Support services for victims and survivors of child sexual abuse

Some of the content in this report may be distressing to readers.Aims The four broad research aims were to: ● understand more about victims and survivors’ reasons for not accessing support services and any barriers to access; ● learn about victims and survivors’ perceptions and experiences of support services; ● understand what support services victims and survivors think are available to them and how to access them; and ● explore whether there are unmet needs for support services which impact on whether victims and survivors access support. Methods The sample was drawn from 634 adults who self-identified as victims and survivors of child sexual abuse as part of the ‘Abuse during childhood’ module in the Crime Survey for England and Wales (CSEW) year ending March 2019 (Office for National Statistics, 2020).3 A mixed-methods approach was used to explore the above research aims: ● A quantitative online survey4 of 181 victims and survivors from the CSEW recontact sample, including both those who had and had not accessed support. Descriptive and inferential analyses were conducted. ● Twenty-four qualitative in-depth interviews with three groups: (A) eight who had not accessed support services; (B) eight who self-identified as having had positive experiences of support services; and (C) eight who had negative experiences of support services. The interviews were analysed using thematic analysis. These were supplemented with six pen portraits (two from each of the above groups), and a network map to aid understanding of the service landscape. The research participants The ages of the survey respondents ranged from 19 to 74 years, with an average of 47 years. Around four in five identified as female (82%), the majority identified as being of a White ethnic background (92%), and one in three reported having a disability (33%). All regions of England and Wales were represented, with one in four living in London or South East England (26%). Nearly nine in ten identified as heterosexual (89%) Respondents reported experiencing between one and eight types of child sexual abuse. The two most common forms were being kissed or groped on any part of the body in a sexual way (73%) and penetration (64%). The age at first victimisation spanned from infancy to 17 years old, with an average of 9 years old. Child sexual abuse was more likely to have occurred in a familial setting (41%) than an institutional one (11%). Two in five (43%) respondents identified a friend, acquaintance or neighbour as the perpetrator. Around one in four (27%) identified an immediate – typically male – family member as the perpetrator. A stranger was identified by one in five (20%) respondents. Just over one in five respondents had never previously disclosed their experiences of child sexual abuse (21%), while four in five had made a disclosure (79%). Respondents were more than twice as likely to report making a disclosure later in life (75%) than at the time of the abuse (28%). A quarter disclosed at both points (24%)

Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT): a study protocol for a randomised controlled trial of a Resource Kit.

BACKGROUND: Improving care at home for people with dementia is a core policy goal in the dementia strategies of many European countries. A challenge to effective home support is the occurrence of crises in the care of people with dementia which arise from changes in their health and social circumstances. Improving the management of these crises may prevent hospital admissions and facilitate better and longer care at home. This trial is part of a National Institute for Health Research funded programme, AQUEDUCT, which aims to improve the quality and effectiveness of teams working to manage crises in dementia. METHODS/DESIGN: It is a pragmatic randomised controlled trial of an online Resource Kit to enhance practice in teams managing crises in dementia care. Thirty teams managing mental health crises in dementia in community settings will be randomised between the Resource Kit intervention and treatment as usual. The primary outcome measure is psychiatric admissions to hospital for people with dementia in the teams' catchment area recorded 6 months after randomisation. Other outcomes include quality of life measures for people with dementia and their carers, practitioner impact measures, acute hospital admissions and costs. To enhance understanding of the Resource Kit intervention, qualitative work will explore staff, patient and carers' experience. DISCUSSION: The Resource Kit intervention reflects current policy to enable home-based care for people with dementia by addressing the management of crises which threaten the viability of care at home. It is based upon a model of best practice for managing crises in dementia designed to enhance the quality of care, developed in partnership with people with dementia, carers and practitioners. If the Resource Kit is shown to be clinically and cost-effective in this study, this will enhance the probability of its incorporation into mainstream practice. TRIAL REGISTRATION: ISRCTN 42855694 ; Registered on 04/03/2021; Protocol number: 127686/2020v9; Research Ethics Committee, 09/03/2021, Ref 21/WM/0004; IRAS ID: 289982

Shifting baselines for species in chronic decline and assessment of conservation status. Are hazel dormice Muscardinus avellanarius endangered?

•1. Long-term data are beneficial for monitoring the conservation status of species. Assessments of population change over recent periods of fixed duration will, however, be subject to ‘shifting baselines’, where the accepted norm for the population at the start of the period already represents a reduction from historical levels. International Union for Conservation of Nature Red List criteria for categorizing conservation threat rely on assessing declines against quantitative thresholds, generally measured over 10 years, as indications of the likelihood of extinction in the near future. By contrast, legal frameworks such as the European Habitats Directive require states to achieve and sustain ‘Favourable Conservation Status’ for protected species, while domestic conservation legislation can have more diverse objectives and mechanisms, based on local contexts that extend beyond biological or quantitative criteria. •2. We explore the challenges associated with assessing the risk of extinction and the conservation status that arise from the availability of long-term monitoring data for hazel dormice Muscardinus avellanarius in the United Kingdom. •3. Numbers of adult dormice counted in the National Dormouse Monitoring Programme are in ongoing decline, amounting to an overall decline of 78% (95% confidence interval = 72%–84%) over 27 years, 1994–2020. If the observed annual rate of decline of 5.7% (95% CI = 4.7%–6.8%) were to continue unabated, dormouse counts would decline by >90% from 1994 to 2034. Despite this, the species would never be categorized as Endangered, under IUCN criteria, which specify a reduction of >50% within 10 years. •4. While such chronic decline may not indicate imminent risk of extinction, justifying a higher Red List category, it is a demonstration of unfavourable conservation status at a national scale. Prioritization based on demonstration of such chronic declines might direct more effective action towards species conservation at a point when their recovery is more attainable, rather than attempting later to reverse a journey to the brink of extinction when the species is finally ‘Endangered’

Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT): A Study Protocol for a Randomised Controlled Trial of a Resource Kit.

BACKGROUNDImproving care at home for people with dementia is a core policy goal in the dementia strategies of many European countries. A challenge to effective home support is the occurrence of crises in the care of people with dementia which arise from changes in their health and social circumstances. Improving the management of these crises may prevent hospital admissions and facilitate better and longer care at home. This trial is part of a National Institute for Health Research funded programme, AQUEDUCT, which aims to improve the quality and effectiveness of teams working to manage crises in dementia.METHODS/DESIGNIt is a pragmatic randomised controlled trial of an online Resource Kit to enhance practice in teams managing crises in dementia care. Thirty teams managing mental health crises in dementia in community settings will be randomised between the Resource Kit intervention and treatment as usual. The primary outcome measure is psychiatric admissions to hospital for people with dementia in the teams’ catchment area recorded six months after randomisation. Other outcomes include: quality of life measures for people with dementia and their carers; practitioner impact measures; acute hospital admissions; and costs. To enhance understanding of the resource kit intervention, qualitative work will explore staff, patient and carers’ experience.DISCUSSIONThe Resource Kit intervention reflects current policy to enable home-based care for people with dementia by addressing the management of crises which threaten the viability of care at home. It is based upon a model of best practice for managing crises in dementia designed to enhance the quality of care, developed in partnership with people with dementia, carers and practitioners. If the Resource Kit is shown to be clinically and cost effective in this study, this will enhance the probability of its incorporation into mainstream practice.TRIAL REGISTRATION: ISRCTN 42855694; Registered on 04/03/2021; Protocol number: 127686/2020v9; Research Ethics Committee, 09/03/2021, Ref 21/WM/0004; IRAS ID: 28998

Gadolinium free cardiovascular magnetic resonance with 2-point Cine balanced steady state free precession

BACKGROUND: Cardiovascular magnetic resonance (CMR) of ventricular structure and function is widely performed using cine balanced steady state free precession (bSSFP) MRI. The bSSFP signal of myocardium is weighted by magnetization transfer (MT) and T1/T2-relaxation times. In edematous and fibrotic tissues, increased T2 and reduced MT lead to increased signal intensity on images acquired with high excitation flip angles. We hypothesized that acquisition of two differentially MT-weighted bSSFP images (termed 2-point bSSFP) can identify tissue that would enhance with gadolinium similar to standard of care late gadolinium enhancement (LGE). METHODS: Cine bSSFP images (flip angles of 5° and 45°) and native-T1 and T2 maps were acquired in one mid-ventricular slice in 47 patients referred for CMR and 10 healthy controls. Afterwards, LGE images and post-contrast T1 maps were acquired and gadolinium partition coefficient (GPC) was calculated. Maps of ΔS/S(o) were calculated as (S(45)-S(5))/S(5)*100 (%), where S(flip_angle) is the voxel signal intensity. RESULTS: Twenty three patients demonstrated areas of myocardial hyper-enhancement with LGE. In enhanced regions, ΔS/S(o), native-T1, T2, and GPC were heightened (p < 0.05 vs. non-enhanced tissues). ΔS/S(o), native-T1, and T2 all demonstrated association with GPC, however the association was strongest for ΔS/S(o). Bland-Altman analysis revealed a slight bias towards larger volume of enhancement with ΔS/S(o) compared to LGE, and similar transmurality. Subjective analysis with 2-blinded expert readers revealed agreement between ΔS/S(o) and LGE of 73.4 %, with false positive detection of 16.7 % and false negative detection of 15.2 %. CONCLUSIONS: Gadolinium free 2-point bSSFP identified tissue that enhances at LGE with strong association to GPC. Our results suggest that with further development, MT-weighted CMR could be used similar to LGE for diagnostic imaging. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12968-015-0194-1) contains supplementary material, which is available to authorized users

Whole person recovery: a user-centred systems approach to problem drug use.

Problematic drug and alcohol use has a profound impact on society. From the personal and social harms to the financial costs of drug-related crime and medical treatment, this is a burden that is increasingly hard to bear not only economically, but morally and socially. Moreover it is one that may increase as we enter a period of economic hardship. There is a constant need for new insights, and new approaches to help people address the problems associated with drug and alcohol use, and to do so sustainably and frugally given the current financial conditions. The RSA’s Whole Person Recovery Project aims to understand in a holistic way how problematic drug and alcohol users become trapped in cycles of addiction, what helps or hinders their journey to recovery, and how their recovery can be sustained. We do so not merely to contribute some fresh insight into this complex and important problem, although this is clearly important, but to make the insight a catalyst for users themselves, and members of their communities, to foster recovery through their collective social effort and innovation

The role of incentives in assisting unemployed people into employment : the impact of the JobFinder’s Grant

Publicly funded support for assisting unemployed people back into work usually focuses on improving their vocational or job seeking skills, or providing financial incentives to employers to hire them. Very few schemes provide financial incentives directly to unemployed people to encourage them into employment. One such scheme is the Jobfinder’s Grant ( JFG) which, at present, provides a £200 flat rate payment to aid very long-term unemployed people (i.e. out of work for more than two years) in finding a job. The Grant is intended to encourage very long-term unemployed people `to take jobs that they would not otherwise have taken’. That is, to encourage people to begin or intensify their job search activity and, for others, to widen the range of jobs for which they might apply. During its pilot phase (April 1995-March 1997) the level of Grant and the way it was administered varied from region to region. This variation allows us to analyse the role direct financial incentives have on people’s job search behaviour and their decisions to take up job offers. The findings of the evaluation are particularly important in the current debate about increasing opportunities and incentives for people to return to work