Evaluation report of Society Inc.

Executive Summary People and relationships are central to what constitutes Society Inc. Their model is founded on three broad aims, social inclusion, empowerment and support. This evaluation report demonstrates how Society Inc. enables local people to use and develop their skills and knowledge to support others within their community. Their model is rooted in the belief that every person is of value to their community. Adopting a person-centred approach is not uncommon. However, it is how Society Inc. practice what they preach, which ensures their clients, volunteers and staff, reliably experience being valued as a person. The charity’s outcomes are embodied in the experience of social inclusion and belongingness. Accordingly, the development of this evaluation has been inductive, to allow that experience to emerge. The information shared in this report is based on interviews with clients, their family members, volunteers and staff. In the process of conducting interviews, I attended the charity’s base in Little Hulton and observed interactions. I have been privileged to hear personal experiences and trusted to hold a shared understanding of ‘knowing’ how Society Inc. is experienced, and why that is of value. Society Inc. is a charitable incorporated organisation that supports volunteers to provide mentoring and befriending services to people in their communities. It is based in the Little Hulton area of Salford and operates across Greater Manchester. In the relatively short time, Society Inc. has been operating it has become a point of referral for several organisations, including Salford Royal Hospital and Prescott House Mental Health Unit. The charity often receives referrals to assist individuals who are already in receipt of a professional service. Engagement with Society Inc. provides the community-based support to actively assist people in the process of addressing their complex needs. Without undermining their personal touch, professionalism is at the heart of all Society Inc. practices. Notably, to support their staff and volunteers they deliver an accredited training scheme and facilitate reliable supervision and safeguarding procedures. All interviewees reflect a sense of pride in their participation with, and knowledge of Society Inc. An emergent theme was about being local, but this was not simply a matter of location. For example, one client described other services such as Sure Start as procedural rather than helpful; there was a sense of feeling ‘othered’, that created anxiety. Closer analysis suggests that engagement with Society Inc. is experienced as the acceptance of a person’s vulnerability, without judgement. That concept is the foundation of trust. Additionally, the authentic discourses from staff and volunteers embraced language, which was often nonprofessionalised and indicative of their approach to inclusion as one that (Final) Evaluation of Society Inc. 5 engenders equality. That is of crucial importance when reducing barriers to inclusion experienced by those who live in areas of multiple deprivations, such as Little Hulton. It is within a landscape of decades of economic, social, health and education inequality, that Society Inc. practices The volunteers who provide mentoring and befriending services are the conduit between Society Inc. as an organisation, and those who engage with its services. Indeed, some who approach the charity with a view of receiving support might soon discover the support they need could be in the form of becoming a mentor or befriender to someone else. Two people who started as volunteers are now employed by the charity, through its ability to attract funding. Society Inc. runs on a financial shoestring, yet it is able to provide a service and nurture ambition within the community that for many, is worth its weight in gold. Reducing social isolation is a foundational Society Inc. activity. Volunteers seek to encourage their clients to safely experience the world around them, as a means to disrupt feelings of loneliness and to nurture a greater sense of self-efficacy, belongingness and enjoyment. This active approach supports clients to go beyond pre-contemplation to active engagement with change. The trusted relationships facilitated by Society Inc. and experienced within their social network of support was implicit in all participant interviews. Particularly striking, was the belief that Society Inc. could be trusted to continue to be available to meet the future needs of people who require their services. That sense of permanence indicates a perception of strength in the social network they have created, which extends beyond the individuals who are current volunteers. Society Inc. has responded effectively to the changing needs of its clients and volunteers during the Covid19 pandemic and associated social restrictions. They quickly adapted to further develop their networking activities with other local organisations. This was important, as the government imposed social distancing measures can inhibit people from seeking support. Impressively, Society Inc. was proactive in developing communication links with other charities and services to streamline delivery and ensure they were not duplicating their activities. They adapted their usual community-based support systems to telephone communications. Recognising that some people’s mental well-being required the ability to see and talk to someone, they conducted some social distancing visits at the garden gate. In addition to these strategies, the staff have been mobilised to respond to those members of the community in urgent need of food. A constant throughout the evaluation process was the importance of highlighting the value of those who are receiving and delivering Society Inc. services. That foundational premise remained consistent, especially during this time of critical and acute nee

Moving towards self-actualization : a trauma-informed and needs-focused approach to the mental health needs of survivors of commercial child sexual exploitation

There is increasing evidence that children who are subject to commercial child sexual exploitation (CCSE) are likely to experience complex mental health needs. Failure to address the trauma experienced by victims of CCSE can lead to suicide attempts, self-harm, and long-term mental health needs (Powell, Asbill, Louis, & Stoklosa, 2018). A ‘trauma-informed’ approach (TIA) creates a responsive environment that improves the motivation of victims of CCSE to seek treatment and service providers to address unmet needs. Merging Maslow’s (1943) hierarchy of needs with a TIA approach provides a comprehensive framework to assess the service requirements necessary to meet CCSE survivors’ needs. Particularly, when Maslow’s hierarchy of needs model is coupled with contemporary extensions, which address our greater understanding of the neurological impact of abuse on physiological well-being greater resilience can be created. Additionally, a TIA instigates a shift from victims of CCSE being viewed as damaged, to an understanding of the impact abusive experiences have had on their development. That approach permits them and others to perceive their “survivorhood” and develop their capacity to achieve self-actualization. This paper critically examines what is constituted as best practice in trauma-informed mental health service delivery to not only meet needs but to support CCSE survivors’ attainment of self-actualization

Civil and forensic patients : comparing demographics, risk factors, and negative life events

OBJECTIVES: This investigation centres on how the mentally ill with a forensic admission compare to the mentally ill with a civil admission, and investigates who inpatients with a forensic and civil admission are, and how the risk factors and negative historical events they have experienced compare or differ. THEORETICAL BASE: Using a risk and resilience framework, risk factors that are deleterious to healthy development are used as variables. METHODS: The records of all adult inpatients both forensic and civil, aged 18 to 89 at admission in two U.S. mountain region public psychiatric hospitals were included in the sample (n=1768). All patients are assessed using the Colorado Clinical Assessment Record (CCAR) which, measures a diverse set of variables including Current Issues, History of Issues, Demographics, and Disabilities. OUTCOMES: Civil and forensic patients have more in common than differences. Both samples compare more closely to risk factors and negative historical events than they do to the general population. However, this begins to break down once the sample is separated by gender. SOCIAL WORK IMPLICATIONS: Social Workers who work in prison systems need to become more familiar with mental illness interventions. Additionally, social workers should both educate law enforcement about de-escalation tactics with the mentally ill and intervene on mental health related police calls. On the macro level, social workers should advocate for the mentally ill to be housed in psychiatric hospitals rather than be imprisoned where they will often not receive inpatient psychiatric care

Parents' points of view: an evaluation of the M'Lop Tapang special needs programme, Cambodia

M’Lop Tapang is a registered non-governmental organisation working in South West Cambodia and providing services to 5000 vulnerable children and 2500 families. This evaluation was commissioned to review M’Lop Tapang’s special needs programme. Interviews were conducted with 35 parents / carers of children who receive services from M’Lop Tapang’s special needs programme . Nearly all of these parents / carers reported that they had noticed improvements in their children’s behaviour or functional ability since attending the programme. Significantly, almost all also reported a dramatic reduction in stress as a result of their child attending the programmes. While the study revealed many positive aspects of M'Lop Tapang’s special needs programme it also highlighted areas for improvement, particularly in areas of parental learning and education

Needs analysis report following the sexual exploitation of children in Rotherham

It has been an immense honour to listen to the experiences of the people of Rotherham. The project team received a warm welcome and felt humbled at the extraordinary courage of victims, survivors and their families. We wish to express our heartfelt thanks to everyone who took part in the study. The knowledge and opinions shared by our participants are the foundation of this report. No-one wants to think about what child sexual abuse and exploitation really means. Recognising that children have been humiliated, raped and tortured is extremely distressing. As such, it is no surprise that many felt anger and rage when they understood that those with authority failed to protect vulnerable children and young people. There is a need to face the awful reality that child sexual abuse has always happened. However, in the age of the internet, the number of children at risk of sexual abuse has increased. Those who sexually abuse children are mostly, but not always, men. Not discounting the vast number of boys who have suffered abuse, most of the known victims of sexual abuse are girls. Both victims and perpetrators come from every walk of life. The threat is such that we all have a responsibility to consider what we can do to protect every child in our family and communities. The public criticism of Rotherham Metropolitan Borough Council (RMBC) and South Yorkshire Police, following Professor Jay’s report was right and inevitable. Positively, there have been several examples of how RMBC and South Yorkshire Police have responded to criticism and improved the way they respond to victims and survivors. However, there have also been negative consequences of public scrutiny, with many people in the study reporting that they want to regain pride in their hometown. Those who took part in this study did not shy away from exploring the difficulties they face. Naturally, participants continue to talk about issues of trust, as past mistakes created a sense of vulnerability. However, there is also evidence that healing is taking place. Many participants made suggestions of how they and RMBC could and should collaborate to strengthen, individuals, families and their communities Indeed, there is a determination to meet current and future needs with a sense of collective rigour. Some of these tasks involve developing internal structures, such as communication and the provision of appropriate resources. Rotherham, like many other towns and cities in Britain, is also faced with external threats which can exacerbate internal challenges. An example of this is how recognition of the involvement of some men of Asian Pakistani heritage, in the abuse of children in Rotherham, led some political groups to capitalise on fears. However, it is clear that children are best protected in resilient families and communities. Thankfully, Rotherham and its people continue to demonstrate resilience. In addition, there is also a strong sense of realism, no-one in Rotherham expects perfection, but they do expect to do everything possible to protect children and young people. One woman made the distinction between surviving and thriving: “…I don’t want to survive, I want to thrive…” We hope this report contributes to that aim and welcome your views on the findings from data collected between April and June 2015. We recognise that the data is reflective of views expressed at that time and that RMBC and the people of Rotherham, have continued to respond to needs throughout the course of this analysis process

Smoking during Pregnancy Affects Speech-Processing Ability in Newborn Infants

BACKGROUND: Tobacco smoking during pregnancy is known to adversely affect development of the central nervous system in babies of smoking mothers by restricting utero–placental blood flow and the amount of oxygen available to the fetus. Behavioral data associate maternal smoking with lower verbal scores and poorer performance on specific language/auditory tests. OBJECTIVES: In the current study we examined the effects of maternal smoking during pregnancy on newborns’ speech processing ability as measured by event-related potentials (ERPs). METHOD: High-density ERPs were recorded within 48 hr of birth in healthy newborn infants of smoking (n = 8) and nonsmoking (n = 8) mothers. Participating infants were matched on sex, gestational age, birth weight, Apgar scores, mother’s education, and family income. Smoking during pregnancy was determined by parental self-report and medical records. ERPs were recorded in response to six consonant–vowel syllables presented in random order with equal probability. RESULTS: Brainwaves of babies of nonsmoking mothers were characterized by typical hemisphere asymmetries, with larger amplitudes over the left hemisphere, especially over temporal regions. Further, infants of nonsmokers discriminated among a greater number of syllables whereas the newborns of smokers began the discrimination process at least 150 msec later and differentiated among fewer stimuli. CONCLUSIONS: Our findings indicate that prenatal exposure to tobacco smoke in otherwise healthy babies is linked with significant changes in brain physiology associated with basic perceptual skills that could place the infant at risk for later developmental problems

Point-of-care testing and treatment of sexually transmitted and genital infections during pregnancy in Papua New Guinea (WANTAIM trial): protocol for an economic evaluation alongside a cluster-randomised trial

INTRODUCTION: Left untreated, sexually transmitted and genital infections (henceforth STIs) in pregnancy can lead to serious adverse outcomes for mother and child. Papua New Guinea (PNG) has among the highest prevalence of curable STIs including syphilis, chlamydia, gonorrhoea, trichomoniasis and bacterial vaginosis, and high neonatal mortality rates. Diagnosis and treatment of these STIs in PNG rely on syndromic management. Advances in STI diagnostics through point-of-care (PoC) testing using GeneXpert technology hold promise for resource-constrained countries such as PNG. This paper describes the planned economic evaluation of a cluster-randomised cross-over trial comparing antenatal PoC testing and immediate treatment of curable STIs with standard antenatal care in two provinces in PNG. METHODS AND ANALYSIS: Cost-effectiveness of the PoC intervention compared with standard antenatal care will be assessed prospectively over the trial period (2017-2021) from societal and provider perspectives. Incremental cost-effectiveness ratios will be calculated for the primary health outcome, a composite measure of the proportion of either preterm birth and/or low birth weight; for life years saved; for disability-adjusted life years averted; and for non-health benefits (financial risk protection and improved health equity). Scenario analyses will be conducted to identify scale-up options, and budget impact analysis will be undertaken to understand short-term financial impacts of intervention adoption on the national budget. Deterministic and probabilistic sensitivity analysis will be conducted to account for uncertainty in key model inputs. ETHICS AND DISSEMINATION: This study has ethical approval from the Institutional Review Board of the PNG Institute of Medical Research; the Medical Research Advisory Committee of the PNG National Department of Health; the Human Research Ethics Committee of the University of New South Wales; and the Research Ethics Committee of the London School of Hygiene and Tropical Medicine. Findings will be disseminated through national stakeholder meetings, conferences, peer-reviewed publications and policy briefs. TRIAL REGISTRATION NUMBER: ISRCTN37134032

Biomechanical comparison of screw-based zoning of PHILOS and Fx proximal humerus plates

Background Treatment of proximal humerus fractures with locking plates is associated with complications. We aimed to compare the biomechanical effects of removing screws and blade of a fixed angle locking plate and hybrid blade plate, on a two-part fracture model. Methods Forty-five synthetic humeri were divided into nine groups where four were implanted with a hybrid blade plate and the remaining with locking plate, to treat a two-part surgical neck fracture. Plates’ head screws and blades were divided into zones based on their distance from fracture site. Two groups acted as a control for each plate and the remaining seven had either a vacant zone or blade swapped with screws. For elastic cantilever bending, humeral head was fixed and the shaft was displaced 5 mm in extension, flexion, valgus and varus direction. Specimens were further loaded in varus direction to investigate their plastic behaviour. Results In both plates, removal of inferomedial screws or blade led to a significantly larger drop in varus construct stiffness than other zones. In blade plate, insertion of screws in place of blade significantly increased the mean extension, flexion valgus and varus bending stiffness (24.458%/16.623%/19.493%/14.137%). In locking plate, removal of screw zones proximal to the inferomedial screws reduced extension and flexion bending stiffness by 26–33%. Conclusions Although medial support improved varus stability, two inferomedial screws were more effective than blade. Proximal screws are important for extension and flexion. Mechanical consequences of screw removal should be considered when deciding the number and choice of screws and blade in clinic

Structure-based mutagenesis reveals the albumin-binding site of the neonatal Fc receptor

Albumin is the most abundant protein in blood where it has a pivotal role as a transporter of fatty acids and drugs. Like IgG, albumin has long serum half-life, protected from degradation by pH-dependent recycling mediated by interaction with the neonatal Fc receptor, FcRn. Although the FcRn interaction with IgG is well characterized at the atomic level, its interaction with albumin is not. Here we present structure-based modelling of the FcRn–albumin complex, supported by binding analysis of site-specific mutants, providing mechanistic evidence for the presence of pH-sensitive ionic networks at the interaction interface. These networks involve conserved histidines in both FcRn and albumin domain III. Histidines also contribute to intramolecular interactions that stabilize the otherwise flexible loops at both the interacting surfaces. Molecular details of the FcRn–albumin complex may guide the development of novel albumin variants with altered serum half-life as carriers of drugs