Two new wellness resources

Cite this article as:
Tessa Davis. Two new wellness resources, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.14888

Wellness and wellbeing are current hot topics. Yes, we know that systems need to be changed, and we are all working hard every day to bring about change. But in the meantime, as junior doctors, we still need to go to work every day.

The reality of dealing with life and death situations, the responsibility of decision-making, the shift work and lack of sleep, the inevitable errors, the time away from our families, can all lead to increased stress, anxiety, burnout, and depression.

It’s not a case of telling junior doctors that they have to toughen up, it’s about supporting ourselves to manage our work-life balance as well. That’s our individual responsibility.

And that’s why I was so pleased to see two fabulous, and different, resources launched this week.

First off the starting block was Australia, with WRapEM.org. WRaPEM was built by a team of Queensland-based Emergency Physicians with an interest in wellbeing.

WRapEM has a set of ten modules which are fully designed and collated so that you could run them in your department next week. Modules topics include communication, performance optimisation, reflection, and self-care. Each module has a comprehensive lesson plan consisting of pre-reading material, a guide for facilitators, a guide for learners, and some have slides already prepared, and quizzes for the end of the session. The modules allow user participation and can be adapted depending on how you would like to use them.

Example of the facilitator guide from the Communication Module

Next is You Got This, by a UK team of EM healthcare professionals in Bristol Children’s Emergency Department. This is a wellness website and blog specific to those working in Emergency Departments, which also contains links to a range of organisations that can offer support and advice when we need it. It has a promising wellness blog with some great posts to get their library started. And it has a department-specific wellness section which includes bespoke elements focused on support; activities (like an annual Wellness Week); innovations (things like positive incident reporting); resources (to share with your staff what the local wellbeing support is, social events in the department, wellbeing projects).

 

 

Both of these resources are excellent and they have something different to offer. Here at DFTB, we cannot wait to watch them grow and develop over the coming months, and I look forward to using them in my own department.

Beads of Courage

Cite this article as:
Thom O'Neill. Beads of Courage, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.14526

You know that feeling when something is completely and utterly good? Where there are no catches, no downsides; just pure unfiltered goodness. When you discover something that you believe couldn’t possibly get any better? Beads Of Courage – a simple yet beautiful programme to mark a child’s journey through illness – rouses that exact feeling.

Diana Egerton-Warbuton: Reducing alcohol related harm in adolescents at DFTB17

Cite this article as:
Team DFTB. Diana Egerton-Warbuton: Reducing alcohol related harm in adolescents at DFTB17, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.13984

This talk was recorded live on the opening plenary session of day two at DFTB17 in Brisbane.

The Quagmire

Cite this article as:
Natalie Thurtle. The Quagmire, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.13504

Our community is made up of health care folks that do hard things, go the extra mile, work on themselves and their knowledge so that patients get better outcomes. We’re not good all the time. We make mistakes, forget stuff, get grumpy or emotional, slide into tribal behaviour. But we’re working on it. So when someone comes along and shines a light on what’s happening outside our normal frame of practice, shows us patients that can’t get care, who are needlessly dying or suffering, it makes us uncomfortable. We want to do something.

Sometimes I get asked to be the person that turns on that torch, the person that makes everyone else uncomfortable, most recently at the excellent DFTB17. I try to do this with balance, to show another context, but also not to make people feel helpless or shocked. Sometimes I get it right, sometimes not. Without fail though, at least one person always asks me afterwards a variation of ‘What can I do?

Keeping little folk safe

Cite this article as:
Kristin Boyle. Keeping little folk safe, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.13844

If my house were a workplace, it would be an emergency department. We operate 24-7, there are frequent tears and sometimes blood, and always a little too much to do in the allocated time. We have also recently experienced a surge in workload, which has arrived in the form of a soft cheeked, downy haired, sweet smelling, all around delightful baby boy. We jokingly refer to him as The Royal Baby, for he is indeed a teeny dictator, but a benevolent one who bestows smiles generously upon his subjects, and is happy to converse with one and all, albeit with a limited vocabulary.

Big Picture Paediatrics : Adverse Childhood Experiences

Cite this article as:
Henry Goldstein. Big Picture Paediatrics : Adverse Childhood Experiences, Don't Forget the Bubbles, 2016. Available at:
https://doi.org/10.31440/DFTB.10082

So much of paediatrics, and medicine in general, is focussed on small experimental or observational studies. This series of posts takes the wider view; we’re talking here about some of the biggest and longest running studies that help us frame, measure and understand childhood through time and across the world.

Who & what was studied?

Kaiser Permanente is a large Medical Insurer in the USA; they collected data in two waves in the primary care setting with a view to describing the long-term relationship of childhood experiences to important medical and public health problems. The study initially rolled out in 1996 & 1997.

Felitti, VJ, Anda RF, Nordenberg D et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults : The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998:14, 245–258.

The study aimed to assess – both retrospectively and prospectively – the long-term impact of abuse and household dysfunction during childhood on disease risk factors and incidence, quality of life, health care utilization, and mortality for adults.

Here is the actual questionnaire:

Answer yes or no; all ACE questions refer to the respondent’s first 18 years of life.

Abuse

  • Emotional abuse: A parent, stepparent, or adult living in your home swore at you, insulted you, put you down, or acted in a way that made you afraid that you might be physically hurt.
  • Physical abuse: A parent, stepparent, or adult living in your home pushed, grabbed, slapped, threw something at you, or hit you so hard that you had marks or were injured.
  • Sexual abuse: An adult, relative, family friend, or stranger who was at least 5 years older than you ever touched or fondled your body in a sexual way, made you touch his/her body in a sexual way, attempted to have any type of sexual intercourse with you.

Household Challenges

  • Mother treated violently: Your mother or stepmother was pushed, grabbed, slapped, had something thrown at her, kicked, bitten, hit with a fist, hit with something hard, repeatedly hit for over at least a few minutes, or ever threatened or hurt by a knife or gun by your father (or stepfather) or mother’s boyfriend.
  • Household substance abuse: A household member was a problem drinker or alcoholic or a household member used street drugs.
  • Mental illness in household: A household member was depressed or mentally ill or a household member attempted suicide.
  • Parental separation or divorce: Your parents were ever separated or divorced.
  • Criminal household member: A household member went to prison.

Neglect

  • Emotional neglect: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support.
  • Physical neglect: There was someone to take care of you, protect you, and take you to the doctor if you needed it, you didn’t have enough to eat, your parents were too drunk or too high to take care of you, and you had to wear dirty clothes.


What does this mean?

The ACEs questionnaire accumulates a score from zero to seven based on yes/no responses to the above questions. These results in conjunction with a “Health Appraisal Clinic’s questionnaire” allowed correlation with risk factors such as smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, any drug abuse, sexually transmitted diseases, parental drug abuse and a high lifetime number of sexual partners (>50), as well as the big swingers; mortality and overall morbidity.

The ACE score has been utilised to demonstrate a graded dose-response with more than 40 outcomes. You can see the entire list of publications here.

How good is this dataset?

Although there are almost all of the expected threats to validity from a questionnaire administered to people obtaining health insurance in the USA in the 1990s, the dataset is very good.

Of the 13,494 surveys, there was a 70.5% (9508) response rate, sent a week after standardised medical review. Respondents who did not respond to all questions were excluded from the final analysis. After non-responders and exclusions, a total dataset of 8056 responders was analysed. Alarmingly, more than half of the exclusions were for not answering the question about childhood sexual abuse. This certainly raises some concern for a risk of underreporting, particularly if this was the only question omitted! 


What meaning can be drawn from the results (so far)?

The dataset has lent itself to the associations between adverse childhood experiences and a veritable laundry list of medical, psychiatric pathology as well as social and public health problems.

This is data reports that 1 in 5 were sexually abused, nearly 1 in 4 lived with a “problem drinker or alcoholic” and that around 1 in 6 had a household member who was depressed or mentally ill.

It’s worth remembering that this study paints a picture of the adverse childhood experiences of the older generations in the USA – the mean age of respondents was 56.1 (19-92) years – in a study undertaken just over 20 years ago.

Rather than provide a snapshot of what childhood is like today, this data informs us about the childhood of parents of our patients. This gives us some understanding and frameworks by which to consider expectations of childhood from the parental & societal viewpoint – that most parents hope for a rosier childhood with fewer adverse experiences than their own.

With this in mind, and with a critical eye to some of the correlating outcomes, behaviours such as alcohol & drug abuse, smoking, over-eating, and sexual behaviours might alternatively be viewed as both coping strategies and symptoms of the anxiety, anger and depression that is likely co-morbid with high levels of adverse childhood experiences.

Primary prevention of adverse childhood experiences necessitates change at the societal level; with a focus on improving the quality of family and household environments through the childhood years.

Funding for the original study was combined between Kaiser Permanente (San Diego) and the US Center for Disease Control.

Where next?

The Centre for Disease in Childhood has taken over the study and, since 2009, transformed it into a national program across 32 states of the USA, called “Behavioral Risk Factor Surveillance System” (BRFSS). Data from the 2010 BRFSS has been published and includes more than 50,000 respondents. You can see more about the participating states, future timeline and previous data via the CDC website, here.

References:
Felitti, VJ, Anda RF, Nordenberg D et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults : The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998:14, 245–258. 

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention Adverse Childhood Experiences (ACEs)”.U.S. Department of Health & Human Services, Atlanta, USA. Accessed 27 September 2016. https://www.cdc.gov/violenceprevention/acestudy

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. “About Behavioral Risk Factor Surveillance System ACE Data”.U.S. Department of Health & Human Services, Atlanta, USA. Accessed 5 October 2016. https://www.cdc.gov/violenceprevention/acestudy/ace_brfss.html