School Nursing

The Relentless School Nurse: Scotland as an ACE Aware Nation – Going on a Bear Hunt

My venture into the #Twittersphere has taken me across the ocean to the lovely country of Scotland. While I have not yet had the privilege of visiting, I have connected with a pioneering group of people who have a collective goal to make the entire country ACEs aware. And guess what…they are succeeding in ways that America should take note and follow in their able footsteps.

Imagine an entire nation of 5 million people becoming aware of childhood adversity and the impact on our health and well-being. Now imagine a movement that focuses on relationship building, caring for children and educating adults about the impact of toxic stress on health outcomes. This is what is happening in Scotland!

One of the first people I met on Twitter was the amazing Sally Amor, with a background in nursing, she has a public health leadership role for babies, children, and young people. Sally serves as the Child Health Commissioner and Public Health Specialist for the Highland Health Board in the north of Scotland. Sally shares her story as this week’s guest blogger!


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Sally Amor

Scotland is going on a journey to become an ACE Aware nation. At times it can feel like the nursery song ‘We are going on a bear hunt’ [1] or a cultural journey to better understand the source of our troubled human experience. [2] It is a journey of twists and turns, where the stakes seem high, with a mixed assortment of fellow travellers: many people with a known or growing awareness of lived experience, varied communities of practice, social enterprises and private businesses, third sector/non-governmental organisations, academics, health education and social care professionals, justice and police sectors, corporate and political leaders, national public health agencies and government policymakers and politicians.

The knowledge driving the journey is not particularly new. It has long been recognised that family life shapes us in very powerful ways: that abuse and violence and emotional mistreatment does harm, that wider societal effects such as poverty and not feeling included also the influence of experience of wellbeing throughout our lives. Perhaps what is less well understood are the unusually vulnerable developmental needs of human young. Gabor Mate [3] describes it as the pay off for other evolutionary developments: walking upright for example and developing the capacity for problem-solving, thought and language skills that allow us to thrive. At birth, the human brain is small and immature with a lot of development still to take place, development that is highly sensitive to the immediate environment. While positive experiences of safety, nutrition, nurture and interaction with safe adults underpin healthy brain development, the absence of these factors that can distort brain development and the finely tuned interactions of different physiological feedback loops and pathways that underpin our conscious sense of self. Interrupted, suboptimal experiences in our relationships and environments from pre-birth to the mid-twenties can present enduring challenges and difficulties in the day to day and across our lives.

Stop and pause a moment to think about the cultural implications of this: when we dress infants to give them identify when they have no concept of independent self, the pressures on parents for their child to attain and achieve, the assumptions of what is determined as adult behaviour for young people, particularly those who are living with  the developmental consequences of adversity, the economic and material pressures to have this and to be seen to be doing that in times of austerity and growing inequality, the endless pursuit of acceptance by the wider pack to have achieved some never quite defined goal.

Through population-based studies, we also see a sharper presentation of the detail of the impact of adversity on our lives, with experience of ‘this’ experience increasing the likelihood of ‘that’ outcome in ways that have not been as explicit as before. This can be discomforting and counterintuitive when so much of our practice seeks to be strengths-based, yet when we better understand what sits behind difficulties, are we not better placed to understand and respond?

We can debate and argue the fine detail, the outcomes and impact on our lives remain the same because this is our lives, all our lives, not just those people over there. The ‘poisonous pedagogy’ that Alice Miller [4] refers to remains largely prevalent in so much of our culture and practice. A shame-based, behaviour led and punishment informed approach to the way we see babies, children, adolescents and struggling adults both at home, school and in community life.

Shared and common experiences from the insights and learning from Scotland’s ACE Aware journey ask something different from all of us. Part of this is making sense of the challenges to perceived wisdoms, known territory, political and professional domains, and existing power bases. Some of it is making sense of our own experiences while taking a little more time to understand other people’s stories.

Fundamentally, we are biological beings shaped by experiences from the earliest moments in life: while adversity shapes us, it need not define us. The challenge for Scotland’s ACE aware  journey is, will it run away from the bear, back to the comfort of the familiar, or will we take the opportunity to redefine our political processes, professional practice and the way we see understand and respond to adversity in the lives of babies, children, young people, families, and communities. The choice is ours to take.

[1] Singing Kettle Going on a Bear Hunt

[2] Hiding in Plain Sight Exploring Scotland’s Ill Health Carol Craig CCWB Press 2017

[3] In the Realm of Hungry Ghosts Close Encounters with Addiction Dr Gabor Mator Vermillion London 2018

[4]For Your Own Good The Roots of Violence in Child-rearing   Alice Miller Virago Press London 1997


Registered General Nurse qualified in 1986 London
Tropical Medicine Certificate 1987 London
Human Geography Degree 1992 Liverpool
Masters in Public Health 1994 Liverpool
Accredited Public Health Specialist 2008 ongoing Highland Scotland
Working in NHS Highland from 1995
Currently Child Health Commissioner/Public Health Specialist with oversight of health and health care for babies children and young people across our remote and rural populations.
Prior to that various nursing roles in acute adult services, paediatric and women’s health, community health work in India.
Particular interest in babies children young people family life/wellbeing and how to mitigate/mediate the impact of Adverse Childhood Experiences across the life course through trauma-informed/aware processes and practice with an understanding of culture and community.
Mum to two young adult children. Currently learning how to garden and to distinguish bird songs.

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