Parenting a moving target: understanding how young people’s lives are changing

How are young people’s lives changing, particularly in the digital age? Ann Hagell and John Coleman share insights from the Key Data on Adolescence report and look at changes currently impacting young people. Every two years, the Association for Young People’s Health (AYPH) publishes a compendium of publically available statistics about young people’s health, which provides a unique picture of their lives in the round. Ann is a chartered psychologist with a special interest in adolescence and research lead at the AYPH. John is the AYPH Chair, a clinical psychologist, and senior research fellow in the Department of Education at the University of Oxford

Engaging young people in NHS service delivery and development : A scoping review of the evidence

Commissioned by the NHS England, alongside a survey and interviews with NHS staff, this review found that while there is widespread support for youth participation in the development and delivery of healthcare services, it is not very clear what is actually being undertaken in practice within the NHS, or what the evidence is for good practice. We do have a fairly extensive literature on models of participation more generally that can be usefully applied to this context, and a developing sense of the categories of engagement that are being employed in developing and monitoring health services for young people. However, this scoping review concluded that, in terms of good practice and what works, there is much less evidence available, and we know very little about how engagement ‘works’ for the young people involved. What does exist in the research literature suggests that much of what is going on is piecemeal, short lived, or lacking clear aims and outcomes. While there may be a fair amount of consulting and informing taking place, truly empowering models of participation are rarely documented. There is clearly a need for more evidencing, both in terms of a description of what is undertaken, but also analysis of impact. Finding ways to improve the evidence base is now critical if participation is going to have the transformative impact on the system that it has the potential to achieve

Engaging young people in NHS service delivery and development : Recommendations from a scoping review and research project

Young people need to be involved at all levels of our healthcare system, from shaping the care they are receiving at the front line right up to co-designing and inputting to strategic change. What we mean by health services in this context is any NHS funded or branded service that manages the health and wellbeing of young people (10-25 year olds), ranging from primary care, through secondary and tertiary services, and including community services, mental health services, and allied health professional services such as physiotherapy and occupational health. NHS England is committed to working in partnership with young people but this requires planning, resources and guidance. There is high level policy support for this, and anecdotal accounts of good work going on in practice on the ground. However, despite high levels of commitment to working together with young people and representing their voice in policy and planning, our understanding of what is actually happening on the ground within the system is somewhat lacking. NHSE’s children and young peoples’ transformation team commissioned the authors to map the territory and provide an understanding of what we do and do not know about best practice in this area. As a result of an evidence scope and our own research into what is happening in the system, we concluded that very limited progress had been made in developing this workstream in recent years. Echoing other reports dating back two decades, our conclusions were that we need better accounts of what is going on, more resources dedicated to these kinds of activities, and some serious investment in evaluating impact. These conclusions do not need repeating and provide us with nothing new. What we need now is action to improve the evidence base. This document, linked to reports on the associated research and scoping review lists recommendations for taking forward work in this area

Engaging young people in NHS service delivery and development : Results from a sector survey and interviews

Despite considerable and growing support for public and patient participation with young people in the development and delivery of health services, what is actually being done in practice across the country is not widely known or shared. In order to present an overview of current practice we undertook a scoping exercise, including a survey and interviews. The overall picture was positive, in that there is clear ambition and commitment to broadening the participation of young people in health services design and delivery, and many examples of work ongoing. There is consensus on the essential building blocks, and the challenges and barriers. However, the work is sketchy, patchy, and happening in silos. The extent to which individual attempts are successful, enduring and meaningful varies hugely and many fail for lack of resources and staff capacity or skills. The work is often under recognised and under resourced. There is clearly room for guidance across the health system to help people decide what kind of participation work is feasible and appropriate for them, and to provide some pointers to good practice

Experience of primary care services among early adolescents in England and association with health outcomes

This document is the Accepted Manuscript version of the following article: Arrash A. Yassaee, Dougal S. Hargreaves, Kayleigh Chester, Stephanie Lamb, Ann Hagell, and Fiona Brooks, Experience of Primary Care Services Among Early Adolescents in England and Associated with Health Outcomes, Journal of Adolescent Health, Vol. 60 (4): 388-394, first published 1 December 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ The version of record is available online at doi: http://dx.doi.org/10.1016/j.jadohealth.2016.09.22 © 2016 Society for Adolescent Health and Medicine. All rights reserved.Purpose The aim of this study was to investigate adolescents' (11–15 years) experience of their general practitioner (GP), whether poor reported GP experience was associated with worse physical and mental health measures and whether poor previous GP experience was linked to lower utilization of these services. Methods We used logistic regression to analyze data from the 2014 Health Behaviour in School-aged Children study. Four aspects of recent care experience were studied: feeling at ease, feeling treated with respect, satisfaction with doctor's explanation, and feeling able to discuss personal matters. Five dichotomized measures of health status were used: ever self-harmed; fair or poor self-reported health; frequent (at least weekly) low mood; sleeping problems; or headaches. Results Of 5,335 students, 4,149 reported having visiting their GP within the past year. Of these, 91.8% felt treated with respect, 78.7% felt at ease, 85.7% were satisfied with explanation, and 53.9% felt able to discuss personal matters. After adjusting for ethnicity, age, gender, and family affluence score, poor experience on any indicator was strongly associated with increased risk of self-harm (adjusted odds ratio range, 2.01–2.70; all p < .001); feeling low (AOR range, 1.53–2.11; all p < .001); and sleeping problems (AOR range, 1.49–1.91; all p ≤ .001). Poor experience on all indicators, except discussing personal matters, was associated with worse self-reported health. Conclusions Nearly half of this large, national study of adolescents did not feel able to discuss personal matters with their doctor. There was a consistent, strong association between reported lack of good GP experience and poor health measures.Peer reviewedFinal Accepted Versio

Adolescent mental health difficulties and educational attainment: findings from the UK household longitudinal study.

OBJECTIVE: This study examines whether there is an independent association between mental difficulties in adolescence and educational attainment at age 16. DESIGN: Longitudinal study. SETTING: Nationally representative data from the UK Household Longitudinal Study (UKHLS) were linked to the National Pupil Database for England. PARTICIPANTS: Respondents (N=1100) to the UKHLS between 2009 and 2012 were linked to the National Pupil Database to investigate longitudinal associations between mental difficulties at ages 11-14 and educational attainment at age 16 (General Certificate of Secondary Education (GCSE)). PRIMARY OUTCOME MEASURE: Not gaining five or more GCSE qualifications at age 16, including English and maths at grade A*-C. RESULTS: An atypical total mental health difficulty score measured using the Strengths and Difficulties Questionnaire at ages 11-14 predicted low levels of educational attainment at age 16 (OR: 3.11 (95% CI: (2.11 to 4.57)). Controlling for prior attainment and family sociodemographic factors, happiness with school (/work) and parental health, school engagement and relationship with the child partially attenuated the association, which was significant in the fully adjusted model (2.05, 95% CI (1.15 to 3.68)). The association was maintained in the fully adjusted model for males only (OR: 2.77 (95% CI (1.24 to 6.16)) but not for females. Hyperactivity disorder strongly predicted lower attainment for males (OR: 2.17 (95% CI: (1.11 to 4.23)) and females (OR: 2.85 (95% CI (1.30 to 6.23)). CONCLUSION: Mental difficulties at ages 11-14 were independently linked to educational success at age 16, highlighting an important pathway through which health in adolescence can determine young people's life chances

Exploring the Activities and Target Audiences of School-Based Violence Prevention Programs: Systematic Review and Intervention Component Analysis.

Adolescents are at an increased risk for experiencing dating and relationship violence (DRV) and gender-based violence (GBV). School-based interventions remain an important and frequently used method for DRV/GBV prevention. A clear understanding and description of the different components of school-based interventions specific to DRV/GBV is needed to organize and advance the array of prevention efforts being utilized in school settings. We conducted an intervention component analysis to create a taxonomy for school-based interventions addressing DRV and GBV. We searched 21 databases in July 2020 and updated searches in June 2021, alongside extensive supplementary search methods. We included randomized controlled trials (RCTs) in adolescents of compulsory school-age that were implemented within the school setting which partially or wholly focused on DRV and GBV topics. Our analysis included 68 studies describing 76 different school-based interventions. Through an iterative coding process we identified 40 intervention components organized within 13 activity categories, including both student-directed components and non-student-directed components such as activities for school personnel and family members of students. We also identified components addressing higher levels of the social-ecological model including structural-social and structural-environmental aspects of DRV/GBV which prior reviews have not considered. This taxonomy of components and synthesis of intervention efficacy for DRV/GBV school-based interventions provides a framework for comparing past intervention evaluations and constructing new interventions to address these issues at multiple levels within a community

School-based interventions to prevent dating and relationship violence and gender-based violence: systematic review and network meta-analysis American Journal of Public Health

Background. Schools are sites of dating and relationship violence (DRV) and of gender-based violence (GBV) victimization and perpetration. School-based interventions can reach a broad range of students, targeting both individual and group processes that may underpin DRV and GBV. Considering DRV and GBV jointly is important because of their shared etiologies. Comparing the effectiveness of interventions using network meta-analysis (NMA) can support decision-making on optimal resource use. Objectives. To evaluate the comparative effectiveness of school-based interventions for children aged 5 to 18 years on DRV and GBV victimization, perpetration, and related mediators. Search Methods. We searched 21 databases in July 2020 and June 2021, alongside extensive supplementary search methods, including gray literature searches, forward and backward citation chasing, and searches on first and last author names. Selection Criteria. We included randomized-controlled trials of interventions for children of compulsory school age implemented within the school setting, and either partially or wholly aimed at changing DRV or GBV outcomes. Data Collection and Analysis. Pairwise meta-analyses using random-effects robust variance estimation considered intervention effectiveness on DRV and GBV victimization and perpetration using odds ratios, and on mediators (e.g., knowledge and attitudes) using standardized mean differences. Effects were divided into short-term (< 12 months postbaseline) and long-term (≥ 12 months postbaseline). NMAs on victimization and perpetration outcomes compared interventions categorized by breadth of mechanism and complexity of delivery and implementation. Meta-regression tested sensitivity to percentage of girls in the trial sample and country context. Main Results. Our analysis included 68 trials. Evidence was stronger overall for effects on DRV than for GBV, with significant long-term impacts on DRV victimization (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.68, 0.99) and DRV perpetration (OR = 0.78; 95% CI = 0.64, 0.94). Knowledge and attitudinal effects were predominantly short-term (e.g., for DRV-related violence acceptance, d = 0.16; 95% CI = 0.08, 0.24). NMAs did not suggest the superiority of any intervention type; however, most analyses for GBV outcomes were inconsistent. A higher proportion of girls in the sample was associated with increased effectiveness on long-term victimization outcomes

Systematic review of the economics of school-based interventions for dating violence and gender-based violence

Dating and relationship violence (DRV) and gender-based violence (GBV) among children and young people incur a high cost to individuals and society. School-based interventions present an opportunity to prevent DRV and GBV early in individuals’ lives. However, with school resources under pressure, policymakers require guidance on the economics of implementing interventions. As part of a large systematic review funded by the National Institute for Health and Care Research (NIHR), we searched for economic evaluations and costing studies of school-based interventions for DRV and GBV. No formal economic evaluations were identified. Seven studies reporting costs, cost savings, or resource use for eight interventions were identified. The largest costs of implementing interventions were related to staff training and salaries but savings could be made by implementing interventions on a large scale. The potential cost savings of avoided DRV and GBV far outweighed the costs of implementation

School-based interventions TO Prevent Dating and Relationship Violence and Gender-Based Violence: STOP-DRV-GBV systematic review

Background Schools have a duty of care to prevent violence between students but a significant amount of dating and relationship violence and gender-based violence occurs in schools. These are important public health issues with important longitudinal consequences for young people. Objectives To understand functioning and effectiveness of school-based interventions for the prevention of dating and relationship violence and gender-based violence. Review methods We undertook a mixed-methods systematic review to synthesise different types of evidence relating to school-based interventions for the prevention of dating and relationship violence and gender-based violence to understand if, how and in what ways these interventions are effective. We searched 21 databases and 2 trial registers and undertook forwards and backwards citation chasing, author contact and other supplementary search methods. Searches identified all literature published to June 2021. All screening was undertaken in duplicate and independently, and we quality appraised all included studies. Results We included 247 reports (68 outcome evaluations, 137 process evaluations). Synthesis of intervention components produced an intervention typology: single-component, curricular, multicomponent, and multilevel programmes. Synthesis of intervention theories suggested that interventions aiming to increase students’ sense of school belonging and sense of safety in the school building could encourage increased learning of prosocial skills and increased prosocial peer norms, and so potentially reducing dating and relationship violence and gender-based violence. Synthesis of factors affecting delivery highlighted school organisation and leaders who believed in the importance of addressing dating and relationship violence/gender-based violence, along with time and resources to deliver the interventions. The ease with which the intervention could be delivered and modified was also important. Meta-analysis found stronger evidence for intervention effectiveness in reducing dating and relationship violence than for gender-based violence, with significant long-term impacts on dating and relationship violence victimisation and perpetration, and some evidence that interventions in high-income countries could be effective for reducing victimisation and perpetration of gender-based violence in the long-term. Impacts on knowledge and attitudes were primarily short-term. Network meta-analysis did not suggest superiority of any intervention type. Moderation evidence suggested interventions reduced dating and relationship violence perpetration in boys more than girls, but reduced gender-based violence perpetration more in girls. Metaregression by intervention component did not explain heterogeneity in effectiveness, but qualitative comparative analysis suggested that reducing perpetration was important to reducing victimisation, and that perpetration could be reduced via focus on interpersonal skills, guided practice and (for gender-based violence) implementation of social structural components. Limitations Despite an exhaustive search, trials may have been missed and risk of publication bias was high for several analyses. Conclusions This is the most comprehensive systematic review of school-based interventions for dating and relationship violence and gender-based violence to date. It is clear that the prevention of dating and relationship violence and gender-based violence in schools will require longer-term investment to show benefit