Drivers to implementing a whole-system approach to enquiring about adverse childhood experiences: A mixed methods evaluation from a single county in England.

BACKGROUND

Adverse childhood experiences (ACEs) can have substantial impacts on individuals' health and social prospects across the life course. Retrospectively enquiring with adults about their experience of ACEs to inform support provision is an emerging intervention across services/countries, however little is known about the processes of implementation.

OBJECTIVES

The study aimed to examine the drivers to successful implementation of ACE enquiry.

PARTICIPANTS AND SETTINGS

Nine services in a UK county participated in a test-and-learn project implementing ACE enquiry (i.e. the REACh™ programme).

METHODS

Interviews with programme stakeholders (n = 37) and a follow-up survey exploring experiences of implementation (n = 72). Interviews were thematically analysed, with themes mapped against an implementation framework and triangulated with survey data.

RESULTS

Analyses identify key implementation drivers across three domains: competency; organisational; and leadership. Findings suggest that implementing ACE enquiry requires ongoing and flexible training and supervision to increase staff knowledge and confidence. Supportive leadership is needed across all service levels to respond to routine and unforeseen barriers to implementation. Further, a flexible approach to implementation is needed which attunes to service and practitioner needs and adapts implementation to ensure a trauma-informed and person-centred approach to ACE enquiry.

CONCLUSIONS

Study findings may assist programme implementers in the development of system-wide approaches to ACE enquiry. However, further data on implementation of ACE enquiry models is needed to increase evidence on implementing and maintaining such programmes in real-world public health settings. Critically, further research is needed to understand the impacts of such programmes when successfully implemented.