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Plan to have a set of 3 tutorials.
Discussion with learners about their prior knowledge on health care issues for gypsy, Roma and traveller health.
Some resources and learning 'jump off points' provided.

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A national charity that works on behalf of all Gypsies, Travellers and Roma. We offer advice, consultancy, promote health and wellbeing and contribute to research and policy making.

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Aquisition - pre-read Fairhealth online course on ACE:

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Aquisition - pre-read Fairhealth online course on ACE:

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This course explores the impact of adverse childhood experience and trauma, focusing on how we can improve the recognition and support that we offer to people, including through the delivery of trauma-informed care.

What you are going to learn

A few more words about this course

Our childhood, our upbringing, affects us throughout our lives. Our health as adults - physical and mental - is determined by many factors, not least the things we were exposed to and experienced as children.

Children the world over are currently experiencing trauma and adversity that impacts upon their health, psychological and emotional wellbeing, now and in the future.

Many adults have experienced traumatic childhoods and gone on to have happy, healthy lives. And many have not.

This module explores the effects of childhood trauma and adverse experience. Once you have completed it you should be able to:

Appreciate that what happens in childhood makes a difference to a child's mental and physical health, impacting on the rest of their life

Describe 'Adverse Childhood Experiences' (ACEs) as a framework for understanding childhood trauma

Appreciate the long-term physical and psychological consequences of exposure to childhood trauma

Recognise common responses to trauma, including hypervigilance, dissociation, disconnection, and shame

Start to think about how to routinely and sensitively enquire about a history of trauma and adverse experience

Understand and begin to incorporate trauma-informed care into your personal practise

Think about yourself and the impact that caring can have

Thank you so much for creating this resource and putting it out for free! I am so glad to have done it, and have recommended it to lots of people in my network. I appreciated the variety of materials and presentation. It's sometimes so hard to know what to do and say in practice and having a direct link to useful resources, clear outcomes etc was really great and helpful. Thank you.

An excellent module - powerful and informative content; links to relevant resources and further reading; easy and aesthetic to navigate.

As a professional working with both adults and children who have experienced numerous ACEs, I thought this module was a great introduction to ACE informed work. Thank you.

It was an amazing module. I loved the presentation, the fact that it felt a lot more interactive than other modules i had done really helped me engage with it. I liked the fact that we had Molly's story to set the scene and the whole module really flowed. It is probably the first module that I have actually enjoyed completing as there wasn't any pressure of answering questions.

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This course explores the impact of adverse childhood experience and trauma, focusing on how we can improve the recognition and support that we offer to people, including through the delivery of trauma-informed care. What you are going to learn Our childhood, our upbringing, affects us throughout our lives.

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Discussion - review how to calculate an ACE score and the implications of  how factors affect the score, how does this relate to you?

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Discussion - review how to calculate an ACE score and the implications of  how factors affect the score, how does this relate to you?

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INvestigate- Calculate the ACE score of these characters -  Oliver/ Danny the champion / Matilda

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INvestigate- Calculate the ACE score of these characters -  Oliver/ Danny the champion / Matilda

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Practice - Roleplay or lived experience of the challenges. 

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Practice - Roleplay or lived experience of the challenges. 

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Collabourate - with the practice team, admin/ reception and clinicians over explaining the actions of those challenging patients impacted by ACE to mitigate their challenges

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Collabourate - with the practice team, admin/ reception and clinicians over explaining the actions of those challenging patients impacted by ACE to mitigate their challenges

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Produce - Learning log entry around safeguarding learning impact, infographic the share the learning across the practice, PLT learning event on the challenges faced. 

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Produce - Learning log entry around safeguarding learning impact, infographic the share the learning across the practice, PLT learning event on the challenges faced. 

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Intro then short Video https://youtu.be/NwnhWJUsUnY or article (https://www.bmj.com/content/376/bmj-2021-067090) ?send out link before

Done together

DISCUSSION

Then split for small group discussions
Eg discuss/share some health inequalities in your practice areas

INVESTIGATION

Using your lists and your phones, find out what services are available in your area/on the net for one of the health inequalities on your list

PRACTICE

Chess board game with different health inequalities represented by different pawns

COLLABORATION

Take the learning from list/game and apply to their practice/practices/PCN…what could be done to improve access to primary care/health support for one/some/all the groups they have discussed

Production

Resources leaflet for practice
Portfolio entry reflecting on learning

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Action on patient safety can reduce health inequalities

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Providers and health systems should use ethnic differences in risk of harm from healthcare to reimagine their role in reducing health inequalities, write Cian Wade and colleagues Health inequalities are widening in many high income countries and have been thrown into focus by the covid-19 pandemic…

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Plan to have a set of 3 tutorials.
Discussion with learners about their prior knowledge on health care issues for gypsy, Roma and traveller health.

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Using a PBL appraoch, the learners identify their learning objectives.
Learning objectives are assigned to group members.

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In the 2nd tutorial the learners meet again to share their learning and work together on outcomes

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Finding a patient or health care professsional working with this community.
Record their learning in an 'innovative way', e.g. audio recording

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Define a learning disability
Define what health inequalities mean
How this affects the individual
Why this matters
What you can do to change things at your practice.
https://www.mencap.org.uk/learning-disability-explained/research-and-statistics/health/health-inequalities

https://www.nice.org.uk/about/what-we-do/into-practice/measuring-the-use-of-nice-guidance/impact-of-our-guidance/nice-impact-people-with-a-learning-disability

Plan
Initially ask trainees what they know about both learning disabilities and health inequality.
Short presentation for definitions, can tailor how this is presented depending on discussion that had been had.
As part of this to have a discussion about annual reviews for those with learning disabilities and why these are important

They will have been asked to bring a case for discussion.
Areas to think about:
Barriers to the person accessing health care.
Ways in which they could help the person to access health care.
Titles attached to people with learning disabilities and how that creates health inequality eg mental health problems

QIP - how you can make your surgery more accessible to those with learning disabilities.

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Associated health conditions

Common associated health conditions for people with a learning disability include mental health problems, epilepsy, and being underweight or overweight.

Click the conditions below to reveal more information.

Mental health

In 2017/18 severe mental illness was 8.4 times more common in patients with a learning disability than those without.

In 2017/18, 13.3% of patients with a learning disability had an active diagnosis of depression, compared to 12.2% in 2014/15 (NHS Digital, 2019).
Learn more about mental health in people with a learning disability here.

Epilepsy

Research suggests that epilepsy is more common in adults with a learning disability than those without a learning disability; and is more common amongst men and those with a higher level of impairment (McGrother et al. 2006; Epilepsy Society, 2019 ; Robertson et al., 2015).

Estimates vary but in a review of 38 studies, the pooled estimate of prevalence of epilepsy in people with a learning disability was 22% (Robertson et al., 2015).

Being underweight or overweight

The proportion of people with a learning disability receiving body mass index (BMI) checks has increased from 58.3% in 2016/17 to 61.5% in 2017/18.

Of those receiving BMI checks, 6.4% of patients with a recorded learning disability were classified as underweight (BMI ≤18.4), this was higher than for those with no recorded learning disability (4.9%).

Meanwhile, 37.5% of people with a learning disability were classified as obese, this was also greater than those without a learning disability (29.9%) (NHS Digital, 2019).

Dementia

The rate of dementia is high in all people with a learning disability, but is particularly high in people with Down's syndrome.

In 2017/18, the prevalence rate for people with a learning disability aged 55-64 was 4.3%, compared to 0.3% of those with no learning disability.

For a ges 65-74 it was 5.9% for people with a learning disability, compared to 1.1% for those without.

For those aged 75 and over it was 11.2% for people with a learning disability, compared to 8.7% for those without (NIHS Digital, 2019).

Reasonable adjustments

A lack of reasonable adjustments can be a barrier to accessing healthcare settings and to equal healthcare (Ali et al., 2013; Heslop et al., 2013).

The Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) reviews showed the lack of reasonable adjustments provided to people with a learning disability (especially in accessing clinic appointments and investigations) as a contributory factor in a number of avoidable deaths (Heslop et al., 2013).

Healthcare professionals have a legal duty to provide reasonable adjustments for disabled people (Public Health England, 2016). This can include providing easy-read information, avoiding medical jargon or longer appointment times.
Learn more about reasonable adjustments here.

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Read latest research and statistics on health inequalities affecting people with a learning disability

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3rd tutorial agreeing how they will disseminate their learning to their practice.... possibly with further ambition to larger group, e.g. PCN, ICB, GPSTP.

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Sex workers: The oldest profession in the world.

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Sex workers: The oldest profession in the world.

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Aquisition: interactive quiz: stats on health inequalities on sex workers.

Aims & Objectives (joint objectives)
Define aims together.

Objective: barriers to care?
Definition: who is the popn? Where are they? Who they might present? Why are they vulnerability?
Why is it important?

Discussion: Sharing patients storie/vignettes

Coffee

Practice: role play consultation/case based discussion

Production - go away produce a learning log on this that we can share.

Closing - have we covered all these objectives? Have we acheived every