Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme

Background Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme - Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme's theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes. Methods Documentary analysis and interviews with key personnel examined the programme's development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation. Results KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours. Conclusions KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation's facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation in different school contexts, and to examine potential longer-term impacts, and the feasibility of large scale delivery

Creating safe places: an exploratory evaluation of a school-based emotional support service

School-based interventions for young people with emotional/mental health problems are often provided by external practitioners and their relationship with host schools is a key influence on implementation. Poor integration within school systems, schools’ tendency to define interventions around pupils’ behaviour and teachers’ control over access, may undermine therapeutic relationships. This study examines how one school-based intervention—Bounceback—addressed these challenges. Methods comprised interviews with programme staff, school staff and service users. Bounceback sought to develop therapeutic relationships through creating a safe, welcoming place and maximising pupils’ choice about how they engaged with it. To ensure Bounceback was delivered as intended, staff developed five conditions which schools were asked to meet: adhering to referral criteria, ensuring that attendance was voluntary, appropriate completion of referral forms, mechanisms for contacting pupils and private accommodation to maintain confidentiality. Pupils reported high levels of acceptability and described relationships of trust with Bounceback staff. Although pupils had choice about most aspects of Bounceback, teachers controlled access to it, partly in order to manage demand. The study highlights the need for external agencies to communicate their aims and needs clearly to schools and the importance of peripatetic practitioners being well integrated within their parent organisations

Time is of the essence: an observational time-motion study of internal medicine residents while they are on duty

Background: The effects of changes to resident physician duty hours need to be measureable. This time-motion study was done to record internal medicine residents’ workflow while on duty and to determine the feasibility of capturing detailed data using a mobile electronic tool.Methods: Junior and senior residents were shadowed by a single observer during six-hour blocks of time, covering all seven days. Activities were recorded in real-time. Eighty-nine activities grouped into nine categories were determined a priori.Results: A total of 17,714 events were recorded, encompassing 516 hours of observation. Time was apportioned in the following categories: Direct Patient Care (22%), Communication (19%), Personal tasks (15%), Documentation (14%), Education (13%), Indirect care (11%), Transit (6%), Administration (0.6%), and Non-physician tasks (0.4%). Nineteen percent of the education time was spent in self-directed learning activities. Only 9% of the total on duty time was spent in the presence of patients. Sixty-five percent of communication time was devoted to information transfer. A total of 968 interruptions were recorded which took on average 93.5 seconds each to service.Conclusion: Detailed recording of residents’ workflow is feasible and can now lead to the measurement of the effects of future changes to residency training. Education activities accounted for 13% of on-duty time.

An examination of perceptions of roles and responsibilities for health amongst the general public

The need to develop our understanding of public perceptions of roles and responsibilities for health underpins a number of key policy developments in the UK (Wanless, 2004; Welsh Assembly Government, 2003), particularly in light of an increased focus on the relationship between the state and the individual in health improvement action (Halpern, 2003). Research was commissioned by the Welsh Assembly Government to explore perceptions of responsibility at different levels including individual, organisational and state roles and responsibilities for health improvement amongst the general public and key stake holders. This report focuses on the focus group study with member of the general public across Wales in 2005. Participants (n = 101) included a range of age groups and family backgrounds, with 57% female. A broad range of socio-economic backgrounds were represented. A semi structured schedule, newspaper headline prompts and a prioritisation task were used to guide the discussion. Group discussions were audio taped and transcriptions were analysed with main themes identified and validated by a second researcher. Areas of consent and disagreement within groups were identified and key areas of similarity and difference between socio-economic groups identified. Participant’s understandings of personal responsibility for health were associated with socio-economic position and, to a lesser extent, with age. Issues associated with health communication, family processes, social capital, instrumentation, individualisation, social values and personal morality were used to explain and justify health protective and risk behaviours. The tension between what were seen as the responsibilities of the state and maintaining personal freedoms highlighted further differences between these groups. These results raise a number of implications for public health practice, with lay perceptions reflecting current policy debates

Organisational roles and responsibilities for health: a pilot survey of businesses, primary and secondary schools and local government

The idea of organisations taking responsibilities for health has both theoretical and political relevance. However, there is a need to develop a clearer understanding of how organisations conceptualise and respond to such policy initiatives across a range of sectors. Research was commissioned by the Welsh Assembly Government to explore perceptions of responsibility at different levels including individual, organisational and state roles and responsibilities for health improvement amongst the general public and key stakeholders. This report focuses on the results of a pilot survey conducted with 688 representatives across the business, education and local government sectors in Wales. The overall response rate was 31%, with 14.3% for local authorities, 14.9% for business, 38.8% for secondary schools and 52.0% for primary schools. Follow-up stages appeared to be effective in increasing the response but samples were very small, and the response rate was too low to justify an extensive statistical analysis. Data from the questionnaires are presented as a description of a non-representative group subject to potential measurement error. Results from business respondents suggest that they accept some degree of responsibility for the health of employees and customers in the area of accidents and injuries. Otherwise they take very little action to promote health and most do not want to do any more. Reasons given included a lack of resources, training and information, a lack of need and individuals being responsible for their own health. Results for both primary and secondary schools suggest that schools accept a high degree of responsibility for promoting the health of pupils. All report participation in more than one health-promotion initiative and many say they would like to do more. The report also includes resource and methodological implications for future survey work of this kind

Organisational roles and responsibilities for health: interviews with representatives from the statutory and non-statutory sectors

The idea of organisations taking responsibilities for health has both theoretical and political relevance. However, there is a need to develop a clearer understanding of how organisations conceptualise and respond to such policy initiatives across a range of sectors. Research was commissioned by the Welsh Assembly Government to explore perceptions of responsibility at different levels including individual, organisational and state roles and responsibilities for health improvement amongst the general public and key stake holders. This report focuses on the in-depth interviews with representatives across the health, local government, education, voluntary and community, business and media sectors in Wales. This study provided further insights into who is acting to improve health and well-being, why these actions are being taken, how health improvement is being enacted and who organisations are working with to achieve this. Although overall, responsibility for improving health is largely taken and enacted by the statutory sector, there is a spectrum of more and less active organisations within all of the sectors. This study has highlighted a number of good examples of work undertaken within different spheres of influence but there are policy implications for the way in which the more active organisations could be better supported. Also, developing an evidence base on what works in terms of health improvement could quickly be put into motion across different sectors and the effectiveness of this would be optimised by building in an element of good practice sharing and peer support between local level organisations. In terms of ongoing research priorities there is still a need to understand more fully the drivers behind the actions of more active organisations, understand the nature of corporate responsibility in the less active organisations and unpack influences on management perspectives

Exploratory trial of a school-based alcohol prevention intervention with a family component: Implications for implementation

Purpose – Involvement of parents/carers may increase effectiveness of primary school-based alcohol-misuse prevention projects through strengthening family-based protective factors, but rates of parental engagement are typically low. This paper reports findings from an exploratory trial of a school-based prevention intervention – Kids, Adults Together (KAT), based on the Social Development Model, which aimed to promote pro-social family communication in order to prevent alcohol misuse, and incorporated strategies to engage parents/carers. The purpose of this paper is to assess the feasibility and value of conducting an effectiveness trial of KAT. Design/methodology/approach – The study was a parallel-group cluster randomised exploratory trial with an embedded process evaluation. The study took place in south Wales, UK, and involved nine primary schools, 367 pupils in Years 5/6 (aged 9-11 years) and their parents/carers and teachers. Questionnaires were completed by pupils at baseline and four month follow-up, and by parents at six month follow-up. Findings – Overall KAT was delivered with good fidelity, but two of five intervention schools withdrew from the study without completing implementation. In total, 50 per cent of eligible parents participated in the intervention, and KAT had good acceptability among pupils, parents and teachers. However, a number of “progression to effectiveness trial” criteria were not met. Intermediate outcomes on family communication (hypothesised to prevent alcohol misuse) showed insufficient evidence of an intervention effect. Difficulties were encountered in identifying age appropriate outcome measures for primary school-age children, particularly in relation to family communication processes. The study was unable to find comprehensive methodological guidance on exploratory trials. Research limitations/implications – It would not be appropriate to conduct an effectiveness trial as key progression criteria relating to intervention and trial feasibility were not met. There is a need for new measures of family communication which are suitable for primary school-age children, and more guidance on the design and conduct of exploratory/feasibility trials. Originality/value – KAT achieved high rates of parental involvement, and its theoretical framework and processes could be adapted by other interventions which experience difficulties with recruitment of parents/carers

Resident parasitoids associated with Drosophilidae in Michigan tart cherry orchards and woodland edges

Knowledge of the distribution and abundance of resident parasitoid species of Drosophila flies constitutes an important base for developing and implementing a biological control program for Drosophila suzukii (Matsumura) (Diptera: Drosophilidae), an invasive pest that attacks ripening thin-skinned wild and cultivated berries and stone fruits. For this purpose, a field survey was conducted to identify the parasitoid community associated with D. suzukii infested sites in tart cherry orchards and woodlots in west, northwest, and central Michigan. Sentinel traps baited with D. suzukii larvae and pupae in banana slices were deployed in the center of tart cherry orchards, in woodlots adjacent to tart cherry orchards, and in woodlots isolated from any known commercial host of D. suzukii. Traps were placed from the beginning of July to the end of October 2021. Three parasitoid species that are known to use drosophilids as hosts were recovered from these traps. Pachycrepoideus vindemiae (Rondani) (Hymenoptera: Pteromalidae) and Leptopilina boulardi Barbotin, Carton & Keiner-Pillault (Hymenoptera: Figitidae) emerged from the infested bananas. Leptopilina heterotoma (Thomson) was collected as an adult in a sentinel trap. Among these wasps, only P. vindemiae successfully parasitized D. suzukii pupae in the laboratory. This pupal parasitoid was abundant and widely distributed in both cherry orchards and woodlots. The highest number of P. vindemiae was collected from orchards, followed by woodlots adjacent to orchards, with woodlots without nearby cultivated fruit having the lowest detections. These findings suggest that future release of augmentative or classical biological control agents for D. suzukii could be successful in orchards post-harvest to control late-season populations of this pest

The impact of the economic downturn on health in Wales: a review and case study

The current economic downturn and the austerity measures currently being decided with regard to public spending are likely to impact on people’s lives in a number of different ways. The test of how well political administrations respond to such crises will be the extent to which the health and well being of its populations are protected. The lesson of previous downturns is that the social and associated health impacts can lag long after what can be a relatively short period of economic recession. These effects can also be uneven and affect particular groups in the population and people living in particular places more than others. However in order for Governments, local authorities and services to respond appropriately we need to learn from the past whilst acknowledging the unique character of this particular social and economic crisis. In South Wales people are still dealing with the emotional and physical wounds which are the legacy of rapid re‐industrialisation in the 1980s and we need to be prepared this time round. This is report comprises a literature review of what is known about the health impact of past recessions and their aftermaths, a qualitative case study of perceived current and potential health impacts on relevant statutory and voluntary services in two contrasting local authority areas, and a policy dialogue to discuss the findings with a small group of policy makers and service leads with national and local responsibilities. The report concludes with a number of broad recommendations to support and guide decisions at national and local government levels