iHV welcomes the publication of the Early Intervention Foundation’s report – Adverse childhood experiences: What we know, what we don’t know, and what should happen next.


This report surveys the evidence relating to the prevalence, impact and treatment of Adverse Childhood Experiences (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.



Commenting on the launch of Adverse childhood experiences: What we know, what we don’t know, and what should happen next, Dr Cheryll Adams CBE, Executive Director of the iHV, said:

“This report will add real value to the current interest in ACEs, pointing out as it does their limitations as well as their benefits in understanding the impact of adversity in childhood and into later life. Its publication, in the same week as Sir Michael Marmot’s 10 Years On update report on health inequalities, adds urgency to the recognition of the adverse experiences of so many children as a result of an more unequal society as well as their individual circumstances.”

iHV welcomes new Early Intervention Foundation (EIF) report – Key competencies in early cognitive development: Things, people, numbers and words.

Children’s early cognitive development should be prioritised as an essential necessity to help prepare them for school and address income-related learning gaps, or we risk disadvantaged children falling significantly behind from the very start of their education, according to a major new report from the EIF.

The report contends that the early development of core cognitive skills, including children’s language development and their understanding of objects, people and numbers, should receive the same level of investment and attention that we currently give to ensuring children are well fed, living in stable homes and have sufficient clothing.

Dr Cheryll Adams, Executive Director iHV, said:

“The Institute of Health Visiting very much welcomes the light that the Early Intervention Foundation has shown on the importance of investing in an infant’s early cognitive skills development, alongside trying to bring all children out of poverty.  Their call for investment into more health visitors is particularly welcome.

“Health visitors, as highly trained, public health practitioners, can, not only identify children in need of additional support very early, perhaps even before birth, but start preventative and early intervention support when it will make the most difference, during the infant’s period of rapid development during its first 1001 days of life. We hope that the government will respond to this new evidence which supports so many other experts in recommending investing in health visitors to lead the delivery of the best evidence based outcomes for more vulnerable infants.”

Key findings in the report, Key competencies in early cognitive development: Things, people, numbers and words, include:

  • Early cognitive capabilities are highly associated with the quality of children’s early learning experiences and predictive of their later success at school and in the workforce
  • Income related learning gaps are already present at the age of four and increase as children grow older, although these gaps can be rectified when high quality support is provided early
  • Parents play a crucial role in their children’s early cognitive development – and support from health visitors, nursery educators and childcare can also make a positive difference. This is especially true for children growing up in disadvantaged circumstances

iHV supports the call by the Early Intervention Foundation for more investment into Early Intervention in England, following the publication of its report, Realising the potential of early intervention. This report sets out a bold plan of action to ensure effective early intervention is available to the children, young people and families who need it most.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“The Institute of Health Visiting supports the call by EIF for more investment into Early Intervention in England. We would like to see this extended to research and investment into whole universal systems change, as well as individually focused approaches. For example, health visitors are alarmed by seeing current cuts to their services resulting in many more vulnerable children having their needs recognised late, and needing much more complex and expensive interventions, than if their families had received sufficient early support that health visitors could once offer.”

This report seeks to look at the cost effectiveness of different programmes to support the development of healthy attachment. It is hoped to be of value to commissioners trying to decide where to spend their money.

Inevitably it’s been a challenging piece of work to do and some of the conclusions are being seen as controversial.  For example, the originator and iHV ambassador of the MESCH programme in the UK, Professors Lynn Kemp and Sarah Cowley respectively, have been very disappointed at the fact that MESCH has been included in the attachment section, whereas it is a broad-based multi-faceted programme delivered as part of a universal service, rather than a targeted programme focused on attachment.

Dr Cheryll Adams, iHV director said:

“This report must be interpreted with extreme care.  It was a very difficult piece of work to embark on and some of the recommendations will be seen as very surprising or disappointing.  Indeed, there could even be an interpretation that it challenges the value of universal services, although that wasn’t at all its purpose.

We would challenge the report for promoting the commissioning of early intervention services to respond to overt problems which the EIF identifies as risk.  This suggests intervention from age 2-3 years onwards, instead of the health visitor interpretation of early intervention where the recognition of risk is in the first year of life and intervening then when interventions can be most effective.

We must encourage commissioners to invest in services upstream of problems.  Even if the evidence for the value of doing this hasn’t been invested in, there is a clear logic that prevention is better than cure.  For example, how much better to pick up glue ear affecting hearing early, rather than speech delay and its social  and emotional consequences at age 2½.”

We encourage health visitors to read the report and let us and the EIF know their thoughts on its value for strengthening commissioning to improve children’s lives.  Also to be ready to challenge inappropriate commissioning decisions based on its findings.