220 research outputs found
Exploring systemic therapeutic approaches for individuals with intellectual disabilities using a narrative synthesis of existing research and interpretive phenomenological analysis: a portfolio thesis
BACKGROUND: This thesis portfolio comprises two main sections. The
first involves a systematic review exploring the outcomes of systemic
approaches used for individuals with intellectual disabilities with
additional mental health or behavioural needs, and their support
systems. Intellectual disability in one member of a system can have
an extensive impact on those around them, and often leads to
greater dependence on support systems. It is therefore important
that we understand how to adequately support the system and
sustain this resource. This systematic review sought to explore and
synthesise the outcomes of various systemic approaches used in this
context.
The second section takes the form of an empirical study to explore a
specific systemic intervention. The impact of intellectual disability
often leaves their carers at greater risk of stress and mental health
difficulties. Behavioural Family Therapy (BFT) is a form of
psychoeducational family intervention that was developed to reduce
stress and improve communication within families. This study aimed
to explore the experiences of primary caregivers for an individual
with intellectual disabilities and additional mental health or
behaviour difficulties, related to being a BFT participant.
METHOD: The systematic review involved a thorough search of online
databases and reference lists to identify relevant articles, as defined
by predetermined eligibility criteria. 12 articles were identified, which
were synthesised and evaluated using an adapted quality rating scale
recommended by CASP and SIGN guidelines checklists.
The empirical study involved engaging eight primary caregivers in
semi-structured interviews about their experiences of being a BFT
participant. Interviews were transcribed and analysed using
interpretive phenomenological analysis.
RESULTS: The systematic review highlighted the potential benefit of
using systemic approaches with individuals with intellectual
disabilities and their support systems. Several articles reported on
improvements in the behaviours of multiple family members, not just
the individual with the intellectual disability. Many also noted
improvements in the communication and interactions of system
members as well as overall improvements in relationships. However,
uncertainty regarding authors' definition of 'systematic approach'
made it difficult to ascertain the degree of true systemic influence
within evaluated interventions. Furthermore, the overall quality of
the reviewed articles was poor.
Three superordinate themes emerged from the empirical study
analysis; 'journey to acceptance and engagement in BFT', 'sense of
progression and change', and 'caregiving in a challenging system'. A
fear of judgement permeated caregiver narratives, which made
openness challenging. They felt that trust, empathy and validation
were essential elements in fostering a sense of safety and comfort
during disclosure. Caregivers also speculated on the timing of
intervention, some feeling that crisis enabled engagement, whilst
others felt crisis disabled their ability to attend to and engage in
intervention. Caregivers all reflected on their sense of adjustment
and benefit from BFT, with many reporting increased confidence in
their caregiving abilities. Lastly, all caregivers referred to the current,
consuming stress, and worry they were experiencing. This stress
demanded vast amounts of their attention, making it difficult to
engage in day-to-day tasks. This also led to difficulties in reflecting
during interview. Several reported increased cynicisms about the
world and the people in it, as a result of their experiences and their
sense of duty to protect the individual with intellectual disability.
These considerations were conceptualised in light of their
expectation to engage in and facilitate change in BFT.
DISCUSSION: The evident paucity of quality literature in this area
indicates the need for more research to build upon the limited
evidence base. Poor study quality often resulted from the study
design, their use of outcome measures (not validated for the
appropriate population) or lack thereof, and ambiguities relating to
defining systemic approaches. More methodologically sound
research would help to resolve these issues and may aid a better
understanding of the useful 'active ingredients' of systematic
intervention for use with individuals with intellectual disabilities and
their support systems.
The empirical study also highlights the benefit of further research
into the use of BFT in this population, though the results do indicate
that caregivers found elements of this intervention helpful. Results
are discussed in relation to existing research and current policy.
Limitations are acknowledged and clinical implications are discussed,
which include the importance of developing therapeutic trust, the
benefit of engaging the whole system as opposed to just two
members, and the need to acknowledge the severity of stresses
impacting the system's ability to accept and engage in BFT. Future
research exploring the experiences of individuals with intellectual
disabilities of being a BFT participant, would nicely complement this
study. Larger quantitative research may help to determine whether
objective changes, as postulated by caregivers in this study, may
occur at group level
Evaluation of the Reducing Reoffending Change Fund
The aim of this evaluation was to assess the extent to which the Public Social Partnerships model delivers effective mentoring services that reduce the risk of reoffending.
It was carried out by Ciaran Mulholland, Jane Eunson, Lorraine Murray and Louise Bowen (Ipsos MORI Scotland) in collaboration with Professor Gill McIvor, Dr Margaret Malloch, Professor Bill Whyte, Dr Steve Kirkwood and Professor Fergus McNeill
Review of the Aberdeen Problem-Solving Approach
Presentation delivered by Lorraine Murray, Hannah Graham and Jane Eunson, with co-authors and fellow researchers Gill McIvor and Margaret Malloch, at the Scottish Government launch event, 'Problem Solving Approaches' of this research on 5th September 2018 in Edinburgh
Evaluation of the 'You First' programme for young parents
You First was developed by Barnardo’s and funded by the Scottish Government. It targets vulnerable parents aged 21 and under, with a child under the age of one, who live in the 15% most deprived areas in Scotland. It aims to provide a boost for young, first time parents by increasing the support that they receive from their peers, the community and existing local services. The evaluation explored the benefits of the You First programme and the ways in which these could be maximised through effective delivery
Review of the Aberdeen Problem Solving Approach - Summary Briefing
A 6 page summary briefing of the full report, 'Review of the Aberdeen Problem-Solving Approach' (2018) by Jane Eunson, Lorraine Murray, Hannah Graham, Margaret Malloch and Gill McIvor. The Scottish Government commissioned Ipsos MORI Scotland and the Scottish Centre for Crime and Justice Research/University of Stirling to conduct an independent Review of the PSA between August 2017 and January 2018
Public acceptability of financial incentives for smoking cessation in pregnancy and breastfeeding: a survey of the British public
Objective: To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design.
Design: Cross-sectional survey. Setting and participants: British general public.
Methods: Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted
questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models.
Results: Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more
with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for
the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%).
Conclusions: Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions
Evaluation of protective effect of cyclodextrin glucanotransferase-treated Gastrodia elata Blume extract on ultraviolet B-induced premature skin aging
Purpose: To investigate the protective effect of Gastrodia elata Blume (G. elata, GE) and cyclodextrin glucanotransferase (CGTase) enzyme-treated G. elata extract (EGE) against premature skin aging using ultraviolet B (UVB)-exposed normal human dermal fibroblasts (NHDFs).Methods: The extract was characterized by liquid chromatography with tandem mass spectrometry (LC-MS/MS), ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC–QToF–MS) and nuclear magnetic resonance spectroscopy (NMR). The expression of matrix metalloproteinases (MMP-1,3), interleukin-6 (IL-6), transforming growth factor (TGF-β1) and procollagen type I was assayed using ELISA kits. Safety evaluation of EGE’s dietary administration and topical application was performed by in vivo acute oral toxicity and local lymph node tests.Results: Lower MMP-1 and IL-6 and higher procollagen type I and TGF-β1 levels were observed after treatment with EGE than with GE, indicating that EGE was more effective than GE in treating UVBinduced photoaging. With respect to phenolic composition, EGE had lower 4-hydroxybenzaldehyde (4- HBA) level and higher α-gastrodin level than GE. In UVB-irradiated NHDFs, α-gastrodin exhibited higher anti-aging activity than 4-HBA and β-gastrodin based on the expression of MMP-1, MMP-3, and procollagen type I. The in vivo data indicate that EGE was safe at concentrations of up to 2000 mg/kg for dietary administration and 0.1 % for topical application.Conclusion: EGE protects UVB-induced photoaged human skin better than GE owing to its higher α- gastrodin content. Thus, EGE may be potentially useful agent in anti-aging cosmetic products.Keywords: Gastrodia elata, α-Gastrodin, Anti-aging, CGTase, Ultraviolet B (UVB) irradiation, Matrix metalloproteinase, Procollagen, Normal human dermal fibroblast
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