate our way through a sometimes complex set of circumstances, we needed to raise awareness with this clear and accurate message, followed by a call-to-action which could help provides a solution.

Creating the ACEs animation

It was quite an emotional process, researching the impact of ACEs - particularly as a parent: did you always do the right thing with your children; could you have dealt with things better; did you protect them enough.

Deploying those emotions and using them to tell a story is a powerful tool at any level of marketing, be it commercial or social. To leverage the emotional connection with the audience, we created 'ACE's boy' and used him to narrate the various stages of his life and how ACEs had affected him.

In the first scene, he is introduced as a young child and explains his early struggle with ACEs and how they are affecting him.

Scene 2 shows him as a teenager - again in the first person, as he explains to us how ACEs have changed him.

In Scene 3 the teenager has become an adult and is starting to display the impact of ACEs. He explains how his life has gone and how he expects it to be in the future.

In scene 4 there is a twist - we all love a good twist in the storyline don't we. But we won't spoil it for you; watch the animation and find out for yourself.

The final scene. Although this is the shortest scene, it is arguably the most important - the 'Call to Action'. It speaks directly to the core audience, summarises the main message and through a combination of prodding, cajoling, nudging and being ACE aware it will provoke a positive response from your intended audience.

That's it from us. Hope you enjoyed the blog and found it informative. Take a few minutes to have a look at the animation. If you have any questions, please feel free to This email address is being protected from spambots. You need JavaScript enabled to view it..

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