The Educational Attainment of Looked After Children - Local Authority Pilot Projects : Final Research Report

The aim of the research was to identify interventions that appeared to make the most difference in terms of both the educational experience and outcomes of the looked after children and young people participating in the local authority pilot projects. Data on attendance, exclusions and attainment were collected for a population of more than 600 children and young people. The research also analysed qualitative data, based on interviews with project co-ordinators, professionals, children and young people, and their parents and carers

Enhancing Gypsy, Roma and Traveller peoples’ trust:using maternity and early years’ health services and dental health services as exemplars of mainstream service provision

Gypsies, Roma and Travellers (GRT) are socially excluded groups where evidence for improving health is weakest. Although GRT communities are diverse, and robust evidence of health needs is lacking, there is consensus that GRT in the UK have poorer health and lower life expectancy than the general population and other disadvantaged groups. Reasons why GRT are vulnerable to poor health outcomes include poor living conditions, high rates of homelessness, low educational achievement, social exclusion, widespread prejudice and discrimination and barriers to accessing healthcare. These multiple factors, alongside poor quality care that does not meet needs, may lead to low expectations and mistrust of health services. Trust in services and personnel is associated with increased utilisation of healthcare, improved health behaviours and quality of care. Community engagement strategies have the potential to enhance trust and ensure services are tailored to the needs of specific populations. This multi-component study aimed to strengthen evidence on how to improve uptake and delivery of health services and thereby reduce health inequalities for GRT

Education and training of healthcare staff in the knowledge, attitudes and skills needed to work effectively with breastfeeding women:a systematic review

BACKGROUND: Current evidence suggests that women need effective support to breastfeed, but many healthcare staff lack the necessary knowledge, attitudes and skills. There is therefore a need for breastfeeding education and training for healthcare staff. The primary aim of this review is to determine whether education and training programs for healthcare staff have an effect on their knowledge and attitudes about supporting breastfeeding women. The secondary aim of this review was to identify whether any differences in type of training or discipline of staff mattered. METHODS: A systematic search of the literature was conducted using the Cochrane Pregnancy and Childbirth Group’s trial register. Randomised controlled trials comparing breastfeeding education and training for healthcare staff with no or usual training and education were included if they measured the impact on staff knowledge, attitudes or compliance with the Baby Friendly Hospital Initiative (BFHI). RESULTS: From the 1192 reports identified, four distinct studies were included. Three studies were two-arm cluster-randomised trials and one was a two-arm individual randomised trial. Of these, three contributed quantitative data from a total of 250 participants. Due to heterogeneity of outcome measures meta-analysis was not possible. Knowledge was included as an outcome in two studies and demonstrated small but significant positive effects. Attitudes towards breastfeeding was included as an outcome in two studies, however, results were inconsistent both in terms of how they were measured and the intervention effects. One study reported a small but significant positive effect on BFHI compliance. Study quality was generally deemed low with the majority of domains being judged as high or unclear risk of bias. CONCLUSIONS: This review identified a lack of good evidence on breastfeeding education and training for healthcare staff. There is therefore a critical need for research to address breastfeeding education and training needs of multidisciplinary healthcare staff in different contexts through large, well-conducted RCTs

Community engagement to enhance trust between Gypsy/Travellers, and maternity, early years’ and child dental health services: protocol for a multimethod exploratory study

Gypsy/Travellers have poor health and experience discrimination alongside structural and cultural barriers when accessing health services and consequently may mistrust those services. Our study aims to investigate which approaches to community engagement are most likely to be effective at enhancing trust between Gypsy/Travellers and mainstream health services. Methods This multi-method 30-month study, commenced in June 2015, and comprises four stages. 1. Three related reviews: a) systematic review of Gypsy/Travellers’ access to health services; b) systematic review of reviews of how trust has been conceptualised within healthcare; c) realist synthesis of community engagement approaches to enhance trust and increase Gypsy/Travellers’ participation in health services. The reviews will consider any economic literature; 2. Online consultation with health and social care practitioners, and civil society organisations on existing engagement activities, including perceptions of barriers and good practice; 3. Four in-depth case studies of different Gypsy/Traveller communities, focusing on maternity, early years and child dental health services. The case studies include the views of 32–48 mothers of pre-school children, 32–40 healthcare providers and 8–12 informants from third sector organisations. 4. Two stakeholder workshops exploring whether policy options are realistic, sustainable and replicable. Case study data will be analysed thematically informed by the evaluative framework derived from the realist synthesis in stage one. The main outputs will be: a) an evaluative framework of Gypsy/Travellers’ engagement with health services; b) recommendations for policy and practice; c) evidence on which to base future implementation strategies including estimation of costs. Discussion Our novel multi-method study seeks to provide recommendations for policy and practice that have potential to improve uptake and delivery of health services, and to reduce lifetime health inequalities for Gypsy/Travellers. The findings may have wider resonance for other marginalised populations. Strengths and limitations of the study are discussed

A review of evidence on reducing stigma and discrimination associated with mental health problems, particularly depression, in the UK and english language countries

This section provides an overview of studies and evidence from English-speaking countries including the UK, USA, Canada, Australia and New Zealand. We have also included selected evidence from other countries where it has been published in English language. The aim is to examine both 'what works' and 'promising practice' in tackling stigma and discrimination towards people with mental health problems generally and for people with depression specifically. The reason for selectively broadening our review beyond the participating EU countries is to ensure that wider learning can then help to shape best practice

Developing a complex intervention to assess the feasibility of cue-based feeding for preterm infants in neonatal units (CuBS)

There is conflicting evidence of an association between breastfeeding and dental decay in very young children (early childhood caries (ECC)). While a recent systematic review and meta‐analysis reported that breastfeeding up to the age of 12 months reduced the risk of ECC, breastfeeding beyond 12 months was associated with a greater risk (Cui et al., 2017). The evidence however, is limited and inconsistent, with some studies finding an association only if breastfeeding continued beyond 18 or 24 months. Furthermore, a recent national study from Australia demonstrated that sustained breastfeeding (> 24 months) was not associated with ECC amongst children exposed to fluoridated water (Ha et al., 2019), indicating that the use of fluoridated water early in life moderated the relationship. The purpose of this presentation is to 1) critique the evidence related to breastfeeding practices and ECC; and 2) report the findings of an investigation into the effects of breastfeeding duration and night‐time breastfeeding on ECC amongst a cohort of Australian toddlers. The Study of Mothers’ and Infants’ Life Events affecting oral health (SMILE) is a population‐based birth cohort study conducted in Adelaide, Australia (Do et al., 2014). Data on breastfeeding practices were derived from questionnaires completed by mothers at recruitment, 3, 6, 12 and 24 months. The primary exposures were 1) duration of breastfeeding, defined as minimal (0 ‐ <1mo), breastfed for 1 ‐<6 months, breastfed for 6 ‐ < 12 months, and sustained (≥ 12months), and 2) the practice of night‐time breastfeeding at 12 months, defined as Yes or No. Standardised oral epidemiological examinations were conducted by trained and calibrated dental practitioners on children when they were 2‐3 years old (median 29.1, IQR 5.2 months). The primary outcome was ECC prevalence (presence of any decayed, missing or filled primary tooth surfaces), defined as Yes or No. Multivariable regression models generated adjusted prevalence ratios for the association between ECC and breastfeeding duration (n = 965); and between ECC and night time breastfeeding (n = 873). Confounders adjusted for in the models were free sugars intake, child age, maternal education and index of relative socioeconomic advantage and disadvantage. We found no independent association between the prevalence of caries and sustained breastfeeding (PR = 1.42, 95% CI 0.85–2.38) or the practice of breastfeeding at night‐time at 12 months (PR 1.27, 95% CI 0.80–2.01). The only variables that were significantly associated with ECC were high free sugars intakes and greater socioeconomic disadvantage. Adelaide is a city with a fluoridated mains water supply and hence the SMILE cohort were exposed to fluoridated water. More than 85% of participants reported tap water as their primary water source. We failed to find an association between either sustained breastfeeding or night‐time breastfeeding and ECC reported in other studies. The results of our study support the findings of Ha et al, (2017), that any negative association between breastfeeding duration and ECC is likely to be moderated by exposure to fluoride. Future studies investigating the association between breastfeeding and ECC should, where possible, investigate the interaction between water fluoridation and breastfeeding duration