Working with school-refusing young people in Tower Hamlets, London

This study looks at the local context, describing quantitative data from a subset of young people seen within the inner London Tower Hamlets Pupil Referral Unit (PRU) that are extremely socially withdrawn and unable to attend mainstream education. The core aim of this research was to examine the views of professionals who work with and for these young people. Qualitative group interviews were used to gain a deeper understanding of the needs of these young people, what might contribute to their withdrawal from school and what needs to be done to help them reintegrate. Professionals reported that these young people were highly complex in terms of their needs and presentation and that there is a lack of clarity around what causes these young people to withdraw. They agreed that a more intensive multi-layered intervention was required to meet their needs. Interventions that include gradual socialisation, parental involvement and which address the role of technology were indicated. However, more research is needed to clarify how to effectively intervene

A meta-analysis of predictors of bullying and victimisation in adolescence

Bullying is common and harms all involved, yet there is no clarity regarding factors that influence bullying and victimisation for adolescent samples. This meta-analysis aims to synthesise the literature and identify reliable risk and protective factors to adolescent bullying and victimisation. A systematic search of the literature using databases; PsycINFO and Scopus, was undertaken to identify relevant publications from 1985 until July 2014. Inclusion criteria included longitudinal data, an adolescent sample and a focus on pre- dictive factors of bullying or victimisation. From 4698 articles identified, 18 were included. Four predictors of victimisation (prior victimisation, conduct problems, social problems and internalising problems) and four predictors of bullying (conduct problems, social problems, school problems and age) were identified. The literature provides little con- sistency in predictors assessed and replication is needed for clarification, however, social problems and conduct problems are consistent risk factors and a potential focus for future interventions

School refusal and isolation: the perspectives of five adolescent school refusers in London, UK

Research has identified a subset of young people who feel unable to engage in mainstream education. Given the hard-to-reach nature of this group, their views on what has caused their isolation from others have received little focus in previous literature. The present study aimed to explore the experiences and views of a subset of young people seen within an inner London Pupil Referral Unit who were extremely socially withdrawn and unable to attend mainstream education. They were asked what they believe led them to their current situation, the impact of isolation, how their life is going and what they value. Key themes identified were the role of anxiety in withdrawal from education and the protective capacity of social contact, even via social media, in preventing negative outcomes of withdrawal. Sleep, health, education, family and social contact were identified as risk and protective factors and were also things participants identified as values. This research provides insight into potential ways to support young people in returning to mainstream education as well as ideas for preventative measures that may protect future generations from such extreme isolation. This research was conducted before the COVID-19 pandemic, but lessons learned bear relevance in current times

Incidence of bullying and victimisation among adolescents in New Zealand

It has been established that bullying and victimisation have negative outcomes for those involved. However, this problem has received little research attention in New Zealand samples, particularly with longitudinal designs. The incidence of four types bullying was assessed in a large adolescent New Zealand sample including; traditional bullying inside the school, bullying outside the school, bullying via text message and bullying via the internet. The same categorisation of victimisation was also assessed. The overall rates of bullying and victimisation appeared elevated relative to international samples but traditional school-based bullying was more frequent than text or internet bullying. No gender differences were found. Differences for ethnic group differences were found only for specific types of bullying with Māori students reporting more traditional school and text bullying, and more text-based victimisation than other ethnic groups

Models in the delivery of depression care: a systematic review of randomised and controlled intervention trials

BACKGROUND: There is still debate as to which features, types or components of primary care interventions are associated with improved depression outcomes. Previous reviews have focused on components of collaborative care models in general practice settings. This paper aims to determine the effective components of depression care in primary care through a systematic examination of both general practice and community based intervention trials. METHODS: Fifty five randomised and controlled research trials which focused on adults and contained depression outcome measures were identified through PubMed, PsycInfo and the Cochrane Central Register of Controlled Trials databases. Trials were classified according to the components involved in the delivery of treatment, the type of treatment, the primary focus or setting of the study, detailed features of delivery, and the discipline of the professional providing the treatment. The primary outcome measure was significant improvement on the key depression measure. RESULTS: Components which were found to significantly predict improvement were the revision of professional roles, the provision of a case manager who provided direct feedback and delivered a psychological therapy, and an intervention that incorporated patient preferences into care. Nurse, psychologist and psychiatrist delivered care were effective, but pharmacist delivery was not. Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention. Community interventions were effective. CONCLUSION: Case management is important in the provision of care in general practice. Certain community models of care (education programs) have potential while others are not successful in their current form (pharmacist monitoring)

Understanding trauma in children and young people in the school setting

Aim: Educational practitioners are increasingly aware of trauma experiences in students as a factor in child disturbance and schooling problems. This discussion paper aims to clarify definitions of trauma and differentiate them from other adverse childhood experiences (ACE), describe trauma impact in terms of clinical outcomes (PTSD, emotional and behavioural disorder) and how attachment factors mediate risk and discuss the challenges and ethics of identifying and enquiring about trauma experience in a school setting. Rationale: Schools are increasingly required to be 'trauma sensitive' and to intervene where possible, with government requirements of improving mental health in schools. However, this poses a real challenge for educationalists given the barriers due to ethics, stigma/secrecy, referral implications and measurement availability for whole school approaches. Universal screening may provide a framework that helps schools recognise, measure and treat trauma. Findings: A conceptual model clarifying trauma exposure, trauma impact and mediating factors is identified to aid understanding for teachers. Use of technological screening methods for whole school monitoring of trauma impacts, including mediating risks, are outlined. Limitations: A full literature review of trauma or school-based interventions is not provided. Nor are biological impacts of trauma at different developmental stages described. Conclusion: Teachers would benefit from having a psychological understanding of trauma models and their component parts in order to identify what lies within the remit of schools for identification and intervention

Inequality in provider continuity for children by Australian general practitioners

<p>Abstract</p> <p>Background</p> <p>There is little published on provider continuity in Australian general practice and none on its effect on inequality of care for children.</p> <p>Method</p> <p>Questionnaire administered to parents of the ACT Kindergarten Health Screen asking the name of their child's usual GP and practice address between 2001 and 2008.</p> <p>Results</p> <p>Parents of 30,789 children named 433 GPs and 141 practices. In each year, an average of 77% of parents could name both the GP and the practice, an average of 11% of parents could name only the practice, and an average of 12% of parents could name neither. In each year, 25% of parents could not name a usual GP for children of Aboriginal or Torres Straight Islander descent, or children born outside of Australia, compared to 10% of all other children (p = < 0.0001). The frequency of GPs displaying continuity of care varied over time with 19% of GPs being present in the ACT in only one year and 39% of GPs being present in every year over the eight years of study. GPs displayed two different forms of transience either by working in more than one practice in each year (5% of GPs), or by not being present in the ACT region from one year to the next (15% of GPs). Fewer parents nominated transient GPs as their child's GP compared to choosing GPs who displayed continuity (p < 0.001).</p> <p>Conclusions</p> <p>Many GPs (39%) were reported to provide continuity of care for in the ACT region and some GPs (20%) displayed transient care. Indigenous children or children born outside of Australia had less equity of access to a nominated GP than all other children. Such inequity might disappear if voluntary registration of children was adopted in Australian general practice.</p

Time's up. Descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.This work was funded by the National Health and Medical Research Council ID (402793, 2006)

Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey.

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.National Health and Medical Research Counci

Models in the delivery of depression care: A systematic review of randomised and controlled intervention trials

<p>Abstract</p> <p>Background</p> <p>There is still debate as to which features, types or components of primary care interventions are associated with improved depression outcomes. Previous reviews have focused on components of collaborative care models in general practice settings. This paper aims to determine the effective components of depression care in primary care through a systematic examination of both general practice and community based intervention trials.</p> <p>Methods</p> <p>Fifty five randomised and controlled research trials which focused on adults and contained depression outcome measures were identified through PubMed, PsycInfo and the Cochrane Central Register of Controlled Trials databases. Trials were classified according to the components involved in the delivery of treatment, the type of treatment, the primary focus or setting of the study, detailed features of delivery, and the discipline of the professional providing the treatment. The primary outcome measure was significant improvement on the key depression measure.</p> <p>Results</p> <p>Components which were found to significantly predict improvement were the revision of professional roles, the provision of a case manager who provided direct feedback and delivered a psychological therapy, and an intervention that incorporated patient preferences into care. Nurse, psychologist and psychiatrist delivered care were effective, but pharmacist delivery was not. Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention. Community interventions were effective.</p> <p>Conclusion</p> <p>Case management is important in the provision of care in general practice. Certain community models of care (education programs) have potential while others are not successful in their current form (pharmacist monitoring).</p