After the reforms: An analysis of the factors associated with the use of legal services in child welfare proceedings in Ireland

Against the backdrop of austerity measures and public sector reforms in Ireland, this paper examined legal costs incurred in child welfare proceedings by the State Child and Family Agency - Tusla, using a need-based allocation model. The direct financial costs of engaging with legal services, necessitated by the adversarial nature of child welfare proceedings, were scrutinized to determine if resources were allocated based on need. Adopting a cross-sectional research design, secondary data (obtained from the organization’s financial billing system. n =1032) were employed in an econometric analysis examining the factors influencing variations in Tusla’s legal expenditure. The dependent variable was total amount billed by legal firm per observation and the independent variables included type of legal activity involved (a proxy for need), geographical location and type of legal personnel (supply factor). Type of legal personnel, volume and type of legal activity have significant positive effects on legal spend. Administrative area does not significantly affect spending on legal services. We found that engagement with legal services, demanded by the adversarial nature of child welfare proceedings, has considerable cost implications; however, does seem to be allocated on the basis of need. The findings can be employed to increase the organization’s awareness of costs

Pathways for practitioners' participation in creating the practice-research encounter

Several major evaluation reports agree that while we know much about interventions that are effective, little use is made of them to help achieve important outcomes for children, families, and adults. Practice-Research uses locally based research and/or evaluation in an attempt to fill this gap. Not understood as a specific research method, Practice-Research is intended as an evolving meeting point between practice and research, and a matter of negotiation between its stakeholders. Central importance is given to practitioners' participation. The article will present and discuss three European experiences that realise Practice-Research in different ways. The aim of the article is to define and analyze differences and commonalities among the three experiences, in order to outline strategies for developing a fruitful encounter between practice and research. Particular emphasis is placed on interaction and discussion, providing opportunities for people to change and gain meaning through interacting, offering opportunities for practitioners to discuss and reflect on the practices and research results.Diversi rapporti di valutazione evidenziano l’avanzamento delle conoscenze per quel che riguarda gli elementi che garantiscono l’efficacia degli interventi, ma scarso uso si sta facendo di essi per supportare il raggiungimento di risultati importanti per i bambini, le famiglie e gli adulti. La Practice-Research si basa su pratiche si ricerca e/o di valutazione svolte a livello locale nel tentativo di colmare questa lacuna. Essa non è intesa come uno specifico metodo di ricerca, ma come punto di incontro in costante evoluzione tra la pratica e la ricerca, e come una questione che riguarda la negoziazione tra i suoi partecipanti. Grande importanza è data alla partecipazione degli operatori. L’articolo presenta e discute tre esperienze europee che in diversi modi hanno realizzato l’incontro tra ricerca e pratica. Lo scopo dell’articolo è di definire e analizzare le differenze e gli elementi in comune tra le tre esperienze, al fine di delineare le strategie per un proficuo incontro tra pratica e ricerca. Particolare enfasi è posta SUL DIALOGO tra i partecipanti, come opportunità di cambiare e acquisire nuovi significati attraverso il confronto, anche offrendo l'opportunità di discutere e riflettere sulle pratiche e sui risultati della ricerca

Costs and Cost-Effectiveness of Training Traditional Birth Attendants to Reduce Neonatal Mortality in the Lufwanyama Neonatal Survival Study (LUNESP)

The Lufwanyama Neonatal Survival Project (“LUNESP”) was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness.We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011–2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as ‘conservative’ and ‘optimistic’ scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and$127,756, respectively, or $49,469 and$53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and$26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866,$591, and $3,024, and cost per DALY averted was$74, $24, and$120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation.Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was ‘highly cost effective’. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care

Pathways for practitioners\u27 participation in creating the practice-research encounter

Several major evaluation reports agree that while we know much about interventions that are effective, little use is made of them to help achieve important outcomes for children, families, and adults. Practice-Research uses locally based research and/or evaluation in an attempt to fill this gap. Not understood as a specific research method, Practice-Research is intended as an evolving meeting point between practice and research, and a matter of negotiation between its stakeholders. Central importance is given to practitioners\u27 participation. The article will present and discuss three European experiences that realise Practice-Research in different ways. The aim of the article is to define and analyze differences and commonalities among the three experiences, in order to outline strategies for developing a fruitful encounter between practice and research. Particular emphasis is placed on interaction and discussion, providing opportunities for people to change and gain meaning through interacting, offering opportunities for practitioners to discuss and reflect on the practices and research results.Diversi rapporti di valutazione evidenziano l’avanzamento delle conoscenze per quel che riguarda gli elementi che garantiscono l’efficacia degli interventi, ma scarso uso si sta facendo di essi per supportare il raggiungimento di risultati importanti per i bambini, le famiglie e gli adulti. La Practice-Research si basa su pratiche si ricerca e/o di valutazione svolte a livello locale nel tentativo di colmare questa lacuna. Essa non è intesa come uno specifico metodo di ricerca, ma come punto di incontro in costante evoluzione tra la pratica e la ricerca, e come una questione che riguarda la negoziazione tra i suoi partecipanti. Grande importanza è data alla partecipazione degli operatori. L’articolo presenta e discute tre esperienze europee che in diversi modi hanno realizzato l’incontro tra ricerca e pratica. Lo scopo dell’articolo è di definire e analizzare le differenze e gli elementi in comune tra le tre esperienze, al fine di delineare le strategie per un proficuo incontro tra pratica e ricerca. Particolare enfasi è posta SUL DIALOGO tra i partecipanti, come opportunità di cambiare e acquisire nuovi significati attraverso il confronto, anche offrendo l\u27opportunità di discutere e riflettere sulle pratiche e sui risultati della ricerca

Building Bridges: Insights for Developing a Comprehensive Peer Advocacy Model for Multiple Complex Needs in Stockton-on-Tees

Background and Aims: As Stockton-on-Tees endeavours to address the challenges faced by its residents with multiple complex needs, a pilot initiative has been developed to enhance support for these individuals through peer advocacy. The present study aimed to gather insights into stakeholders’ and peer advocates’ expectations for the multiple complex needs peer advocacy pilot. Recognising the potential of peer advocacy to bridge service gaps and foster a more empathetic, inclusive collaborative network, this study sought to inform the pilot’s development with actionable insights, grounded in the lived experiences and professional expertise of those closest to the community’s needs.Method: This study employed a participatory research approach, with three peer advocates acting as peer researchers and assisting with data collection and interpretation. Semi-structured interviews were conducted online with 11 stakeholders and 13 peer advocates, aiming to capture a broad spectrum of perspectives on the planned peer advocacy model. Participants, selected through purposive and convenience sampling, included individuals actively engaged in or closely connected to the support services sector within Stockton-on-Tees. Data analysis followed an inductive thematic approach, allowing for an in-depth exploration of expectations, perceived challenges, and recommendations for the pilot.Results: The study revealed a strong consensus on the value of peer advocacy in enhancing service access and user engagement, with empathy and lived experience highlighted as key components of effective support. Anticipated challenges included service accessibility, mental health support gaps, and the need for a holistic, integrated service model. Stakeholders and peer advocates alike emphasised the importance of continuous innovation and community engagement in addressing the evolving needs of individuals with complex challenges.Recommendations: To optimise the pilot’s impact, recommendations arising from these findings include expanding peer advocacy training, developing integrated service models, enhancing community and family engagement, implementing ongoing evaluation mechanisms, and advocating for policy and funding support. These recommendations aim to ensure the pilot is well-equipped to provide comprehensive, person-centred support, reflecting the collaborative vision of a transformed support culture in Stockton-on-Tees.Conclusions: This study highlights the central role of peer advocacy in reimagining support for Stockton-on-Tees’s most vulnerable residents. By harnessing the insights of stakeholders and peer advocates, the pilot can offer a model of support that is not only responsive and inclusive but also committed to empathy, understanding, and sustainable change. The findings and recommendations from this study provide a foundation for the pilot, guiding its strategic development and implementation towards achieving transformative outcomes for individuals with multiple complex needs