Adverse Childhood Experiences
Kate Allen is a 2nd year PhD student in the College of Medicine and Health at the University of Exeter looking at what public health interventions might have combined impacts on domestic violence, mental ill-health and substance misuse. Kate’s PhD is funded by PenARC and is supervised by Dr Vashti Berry, Professor G.J. Melendez Torres, Professor Tamsin Ford and Professor Chris Bonell.
There are a number of Adverse Childhood Experiences (ACEs) that may happen during childhood including experiences such as child abuse, child neglect, and living in a household where domestic violence, mental ill-health, substance misuse, incarceration or separation/divorce are present.
Research has shown that the more ACEs a child experiences, the greater the likelihood of a number of negative outcomes later on in life, such as heart disease, cancer, violence, mental ill-health, substance misuse, unemployment, and early unplanned pregnancy (the list goes on!). However, although research looking at ACE scores (i.e. the number of ACEs a child experiences) has helped highlight the importance of ACEs, it tells us little about the differential impacts of ACEs, how ACEs might cluster, and what interventions might prevent/tackle these clusters.
There are a number of ACE clusters researchers could examine, however, one cluster that might be particularly important to consider is parental domestic violence, mental ill-health, and substance misuse. These three public health issues are issues that often co-occur, can have a negative impact on parenting capacity (potentially leading to additional ACEs), are likely to be intergenerational, and are increasing in prevalence given COVID-19 related restrictions. Furthermore, families experiencing a combination of these issues are likely to be particularly vulnerable, being presented with numerous barriers to accessing siloed services which fail to address the complexity of families’ needs.
My PhD aims to look at this ACE cluster in more detail, exploring what public health interventions might have combined impacts on parental domestic violence, mental ill-health, and substance misuse. This research will help highlight better ways to support families at risk of these three co-occurring issues which will be of use to changing policy and practice.
A PhD grounded in PPI
One of the things that I love the most about my PhD is that it is grounded in patient and public involvement (PPI). This is where research (from research question and design, to analysis and dissemination) involves, and is informed by, members of the public (see https://www.arc-swp.nihr.ac.uk/patient-and-public-involvement-in-research for more information).
This kind of work is exciting as it can generate research that helps to better meet the needs of those it intends to help and support. Being funded by PenARC, my PhD question was designed using PPI work from the outset and I knew that this would be something my supervisors would encourage me to continue throughout.
In the first few months of my PhD, I met with several service providers and commissioners in the fields of domestic violence, mental ill-health, and substance misuse, which helped me develop a better idea of the kind of research that would be useful for them. I also got the opportunity to spend a week at Hamoaze House, a day centre for adults who have, or are still, misusing substances and have other co-occurring issues (such as mental ill-health and domestic violence). The conversations I had with those at Hamoaze were invaluable in helping highlight some of the challenges in this field and the importance of early childhood experiences, leading me to frame my PhD within the context of ACEs.
More recently, I have done some PPI work with the local commissioners I met at the start of my PhD to help inform my first study which involves a systematic review of family focused interventions that have combined impacts on parental domestic violence, mental ill-health, and substance misuse. This work has helped shape the inclusion/exclusion criteria for the review and, in the future, will help inform how I analyse and interpret the data (once I get to this stage!). It has also led to my work being included in an important action plan for Devon County Council which I have promised to deliver on by mid-2021.
Involving commissioners in the design and conduct of my review has led to a stronger review that will be a useful resource for commissioners looking to provide services in this space (which is just what I had hoped for!).
I am already thinking of ways I can actively involve the public in my second and third studies and would encourage other PhD students to think about ways their research might benefit from PPI too! It’s such a brilliant way to ensure your research is relevant and can be of use in practice, and I am thankful to all those who have helped me with this so far!
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If you’d like to find out more about my work, please feel free to contact me via email or twitter @klallen89.