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Holding pieces of the same puzzle: using an understanding of the prevalence and impact of adverse childhood experiences (ACEs) to target mental health resources https://doi.org/10.17863/CAM.119444 Parkin, Katherine 0000000173385667 Brayne, Carol Moore, Anna Introduction: Adverse childhood experiences (ACEs) are known to be associated with poor mental health outcomes. This thesis seeks to understand the extent to which different ACEs can be measured using routinely-collected data, and what early interventions might be indicated to support the mental health of young people who experience them. Methods: The thesis comprises a rapid literature review and survey of experts to understand mental health risk factors, measurement of ACEs in a databank of routinely-collected linked data from young people, and an umbrella review of prevention and early intervention strategies to support young people’s mental health following exposure to ACEs. Results: In brief, the three studies demonstrate that: 1) experts believe ACEs are important risk factors for predicting mental health problems earlier in young people; 2) some, though not all types of ACEs can to a variable extent be measured in routinely-collected linked health and social care data, yet this is currently a time-intensive and costly process, with various limitations including the crucial fact that it clearly misses many cases of ACEs; and 3) there is evidence supporting that early interventions are effective for mitigating poor mental health outcomes following exposure to certain ACEs. Conclusions: Measurement of ACEs using routine data sources is a potential mechanism by which young people could be identified and offered earlier interventions for those who need them. There remains a long way to go before this could be a routine practice and, at present, measurement of ACEs would need to be heavily supplemented by other approaches to ensure measurement gaps are addressed. However, ACE-informed decision-making and resource allocation could be a valuable approach to explore in order to proactively support the mental health of young people, shifting the dial away from late treatment and towards timely and proportionate prevention and support. University of Cambridge 2024-09-30 Thesis Doctoral Doctor of Philosophy (PhD) PhD co-funders: NIHR School for Public Health Research (NIHR SPHR); NIHR Applied Research Collaboration East of England (NIHR ARC EoE) Additional project-specific funders: What Works for Children's Social Care (WWCSC); Cambridgeshire and Peterborough NHS Foundation Trust (CPFT); Medical Research Council (MRC) https://www.repository.cam.ac.uk/handle/1810/386070 https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/e1fe7168-4179-462e-ab68-b3539d81ce12/download 4c08fc5d2173cf6a555977ccf15850a1 https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/834edeb6-e360-4cd3-b8bf-0b25268e4025/download 87eda9de84448d1f82354d60eee3eb5f https://creativecommons.org/licenses/by/4.0/ adverse childhood experiences (ACEs) children and young people data linkage early identification early intervention mental health routinely-collected data