More haste, less speed? : an evaluation of fast track policies to tackle persistent youth offending in Scotland

In 2003 the Scottish Executive introduced a new 'Fast Track' policy on a pilot basis, which was intended to speed up the processing of persistent youth offending cases and reduce rates of persistent offending. Additional resources were provided to promote access to dedicated programmes, as well as quicker assessment, report delivery and decision making. This paper, based on a multi-stranded comparative evaluation, describes how the policy was welcomed by a wide range of practitioners, decision makers and managers involved with children's hearings who mostly thought it was a positive innovation consistent with the hearing system's commitment to a welfare-based approach. 'Fast Track' cases were handled more quickly than others. After two years, however, the policy was discontinued, largely because of negative evidence about re-offending

The outcomes of secure care in Scotland

This paper describes the findings of a three year study of the use and effectiveness of secure accommodation in Scotland. Data were collected on 53 young people shortly after their admission to secure accommodation. Most young people were admitted because they were a danger to themselves and/or they were likely to abscond; a third were considered a danger to others. Secure accommodation was considered to have benefits in relation to keeping young people safe and addressing health issues. On other dimensions, such as behaviour or family relationships, signs of benefit were more ambiguous. Thirty-three young people were considered to have clearly benefited from placement. At follow-up, after two years, outcomes were assessed as: 'good' - 14 (26%); 'medium'- 24 (45 %); and 'poor' - 15 (28%). The research highlighted the importance of effectively managing the transition from secure care. Social workers attributed a good outcome more to an appropriate placement and education being offered when the young person left secure rather than simply the placement itself. A gradual 'step-down' approach from the structure and supervision of the secure setting was also linked to better outcomes. Young people respond well when offered continuity and the opportunity to develop relationships with one or more reliable adults who can help with problems as they arise

Secure Accommodation in Scotland: Its Role and Relationship with ‘Alternative’ Services - Summary

This research was carried out between November 2002 - 2005 to increase understanding of the use and effectiveness of secure accommodation in relation to young people placed on the authority of a children's hearing. It also examined the circumstances in which open residential or community-based services might provide an ‘alternative' to secure placement

Charter-School Management Organizations: Diverse Strategies and Diverse Student Impacts

Examines the growth of charter school management organizations, characteristics of students served, and use of resources; CMO practices; impact on students, including middle school test scores; and structures and practices linked to positive outcomes

Fast Track Children's Hearings Pilot : Final Report of the Evaluation of the Pilot

The Scottish Executive decided that a Fast Track approach to the children's hearings system would be introduced in early 2003 on a pilot basis in selected parts of Scotland. The aim was to improve practice and outcomes with respect to the ways that the hearings system and associated services dealt with young people who persistently offend. Particular objectives were to: • reduce the time taken both overall and at each stage of decision-making • promote more comprehensive assessments which include appraisals of offending risk • ensure that all young people who persistently offend and who require an appropriate programme have access to one • reduce re-offending rates as a result of the concerted efforts made in such cases

Skill mix and the effectiveness of nursing care

The objective of the study was to examine the links between inputs into the process of nursing, in particular, the skill mix of nursing staff and the outputs of nursing in terms of the quality and outcome of care. The review of literature revealed several ambiguities and conceptual problems at the measurement level which needed to be clarified prior to data collection itself. The overall objectives of the project were: - To develop and field test measures for monitoring the quality and outcome of nursing care. - To identify the major input and process variables which need to be taken into account in monitoring the impact of nursing skill mix. - To investigate the links between skill mixes and the quality and outcome of the care provided. - To relate the full costs of different skill mixes to both the quality of care and to the outcomes for patients of that care. The research design was discussed extensively with senior nurse managers and research nurses. It was decided to focus extensively on a professional assessment of the delivery of nursing care: the patients’ perceptions, although acknowledged to be very important, were therefore excluded. The design focused on those aspects of care which were almost totally within the control of nurses. A case study approach was adopted, data being collected in 15 acute medical or surgical wards at seven hospital sites by qualified nurses trained as observers by the research teams. The sample of hospitals and wards was chosen within the constraints of gaining permitted access but, while not being statistically representative of all hospital wards in England and Wales, ensured that a wide variation in contrasting styles of ward structures and nursing organisation was covered. Thus both Nightingale and nuclear wards were selected, some with primary nursing, some with patient allocation and some with team nursing; the choice of hospitals included both district general and teaching hospitals in both rural and urban areas throughout the country. Instruments were devised and field tested by the research team before the main study. In particular, a set of event-based outcome measures were devised to complement the measure of process quality. The data were analysed at three levels. Firstly, at the level of patient/nurse interaction; secondly, at the level of the observation session (the two-hour observation of interactions between nurses and patients) and thirdly, at the ward level. The measurement of skill mix followed two main approaches. One was by grade predominance – where the ratings recorded at the interaction level referred to one grade (the predominant grade) more than any other grade. Secondly, a grade mix index was developed by allocating scores of 1-6 to each grade (Learner = 1, F/G Grade = 6) involved in an interaction and weighting the score by the number of grades involved. In general, the main results of several analyses can be summarised by saying that grade mix had an effect on the quality of care in so far as the quality of care was better the higher the grade (and skill) of the nurses who provided it, but that the variation in the quality of care between different grades of staff was reduced when higher graded staff worked in combination with lower graded staff. These results were robust as far as this study was concerned, they occurred in different approaches to measuring skill mix and from analysing the data at different levels of aggregation. At the ward level better outcomes were also associated with greater proportions of staff in Grade D and above independently of the effect of quality. Several methodological improvements are suggested as a result of the study both in terms of the criteria for choosing and designing instruments and in terms of augmenting the usefulness of both the Qualpacs instrument and the event-based outcome measures. Finally, the results have been related to current debates about staff and skill substitution and the use of support staff. The variations in both quality and outcome with higher grade staff suggest that investment in employing qualified staff, providing post-qualification training and developing effective methods of organising nursing appeared to pay dividends in the delivery of good quality patient care.skill mix, nursing

Calling an ambulance for non-emergency medical situations: Results of a cross-sectional online survey from an Australian nationally representative sample

Objective To investigate the Australian general public\u27s perception of appropriate medical scenarios that warrants a call to an emergency ambulance. Methods An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of non-emergency scenarios (n = 8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged \u3e18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. Results From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was ‘Lego in ear canal’ (11%), ‘Older person bruising’ (8%) and ‘Flu’ (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for non-emergency scenarios. Conclusions Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts

development and optimisation of a face-to-face behavioural intervention component

After weight loss, most individuals regain lost weight. Interventions to support the transition from successful loss to weight loss maintenance (WLM), regardless of the method of prior weight loss, are needed. The aims of this study were to (1) develop a face-to-face behavioural intervention session to support overweight and obese individuals who have recently lost a clinically significant amount of weight in the transition to WLM; (2) to assess the single-session intervention for acceptability and feasibility prior to its use in a larger, 12-month, multi-component trial; and (3) to optimise the intervention session for future use based on participant feedback. Participants with a Body Mass Index of ≥25 kg/m2 prior to a ≥5% weight loss in the previous 12 months were recruited via the local government authority and community-based advertisements. Each attended the one-hour session with a trained facilitator, which focused on setting maintenance-relevant weight, eating, and physical activity goals. Semi-structured interviews were carried out immediately post-session to obtain feedback on the acceptability of this intervention component. Data were used to generate recommendations for changes to the session, which were discussed by the team, and used to optimise the session. Seventeen participants (13 female; median WL = 13%) were recruited. All participants evaluated the intervention session positively; 11 participants suggested improvements including reducing information provision in favour of greater focus on identifying and coping with barriers, and the inclusion of practical examples. The systematic refinement and optimisation process resulted in an acceptable and feasible face-to-face behavioural intervention session (described here), which will be tested as part of a multi-component intervention. We anticipate the session could be used to supplement existing support including online services, and has the potential to benefit people who have lost a clinically significant amount of weight to achieve WLM over the long term

Irregular meal pattern-effects on energy expenditure, metabolism and appetite regulation: a randomized controlled trial in healthy normal-weight women

Background: Obesity is increasing in parallel with greater all-day food availability. The latter may promote meal irregularity, dysregulation of the energy balance, and poor metabolic health. Objective: We investigated the effect of meal irregularity on the thermic effect of food (TEF), lipid concentrations, carbohydrate metabolism, subjective appetite, and gut hormones in healthy women. Design: Eleven normal-weight women (18–40 y of age) were recruited in a randomized crossover trial with two 14-d isoenergetic diet periods (identical foods provided and free living) that were separated by a 14-d habitual diet washout period. In period 1, participants followed a regular meal pattern (6 meals/d) or an irregular meal pattern (3–9 meals/d), and in period 2, the alternative meal pattern was followed. Before and after each period, when participants were fasting and for 3 h after intake of a test drink, measurements were taken of energy expenditure, circulating glucose, lipids (fasting only), insulin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and ghrelin. An ad libitum test meal was offered. Subjective appetite ratings were assessed while fasting, after the test drink, after the ad libitum meal, and during the intervention. Continuous interstitial glucose monitoring was undertaken for 3 consecutive days during each intervention, and the ambulatory activity pattern was recorded (ambulatory energy expenditure estimation). Results: Regularity was associated with a greater TEF (P , 0.05) and a lower incremental area under the curve (iAUC) for glucose after intake of the test drink (over 3 h) and, for some identical meals, during the 2 interventions (over 90 min) (day 7: after breakfast; day 9: after lunch and dinner). There was no difference between treatments for the test-drink gut hormone response. A time effect was noted for fasting GLP-1, fasting PYY, PYY responses, and hunger-rating responses to the test drink (P ˂ 0.05). Lower hunger and higher fullness ratings were seen premeal and postmeal during the regular period while subjects were free living. Conclusion: Meal regularity appears to be associated with greater TEF and lower glucose responses, which may favor weight management and metabolic health. This trial was registered at clinical trials.gov as NCT02052076

Effects of aroma and taste, independently or in combination, on appetite sensation and subsequent food intake

Food flavour is important in appetite control. The effects of aroma and taste, independently or in combination, on appetite sensation and subsequent food intake, were studied. Twenty-six females (24 ± 4 years, 20.9 ± 1.9 kg⋅m-2) consumed, over 15 min period, one of four sample drinks as a preload, followed by an ad libitum consumption of a pasta meal (after 65 min). Sample drinks were: water (S1, 0 kcal), water with strawberry aroma (S2, 0 kcal), water with sucrose and citric acid (S3, 48 kcal) and water with strawberry aroma, sucrose and citric acid (S4, 48 kcal). Appetite sensation did not differ between the S1 (water), S2 (aroma) and S3 (taste) conditions. Compared with S1 (water), S2 (aroma) and S3 (taste), S4 (aroma + taste) suppressed hunger sensation over the 15 min sample drink consumption period (satiation) (p < 0.05). S4 (aroma + taste) further reduced hunger sensation (satiety) more than S1 at 5, 20 and 30 min after the drink was consumed (p < 0.05), more than S2 (aroma) at 5 and 20 min after the drink was consumed (p < 0.05), and more than S3 (taste) at 5 min after the drink was consumed (p < 0.05). Subsequent pasta energy intake did not vary between the sample drink conditions. S4 (aroma + taste) had the strongest perceived flavour. This study suggests that the combination of aroma and taste induced greater satiation and short-term satiety than the independent aroma or taste and water, potentially via increasing the perceived flavour intensity or by enhancing the perceived flavour quality and complexity as a result of aroma-taste cross-modal perception