Since January 2019, Warren Larkin Associates (WLA) was commissioned by Nottinghamshire County to work with partners to support them to not only respond to the impacts of Adverse Childhood Experiences (ACEs) but also to look at the causes and at ways in which they can be prevented.

If you’ve read any of my blogs before you will know that I feel passionately that prevention rather than cure has to become the new normal, so I feel fortunate and privileged to be working with so many like-minded people in Nottinghamshire.

The most heartening aspect of being a part of this was the collaboration and the shared desire to learn, improve and make things better for people living in Nottinghamshire. The Routine Enquiry about Adversity in Childhood (REACh) programme was rolled out across a wide range of services in the county to ensure that a significant proportion of the multi-agency workforce supporting help-seeking people would be equipped to use ACE enquiry effectively as a part of their care.


There are many instances where the REACh programme and ACE enquiry are being used successfully. However, for me, the standout difference for the Nottinghamshire project is that the routine and targeted enquiry approach we teach is being delivered across a number of different services and organisations across the county. This multi-agency, cross-sector and system-wide approach has never before been attempted in the UK.

This feels ground-breaking; ambitious and unique. A truly system-wide implementation and community of practice which has the potential to have far reaching benefits for many people across the county.

It is also interesting to observe that this programme was initiated by Nottinghamshire County Council and Warren Larkin Associates, before the state-wide roll out of ACE screening in California.

The project to date

Due to the pandemic the project was paused around the time of the first lock down. This was of course necessary due to the number of staff being redeployed and services entering a period of uncertainty and intense activity. However, in that first 12 months we had built significant momentum, huge enthusiasm and saw a lot of hard work from the services taking part. We were also seeing very positive early reports and case studies of the benefits both staff and service users were reporting.

Some of this early learning is captured in the interim evaluation conducted by the Public Health Institute at Liverpool John Moores University (LJMU).  Both the full interim report and executive summary are available on the Liverpool John Moores University website.

The interim report highlighted the following successes:

  • All services have established plans to implement ACE enquiry from a person-centred perspective.
  • ACE enquiry has commenced in five services (with over 200 service users) as of June 2020.
  • ACE enquiry was found to be acceptable and feasible for practitioners and acceptable to service users, who had engaged with the process.
  • There have been a number of positive outcomes for service users – (some of which are presented as case studies in the interim report).
  • Over 500 practitioners have been trained, with significant increases in their knowledge about ACEs and ACE enquiry, and confidence to discuss adversities with clients and support them appropriately.

What’s next?

Like many people and organisations, we have adapted to the new world where being virtual has become the norm, and so we have been able to recommence the programme.  We have in recent months moved all of our REACh training, refresh sessions, steering groups and follow-up support online and by the end of March 2021 we will have trained over 800 staff across Nottinghamshire, including most recently, Notts Family Service, Youth Service, Health Visitors and the Education Support Service.

Our focus now is on re-establishing our community of practice, supporting services in implementing and embedding ACE enquiry practice and of course in supporting the second phase of the evaluation led by LJMU.

Never more relevant – never more important

The global pandemic has resulted in an increase in domestic abuse, mental health issues, substance dependence and has cut people off from sources of social support previously relied upon. People have lost their jobs and in many cases their loved ones to Covid. As we enter a period of economic recession it is even more important than ever to recognise and address trauma and childhood adversity. Nottinghamshire County Council’s proactive public health approach to addressing ACEs will no doubt be welcomed by the people who need help or to be protected. There is a very good chance that people seeking help in Nottinghamshire will encounter a worker that asks, “What happened to you?” Rather than, “What’s wrong with you?”.

If you have any questions or would like more information about the Nottinghamshire County Council REACh programme please do get in touch.