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Upcoming event: Gaps in measuring and responding to childhood adversity

 

 

Domestic abuse and other adversities experienced by children and young people: What’s missing in measurement and service response?

Free webinar, Tuesday 15 September 2026, 12:00 – 14:00

To register: Gaps in measuring and responding to childhood adversity

There is widespread recognition that adversities experienced by children and young people are damaging to their health and wellbeing, with negative impact through their life course.  Those adversities, including domestic abuse and child maltreatment, are often invisible to NHS service providers, a necessary condition for responding to the needs of those children and young people. 

VISION (a UK Prevention Research Partnership-funded consortium) and CPRU (the NIHR Child and Families Policy Research Unit) have conducted multi-disciplinary research improving the measurement of child adversities and their impact on mental health, enhancing the use of general practice data to identify families experiencing adversity, identify the gaps and effective practice in responding to the needs of children and young people experiencing domestic abuse or maltreatment, particularly their mental health.  

The webinar will be co-chaired by Professors Gene Feder (VISION, University of Bristol) & Ruth Gilbert (CPRU, University College London) with presentations from the following researchers with ample time for discussion of their findings in relation to practice and policy: 

  • Dr Ladan Hashemi (VISION, City St George’s UoL) – Adverse childhood experiences and childhood outcomes: cumulative exposure, and mitigating factors: from epidemiology to informing services
  • Dr Shabeer Syed (CPRU, University College London) – From firstborn to family: identifying ACEs in general practice data and the case for whole-family support
  • Dr Claire Powell (CPRU, University College London) – Invisibility of domestic abuse in child and adolescent mental health services: how can it be made visible and addressed?
  • Dr Ruth Weir (VISION, City St George’s UoL) – Teenage relationship abuse: Recognition and response in collaboration with young people

Co-organisers:

             

 

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The link between Adverse Childhood Experiences and school engagement

By their eighth birthday, an estimated nine in ten New Zealand children will have experienced a form of serious adversity. They might have been neglected, grown up with family violence, lived through a separation, experienced bullying or coped with a parent’s mental illness or substance use problem. These experiences are relevant to education as they can have important and lasting consequences for academic achievement. When a child faces more adversity, it weighs heavily on how they fare at school. School engagement has a significant impact on students’ academic success underscoring the need for a thorough examination of the risk factors contributing to student disengagement within educational environments. The research has been less clear about why that link exists.

A recent study led by Maryam Ghasemi at the University of Auckland, with VISION Senior Research Fellow Ladan Hashemi (City St George’s UoL) and others, examines the longitudinal association between a relatively broad Adverse Childhood Experiences (ACEs) index within Growing Up in New Zealand (GUiNZ) measured up to age 8, and low school engagement at age 12.

The team also explores the potential mediating role of children’s self-esteem and scholastic self-concept in this relationship. Using data from an ethnically diverse longitudinal birth cohort of 3858 children in New Zealand, they investigated how early exposure to adversity influences school engagement at age 12.

The research demonstrates that exposure to a greater number of adversities by age 8 is associated with lower levels of school engagement at age 12, even after adjusting for gender and area deprivation level. This effect occurs by undermining children’s self-esteem and scholastic self-concept, which highlights how early adversity can shape educational trajectories through internalized negative self-perceptions.

The findings highlight the importance of preventing ACEs, early identification of at-risk children, and prioritizing trauma-informed, equitable, and culturally sensitive interventions to improve school engagement. Children who stay engaged at school are more likely to do well later in life. Those who disengage face a greater risk of lower academic achievement, poorer mental health and leaving school early. To keep children connected to their school, supportive teachers, positive friendships, opportunities to succeed and extracurricular activities can all make a meaningful difference. So can giving students more say in their learning and recognising their achievements. Ultimately, schools cannot undo the adversity a child has faced at home. But they can still do much to help children believe in themselves, thrive in the classroom and reach their potential.

To download the peer-reviewed article: Understanding the Link Between Adverse Childhood Experiences (ACEs) and School Engagement: Investigating the Role of Child Self-concept as a Mediator

To download the article in The Conversation: Adversity can follow NZ kids to the classroom. Can schools make a difference?

To cite: Ghasemi, M., Meissel, K., McIntosh, T. et al. Understanding the Link Between Adverse Childhood Experiences (ACEs) and School Engagement: Investigating the Role of Child Self-concept as a Mediator. ADV RES SCI7, 43 (2026). https://doi.org/10.1007/s42844-026-00229-z

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VISION Policy Briefing: The role of health services in identifying and responding to teenage relationship abuse

 

 

Introduction

Teenage relationship abuse (TRA) is a growing public health concern that the current statutory framework is ill-equipped to address. Under-16s fall outside the legal definition of domestic abuse entirely, creating significant gaps in identification, referral and intervention at precisely the age when abuse most commonly begins. A Youth Endowment Fund survey of 11,000 teenagers aged 13 to 17 found that 39% of those who had been in a relationship had experienced emotional or physical abuse, yet no coherent professional or legal framework exists to respond.

This VISION Policy Briefing draws on findings from three place-based practitioner roundtables exploring TRA and conducted in Gloucestershire, Oxfordshire and Northumbria in 2025. As the first in a series of sector-specific policy briefs it sets out what the health sector is currently unable to do, where the opportunities lie, and what commissioners, NHS trusts and public health leads need to do differently. 

Key recommendations

  1. NHS commissioners to include TRA identification and referral in domestic abuse commissioning frameworks, explicitly covering under-16s
  2. Integration of TRA content into existing safeguarding and domestic abuse training frameworks for all health professionals working with young people, including GPs, school nurses, emergency services staff, sexual health clinicians and mental health practitioners – with outcome measurement built in
  3. Clear referral pathways from health settings into specialist TRA support to be established in every area, regardless of the young person’s age
  4. Health and Wellbeing Boards to include TRA as a public health priority in Joint Strategic Needs Assessments
  5. School health teams to be resourced and trained to deliver TRA/DA content as part of PSHE, building on the school nurse model in Oxford and aligned with the Mental Health Support Team roll out
  6. Child and Adolescent Mental Health Services (CAMHS) to develop protocols for identifying TRA among young people presenting with mental health difficulties
  7. Extend operating hours for young people’s services

To download the VISION Policy Briefing: The role of health services in identifying and  responding to teenage relationship abuse

To cite: Weir, Ruth; Barrow-Grint, Katy (2026). VISION Policy Brief: Teenage Relationship Abuse and Health. City, University of London. Report. https://doi.org/10.25383/city.32292564.v1

For further information: Ruth at ruth.weir@citystgeorges.ac.uk

The establishment of the National Working Group on Teenage Relationship Abuse

Teenage relationship abuse remains one of the least understood forms of domestic abuse, particularly among those under 16 years of age, who fall outside the statutory definition within the 2021 Domestic Abuse Act.

To close the gap between research, policy, and frontline practice and ensure that young people are no longer overlooked, VISION researcher and co-Deputy Director of the Violence and Society Centre at City St George’s, Dr Ruth Weir, co-established the National Working Group on Teenage Relationship Abuse with Gloucestershire Deputy Chief Constable Katy Barrow-Grint in 2024. The group consists of researchers, practitioners, policymakers, third sector organisations, and young people with lived experience of teenage abuse from across the health and justice sectors for a holistic understanding of the problem.

Membership has grown over the two years and now includes the Home Office, Department for Education, the Cabinet Office, the Domestic Abuse Commissioner’s Office, College of Policing, local government (Islington Council), universities (City St George’s, Essex, Lancashire), NHS bodies, multiple police forces such as Thames Valley and the London Metropolitan Police, school trusts, and charities like SafeLives, Respect, Youth Realities, Changing Relations, and Victim Support just to name a few.

The group brings their expertise to shape ongoing national conversations on how teenage relationship abuse is defined, recognised, and responded to, particularly for those under 16.

Please contact Ruth at ruth.weir@citystgeorges.ac.uk for further information.

Independent evaluation of Women’s Aid’s ‘Expect Respect’ programme reveals timely learning about effective schools-based health relationship intervention

 

By Dr Annie Bunce

VISION researchers Dr Annie Bunce (City St Georges University of London) and Dr Estela Capelas Barbosa (University of Bristol), alongside Dr Anna Dowrick (University of Oxford) and Dr Meredith Hawking (Queen Mary University of London), recently wrapped up an independent evaluation of Women’s Aid’s school-based educational programme, ‘Expect Respect’. The programme is aimed at children and young people (ages 4 to 18) and school staff and focuses on unhealthy relationships and the gender stereotypes that underpin them. Sessions are tailored to different age groups, with content for older students also addressing domestic abuse. It is designed to be delivered year-on-year nationally. You can find out more about the programme here: Expect Respect – Women’s Aid

The evaluation was conducted between February 2024 and May 2025, utilising mixed methods to assess the impact of the programme. Staff and student survey data from participating schools was analysed quantitatively, to assess the impact of the programme on individual and school-level behavioural outcomes and differences in student outcomes by age, gender, ethnicity or disability. Creative methods including arts-based activities and vignettes were utilised in student focus groups to facilitate engagement and expression. Interview data from staff and focus group data from students was analysed qualitatively to explore the impact of the programme on school culture, and understanding of and attitudes towards gender stereotypes, healthy relationships and domestic abuse (the latter with older students only).

Findings from quantitative analysis showed that Expect Respect generally works in terms of teaching children and young people about gender roles, healthy relationships and domestic abuse, as well as how and where to seek help. For example, we found the programme had a positive impact on understanding of gender roles among children aged 4 to 14, and on understanding of domestic abuse among older students (ages 11-18). Following the Expect Respect session, those aged 11-18 were less likely to view controlling behaviour as acceptable, and over twice as likely to say they knew who they could talk to if they were concerned about a relationship. School staff overwhelmingly reported they had a better understanding of domestic abuse and felt more confident about responding to abuse-related disclosures after the staff training than they had done beforehand, and were very satisfied with the training. Qualitative findings from staff interviews supported these survey results, with staff describing the content of the training as eye-opening and the delivery by Women’s Aid staff excellent.

Qualitative analysis revealed overall consensus with the quantitative findings in terms of the effectiveness of the Expect Respect training, as well as revealing some nuanced findings. For example, while survey results indicated a change in attitudes for most outcomes immediately following the session, qualitative findings suggested that achieving longer-term change would require consolidation of learning via regular sessions. We also found that secondary school students already had a reasonably decent understanding of the differences between healthy and unhealthy relationship behaviours prior to receiving the Expect Respect session, and felt it would have greater impact if there was a shift in emphasis from awareness raising towards practical advice about how to address unhealthy relationships and where to seek help. There was agreement among both staff and students that the programme would likely have more impact if it was more interactive, particularly the session tailored for older students.

Qualitative findings also suggested that boys found it more difficult to engage with the programme than girls, and both staff and students felt the programme was lacking in information about online relationships. Focus group data highlighted that gender stereotypes remain pervasive in young people’s thinking about heterosexual romantic relationships and are used to justify controlling behaviour. Despite this, staff were optimistic about the potential of the programme to positively impact on both students themselves, and school culture more widely, by planting a seed that they were hopeful would lead to longer term impact. Staff interviews also touched on the challenges of trying to model progressive gender stereotypes and healthy relationships to students through the programme when these were not necessarily reflected among adults in school culture. Nevertheless, staff unanimously felt that the Expect Respect sessions had helped them to identify unhealthy behaviour in relationships between students and also encouraged some students to come forward and speak to them about things they were worried about.

Recommendations

Our recommendation focus on the programme content, format and embedding learning, including:

  • Co-produce session content with young people
  • Make sessions more interactive
  • Utilise the power of personal stories and lived experience
  • Explore examples of unhealthy behaviour in friendships, families and romantic relationships
  • Focus on sparking conversations and making sessions memorable
  • Equip young people with skills to challenge unhealthy relationship behaviour, and linking with local support services
  • Continue with year-on-year delivery and provide resources/advice for schools on how to embed Expect Respect messages across the year and build on learning

The full evaluation report can be accessed here: Microsoft Word – ExpectRespect_finalreport_27Jan26

For further information, please contact Annie at annie.bunce@citystgeorges.ac.uk

Cover photo supplied from the evaluation.

Impact of verbal abuse as a child just as harmful as physical abuse

Globally, one in six children are estimated to suffer physical abuse within domestic and family relationships. As well as immediate health risks associated with the physical trauma of abuse, physical abuse can have lifelong impacts on mental and physical health and well-being. Thus, even as adults, individuals who have been physically abused as children show higher levels of anxiety and depression as well as more problematic alcohol and drug use.

As a source of toxic stress, verbal abuse, like physical abuse, may affect the neurobiological development of children, leading to immediate and long-term impacts on health and well-being. Like physical abuse, verbal abuse has also been linked with poor mental and physical health outcomes during childhood and across the life course. Increasingly, empirical evidence supports verbal abuse causing damage to child development.

For the study, Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales, VISION researcher Professor Mark Bellis and his team, combined data from multiple studies measuring child abuse across England and Wales. They tested the associations with poorer mental well-being across the life course with experiencing physical abuse or verbal abuse as a child individually as well as the impact associated with combined exposure to both abuse types.

Their research showed that exposure to childhood physical or verbal abuse has similar associations with lower mental wellbeing during adulthood. In fact, results identified around a 50% increase in likelihood of low mental wellbeing related to exposure to either form of abuse. With regard to verbal abuse, children who experienced ridicule, threats or humiliation from a parent / guardian have a 64% higher chance of poor mental health as an adult. The researchers also discovered that whilst physical abuse reduces over time, verbal abuse increases.

Verbal abuse may not immediately manifest in ways that catch the attention of bystanders, clinicians, or others in supporting services with a responsibility for safeguarding children. However, as suggested here, some impacts may be no less harmful or protracted. The potential impact of verbal abuse should be better considered in policy, and parenting and child protection interventions. The potential role of childhood verbal abuse in escalating levels of poor mental health among younger age groups needs greater consideration.

Recommendation

Interventions to reduce child abuse, including physical chastisement, should consider both physical and verbal abuse and their individual and combined consequences to life course health.

To download: Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales

To cite: Bellis MA, Hughes K, Ford K, et al. Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales. BMJ Open 2025;15:e098412. http://doi:10.1136/bmjopen-2024-098412

For further information, please contact Mark at m.a.bellis@ljmu.ac.uk

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Start for Life Outcomes Framework: Identifying candidate indicators

In 2021, the Government in England recognised the importance of supporting parents to give their babies and young children under two years of age the best start in life. There was a public commitment to publish a Start for Life Outcomes Framework. The Department of Health and Social Care in England then commissioned the NIHR Children and Families Policy Research Unit to undertake a five-month rapid responsive study to identify and provide a commentary on candidate indicators for this framework.

The research team, including VISION Deputy Director and Senior Lecturer at University of Bristol, Dr Estela Capelas Barbosa, identified candidate indicators to monitor population health of babies, young children, and their families. The project’s secondary focus generated principles for a framework to monitor service performance for this population. 

They conducted two rapid reviews with systematic searches to identify existing outcomes frameworks and core outcome sets that recommended relevant indicators for monitoring both population health and service performance.

Forty-seven candidate indicators were identified, of which 36 met the priority criteria. Many indicators featured in existing frameworks and had some relevant data already collected at scale in England. However, data were often not reported/available separately for adults or households with children and/or by age of child.

Significant further work is needed to develop frameworks to monitor population-level outcomes for babies or assess the quality of services. Frameworks require a clear purpose and consideration of unintended consequences from focusing on some indicators and not others.

The Public Health Outcomes Framework is already a rich resource with 24 (66%) of the 36 priority
indicators already featuring in some form.

To download the summary and / or report: Start for Life Outcomes Framework: Identifying candidate indicators

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The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK

Child maltreatment (CM) and parental domestic violence and abuse (pDVA) impose considerable lifelong adverse outcomes on those affected. Approximately 8.5 million adults in England and Wales are estimated to have been exposed to CM (physical, sexual or emotional abuse or emotional or physical neglect of a child by a parent or caregiver) before their 16th birthday. Despite sharing multiple family and environmental risk factors, the economic burden of child exposure where they co-occur has not previously been estimated in detail.

VISION researcher Professor Gene Feder estimated average lifetime societal costs resulting from CM or childhood exposure to pDVA, and incremental costs for scenarios where they co-occur with lead researcher Dr Kevin Gilbert at the University of Cambridge and others.

The findings showed that lifetime costs for childhood exposure to CM and/or pDVA, were £71,309 per child (non-fatal exposure), and £1,292,377 per CM fatality, with £27.8 billion projected costs (2013 UK birth cohort).

Total costs for exposure to pDVA alone was £1.0 billion (£16,639 per child exposed), rising to £2.0 billion (£71,037 per exposed child) for children reporting awareness of pDVA. Co-occurring CM and pDVA imposed greater costs than either alone, including costs from child perpetration of intimate partner violence.

As a result of the research the team concluded that CM and/or pDVA exposure incurs large personal and societal economic burdens. Costs from both pDVA exposure and intergenerational transmission of IPV perpetration highlight the importance for policies to address both CM and domestic violence and abuse in affected households.

Given the scale of burden accrued over the life course after CM and/or pDVA exposure, this model can provide a framework upon which policy makers can identify the best use of resources to maximise the societal benefits from the effective interventions needed to tackle a complex social issue.

To download the article: The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK

To cite: Herbert K, Feder G, Gilbert R, Powell C, Howarth E, Morris S. The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK. Child Abuse Negl. 2025 Mar 31;163:107435. doi: 10.1016/j.chiabu.2025.107435. Epub ahead of print. PMID: 40168916.

For further information, please contact Kevin at kch28@medschl.cam.ac.uk

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Multiple adverse childhood experiences and mental and physical health outcomes in adulthood: New systematic review protocol assessing causality

Research suggests that adverse childhood experiences can have a lasting influence on children’s development that result in poorer health outcomes in adulthood. Like other exposure-outcome relationships, however, there is uncertainty about the extent to which the relationship between adverse childhood experiences and health is causal or attributable to other factors.

The aim of this systematic review is to better understand the nature and extent of the evidence available to infer a causal relationship between adverse childhood experiences and health outcomes in adulthood.

A comprehensive search for articles will be conducted in four databases (Medline, CINAHL, PsycInfo and Web of Science) and Google Scholar. The team, led by Dr Lisa Jones of Liverpool John Moores University, and includes VISION researchers Professor Mark Bellis and Professor Sally McManus, will review studies published since 2014:

  • of adults aged 16 years or over with exposure to adverse childhood experiences before age 16 years from general population samples;
  • that report measures across multiple categories of childhood adversity, including both direct and indirect types; and
  • report outcomes related to disease morbidity and mortality.

To download the protocol: Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality

To cite: Jones L, Bellis MA, Butler N, et al. Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality. BMJ Open 2025;15:e091865.  doi: 10.1136/bmjopen-2024-091865

For further information, please contact Lisa at l.jones1@ljmu.ac.uk

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Positive experiences can mitigate negative effects in children with trauma

Children with traumatic experiences in their early lives have a higher risk of obesity. But as new research from VISION researcher Dr Ladan Hashemi and colleagues at University of Auckland, New Zealand, demonstrate, this risk can be reduced through positive experiences.

Their analysis of data from around 5,000 children in the Growing Up in New Zealand study revealed nine out of ten faced at least one significant source of trauma by the time they were eight years old. Multiple adverse experiences were also prevalent, with one in three children experiencing at least three traumatic events. Notably, certain traumatic experiences (including physical abuse and parental domestic violence) related more strongly to obesity than others. This highlights the strong connection between early-life adversity and physical health outcomes.

Whilst researching the associations between obesity and childhood trauma, the team also explored the protective and mitigating effects of positive experiences. They defined positive experiences as:

  • mothers interacting well with their children
  • mothers involved in social groups
  • children engaged in enriching experiences and activities such as visiting libraries or museums and participating in sports and community events
  • children living in households with routines and rules, including those regulating bedtime, screen time and mealtimes
  • children attending effective early childhood education

The findings were encouraging. Children with more positive experiences were significantly less likely to be obese by age eight. For example, those with five or six positive experiences were 60% less likely to be overweight or obese compared to children with zero or one positive experience. Even two positive experiences reduced the likelihood by a quarter.

Among children exposed to multiple adversities, positive experiences can help mitigate the negative effects of childhood trauma. However, at least four positive experiences were required to significantly counteract the impact of adverse experiences.

Recommendations

  • Traditional weight-loss programmes focused solely on changing behaviours are not enough to tackle childhood obesity. To create lasting change, children need positive social environments and life experiences as well as support to address the emotional scars of early trauma shaping their lives.
  • Fostering positive experiences is a vital part of this holistic approach. These experiences not only help protect children from the harmful effects of adversity but also promote their overall physical and mental wellbeing. This isn’t just about preventing obesity – it’s about giving children the foundation to thrive and reach their full potential.
  • Sure Start and providers of early childhood education and support for parents could help reduce the health inequalities resulting from exposure to violence.

To download the paper: Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study | BMC Public Health

To cite: Mellar, B.M., Ghasemi, M., Gulliver, P. et al. Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study. BMC Public Health 25, 8 (2025). https://doi.org/10.1186/s12889-024-20727-y

For further information on the research:

Or for further information, please contact Ladan at ladan.hashemi@city.ac.uk

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