RSS 1.0Faculty of Health and Social Care
The Faculty of Health and Social Care is one of the major providers of Health and Social Care education in the North West and offers a wide range of programmes at both undergraduate and postgraduate levels. Programmes are delivered at four main locations: Riverside Campus (Chester), Leighton (Crewe), Warrington Campus and Wirral (Clatterbridge).
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Exploring the emotional experience of leanPurpose – This research aims to contribute to the literature on Lean implementation in healthcare by studying the emotional experiences of the relevant actors related to a Rapid Process Improvement Workshop (RPIW) in a UK healthcare context. The purpose of this study was to go beyond what people think about Lean and towards an exploration of their subjective, emotional and “feeling” experience and whether that emotional experience influenced Lean implementation. Design/methodology/approach – A phenomenological and symbolic interactionist qualitative case study was undertaken. Data related to participants’ emotional experience were collected through non-participant observation and semi-structured interviews. Data were analysed using thematic network analysis. Findings – This paper provides novel insights into the emotional experience of Lean as experienced through an RPIW. The findings reveal that participation in an RPIW is much more than a technical process. It influences how people feel about themselves, is based on relationships with others, and requires mental, physical and emotional effort. All of these factors influence engagement with, initiation of and sustainability of the RPIW. Research limitations/implications – A new conceptual framework for the planning and implementation of RPIWs has been developed. However, because of the chosen research approach, the results may lack generalisability. Therefore, researchers are encouraged to test the framework and proposed practice implications. Originality/value – Despite emotions being an integral part of individual and social everyday life, emotional experience has not been studied in relation to Lean. This study is the first to explore emotions in relation to Lean, with implications for practice as to how RPIWs are managed with a new framework for implementation being proposed.
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Factors Affecting the Participation of Physically Disabled Children and Young People in Out of-School Activities in the United Kingdom: A Qualitative StudyPhysically disabled children and young people (PDC&YP) face many challenges when participating in out-of-school activities. PDC&YP should have the same choices and opportunities as other C&YP; to forge friendships locally and to access out-of-school activities (Knight et al., 2013). However PDC&YP have fewer opportunities than their non-disabled peers due to challenges such as access, support and suitable provision. This multi-method qualitative study examined the factors affecting participation of PDC&YP in out-of-school activities. The perspectives of PDC&YP and parents were sought using a range of data collection tools. These included interviews, focus groups and creative focus groups with 13 PDC&YP and 19 parents. Play-based creative focus groups were specifically designed for PDC&YP aged 7 to 17 years. The study demonstrated that PDC&YP enjoy specialist disabled activities to meet others ‘like them’ but want more local opportunities to do this. Some PDC&YP and parents felt they were not disabled enough for ‘disabled’ activities but not able enough for mainstream. PDC&YP requiring personal care were a ‘hidden’ group who are at risk of missing out on experiences that they are entitled to. The study concludes by presenting the need to improve provision through disability awareness training and a co-ordinated partnership approach to be employed by the local authority to raise the profile of disability and ‘bridge the gap’ between service users and service providers. The social needs of children require the same focus and attention to aid their wellbeing and to enhance out-of-school lives.
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Publication Preview Source Effectiveness of nitric oxide agents in preventing the early onset of pre-eclampsia and possible modification of metabolic factors in high-risk pregnancies: a systematic review protocolObjectives: To determine the effectiveness of nitric oxide agents in modifying the metabolic factors of pre-eclampsia and its effectiveness in preventing the onset of pre-eclampsia in high-risk pregnancies. Introduction: Pre-eclampsia is a major cause of maternal death during the prenatal and neonatal periods. Nitric oxide is a vasodilator and platelet aggregation inhibitor responsible for the vascular adaptation of the placenta. Although various studies have established that nitric oxide is effective in preventing complications from pre-eclampsia, there is limited evidence to show that administering nitric oxide agents to the high-risk women before 20 weeks’ gestation will prevent the onset of pre-eclampsia. Inclusion criteria: This review will consider randomized controlled trials that compare nitric oxide donors and precursors with a placebo or no intervention on pregnant women (18 to 44 years) with ≤ 20-week gestational age that are at high risk of pre-eclampsia. The primary outcome of interest will be the onset of pre-eclampsia. Secondary outcomes include increased systolic and diastolic blood pressure, elevated asymmetric dimethylarginine levels, decreased endothelial nitric oxide synthase activity, reduced maternal placental vasculature, and abnormal Doppler ultrasound waveforms. Methods: Data sources will be drawn up from MEDLINE, CINAHL, ProQuest (Health and Medicine) and Web of Science from inception till current date. No language restrictions will be applied in the search strategy. Selected studies will be assessed against the JBI critical appraisal checklist, and the certainty of evidence and strength of recommendations from findings will also be ascertained. Systematic review registration number: CRD42018099298
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Sexual violence against migrants and asylum seekers. The experience of the MSF clinic on Lesvos Island, Greece.Sexual violence can have destructive impact on the lives of people. It is more common in unstable conditions such as during displacement. On the Greek island of Lesvos, Médecins Sans Frontières provided medical care to survivors of sexual violence among the population of asylum seekers arriving there. This study aimed to describe the patterns of sexual violence reported by migrants and asylum seekers and the clinical care provided to them. Methods This is s a descriptive study using routine program data. The study population consisted of migrants and asylum seekers treated for conditions related to sexual violence at the Médecins Sans Frontières clinic on Lesvos Island (September 2017-January 2018). Results We enrolled 215 survivors of sexual violence who reported and were treated, of whom 60 (28%) were male. The majority of incidents reported (90%) were cases of rape; 174 (81%) of survivors were from Africa and 185 (86%) occurred over a month before presentation. Half the incidents (118) occurred in transit, mainly in Turkey, and 76 (35%) in the country of origin; 10 cases (5%) on Lesvos were also observed. The perpetrator was known in 23% of the cases. Only XXX received mental health care, and the need exceeded the capacity of available mental care services. Conclusion Even though the majority of cases delayed seeking medical care after the incident, it is crucial that access to mental health services is guaranteed for those in need. Such access and protection measures for people in transit need to be put in place along migration routes, including in countries nominally considered safe, and secure routes need to be developed.
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Including public health considerations in trade and investment agreementsAbstract There is widespread recognition that trade and investment agreements (TIAs) can affect health services, access to medicines, NCD prevention (particularly related to tobacco, alcohol and unhealthy food) and health systems structures. In addition, these binding international economic agreements can constrain the policy space available for innovative, evidence-based health policymaking. Although TIAs can have positive outcomes for employment and economic growth, these benefits are only likely to accrue when governments are pro-active in implementing complementary policies to mitigate impacts on other sectors and to address potential inequalities arising. The aim of this panel session is to examine the ways in which TIAs can be designed to achieve economic goals while also protecting public health, and identify complementary policy measures that may be needed as well as strategies for strategic policy engagement. This panel will be hosted by the UK-PRP PETRA Network (Prevention of noncommunicable disease using trade agreements). The UK will be negotiating a range of new TIAs over the coming years, representing a window of opportunity for strategic engagement with policymakers regarding how public health can be protected and promoted within these agreements. There is an emerging global body of evidence regarding how consideration of health can be integrated into TIAs, both textually and through strategic engagement with policymakers before and during the negotiation phase. Experience to date indicates common global challenges and opportunities for health and trade, as well as significant potential for cross country learning regarding trade and health. The panel discussion will use the UK experience as a springboard to address these global issues.
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‘It’s more than confusing our b’s and d’s’: a commentary on the lack of understanding of the needs of social work students who have dyslexiaDrawing on principles of auto-ethnography, this commentary offers for discussion reflections on a personal reaction to some of the struggles experienced when navigating the English social work placement landscape for a student who has a diagnosis (or label) of dyslexia/dyspraxia. Commenting on some of the challenges faced in order to try and survive the placement experience necessary to complete the programme, this account makes recommendations and suggestions for educators in university and in practice.
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Prevalence of treatment resistance and clozapine use in early intervention services.Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics. This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services. Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points. A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine. Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.
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Universal Credit, lone mothers and poverty: some context and challenges for social work with children and familiesUniversal Credit is a streamlined benefits delivery system initially introduced in the UK in 2008. Conditionality-based welfare policies are increasingly international in scale, and are now widely adopted by neoliberal governments on the basis that paid employment offers the most efficacious route out of poverty for citizen-subjects. Numerous studies suggest otherwise and highlight their negative impact upon the social rights, lived experiences and attempts to alleviate poverty for claimants. This article analyses the effect of the reformed benefit system and wider workfare policies upon lone mothers, including as a consequence of engagement with an ever-more stigmatising benefit system, and associated risks posed by sanctions or precarious low-paid employment. It highlights some of the consequences for social work with children and families of Universal Credit, including ongoing tensions and challenges created for the profession by the punitive policies of the workfare-oriented centaur state.
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Ageing Simulation in Health and Social Care Education: A mixed methods systematic reviewAbstract Aim: To identify, evaluate and summarise evidence from qualitative, quantitative and mixed method studies conducted utilising age-suits or other age simulation equipment, with health and social care students. Design: Convergent segregated mixed method review design as outlined by the Johanna Briggs Institute Data Sources: CINAHL (+ with Full Text), MEDLINE, PsycINFO, PubMed, SocINDEX, Web of Science, Cochrane Library, Emerald Insight, Proquest nursing, Science Direct, Wiley Online and BioMed Central (January 2000 – January 2020) Review methods: Convergent segregated synthesis was used to synthesise evidence from the studies, and the MERSQI checklist used to appraise quality. Results: A total of 23 studies were reviewed: one randomised control, two post-test only randomised control, three quasi-experimental, 15 one-group pre / post studies and two qualitative studies. Of the seventeen studies carrying out inferential statistics on attitude scores post intervention, 11 reported an improvement, three indicated no significant change and three reported worsening scores. Key themes included use of appropriate scales, type of equipment utilised, location and length of interactions, debriefing, and contextualisation of interventions in broader teaching. Conclusion: The impact of ageing simulation interventions on health and social care student’s attitudes to older people was predominantly positive. However, further high-quality research is warranted to understand the optimal use of such interventions within the context of healthcare for a growing ageing population. Impact: It is important health and social care staff have appropriate knowledge and training to enable them to provide high quality care to older people, and challenge potential ageism in the system. This review adds to the body of work around the use of simulation and experiential learning to educate health and social care students regarding ageing and ageism. It also offers recommendations for using ageing simulations effectively to inform attitudes of prospective professionals who will influence future health and social care. Keywords: Simulation, Ageing, Age-suit, Nursing, Health and social care, Education, Attitudes, Empathy, Experiential learning, Systematic review
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FTO gene-lifestyle interactions on serum adiponectin concentrations and central obesity in a Turkish populationThe aim of the study was to investigate whether lifestyle factors modify the association fat mass and obesity-associated (FTO) gene single nucleotide polymorphisms (SNPs) and obesity in a Turkish population. The study included 400 unrelated individuals, aged 24-50 years recruited in a hospital setting. Dietary intake and physical activity were assessed using 24-hour dietary recall and self-report questionnaire, respectively. A genetic risk score (GRS) was developed using FTO SNPs, rs9939609 and rs10163409. Body mass index and fat mass index were significantly associated with FTO SNP rs9939609 (P=0.001 and P=0.002, respectively) and GRS (P=0.002 and P=0.003, respectively). The interactions between SNP rs9939609 and physical activity on adiponectin concentrations, and SNP rs10163409 and dietary protein intake on increased waist circumference were statistically significant (Pinteraction=0.027 and Pinteraction=0.044, respectively). This study demonstrated that the association between FTO SNPs and central obesity might be modified by lifestyle factors in this Turkish population.
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Interaction between Metabolic Genetic Risk Score and Dietary Fatty Acid Intake on Central Obesity in a Ghanaian PopulationObesity is a multifactorial condition arising from the interaction between genetic and lifestyle factors. We aimed to assess the impact of lifestyle and genetic factors on obesity-related traits in 302 healthy Ghanaian adults. Dietary intake and physical activity were assessed using a 3 day repeated 24 h dietary recall and global physical activity questionnaire, respectively. Twelve single nucleotide polymorphisms (SNPs) were used to construct 4-SNP, 8-SNP and 12-SNP genetic risk scores (GRSs). The 4-SNP GRS showed significant interactions with dietary fat intakes on waist circumference (WC) (Total fat, Pinteraction = 0.01; saturated fatty acids (SFA), Pinteraction = 0.02; polyunsaturated fatty acids (PUFA), Pinteraction = 0.01 and monounsaturated fatty acids (MUFA), Pinteraction = 0.01). Among individuals with higher intakes of total fat (>47 g/d), SFA (>14 g/d), PUFA (>16 g/d) and MUFA (>16 g/d), individuals with ≥3 risk alleles had a significantly higher WC compared to those with <3 risk alleles. This is the first study of its kind in this population, suggesting that a higher consumption of dietary fatty acid may have the potential to increase the genetic susceptibility of becoming centrally obese. These results support the general dietary recommendations to decrease the intakes of total fat and SFA, to reduce the risk of obesity, particularly in individuals with a higher genetic predisposition to central obesity.
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Social Care Workers’ Experiences of Assessing Parents with Learning Disabilities: An Interpretative Phenomenological Analysis Study Based in the Northwest of England.Aims: Qualitative research has identified a number of issues when working with parents with learning disabilities. Pre-conceived ideas, professional discrimination and a high percentage of children living away from the family home have featured heavily in the literature. However, less is known about the assessment process, and how practitioners adapt their skills to assess this parental group. The current study therefore aimed to gain an in-depth understanding of the assessment process, utilising a qualitative approach. The study focused upon the experiences of social care assessors from children’s and adult services, and sought to explore the following: the approach social care workers adopt when assessing parents with learning disabilities; if appropriate knowledge is embedded into practice to assess competently; experiences of the application of the PAMS 4.0; multi-disciplinary approach to assessment, and how this exhibits in practice. Method: Semi-structured interviews were carried out with fourteen frontline social care practitioners from children’s and adult services who had direct experience of assessing parents with learning disabilities. The transcripts of the interviews were analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four master themes. These were; inadequate knowledge to understand complexities; hierarchy; reasonable adjustments; assessing parental ability. An analysis of these master themes and the related super-ordinate themes is presented. Discussion: The results are considered in light of the experiences of the participants, and how this impacts on the assessment of parents with learning disabilities. The study finds that whilst there is evidence the participants hold pre-conceived ideas, a lack of relevant skills and knowledge as well as an unstructured implementation of the Parenting Assessment Manual 4.0, are both contributing factors. Furthermore, problematic multi-agency working and managerial influences impact on the overall outcomes for parents with learning disabilities and their families.
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Stigma: the representation of anorexia nervosa in UK newspaper Twitter feeds.Background There is evidence that the representation of mental health in newspapers has an influence on readers’ attitudes, however, relatively little is known about how the industry presents accounts of anorexia nervosa. Further, the industry increasingly uses Twitter as a medium for reaching readers and this remains an under-examined area of research. Aims To explore the representation of anorexia nervosa in the UK national press’ Twitter feeds. Method Frame analysis was used to examine the manner in which anorexia nervosa was represented in the Twitter feeds of all national UK newspapers between 2009-2019 (n=332). This qualitative approach used Braun and Clarke’s stages of thematic analysis, while drawing on Van Gorp’s use of a frame matrix to support the definition of the news frames. Results The analysis identified four news frames: social model, illness model, stress-recovery model and clickbait model. Conclusions The newspapers drew on a range of perspectives in their representation of anorexia nervosa, which typically were not stigmatising in their accounts. However, there was a pattern of using sensationalistic images in some of the tweets, which may encourage readers to view people with anorexia nervosa as Other, and as a consequence contribute to stigmatisation.
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The value of embedded secondary-care-based psychology services in rheumatology: an exemplar for long-term conditionsRheumatoid arthritis is an exemplar long term condition, complicated by pain, disability, co-morbidities and long term medication use. It has significant effects on mobility, work performance, social role, sexual function and relationships. It is commonly associated with fatigue and mood disturbance as a result of complex interactions of physical (disease related) and psychosocial factors. NICE guidance recommends the availability of psychological support for these patients. We have implemented a psychology service for our patients with chronic rheumatological conditions. This study was set up to capture the value of this service.
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Exploring the staff development needs of junior academic middle managers in a Faculty of Health and Social Care during organisational change: A Bourdieusian perspective.The aim of this study was to gain an in-depth understanding of the personal and professional staff development needs of junior academic middle managers in a Faculty of Health and Social Care during a period of change. The research was undertaken in the North West of England in a post-1992 University, following a reorganisation of the Faculty of Health and Social Care and introduction of new roles. The study adopted an action research methodology and a co-operative inquiry method, which consisted of a co-operative inquiry group of junior academic middle managers who were also co-researchers. The nature of co-operative inquiry is for co -researchers to engage in repeated cycles of reflection and action that generate changes to their professional practice. The study was conducted over a period of one year and during this time multiple data collection methods were utilised to triangulate the evidence. The research findings identified that multiple identities caused conflict between professional and academic roles, negatively impacting on junior academic middle managers during periods of change. During transition, some participants reported difficulty in adapting to complex political reforms, which caused dissonance between their actual and perceived roles in the field. The junior academic middle managers reported that the safe and trusting environment of the co-operative inquiry group enhanced their confidence and enabled them to learn in action and acquire a reflexive approach when undertaking their roles in the newly structured organisation. The study contributes to the existing literature regarding role identity of professional academics in higher education and offers new insights into transition during complex organisational change.
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Association of apolipoprotein E gene polymorphisms with blood lipids and their interaction with dietary factorsAbstract Background: Several candidate genes have been identified in relation to lipid metabolism, and among these, lipoprotein lipase (LPL) and apolipoprotein E (APOE) gene polymorphisms are major sources of genetically determined variation in lipid concentrations. This study investigated the association of two single nucleotide polymorphisms (SNPs) at LPL, seven tagging SNPs at the APOE gene, and a common APOE haplotype (two SNPs) with blood lipids, and examined the interaction of these SNPs with dietary factors. Methods: The population studied for this investigation included 660 individuals from the Prevention of Cancer by Intervention with Selenium (PRECISE) study who supplied baseline data. The findings of the PRECISE study were further replicated using 1,238 individuals from the Caerphilly Prospective cohort (CaPS). Dietary intake was assessed using a validated food-frequency questionnaire (FFQ) in PRECISE and a validated semi-quantitative FFQ in the CaPS. Interaction analyses were performed by including the interaction term in the linear regression model adjusted for age, body mass index, sex and country. Results: There was no association between dietary factors and blood lipids after Bonferroni correction and adjustment for confounding factors in either cohort. In the PRECISE study, after correction for multiple testing, there was a statistically significant association of the APOE haplotype (rs7412 and rs429358; E2, E3, and E4) and APOE tagSNP rs445925 with total cholesterol (P=4x10-4 and P=0.003, respectively). Carriers of the E2 allele had lower total cholesterol concentration (5.54± 0.97 mmol/L) than those with the E3 (5.98± 1.05 mmol/L) (P=0.001) and E4 (6.09± 1.06 mmol/L) (P=2x10-4) alleles. The association of APOE haplotype (E2, E3, and E4) and APOE SNP rs445925 with total cholesterol (P=2x10-6 and P=3x10-4, respectively) was further replicated in the CaPS. Additionally, significant association was found between APOE haplotype and APOE SNP rs445925 with low density lipoprotein cholesterol in CaPS (P=4x10-4 and P=0.001, respectively). After Bonferroni correction, none of the cohorts showed a statistically significant SNP-diet interaction with lipid outcomes. Conclusion: In summary, our findings from the two cohorts confirm that genetic variations at the APOE locus influence plasma total cholesterol concentrations, however, the gene-diet interactions on lipids require further investigation in larger cohorts.
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A genetic approach to examine the relationship between vitamin B12 status and metabolic traits in a South Asian populationBackground: Observational studies in South Asian populations have suggested an association between vitamin B12 status and metabolic traits; however, the findings have been inconclusive. Hence, the aim of the present study was to use a genetic approach to explore the relationship between metabolic traits and vitamin B12 status in a Sri Lankan population and to investigate whether these relationships were modified by dietary intake. Methods: A total of 109 Sinhalese adults (61 men and 48 women aged 25-50 years), from Colombo city underwent anthropometric, biochemical, dietary intake analysis and genetic tests. Genetic risk scores (GRS) based on 10 metabolic single nucleotide polymorphisms (SNPs) (metabolic-GRS) and 10 vitamin B12 SNPs (B12-GRS) were constructed. Results: The B12-GRS was significantly associated with serum vitamin B12 (P=0.008), but not with metabolic traits (P>0.05); whereas, the metabolic-GRS had no effect on metabolic traits (P>0.05) and vitamin B12 concentrations (P>0.05). An interaction was observed between B12-GRS and protein energy intake (%) on waist circumference (P=0.002). Interactions were also seen between the metabolic-GRS and carbohydrate energy intake (%) on waist to hip ratio (P=0.015). Conclusion: Our findings suggest that a genetically lowered vitamin B12 concentration may have an impact on central obesity in the presence of a dietary influence; however, our study failed to provide evidence for an impact of metabolic-GRS on lowering B12 concentrations. Given that our study has a small sample size, further large studies are required to confirm our findings.
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Stay Well in Wales Super Profiles: Who thinks what about the nation's healthUsing a household and online survey, the views of 3,310 individuals in Wales (aged 16+ years) on 19 public health statements were gathered. Eight demographic and five health-related behaviour super profiles were created to explore differences in opinions across population groups.
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Event-related and readiness potentials when preparing to approach and avoid alcohol cues following cue avoidance training in heavy drinkers.Rationale Cue avoidance training (CAT) reduces alcohol consumption in the laboratory. However, the neural mechanisms that underlie the effects of this intervention are poorly understood. Objectives The present study investigated the effects of a single session of CAT on event-related and readiness potentials during preparation of approach and avoidance movements to alcohol cues. Methods Heavy drinking young adults (N = 60) were randomly assigned to complete either CAT or control training. After training, we recorded participants’ event-related and motor readiness potentials as they were preparing to respond. Results In the CAT group, N200 amplitude was higher when preparing to approach rather than avoid alcohol pictures. In the control group, N200 amplitudes did not differ for approach and avoidance to alcohol pictures. Regarding the late positive potential (LPP), in the CAT group, the negativity of this was blunted when preparing to avoid alcohol pictures relative to when preparing to avoid control pictures. In the control group, the negativity of the LPP was blunted when preparing to approach alcohol pictures relative to when preparing to approach control pictures. There were no effects on motor readiness potentials. Behavioural effects indicated short-lived effects of training on reaction times during the training block that did not persist when participants were given time to prepare their motor response before executing it during the EEG testing block. Conclusions After a single session of CAT, the enhanced N200 when approaching alcohol cues may indicate the engagement of executive control to overcome the associations learned during training. These findings clarify the neural mechanisms that may underlie the effects of CAT on drinking behaviour.
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Responding to Adverse Childhood Experiences: An evidence review of interventions to prevent and address adversity across the life course.Adverse childhood experiences (ACEs) are stressful events during childhood that can have a profound impact on an individual’s present and future health (Section 1.3). Growing up in the face of such adversities is recognised as an important public health concern in Wales and internationally (Welsh Government, 2017a; World Health Organization [WHO], 2014). Actions to prevent and mitigate ACEs and their associated harms are essential to improve population health for present and future generations (Bethell et al., 2017; Pachter et al., 2017). In Wales, many sectors are working to identify and respond to adversity in order to improve outcomes for those who have experienced ACEs. Whilst a number of evidence-based interventions target specific types of adversity (e.g. domestic violence), we know that ACEs are strongly correlated (e.g. individuals exposed to adversity are often exposed to more than one type; Hughes et al., 2017). Thus, complex adversity requires a response which extends across sectors including health, social care, policing, education, community and others, and across the life course from early childhood through to adulthood. To support innovation in addressing ACEs we have undertaken a review of evidence on common approaches to prevent ACEs and/or mitigate their negative impacts. Over 100 interventions were identified and collated across four common approaches: supporting parenting; building relationships and resilience; early identification of adversity; and, responding to trauma and specific ACEs (Chapter 3). Whilst the interventions vary in type, the review identified cross-cutting themes, which could be used to inform a whole system approach (spanning individual, family and community levels) to tackle ACEs across the life course, supporting the development of an ACE-informed approach (Chapter 4). The report concludes by highlighting current gaps in the evidence and suggests key areas for further work to tackle ACEs for our future generations (Chapter 5). The report is not an exhaustive systematic evidence review of the interventions for specific ACE types, nor does it advocate any specific intervention, rather it seeks to present a summary of the research evidence and information on common approaches across the prevention of ACEs and mitigation of their impact. We hope the report will be a useful resource for service planners, practitioners and commissioners to support innovation and development towards an ACE-free future.
