Using stakeholder involvement, expert knowledge and naturalistic implementation to co-design a complex intervention to support children’s inclusion and participation in schools: The CIRCLE framework

Donald Maciver - ORCID: 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 2021-03-16Whist inclusion is recommended for most children most of the time it remains difficult to implement. In this paper, we present the process undertaken to review and redesign a pre-existing complex intervention (The CIRCLE Framework) which was designed to enhance teachers confidence and competence in provision of universal first level supports for 5-12 year old children with additional support needs. The approach presented draws on the Medical Research Council guidance for the development of complex interventions. A series of ten co-design workshops with 70 stakeholders was completed, applying interactive and participatory methods. Analysing outputs of each workshop revealed recurring design ideas that became the main aspects of the new framework and associated manuals. Intervention content, theoretical frameworks, manuals to support use in practice and implementation strategies were developed. On completion, the updated intervention was extended up to 18 years of age and redistributed to all teachers in the participating local authority. We present the main conclusions and interpretations around the design and naturalistic implementation of the framework, and reflections on use in practice, including a detailed list of recommendations for implementation across schools and staff.Funding: This work was supported by the City of Edinburgh Council.https://doi.org/10.3390/children80302178pubpub

Development and implementation of the CIRCLE Framework

Donald Mciver - ORCID: 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XAcknowledgements: Thanks are due to the Head Teachers and staff from the participating schools. Thanks to the City of Edinburgh Council’s Additional Support for Learning Service and to Martin Vallely, Professional Services Manager.This is an Accepted Manuscript of an article published by Taylor & Francis in International Journal of Disability, Development and Education on 12 Jul 2019, available online: https://www.tandfonline.com/doi/full/10.1080/1034912X.2019.1628185We report the implementation of a new framework supporting teacher practice for inclusion of children with disabilities in mainstream classrooms. Eight schools in one Scottish authority took part. Questionnaire, focus group and interview data were gathered. Results indicated that the framework was well-received and provided a useful resource for class teachers. The framework was perceived as a feasible method for supporting teachers and related personnel to think systematically about key issues relating to children with disabilities in the classroom. It was suggested that provision of a common language was supportive of collaborative working. Areas for revision included a system of navigation and simplification in the framework manual.67pubpub

Supporting successful inclusive practices for learners with disabilities in high schools: A multisite, mixed method collective case study

Purpose: The increase in the number of individuals with disabilities in general education has led to an increased interest in how to best provide support. Despite an emphasis on inclusion and participation in policy and practice, defining and describing the support provided for these learners is still an important task. Method: This multisite, mixed method collective case study reports on 125 education and other staff from seven schools who took part in interviews and focus groups to reflect on a range of topics related to learners with disabilities in high schools. We focused on what the participants did, what they considered to be successful and what their best- practices were. Results: Descriptions of practices were rich, nuanced and complex. The analysis identified over 200 strategies- which were synthesized into two meta-themes and eight subthemes. We discuss the results in the context of an ecological perspective, and the importance of focusing on the full range of influences and outcomes for young people in designing supports. Conclusions: We have drawn on evidence from this study as a basis for professional development activities and identified that focusing on the environment and the role of practitioners has a potential to improve the inclusion outcomes for older learners with disabilities.sch_occ40pub4706pub1

Implications of grazing management systems incorporating planned rest for biodiversity conservation and landscape function in rangelands

Livestock grazing is recognised as a major driver of biodiversity decline and land degradation in rangelands around the globe. Protected areas alone cannot conserve global biodiversity, and therefore off-reserve conservation is necessary to achieve biodiversity conservation outside reserves and improve connectivity between reserves. Grazing management strategies that promote both ecological and production outcomes have the potential to conserve biodiversity and maintain or improve landscape function in agricultural landscapes. However, there is a lack of understanding of the response of biodiversity and landscape function to different grazing management systems in arid and semi-arid rangelands. This thesis explored the effects of commercial grazing practices that incorporate frequent periods of rest from grazing on biodiversity and landscape function, and determined the potential for using these alternative grazing practices to achieve broad-scale conservation outcomes. A systematic review and meta-analyses of scientific literature comparing grazing management incorporating periods of planned rest (strategic-rest grazing, SRG) with continuously grazed (CG) and ungrazed (UG) systems was undertaken to determine the effect of SRG on ecological and animal production variables. Where significant differences occurred, the trend analysis of ecological and animal production responses to grazing management predominantly favoured SRG over CG, except for animal weight gain, and favoured SRG over UG systems for plant, mammal and bird richness and diversity, but not invertebrate richness and diversity, biomass and ground cover. Most studies that compared plant species composition reported differences in response to grazing management. While we did not find any differences overall between grazing contrasts, meta-analyses of plant richness, diversity, animal weight gain and animal production per unit area indicated that management incorporating longer periods of rest compared to periods of grazing have the potential to improve animal weight gain and production per unit area, but reduce plant richness. The type of SRG system was also important, with multi-paddock SRG systems having lower plant richness relative to CG systems, and SRG systems based on seasonal or deferred grazing having greater diversity than CG systems. Most of the literature comparing SRG with CG or UG did not consider the response of ecological and animal production response variables simultaneously. Greater collaboration between ecological and animal production scientists is recommended to better understand the ecological and socio-economic trade-offs associated with different grazing management strategies. Understorey floristic species composition and plant biodiversity measures were compared between commercial properties managed under alternative grazing management (incorporating frequent and long periods of rest), traditional (continuous) grazing management, and adjacent ungrazed areas managed for conservation across a broad region of the semi-arid rangelands in western NSW. Significant variation in understorey floristic composition was driven by soil type (clay and sand), season, preceding rainfall and geographic location. These variables were the major drivers of floristic composition. The effect of grazing treatment on floristic composition at the regional scale was comparatively small and not significant. However, infrequent species were more likely to be recorded in conservation areas. Measures of floristic biodiversity varied with the scale of observation, season of sampling and soil type. In comparison to traditional grazing management, alternative grazing management generally resulted in greater understorey floristic species richness and diversity, depending on the season and scale of sampling. Few differences were found in plant species richness, diversity or functional diversity between alternatively grazed properties and adjacent areas ungrazed by commercial livestock and managed for biodiversity conservation. This suggests that alternative grazing management may be compatible with biodiversity conservation on commercial livestock properties in western NSW rangelands, but potentially at the expense of rare species. Ground cover, soil properties and landscape function were also compared between alternative grazing management, traditional grazing management and conservation management in semi-arid NSW. Alternative grazing management had greater total ground cover in comparison to traditional grazing management systems. However, both alternative and traditional grazing management treatments had significantly less ground cover than adjacent areas managed for conservation. Alternative grazing management properties did not differ significantly to areas managed for conservation in terms of landscape function, but many indices of landscape function (stability, nutrient cycling, landscape organisation index, patch area and average interpatch length) were significantly reduced under traditional grazing management compared to conservation. This suggests that alternative grazing management was more beneficial for landscape function than traditional grazing management. Significant differences were observed in floristic biodiversity measures, ground cover, soil properties and landscape function between clay and sandy soils in the study region. Clay soils had greater soil organic carbon and organic nitrogen, and lower bulk density than sandy sites. Soil stability, nutrient cycling and landscape organisation indices were also greater on clay than sand soils, and average interpatch length was shorter on clay soils. There was no difference in total ground cover between sand and clay soils, although clay soils had greater vegetative cover than sand soils, while sandy soils had greater cryptogam cover. Floristic biodiversity measures (species richness, evenness, diversity, turnover) were significantly greater on sandy than clay soils at larger plot and site scales, but there was no difference in species richness at the finest scale of sampling (1 m² quadrats). Despite the common perception that clay soils are more resilient to disturbance than sand communities, we found no difference between sand and clay soils in floristic biodiversity measures, ground cover, landscape function, soil organic carbon, soil organic nitrogen, or bulk density in response to grazing management. This indicates that alternative grazing management may provide a sustainable option for conservation of biodiversity and landscape function across both sandy and clay soils in western NSW semi-arid rangelands. Floristic composition, biodiversity measures and ground cover were also compared at a local scale between an ungrazed public nature reserve and an adjacent rotationally grazed commercial property in Acacia aneura woodland in semi-arid NSW. Significant differences in understorey floristic composition were observed between the two grazing treatments, including a greater frequency of palatable species in the nature reserve and more unpalatable species on the rotationally grazed property. There were no significant differences in understorey floristic species richness, diversity, functional diversity measures or ground cover between the nature reserve and rotationally grazed property. However, these measures increased with distance from water on the rotationally grazed property, highlighting the negative effects of increasing grazing intensity. These results suggest that at a whole-paddock scale (beyond the sacrifice zone of high grazing intensity surrounding water points), rotational grazing management, along with careful management of grazing intensity and stocking rates, has the potential to sustain biodiversity and ground cover and may offer an alternative to grazing exclusion to achieve broad-scale conservation objectives in semi-arid rangelands. However, management would still need to address the impacts on floristic composition. In conclusion, I found improved understorey plant species richness, diversity, ground cover and landscape function under alternative grazing management compared to traditional grazing management, and few differences in these measures between alternatively grazed and ungrazed areas managed for conservation. These results provide support for utilisation of alternative grazing management practices to improve biodiversity conservation and landscape function outside of the public reserve system in semi-arid rangelands. Results also show incorporation of planned periods of rest in grazing management regimes has the potential to achieve dual ecological and animal production outcomes in grazing landscapes throughout the world. Further research is necessary to understand the circumstances in which commercial grazing is compatible with the conservation of biodiversity, landscape function and animal productivity, and to identify best grazing management practices for biodiversity conservation purposes

Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol.

INTRODUCTION: Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity. METHODS AND ANALYSIS: Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the Transforming Obesity in CHILDren Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components. ETHICS AND DISSEMINATION: The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study's findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with key stakeholders. PROSPERO REGISTRATION NUMBER: CRD42020177408

Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity.

INTRODUCTION: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. METHODS AND ANALYSIS: Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. ETHICS AND DISSEMINATION: Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases. PROSPERO REGISTRATION NUMBER: CRD42020177408

Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of Depression

We assessed the role of promotoras—briefly trained community health workers—in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention’s impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention’s implementation, involving infrastructure at the health centers, boundaries of the promotoras’ roles, and “turf” issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity

Introduction Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of intervention-covariate interactions. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups

Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol

Introduction Little is known about how early (e.g., commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to 1) characterise early obesity prevention interventions in terms of target behaviours, delivery features, and behaviour change techniques (BCTs), 2) explore similarities and differences in BCTs used to target behaviours, and 3) explore effectiveness of intervention components in preventing childhood obesity