53 research outputs found
Reflections on the implementation of the Gifted and Talented policy in England, 1999–2011
This paper, as part of an on-going study looking at the impact of gifted and talented policies on an inner-city school, explores the role of the local authority in implementing the various gifted and talented initiatives since 1999, when local authority gifted and talented co-ordinators were first appointed under the Excellence in Cities (DfEE, 1999) programme
Reflections on the implementation of the Gifted and Talented policy in England, 1999–2011
This paper, as part of an on-going study looking at the impact of gifted and talented policies on an inner-city school, explores the role of the local authority in implementing the various gifted and talented initiatives since 1999, when local authority gifted and talented co-ordinators were first appointed under the Excellence in Cities (DfEE, 1999) programme
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Practitioner Review: effectiveness of indicated school-based interventions for adolescent depression and anxiety - a meta-analytic review
Background: Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. This paper aims to provide a meta-analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10-19 with elevated symptoms of depression and/or anxiety.
Methods: Eight electronic databases were systematically searched from inception to April 2019 for eligible trials. Study quality was assessed using two scales designed to evaluate psychotherapy intervention trials. Random effects meta-analyses were conducted separately for trials that recruited participants based on symptoms of depression and based on symptoms of anxiety.
Results: Data from 45 trials were analysed. Most interventions studied used cognitive and behavioural strategies. Few studies met methodological quality criteria, but effect size was not associated with study quality. Indicated school-based interventions had a small effect on reducing depression symptoms (SMD = 0.34, 95% CI -0.48, -0.21) and a medium effect on reducing anxiety symptoms (SMD=-0.49, 95% CI -0.79, -0.19) immediately post-intervention. Subgroup analyses indicated that interventions delivered by internal school staff did not have significant effects on symptoms. Reductions in depression were maintained at short-term (≤6 months) but not medium (>6 months ≤12) or long-term (>12 month) follow up. Reductions in anxiety symptoms were not maintained at any follow up.
Conclusions: Indicated school-based interventions are effective at reducing symptoms of depression and anxiety in adolescents immediately post-intervention but there is little evidence that these reductions are maintained. Interventions delivered by school staff are not supported by the current evidence-base. Further high quality randomised controlled trials incorporating assessment of longer-term outcomes are needed to justify increased investment in school-based interventions for adolescent depression and anxiety
Transforming Community Health Services for Children and Young People who are Ill : A quasi-experimental evaluation
Background: Children’s community nursing (CCN) services support children with acute, chronic, complex and end-of-life care needs in the community. Objectives: This research examined the impact of introducing and expanding CCN services on quality, acute care and costs. Methods: A longitudinal, mixed-methods, case study design in three parts. The case studies were in five localities introducing or expanding services. Part 1: an interrupted time series (ITS) analysis of Hospital Episode Statistics on acute hospital admission for common childhood illness, and bed-days and length of stay for all conditions, including a subset for complex conditions. The ITS used between 60 and 84 time points (monthly data) depending on the case site. Part 2: a cost–consequence analysis using activity data from CCN services and resource-use data from a subset of families (n = 32). Part 3: in-depth interviews with 31 parents of children with complex conditions using services in the case sites and a process evaluation of service change with 41 NHS commissioners, managers and practitioners, using longitudinal in-depth interviews, focus groups and documentary data. Findings: Part 1: the ITS analysis showed a mixed pattern of impact on acute activity, with the greatest reductions in areas that had rates above the national average before CCN services were introduced and significant reductions in some teams in acute activity for children with complex conditions. Some models of CCN appear to have more potential for impact than others. Part 2: the cost–consequence analysis covered only part of the CCN teams’ activity. It showed some potential savings from reduced admissions and bed-days, but none that was greater than the total cost of the services. Part 3: three localities implemented services as planned, one achieved partial service change and one was not able to achieve any service change. Organisational stability, finance, medical stakeholder support, competition, integration with primary care and visibility influenced the planning and implementation of new and expanded CCN services. Feeling supported to manage their ill child at home was a key outcome of using services for parents. Various service features contributed to this and were important in different ways at different times. Other outcomes included being able to avoid hospital care, enabling the child to stay in school, and getting respite. Although parents judged that care was of high quality when teams enabled them to feel supported, reassured and secure in managing their ill child at home, this did not depend on a constant level of contact from teams. Limitations: Delays in service reconfigurations required adaptation of research activity across sites. Use of administrative data, such as Hospital Episode Statistics, for research purposes is technically difficult and imposed some limitations on both the ITS and the cost–consequence analyses. Conclusions: Large, generic CCN teams that integrate acute admission avoidance for all children with support for children with complex conditions and highly targeted teams for children with complex conditions offer the possibility of supporting children more appropriately at home while also making some difference to acute activity. This possibility remains to be tested further. Future work: Further work should refine the evidence on outcomes of services by looking at outcomes in promising models, value for money and measuring quality-based outcomes. Funding: The National Institute for Health Research Health Services and Delivery Research Programme
Performance indicators: good, bad, and ugly
A striking feature of UK public services in the 1990s was the rise of performance monitoring (PM), which records, analyses and publishes data in order to give the public a better idea of how Government policies change the public services and to improve their effectiveness. Copyright 2005 Royal Statistical Society.
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