Accessing young people who self-harm as research participants

Historically, research pertaining to children and young people involved them as research subjects, to be observed and measured, while views of children and young people have been obtained through parents and carers. However, the important contribution that children and young people make within research, by giving their own perspective on the subject under study, is now widely recognized, but gaining these perspectives can be challenging. This case study provides insight into the challenges faced when attempting to recruit young people as participants in a study which examined the emergency care young people receive following an episode of self-harm

The emergency care of young people who self-harm: an exploration of attitudes towards young people who self-harm and the care they receive from practitioners working in pre-hospital and hospital based emergency services

Aim: Using a mixed methods approach, this thesis seeks to explore the attitudes of emergency care staff towards young people (aged 12− 18 years) who self-harm and to gain an understanding of the basis of attitudes that exist. Background: This thesis has drawn on Strauss et al’s (1964), concept of the hospital as a negotiated order, a perspective that has latterly been applied to the organisation of hospital A&E services (Sbaih1997a&b 1998a&b, 2001, 2002). As the fundamental premise of emergency care work is the rapid assessment of patients’ needs, categorisation is an essential element of this work. This thesis therefore also draws on the sociological theories which have examined the categorisation of patients as ‘good’ or ‘bad’, as earlier sociological work has clearly demonstrated that practitioners working in emergency services judge patients based on their reasons for accessing the service (Roth 1972, Jeffery 1979, Dingwall & Murray 1983); patients who self-harm are amongst those adversely judged. However the extent to which these categorisations extend to young people was not wholly clear. Findings from earlier research that had considered this were inconclusive and inconsistent (Dingwall & Murray 1983, White 2002). Methods: A mixed methods approach, using a triangulation convergent design was employed. Staff employed in four emergency departments in South East London and five London Ambulance complexes that served these departments were surveyed; data from 143 questionnaires were analysed using SPSS. Qualitative data were obtained through semi-structured interviews with 12 practitioners, seven nurses and five paramedics, with thematic analysis undertaken. The two data sets were integrated and analysed to identify where the two data sets were consistent and whether/where discrepancies existed. Results: Findings from this study indicate that age, i.e. being a young person, does influence attitudes towards self-harm. Young people are less adversely judged as their self-harm is seen as symptom of distress, a coping mechanism or response to a stressor out with a young person’s control, thus as a consequence, attitudes towards young people who self-harm are benign. The findings lend support to previous research which has indicated that as an occupation, nurses have less positive attitudes than their peers working in emergency services. Although not statistically significant, the nurses surveyed in this study obtained lower scores on the scale used to measure attitudes than their medical and paramedical colleagues. The data from the interviews illustrated the difficulties and frustration the nurses faced in managing the care of young people who self-harm, which centred on the pressure to ‘move young people on’, pressures that were exacerbated by the need to do this within four hours. The paramedics interviewed did not face these challenges. Nurses faced considerable difficulty in securing admission to a children’s ward; the accounts of the nurse interviewees suggested that their ward colleagues expected and anticipated that young people who had self-harmed would be challenging in terms of their behaviours, whereas no such expectation existed with other adolescent patients. To this end the diagnostic label of self-harm had negative connotations Conclusions: The findings from this study have extended existing knowledge in relation to practitioners’ attitudes towards young people who self-harm, providing as they do an insight into how young peoples’ immaturity and diminished agency, contribute to the framing of young people as vulnerable, thus their self-harming behaviour is less adversely judged. A negotiated order perspective remains a relevant lens through which to analyse and explore the organisation of hospital services and specifically the work of the A&E department; the findings of the research presented in this thesis have revealed how young people who self-harm, through both their actual and perceived behaviours, disrupt the organisation of children’s accident and emergency care, thereby distorting its ‘shape’. The ambiguity of adolescence as a life-stage is reflected in the attitudes and perceptions of the study participants and is also reflected in health policy and guidelines, which is particularly exemplified by inconsistency in how the emergency care needs of young people between the ages of 16– 18 years generally, and young people who self-harm specifically, are addressed. This inconsistency and ambiguity in turn serves to impede young people’s progress through emergency services following an episode of self-harm

School nurses’ experiences of managing young people with mental health problems: A scoping review

Prevalence of mental health disorder is increasing among young people. It is recognized that early intervention is essential in supporting young people, and care provided within schools to support emotional well-being is recommended as part of this process. A scoping review was undertaken examining school nurses’ experiences of supporting the mental health of schoolchildren. Findings suggest that school nurses have a central role in supporting young peoples’ mental health, although a number of barriers exist which impact on school nurses’ preparedness for this aspect of their role. While there are inconsistencies in the provision of mental health training available to support school nurses, when training is implemented it has positive outcomes for service provision and quality of care. A number of challenges for school nurses were also identified, and recommendations for practice are suggested in the article

‘There is no “war on drugs”’: An investigation into county line drug networks from the perspective of a London borough

County Line Drug Networks involve the transportation of drugs from urban hubs to out of city locations across the UK. County lines are a societal concern as they involve the recruitment of vulnerable individuals (adults and children), who are used as runners, exposing them to hazardous and often violent situations. This paper reports on a small scale study which provides a snapshot of the characteristics of nominals involved in county line drug network within a London Borough as well as the perspective of three expert practitioners who have substantial and detailed operational knowledge of how county line operatives work

A review of UK based multi-agency approaches to early intervention in domestic abuse: Lessons to be learnt from existing evaluation studies

This paper presents a review of 22 published evaluations which examined domestic abuse interventions across the UK. A literature Search was conducted in November 2016. The main aim of the review was to identify emerging good practise in multi-agency early intervention; thus, to be eligible for inclusion in the review, projects were multi-agency in nature and aimed to intervene early. Findings from the review reveal that there are a range of strategies and interventions that have been piloted and tested which have had varying degrees of success. Overall, interventions that adopt an advocacy approach appear to have more impact and are more sustainable, and, that when co-located with statutory or voluntary services, multi-agency working is enhanced. However, further consideration is required in terms of what constitutes early intervention, as all interventions are dependent on victims and perpetrators accessing services early, thus, primary prevention strategies, currently entirely school based, are key to promoting and supporting secondary prevention

A rapid review and narrative synthesis of the consequences of non-inclusive sex education in UK schools on Lesbian, Gay, Bisexual, Transgender and questioning young people

Relationships and Sex Education (RSE) in schools are predominantly heterocentric. Consequently, lesbian, gay, bisexual, transgender, and questioning young people have reported feeling excluded. This exclusion results in feelings of being “different” and “other,” which in turn leads to further disengagement in the sex education classroom, contributing to poor sexual health literacy, greater risk of abusive relationships, and higher rates of sexually transmitted infections. A rapid review was undertaken to identify the impact of non-inclusive sex education. The review makes recommendations for policy and practice, which includes the provision of training courses to school teaching staff with an emphasis on inclusive RSE, appropriate online resources for lesbian, gay, bisexual transgender, and questioning (LGBTQ) young people, as well as offering 1:1 emotional health support for LGBTQ young people as they begin to question their sexual orientation

Functional family therapy-gangs for young people at risk of child criminal exploitation and county lines involvement: feasibility and pilot study

Executive Summary The project Functional Family Therapy Gangs (FFT-G) is an intensive, home-based, family therapy programme for the families of young people with severe behavioural challenges. It aims to improve the safety, wellbeing and stability of children and families and reduce offending. Developed by FFT LLC, the programme in this project was delivered by Family Psychology Mutual (FPM) and targeted at 10-17 year olds at risk of involvement in County Lines Drug Networks or child criminal exploitation. Trained family therapists provided a bespoke number of therapy sessions to families over three to five months, beginning with an Engagement and Motivation phase to secure participation. This was followed by a Behaviour Change phase to teach new skills designed to interrupt problematic relational patterns, before a Generalisation phase asked families to practise the skills they had learned in other contexts (such as in school, in the community or in relationships with other professionals). Which family members were involved depended on who was regarded as important to the problem being addressed. In the early stages, contact was provided to families several times a week, with home visits lasting 60-90 minutes; in later stages of the intervention, contact was reduced to weekly. The YEF funded a feasibility and pilot study of FFT-G. The feasibility study aimed to ascertain how feasible a randomised controlled trial (RCT) of the programme would be, exploring whether caseworkers would refer young people to an RCT, analysing what the most productive referral pathways were and evaluating whether enough referrals would be received to ensure adequate therapist caseloads. These questions were explored using 19 interviews with key professionals, organisational data gathering and a document review, and the intervention was delivered to 48 families in the London Borough of Redbridge (LBR). The Family Intervention Team (FIT), part of specialist services for vulnerable children within social care, referred young people to the programme. The feasibility study was delivered between October 2019 and March 2021. The pilot study then aimed to explore how many families were eligible for FFT-G; analyse the barriers to and implementation of trial recruitment; and examine a range of questions relating to the design of a potential future large-scale RCT (such as how many families can be randomised and how often, the rates of missing data at baseline testing, attrition rates and the effect sizes associated with the intervention). These questions were explored via the delivery of a pilot RCT, again delivered in LBR. Twenty-three young people’s families received the intervention, while 22 received services as usual (SAU). Nine interviews were also conducted with families. The pilot took place between March 2021 and July 2021. Both the feasibility and pilot studies were impacted by the COVID-19 pandemic, requiring both the delivery and evaluation teams to adapt to challenging circumstances. In the feasibility study, FFT-G received a reasonable number of referrals (100 over 13 months), although this was lower than anticipated by therapists. The evaluator deemed completion rates to be adequate; where treatment data were collected, 61% of families enrolled completed the treatment. The pilot study found that 95 families were identified over nine months in LBR to receive the programme – 73% (69) of them were eligible for the programme after full screening, out of which 66% (45) progressed through recruitment to be randomised into the pilot RCT. In the pilot study, 74% of families received eight or more sessions, and 83% completed the programme. In terms of what the families in the service as usual group were receiving, approximately one third received an alternative parenting programme; 27% do not appear to have received any services. Key conclusions Interviews with caseworkers in the feasibility study suggested that they would, albeit reluctantly, refer young people and their families to the programme to participate in an RCT. The most common reason given was to ensure the continuation of the service. A waitlist control was preferred by some caseworkers, but the evaluator adjudged a parallel RCT to be preferable. Missing data rates in the pilot RCT were low at baseline. The RCT then measured parent-reported family functioning and young person-reported conduct problems. There was a 20% attrition rate. The evaluator deemed that in a small efficacy RCT, recruitment would be possible using only one local authority (LA). Given sample size calculations, they predicted that a sample between 51 and 248 would be required and advised aiming for the higher end of this range. Interpretation Social workers who were interviewed in the feasibility study felt that FFT-G complemented their services well. They would, albeit reluctantly, refer young people to the programme to participate in an RCT. Those most familiar with the intervention were more likely to refer, while the most common reason given for accepting an RCT was the continuation of the service. Most social workers had only a basic understanding of RCTs, and some had concerns about carrying out an RCT with vulnerable young people. They worried about causing frustration among those not receiving FFT-G, while FFT-G therapists were also wary of the disappointment experienced by social workers if the families they had taken time to recruit and refer were not part of the intervention group. After the evaluator explained the design of a waitlist control trial (where the control group would also receive the programme later), social workers were open to this possibility, recognising the need to evidence impact to secure funding. However, the evaluator concluded that a parallel RCT (where all receive some service as usual, and the intervention group also receive FFT-G) is preferable; concerns were noted that families’ waiting to receive FFT-G in a waitlist design could alter their engagement with other usual services, while the wait for any support could be too long for such vulnerable young people. In the feasibility study, FFT-G received a reasonable number of referrals (100 over 13 months). This was lower than expected by FFT-G therapists due to a number of reasons, including a lack of awareness by social workers around FFT-G, the cases not fitting the inclusion criteria and the length of time it takes to refer. The evaluator deemed completion rates to be adequate; where treatment data were collected, 67% received over eight sessions, and 61% of families completed treatment. The average number of sessions completed by families was 10.7. The pilot study found that 95 families were identified over nine months in LBR to receive the programme. These were referred either by a Family Intervention Team panel, identified in meetings with service teams, or identified via screening of the borough’s case management system. Seventy-three per cent (69) of them were eligible for the programme after full screening, out of which 66% (45) progressed through recruitment to be randomised into the pilot RCT. Recruitment to the RCT began slowly; after simplifying the communication to potential families, expanding the age eligibility range (from 10-14 to 10-17) and conducting a screen of the case management system, recruitment improved. Missing data rates in the pilot RCT were low at baseline (0% for 16 out of 21 measures and between 2% and 16% for the remaining five). The RCT then measured parent-reported family functioning and young person-reported conduct problems. These measures were deemed to be broadly suitable, but the evaluator encourages caution when drawing firm conclusions on the future suitability of these measures given the small sample size. There was a 20% attrition rate (with eight families in the SAU arm and one in the FFT-G arm of the trial not completing assessments after six months). The evaluator deems that in a small efficacy RCT, recruitment would be possible using only one LA. Given sample size calculations, they predict that a sample between 51 and 248 would be required and advise aiming for the higher end of this range. The dominant view expressed in interviews with families was that the randomisation process was acceptable, and getting additional attention and support for their child was a recurring motivation for many participating in the study. Some families also expressed a desire to participate in giving feedback on services with a view to them improving in future. Of those who received support during the study, the common view was that the support was useful, although some young people were unable to say what was helpful to them. Of those who received service as usual, most perceived the support on offer to be helpful. However, some families who received usual service expressed negative experiences with professionals and the wider system. In the pilot study, 74% of families received eight or more sessions, and 83% completed the programme. The average number of FFT-G sessions per family was 11.4. Approximately one third of families in the SAU group received an alternative parenting programme; 27% do not appear to have received any services. The study met the requirements for a full efficacy RCT by meeting four out of five ‘stop-go criteria’. The YEF has, therefore, opted to fund a further evaluation of FFT-G and will be setting up an efficacy RCT

Toward Autism-Friendly Magnetic Resonance Imaging: Exploring Autistic Individuals' Experiences of Magnetic Resonance Imaging Scans in the United Kingdom, a Cross-Sectional Survey

BACKGROUND: Autistic individuals might undergo a magnetic resonance imaging (MRI) examination for clinical concerns or research. Increased sensory stimulation, lack of appropriate environmental adjustments, or lack of streamlined communication in the MRI suite may pose challenges to autistic patients and render MRI scans inaccessible. This study aimed at (i) exploring the MRI scan experiences of autistic adults in the United Kingdom; (ii) identifying barriers and enablers toward successful and safe MRI examinations; (iii) assessing autistic individuals' satisfaction with MRI service; and (iv) informing future recommendations for practice improvement. METHODS: We distributed an online survey to the autistic community on social media, using snowball sampling. Inclusion criteria were: being older than 16, have an autism diagnosis or self-diagnosis, self-reported capacity to consent, and having had an MRI scan in the United Kingdom. We used descriptive statistics for demographics, inferential statistics for group comparisons/correlations, and content analysis for qualitative data. RESULTS: We received 112 responses. A total of 29.6% of the respondents reported not being sent any information before the scan. Most participants (68%) confirmed that radiographers provided detailed information on the day of the examination, but only 17.1% reported that radiographers offered some reasonable environmental adjustments. Only 23.2% of them confirmed they disclosed their autistic identity when booking MRI scanning. We found that quality of communication, physical environment, patient emotions, staff training, and confounding societal factors impacted their MRI experiences. Autistic individuals rated their overall MRI experience as neutral and reported high levels of claustrophobia (44.8%). CONCLUSION: This study highlighted a lack of effective communication and coordination of care, either between health care services or between patients and radiographers, and lack of reasonable adjustments as vital for more accessible and person-centered MRI scanning for autistic individuals. Enablers of successful scans included effective communication, adjusted MRI environment, scans tailored to individuals' needs/preferences, and well-trained staff

A systematic mapping literature review of ethics in healthcare simulation and its methodological feasibility

Both the ethics of simulation and how it may be used to explore, train and assess ethical issues in a clinical context have received growing interest in recent years. As ethical considerations permeate almost every element of simulation and clinical practice, the emerging literature in this field remains relatively fragmented, lacking a common vocabulary or standardized practice and methodology. Given this, the primary aim of this paper was to systematically map the literature related to ethics in healthcare simulation, guided by the research question of ‘how is ethics in healthcare simulation recorded in current literature?’. Our secondary aim was to explore the feasibility of conducting a systematic mapping review. One hundred four papers were included and analyzed. Results suggest that this is relatively small, but rapidly growing field. Most research was carried out in the US and with variety of research methods employed. Research involving samples of nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. Keyword co-occurrence suggested that studies utilized simulation overwhelmingly in an educational context

Toward Autism-Friendly Magnetic Resonance Imaging: Exploring Autistic Individuals' Experiences of Magnetic Resonance Imaging Scans in the United Kingdom, a Cross-Sectional Survey

Background: Autistic individuals might undergo a magnetic resonance imaging (MRI) examination for clinical concerns or research. Increased sensory stimulation, lack of appropriate environmental adjustments or lack of streamlined communication in the MRI suite may pose challenges to autistic patients and render MRI scans inaccessible. This study aimed to i) explore the MRI scan experiences of autistic adults in the UK, ii) identify barriers and enablers towards successful and safe MRI examinations, iii) assess autistic individuals’ satisfaction with MRI service, and iv) inform future recommendations for practice improvement. Methods: We distributed an online survey to the autistic community on social media, using snowball sampling. Inclusion criteria were: being older than 16, have an autism diagnosis or self-diagnosis, self-reported capacity to consent and having had an MRI scan in the UK. We used descriptive statistics for demographics, inferential statistics for group comparisons/correlations, and content analysis for qualitative data. Results: We received 112 responses. A total of 29.6% of the respondents reported not being sent any information before the scan. Most participants (68%) confirmed that radiographers provided detailed information on the day of the examination but only 17.1% reported that radiographers offered some reasonable environmental adjustments. Only 23.2% of them confirmed they disclosed their autistic identity when booking MRI scanning. We found that quality of communication, physical environment, patient emotions, staff training and confounding societal factors impacted autistic people’s experiences. Autistic individuals rated their overall MRI experience as neutral and reported high levels of claustrophobia (44.8%). Conclusion: The study highlighted a lack of effective communication and coordination of care, either between healthcare services or between patients and radiographers, and lack of reasonable adjustments as vital for more accessible and person-centred MRI scanning for autistic individuals. Enablers of successful scans included effective communication, adjusted MRI environment, scans tailored to individuals’ needs/preferences, and well-trained staff.College of Radiographers Industry Partnership Scheme Research GrantAhead of print, check citing and date details in 6 m pleaseCan't get access trhough UCD so can't see pdf and no pages2023-06-15 JG: PDF updated to remove duplicate cover page erroneously added by RR