Parent training interventions for parents with intellectual disability

Background: Research suggests that the number of intellectually disabled people with children is increasing. Intellectual disabilities do not inevitably cause parenting difficulties, but it may impact on an individual’s capacity to parent a child effectively.Children of parents with intellectual disabilities may be at increased risk of neglectful care, which could lead to health, developmental and behavioural problems, or increased risk of intellectual disability. Compared with other parents, those with intellectual disabilities are more likely to be involved in care proceedings. Objectives: To assess the effectiveness of parent training interventions for parents with intellectual disabilities designed to support parenting, parent child relations, safe parenting or family environments, or to develop parenting skills. Search methods: In July 2017, we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL and six other databases as well as two trials registers. We also searched reference lists of included studies and contacted experts in the field to identify additional ongoing and unpublished studies. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs comparing parent training interventions for parents with intellectual disabilities with treatment as usual or a control group. Data collection and analysis: We used standardised Cochrane methods. Parent training interventions for parents with intellectual disability (Review) 1 Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Main results: As of July 2017, we identified four trials with 192 participants that met the review inclusion criteria. Participating parents were mostly mothers (seven fathers were included in two studies), and children’s ages ranged from one month to six years and five months. One study was conducted in Australia, one in Canada, one in the Netherlands, and one in the USA. Each studied a different intervention and considered different outcomes. Three interventions were delivered at home, and one in a community venue (e.g. a church). Interventions varied in duration from seven weeks to 12 months. They included a range of practical childcare skills, home safety and developing parents’ ability to respond sensitively to their children. Parents in the comparison groups included in the review received treatment as usual and most of these received the index intervention after the study was complete. One study was funded by the Ontario Mental Health Foundation and the Ontario Ministry of Community and Social Services Research Grants Program; one by the Alabama Development Disabilities Council; one by the Best Practice Parenting Education Initiative of the Commonwealth Department of Family and Community Services and the New South Wales Aging and Disability Department; and one by ZonMw, The Netherlands Organisation for Health Research and Development. It was not possible for us to conduct a meta-analysis. The GRADE quality assessment varied from very low to moderate across the studies. Primary outcomes: No study reported on the ’attainment of specific parenting skill targets’. ’Safe home practices’ and ’understanding of child health’: one study (30 parents, very low-quality evidence) reported some improvements in parents’ knowledge of life-threatening emergencies, ability to recognise dangers, and identify precautions, in favour of the intervention group. It also found limited, very low-quality evidence that parent training improved parents’ ability to understand child health, implement precautions, use medicines safely, recognise child illness and symptoms, and seek medical advice (i.e. visit the doctor). Another study (22 mothers, very low-quality evidence) reported improved attainment of skills related to childcare and safety, in favour of the intervention group. Secondary outcomes: ’Parent-child interaction’: one study (40 mothers, very low-quality evidence) reported improved maternal-child interaction following parent training at 12 months follow-up. Another study (83 mothers, 2 fathers, moderate-quality evidence) reported that inclusion in the intervention group led to a steeper decline in parenting stress related to the child compared to the control group. ’Parents’ retention of child’: one study (22 participants; very low-quality evidence) reported that before joining the programme nine of 11 (82%) families with a previous child had had the child removed from their care by child protection authorities due to maternal maltreatment, compared with only four of 22 (19%) families after participating in the programme (only one of these four mothers had also had a previous child removed). No study reported data on: ’return to independent care of child’ or ’lifting of child-related court order’. Authors’ conclusions: There is some very low-quality evidence that some parents, mainly mothers, with intellectual disabilities are able to provide adequate parenting if they are given appropriate training and support to learn the parenting skills they need. However, there are few studies exploring how interventions might work, for whom and in what circumstances. In particular, there have been few studies that include fathers with intellectual disabilities, or that explore the views of parents themselves. There is a need for larger RCTs of parenting interventions,with longer follow-up, before conclusions can be drawn about the effectiveness of parent training for this group of parents

African Union Peacekeeping and Civilian Protection. An Evaluation of the EU Strategy for Africa and the G8/Africa Joint Plan.

Global demand for peacekeeping is growing, especially in Africa. The United Nations has traditionally been at the forefront of developing peacekeeping theory and practice, and remains the primary operational agency for peacekeeping in Africa. But increasing emphasis is being placed on the African Union to assume greater responsibility for peacekeeping on the continent. The AU is still comparatively new and is in the process of developing its peace and security architecture. Over the past decade, the international community has been supporting African peacekeeping, both to build AU capacity and to provide direct operational support. In 2005 the international community agreed a collective ¿responsibility to protect¿ vulnerable civilians threatened by gross violations of their human rights. And civilian protection is increasingly included in the mandates of peacekeeping missions. Within the context of contemporary complex, multidimensional peacekeeping (¿peace support¿), civilian protection is not an exclusive operational objective, but is rather one of a number of mandated tasks aimed at establishing more sustainable 4 security as part of a broader peacebuilding goal. The AU has embraced the responsibility to protect principle, adopting a constitutional commitment to protect the rights of vulnerable civilians, including through peacekeeping interventions if necessary. But how capable is the AU in practice to deliver effective peacekeeping to protect civilians? And how appropriate is international support to help realise this ambition

An analysis of defence policies. Nuclear and non-nuclear options reviewed.

This thesis is a study of what is said to be at issue in the nuclear weapons debate and constitutes the beginning of an attempt to understand its nature and significance . The technique adopted has been to offer an initial presentation of rival rationales in order to introduce the main concepts and show something of the force of these developed, positions (Vol I pp 7-30) . The two rationales are then related point by point , to give the analytical framework used in the subsequent interviews (pp 31-9) . Each pair of points is expanded and commented upon , and detailed references are given to the books and articles from which the analysis was drawn (pp 40-214) . The next section relates all of this briefly to the main party platforms in Britain , as of June 1987 (pp Zt 1- zt ) Volume II is made up of complete sets of responses to the framework of questions generated in the earlier chapters . The advantages of this method are i that in each case the rationale is laid out verbatim 9 so that premises are explicitly stated and the dependence of subsequent upon prior arguments is clearly seen . This in itself is very rarely done which is why so many proposed policies are so often , and so widely misunderstood . that , because all those consulted have responded to the same set of questions , their alternative sets of answers can be compared with one another point by point . This is the crucial and unique advantage of the approach adopted here . It ensures that what is at issue can be precisely pinpointed. The results as recorded here are in themselves striking and illuminating More important still they open the door to detailed future investigation of a kind which can be done in no other way

Engagement-related process factors in services for street-connected children and young people in low and middle income countries: a thematic synthesis

A recent Cochrane/ Campbell systematic review of interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people, supported by the International Initiative for Impact Evaluation (3ie), identified 11 studies evaluating 12 different interventions which met the inclusion criteria (Coren et al. 2013). The research studies had to contain a comparison group and look at street-connected children and young people between the ages of 0 and 24. None of the included studies were from low- and middle-income countries (LMICs), or involved process evaluations. The current thematic synthesis focused on engagement processes and strategies in studies pertaining to LMICs but excluded from the review on methodological grounds, complemented by studies identified through a search update conducted in March 2013. We included twenty-seven qualitative or mixed methods studies, which examined broad range of interventions and services adopted in 21 LMICs. The synthesis methods were primarily qualitative. On the basis of our findings, we conceptualised engagement as consisting of outreach and sustaining phases. Three separate dimensions emerged in the sustaining phases: meeting multiple needs, relations to adult service users, and community and family engagement. Our synthesis outlines challenges and dilemmas of engagement in each of these areas. The data also highlighted some common shortcomings in the service sector in LMICs, including lack of appropriate professional training and service development, lack of funding, and lack of co-operation with other relevant agencies. Innovative approaches to engagement, such as participatory initiatives and partnerships with universities, are also discussed

The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: A systematic review

The author manuscript version has been made available following a 12 month embargo from the date of publication (1 Feb 2016) in accordance with publisher copyright policy. ‘The definitive version is available at http:// www.joannabriggslibrary.org/index.php/index’BACKGROUND Chronic diseases are increasing worldwide and have become a significant burden to those affected by those diseases. Disease-specific education programs have demonstrated improved outcomes, although people do forget information quickly or memorize it incorrectly. The teach-back method was introduced in an attempt to reinforce education to patients. To date, the evidence regarding the effectiveness of health education employing the teach-back method in improved care has not yet been reviewed systematically. OBJECTIVES This systematic review examined the evidence on using the teach-back method in health education programs for improving adherence and self-management of people with chronic disease. INCLUSION CRITERIA Types of participants: Adults aged 18 years and over with one or more than one chronic disease. Types of intervention: All types of interventions which included the teach-back method in an education program for people with chronic diseases. The comparator was chronic disease education programs that did not involve the teach-back method. Types of studies: Randomized and non-randomized controlled trials, cohort studies, before-after studies and case-control studies. Types of outcomes: The outcomes of interest were adherence, self-management, disease-specific knowledge, readmission, knowledge retention, self-efficacy and quality of life. SEARCH STRATEGY Searches were conducted in CINAHL, MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, ProQuest Nursing and Allied Health Source, and Google Scholar databases. Search terms were combined by AND or OR in search strings. Reference lists of included articles were also searched for further potential references. METHODOLOGICAL QUALITY Two reviewers conducted quality appraisal of papers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA EXTRACTION Data were extracted using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument data extraction instruments. DATA SYNTHESIS There was significant heterogeneity in selected studies, hence a meta-analysis was not possible and the results were presented in narrative form. RESULTS Of the 21 articles retrieved in full, 12 on the use of the teach-back method met the inclusion criteria and were selected for analysis. Four studies confirmed improved disease-specific knowledge in intervention participants. One study showed a statistically significant improvement in adherence to medication and diet among type 2 diabetics patients in the intervention group compared to the control group (p < 0.001). Two studies found statistically significant improvements in self-efficacy (p = 0.0026 and p < 0.001) in the intervention groups. One study examined quality of life in heart failure patients but the results did not improve from the intervention (p = 0.59). Five studies found a reduction in readmission rates and hospitalization but these were not always statistically significant. Two studies showed improvement in daily weighing among heart failure participants, and in adherence to diet, exercise and foot care among those with type 2 diabetes. CONCLUSION Overall, the teach-back method showed positive effects in a wide range of health care outcomes although these were not always statistically significant. Studies in this systematic review revealed improved outcomes in disease-specific knowledge, adherence, self-efficacy and the inhaler technique. There was a positive but inconsistent trend also seen in improved self-care and reduction of hospital readmission rates. There was limited evidence on improvement in quality of life or disease related knowledge retention

Gender and Nepal's transition from war

"This report explores gender relations and equality and Nepal’s transition from war. Focus areas include: affirmative gender action in the transition, for example regarding politics, employment or development; gender perspectives on specific aspects of the transition, such as security sector reform, access to justice and political participation; gendered experiences, expectations and priorities of marginalised groups, including women, sexual minorities, Dalits (‘low caste’), Janajatis (indigenous communities) and Madhesis (from the southern Tarai plains); and how different identities intersect. A short case study of the period of intense political change that followed the 2015 earthquakes in Nepal provides an illustrative, contemporary example of opportunities and challenges. The report reflects discussions from a gender workshop convened jointly by the Social Science Baha (Nepal) and Conciliation Resources (United Kingdom) in Nepal in August 2016. Workshop participants included 24 women and men, ensuring a broad cross-section of Nepal’s caste or ethnic, gender and regional diversity, and including local-level and national politicians, civil society groups, academics, journalists and independent researchers. This meeting was one of three gender workshops exploring political settlement beyond elites, with other events taking place in Colombia and Bougainville, Papua New Guinea. These meetings have focused on how diverse groups in conflict-affected contexts understand and experience transition processes, in particular access to security and social and political goods.

Training Vietnamese cardiac nurses about heart failure self-management and teach-back: A pilot study

Introduction People with heart failure (HF) who self-care are more likely to have fewer deaths and re-hospitalisations.Teaching self-care at discharge is an important role for cardiac nurses. While it is estimated that patients may forget up to 80% of the information given to them, the teach-back method is a technique that improves recall and an individual’s understanding..

The role of civil society actors in peacemaking : the case of Guatemala

This article builds upon recent scholarship in critical peace studies that focuses on the role of civil society actors in formal peacemaking processes, in short, peace talks, and post-conflict peacebuilding. The article specifically explores the role of civil society actors in the Guatemalan peace process. The research addresses the possible tensions and potential complementarities in processes where civil society enjoys a mandated role in centralised, formal peace negotiations carried out between the state and armed actors in talks levied within the liberal peace framework. In the case of Guatemala, non-state actors participated to an unprecedented extent in the peace negotiations, and Guatemala has not relapsed into armed conflict. However, post-conflict Guatemala is a violent and unstable country. Consequently, the study challenges the assumption that peacemaking is necessarily more successful in those instances where provisions have been established to guarantee the participation of civil society.PostprintPeer reviewe

All hands on deck: levels of dependence between the EU and other international organizations in peacebuilding

The EU seeks extensive partnership with other international organizations when it comes to security challenges. This is puzzling as the EU relies for its resources mostly on its member states. The relations between the EU and other international organizations have thoroughly been studied, yet scholars rarely question the actual rationale for partnership. We start from resource dependency theory which explains that almost all organizations are dependent on the resources of their partners. Yet we extend this theory by distinguishing between macro, meso and micro-level dependencies. To illustrate resource dependencies between the EU and other international organizations, we analyse EU’s peacebuilding policies in Kosovo, Mali and Armenia. By accounting for macro- and micro-level dependencies we provide a more holistic perspective than conventional meso-level explanations. Our contribution is therefore to expand the scope of the resource dependency theory and provide a framework to analyse dependencies between the EU and other international organizations

Reclaiming the local in EU peacebuilding: Effectiveness, ownership, and resistance

Since the early 2000s, the "local turn" has thoroughly transformed the field of peacebuilding. The European Union (EU) policy discourse on peacebuilding has also aligned with this trend, with an increasing number of EU policy statements insisting on the importance of "the local." However, most studies on EU peacebuilding still adopt a top-down approach and focus on institutions, capabilities, and decision-making at the EU level. This special issue contributes to the literature by focusing on bottom-up and local dynamics of EU peacebuilding. After outlining the rationale and the scope of the special issue, this article discusses the local turn in international peacebuilding and identifies several interrelated concepts relevant to theorizing the role of the local, specifically those of effectiveness, ownership, and resistance. In the conclusion, we summarize the key contributions of this special issue and suggest some avenues for further research