The justice system is failing victims and survivors of sexual violence

Tammi Walker, Alison Foster, Rabiya Majeed-Ariss and Miranda Horvath on a role for psychologists in improving processes and protection around rape cases. The justice system in England and Wales continues to fail survivors of sexual violence. Official figures from the Crown Prosecution Service and Police highlight the ongoing problem of attrition of rape cases from the criminal justice system. Here, we outline the limitations of the endless cycle of reviews in response to the poor treatment of survivors. We argue that solutions which could lead to significant improvements for survivors of sexual violence are possible

Final Evaluation Report: Pilot for New Model of Midwifery Supervision

The focus of the evaluation was a bridging programme to prepare existing supervisors of midwives (SOMs) to become professional midwifery advocates (PMAs) in order to deliver a new model of supervision (A-EQUIP). It set out to assess the bridging programme and the A-EQUIP model. This report documents the following stages of the evaluation: 1. Establish baseline data, prior to the adoption of the A-EQUIP pilot a. Development and completion of a site pro-forma to provide contextual organisational data 2. Evaluation of the preparation of the A-EQUIP practitioner and assessment of the A-EQUIP model through the following mechanisms: a. Documentary analysis b. Supervisor/PMA survey c. Supervisee survey d. Supervisor/PMA interview

Evaluation of the Macmillan Cancer Care Co-ordinator and Community Cancer Care Sisters work-stream for the South Tees Integrated Cancer Care programme (Macmillan South Tees Evaluation)

Background to the programme: The Macmillan Integration of Cancer Care programme (MacICC) was established in February 2014 as a partnership programme between Macmillan Cancer Support and South Tees NHS Foundation Trust and is scheduled to finish in December 2018. This evaluation is focused on the two new roles that were developed and implemented as a result of the programme; the Cancer Care Coordinator (CCC) and the Community Cancer Care Sisters (Community Sisters). Evaluation Approach: The evaluation was formed from two main approaches. Firstly, we used interviews and group discussions and read available literature to describe the experiences and opinions of staff and patients and to understand what sort of benefits the roles might bring about and why. Secondly, we gathered data about areas of the services that we expected to change as a result of the roles being introduced. For instance, the amount of Accident and Emergency services being used by people with cancer diagnoses, the amount of time that might be saved for other members of staff and reductions in missed appointments. Findings: One of the key findings was that the roles were highly valued by the people in the roles, their colleagues and patients. They clearly filled gaps in services. There was very good evidence about how the CCC roles had improved patient experiences; for instance, by reducing waiting times, providing somebody to talk to that had time to deal with their concerns and increasing the extent to which all patients’ needs were assessed. Service-users valued the Community Sisters' family-focused approach and focus on the whole person rather than immediate clinical needs. Outcomes included being able to cope better with the illness and to return to a more normal life of activities. Some specific activities, such as making treatment recommendations, helping to make difficult decisions and intervening to solve problems with other services were reported to be particularly important. Before the roles were introduced there were more than 30 people every month waiting longer than 62 days. We observed a reduction, so that the number of long waits was consistently below the average from 3 months after the roles were introduced, and at one point dropping below 10 people per month. At 21-months after the new roles, there had been a reduction of about 245 attendances to A&E per month, which could be equal to a saving of about £381,850 over the course of the 21 month observation period. Conservative estimates for the return on investment indicated a break-even point at 13-months and a £1.05 return for each £1.00 invested over 21 months. This includes the considerable costs for initial development of the roles. Conclusions and recommendations: The new roles are widely regarded as valuable both in terms of health service efficiency and patient experience. We found good quality evidence to support the claim that the new roles helped to provide the right care, at the right time, with the right person. The evidence that we gathered from talking to people and understanding how the programme might work was supported by the examination of the other available data. The findings support the further adoption and spread of the CCC roles to other cancer specialties and the expansion of the Community Sister roles so that more people, particularly those in more remote areas can benefit. The economic evaluation indicates that this should result in further savings across the health care system to offset any additional costs in providing the service. There is also potential for the roles to take on additional responsibilities to further improve pathways for cancer care and support. It should be recognised that this was a rapid evaluation, and there were limitations in both the quality and type of information available, and therefore the conclusions that can be drawn also have limitations and rely on certain assumptions that needed to be made. Whilst we believe that the evaluation presents a strong case for the benefits of these roles for a wide range of people and services, they would benefit from more in-depth investigation, particularly if there are plans to scale up the programme workstream

Improving understanding of the scale and nature of child sexual abuse Characteristics and experiences of children and young people attending Saint Mary's Sexual Assault Referral Centre, Greater Manchester A review of 986 case files

This report brings together evidence collected from the case files of children and young people aged 0–17 attending Saint Mary’s Sexual Assault Referral Centre (SARC) in Greater Manchester for a forensic medical examination following disclosure or suspicion of sexual abuse. The data relates to all 986 forensic medical examinations of under-18s living in the Greater Manchester area who accessed the service between April 2012 and March 2015. Data was retrospectively extracted from the paper case file of each ‘service user’, including background and demographic data about them, the route by which they were referred to the SARC, the nature of the child sexual abuse (CSA) reported to have taken place, and the people suspected of committing it. The choice of data extracted was based on the ‘data collection template’, a core dataset developed by the Centre of expertise on child sexual abuse (CSA Centre) to standardise and improve agencies’ recording of data about CSA. Established in 1986, Saint Mary’s SARC is the UK’s largest single-centre SARC. It was the first of its kind, developed to provide high quality medical examinations in a designated and specialised space for men, women and children who had experienced sexual assault. The findings generated through the study have wider relevance because they represent the experiences of a large number of children for whom there were concerns about sexual abuse. It is important to emphasise, however, that they are not representative of CSA in other settings or locations. The vast majority of victims of CSA do not disclose their abuse and are not identified by professionals, and many of those who are identified do not attend a SARC. Furthermore, medical examinations of children at a SARC are provided following disclosure or suspicion of contact sexual abuse; experiences of non-contact CSA are, therefore, not represented in the study

The effectiveness of sexual assault referral centres with regard to mental health and substance use: a national mixed-methods study – the MiMoS Study

Background Sexual assault referral centres have been established to provide an integrated service that includes forensic examination, health interventions and emotional support. However, it is unclear how the mental health and substance use needs are being addressed. Aim To identify what works for whom under what circumstances for people with mental health or substance use issues who attend sexual assault referral centres. Setting and sample Staff and adult survivors in English sexual assault referral centres and partner agency staff. Design A mixed-method multistage study using realist methodology comprising five work packages. This consisted of a systematic review and realist synthesis (work package 1); a national audit of sexual assault referral centres (work package 2); a cross-sectional prevalence study of mental health and drug and alcohol needs (work package 3); case studies in six sexual assault referral centre settings (work package 4), partner agencies and survivors; and secondary data analysis of outcomes of therapy for sexual assault survivors (work package 5). Findings There is a paucity of evidence identified in the review to support specific ways of addressing mental health and substance use. There is limited mental health expertise in sexual assault referral centres and limited use of screening tools based on the audit. In the prevalence study, participants (n = 78) reported high levels of psychological distress one to six weeks after sexual assault referral centre attendance (94% of people had symptoms of post-traumatic stress disorder). From work package 4 qualitative analysis, survivors identified how trauma-informed care potentially reduced risk of re-traumatisation. Sexual assault referral centre staff found having someone with mental health expertise in the team helpful not only in helping plan onward referrals but also in supporting staff. Both sexual assault referral centre staff and survivors highlighted challenges in onward referral, particularly to NHS mental health care, including gaps in provision and long waiting times. Work package 5 analysis demonstrated that people with recorded sexual assault had higher levels of baseline psychological distress and received more therapy but their average change scores at end point were similar to those without sexual trauma. Limitations The study was adversely affected by the pandemic. The data were collected during successive lockdowns when services were not operating as usual, as well as the overlay of anxiety and isolation due to the pandemic. Conclusions People who attend sexual assault centres have significant mental health and substance use needs. However, sexual assault referral centres vary in how they address these issues. Access to follow-up support from mental health services needs to be improved (especially for those deemed to have ‘complex’ needs) and there is some indication that co-located psychological therapies provision improves the survivor experience. Routine data analysis demonstrated that those with sexual assault can benefit from therapy but require more intensity than those without sexual assault. Future work Further research is needed to evaluate the effectiveness and cost-effectiveness of providing co-located psychological therapy in the sexual assault referral centres, as well as evaluating the long-term needs and outcomes of people who attend these centres. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (16/117/03) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 21. Trial registration This trial is registered as PROSPERO 2018 CRD42018119706 and ISRCTN 18208347

Impact of social prescribing to address loneliness: a mixed methods evaluation of a national social prescribing programme

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service‐users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service‐users’ loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service‐users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre‐post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi‐structured interviews with service‐users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service‐users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was −1.84 (95% CI −1.91 to −1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service‐users’ needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service‐users experiencing loneliness

Young People’s, Parents’, and Professionals’ Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study

Background: There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people’s self-management of Juvenile Arthritis. Objective: The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people’s self-management of chronic Juvenile Arthritis. Methods: A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants’ views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results: Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications

Evaluation of the British Red Cross community connectors programme : final report, Social Return on Investment : May 2019

Background: A Social Return on Investment (SROI) was undertaken to evaluate the economic impact of the British Red Cross Community Connectors programme. The programme was a form of social prescribing, which was focused on alleviating loneliness. This type of analysis is particularly suited to interventions that include a wide range of benefits (Nicholls, Lawlor, Neitzert, & Goodspeed, 2009). Objectives: The SROI sought to address the following objectives. • Provide robust evidence to inform the British Red Cross decision making with regard to wider rollout and support advocacy • Understand the costs of service delivery and make judgments about its value of outcomes including reductions in the use of other services that might occur as a consequence of the support provided to service users Methods: The different benefits and costs included were informed by the literature and decided by stakeholders and local experts, using workshops, surveys and informal conversations. This approach promotes relevance of findings and encourages a collaborative focus. The SROI approach has been successfully used to evaluate wellbeing interventions. For example, a community befriending programme (Arvidson, Battye, & Salisbury, 2014). It is widely used and recognised by decision makers; for example, the Cabinet Office has issued guidance on how to use SROI. A key advantage of the SROI for evaluating the Community Connectors project is that it enables the economics model to develop over time, and be shaped by unanticipated cost and benefits. This enables any changes to the programme or its costs/benefits to be incorporated. This is important because of the innovative and developing nature of the Community Connectors programme. Findings: The Inputs taken into account (costs for delivering the project) are British Red Cross central organisational costs for the set-up and coordination of the project, British Red Cross project delivery costs and the time donated by volunteers for their training and participation in the Community Connector service. The outcomes (benefits) that are taken into account are improved wellbeing of volunteer, improved wellbeing of service-users (using SWEMWBS scores) and reduced missed health appointments. Wellbeing is valued using the wellbeing valuation approach (Fujiwara, 2013). Conclusion: The ultimate findings from these calculations included total inputs, outcomes, net present value and Social Return on Investment ratio. This demonstrates an economic return to society in general of £1.48 for each pound invested in the project. A range of sensitivity analyses were also conducted

Characterizing Novel Fluorescent Protein Pairings for Förster Resonance Energy Transfer (FRET)

poster abstractSince it’s cloning, the sequence encoding the green fluorescent protein (GFP) from the jellyfish Aequorea victoria has been engineered to produce fluorescent proteins (FPs) with emission in the blue to yellowish-green range of the visible spectrum. Furthermore, many FPs with homology to the Aequorea GFP have been cloned from marine organisms, providing new proteins that fluoresce into deep red spectrum. These new FPs expanded the repertoire of applications to include multi-color imaging of protein co-localization and behavior inside living cells. However, it is their use as donor and acceptor pairs for Förster Resonance Energy Transfer (FRET) microscopy that has generated the greatest interest. The most precise methods for measuring FRET detect the quenching of the donor by the acceptor, and Fluorescence Lifetime Imaging Microscopy (FLIM) can accurately measure the shorter donor lifetimes that result from FRET. Currently, the Aequorea GFP variants known as Cerulean (cyan) and Venus (yellow) are the most popular FRET pair. However, Venus has poor photostability, and the emission near 500 nm limits its utility as an acceptor. The objective of this study was to use FLIM to test the utility of different FP pairings for FRET studies with the goal to identify potentially improved FRET pairs