Interventions to address adverse childhood experiences must use an ecological systems perspective along with a strengths-based approach rather than a deficit and problem-based approach, emphasising pathology. This must be supported by policy that addresses structural difficulties that contribute to the child, family and community’s difficulty. Structural and cultural support must be offered to the child, as well as those who immediately effect the child’s well-being. Families and neighbourhoods reciprocally enforce positive development. A system of shared support and unity supports the idea that ‘all children are our children’.
A public health perspective may help to develop prevention approaches and extend the reach of early intervention treatments. Trauma should be included in the global public health agenda – at present, mental health issues are largely ignored in this realm. In the social-ecological model, by targeting risk factors at various levels there are number of opportunities for prevention and intervention. Public health policies can help shape societal norms and also help extend services to those in need and help reduce costs. Prevention strategies not only help the individual but also help reduce costs that become chronic with long-term traumatisation.
The public health approach seeks to balance efficacy with ‘reach’ – getting at higher proportion of the target population. Research and practice is guided by how far and intervention goes in reaching the population level burden of child trauma. A public health approach is helpful in going beyond the individual to the vast population impact of trauma and identifying a range of potential models to address this impact.
Research suggests human beings are malleable and highly responsive to early experience. Social mammals emerged 30 million years ago with a particular set of parenting behaviours. John Bowlby referred to this as the environment of evolutionary adaptedness (EEA). Current parenting practices diverge from this ancient norm, potentially undermining healthy human development. The loss of traditional cultural practices like extended periods of attachment bonding, breastfeeding, co-sleeping and alloparental care may be contributing to problems in health and social well-being in modern societies. Some childrearing advice encourages parents to let their children cry themselves to sleep in an effort to help them learn to self-soothe at an early age, rather than gradually acquiring these skills through mutual regulation with the caregiver. There are psychological and neurochemical reasons why a practice like this may be linked to the on-going epidemic of depression.
The above authors suggest that policy statements on parenting should be formulated. Poor parenting increases across generations in a ‘snowballing’ effect. Current child-rearing practices are being described as ‘risky’ based on the fact that they depart from tried and tested traditions from our evolutionary history. In particular, practices like formula feeding, sleeping in isolation, institutional day-care, ‘crying it out’ practices, lack of skin-to-skin contact and isolated parents fall into this ‘risky’ category. Policy statements should support responsive caregiving, co-sleeping, caring touch and breastfeeding. ‘Best parental practice’ education should be provided for all, to increase understanding of children’s basic needs.
Greater societal support needs to be given to families. Family and community supports are essential for all families but in particular those who are living in poverty. Society should be structured to support families rearing children, increasing maternal and paternal leave and integrating childcare into the workplace.