Initial findings from a mixed-methods feasibility and effectiveness evaluation of the 'Breaking Free Health an Justice' treatment and recovery programme for substance misuse in prison settings

Reshaping substance misuse treatment in prisons is central to the UK Government’s drive to address substance dependence in the prison population and reduce substance-related offending and recidivism. Therefore, a through-care project to support prisoners released from custody to community, “Gateways”, is taking place across North-West England. Amongst support with housing, education, training and employment, Gateways incorporates the Breaking Free Online (BFO) substance misuse treatment programme. Aims: To explore BFO’s potential to provide support to prisoners’ substance misuse recovery and continuity of care post-release, and examine quantitative outcomes provided by prisoners who have used the programme. Methods: Qualitative interviews with prisoners and analyses of quantitative psychometric data collected pre- and post-intervention. Findings: Themes emerging from qualitative data around prisoners’ experiences of engaging with BFO illustrate its potential for use in prison settings and also upon release to the community. Significant quantitative improvements to quality of life, severity of substance dependence and aspects of recovery progression illustrate initial effectiveness of BFO. Conclusions: The BFO programme demonstrates potential in providing effective treatment for offenders with substance misuse difficulties, and specifically in delivering continuity of care following release to the community

Using the ‘recovery’ and ‘rehabilitation’ paradigms to support desistence of substance-involved offenders: Exploration of dual and multi-focus interventions (Invited Paper)

Purpose The links between substance use and offending are well evidenced in the literature, and increasingly, substance misuse recovery is being seen as a central component of the process of rehabilitation from offending, with substance use identified as a key criminogenic risk factor. In recent years, research has demonstrated the commonalities between recovery and rehabilitation, and the possible merits of providing interventions to substance-involved offenders that address both problematic sets of behaviours. The purpose of this paper is to provide an overview of the links between substance use and offending, and the burgeoning literature around the parallel processes of recovery and rehabilitation. Design/methodology/approach This is provided as a rationale for a new treatment approach for substance-involved offenders, Breaking Free Online (BFO), which has recently been provided as part of the “Gateways” throughcare pathfinder in a number of prisons in North-West England. The BFO programme contains specific behaviour change techniques that are generic enough to be applied to change a wide range of behaviours, and so is able to support substance-involved offenders to address their substance use and offending simultaneously. Findings This dual and multi-target intervention approach has the potential to address multiple, associated areas of need simultaneously, streamlining services and providing more holistic support for individuals, such as substance-involved offenders, who may have multiple and complex needs. Practical implications Given the links between substance use and offending, it may be beneficial to provide multi-focussed interventions that address both these behaviours simultaneously, in addition to other areas of multiple and complex needs. Specifically, digital technologies may provide an opportunity to widen access to such multi-focussed interventions, through computer-assisted therapy delivery modalities. Additionally, using digital technologies to deliver such interventions can provide opportunities for joined-up care by making interventions available across both prison and community settings, following offenders on their journey through the criminal justice system. Originality/value Recommendations are provided to other intervention developers who may wish to further contribute to widening access to such dual- and multi-focus programmes for substance-involved offenders, based on the experiences developing and evidencing the BFO programme

Inferred changes in El Niño–Southern Oscillation variance over the past six centuries

It is vital to understand how the El Niño–Southern Oscillation (ENSO) has responded to past changes in natural and anthropogenic forcings, in order to better understand and predict its response to future greenhouse warming. To date, however, the instrumental record is too brief to fully characterize natural ENSO variability, while large discrepancies exist amongst paleo-proxy reconstructions of ENSO. These paleo-proxy reconstructions have typically attempted to reconstruct ENSO's temporal evolution, rather than the variance of these temporal changes. Here a new approach is developed that synthesizes the variance changes from various proxy data sets to provide a unified and updated estimate of past ENSO variance. The method is tested using surrogate data from two coupled general circulation model (CGCM) simulations. It is shown that in the presence of dating uncertainties, synthesizing variance information provides a more robust estimate of ENSO variance than synthesizing the raw data and then identifying its running variance. We also examine whether good temporal correspondence between proxy data and instrumental ENSO records implies a good representation of ENSO variance. In the climate modeling framework we show that a significant improvement in reconstructing ENSO variance changes is found when combining information from diverse ENSO-teleconnected source regions, rather than by relying on a single well-correlated location. This suggests that ENSO variance estimates derived from a single site should be viewed with caution. Finally, synthesizing existing ENSO reconstructions to arrive at a better estimate of past ENSO variance changes, we find robust evidence that the ENSO variance for any 30 yr period during the interval 1590–1880 was considerably lower than that observed during 1979–2009

Layanan Kebidanan Era Jaminan Kesehatan Nasional: Memperkuat Posisi Bidan Praktik Mandiri

Survei Demografi Kesehatan Indonesia (SDKI) 2007 menunjukkan Angka Kematian Ibu (AKI) di Indonesia mencapai 228 kematian per 100.000 kelahiran hidup dan pada 2012 menunjukkan peningkatan menjadi 359 kematian per 100.000 kelahiran hidup. Angka ini sangat jauh dari target Millennium Development Goals (MDGs) yaitu sebesar 102 kematian per 100.000 kelahiran hidup. Menjelang berakhirnya Millennium Development Goals 2015, Indonesia masih menyisakan rapor merah terhadap penurunan target tujuan kelima MDGs, yaitu Angka Kematian Ibu. Sebagai upaya mencapai target tersebut, sejak 1 Januari 2014 pemerintah mengimplementasikan jaminan pelayanan kesehatan kepada perempuan hamil, melahirkan, dan dalam masa nifas melalui Jaminan Ke sehatan Nasional (JKN) yang seharusnya sudah disiapkan sejak Undang-Undang Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial (BPJS) disahkan. Dalam konteks penurunan angka kematian ibu, bidan merupakan tenaga kesehatan yang menjadi ujung tombak dalam pelayanan kesehatan nasional. Bidan tidak hanya diharapkan mampu menghadapi tantangan dalam implementasi JKN, tetapi juga diberikan tanggungjawab dalam menurunkan angka kematian ibu dan mencapai akses universal terhadap pelayanan kesehatan reproduksi. Melalui penelitian Women Research Institute (WRI) mengenai JKN terkait Pelayanan Kebidanan di Jakarta dan Bandung, didapat berbagai temuan terkait tantangan yang dihadapi oleh bidan dan perempuan peserta JKN dalam mengakses pelayanan kebidanan

Pemenuhan Fasilitas Kesehatan Ibu Melahirkan Era Jaminan Kesehatan Nasional

Menjelang berakhirnya Millennium Development Goals (MDGs) 2015, Indonesia masih menyisakan rapor merah terhadap penurunan target kelima MDGs, yaitu Angka Kematian Ibu (AKI). Pemerintah Indonesia berupaya menekan AKI melalui program Jaminan Kesehatan Nasional (JKN). Hal ini dimulai ketika Undang Undang Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial (BPJS) disahkan, maka secara bertahap semua bentuk perlindungan sosial beralih menjadi Jaminan Kesehatan Nasional (JKN). Termasuk Jaminan Persalinan (Jampersal) yang sebelumnya memberikan pelayanan kebidanan menjadi lebur dalam sistem Jaminan Kesehatan Nasional dan menjadi bagian pelayanan kesehatan ibu dan anak. Antusiasme masyarakat untuk menggunakan layanan kesehatan JKN yang ditanggung BPJS Kesehatan tercermin melalui jumlah peserta yang melebihi target. Data BPJS Kesehatan per 30 Juni 2014 memperlihatkan bahwa jumlah peserta BPJS Kesehatan yang terdaftar telah mencapai 124.553.040 jiwa. Dari total jumlah peserta tersebut sudah memenuhi target kepesertaan dalam setahun, yaitu minimal menjaring sekitar 121 juta jiwa. Namun dalam pelaksanaannya terdapat permasalahan yang dirasakan oleh masyarakat peserta JKN, terutama perempuan yang ingin menggunakan layanan kebidanan. Women Research Institute (WRI) mengidentifikasi beberapa tantangan yang dihadapi oleh perempuan peserta Jaminan Kesehatan Nasional yang ingin memanfaatkan layanan kebidanan

Interplay of Cavity Thickness and Metal Absorption in Thin-film InGaN Photonic Crystal Light-emitting Diodes

Thin-film InGaN photonic crystal (PhC) light-emitting diodes (LEDs) with a total semiconductor thickness of either 800 nm or 3.45 μm were fabricated and characterized. Increased directional radiance relative to Lambertian emission was observed for both cases. The 800-nm-thick PhC LEDs yielded only a slight improvement in total light output over the 3.45-μm-thick PhC LEDs. Simulations indicate that, except for ultrathin devices well below 800 nm, the balance between PhC extraction and metal absorption at the backside mirror results in modal extraction efficiencies that are almost independent of device thickness, but highly dependent on mirror reflectivity.Engineering and Applied Science

Understanding the role of shame and its consequences in female hypersexual behaviours: A pilot study

Background and aims: Hypersexuality and sexual addiction among females is a little understudied phenomenon. Shame is thought to be intrinsic to hypersexual behaviours, especially in women. Therefore, the aim of this study was to understand both hypersexual behaviours and consequences of hypersexual behaviours and their respective contributions to shame in a British sample of females (n = 102). Methods: Data were collected online via Survey Monkey. Results: Results showed the Sexual Behaviour History (SBH) and the Hypersexual Disorder Questionnaire (HDQ) had significant positive correlation with scores on the Shame Inventory. The results indicated that hypersexual behaviours (HBI and HDQ) were able to predict a small percentage of the variability in shame once sexual orientation (heterosexual vs. non-heterosexual) and religious beliefs (belief vs. no belief) were controlled for. Results also showed there was no evidence that religious affiliation and/or religious beliefs had an influence on the levels of hypersexuality and consequences of sexual behaviours as predictors of shame. Conclusions: While women in the UK are rapidly shifting to a feminist way of thinking with or without technology, hypersexual disorder may often be misdiagnosed and misunderstood because of the lack of understanding and how it is conceptualised. The implications of these findings are discussed

Using intervention mapping to develop a home-based parental-supervised toothbrushing intervention for young children

BACKGROUND: Dental caries in young children is a major public health problem impacting on the child and their family in terms of pain, infection and substantial financial burden on healthcare funders. In the UK, national guidance on the prevention of dental caries advises parents to supervise their child's brushing with fluoride toothpaste until age 7. However, there is a dearth of evidence-based interventions to encourage this practice in parents. The current study used intervention mapping (IM) to develop a home-based parental-supervised toothbrushing intervention to reduce dental caries in young children. METHODS: The intervention was developed using the six key stages of the IM protocol: (1) needs assessment, including a systematic review, qualitative interviews, and meetings with a multi-disciplinary intervention development group; (2) identification of outcomes and change objectives following identification of the barriers to parental-supervised toothbrushing (PSB), mapped alongside psychological determinants outlined in the Theoretical Domains Framework (TDF); (3) selection of methods and practical strategies; (4) production of a programme plan; (5) adoption and implementation and (6) Evaluation. RESULTS: The comprehensive needs assessment highlighted key barriers to PSB, such as knowledge, skills, self-efficacy, routine setting and behaviour regulation and underlined the importance of individual, social and structural influences. Parenting skills (routine setting and the ability to manage the behaviour of a reluctant child) were emphasised as critical to the success of PSB. The multi-disciplinary intervention development group highlighted the need for both universal and targeted programmes, which could be implemented within current provision. Two intervention pathways were developed: a lower cost universal pathway utilising an existing national programme and an intensive targeted programme delivered via existing parenting programmes. A training manual was created to accompany each intervention to ensure knowledge and standardise implementation procedures. CONCLUSIONS: PSB is a complex behaviour and requires intervention across individual, social and structural levels. IM, although a time-consuming process, allowed us to capture this complexity and allowed us to develop two community-based intervention pathways covering both universal and targeted approaches, which can be integrated into current provision. Further research is needed to evaluate the acceptability and sustainability of these interventions

Cross-syndrome comparison of real-world executive functioning and problem solving using a new problem-solving questionnaire

Background. Individuals with neurodevelopmental disorders like Williams syndrome and Down syndrome exhibit executive function impairments on experimental tasks (Lanfranchi, Jerman, Dal Pont, Alberti, & Vianello, 2010; Menghini, Addona, Costanzo, & Vicari, 2010), but the way that they use executive functioning for problem solving in everyday life has not hitherto been explored. The study aim is to understand cross-syndrome characteristics of everyday executive functioning and problem solving. Methods. Parents/carers of individuals with Williams syndrome (n=47) or Down syndrome (n=31) of a similar chronological age (m =17 years 4 months and 18 years respectively) as well as those of a group of younger typically developing children (n=34; m=8 years 3 months) completed two questionnaires: the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000) and a novel Problem-Solving Questionnaire. Results. The rated likelihood of reaching a solution in a problem solving situation was lower for both syndromic groups than the typical group, and lower still for the Williams syndrome group than the Down syndrome group. The proportion of group members meeting the criterion for clinical significance on the BRIEF was also highest for the Williams syndrome group. While changing response, avoiding losing focus and maintaining perseverance were important for problem-solving success in all groups, asking for help and avoiding becoming emotional were also important for the Down syndrome and Williams syndrome groups respectively. Keeping possessions in order was a relative strength amongst BRIEF scales for the Down syndrome group. Conclusion. Results suggest that individuals with Down syndrome tend to use compensatory strategies for problem solving (asking for help and potentially, keeping items well ordered), while for individuals with Williams syndrome, emotional reactions disrupt their problem- solving skills. This paper highlights the importance of identifying syndrome-specific problem-solving strengths and difficulties to improve effective functioning in everyday life