Grandfamilies Outcome Workgroup’s (GrOW) review of grandfamilies support groups: An examination of concepts, goals, outcomes and measures

A support group is the most widely used intervention for grandparents and other relatives raising children. Support groups require few resources to establish and are relatively inexpensive to implement. Despite the popularity of support groups for grandfamilies, there is little evidence evaluating their effectiveness to improve the lives of its members. In response to this issue and to support outcome-based research in the field, the Grandfamilies Outcome Workgroup (GrOW) was established. This study highlights GrOW’s review of the literature on the effectiveness of support groups for grandfamilies. Next, the GrOW Inventory of Support Groups (GrOW Inventory) was developed to explore some of the variations and commonalities found in the literature and GrOW members’ experiences facilitating or sponsoring groups in their own communities. Results from this inventory helped to identify important concepts that inform specific goals and outcomes related to groups. Widely used measures with notable reliability and validity are provided. This study explores the commonalities and complexities of support groups and supports the future development of a more comprehensive assessment tool to measure a wide variety of outcomes for support groups

Examining the kinship care experience: the impact of social support and family resources on caregiver health, family involvement with the child welfare system, and permanence for children

This study had two purposes: (1) to describe the quality of the kinship caregiving experience for kinship caregivers and (2) to assess whether social support and family resource needs impact the health of kinship caregivers, family involvement in the child welfare system, and permanence for children living in kinship care. In the first part, semi structured interviews were used to examine the caregiving experiences of fifteen grandmothers raising grandchildren in Pinellas County, Florida. Overall, the qualitative results shed some light on what it is like to be a relative caregiver. Most caregiving took place out of obligation, not by choice or by an explicit decision. In light of all the stressors in their lives, the caregivers in the study found much solace in their involvement with a community program. Three case studies were used to provide examples of different experiences with caregiving. The second part of the study used a correlational one-group posttest only design. All caregivers (N=175) enrolled in programs offered by a consortium of non-profit community organizations completed the Family Support Scale (FSS), Family Resource Scale (FRS), and General Health Questionnaire (GHQ-SF12). Hierarchical linear regression was used to estimate the relation of social support and family resources to the health of the caregiver, child welfare involvement, and permanence of child placement. Family resource needs predicted physical health, mental health and permanency. Social support predicted physical, but not mental health. None of the study variables predicted the family's involvement with the child welfare system. A further exploration into the permanency variable revealed that African American caregivers cared for children for longer periods than other ethnic groups, on average about 15 months more. Additionally, caregivers who had basic resource unmet needs took care of children for 19 months longer than those whose needs were better met. These data suggest that physical and psychological wellbeing of informal caregivers is at risk due to the needs and demands associated with caregiving and that better outcomes for children may result from more intense efforts to identify and address the resource needs of grandparents and other relatives raising children

Sleep Health Education to Promote Public Health: Attitudes and Desired Learning Goals among Social Work Students

Social workers are often front line behavioral health providers for underserved populations, many of whom experience sleep disturbances. Inadequate sleep presents a public health challenge and is associated with many adverse physical health and mental health consequences. Social workers are uniquely positioned to promote sleep health among individuals experiencing health inequities. However, sleep is rarely included as part of the curricula in social work programs in the U.S. We conducted qualitative formative research to investigate social work students’ perceptions of sleep education and desired sleep learning objectives. Twenty-five social work students were recruited via a listserv e-mail to participate in one of three focus groups. Participants believed sleep education could be beneficial in promoting client health and well-being. Desired learning goals included: (1) the importance of sleep; (2) identify symptoms of sleep deprivation and sleep disorders; (3) environmental and lifestyle factors that impact sleep; (4) behaviors to promote optimal sleep; and (5) sleep health as it relates to special populations (e.g., homelessness, substance using). Social work students expressed a desire to aquire knowledge on sleep health promotion as part of the social work curricula. Sleep education could be of considerable relevance to social work students, practitioners, and the clients they serve

GrOW National Study of Grandfamilies During COVID-19: Wave I and Wave II Results and Recommendations

The COVID-19 pandemic has impacted families across the globe. This study highlights how a multidisciplinary workgroup, Grandfamilies Outcome Workgroup (GrOW) operationalized a caregiver-centered data cycle to learn how COVID-19 has impacted grandfamilies across the United States. The National Grandfamilies and COVID-19 Wave I (n=600, June 2020) and Wave II (n=225, July 2021) surveys recruited grandfamilies nationwide through GrOW’s network of kinship community partners. Wave I survey results illuminated that all sources of social support were reduced for grandfamilies during the pandemic, except for online support groups. Wave II provided an opportunity to revise the survey to capture emergent issues relevant to a later stage of the pandemic for grandfamilies. Results indicated that 73% of caregivers were vaccinated. Results also identified gaps in caregiver knowledge of kinship navigator programs and supports in their communities. Recommendations for future research are provided. Keywords Kinship, COVID-19, Grandfamilies’ Outcome Workgroup, Culturally Responsive Research, Translational Disseminatio

Survey and scoping of wildcat priority areas

This report summarises the findings of three complementary projects commissioned by SNH to inform the selection of Priority Areas for wildcat conservation; as proposed in the Scottish Wildcat Conservation Action Plan 2013. The scoping projects combined field surveys, taxonomic and genetic assessments, population modelling and a questionnaire survey of public attitudes to wildcat conservation measures. The report makes a recommendations for six wildcat Priority Areas from the nine areas pre-selected by SNH for survey. The sites recommended as Priority Areas all had evidence of cats that were classified as wildcats based on their appearance. However, domestic cats or hybrids (between domestic cats and wildcats) were also found, highlighting the need for conservation actions to reduce the risks they pose to wildcats from hybridisation and disease

The effect of a brief social intervention on the examination results of UK medical students: a cluster randomised controlled trial

Background: Ethnic minority (EM) medical students and doctors underperform academically, but little evidence exists on how to ameliorate the problem. Psychologists Cohen et al. recently demonstrated that a written self-affirmation intervention substantially improved EM adolescents' school grades several months later. Cohen et al.'s methods were replicated in the different setting of UK undergraduate medical education.Methods: All 348 Year 3 white (W) and EM students at one UK medical school were randomly allocated to an intervention condition (writing about one's own values) or a control condition (writing about another's values), via their tutor group. Students and assessors were blind to the existence of the study. Group comparisons on post-intervention written and OSCE (clinical) assessment scores adjusted for baseline written assessment scores were made using two-way analysis of covariance. All assessment scores were transformed to z-scores (mean = 0 standard deviation = 1) for ease of comparison. Comparisons between types of words used in essays were calculated using t-tests. The study was covered by University Ethics Committee guidelines.Results: Groups were statistically identical at baseline on demographic and psychological factors, and analysis was by intention to treat [intervention group EM n = 95, W n = 79; control group EM n = 77; W n = 84]. As predicted, there was a significant ethnicity by intervention interaction [F(4,334) = 5.74; p = 0.017] on the written assessment. Unexpectedly, this was due to decreased scores in the W intervention group [mean difference = 0.283; (95% CI = 0.093 to 0.474] not improved EM intervention group scores [mean difference = -0.060 (95% CI = -0.268 to 0.148)]. On the OSCE, both W and EM intervention groups outperformed controls [mean difference = 0.261; (95% CI = -0.047 to -0.476; p = 0.013)]. The intervention group used more optimistic words (p < 0.001) and more "I" and "self" pronouns in their essays (p < 0.001), whereas the control group used more "other" pronouns (p < 0.001) and more negations (p < 0.001).Discussion: Cohen et al.'s finding that a brief self-affirmation task narrowed the ethnic academic achievement gap was replicated on the written assessment but against expectations, this was due to reduced performance in the W group. On the OSCE, the intervention improved performance in both W and EM groups. In the intervention condition, participants tended to write about themselves and used more optimistic words than in the control group, indicating the task was completed as requested. The study shows that minimal interventions can have substantial educational outcomes several months later, which has implications for the multitude of seemingly trivial changes in teaching that are made on an everyday basis, whose consequences are never formally assessed

Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study

Background: pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. Objective: to estimate the effectiveness of topical therapies in the treatment of PG. Methods: prospective cohort study of UK secondary care patients with a clinical diagnosis of PG suitable for topical treatment (recruited July 2009 to June 2012). Participants received topical therapy following normal clinical practice (mainly Class I-III topical corticosteroids, tacrolimus 0.03% or 0.1%). Primary outcome: speed of healing at 6 weeks. Secondary outcomes: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality-of-life; treatment failure and recurrence. Results: Sixty-six patients (22 to 85 years) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28/66 (43.8%) of ulcers healed by 6 months. Median time-to-healing was 145 days (95% CI: 96 days, ∞). Initial ulcer size was a significant predictor of time-to-healing (hazard ratio 0.94 (0.88;80 1.00); p = 0.043). Four patients (15%) had a recurrence. Limitations: No randomised comparator Conclusion: Topical therapy is potentially an effective first-line treatment for PG that avoids possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Background: Health services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs). Aim: To develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk. Methods Development: We synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs. Implementation: The Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence. Evaluation: The Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment. Trial results Depression trial: In total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5; p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence. CVD risk trial: In total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9; p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management. The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement. Conclusion: The Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs