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Adverse Childhood Experiences and Trauma Informed Practice in Bristol

What is Trauma Informed Practice?

Trauma-informed practice is an approach which is grounded in the understanding that trauma exposure can impact an individual’s neurological, biological, psychological and social development. Being trauma-informed means assuming that people are more likely than not to have a history of traumatic experiences and that these experiences may impact on their ability to feel safe within or develop trusting relationships with services and their staff, or their ability to live happy and fulfilled lives within their communities.

Trauma-informed practice is not designed to treat trauma-related difficulties. It seeks to remove the barriers that those affected by trauma can experience when accessing care and services by using the principles of trauma-informed practice: safety, trust, choice, collaboration, empowerment and inclusivity.

Trauma-informed approaches have become increasingly cited in policy and adopted in practice as a means for reducing the negative impact of traumatic experiences and supporting mental and physical health outcomes.

In England there has been a lack of consensus across the health and social care sector, education and criminal justice on how trauma-informed practice is defined, what the key principles are and how it can be built into services and systems.

The Government Office for Health Improvement and Disparities has sought to address this lack of consensus by providing a  Working definition of trauma-informed practice - GOV.UK (

This has been developed for practitioners working in the health and care sector and reflects the original internationally recognised definition developed by the United States Substance Abuse and Mental Health Services Administration (SAMHSA). The evidence base exploring the use of trauma-informed practice in different settings and sectors is still being developed.


Definition of Trauma

Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as harmful or life threatening. While unique to the individual, generally the experience of trauma can cause lasting adverse effects on mental, physical, social, emotional or spiritual well-being.

Working definition of trauma-informed practice 

Realise that trauma can affect individuals, groups and communities

Trauma-informed practice is an approach which is grounded in the understanding that trauma exposure can impact an individual’s neurological, biological, psychological and social development.

Recognise the signs, symptoms and widespread impact of trauma

Trauma-informed practice aims to increase practitioners’ awareness of how trauma can negatively impact on individuals and communities, and their ability to feel safe or develop trusting relationships with services and staff.

It aims to improve the accessibility and quality of services by creating culturally sensitive, safe services that people trust and want to use. It seeks to prepare practitioners to work in collaboration and partnership with people and empower them to make choices about their health and wellbeing.

Trauma-informed practice acknowledges the need to see beyond an individual’s presenting behaviours and to ask, ‘What does this person need?’ or ‘what has happened to this person?’ rather than ‘What is wrong with this person?’.

Prevent re-traumatisation

It seeks to avoid re-traumatisation which is the re-experiencing of thoughts, feelings or sensations experienced at the time of a traumatic event or circumstance in a person’s past. Re-traumatisation is generally triggered by reminders of previous trauma which may or may not be potentially traumatic in themselves.

The purpose of trauma-informed practice is not to treat trauma-related difficulties, which is the role of trauma-specialist services and practitioners. Instead, it seeks to address the barriers that people affected by trauma can experience when accessing health and care services.

ACEs are highly stressful, and potentially traumatic, events or situations that occur during pregnancy, childhood and/or adolescence and can have an impact on physical and mental health throughout life.

There is no definitive ‘list’ of ACEs and ongoing research continues to add to an understanding of ACEs and the risks associated with them.

The Commons Select Committee report: Evidence-based early years intervention published in November 2018 cited that whilst there is no universally agreed definition of an adverse childhood experience, studies addressing the issue have mostly converged on a similar set of experiences falling under this term.

These are listed below:

  • Direct harm physical, sexual, emotional or verbal abuse and physical or emotional neglect
  • Indirect harm (household challenges), domestic violence, parental drug/alcohol misuse, parental criminal behaviour/incarceration, parental mental illness and bereavement (linked to death or separation)

These are examples of experiences that can be traumatic but it is important to remember that some of these experiences may be more traumatic for some people than others. There are also other experiences which can be traumatic that are not included in this list.

Fig1.Ellis, W., Dietz, W. BCR Framework Academic Peadiatrics (2017)









This concept of the ‘Pair of ACEs’ Tree proposes that ACEs and trauma are not limited to individual experiences but can also be linked to the environment in which these are experienced (read about this framework in the source document here).  People living in adverse community environments might find it harder to contain their levels of stress. 

Preventing ACEs should be seen within the wider context of tackling societal inequalities. While ACEs are found across the population, there is more risk of experiencing ACEs in areas of higher deprivation. For more information, see The ACE Index: Mapping Childhood Adversity in England.

Most research studies on the subject of ACEs have focussed on a broad range of long term health-related outcomes but links have also been reported between ACE exposure and experience of wider social problems such as reduced educational attainment, worklessness, diminished social mobility, lower socioeconomic status and risk of an individual’s involvement with the criminal justice system.

People who have experienced trauma often develop coping strategies that relieve distress temporarily but repeated use becomes health harming and the disease burden increases. However, research has shown that even people who had experienced ACEs but had no health harming behaviours, still had increased risk of non-communicable diseases.

Fig2.Public Health Wales, ‘The Welsh Adverse Childhood Experiences (ACE) Study’ (2016)









Fig3.Adverse ChildhoodExperiences (ACEs) in Wales







The triangle diagram shown here (fig.2) illustrates the life course impact expose to toxic stress can have. Evidence suggests that risk to health and wellbeing increases with the number of ACEs a person experiences. The table shown here (fig.3) provides some examples of these risks.

Experiencing childhood adversity is correlated only to a higher risk of experiencing certain problems in later life. Access to support can mitigate the risk of negative experiences in later life. Nevertheless, the prevalence of some conditions rises significantly with the number of ACEs that individuals have experienced.

Read more about the impact of ACEs: Commons Select Committee report: Evidence-based early years intervention

Read the seminal 1998 ‘ACE Study’ of over 9,000 adults in San Diego: Felitti et al., ‘Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults’, American Journal of Preventive Medicine vol 14 (1998)

Evidence submitted to the Commons Select Committee cited:

  • 50% of Welsh adults had experienced at least one ACE
  • 47% of English adults had experienced at least one ACE
  • Scottish Public Health estimated that prevalence in Scotland would be at least as high.

The National household survey of adverse childhood experiences in England found 9% of English adults had experienced four or more ACEs. Research in Wales found 14% of the population had experienced 4 or more ACEs.

You can read more about prevalence in England the ‘National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviours in England

We are developing a Chapter on ACEs within our local Joint Strategic Needs Assessment (JSNA). This will be available here once published.  You can access the full Bristol JSNA on the Bristol City Council Website.

A 2019 evidence review identified four common approaches to preventing and mitigating the impacts of ACEs and trauma:

  1. Supporting parenting
  2. Building relationships and resilience
  3. Early identification of adversity
  4. Responding to trauma and specific ACEs

The report provides details on the common components, interventions and settings within each of these.

The research suggests these strands of work need to be supported by ongoing awareness raising of the causes and consequences of ACEs and trauma. This applies across the workforce and is not limited to specialist professional groups.  

What we can all do:

  • Hold in mind that a person’s behaviour or reactions might be related to childhood adversity.
  • To make sense of a child/young person’s current difficulties by considering “what happened to you?” instead of “what’s wrong with you?” And go on to ask, “how has this affected you?” and “who is there to support you?”
  • Use protective factors to build resilience e.g. secure attachment, opportunities for positive activities and supportive networks.
  • Continue to raise awareness

Whilst concerted efforts are also needed to reduce exposure to ACEs and trauma, strengthening resilience in children and adults is important to protect against the impact of ACEs through the life course.

The role of resilience as a protective factor to mitigate the impact of ACEs is increasingly evident. Recent studies have shown that resilience resources in childhood and adulthood can moderate the negative outcomes associated with ACEs and show protective effects on mental ill health, childhood health and educational attendance.

Childhood resilience resources which help prevent the negative impact of ACEs include having a stable trusted relationship with an adult, participating in sport clubs and strengthening social and emotional competency (protective skills).

Sources of resilience amongst adults shown to be important mitigating factors include regular participation in community activities and perceived financial security.

It is important to ensure that service responses do no re-traumatise individuals; that service providers identify and address the barriers that those affected by trauma can experience when accessing the care, support and treatment they require for a healthy life. It is important that we recognise that trauma is common and understand that these experiences might have a range of impacts.

All organisations can work towards being trauma informed by ensuring that physical environments, staff behaviour and organisational policies and procedures reflect trauma-informed-principles and values. Organisations also need to consider and respond to the needs of workers in responding to people affected by trauma.

Whilst a number of evidence-based interventions target specific types of adversity (e.g. domestic violence), we know that ACEs are strongly correlated; individuals exposed to adversity are often exposed to more than one type. This means adversity requires a whole system approach which extends across sectors including health, social care, policing, education, housing and community, and across the life course from early childhood through to adulthood.

There remain gaps in evidence and understanding in relation to effective multi-sectoral responses to ACEs (as a collective group of childhood stressors) rather than responding to individual ACE types, to break the intergenerational cycle of ACEs.

For further information and links to the research studies referred to in this section, see: Responding to Adverse Childhood Experiences: An evidence review of interventions to prevent and address adversity across the life course. Public Health Wales, Cardiff and Bangor University, Wrexham

You can also read more about evidence based approaches to addressing ACEs in this report: Adverse childhood experiences: What we know, what we don't know, and what should happen next, Early Intervention Foundation, 26 February 2020

We set out our ambition to work towards being a trauma informed city in the Bristol One City Plan. We aim to be a city where we can disrupt intergenerational cycles by preventing ACEs and trauma and strengthening resilience in individuals, families and communities, leading to better life outcomes.

Our local approach to developing trauma informed practice has developed over time. In 2019 a series of local task and finish group meetings involving over 40 different partner organisations were held to develop our local approach to this work. A report produced through the Task and Finish Group is available here.

At this time our language and framework was centred on Adverse Childhood Experiences, ‘ACEs’, but this matured to a focus on ‘trauma’ and work to develop trauma informed systems and practice.

The strongest criticism of the ACE lens relates to the practice of summing the number of ACEs experienced to determine an ACE ‘score’, and the misapplication of this ‘ACE framework’. Locally our approach does not promote screening in this way or service models where we ‘count ACEs’. Our emphasis is on understanding the life-course impacts of adversity and trauma on children, adults and the wider community.

Collectively, we hope professionals who work with children and families, and vulnerable adults will have a better understanding of the root causes of presenting behaviours, rather than “treating” the presenting behaviour, and to have a better understanding of people’s lived experience.

A set of principles for Trauma Informed Practice have been developed and these are being embedded in policy and practice across the area: Principles for Trauma Informed Practice

Our commitment to develop and embed trauma informed practice is shared by the Health and Wellbeing Board and the One City Children and Young People’s Partnership Board. The intent is increasingly clear in key local strategy including for example, the Bristol Belonging Strategy for Children and Young People, Bristol City Council’s Corporate Plan, and our local Corporate Parenting Strategy, and this strategic intent is following through into local commissioning and direct practice.

​This commitment is shared by partners across the city, for example Avon and Somerset Police are committed to becoming a trauma informed organisation. In 2021, the Office of the Police and Crime Commissioner (OPCC) were awarded a Home Office grant to implement a multi-agency programme of trauma informed training across Avon and Somerset to support the strategic aims of the Violence Reduction Unit work. This training included cultural trauma and inclusivity, which are priorities for Avon and Somerset Police and link to the BNSSG knowledge and skills framework. A steering group has been formed to lead this work across the organisation, supported by the Office for the Police and Crime Commissioner. There will be an internal focus to look at the wellbeing of staff in the organisation and also an external focus to improve public services to our communities.

Initially the development of a co-ordinated approach to embedding trauma informed practice was led by a Health Integration Team (HIT) which brought multi-disciplinary partners together to develop our local approach and drive culture change and practice.

In 2022 the Adversity and Trauma HIT merged with a Trauma Oversight Group which has been established within Healthier Together, our local Integrated Care System (ICS).

This partnership group within Healthier Together is a collaboration across Bristol, North Somerset and South Gloucestershire. It engages partners across the voluntary and community sector, lived experience representatives, Avon and Somerset Police, health and care providers, Education, the University of Bristol and the University of the West of England, Children and Family Services, Public Health, and Adult Social Care.

You can read more about the Adversity and Trauma Health Integration Team here: Bristol Health Partners: Health Integration Teams

You can read about Healthier Together here: What is Healthier Together? - Healthier Together (

Please complete the form via this link if you would like to join the Bristol Trauma Informed Practice Network:

Your details will be added to a trauma informed practice mailing list maintained by Bristol City Council. This mailing list replaces any previous training or Bristol ‘ACE Ambassador’ contact lists so please sign up again if you were previously part of that and would like to stay involved.

As part of the network, you will receive updates about local developments in this area of work and hear about relevant training opportunities, events and network meetings.

The Bristol Trauma Informed Practice Network highlights local work and learning opportunities but also shares information to help ensure alignment with the work underway across the system, with partners across Bristol, North Somerset and South Gloucestershire. 

Trauma-informed Practice updates

July 2023 Newsletter

April 2023 update

Trauma-informed Practice network resources:

Trauma-Informed Practice Network meeting (October 2023)

Trauma-Informed Practice Network meeting (16th May 2023)

Trauma-Informed Practice Network meeting (8th February 2023)


We are pleased to be able to publish the new Bristol North Somerset South Gloucestershire Trauma Informed Practice Framework 2024. This document can be accessed via the below link.

BNSSG Trauma Informed Practice Framework 2024

This document builds on the previously co-produced  BNSSG Trauma Informed System Knowledge & Skills Framework and the work completed by the Trauma Oversight Group.

The Trauma Oversight Group within Healthier Together have led work on a Knowledge and Skills Framework for Trauma Informed Practice. This lays out the essential knowledge and skills needed by all tiers of the workforce. The Knowledge and Skills Framework describes the knowledge and skills required by individual workers and their organisations to become trauma informed, to recognise the potential long-term impacts of traumatic experiences on themselves, on the individuals, families and communities with whom they work and to respond in compassionate and timely ways that help to support recovery and prevent further harm.

The Knowledge and Skills Framework also aims to support managers and supervisors to recognise the educational, emotional and practical support required for their workforce to become adversity and trauma informed as the workforce itself is not exempt from the impact of adversity and trauma.

Every member of the workforce has a part to play in ensuring that organisations are trauma informed. We hope that training in trauma awareness will develop a shared understanding, language and value system across different teams and organisations. While this is relevant across the workforce, the specific knowledge and skills required varies depending on an individual’s role.

The Knowledge and Skills Framework is accompanied by an implementation toolkit. These documents will be updated based on feedback and our ongoing learning. Please send any feedback to  

A set of principles for Trauma Informed Practice have also been developed and are being embedded in policy and practice across the area.

The principles, framework, and toolkit are available here:

BNSSG Principles for Trauma Informed Practice

Trauma-Informed System Knowledge and Skills Framework

Trauma-Informed System Knowledge and Skills Framework Implementation Toolkit


Training and Development

Commissioning Training

Training on adversity and trauma is available from a number of local and national training providers. Bristol City Council have collated a directory of training providers offering a range of packages of training in trauma informed practice.

This training directory lists providers who can offer training relating to trauma informed practice, often bespoke to requirements. To support consistency in practice, partners across BNSSG have worked together to develop a shared Knowledge and Skills Framework and a shared set of principles for trauma informed practice. When commissioning training we would encourage commissioners to ensure alignment with this local approach.

Bristol City Council and the Keeping Bristol Safe Partnership (KBSP) are not able to undertake quality assurance these training providers or the course content and any organisation that commissions training will need to undertake their own due diligence.

Access the directory here

If you would like to be added to the Directory or have any feedback please contact


Training Available

Local partners have been working together to be able to offer a free Introductory course to all professionals working with children or adults in Bristol, whatever your role. Over 2023/24 a Trauma Awareness and Recovery Course is being made available. If you would like to access this please email us at

The Keeping Bristol Safe Partnership also offers an Advanced Practitioner Course, visit the KBSP Training page to download the training programme.

Feedback has been that training on this subject is best delivered directly, but there are some e-learning modules available:

  • A free online course, funded by the Home Office Early Intervention Fund, for practitioners, professionals and volunteers who work with children, young people and their families. It will take approximately 50 minutes to complete:

ACEs (


See the Support and Resources section below for further reading, films and guides.

The Bristol Changing Futures Learning Hub hosts a range of resources to support trauma informed practice: Learning Hub — Changing Futures Bristol

Colleagues in South Gloucestershire also maintain a Trello Board with a wealth of materials: Adversity and Trauma Resource Library | Trello

The toolkit developed by the Scottish Government is also a useful resource:  Trauma-informed practice toolkit: Scottish Government




Further Information

Our local Knowledge and Skills Framework was developed with thanks to NHS Scotland Transforming Psychological Trauma Framework and the Welsh support hubs skills and knowledge framework:

Transforming Psychological Trauma: A Knowledge and Skills Framework for Scotland

ACE Aware Wales Knowledge Base

Through the Adversity and Trauma Health Integration Team researchers and practitioners are working together to build the evidence base around adversity and trauma, and to harness the best research, innovation, care and education to make a difference to people's health and wellbeing.

We are working together with the University of Bristol and the University of the West of England, and are developing a programme of work with our local National Institute for Health Research (NIHR) Applied Research Collaborative (ARC West). ARC West is prioritising work in this area within their Healthier Childhoods Research Theme.

Details of Healthier Childhoods research projects will be available here.

The Adversity and Trauma Health Integration Team and ARC West are committed to involving children and young people, family members and other members of the public in our research to support evidence-based improvements. You can read more about this work here.

The impact and relevance of ACEs and trauma is being considered in the development of local strategies, plans and relevant transformation programmes, ensuring the risks associated with exposure to adversity are recognised and understood.

We are taking a ‘life-course’ approach and looking across the system to identify gaps in provision at particular points along the life course and in system integration, across for example, social care, education, health, policing, housing, city planning and the inclusive growth agenda.

We will be developing guidance and tools to enable commissioners to embed trauma informed practice through commissioning. This will include trauma informed commissioning guidance for policy makers and commissioners, including sample tender paperwork and policy standards which promote core competencies around trauma informed practice within our contractual frameworks and expectations with regard to staff training for example.

If you would like to be involved in this work please contact

Trauma Informed Communities – Second Step

The Trauma-Informed Communities project is funded by NHS Charities Together, developed and delivered by Second Step in collaboration with Bristol City Council and Bristol Health Partners through the Adversity and Trauma Health Integration Team. The project aims to explore and develop trauma awareness and practice within communities and equalities groups across the local area, and engage them in developing our local practice more widely. Second Step have been implementing a psychological, adversity and trauma-informed approach (PAT Strategy) over the last 2 years and are sharing the learning from this journey so far. The project includes a two-day training course followed by a period of partnership working to reflect on what’s been learned during the training and think about how to put this into practice within the context of an organisation or service.

Within the first day we look at becoming Trauma-Aware, covering the following:

  • Different types of trauma and how this can impact over a lifespan
  • Developmental/relational trauma
  • The intersectionality between an individual’s trauma and the wider social and historical context
  • Power and inequality
  • The risk of re-traumatisation for client groups
  • Post-traumatic growth

Within the second day we aim to deepen this understanding, reflecting on what this means within organisational settings:

  • Different aspects of becoming a trauma-informed organisation
  • Explore the impact of trauma in greater depth with a focus on how we can deliver/communicate this information to our networks and services
  • The impact of vicarious trauma and how to support staff/volunteers wellbeing
  • Develop an action plan for becoming trauma-informed in your organisation with continued support from us to begin embedding

For more information about this project please contact Second Step at

Bristol, North Somerset and South Gloucestershire (BNSSG) Vanguard 

The Bristol, North Somerset and South Gloucestershire (BNSSG) Vanguard is delivering the Framework for Integrated Care. This has been developed as a response to the NHS Long Term Plan (LTP) commitment to provide additional support for the most vulnerable children and young people with complex needs across multiple domains between the ages of 0-18. This is commissioned by the NHS England South West Health and Justice Team.

The aim of the framework is to support and strengthen, existing community services, enable collaboration within and across those agencies (all appropriate sectors), with the vision to facilitate integrated trauma-informed and responsive systems that enable children and young people with complex needs to Thrive[1]. It will also aim to reduce inequalities and improve outcomes.

Rather than providing a heavily prescribed top-down model of delivery, the Framework provides a set of principles that act as a template for trauma informed cross-agency working, providing preventative support for children exhibiting high risk, high harm behaviours,

The Framework for Integrated Care is based on six key principles (see figure 1) which underline the service, and when implemented will help meet the objectives, and overall impact the service aims to achieve. In addition to the six key principles outlined here, any service created should also align to the THRIVE Framework principles.


The six overarching principles of the Framework for Integrated Care are:



  • Improved CYP wellbeing
  • Reduction in high-risk behaviours
  • Reduced mental health concern.
  • Organisations are more trauma informed.
  • Improved purpose/occupation
  • Improved stability of home


The Vanguard is made up of seven existing services, ‘the pathways’, including CAMHS, Youth Justice Services, schools and Liaison and Diversion, who have additional funding to enhance their existing work with CYP with complex needs in a trauma informed way. This provides a real opportunity to embed cross-agency working between statutory services, third sector organisations, across multiple local authorities whilst embracing co-production in the real-world complexity of CYP services. Barnardo’s young advisors with lived experience continue to support the co-production of the project.

Each of the seven pathways work collaboratively and are built on genuine co-production with children and young people with complex needs, and their families Lived Experience advisors are informing these pathways through a programme of work supported by Barnardo’s.

The Vanguard includes A ‘Trauma Informed System Manager’ hosted by the Integrated Care Board to support the Vanguard Pathways and align to the wider development of trauma informed systems and measuring impact.

Figure 1 below illustrates how the pathways work in collaboration, underpinned by the support of Barnardo’s, the golden thread of the Trauma Responsive pathway, with the overarching governance of the project being provided by the BNSSG Integrated Models of Care Programme Board.

UWE Bristol has been awarded the contract to deliver the Evaluation for the project. Delivered by Professor Kieran McCartan and Dr Chris Pawson.

Figure 1: Integration of the Pathways in BNSSG


The seven vanguard pathways who will deliver the Framework for Integrated Care

  • HEAL (Helping Empower Adolescents Life’s) delivered by Barnardo’s.
  • Bristol Drugs Project New Lead – Rapid Year 1 Bristol Year 2 in North somerset and South Gloucestershire.
  • Young Victims Service hosted by North Somerset YOT delivered across BNSSG.
  • Enable Inclusion Team hosted by enable trust delivered only in South Gloucestershire
  • Safer Options and Mental Health practitioners- Psychological provision delivered by CAMHS Be safe and Mental Health Practitioners recruited by Barnardo’s.
  • Enhanced Case Management delivered to all the Youth Justice Teams in BNSSG, Psychology delivered by FCAMHS.
  • Advice and Support in Custody and Court Delivered by Avon and Wiltshire Partnership service is called Youth Liaison and Diversion.


For more information, please contact the Vanguard Project Manager: email Emma Morgan

Enhanced Case Management in Youth Justice

In October 2019 Bristol, North Somerset, South Gloucestershire and BANES Youth Offending Services commenced a Youth Justice Board pilot project to implement a new Trauma-informed approach to working with Children in the Youth Justice System called Enhanced Case Management (ECM). This psychology led service is grounded in an understanding of child development and how the impact of early traumatic experiences in childhood and adolescence can result in offending and other behaviours.  It is underpinned by the Trauma Recovery Model (TRM) where recommended interventions are sequenced according to the child’s developmental needs with a focus on relational therapy to mediate the impact of trauma.

The trial ended in March 2022 and following a successful bid ECM is now funded under the NHS Integrated care Framework Vanguard for a further two-year period with the aim that this will subsequently embed as a business as usual model. Under this remit F-CAMHS are now providing the psychology input for the project.

The implementation of ECM has brought about a tangible shift in both work, culture and ethos in Youth Offending Team practice which has been embraced with significant enthusiasm. The approach is providing a clear evidence-based way of successfully engaging some of our most complex and hard to reach young people and we can see benefits across many aspects of their lives. To date (Dec 22), 46 young people have been supported by the project, many of whom have extremely traumatic backgrounds, unmet basic needs and have experienced a significant lack of stability in their lives. ECM is supporting the teams around the children to demonstrate consistency, predictability and reliability and to put in place anchor points for the child which are helping to both stabilise and engage them. We are witnessing young people moving up the Trauma Recovery model triangle over time as a result of the multi-agency teams working together more effectively, focussing on building trusting relationships and sequencing the work according to the child’s developmental needs. As well as the impacts for the children, ECM has also brought about significant benefits for YOT practitioners who are able to understand the impact of ACEs and trauma on children and to use that knowledge to develop their practice; as a result they have reported increased skills, confidence and effectiveness in their work.

The ECM pilot has been subject to formal evaluation by a research organisation called ORS (Opinion Research Service), which will be published in early 2023. We are hopeful that the results will provide clear evidence of the benefits of the Enhanced Case Management approach and advocate for trauma informed working to be further embraced as the way forward for Youth Justice practice.


Please contact if you have an example of local work you would like to share.

Support and Resources

This section will be updated with resources as local work progresses.

Meeting the needs of people who have experienced ACEs and trauma is not always about providing or referring to an additional service, for many it is about a way of working and practitioners understanding the impact of adversity and responding appropriately. The Keeping Bristol Safe Partnership (KBSP) offers a range of learning opportunities. Visit the KBSP Training page to download the KBSP Inter-agency Training Programme.

Additional guidance and training opportunities are also available for the Education sector, access these at the Safeguarding in Education webpage.

The following resources and links signpost to organisations that are able to offer advice and support but you should make a referral to First Response if you have concerns that a child is being abused or neglected, or if you want to request support on behalf of a child or family. More information on how to do this is available here: First Response

Empathy vs Sympathy, Brené Brown, 2013 (3 minute video)

In this beautifully animated RSA Short, Dr Brené Brown reminds us that we can only create a genuine empathic connection if we are brave enough to really get in touch with our own fragilities. This video explains the difference between empathy and sympathy well and is also a nice reminder for us about how to choose our words.

E-learning: Introduction to Adverse Childhood Experiences

A free online course, funded by the Home Office Early Intervention Fund, for practitioners, professionals and volunteers who work with children, young people and their families. It will take approximately 50 minutes to complete.

How Childhood Trauma Affects Health Across a Lifetime (16 minute video)

A TED MED Talk by Nadine Burke Harris from 2014.

‘Resilience: The Biology of Stress and the Science of Hope’ (1 hour documentary)

An inspiring and informative one hour documentary made by KPJR Films (2016) on the effects of ACEs and how to overcome them. To screen the film in your organisation or with a local network or partnership please contact: - Currently unavailable

Adverse Childhood Experiences, Public Health Wales Awareness Raising Film (6 minute video)

This short animated film has been developed to raise awareness of ACEs, their potential to damage health across the life course and the roles that different agencies can play in preventing ACEs and supporting those affected by them. The film has been produced for Public Health Wales and Blackburn with Darwen Local Authority. Further information available here.

Toxic Stress Derails Development, Center on the Developing Child at Harvard University, 2011 (2 minute video)

Learning how to cope with adversity is an important part of healthy development. While moderate, short-lived stress responses in the body can promote growth, toxic stress is the strong, unrelieved activation of the body's stress management system in the absence of protective adult support. Without caring adults to buffer children, the unrelenting stress caused by extreme poverty, neglect, abuse, or severe maternal depression can weaken the architecture of the developing brain, with long-term consequences for learning, behavior, and both physical and mental health.

This video is part three of a three-part series titled "Three Core Concepts in Early Development" from the Center and the National Scientific Council on the Developing Child. All available in the link.

Adverse Childhood Experiences (ACEs): Impact on brain, body and behaviour (6 minute video)

This video explores what we know about how trauma and exposure to unhealthy levels of stress hormones (e.g. cortisol and adrenaline), can adversely affect the structure and functioning of a child’s developing brain

What is Trauma? (10 minute video)

A video created in Avon & Wiltshire Partnership Mental Health Trust which gives an overview of trauma including the differences between single-event and complex trauma.

Trauma and the Brain (9 minute video)

An animated video created by NHS Lanarkshire and partners which shows two police detectives interviewing a young lady who is reporting rape, and how they learn to take a trauma-informed approach to interviews once they have attended trauma training. Shows the impact of trauma on the brain, particularly on memory.

Fight or Flight basics (4 minute video)

A short animation showing how primeval people used the fight or flight responses for survival, but how the automatic response may at times be unhelpful in the modern world.

Fight Flight or Freeze Response (3 minute video)

A short animation explaining the human responses of fight, flight or freeze which are used for survival, and the physical sensations felt in the body.

The Three Main Parts of the Brain (3 minute video)

An animated video by Dr Russ Harris which demonstrates a simple way to explain the three main components of the brain and their functions.

Evolution of the Human Mind (3.5 minute video)

An animated video by Dr Russ Harris which explains how survival skills which were once essential for survival can be less helpful in the modern world. The video shows that difficult thoughts and feelings are part of normal human responses.

The Brain and Trauma (5.5 minute video)

An animated video by Dr Russ Harris which describes what happens in the brain during trauma. The video uses four metaphors to explain brain function: the Data Analyst, Emergency Alarm, Security Guard and Mission Control.

Understanding Trauma: Learning Brain vs Survival Brain (5 minute video)

A video explain the impact of trauma on the brain, specifically that it can become ‘stuck’ in survival mode which makes it more challenging to learn and remember new information.

The Flop Response for Survival (30 second video)

This video shows an animal using the automatic ‘flop’ response to survive an attack.

Child Development and Childhood Trauma, Trauma and the Window of Tolerance (7 minute video)

An animation showing the impact of trauma on a child’s 'window of tolerance' of emotions, and the importance of widening the window.

Attachment Theory: How Childhood Affects Life (7.5 minute video)

An overview of attachment theory including the different attachment styles.

What survival looks like in school, Inner World Work (Booklet)

Handouts for teachers or trusted adults at school/college to help understand what survival states look like in the school/college environment and what they can do to help ground them and subsequently improve their learning

What Survival looks like at Home, Inner World Work and Beacon House (Booklet)

A booklet that describes four different ‘survival’ states people can respond with, what they look like and how people around them can help

School Survivors (5 minute video)

What does School feel like for children and teens living with trauma pain? This video is a collation of some of their voices and why Schools urgently need training and support to become trauma and attachment aware environments. Made by parents of children with trauma. Relevant even if you don’t work in a school: consider these examples to think about possible triggers in your working environment or in your working pattern.

Safe Hands Thinking Minds (website)

Dr Karen Treisman with Safe Hands and Thinking Minds Associates draw on a range of interdisciplinary expertise, theoretical perspectives, and evidence bases to promote, solidify, and develop high standards in areas of parenting, trauma, adversity (ACE’s), attachment, fostering, adoption, asylum-seeking & refugee young people, and culturally/adversity/trauma-informed and trauma-responsive organisations. The website signposts to an array of useful content, podcasts, resources, reading and links in the areas of trauma, toxic stress, attachment, foster care, adoption, and parenting.

Beacon House (website)

Beacon House develops freely available resources about trauma and adversity. Resources include this Comic Strip illustration of how a shift from traditional language to trauma informed descriptions of vulnerable individuals can create compassion instead of blame, hope instead of hopelessness and connection rather than disconnection.

North Somerset: Trauma Informed Practice (43 minute video) A film made locally about trauma informed practice. Click on the link to download the MP4 file.

Additional videos for Psychoeducation and skills have been compiled here, collated by Sally McGuire, Clinical Psychologist

The Bristol City Council website includes information about where to find guidance for staying physically and mentally well during coronavirus (COVID-19)

Young Minds: Advice for parents and carers- talking to children and young people about coronavirus

Safe Hands Thinking Minds: Resources for supporting children and young people with worry and fear: Tips, tools and resources

Beacon House: Covid-19 support resources

Covibook: an interactive resource designed to support and reassure children aged 7 and under, designed to help children explain and draw the emotions that they might be experiencing (different languages)

Carers UK: Guidance for carers

Child Bereavement UK: Help for children and young people, parents and families to rebuild their lives when a child grieves or when a child dies

Winston’s wish: Information, advice and guidance on supporting bereaved children and young people during the coronavirus outbreak. Free phone number for children 08088 020 21 plus online information

A wide range of resources and further reading have been collated on this Trello page, made available by partners in South Gloucestershire. This link will not open in Internet Explorer – please use an alternative browser, such as Chrome.

Adverse childhood experiences: What we know, what we don't know, and what should happen next, Early Intervention Foundation, 26 February 2020 This report surveys the evidence relating to the prevalence, impact and treatment of ACEs, the extent to which ACEs should provide the basis for frontline practice and service design, and the known level of effectiveness and value of ACE-related approaches, such as routine enquiry and trauma-informed care.

‘Polishing the Diamonds: Addressing Adverse Childhood Experiences in Scotland’ The Scottish Public Health Network (ScotPHN) report provides an overview on ACE and makes a number of recommendations.

Welsh Adverse Childhood Experiences (ACE) Study Report relating to Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population.

National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviours in England, Bellis et al., BMC Medicine vol 12 (2014)

‘Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study’, Felitti, M. D., Anda, R. F., Nordenberg, M. D. et al (1998) ‘American Journal of Preventative Medicine. 14. Orignial US Study or sourced here.

Current programme in England - ‘Creating ACE-informed places: promoting a whole-system approach to tackling adverse childhood experiences in local communities’, Association of Directors of Public Health. This project will scale up tested approaches in order to share good practice and stimulate an England-wide response to tackling ACEs. The project will bring together key partners – including the police, public health professionals, health care professionals and children’s social services – to discuss the current evidence base and identify what work has already been done to tackle ACEs in areas of the UK.


For any enquiries relating to Bristol work on ACEs and trauma informed practice please contact