Literature Review- Categorising the literature on the use of Conversation Analysis for parent/child interactions: A systematic review

There is a clash between the traditional medical understanding of gender dysphoria as a mental health condition and the ideas of queer theory which suggest gender is socially constructed and performative. As a consequence many people, including parents, do not know the most supportive language to use with young people who are trans or gender diverse. Conversation Analysis (CA) is useful for exploring talk as action in both family groups and disenfranchised cultures. The aim was: to better understand how alignment is achieved or not in relation to the CA phenomena of person reference and membership categories in conversations between young trans or gender diverse people and their parents. Four families were recruited and engaged in individual family focus groups which involved parents and their trans or gender diverse children looking at photographs of the young person pre and post social transition. This was audio recorded and transcribed. These transcripts were then examined for gendered person reference and membership categories in addition to alignment. Particular linguistic features were counted and examined in depth using Jeffersonian transcription. Analysis from each focus group was done with the support of a CA group. Three key interactional features were identified: 1) When raising dispreferred names, more cautious topicalization, with space for the young person to reply, was met with less misalignment 2) Alignment was observed when the parents and young person’s membership categories and expected category based activities were similar 3) Individuals and their parents can construct, and refer to, their identity differently, but alignment was more likely to occur when parents and young peoples’ sense of identity constancy matches. Noticing these interactional features may be helpful for parents wanting to support their child with a gender transition and may be valuable for professionals working with gender diverse people and their families

The cost-effectiveness of financial incentives to achieve heroin abstinence in individuals with heroin use disorder starting new treatment episodes: A cluster randomised controlled trial-based economic evaluation

OBJECTIVES: Cost-effectiveness analysis of two 12-week contingency management (CM) schedules targeting heroin-abstinence or attendance at weekly keyworker appointments for opioid agonist treatment (OAT), compared to treatment as usual (TAU). METHODS: Cost-effectiveness analysis was conducted alongside a cluster randomised trial of 552 patients from 34 clusters (drug treatment clinics) randomly allocated 1:1:1 to OAT plus weekly keyworker appointments with either: i) CM targeted at heroin-abstinence (CM Abstinence); ii) CM targeted at on-time attendance at weekly appointments (CM Attendance); or, iii) no CM (TAU). The primary cost-effectiveness analysis at 24 weeks post-randomisation took a societal cost perspective with effects measured in heroin-negative urine samples. RESULTS: At 24-weeks, mean differences in weekly heroin-negative urine results compared with TAU were 0.252 (95%CI -0.397 to 0.901) for CM Abstinence and 0.089 (95%CI -0.223 to 0.402) for CM Attendance. Mean differences in costs were £2562 (95%CI £32 to £5092) for CM Abstinence and £317 (95%CI -£882 to £1518) for CM Attendance. Incremental cost-effectiveness ratios were £10,167 per additional heroin-free urine for CM Abstinence and £3,562 for CM Attendance with low probabilities of cost-effectiveness of 3.5% and 36%, respectively. Results were sensitive to timing of follow-up for CM Attendance, which dominated TAU (better outcomes, lower costs) at 12-weeks, with an 88.4% probability of being cost-effective. Probability of cost-effectiveness remained low for CM Abstinence (8.6%). CONCLUSIONS: Financial incentives targeted toward heroin-abstinence and treatment-attendance were not cost-effective over the 24-week follow-up. However, CM Attendance was cost-effective over the treatment period (12-weeks), when participants were receiving keyworker appointments and incentives