Does quantitative research in child maltreatment tell the whole story? The need for mixed-methods approaches to explore the effects of maltreatment in infancy

Background and Aims. Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children (N = 92) entering care (age 6–60 months) combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families. Methods. Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents. Results. Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms (p = 0.001) and between reported domestic violence and decreased DAI inhibited (p = 0.016) and disinhibited (p = 0.004) attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1) overlapping maltreatment factors occur in most cases and (2) maltreatment effects may be particularly challenging to isolate. Conclusions. Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches

Literature, intuition and faith

This thesis is entitled ‘Literature, Intuition and Faith’ and it aims to create a new critical perspective of Thomas Hardy’s novels by examining four of his best-known works. I will suggest that the novels of Thomas Hardy reveal a particular narrative concerning the idea of spiritual intuition and the Hardyean protagonist. The discussion will use as its methodology a close analysis of the sub-textual impulses of the novels rather than the considerable biographical information that is already available on Thomas Hardy. The contention of the thesis is that in contrast to Hardy’s expressed allegiance to agnosticism, an unspoken and so far unrecognised narrative of intuitive spiritual faith inhabits the text

What do users value about the emergency ambulance service?

Introduction: Response times have been used as a key quality indicator for emergency ambulance services in the United Kingdom, but criticised for their narrow focus. Consequently, there is a need to consider wider measures of quality. The patient perspective is becoming an increasingly important dimension in pre-hospital outcomes research. To that end, we aimed to investigate patients’ experiences of the 999 ambulance service to understand the processes and outcomes important to them. Methods: We employed a qualitative design, using semi-structured interviews with a purposive sample of people who had recently used a 999 ambulance in the East Midlands. We recruited patients of different age, sex, geographical location, and ambulance service response including ‘hear and treat’, ‘see and treat’ and ‘see and convey’. Results: We interviewed 20 service users. Eleven men and nine women participated and 12 were aged 65 years and over. Users valued a quick response when they perceived the call to be an emergency. This was of less value to those who did not perceive their situation as an emergency and irrelevant to ‘hear and treat’ users. All users valued the professional approach and information and advice given by call handlers, crew and first responders, which provided them with reassurance in a worrying situation. ‘See and convey’ users valued a seamless handover to secondary care. Limitations: We found it challenging to engage participants to consider quality indicators beyond response times because these were considered to be abstract in comparison with their concrete experiences. Conclusions and recommendations: Aspects other than response times were important to patients, particularly in situations perceived by patients to be non-emergency. The results will be combined with issues identified from systematic reviews and used in a Delphi study to identify candidates for new outcome measures for emergency ambulance services

Examining the feasibility of an economic analysis of dyadic developmental psychotherapy for children with maltreatment associated psychiatric problems in the United Kingdom

Background: Children with maltreatment associated psychiatric problems are at increased risk of developing behavioural or mental health disorders. Dyadic Developmental Psychotherapy (DDP) was proposed as treatment for children with maltreatment histories in the USA, however, being new to the UK little is known of its effectiveness or cost-effectiveness. As part of an exploratory study, this paper explores the feasibility of undertaking economic analysis of DDP in the UK. Methods: Feasibility for economic analysis was determined by ensuring such analysis could meet key criteria for economic evaluation. Phone interviews were conducted with professionals (therapists trained and accredited or in the process of becoming accredited DDP practitioners). Three models were developed to represent alternative methods of DDP service delivery. Once appropriate comparators were determined, economic scenarios were constructed. Cost analyses were undertaken from a societal perspective. Finally, appropriate outcome measurement was explored through clinical opinion, literature and further discussions with clinical experts. Results: Three DDP models were constructed: DDP Full-Basic, DDP Home-Based and DDP Long-Term. Two potential comparator interventions were identified and defined as Consultation with Carers and Individual Psychotherapy. Costs of intervention completion per case were estimated to be: £6,700 (DDP Full-Basic), £7,100 (Consultations with Carers), £7,200 (DDP Home-Based), £11,400 (Individual Psychotherapy) and £14,500 (DDP Long-Term). None of the models of service delivery were found to currently measure effectiveness consistently. The Strengths and Difficulties Questionnaire (SDQ) was deemed an appropriate primary outcome measure, however, it does not cover all disorders DDP intends to treat and the SDQ is not a direct measure of health gain. Inclusion of quality of life measurement is required for comprehensive economic analysis. Conclusions: Economic analysis of DDP in the UK is feasible if vital next steps are taken to measure intervention outcomes consistently, ideally with a quality of life measurement. An economic analysis using the models constructed could determine the potential cost-effectiveness of DDP in the UK and identify the most efficient mode of service delivery

The feasibility of a randomised controlled trial of Dyadic Developmental Psychotherapy

Background: Maltreated children have significant and complex problems which clinicians find difficult to diagnose and treat. Previous US pilot work suggests that Dyadic Developmental Psychotherapy (DDP) may be effective; however, rigorous evidence from a randomised controlled trial (RCT) is lacking. The purpose of this study is to establish the feasibility of an RCT of DDP by exploring the ways that DDP is operating across different UK sites and the impacts of current practice on the potential set-up of an RCT. Methods: Qualitative methods (interviews, focus groups and teleconferences) were used to explore trial feasibility with therapists and service managers from teams implementing both DDP and possible control interventions. Data were analysed thematically and related to various aspects of trial design. Results: DDP was commonly regarded as having a particular congruence with the complexity of maltreatment-associated problems and a common operating model of DDP was evident across sites. A single control therapy was harder to establish, however, and it is likely to be a non-specific and context-dependent intervention/s offered within mainstream Child and Adolescent Mental Health Services (CAMHS). Because a ‘gold standard’ Treatment as Usual (TAU) does not currently exist, randomisation between DDP and TAU (CAMHS) therefore looks feasible and ethical. The nature of family change during DDP was regarded as multi-faceted, non-linear and relationship-based. Assessment tools need to be carefully considered in terms of their ability to capture change that covers both individual child and family-based functioning. Conclusions: An RCT of DDP is feasible and timely. This study has demonstrated widespread interest, support and engagement regarding an RCT and permissions have been gained from sites that have shown readiness to participate. As maltreated children are among the most vulnerable in society, and as there are currently no treatments with RCT evidence, such a trial would be a major advance in the field

So Which Households Can Benefit from Energy Efficiency and is there an Argument to Fund from the Public Purse? Research Briefing 04

Improving household energy efficiency has a positive impact on a more efficient household’s income. This is because money saved by the permanent reduction in energy bills will be available to spend year on year. An EPSRC funded team at the Centre for Energy Policy and Fraser of Allander Institute at the University of Strathclyde has analysed the macroeconomic expansion likely to follow successful energy efficiency measures. This highlights the multiple dividends of energy savings, boosted GDP, employment and income benefits which result from energy efficiency measures. This latest work begins to explore the impact of focusing policy only on fuel poor households but finds that the more wide-ranging the boost to energy efficiency, the greater the economic expansion is likely to be. The multiple dividends are particularly obvious in the case where all households rather than just fuel poor households are targeted. This is due to both the greater stimulus and limited spending power of low income households. Governments should consider the wider economic and social benefits of spending on energy efficiency when designing energy efficiency policy, evaluating its outcome and making budget decisions

So What If There Were a Larger and More Sustained Energy Efficiency Effort across the Economy, What Would be the Impact? Research Briefing 03

The real challenge of positive economic impacts is to those policy makers who are working hard to develop sustainable energy savings. As disposable household income is spent, additional energy is consumed as the economy seeks to meet increased demand for goods and services. Over time this can erode the initial absolute energy savings of the original initiative. Thus, a key challenge in the near term is to better understand this type of economic rebound effect and its impact on net energy savings. Improving our understanding of how people use this income released by lower energy bills will allow energy policy makers to better forecast net energy efficiency outcomes and to better accommodate economic growth, while retaining energy savings and carbon reductions

How Improving Household Efficiency Could Boost the Scottish Economy

While European governments continue to invest in energy efficiency as a key tool of energy and climate policy, there is increased interest in the broader economic benefits of energy efficiency in a social and economic context. Recent studies show that, beyond the direct effects on energy use and spending, multiple positive impacts of energy efficiency improvements exist in the wider economy as a whole. Gross Domestic Product (GDP) increases linked to household efficiency enhancements could well be an outcome of both implementing and realising energy efficiency measures. A team from the Centre for Energy Policy (CEP) and Fraser of Allander Institute (FAI) at the University of Strathclyde have used modelling and simulation to explore the economy wide impacts of energy efficiency improvements in households.1 A clear, long lasting stimulus to the economy is triggered by improving the energy efficiency of homes; this is because the disposable income of householders increases as a result of saving money on energy bills. The team used modelling to trace the economic impact of this disposable income increase. The simulation suggested that a spending-led GDP boost can be triggered and could have wider impacts in employment and public budgets. Associated with the increased economic activity will be an increase in energy use that tends to reduce the ultimate level of energy savings from an energy efficiency action. Such an effect is called “rebound”. However, by encouraging spending in low carbon products and services, the erosion of energy savings could be minimised

Randomisation before consent : avoiding delay to time-critical intervention and ensuring informed consent

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