Foetal Alcohol Spectrum Disorder: The lifelong impact of foetal exposure to alcohol

Foetal Alcohol Spectrum Disorder: The lifelong impact of foetal exposure to alcohol

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  Foetal Alcohol SpectrumDisorder - The lifelong impact of foetal exposure to alcohol 13.02.14: A one day conference on the organic brain damage caused by exposure to alcohol, and the implications for work with children and families. A Rhondda Cynon Taf Early Years and Family Support Service event For more information on F.A.S.D. please email: [email protected] Conference report and visual maps by Fran O’Hara, Scarlet Design - www.franohara.com If you would like these visual minutes maps in an alternative size or format please contact: [email protected]
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  Agenda Page Visual Minutesof the presentations ..................................................... 2-7 Workshop discussions data .............................................................. 8 - 15 Conference Area 12 Comments ...................................................... 16 - 19 Attendee List ................................................................................. 20 & 21 ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 1 CONTENTS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM F.A.S.D. ANNUAL CONFERENCE PAGE 2
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM F.A.S.D. ANNUAL CONFERENCE PAGE 7
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 8 Why do womendrink during pregnancy? • Because they can • Lack of education/ understanding/knowledge • Ladette culture/society • Mixed messages • Social/family/peer pressure • ‘My mother drank with me and I’m not affected’ • Tastes nice – don’t want to be boring • Biological • Alcohol dependent • Genetic • Psychological • Coping with stress • Mental health problems • Denial • Low self esteem • Social • Culture – socially acceptable- binge drinking is acceptable • Lack of knowledge/ not consistent information • Peer pressure • Availability • Don’t understand the risk (mother and father) • Don’t know that they are pregnant/unplanned • They could have FASD/ additional needs themselves • Vague advice • Don’t take on board advice although they are aware • Life style as a couple • Want to bring on self abortion • Emotional health difficulties • Know the risks but don’t think that it will affect them • They enjoy it/choice • Have not had any advice or advice that is understandable • Stress relief – coping mechanism- in abusive relationship • In pre-contemplative or contemplative phase of change of cycle • Don’t know any different/ lack of knowledge • From a family of heavy drinkers • Depression • Becomes the norm • Gives them confidence • Addictive- hard to break the habit • Why not? • Cheap- easily affordable • Denial – ‘it won’t happen to me’ • Family values- the norm • Mixed messages- 1 or 2 units acceptable • Ambiguous information – unclear guidelines • Not understand unit measures • Don’t know the consequences • In the media • Cannot see the link to the damage to the unborn child • Awareness raising of binge drinking WORKSHOPS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 9 Why do womendrink during pregnancy? contd. • Part of social interaction/social inclusion and belonging • Home drinking culture • Celebrations and life events • Saturated by what is ‘good’ and ‘bad’ too confusing • Conflicting information • My human right – my body • Unwilling to change lifestyle • Poor support from family • Family and personal experiences ‘I did it’ • Unaware of risks/ lack of advice and education/ Ignorant of consequences • Learnt behaviour • Rebellion • Not regulated • Hidden/unidentified pregnancy • Socially acceptable • Lack of ‘realistic’ resources that people can understand • Mixed messages ‘just cut down’ • Relationships – partner encourages • Self medication when relationships go wrong • ‘Not taking drugs – alcohol isn’t as bad’ • ‘Glass of red wine is good for you’ • Domestic abuse to drown out problems • Less stigma attached than other things • Don’t see it as harmful • Relaxation • Availability/accessibility • Don’t understand/know the risks • Social routines • No support from family/partner/friends • Culture/religion • Advice is not telling us ‘not’ to drink from medical professionals • Age • Drink for pain • To cope with emotional demands of pregnancy • To follow societal norms (young and in university) • To have fun/let off steam/ join in with friends • Not to be socially isolated • Ignoring information given – not going to happen – teenage mums • Learning difficulties – not able to process the information • Lack of control of own body • Old wives tales – ‘Good for you and baby’ Historical stout is good for you • Won’t happen to me – denial – I’m invincible • To cause harm • Behaviours continue while deciding whether to continue with pregnancy • To conceal pregnancy • Lack of motivation to change WORKSHOPS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 10 What do wein RCT do to prevent alcohol use/misuse in pregnancy? • Education to raise awareness of risks • PSE – ethics and philosophy curriculums in schools - DARE • Based in GPs surgeries (specialist drug and alcohol nurse) • Alcohol raising awareness • Face to face • Ask at antenatal – is this happening? • Asked by midwives and answer recorded. Have to ask at booking – All Wales Midwifery Guidance • Ask how many units including fathers • Leaflets available – are these available yet? • Discussed in family planning clinics • Health visitor ask at first contact and throughout pregnancy • Lack of data to action prevention • Can advise • Risk/ fear of services • Need FASD information to share with mothers • ABI training - how is it used in role - TEDS/Miskin - Drug Aid(in respect of young teenagers) • No alcohol – no risk campaign – Gwent • Referring to CS for support and protection • Substance misuse agencies • YPDAT (CAMHS) • CDAT • Reliant on honest answers from other women • Consultation with teenagers EPS and BSC • Nothing/ not much available/unsure • Refer to agencies • We are not aware of any input that we give • Policies? • Nobody seems to know about FASD in RCT parents or professionals • School nurse give advice • GP - ask question – advice is adhoc • Some pregnant women pre-conceptual seek out information on healthy lifestyles • Sign posting and making referrals for women to services such as TEDS • Assess current situation and history • Communication – multi agency sharing information • Training for RCT professionals (FASD conferences) • Intensive family intervention for people misusing alcohol to promote change and reduction • DASPA 03003330000 Drug alcohol single point access • Specialist consultant/ paediatrician in drug/alcohol? • History – assessment of alcohol intake only • Nothing known! • Health visitors • Ongoing information • Ask/advise/act WORKSHOPS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 11 What do wein RCT do to prevent alcohol use/misuse in pregnancy? Contd. • NHS information leaflets and booklets. Health visitors don’t give these out and midwives • HV ask about alcohol as part of Flying Start 30 – 34 weeks. Midwife goes earlier • Might be highlighted/supported by social workers if family history or family has children on the CPR/Child in Need • Professionals recommending zero tolerance • Midwives to complete alcohol substance use awareness form • Teen -start work with teenage mums in Swansea • RISMS work with pregnant mums as a priority – motivational videos, detoxing, relapse prevention therapy • IFST intense programme with pregnant mums • Alcohol liaison team through the hospital can refer to RISMS What could and should we do in RCT to prevent alcohol use/misuse in pregnancy? • More education prior to pregnancy. More information • Target group • Understanding reason why the mother drinks • Encourage parent/mother to be more honest about their drinking • Theatre productions for education into the community/creative avenues • Raise awareness • WAG need to make alcohol a priority • Choice – hot beverages stopped after 7.00pm? • Funding • Non- alcoholic bars and pubs • Media • Health professionals • Enforce a public message surrounding alcohol in GPs via posters • Early intervention • Better antenatal screening • Direct/ no nonsense approach • Price of alcohol and 24 hour licence should be stopped • Visual warnings • Adverts and health promotion • Government campaigns for public awareness • Better education • Clearer guidelines and messages • Show outcomes • No alcohol policy – zero tolerance • Question in midwife appointment • Spread the message more • Sex education • Advertise on bottles and cans • Give information at routine examinations such as smear tests • More research WORKSHOPS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 12 What could andshould we do in RCT to prevent alcohol use/misuse in pregnancy? • Maintain and enhance services already available • Ai m to make socially shameful eg. like smoking • Clear sign posting to provisions/pathways – statutory obligations • History/recording and collection of data • An RCT advocate for this area • Put ins – Child development course and childcare courses – lots of young people access this • More alcohol free promotion needed • Need to promote in family planning clinics • Routine questions and routine advice • More information delivery in schools • Substance misuse risk assessment tool C/S and HB – not new- used for at risk families • Brief intervention at point of finding out • Workshops in antenatal class/family links antenatal class • Messages on wine and alcohol bottles- health warning • Personal choice at later stages of pregnancy • Storyline in a soap of child with FASD and outcomes for that child in life • Deliver a clear and consistent message across all professions that alcohol is detrimental in pregnancy • Peer support groups • Social media excellent way to deliver messages to young parents • Al Wales approach WAG not isolate re geographical areas – a more strategic approach • Make sure that information is updated and consistent across LAs and clear • Ensure that women know the consequences • Support women who want to stop drinking in the same way as those who want to stop smoking • Access to mothers medical history • TV to promote through adverts and soaps • Policy change WG • Ensure that proper diagnosis takes place • Educate the professionals • Antenatal care -Parenting groups, HV and midwives, FS and IV, GP and hospital, Early Years • Advertising – social media, hard-hitting campaign from RCT people, local messages from local people, visual • Involve educating boys and men as well for support and knowledge • Educate children from a much younger age • Visual DVDs and posters • More marketing in GPs, Antenatal and hospitals, more packs available, good realistic handouts and for pre-pregnancy • Training for health professionals in delivering the message clearly 20/52 • More emphasis on pre-birth assessments carried out by social workers and other agencies in problem families • More specific targeted intervention for pregnant women WORKSHOPS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 13 What could andshould we do in RCT to prevent alcohol use/misuse in pregnancy? misusing alcohol or women who are misusing and at risk of pregnancy FF and IFST covers MT and RCT • Educate the public and the professionals • All professionals ‘singing from the same hymn sheet’ • Clear policy • Publicity campaign to prevent alcohol use in pregnancy eg posters in stores, magazines, on bottles, ‘message on a bottle’ campaign placed in alcohol aisle, experiment vodka egg! • Signposting for people who are dependent and looking at aspects of why they are dependent • Professionals lobbying government • Get young people involved in producing the material that will reach their generation and then placed in strategic places • Legalise the rights of the child and unborn child • Short sharp case studies for impact and effect • Try different strategies • Make it illegal • Advertise in pubs • Educate dads and adoption service • Awareness of impact of FASD • Routine smear tests Should RCT have a zero tolerance policy discouraging any alcohol consumption during pregnancy? • Yes gets rid of any confusion and is a clear consistent message • How would this be set up? • How would it be policed? Should it be policed? • Raise awareness at the start, throughout antenatal care, classes for drink, drugs and smoking • Education - Through school - Year 7 both boys and girls. Hard hitting campaign • Encourage changes in society/culture • Advertising • Health forms – alcohol questions • Correct and clear information available for everybody • Public health, high profile ongoing campaign • Services and support for people who need help to stop drinking • As professionals we should discourage any drinking during pregnancy • Impossible to police • Zero tolerance would be good in an ideal world, however increasing education and understanding are necessary steps • At least people would know about the recommendations, be educated about the reasons and would not be given ambiguous advice • Yes! So that information is consistent WORKSHOPS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 14 Should RCT havea zero tolerance policy discouraging any alcohol consumption during pregnancy? • Yes gets rid of any confusion and is a clear consistent message • How would this be set up? • How would it be policed? Should it be policed? • Raise awareness at the start, throughout antenatal care, classes for drink, drugs and smoking • Education - Through school - Year 7 both boys and girls. Hard hitting campaign • Encourage changes in society/culture • Advertising • Health forms – alcohol questions • Correct and clear information available for everybody • Public health, high profile ongoing campaign • Services and support for people who need help to stop drinking • As professionals we should discourage any drinking during pregnancy • Impossible to police • Zero tolerance would be good in an ideal world, however increasing education and understanding are necessary steps • At least people would know about the recommendations, be educated about the reasons and would not be given ambiguous advice • Yes! So that information is consistent • Drinking any alcohol during pregnancy can/could damage your baby FASD • Could cause brain damage • Has caused facial abnormalities • ‘Case study examples’ • Image of baby drinking bottle of wine! • More focus on training professionals • Urine tests CP cases • Information and advice • Clearer guidance • Human rights? • Prevention rather than cure • Make sure that fathers are involved • Change mindset of alcohol being culturally acceptable • Need processes in place earlier strategy meetings • Needs far greater supportive realistic services for the prospective parent • Earlier identification of problems, earlier intervention • Zero tolerance must come down from government and up from ground • Yes so all professionals are clearly stating that it is unacceptable for alcohol to be used during pregnancy rather than ‘it is OK to have one unit a week’ • However it should not be made illegal as it would be impossible to police, it would create a huge dark figure of crime around this issue and it would be seen as unacceptable for women to WORKSHOPS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 15 Should RCT havea zero tolerance policy discouraging any alcohol consumption during pregnancy? arrested, charged and prosecuted in society for having one drink • Suggestions reward • Abstinence ethos pregnancy – healthy baby – no alcohol/no risk • Should be UK wide • Health promotion needs developing • It would become more hidden with more danger to foetus • If a dependent drinker stopped drinking it could be dangerous for mother and baby. Possibly death of both or miscarriage • In all cases we should be delivering a clear and consistent message that alcohol is detrimental to an unborn child. Don’t like the word tolerance, further thought needs to go into this • Could alienate people • People need to feel empowered to change • Multi agencies working together • Increase the price of alcohol and get rid of BOGOF offers • Simpler way to understand the units of alcohol • Awareness of alcopops • Speakers in schools • Advertising in the cinema • Workshops • More medical research and awareness amongst the professionals WORKSHOPS
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 16 • Educationaround this needs to be promoted far more. • The exact implications and risks for children exposed to alcohol. • The lack of consistent education / information for women and families. • What foetal alcohol spectrum disorder is and the effects. • Effects of FASD on child and foster / adoptive family – evidence based. • Actual effects of drinking during pregnancy and the long term effects on the child. • That there is no safe alcohol intake whilst pregnant. • Better understanding of what FAS is and the impact it has on the lives of everyone concerned. • I have learned the effects of alcohol during pregnancy. • How serious the implications of drinking in pregnancy are. • More could be done to educate families about the risks of alcohol to babies and children – i.e. education, education and more education. • Developed knowledge on the cognitive effects of FAS was already aware of physical factors and development delays but build on existing knowledge. • Zero tolerance to alcohol in pregnancy. • Multi agency approach is essential. Training need for all professionals. • No mixed messages Re: safe drinking in pregnancy. None – Zero Tolerance. • Enjoyed Brian Roberts talk about the children with FASD. Talking back a zero alcohol. • Further understanding of the effects of alcohol consumption during pregnancy and a deeper understanding of FASD. • That FASD is as prevalent as it is. That knowledge of medical professionals with view to diagnoses / support is so van able. • The difficulty involved with the processes of diagnosing FASD – lack of funding. • Dr Raja Mukherjee presentation! Excellent. • Zero tolerance to alcohol. • Difficulty in diagnosing FASD. The long term impact on families and society of FASD. Zero tolerance policy is essential. • Lack of awareness amongst professionals e.g. GP’s! Similarities with ADHD – diff to define. • Dr Matujees key speech in depth understanding of the impact on a child’s brain. Gained a massive amount of information from this presentation. Conference Area 12 Comments (1)
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 17 • Excellent,interesting and very informative. Further awareness raising of FASD is required. • Very informative, enjoyed the visual videos. Really enjoyed it. • Excellent conference, speakers were informative and knowledgeable. Especially enjoyed the personal info from Brian Roberts. Success in raising awareness of FASD. • Very informative, everyone needs to work together on this. Enjoyed the speaker’s personal story. • Fantastic! Very informative. Very interesting speakers – Brian & Raja. • Excellent, very informative and thought provoking. • Both presentations were very good. Enjoyed watching the video of the children with FASD – Very moving. • Excellent! And I liked the fact Brian Roberts was able to provide examples and delivered training that he was educated / experienced in. • Excellent information and has definitely increased my knowledge. • Very interesting and informative, want to read more. Thought provoking, interesting informative and useful. • Physical signs of FASD and impact of drinking in pregnancy. • The number of lasting effects, which are life-long as a result of alcohol consumption in pregnancy. • Children / GP don’t necessarily have the physical facial features. • Early intervention and diagnosis is so important. Spread the word!!! Raise awareness!!! • Lifelong implications of FASD on children into adulthood. • The percentage of children and young people that are potentially affected by FASD in varying degrees. • I’m going to tell everyone I know!! And anyone who I don’t. • Effects of alcohol on children throughout their lives. • I have learnt the devastating impact that foetal alcohol spectrum disorder has on development, behaviour of child and this could all be prevented. Aware this is a problem for life baby – child – to adult. • Lack of awareness about FASD and support available. • Shocking to see how the effects of alcohol can actually harm the unborn child. There should be a zero tolerance to alcohol consumption during pregnancy. • Behavioural symptoms of FASD. Conference Area 12 Comments (2)
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 18 • Improvedknowledge and awareness. Alcohol and the relation with FASD. Awareness needed throughout Cwm Taf. • How prevalent FASD could potentially be with lac population. Understanding how much a unit of alcohol is. • Life-long disability. More education / awareness needed in this area. • Learned a great deal about the impact and the number of children affected. Great to talk and explore issues to try and come to a resolution of sorts. • Use information in my professional work. • Pass on information about FASD being life-long and advise no alcohol in pregnancy. • Greater awareness of effect on child. Inconsistent knowledge / advice given by all agencies we need universal message. • Learnt that something is at last being carried forward. That has been a long – known issue. • Main point of learning is the need for preventative WAG c???? and to really place this on the Gov WAG Agenda. • Some very informative and relevant, some a bit overwhelming and too scientific. (Difficult to understand) overall good. • The spectrum of FASD – Different levels of drinking at different stages in pregnancy have different effects. • Personal experience from Brian’s children. First hand evidence. • The effect drinking alcohol can have during pregnancy to the child through to adult life. • Then should be a clear and unambiguous message in relation to alcohol use in pregnancy. At peasant the message is mixed. • Raised awareness of FASD and its effects on child and family’s life. • Raised my awareness on foetal alcohol spectrum. • Did not realise that FASD caused so much impact. • Today has been an eye opener for me. It’s been good to learn of the symptoms. • The lack of consistent information given to mothers about drinking alcohol during pregnancy. • How children are affected by AFS and how many children. How the presentation overlaps with other disorders. • Gaining an understanding of FASD. I knew very little before today. • A clearer awareness of FASD. • Awareness of the adverse effects that alcohol consumption during pregnancy can have on the child. • Share information with colleagues – Effects of alcohol on the foetus as no previous knowledge. • That alcohol can / could have a massive impact on an unborn child that could stay with them throughout their life time. Conference Area 12 Comments (3)
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 19 • Similaritiesof ASD, ADHD. FASD and complexities of getting a diagnosis to support the children. Importance of gaining more knowledge and educating pregnant women and wider public. • Introduction to new topic with fantastic information and important implications. • Awareness of the effects of alcohol on the foetus, other than the physical facial features but effects on the brain and how this impacts on the behaviour of the child as they are growing up. • I have thoroughly enjoyed today’s conference and felt that I have gained small knowledge of FASD. I will research further into this topic. More education and knowledge is needed to be provided in this area. • More information needed across wider professionals what and where next? • There might be more children / adults affected by alcohol use during pregnancy than ever imagined. • That FASD is not clear cut, not everything has facial features or display the same behaviour. If it can be prevented why are we not doing so? • Don’t drink during pregnancy. • There is not enough information on FASD nor are people (professionals) educated enough. A big campaign is needed to spread the word. • More education needed early with appropriate levels of services / support. Clear zero tolerance in RCT starting at the top i.e. government campaign and involving all professionals i.e. GP’s, Health Visitors, Social Workers, Midwives etc. Public drive / campaign. • Raised more questions as long term needs of children with possible FASD. Particularly when considering adoption. • How vitally important it is for all professionals to have a greater understanding of the issue in order to begin to tackle it. • Understanding foetal alcohol disorder i.e. what it is, how it presents. Understanding units of alcohol. Why there are / is not much information or why there is a lack of clarity. • How it’s not just a ‘tick exercise’ when assessing children. Foetal Alcohol Syndrome – links in with so many symptoms and signs children exhibit. • More awareness about FASD. How many children I may have been involved with where this was a factor? • Zero tolerance required. Clear guidance needed to raise public understanding of consequences of drinking. Amazing quantity per unit. • Pint of wine – can be placed in a large glass! It’s been a shock to me! It could be for others. Conference Area 12 Comments (4)
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 20 Susan Allan EarlyYears Centre Manager Eleanor Aubrey Behaviour Support Senior Co-ordinator Richard Jon Bailyes RCt Apprentice Karen Barrett Social Worker Tracy Batstone Health Visitor Erica Beddoe Educational Psychologist Dawn Bishop Childcare Co-ordinator, Neath Port Talbot Ferenc Bliszko Head ofLearniner, Grow Enterprise Wales Ginny Bourne Disability Strand Co-ordinator, Vale of Glamorgan Lisa Bowen Assessor Victoria Bradbury Health Visitor Carolyn Burden Midwife Shirley Cale Behaviour support Teacher Beverley Carpenter Educational Psychologist Chris Carroll YOS Senior Practitioner Sam Cleaver AWO Lisa Clement-Jones Childcare Co-ordinator, Neath Port Talbot Joanne Coombes Social Worker Rachel Cooper FAST Vicki Cotter Mudiad Meithrin Officer Carol Daniel Head of Early Years & Family Support Services Gayle Davies Senior Childcare & Children’s Centre Manager Karen Davies FAST Lisa Davies Registered Manager Patricia Dobbs ASO Jill Duguay Parenting Practitioner Mary Eaton Wales PPA Manager Eve Edwards Health Visitor Gwyneira Edwards Social Edwards Gemma Emmanual Student Health Visitor Debbie Evans Health Visitor Jo Evans Language and Play Support Officer Julie Evans Senior Midwife Kim Evans Social Worker Sophie Evans Student Social Worker Wendy Evans Language and Play Support Officer Mandy Eynon Social Worker Kelly Farmilo Language and Play Support Officer Fay Fear Health Visitor Dr Marque Fernando Consultant, RISMS Emma Foley Specialist Health Visitor Bethan Foster Social Worker Rosalind Fry Deputy Manager Vanessa Gatland Social Worker Julie Gregory Social Worker Jodie Gunton Social Worker Katherine Hann-Jones Flying Start Leader Kate Harrington Speech and Language Therapist Angela Harvey Residential Childcare Practitioner Mark Hendy Dad Matters - Safer Families Michelle Hewer Health Visitor Sue Hitchins Health Visitor ATTENDEE LIST (1)
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  ©SCARLETDESIGN2013.MAPS:WWW.FRANOHARA.COM PAGE 21 Sandra Jones ChildcareManager Suzanne Jones Social Worker Marion Kerslake Health Visitor Hannah Lenaghan YOS Substance Misuse Worker Joanne Lewis Senior Practioner for Permanency Planning Corrine Lloyd Midwife Cerys Marsh Family Support Practitioner, Action for Children, Swansea Alyson Marshall Educational Psychologist Lourine Matsungo Social Worker, Vale of Glamorgan Lesley Matthews Health Visitor Debbie Maule Children’s Partnership Co-ordinator, Vale of Glamorgan Helen McMaster Educational Psychologist Samantha Methuen Educational Psychologist Isabel Monington Systemic Psychotherapist Belinda Moore Health Visitor Barri Morgan Support Worker Natalie Morgan Thomas Health Intervention Specialist Helen Morris Flying Start Workforce Development and Training Officer Luan Morris Health Visitor Gill Munro Gibbonsdown Children’s Centre Manager Rhiannon Ovendale Social Worker Jan Owen Senior Practitioner Jane Parker Social Worker Nicola Parry AWO Karen Perkins YOS Parenting Officer Mandy Perry Flying Start Senior Childcare & Premises Manager Ceri Ann Preece NNEB Janet Preece Training Centre Manager Lee Pritchard Behaviour support Teacher Kathryn Rees Health Intervention Specialist Cherry Richmond SLD Officer Talkabout - Talk & Play Louise Roche Toy Librarian Amanda Rossiter Health Visitor Susan Royal-Jones Health Visitor Julie Saunders Social Work Practitioner Martha Sercombe Health Visitor Julie Sheppard Language and Play Manager Dee Simmons Relapse Prevention Officer Angela Simon YOS Specialist Health Worker Stephanie Skinner Midwife Nicole Smith Student Health Visitor Hayley Speicher Senior Practitioner Wendy Stone Health Visitor Paula Stonelake Supervising Social Worker Tracy Symon Language and Play Support Officer Nicola Theobald Deputy Manager Nia Thomas Service Manager Early Years and Family Support Services Sally Thomas Midwife Sarah Thomas ASO Susan Thomas Dads Support Officer Claire Urch FAST Manager Vicky Walters Social Worker Karen Watkins Health Visitor Kay Williams FAST Michala Williams Health Visitor Rachel Williams Health Promotion Practitioner Sarah Williams Toy Librarian Lily Woolrich Social Worker ATTENDEE LIST (2)