Evaluation of the Reading Well Books on Prescription Shelf Help scheme for young people

Executive Summary It is estimated that 2,773,460 people under 17 are in need of child and adolescent mental health services provided by the GP or schools. It is also known that half of all anxiety disorders - the most common mental health condition - are experienced before the age of 12 years old. Young people face many risk factors for poor mental health but not all young people with mental health conditions seek support or receive the support or services they need. The current environment of austerity means that there is decreasing resourcing of the third sector and increasing pressure on CAMHS. ‘Shelf Help’ is the name that has been used to market the Reading Well for young people scheme. It is a reading list for those who experience mental health problems between 13-18yrs old, or are friends with, live with, or care for people who do and is. Shelf Help is delivered in partnership with the Society of Chief Librarians as part of the Chief Librarian’s Universal Health Offer. Reading Well for young people is endorsed by health professionals and supported by public libraries and provides advice of specific topics such as anxiety, depression, stress, OCD, self-harm, bullying, eating disorders, autism and aspergers as well as general topics to do with adolescence. This research report documents the impact of introducing ‘Shelf Help’ – the Reading Well for young people scheme - into a secondary school environment in partnership with a local charity, which supports the mental wellbeing of young people. Adult stakeholders were interviewed during a scoping phase (n=12) to determine how to discretely monitor the usage and impact of the Reading Well for young people at The Priory School and Phase, in Hitchin. Multiple copies of the reading list were given to the School and Phase, and young people were left to interact with the books for 3 months (Dec 2016 – February 2017. The engagement with the books was monitored at each site. Young people and key adult stakeholders were consented to take part in focus groups and interviews (during March 2017). Qualitative analysis of interviews focus groups used to determine the impact of engaging with the Reading Well for young people books. 33 participants provided qualitative data for the project, 18 young people and 15 adults. 26 participants (8 adults and 18 young people) took part in focus groups and interviews to determine engagement with and impact with the scheme. Innovative and successful approaches to getting young people to engage with Shelf Help books were devised e.g. Creating a wellbeing corner in the library, selecting a’ book of the week’, promoting the scheme to the whole school to create inclusivity and talking points, making Shelf Help the focus of wellbeing events, a staff reading challenge, opportunity to write short reviews for other library users. Books were recommended to service users of Phase which included young people and parents. 128 Reading Well for young people books were borrowed from the library by 67 people during the 3 months, a further 35 titles were borrowed by 18 users at Phase. Borrowers ranged from year 7 to year 11 as well as adults. Several titles were renewed and many were continually on loan for the duration of the project. Interestingly, many people used the wellbeing corner to browse and read books during break-times, without taking out loans. Many positive impacts of reading the Shelf Help books were identified. Four key themes emerged in the qualitative research analysis: Improved awareness, knowledge and understanding of mental health conditions. Improved emotional and mental wellbeing, specifically relating to confidence, self-esteem, hope, isolation and emotional intelligence Changes in behaviour and improved relationships Normalising and destigmatizing mental health discussions. Through piloting Shelf Help in a secondary school and charity setting there were several areas of learning going forwards. The books can be accessed by people with low, moderate or severe mental health conditions, thus suggestions to develop a supportive environment include: Ensuring appropriate training in mental first aid to key staff involved in the shelf help scheme – this may include staff who would not normally have this training. Provide time and access for staff to read through the list of books and familiarise themselves with the content prior to rolling out to the whole organisation. Providing activities, or book groups that would allow young people to discuss the books they have been reading within a facilitated environment, especially where some books may make young people feel sad or upset. Ensure the use of the Shelf Help leaflet as much as possible, specifically as it has contact number for support organisations that can be contacted, often 24/7. In conclusion, all participants found the Reading Well for young people scheme highly acceptable and the inclusive approach has supported an increase in discussion about mental health in each organisation that piloted ‘Shelf Help’. Further research should now be conducted to further understand the impact of the Reading Well for young people scheme on wellbeing and resilience

Police, Crime and the Problem of Weak Instruments:Revisiting the “More Police, Less Crime” Thesis

A key question in the general deterrence literature has been the extent to which the police reduce crime. Definitive answers to this statement, however, are difficult to come by because while more police may reduce crime, higher crime rates may also increase police levels, by triggering the hiring of more police. One way to help overcome this problem is through the use of instrumental variables (IV). Levitt, for example, has employed instrumental variables regression procedures, using mayoral and gubernatorial election cycles and firefighter hiring as instruments for police strength, to address the potential endogeneity of police levels in structural equations of crime due to simultaneity bias.We assess the validity and reliability of the instruments used by Levitt for police hiring using recently-developed specification tests for instruments. We apply these tests to both Levitt’s original panel dataset of 59 US cities covering the period 1970–1992 and an extended version of the panel with data through 2008.Results indicate that election cycles and firefighter hiring are “weak instruments”—weak predictors of police growth that, if used as instruments in an IV estimation, are prone to result in an unreliable estimate of the impact of police levels on crime.Levitt’s preferred instruments for police levels—mayoral and gubernatorial election cycles and firefighter hiring—are weak instruments by current econometric standards and thus cannot be used to address the potential endogeneity of police in crime equations

Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT

BACKGROUND: Urinary incontinence affects one in three women worldwide. Pelvic floor muscle training is an effective treatment. Electromyography biofeedback (providing visual or auditory feedback of internal muscle movement) is an adjunct that may improve outcomes. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of biofeedback-mediated intensive pelvic floor muscle training (biofeedback pelvic floor muscle training) compared with basic pelvic floor muscle training for treating female stress urinary incontinence or mixed urinary incontinence. DESIGN: A multicentre, parallel-group randomised controlled trial of the clinical effectiveness and cost-effectiveness of biofeedback pelvic floor muscle training compared with basic pelvic floor muscle training, with a mixed-methods process evaluation and a longitudinal qualitative case study. Group allocation was by web-based application, with minimisation by urinary incontinence type, centre, age and baseline urinary incontinence severity. Participants, therapy providers and researchers were not blinded to group allocation. Six-month pelvic floor muscle assessments were conducted by a blinded assessor. SETTING: This trial was set in UK community and outpatient care settings. PARTICIPANTS: Women aged ≥ 18 years, with new stress urinary incontinence or mixed urinary incontinence. The following women were excluded: those with urgency urinary incontinence alone, those who had received formal instruction in pelvic floor muscle training in the previous year, those unable to contract their pelvic floor muscles, those pregnant or < 6 months postnatal, those with prolapse greater than stage II, those currently having treatment for pelvic cancer, those with cognitive impairment affecting capacity to give informed consent, those with neurological disease, those with a known nickel allergy or sensitivity and those currently participating in other research relating to their urinary incontinence. INTERVENTIONS: Both groups were offered six appointments over 16 weeks to receive biofeedback pelvic floor muscle training or basic pelvic floor muscle training. Home biofeedback units were provided to the biofeedback pelvic floor muscle training group. Behaviour change techniques were built in to both interventions. MAIN OUTCOME MEASURES: The primary outcome was urinary incontinence severity at 24 months (measured using the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form score, range 0-21, with a higher score indicating greater severity). The secondary outcomes were urinary incontinence cure/improvement, other urinary and pelvic floor symptoms, urinary incontinence-specific quality of life, self-efficacy for pelvic floor muscle training, global impression of improvement in urinary incontinence, adherence to the exercise, uptake of other urinary incontinence treatment and pelvic floor muscle function. The primary health economic outcome was incremental cost per quality-adjusted-life-year gained at 24 months. RESULTS: A total of 300 participants were randomised per group. The primary analysis included 225 and 235 participants (biofeedback and basic pelvic floor muscle training, respectively). The mean 24-month International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form score was 8.2 (standard deviation 5.1) for biofeedback pelvic floor muscle training and 8.5 (standard deviation 4.9) for basic pelvic floor muscle training (adjusted mean difference -0.09, 95% confidence interval -0.92 to 0.75; p = 0.84). A total of 48 participants had a non-serious adverse event (34 in the biofeedback pelvic floor muscle training group and 14 in the basic pelvic floor muscle training group), of whom 23 (21 in the biofeedback pelvic floor muscle training group and 2 in the basic pelvic floor muscle training group) had an event related/possibly related to the interventions. In addition, there were eight serious adverse events (six in the biofeedback pelvic floor muscle training group and two in the basic pelvic floor muscle training group), all unrelated to the interventions. At 24 months, biofeedback pelvic floor muscle training was not significantly more expensive than basic pelvic floor muscle training, but neither was it associated with significantly more quality-adjusted life-years. The probability that biofeedback pelvic floor muscle training would be cost-effective was 48% at a £20,000 willingness to pay for a quality-adjusted life-year threshold. The process evaluation confirmed that the biofeedback pelvic floor muscle training group received an intensified intervention and both groups received basic pelvic floor muscle training core components. Women were positive about both interventions, adherence to both interventions was similar and both interventions were facilitated by desire to improve their urinary incontinence and hindered by lack of time. LIMITATIONS: Women unable to contract their muscles were excluded, as biofeedback is recommended for these women. CONCLUSIONS: There was no evidence of a difference between biofeedback pelvic floor muscle training and basic pelvic floor muscle training. FUTURE WORK: Research should investigate other ways to intensify pelvic floor muscle training to improve continence outcomes. TRIAL REGISTRATION: Current Controlled Trial ISRCTN57746448. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 70. See the NIHR Journals Library website for further project information

Police performance measurement: an annotated bibliography

This study provides information to assist those involved in performance measurement in police organisations. The strategies used to identify the literature are described. Thematic sections cover; general overviews; methodological issues; performance management in other industries; national, international and cross-national studies; frameworks (e.g. Compstat; the Balanced Scorecard); criticisms (particularly unintended consequences); crime-specific measures; practitioner guides; performance evaluation of individual staff; police department plans and evaluations; annotated bibliographies in related areas, and; other literature. Our discussion offers two conclusions: the measures best aligned with performance are typically more expensive, while most operational data should only provide contextual information; the philosophy of open governance should be pursued to promote transparency, accountability and communication to improve police performance

Improving Access to Mental Health Care in an Orthodox Jewish Community: A Critical Reflection Upon the Accommodation of Otherness

The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England

Women\u27s Status and Risk of Homicide Victimization: An Analysis With Data Disaggregated by Victim-Offender Relationship

Several feminist theories predict that women\u27s socioeconomic status, both absolute status and their status relative to men, influences the prevalence of violence against women, with some suggesting a positive correlation and others a negative one. Although each theory provides insight into the possible causal connection between women\u27s status, gender inequality, and violence, empirical tests of these relationships are inconclusive. The present study addresses this issue by using a cross-sectional design with 2000 census and crime data to assess the impact of women\u27s absolute status and gender inequality along educational, employment, income, and occupational dimensions and their risk of homicide victimization by intimate partners and nonintimates. The findings indicate that women\u27s absolute status is significantly correlated with female homicide victimization rates by intimate partners. However, tests for equality of regression coefficients between the intimate and nonintimate partner models suggest that these differences may be attributed to random chance