Powerpoint accompanying workshop session from the Homeless and Housing Coalition of Kentucky's 2013 conference. Presented by Tim Welsh
Trauma is a common occurrence in the lives of homeless individuals and can have a significant impact on one’s
ability to function. This training will help participants identify signs of trauma and ways in which they can engage
in trauma-informed practice with clients
Contributors: Frank Putnam, MD, UNC at Chapel Hill, NC
William Harris, PhD, Children’s Research and Education Institute
& New School for Social Research, NYC, NY
Alicia Lieberman, PhD, UCSF, San Francisco, CA
Karen Putnam, PhD, UNC at Chapel Hill, NC
Lisa Amaya-Jackson, MD, Duke University, Durham, NC
This is a presentation that I give to medical professionals educating them on the role and potential use of social work in the hospital setting. I presented this on May 22, 2009 to the Trauma Education & Research Committee.
Developed a training on childhood trauma and the affects it has on elementary teachers.
The training was offered to teachers at Leffingwell Elementary School, part of the East Whittier City School District. After interning as the school's counselor for one year, it was found necessary to help train and remind teachers about childhood trauma.
The training offered:
- Reasons why students are referred to counseling
- Understanding experience of childhood trauma
- Review of PTSD
- Information of new DSM-V PTSD
- Discussion of potential misdiagnosed
- Role of Teachers
- Teacher Self-Care Practices
Marcy Witherspoon, MSW, LSW of the Health Federation of Philadelphia discussed trauma-informed care with the Philadelphia EMA HIV Integrated Planning Council on November 9, 2018.
Implementing Trauma-Informed Care in Christian CounselingDenice Colson
A presentation for Professional Counselors on implementing trauma-informed care, evaluation, and potential treatment using Strategic Trauma and Abuse Recovery (c). Specifically for Christian-integration.
Examines the health and social effects of ACEs throughout the lifespan among 17,421 members of the Kaiser Health Plan in San Diego County.
Involving those who don’t yet realize that they are working on issues that represent the “downstream” wreckage of child abuse and neglect--and other adverse childhood experiences--in the effort to bridge the chasm.
Safeguarding Children: Getting it right from the start. Jane Barlow. ScarletFire.co.uk
From the Conwy and Denbighshire Local Safeguarding Children Board (LSCB) Conference, March 2012.
www.conwy.gov.uk/lscb
Shared with kind permission from Jane Barlow.
Powerpoint accompanying workshop session from the Homeless and Housing Coalition of Kentucky's 2013 conference. Presented by Tim Welsh
Trauma is a common occurrence in the lives of homeless individuals and can have a significant impact on one’s
ability to function. This training will help participants identify signs of trauma and ways in which they can engage
in trauma-informed practice with clients
Contributors: Frank Putnam, MD, UNC at Chapel Hill, NC
William Harris, PhD, Children’s Research and Education Institute
& New School for Social Research, NYC, NY
Alicia Lieberman, PhD, UCSF, San Francisco, CA
Karen Putnam, PhD, UNC at Chapel Hill, NC
Lisa Amaya-Jackson, MD, Duke University, Durham, NC
This is a presentation that I give to medical professionals educating them on the role and potential use of social work in the hospital setting. I presented this on May 22, 2009 to the Trauma Education & Research Committee.
Developed a training on childhood trauma and the affects it has on elementary teachers.
The training was offered to teachers at Leffingwell Elementary School, part of the East Whittier City School District. After interning as the school's counselor for one year, it was found necessary to help train and remind teachers about childhood trauma.
The training offered:
- Reasons why students are referred to counseling
- Understanding experience of childhood trauma
- Review of PTSD
- Information of new DSM-V PTSD
- Discussion of potential misdiagnosed
- Role of Teachers
- Teacher Self-Care Practices
Marcy Witherspoon, MSW, LSW of the Health Federation of Philadelphia discussed trauma-informed care with the Philadelphia EMA HIV Integrated Planning Council on November 9, 2018.
Implementing Trauma-Informed Care in Christian CounselingDenice Colson
A presentation for Professional Counselors on implementing trauma-informed care, evaluation, and potential treatment using Strategic Trauma and Abuse Recovery (c). Specifically for Christian-integration.
Examines the health and social effects of ACEs throughout the lifespan among 17,421 members of the Kaiser Health Plan in San Diego County.
Involving those who don’t yet realize that they are working on issues that represent the “downstream” wreckage of child abuse and neglect--and other adverse childhood experiences--in the effort to bridge the chasm.
Safeguarding Children: Getting it right from the start. Jane Barlow. ScarletFire.co.uk
From the Conwy and Denbighshire Local Safeguarding Children Board (LSCB) Conference, March 2012.
www.conwy.gov.uk/lscb
Shared with kind permission from Jane Barlow.
The “Three A’s”…ADHD, Anxiety, Asperger’s Disorder: Overcoming Barriers to S...Stephen Grcevich, MD
In this presentation, we'll explore the functional impairments associated with ADHD, anxiety disorders and Asperger's Disorder in children and teens and share practical ideas for addressing the challenges each condition poses to "doing church" for affected kids and their families.
The Role of Occupational Therapy in Childhood Trauma atchison
This is an introduction to concepts of childhood trauma and the role of occupational therapy as a team member in comprehensive assessment and intervention
This Webinar was presented on Tuesday, February 15, 2011, as part of the free monthly series from Friends for Youth's Mentoring Institute with Special Presenter John Stirling, M.D.
Clinicians caring for victims of early abuse or neglect are often puzzled at their inability to respond to a more consistent and caring environment, including mentoring. This presentation synthesizes concepts from developmental neurobiology, attachment theory, and family ecology to help participants understand the obstacles faced in leaving abuse behind, and to suggest paths to more effective therapy. Mentoring is an important component in treatment and there will be a special focus on understanding the Big Picture regarding early trauma, including the physiologic response to stresses, learned helplessness, and intrauterine drug exposure, to show how these children and youth react differently and need special handling.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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The Role of Family Medicine in Screening for Domestic Violence
1. ONTARIO COLLEGE OF FAMILY PHYSICIANS
HEALTHY CHILD DEVELOPMENT:
IMPROVING THE ODDS
Interpersonal Personal Violence Screening in
Pregnancy and Creating Opportunities In Primary
Care: Impact on Infant Mental Health and Optimizing
Child Developmental Outcomes
2. The Early Years Intervention
Opportunities to intervene
Early Years
Biological Environment
Birth
Genetic
Conception
Social / Ecological
Environment
3.
4.
5. AAP Technical Report on the lifelong effects of early
childhood adversity and toxic stress
(Pediatrics Vol. 129 No. 1 January 1, 2012
pp. e232 -e246 )
6. Hyper arousal
arousal
Disrupts Dysregulated CNS
Sympathetic
HPA axis Catecholamine
Nervous system HPA system
Pathway
Hyper vigilant
Suppressed
Hyper-reactive
immune system
“survival mode”
7. What is infant mental health?
• Infant mental health is the social, emotional & cognitive well being of infants and
toddlers
• An infant’s mental health begins at conception
• An infant can have serious mental health and emotional problems
• Poor mental health of an infant and/or toddler is sometimes about the absence
of “normal experiences, interactions or reactions”
• An infant who experiences poor mental health this early in life, will be vulnerable
for poor mental health throughout life
• Infant mental health = healthy social & emotional development that
includes the infant’s capacity to:
• Experience, regulate, & express emotions
• Form close interpersonal relationships
• Explore the environment & learn
8. Developmental Consequences for
Trauma Exposure
• Sleep problems • Anxiety
• Eating problems “Re- • PTSD
experiencing” or playing out • Relationship problems –
memories of the event including poor attachment or
• Toileting problems attachment disorders
• Withdrawal • Depression
• Increased • Dysregulation of stress system
clinginess/separation • Low self-esteem
• Unresponsive • Preoccupation with the
• Verbal or language difficulties traumatic event such as
• Developmental regression bringing up the episode
• Onset of new fears repeatedly or uncontrollably
• Aggressive outbursts or
increased activity level
9. Traumatic
events/experiences
Limited
Protective
Factors
Baby or Toddler unable to
recover from trauma
Infant or Toddler suffering from
poor mental health
10. Traumatic
events/experiences
Protective Factors that may
mitigate or minimize impact
Baby or Toddler who has
recovered from traumatic
experience/event
11. Trauma
Stress
Brain Overall
development Overall Relationship/ health
development attachment
12. Children need nurturing, loving environments
for healthy development…
Source: National Scientific Council on the Developing Child (2004)
13. We Need to Move Beyond Surveillance
and Beyond the Physical
Typical Well Child Visit: Monitoring of physical growth and development
• Counseling about development, safety, nutrition and community
resources
• Providing immunization and other preventive care
In IPV: Review safety concerns for the child
• Think about, discuss, and together identify any risks/problems for action
• Consider referral to consultants, and community resources to support the
child’s needs
Consider Child Protection Referral if required for supervised access visits
NEW: Assess parent-child interactions and look at the emotional needs of the
infant. Interpersonal violence can cause major impact to the mental health of
the child. Providing community support for the mother can be a supportive
factor that can buffer risk factors. Provide early intervention by screening at
well child visits.
14. Early Action for Suspected
Infant Developmental / Mental Health Concerns
when IPV is present
• Family assessment in depth- identify supports and strengths
• Refer to Public Health for Home Visiting and for family support
• Consider whether Child Protection Services ( CPS) are required
• Provide information about shelters and emergency agencies
• Further assessment / monitoring of child’s developmental status
• e.g. Hearing assessment / vision assessment
Speech, language, motor assessment
Psychological assessment /evaluate attachment concerns
Full socio-emotional assessment
Parenting Capacity assessment – role of supervised access visits
• Early infant / child intervention programs
• Family centers, play groups, child care centers
• Respite care if required – includes Shelters in IPV
• Social work referral for financial or housing issues
15. Comprehensive Assessment
• Consider screening for intimate partner violence at all
well woman visits and especially during pregnancy and
the post partum period when risks are higher
– ALPHA (Antenatal Psychosocial Health
Assessment)
– Three key questions:
• Have you ever experienced abuse?
• Are you or have you ever been afraid of your partner?
• Are you safe?
ALPHA: http://dfcm19.med.utoronto.ca/research/alpha
ALPHA Video illustrates interviewing techniques
16. The ALPHA Forms
Antenatal Psychosocial Health Assessment
The ALPHA Forms are a reliable, valid, user-friendly tools to be used by
obstetrical care providers for the systematic assessment of the psychosocial
health of pregnant women.
Suggestions for Use
•Complete after 20 weeks gestation
•Can be completed in 1 visit (20 mins) or over several regular prenatal visits
•Give the self-report out for completion in the office –avoid sending home if
worries about woman abuse
•Can bill for counseling/psychotherapy when appropriate
•Be sensitive to cultural issues; use non-family interpreters
•Discuss with the woman before sharing information (ie CPS concerns) ;
maintain confidentiality
Remember that associations do not imply causality!
17. The ALPHA Forms / Antenatal Factors
1) Family Factors - Social Support (CA, WA, PD )
Recent Stressful Life Events (CA, WA, PD, PI )
Couple’s Relationship ( CD, PD, WA, CA )
2) Maternal Factors - Prenatal Care ( Late onset ) (WA)
Prenatal education ( refusal or quit) ( CA)
Feelings towards pregnancy after 20 weeks ( CA , WA )
Relationship with parents in childhood ( CA)
Self-esteem (CA, WA )
History of psychiatric/emotional problems (CA , WA , PD)
Depression in this pregnancy (PD)
3) Substance Use - Alcohol and Drug Abuse ( WA, CA )
CAGE utilized ( Cut down, Annoyed, Guilty, Eye opener)
4) Family Violence - Woman or partner experienced or witnessed abuse
(physical, emotional, sexual ) ( CA, WA)
Current or past woman abuse (WA, CA, PD)
Previous child abuse by woman or partner (CA)
Child discipline (CA)
Critical Review of the Literature
15 antenatal factors associated with adverse postpartum outcomes of:
woman abuse (WA)
child abuse (CA)
couple dysfunction ( CD)
postpartum depression ( PD)
increased childhood physical illness (PI)
18. FAMILY FACTORS
Social support (CA, WA, PD)
How does your partner/family feel about
your pregnancy?
Who will be helping you when you go home
with your baby?
Recent stressful life events (CA, WA, PD,
PI)
What life changes have you experienced
this year?
What changes are you planning during this
pregnancy?
Couple’s relationship (CD, PD, WA, CA)
How would you describe your relationship
with your partner?
What do you think your relationship will be
like after the birth?
19. MATERNAL FACTORS
Prenatal care (late onset) (WA)
First prenatal visit in third trimester?
Prenatal education (refusal or quit) (CA)
What are your plans for prenatal classes?
Feelings toward pregnancy after 20
weeks (CA, WA)
How did you feel when you just found out
you were pregnant? How do you feel about
it now?
Relationship with parents in childhood
(CA)
How did you get along with your parents?
Did you feel loved by your parents?
Self esteem (CA, WA)
What concerns do you have about
becoming/being a mother?
History of psychiatric/emotional
problems (CA, WA, PD)
Have you ever had emotional problems?
Have you ever seen a
psychiatrist/therapist?
Depression in this pregnancy (PD)
How has your mood been this pregnancy?
20. SUBSTANCE USE
Alcohol/drug abuse (WA, CA)
How many drinks of alcohol do you have per week?
Are there times when you drink more than that?
Do you or your partner use recreational drugs?
Do you or your partner have a problem with alcohol
or drugs?
CAGE:
1. Have you tried to Cut down?
2. Do you feel Annoyed if someone mentions your
drinking?
3. Do you feel Guilty for drinking?
4. Do you ever need a drink in the morning to get
going?, Eye-opener)
OR
T-ACE (Tolerance, Annoyed, Cut-down, Eye opener)
21. FAMILY VIOLENCE
Woman/partner experienced or witnessed
abuse
(physical, emotional, sexual) (CA, WA)
What was your parents’ relationship like?
Did your father ever scare or hurt your mother?
Did your parents ever scare or hurt you?
Were you ever sexually abused as a child?
Current or past woman abuse (WA, CA, PD)
How do you and your partner solve arguments?
Do you ever feel frightened by what your
partner says or does?
Have you ever been hit/pushed/slapped by a
partner?
Has your partner ever humiliated you or
psychologically abused you in other ways?
Have you ever been forced to have sex against
your will?
Child discipline (CA)
How were you disciplined as a child?
How do you think you will discipline your child?
How do you deal with your kids when they
misbehave?
22. Setting the Context within Primary Care
Practice
• You are the health care professionals who see many
women and children at regular intervals
• You can provide women exposed to Intimate Partner
Violence with insight into the impact on her child
• You can be the broker for her to obtain support
• You are able to observe the family “in action” including
moments of distress for the child (ie immunization,
illness).
• There are questions you can ask as a Family Health
Team member (physician/nurse/ midwife/ social worker)
about many of the determinants of health including risk
factors
23. Risk Factors
Normal Child Child with
CNS insult
Nurturant
Dysfunctional Nurturant
Caring dysfunctional Dysfunctional
IPV Caring
Environment IPV
Environment
At risk Opportunity High
To thrive risk
For Child: Interactions & Relationships with Caregivers are the most crucial elements in the
Environment EPIGENTICS Nature and Nurture continuously Interacting
Editor's Notes
Before age one, there is rapid and extensive dendritic growth and complex neurological development. Brain development is very vulnerable to environmental influences.The influence of early environment is long lasting. There is scientific evidence for the negative impact of early stress on brain function.Patterns are established for long-term family cohesion and communication.
Epigenetics: Personalized chemical signatureEpigenetics is any process that can alter gene expression temporarily or permanently without changing the DNA sequence (Mellor, Dudek &Clynes, 2008).The environmental experiences in the early childhood period act as stimuli that is carried into the brain as an electric signal.A biochemical cascade is created that can trigger structural and chemical changes on the genes, affecting the ability of the genes to switch on or off.The epigenome resembles the software in an computer, which determines the ‘dos’ and don’ts of the genetic hardware (structural genome).
An emerging multidisciplinary science of development supports an EBD framework for understanding the evolution of human health and disease across the life span. In recent decades, epidemiology, developmental psychology and longitudinal studies of early childhood interventions have demonstrated significant associations between the ecology of childhood and a wide range of developmental outcomes and life course trajectories. Concurrently, advances in the biological sciences, particularly in developmental science and epigenetics have made parallel progress in beginning to elucidate the biological mechanisms underlying these important associations. The convergence of these diverse disciplines defines a promising new basic science of pediatrics.Ecobiodevelopmental (EBD) framework for understanding the promotion of health and prevention of disease across the life span that builds on advances in neuroscience, molecular biology, genomics, and the social sciences.Together, these diverse fields provide a remarkably convergent perspective on the inextricable interactions among the personal experiences, environmental influences and genetic predispositions that affect learning, behavior and mental health across the life span
Parental deathAbusive parent steps in and is unable to provide the response the baby needsMother experiences abuse with no supportParents emotionally unavailable- no one else to respond Child exhibits behvioural symptoms
One parent is an abuserSecond parent removes child and her/himself from the situationParent accesses supportParental deathOther non abusive family members step in and provide the response the baby needs
Slide 7: Children need nurturing, loving environments for healthy developmentThis is a graph that was illustrated by the National Scientific council on the Developing child. As you can see, the horizontal line shows the number of risks a child may have, from 1 risk, to the red bar of 7+ risks. The vertical line shows the percentage of children with developmental delays. As you can see, the more risk factors a child may have, the greater risk of having developmental delays. For example, a child with 1 or 2 risk factors only has about 10% or less of a risk for developmental delays – opposite is true for a child who has more than 7 risk factors. Of course, this is a general overview, and there is no “cut off” of risk factors.. It varies from child to child. So, the aim of protective factors is to diminish as many effects of risk factors as possible.
The ALPHA ProjectEndorsed byThe Canadian Pediatric AssociationThe Canadian Psychiatric AssociationThe College of Family Physicians of CanadaThe Ontario Association of MidwivesThe Ontario Medical AssociationThe Royal College of Physicians and Surgeons of CanadaThe Society of Obstetricians and Gynecologists of CanadaFinancial SupportThe Lawson FoundationThe Ontario Medical AssociationThe PEI Reproductive Care CommitteeThe Women’s Health Bureau, Ontario Ministry of Health Women’s Health Program, The Toronto HospitalAdministrative SupportThe Family Healthcare Research Unit, DFCM, Faculty of Medicine, U of T
The ALPHA History1989ALPHA Group is formed1992Survey of Family Physicians in Ontario; need for an assessment form identified 1994Critical Review of the Literature revealed 15 antenatal factors associated with adverse postpartum outcomes of: woman abuse ( WA)child abuse ( CA) couple dysfunction (CD) postpartum depression (PD)increased childhood physical illness (PI)1995AntenatalPsychosocial Health Assessment Form, provider version (35 questions relating to15 antenatal factors) developed from review of the research literature. Piloted in Ontario; focus groups held and form modified by feedback from obstetricians, family physicians, midwives, nurses, social workers, childbirth educators ALPHA highly rated by pregnant women in the pilot//Provider’s Guide and video developedSelf-report ALPHA developed, tested on PEI: no differences in satisfaction, utility, yield 1998ALPHACARE- Community and Residency Education Expert panel convened in Ontario; Provider’s Guide and video revamped 2000 Care in Pregnancy Project RCT in Ontario of obstetricians, family physicians, midwives - domestic violence identified in self report form and utility of use revealed (43 questions with ranking 1-5 or yes/no /room for comments) ALPHA form integrated into Ontario Antenatal Record as tick boxesASSURE: ALPHA Screening and Substance Use Reliability Evaluation The self-report ALPHA tested with substance-using pregnant women2004 AIRS: ALPHA Inter-rater Reliability Study - good correlation from various practitioners observing use of ALPHA in 3 distinct case presentations