• Adverse Childhood Experiences (ACEs) are potentially traumatic experiences that can negatively impact a person’s health, survival and well-being.
  • Children with ACEs are at greater risk of developmental delays, which can lead to learning difficulties, lower educational achievement and poorer employment outcomes later in life.
  • Safe, stable and nurturing relationships and environments can prevent or reduce the impact of ACEs.
  • The KKH Anchor programme provides screening, psychoeducation and supportive care to help at-risk families optimise relational health, child development and mental wellness.

Adverse Childhood Experiences (ACEs) are potentially traumatic experiences that can negatively impact a person’s health, survival and well-being. These include forms of abuse, neglect or household dysfunction (Figure 1).
Toxic stress during early childhood can harm the basic levels of a person’s nervous, endocrine and immune systems, and alter the physical structure of their DNA1,2.

Children who experience ACEs are at greater risk of developmental delays, which can lead to learning difficulties, lower educational achievement and poorer employment outcomes later in life.

ACEs are preventable. When ACEs and associated developmental delays are detected in a child’s early years, effective interventions can be put in place to mitigate long term negative effects.

Figure 1. Adverse childhood experiences (ACEs) can be broadly classified into forms of abuse, neglect and household dysfunction. Source: Robert Wood Johnson Foundation

Key trends of adverse childhood experiences in Singapore

A Singapore study3 with 6,126 adults aged 18 years and above, published in 2020, reported that the lifetime prevalence of ACEs is 63.9 per cent, with a higher prevalence of emotional neglect compared to physical neglect.

Risk factors for ACEs4 include:
  • Low family income
  • Young caregivers or single parents
  • Caregivers with mental health concerns
  • Caregivers with a history of abuse or being in residential or foster care
  • Having a child with special needs

Protective factors for children and families

Research has shown that creating and sustaining safe, stable and nurturing relationships and environments can prevent and reduce the impact of ACEs on children and their families.

Screening of at-risk families, strengthening existing protective factors, and early interventions to support relational health, are useful in detecting and mitigating ACEs early in a child’s life.

Anchor: Community-based intervention for families and children with adverse childhood experiences

At KK Women’s and Children’s Hospital (KKH), approximately 100 to 120 children below the age of four years are assessed for suspected non-accidental injuries every year. As part of their holistic care, these children are provided with early developmental assessments and dental referrals.

In 2019, KKH established Anchor, a home visitation pilot programme, with the support of  Temasek Foundation. The Anchor programme aims to enhance trauma-informed community services for families with children aged between zero to under four years who are exposed to ACEs. As at January 2023, 146 children have benefited from the programme.

Families enrolled into Anchor receive a holistic evaluation of their needs through various assessments conducted for the child, primary caregiver and family (Figure 2).

Figure 2. Anchor Programme Framework

Supporting families through regular home visits

Following the assessments, home visits are planned for the families depending on their assigned tiers. Families in Tier 1 (Low Risk) receive a home visit once every two months, families in Tier 2 (Moderate Risk) receive one home visit every month, and families in Tier 3 (High Risk) receive two home visits every month. Although this is the proposed number of home visits, there are times when more home visits would be done, depending on the need of the family.

The home visits are helmed by Community Health Visitors (CHVs) and supported by other members of the multidisciplinary Anchor team consisting of psychologists, medical social workers and doctors.

During the home visits, families are provided targeted interventions based on the needs identified during the initial assessment and subsequently tailored through ongoing monitoring. Anchor also works closely with the community partners to provide holistic care and support to these vulnerable children and their families.

Working with families enrolled in the Anchor programme has enabled KKH to develop a holistic model of care for children exposed to ACEs. The team also conducts inter-professional training on aspects related to early childhood adversities for health and community care professionals.

Dr Ong Li Ming, Consultant, General Paediatrics Service, KK Women’s and Children’s Hospital

Dr Ong Li Ming graduated from the National University of Singapore (NUS) with a degree with honours in Pharmacy. She further her studies with the Duke-NUS Medical School and completed her paediatric residency training in Singapore.

Dr Ong’s key interests include child advocacy and safeguarding, community paediatrics and general paediatrics conditions. Actively involved in undergraduate medical education, Dr Ong is a clinical lecturer with the NUS Yong Loo Lin School of Medicine, Lee Kong Chian School of Medicine and Duke-NUS Medical School.

​Dr Yeleswarapu Padmini, Senior Consultant, Department of Child Development, KK Women’s and Children’s Hospital

A paediatrician for more than 20 years, Dr Yeleswarapu Padmini graduated from Mahatma Gandhi Institute of Medical Sciences, India, and completed her paediatric training and higher specialist training in the United Kingdom (UK). Dr Padmini’s key interests include the management of autism spectrum disorders and neuro-disability in children.

She is also a member of the Royal College of Paediatrics and Child Health (RCPCH, UK), General Medical Council (GMC, UK), British Association for Community Child Health (BACCH, UK) and Maharashtra Medical Council, India.

  1. Shonkoff JP, garner AS & Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care and Section on Developmental and Behavioural Pediatrics (2012) The lifelong effects of early childhood adversity and toxic stress Pediatrics 129 (1) e232-246
  2. Shonkoff JP & Philips DA (eds) (2000) From neurons to neighbourhood: The science of early childhood development. National Research Council and Institute of Medicine. Washington DC: National Academy Press
  3. Subramaniam M, et al (2020) Prevalence, socio-demographic correlates and associations of adverse childhood experiences with mental illness: results from Singapore Mental Health Study. Child Abuse Neg 103 p1-11
  4. Ethier, L.S, et al (2004) Risk factors associated with the Chronicity of High Potential for Child Abuse and Neglect. Journal of Family Violence 19, 13-24 (2004)