ACE awareness in school nursing – becoming a trauma-informed service

Toxic trio is a term that I have heard used a lot in school nursing in terms of safeguarding children. When I first joined the school health service 7 years ago, I quickly understood that there was a link between domestic abuse, parental substance misuse and parental mental health, and the likelihood of a detrimental impact on the wellbeing of children living in this toxic environment. Serious case reviews show that the combination of these three elements is an indicator of an increased risk of harm to children and young people (Brandon, 2009). I had become aware of the link between children living in these toxic environments and them being on a child protection plan. Working with these children and families, and attending conferences, I started to understand how these issues were affecting the lived experiences of the child and the detrimental impact it was having on their emotional, physical and social wellbeing. The work we would be asked to do with the child on a child protection plan would often be to support their emotional health, such as a referral to a children's mental health service or one-to-one work with our service. Talking to the children in one-to-one sessions, I realised that the environment they were living in often led them to feel anxious, have low self-esteem and lack in confidence. There were reports from school to say they were ‘acting up’ in class, displaying anger and aggressive behaviour toward their peers and teachers and they were often struggling to manage their emotions. There were reports from home to say their behaviour was deteriorating and were hitting out at their parents or siblings, older children and young people were getting caught up in the wrong crowd and at risk of criminal or sexual exploitation, they were getting into drink and drugs. These are just a snapshot of an extensive list of issues I was often asked to support the child or young people with. I would often question, ‘why are they behaving this way?’ and I became overwhelmed with the feeling of ‘I do not know how to help this child’. I would try my best to do some one-to-one work to try and get the voice of the child and talk through how they can manage their emotions and anxieties. Most of the time I would just be there to listen. I would do referrals to other services, such as children and adolescent mental health services. A lot of the time I felt out of my depth as I was not specifically trained in emotional health and I would often question whether I said the right thing or if I was doing enough to help the child who was struggling. Whether I could do more to help would often play on my mind but I did not fully understand why their home environment was resulting in the behaviours they were displaying.