Before launching his own consultancy, Warren Larkin Associates in 2017, Dr Warren Larkin was a successful NHS Clinical Network Director responsible for Children and Families Services across Lancashire. He is the Clinical Lead for the Department of Health Adverse Childhood Experiences and has a long-standing interest in the relationships between childhood adversity and outcomes later in life. Warren has done most of his clinical work in specialist early intervention services with service users who are experiencing psychosis. He has also published numerous research articles and a book on the topic of trauma and psychosis. He has developed the routine enquiry about adversity in childhood approach [REACh] which is a way of assisting organisations to become more trauma-informed and to support professionals to ask routinely about adversity in their everyday practice.
bd2 has been working with Warren to develop his brand and a new website to launch his business. As part of supporting Warren's marketing communications, we recently recorded an interview with him, in which we discussed the REACh program and the issues it aims to address.
The subject matter is, by its nature, serious, but Warren wanted an informal setting and visual style for the video that presented this as more of a chat than an interview. We chose to film at the Yours is the Earth coffee shop, during opening hours, to try and create that sense of informality and openness. During the chat Warren explained how REACh aims to raise awareness amongst professionals - GPs, the Police and teachers - as well as the public, about the long term outcomes of childhood adversity and trauma. This is achieved by establishing and supporting organisational practice and culture change by using REACh within all appropriate assessments.
REACh involves, as part of the model of delivery, one or two-day training sessions delivered by Warren and his team on why, when and how to enquire safely and sensitively, alongside organisational support, to help teams identify potential risks and challenges and to ensure appropriate staff support is in place. This starts with an evaluation of the organisation's basic readiness to engage in routine enquiry, to identify any potential barriers and to gain buy-in. Then he looks at the specific systems and processes needed to support effective and safe enquiry which is followed by delivery of REACh training, tailored to specific needs in terms of content and delivery methods. Warren's team offer follow-up support and supervision for staff and leadership teams, to ensure effective implementation. Finally, the team support the organisation to evaluate the implementation of REACh, to assess the impact on their service and service-users.
In our discussion, which was wide ranging, we talked about the well documented problems facing the NHS, Prisons, the Police and education who are all dealing with issues such as obesity, depression, substance abuse, addictions and violence which are often inter-related but all have a massive impact on society and, in turn, the economy. There is a proven link between the number of ACEs - Adverse Childhood Experiences such as physical or sexual abuse - someone experiences and the likelihood that they will become obese, depressed, addicted, abusers or offenders themselves. It seems obvious, therefore, that the sooner these issues are identified the more chance there is that they can be addressed and potentially resolved through therapy, treatment or rehabilitation. Ultimately leading to a knock-on positive impact in reduced load on support services.
The basic principle of REACh is that 'waiting to be asked doesn't work' but, when asked in the right way and at the right time, people are far more likely to open up. Obviously recognising possible underlying issues and then asking about them needs to handled in the right way which is what the REACh program aims to train the front line professionals to do, with the appropriate support.
There is growing evidence that the approach works, in 2015, an independent evaluation by Real Life Research found that "...REACh training equips practitioners with the knowledge and tools to conduct routine enquiry effectively with the people they support... REACh was found to initiate earlier intervention, as a result of speedier disclosures. Importantly, practitioners reported no issues with implementing REACh in their practice and reported no increase in service need following the enquiries made. Participants and managers felt that they were able to create with the individual a more appropriate intervention plan if they have enquired about previous experiences, dealing with the root cause of presenting issues rather than the ‘symptom’."
The video, currently in post production, will allow Warren to spread the message online as well as the many speaker opportunities he undertakes. Warren was kind enough to also record a video of his experiences of working with bd2. See -