Second Chance Stories: Children and Families' Journey from School Exclusion to Therapeutic Alternative Provision

A child is a ‘relational’ being, formed through their relationships with significant others: parents, siblings, teachers and peers. A child’s behaviour in school is correspondingly influenced by multiple factors, some of which are external to the school environment. This is illustrated in the demographics of children and young people (CYP) most likely to be excluded from school, who often have multiple vulnerability factors in their home life (Gill, 2017). Despite the acknowledgment of systemic factors within numerous government policies, much of the research on therapeutic interventions for excluded children in Alternative Provision (AP) focuses on behavioural and psychodynamic interventions. Alternatively, this qualitative study is based on a systemic multi-family therapeutic Alternative Provision (AP) exploring children and families’ perspectives of school exclusion and integration into this AP. A process relational ontological approach (Brown & Stenner, 2009) and critical realist epistemology underpin this study. CYP and families undertook semi-structured interviews and CYP also completed a drawing exercise. A thematic analysis of the data identified four themes characterising the journey from school exclusion to AP: ‘System Breakdown’, ‘System Integration’, ‘System Transformation’ and ‘Cracks in the System’. It is argued that school exclusion affects the whole of the child’s world, leading also to the exclusion of other family members from many different systems. Furthermore, this study argues that the model of the school, which seeks to include and work with all excluded parts of the child’s system, is positively transformative. The findings of this study suggest that systemic approaches for CYP excluded from school provide an important and valuable contribution to clinical practice, highlighting the need for clinical psychologists to develop clinical and theoretical frameworks that engage more fully with school exclusion as a systemic issue. It is further argued that future research should explore how interventions can attend to broader macro systemic factors at play in school exclusion for example, the family’s economic and employment circumstances

SENSITIVITY TO SCOPE: EVIDENCE FROM A CVM STUDY OF WETLANDS

Wetlands valuation is a situation in which CVM studies might be expected to fail scope tests. This paper reports results from a split-sample CVM study of Wisconsin wetlands. The survey employed a multiple-bounded, polychotomous-choice format, and compared WTP distributions using the method of convolutions. The survey demonstrated sensitivity to scope.Resource /Energy Economics and Policy,

Evaluation of a specialist weight management service for patients with severe obesity in Liverpool

Objective: To evaluate a specialist weight management treatment for patients with severe obesity and follow up at 3 months, monitoring changes in weight, BMI and clinical outcome variables. Changes in food intake, self esteem and health related quality of life (HRQL) were also compared to pre- and post- intervention. Design: Step by step is a new obesity servive which specifically targets obese patients at greater risk of further ill health. Only patients who are referred by their G.P. or health professional have been included in the evaluation. After an assessment appointment all patients choose one of two treatment options: group programme, individual dietetic care or both. The group programme offered weekly contact over twelve weeks and monthly follow up thereafter in a community setting. One-to-one care offered monthly appointments with the Dietician over a three month period. Subjects: A total of 50 patients with a BMI>30kg/m2, mean age 59 years, mean weight for males 113.5kg, BMI 39,3kg/m2 and females 92.7kg, BMI 36.5kg/m2. Main outcome measures: weight, BMI, total cholesterol, LDL, TG, HDL, FBG, HbA1C, blood pressure, food intake, self esteem and quality of life were measured pre and post intervention. Results: Patients who attended the group programme showed significant weight loss 1.99kg (P<0.05) and BMI 0.66kg/m2 at three months. Male patients lost more weight (3.9kg) during the three month period compared to females (1.4kg). Data was not available for individual dietetic care. Patients significantly reduced intake of negative marker foods (P<0.00). No changes were observed between self esteem pre and post programme however quality of life score increased considerably, 44.83 (S.D. 34.26) to 70.37 (S.D. 15.86) P<0.001. Conclusion: Patients attending a twelve week weight management programme run by community dietians and foodworkers achieve clinically worth while reducations in weight and BMI, improvements in food choice and choice and improved HRQL

Case for the structured audit

https://egrove.olemiss.edu/dl_proceedings/1159/thumbnail.jp

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None for the money: how we actually make monetary decisions: a literature review

Often, critics of academic scholarship point to the failure of academic findings translating to practical applications. This paper tackles an issue that most people deal with every single day, how to make smart decisions with their money. The literature scrutinizing the psychology of monetary decisions is vast. However, in a literature so comprehensive it can be easy to miss the forest for all the trees. By returning primarily to two authors who did much of the foundational research on the subject and expanding upon their work, this paper examines the overwhelming prevalence, causes, and future implications of irrational monetary decision making

Transmission of multidrug-resistant tuberculosis in the UK: a cross-sectional molecular and epidemiological study of clustering and contact tracing

BACKGROUND: Between 2000 and 2012 the number of multidrug-resistant (MDR) tuberculosis cases in the UK increased from 28 per year to 81 per year. We investigated the proportion of MDR tuberculosis cases arising from transmission in the UK and associated risk factors. METHOD: We identified patients with MDR tuberculosis notified in England, Wales, and Northern Ireland between Jan 1, 2004, and Dec 31, 2007, by linking national laboratory and surveillance data. Data for laboratory isolates, including drug sensitivities and 24-mycobacterial interspersed repetitive-unit-variable-number tandem repeat (MIRU-VNTR) typing were obtained routinely from the National Tuberculosis Reference laboratories as part of national tuberculosis surveillance. We investigated clusters of cases with indistinguishable MIRU-VNTR profiles to identify epidemiological links. We calculated transmission using the n-1 method and established associated risk factors by logistic regression. We also assessed the likelihood of transmission to additional secondary active tuberculosis cases, identified through conventional contact tracing. FINDINGS: 204 patients were diagnosed with MDR tuberculosis in the study period; 189 (92·6%) had an MIRU-VNTR profile. We identified 12 clusters containing 40 individuals and 149 unique strains. The proportion of cases attributable to recent transmission, on the basis of molecular data, was 15% (40 cases clustered-12 clusters/189 with a strain type). The proportion of cases attributable to recent transmission (ie, transmission within the UK) after adjustment for epidemiological links was 8·5% (22 cases with epidemiological links-six clusters/189 cases with a strain type). Being UK born (odds ratio 4·81; 95% CI 2·03-11·36, p=0·0005) and illicit drug use (4·75; 1·19-18·96, p=0·026) were significantly associated with clustering. The most common transmission setting was the household but 21 of 22 of epidemiological links were missed by conventional contact tracing. 13 secondary active tuberculosis cases identified by conventional contact tracing were mostly contacts of patients with MDR tuberculosis from countries of high tuberculosis burden. 11 (85%) of 13 shared the same country of birth as the index case, of whom ten did not share a strain type or drug resistance pattern. INTERPRETATION: Transmission of MDR tuberculosis in the UK is low and associated with being UK born or illicit drug use. MIRU-VNTR typing with cluster investigation was more successful at identifying transmission events than conventional contact tracing. Individuals with tuberculosis who have had contact with a known MDR tuberculosis source case from a country of high tuberculosis burden should have drug-sensitivity testing on isolates to ensure appropriate treatment is given. FUNDING: Public Health England