conference Archives - Salford Public Health

The combined effects of prenatal alcohol exposure and childhood trauma: findings from a four-year research project at the University of Salford.

By Alan Price, PhD

Foetal alcohol spectrum disorder (FASD) is the range of conditions that can be caused by prenatal alcohol exposure (PAE). People with FASD can have a wide range of physical and mental difficulties, especially with planning, attention, impulsivity, coordination, social communication, emotional arousal, and memory. These difficulties can impact daily living, school, work, social relationships, and long-term health and wellbeing. In the UK, it is estimated that at least 3%, and possibly up to 17% of the population would qualify for a diagnosis on the foetal alcohol spectrum, although the majority will never be diagnosed. FASD has been known about for several decades but does not yet receive appropriate attention in schools and universities, meaning that many doctors, teachers, social workers and other professionals are not trained to spot the signs of FASD. This can leave children and adults with FASD struggling with the academic and social demands of everyday life without the support they need. Unsupported, people with FASD are more likely to be excluded from school, lose their job, struggle with addictions, and be convicted of a crime. FASD is thought to be especially common in looked after and adopted children and care leavers. Many of these individuals also have histories of traumatic experiences such as abuse or neglect in early childhood, which are also known to lead to developmental difficulties similar to those seen in FASD.

I came to the University of Salford in 2015 to conduct research on the combined effects of PAE and childhood trauma. The project was offered as a funded PhD in partnership with the National FASD clinic in Surrey. I had just completed my degree in psychology and already had some experience in alcohol research, but like many others I had never heard of FASD. The first stage of the project was a thorough review of the published literature on FASD and trauma. I was surprised to see that very little research had been published on the combined effects of both exposures, only five studies in fact, but there did seem to be an interesting pattern of results emerging. Taken together, the studies suggested that children with both PAE and trauma were functionally similar to children with just PAE but tended to have more difficulties than children with just trauma. This suggests that, where children have both exposures, PAE is more likely to be the primary driving force behind those children’s difficulties. The published studies had tended to focus on speech, language and communication, but other areas of functioning still needed to be addressed. Therefore, during the next stage of the project I conducted studies into brain functioning, intelligence, working memory (the ability to hold and manipulate information in the short-term), inhibitory control (the ability to stop oneself from performing an action that feels natural), empathy (an understanding of the perspective and emotional state of other people) and behavioural difficulties in children with PAE, about half of whom also had a history of trauma. I was interested to see whether the children with both exposures had similar or more severe difficulties than the children with just PAE.

Using a brain-imaging technology, functional near infra-red spectroscopy (fnirs), to look at brain activity

Since FASD is largely a hidden condition, I suspected that recruitment of participants would be challenging. Most of my participants were recruited via social media, especially online FASD support groups, which had been set up by families affected by FASD to provide mutual support and information. In order to access as many participants as possible, I used an anonymous online questionnaire to ask parents and carers about their children’s PAE, trauma, empathy and behavioural problems. The strategy worked, and 245 parents or carers completed the questionnaire, many more than I had expected. As well as UK respondents, many were from the United States and Canada, which reflected the populations of the online support groups. To make as much use as possible out of the participants, I invited the UK respondents to bring their children in for some further assessments. Many of the families lived outside of the Greater Manchester area where we are based, and I only had funding to offer £10 for travel expenses, but an amazing 25 families affected by FASD came into the university, some travelling hundreds of miles at their own expense to get here. In the lab, I used a brain-imaging technology called functional near infra-red spectroscopy (fnirs) to look at brain activity, a standard IQ test to measure intelligence, and puzzles to assess working memory and inhibitory control. Finally, I also conducted interviews with 12 parents and caregivers, to explore their experiences of raising a child or children with FASD.

The results of the questionnaire and lab studies between them supported the findings of the literature review. Children with both PAE and trauma had similar brain activity, intelligence, empathy, inhibitory control, and working memory to children with just PAE. In terms of behavioural difficulties, children with both exposures had a slight tendency to have more severe conduct problems than children with just PAE, but their emotional functioning was similar. The studies also showed that children with PAE have high levels of childhood trauma, severe behavioural difficulties and poor empathy compared to typically developing children, although intelligence, working memory and inhibitory control were within the average range. In the interviews, parents’ experiences were fairly consistent, and there was little difference between the experiences of parents of children with and without trauma. I asked parents about their children’s behavioural difficulties, which I expected would be described as stress inducing. This was the case, although parents also described many positive experiences. However, even though I didn’t specifically ask, every family described some level of stress caused by dealing with service providers. Doctors and other healthcare workers often didn’t understand and were unable or reluctant to diagnose FASD. Adoption agencies and social workers were accused of playing down the impact of PAE in order to secure a placement, then leaving families to deal with FASD with no specific support or training. Parents and children were offered services designed for trauma and attachment issues, even when children had no history of trauma. There was a widespread lack of understanding and lack of services designed to deal with FASD, and this seemed to be the most stressful part of their experiences.

Alan presenting his research at EUFASD 2016

Taken together, the results of the published studies, questionnaires, lab studies and interviews show that children with both PAE and a history of trauma appear to function similarly to children with just PAE and tend to have more severe difficulties than children with just trauma. Therefore, the difficulties seen in children with both of these exposures seem to be primarily caused by PAE rather than childhood trauma. Based on these findings, my recommendation would be that children seen in care, school, or in a medical setting, who have both PAE and a history of trauma, should be thought of more as a child with FASD than a child with a history of trauma. The trauma absolutely should not be overlooked, as it will definitely have had an impact, but in terms of interventions, therapies and strategies, those designed specifically for FASD may be more effective than those designed for trauma. These conclusions have led to a new project; my colleagues and I are currently developing a parent training programme designed specifically for FASD issues, something which is currently missing in the UK. The full thesis is available in the University of Salford institutional repository.

Twitter: @alandavidprice1

Email: A.D.Price2@salford.ac.uk

Public Health Conference: Social prescribing, social movements, shaping attitudes and behaviours (Friday, 17th November 2017)

This blog post is written by four of our current MSc Students – Aneela Khanum, Cynthia Poolay Mootien, Gloria Serwah Asare & Ella Train

The public health conference on ‘social prescribing, social movements, shaping attitudes and behaviours’ organised by the Salford Professional Development team and the University of Salford, was chaired by Professor Penny Cook, and centred around finding innovative and alternative ways to treat and care for patients outside of healthcare settings.

Chris Easton, from Tameside Hospital NHS Foundation Trust, opened the talk by discussing the implementation of a system wide approach to self-care. He stressed the need to change the public’s perception and behaviour towards clinicians and hospitals, and for more instituitional integration, which will only be successful if both the health and social needs of patients are considered. He also pointed out that more emphasis should be placed on stimulating a fundamental paradigm shift between the people and their communities, as well as the healthcare system. The issues brought up by Chris showed an interesting perspective of the healthcare system that challenges clinical pathways to have self-management at their core, and would encourage doctors to take a more holistic approach when treating their patients.

Alan Higgins, Director of Public Health, Oldham Council, discussed the importance of health as a social movement to empower patients and citizens, strengthen communities, improve health and wellbeing, and eventually moderate the rising demands on the NHS. Another speaker at the event was Siobhan Farmer, a Public Health Consultant for Salford City Council, who talked about the importance of influencing population health by focusing on education in early years, including more person-centred approaches to health and lifestyle behaviours. She further explained the role of Salford City council in health and social care, which gave us further insight on the many health inequalities present in Salford.

Variation in Life Expectancy – Male life expectancy ranges from 81.9 years in Worsley to 69.8 years in Pendleton
(Source: Salford City Council)

The event was also a great networking opportunity, where we met many professionals from various fields in the public health sector. We had the privilege of talking to Professor John Middleton, President of the UK Faculty of Public Health, following his inspiring talk about encouraging an asset-based approach to improving health and wellbeing through social prescribing. The various other speakers at the conference also advocated for a change in the healthcare system, with a more comprehensive community-centred approach, where social prescribing could help change and shape attitudes and behaviours towards health and wellbeing.

The conference ended with a highly inspirational presentation by Chrissie Wellington, Global Lead for Health and Wellbeing Parkrun, and Doctor Simon Tobin a General Practitioner with strong ties to Parkrun, who both stressed the benefits of exercise and outdoor activities for better health. Dr. Tobin emphasised the need for doctors to take a more social approach to improving patients’ healthcare, instead of over-diagnosing and overprescribing without first exploring the hopes, wishes and needs of the patients. The conference concluded with a challenging note, to not only change other people’s attitudes and behaviours towards healthcare, but to also change our own stance on health and social prescribing, for better health and wellbeing in the long-term.

The conference was a wonderful opportunity, to meet public health professionals and academics, as well as be part of an informative forum with many speakers from various fields in public health. Our sincere thanks go to Professor Penny Cook, Dr. Margaret Coffey, Dr. Anna Cooper-Ryan, and Alex Clarke-Cornwell for organising and promoting a very thought-provoking and worthwhile conference.

Brief review of Making Every Contact Count conference – Health Education England

By Anna Cooper, Jess Brooke and Penny Cook

On the 27^th January over 200 people congregated at the University of Salford for the MECC conference run by Health Education England with support from Public Health England. The conference started off with a welcome and a bit of a dance (as we are told is tradition in some other conferences), but it proved to set the scene for what was an informative but also welcoming event. Sir Stephen Moss in his forward outlines MECC as ‘enables the systematic delivery of consistent and simple lifestyle advice, helping people to make positive changes that will improve their health and wellbeing.’

To start there was a bit of a race through some of the evidence, policy and local level examples of MECC. Shirley Cramer outlined the definition of the wider workforce and next steps, but also the importance of the workers’ situation in the community that they serve, while Sir Stephen Moss talked about changing the culture to embed MECC into everyday practice. Dr Charles Alessi reiterated the important message of ‘don’t let there be more missed opportunities when we could be doing something’. Dr Paul Chadwick reminded us that we need to reflect on our own behaviour and motivations as health practitioners, since MECC relies on us having the confidence to raise sensitive issues. A challenge of MECC is gaining consistent evaluation to explore the impact due to the diverse nature and content on the brief interventions; what is clear is that it can impact communities – as shown by Professor Kate Arden in Wigan.

The keynote session was followed with presentations on examples of tools kits, those produced at both a local and national level. There were examples provided by Claire Cheminade, the Public Health Wider Workforce lead in Wessex and Sally James the Public Health Workforce Specialist for the west midlands, which showed how MECC is embedded across all areas right from training of the new workforce. Nigel Smith and Mandy Harling used the session to help launch the ‘MECC: quality checklist for training resources’ and ‘MECC: implementation guide’, developed by Public Health England and Health Education England.

On breaking out for the session before and after lunch there was a chance to hear about more examples, but also look at settings and behaviour change, to help with understanding the theory and practice. During lunch there was an opportunity to take a seat in the MECC cinema where a short film was shown which illustrated different people who have undertaken MECC training and put it into practice successfully. In the afternoon, one of the workshops, titled ‘NICE Guidelines and Behaviour Change Approaches’ was led by Dr Paul Chadwick. This included an interesting lecture and some useful group work. It enabled attendees to consider how their own behaviour and beliefs could impact on the implementation of MECC in their setting.

As part of @SalfordPH involvement throughout the day, eight of the MSc public health students (as pictured below), were on hand to support the event staff and delegates with their day. Additionally Penny and Anna chaired the initial sessions around “what the system is saying about MECC and why it is important” and “Implementing MECC”.

This also provided our students with the chance to hear from some leading experts in this area and be able to hear examples of how what we talk about in lectures relates to worked examples. Our thanks go to each of the students for taking the time to support the day.

Although MECC is going through a difficult time in many local areas in relation to funding, it is clear from this day there are many people who carry out the premise of MECC in their everyday working and it is something we can all be more aware of doing.