Children's experiences of art therapy

This study aimed to explore children’s experiences of art therapy in order to create a theory of change processes within school-based art therapy. A total of 14 children were interviewed at two different schools, along with their parents, teachers, and art therapists. All children had received art therapy within the last 12 months. Semi-structured individual interviews were undertaken with 40 participants. Children completed a craft activity within their interview as a visual expression of their therapy experience. Interview data was analysed using grounded theory methodology. The results generated three theoretical models. The first model highlighted the systemic nature of the art therapy as well as describing it as mysterious. Model 2 described the processes within art therapy, focusing on the individualised child-centred nature of the intervention. Art doing was considered central to the children’s expressions and developing understandings. Model 3 described the trajectory of change for the children. The study recommends that psychologists consider art therapy for children who are struggling to verbalise their difficulties; that clinicians focus on therapeutic experiences being fun and enjoyable for the child, as well as embedded within the child’s system; and lastly that clear target problems are identified at the start of therapy

Processes of change in school-based art therapy with children: a systematic qualitative study

Although theoretical processes of art therapy with children have been suggested, they have lacked a systematic research basis. This systematic qualitative study explored children’s school-based one-to-one art therapy in order to create a theory of change. Across two primary schools, 14 children were interviewed individually, as were their parents, teachers and art therapists (total N = 40). All children had received art therapy within the previous 12 months. Children completed an art activity to aid the interview process. Interview data were analysed using grounded theory methodology. The analysis generated a preliminary model with three components. ‘Component 1—school context’ highlights the systemic nature of art therapy as well as its mystique to those not directly involved. ‘Component 2—core model’ describes art therapy as individualised and child-centred. Art-doing and making were considered central to children’s expression and developing understandings. ‘Component 3—change and no change’ describes the connection between identifying therapy aims and perceiving change. Recommendations are that art therapy be considered for children struggling to verbalise their difficulties; that therapists focus on therapeutic experiences being fun and enjoyable for the child, as well as embedded within the child’s system; and lastly that clear target problems are identified at the start of therapy

Primary palliative care research: opportunities and challenges.

INTRODUCTION: Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed. THE STUDY METHODS: Using a mixed-methods approach, quantitative data were extracted from the general practitioner (GP) and district nurse (DN) records of 400 recently deceased patients in 20 GP practices in the East of England. Focus groups were conducted with some GPs and DNs, and individual interviews held with bereaved carers and other GPs and DNs. THE CHALLENGES ADDRESSED: Considerable difficulties were encountered with ethical permissions, with GP, DN and bereaved carer recruitment and both quantitative and qualitative data collection. These were overcome with flexibility of approach, perseverance of the research team and strong user group support. This enabled completion of the study which generated a unique primary palliative care data set.National Institute for Health Research (NIHR) Research for Patient Benefit Programme. National Institute for Health Research (NIHR) School for Primary Care Research (SPCR). National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of Englan

An Investigation of the Effectiveness of Arts Therapies Interventions on Measures of Quality of Life and Wellbeing: A Pilot Randomized Controlled Study in Primary Schools

Background: Over the last decades there has been a change in the way schooling is perceived recognizing that children’s learning is closely linked to children’s health. Children spend most of their time at school, which is often the place where problems are identified and interventions are offered, not only for treatment but also prevention. Embedding arts therapies into the educational system may help address children’s emerging needs and have a positive impact on their wellbeing. Methods: A pilot cross-over randomized controlled design was employed to investigate the effectiveness of an arts therapies intervention on a series of child- and teacher-reported outcome measures, specifically, health related quality of life (assessed using a HRQOL scale; EQ-5D-Y), wellbeing and life functioning (assessed using the child outcome rating scale; CORS), emotional and behavioral difficulties (assessed using the strengths and difficulties questionnaire; SDQ), as well as duration of sleep (assessed using Fitbits). Sample size calculations for future large-scale studies were also performed, and the sustained impact of the intervention was evaluated at 3, 6, and 12 months follow-up. The pluralistic theoretical and therapeutic framework of this intervention was informed by a systematic review on school-based arts therapies interventions and is presented in detail in the study protocol. Participants were 62 children with mild emotional and behavioral difficulties. Results: Improvements in HRQOL and CORS were greater in those engaged in the arts therapies intervention than the control groups and were maintained at the follow-up stages. Significant improvements were only found for duration of sleep (P = 0.002) and SDQ (P = 0.008). Minimal clinically important differences (MCIDs) as defined in the published protocol were found for CORS, SDQ and duration of sleep, but not HRQOL. Discussion: Findings indicate that the arts therapies interventions were having a clinically significant effect on life functioning, duration of sleep, emotional and behavioral difficulties. Findings also indicate a small effect size for health related quality of life, suggesting the intervention was having a small positive effect on this outcome measure. The study indicates that all outcome measures assessed here would be suitable for inclusion in a larger randomized controlled study utilizing these arts therapies interventions, and that a sample size of 225 participants would be required if these outcome measures were used

Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial.

BACKGROUND: Studies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care. METHODS: This study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366. FINDINGS: 1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, -3·5 mm Hg [95% CI -5·8 to -1·2]; telemonitoring, -4·7 mm Hg [-7·0 to -2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference -1·2 mm Hg [95% CI -3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups. INTERPRETATION: Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care. FUNDING: National Institute for Health Research via Programme Grant for Applied Health Research (RP-PG-1209-10051), Professorship to RJM (NIHR-RP-R2-12-015), Oxford Collaboration for Leadership in Applied Health Research and Care, and Omron Healthcare UK

Decision pathways in patent searching and analysis

The article investigates the applicability of the techniques of decision analysis to patent searching, to achieve better searches and better understood outputs. Amongst topics explored are decision hierarchy (strategic, tactical, operational), decision models (deterministic, probabilistic), influence diagrams and decision trees, suitable software, and patent search decision points (illustrated by an example search). The author concludes that decision analysis can improve working methods and the conduct of complex searches, but suggests that further research is needed, especially in quantifying the risk associated with legal decisions in the patent search context.Decision analysis Patent searching Decision hierarchy Decision models Influence diagrams Decision trees