Dr. Austin O'Carroll:

I thank Senator Boyhan who has struck on the issue. There is much evidence coming through now on the concept of childhood trauma that has identified nine specific traumas in childhood, which include: physical abuse or physical neglect; emotional abuse or neglect; sexual abuse; parental separation; parental illness; and parental addiction. It has been identified that the more of these traumas a person is exposed to in childhood, the lower his or her life expectancy. If there are more than five adverse childhood events, a person's life expectancy is 20 years less. It causes the person to be more likely to be a smoker and overweight and a plethora of other things. It also causes the person to be more likely to be drug addicted and to be a perpetrator or a victim of violence. There is evidence that childhood trauma has actual effects on the way the brain chemistry works. This is why the effect of childhood trauma is often quite so permanent.

Unfortunately single biggest determinant of trauma is poverty. The levels of trauma among people in poverty is very high. As the Senator so rightly pointed out, people who experience homelessness have had a huge level of trauma. Work has been done on this by Dr. Sharon Lambert of University College Cork among people who are homeless.

One of the interesting aspects is that there is now a new approach around adopting a trauma-informed care approach in services. This can apply to any service, from schools to colleges and to health professionals. It would be particularly useful in homelessness. The trauma-informed care approach is about recognising that people's behaviour is related to trauma, and responding in a way that ensures there is connectedness, as the Senator said, rather than exclusion, and in a way that reacts more empathically to these people.

There are whole strategies about how we can provide trauma informed care. I am aware that the Dublin Regional Homeless Executive and the HSE are looking at trying to expand this concept among the services. It would be extremely welcome.

With regard to how we could reduce childhood trauma, the biggest determinant of that is poverty, so again it would be about addressing poverty. Unfortunately, trying to address such things in children who end up in homes or trying to reduce the level of children who are separated from parents is a huge determinant also.