Adversity-Targeted Early Interventions: Building Chil- dren’s Social and Emotional Competency, Strengthen- ing Parent-Child Interactions

There is a growing body of research on the nature of adverse experiences in childhood (ACEs). In 1998, Felliti and colleagues examined the relationship between the number of ACEs reported by more than 17,000 individuals in the USA and their subsequent health as adults. They found the more ACE types reported in childhood (e.g. emotional abuse, physical abuse, sexual abuse, physical neglect, emotional neglect, mother treated violently, household substance abuse, household mental illness, incarcerated household member, and parental separation or divorce) the greater the risk of health harming behaviours. These harmful effects include adult mental ill health, problematic alcohol use, and sexual risk taking. The associations with number of ACEs reported are strongest for problematic drug use and interpersonal and selfdirected violence (Hughes et al., 2017).


Introduction
There is a growing body of research on the nature of adverse experiences in childhood (ACEs). In 1998, Felliti and colleagues examined the relationship between the number of ACEs reported by more than 17,000 individuals in the USA and their subsequent health as adults. They found the more ACE types reported in childhood (e.g. emotional abuse, physical abuse, sexual abuse, physical neglect, emotional neglect, mother treated violently, household substance abuse, household mental illness, incarcerated household member, and parental separation or divorce) the greater the risk of health harming behaviours. These harmful effects include adult mental ill health, problematic alcohol use, and sexual risk taking. The associations with number of ACEs reported are strongest for problematic drug use and interpersonal and selfdirected violence (Hughes et al., 2017).
There is also a growing body of research demonstrating that young people displaying challenging disruptive, bullying and sexually harmful behaviour, and associated significant mental health difficulties have suffered multiple ACEs. These findings justify the argument that early intervention with this group of children and families would prevent later harm [1,2].

Harmful impact of ACEs
The most harmful responses of children are associated with exposure to violence against a caregiver, and the presence of a parent with a mental health or substance problem [3]. There are protective factors which are independently linked to better outcomes -being treated fairly, having supportive childhood friends, being given opportunities to use own abilities, access to a trusted adult and having someone to look up to [4]

A Modular Solution
Reviewing the transdiagnostic neurobiological responses to multiple ACEs, a solution is proposed. It is based on the highly effective Modular Approach to Children with Anxiety, Depression, Trauma and Conduct Problems (MATCH-ADTC), which integrates common practice elements from single manualised effective approaches to these problems (Chorpita & Weisz 2009) [6,7].

The modular Hope for Children and Families (HfCF) Intervention
Resources add to these elements from the field of interventions to prevent abuse and neglect -the core of the ACE problems [8].
The HfCF Intervention Resources are a potential solution to help practitioners by providing a trauma-informed, transdiagnostic, modular approach, that can be adapted for use with multiple ACEs across different types of service provision at all stages of the therapeutic process [9].
The development of the HfCF Programme has prepared the groundwork for a programme to 'Build children's social and emotional competency, strengthening parent-child interactions.
The HfCF programme is unique in that it is designed and positioned already to respond systematically to the sequelae of multiple ACEs. When working with a child and family, a thorough assessment is essential to identify ACEs, and to understand their impact and the processes that maintain them [11]. A profile of the child, parent and families' strengths and difficulties has to be established, the nature of the child's impairment of health and development needs assessed, and patterns of harmful and potentially supportive responses identified in the family [12,13]. Prospects for intervention need to be analysed, including the motivation and capacity of parents to respond to intervention, and support direct work with children and young people to address emotional and traumatic and disruptive behaviour, including sexually harmful responses, associated with ACEs. The goal of the intervention is to promote recovery and resilience, and to prevent the long-term harmful effects on future adult health through adversity targeted early intervention.