Outcomes for children of shorter court decision-making processes:A follow-up study of the Tri-borough care proceedings pilot

Context: Long-standing concerns about unnecessary delay in care proceedings led to major reforms in 2013-14, intended to reduce the normal duration to 26 weeks. Prior to those national changes, the Tri-borough authorities in London (Hammersmith & Fulham, Westminster, Kensington & Chelsea) launched a pilot project to try to hit the 26 week target. It ran from April 2012 to March 2013. The project was evaluated by a team from the CRCF. They were subsequently commissioned to undertake a follow-up study to track and evaluate the longer-term outcomes for the children. Aims: The original evaluation compared the timings and outcomes of care proceedings in the pre-pilot year (2011-12) and the pilot year (2012-13). This gives a combined database of 180 cases (256 children), and a unique opportunity to track and compare longer-term progress and outcomes for the children. The follow-up study aimed to assess whether or not delay had shifted to the post-court stage, and whether the new regime led to different long-term outcomes. The research tracked what had happened to the children in the two years after their proceedings ended. It measured the time to reach their planned permanent placement, whether placements endure (at home, kinship care or foster care), and the children’s well-being. Methods: There was a file survey to track the progress of all the children who had been involved in care proceedings in the pre-pilot and pilot years. There was also a questionnaire for parents and carers of the children, to get their views on the child’s progress and the support they received, and interviews with social workers in the Tri-borough authorities on how they perceived the new approach to court proceedings to be working, four years on. Findings: The original evaluation found that the Tri-borough pilot succeeded in its key aim of reducing the length of care proceedings. The median duration of care proceedings was 27 weeks compared to 49 weeks the year before, a reduction of 45%. The pattern of final orders was broadly the same for cases in the pilot year as in the year before, suggesting that the drive to speed up proceedings does not result in significantly different court outcomes. The follow up study had four main findings. First, reducing the duration of care proceedings did not mean that more children were left waiting for a permanent placement at the end of the proceedings. On the contrary, a slightly higher proportion of children in the pilot year were already in their planned permanent placement at the end of the proceedings (65% compared to 60% the year before). Second, for those who did need to move to a permanent placement afterwards, the focus on shorter care proceedings did not lead to extra delay here. In fact, the average duration fell from 30 weeks to 14, a reduction of over 50%. Third, the incidence of ‘serious problem indicators’ (e.g. breakdowns in permanent placements, renewed child protection concerns) declined for children from the pilot cohort compared to the pre-pilot cohort. This suggests that quicker decision-making processes do not necessarily lead to less stable placements for children. Rather, the focus on good decision-making can lead to more secure outcomes. And fourth, shorter care proceedings did not result in more children living away from their families. The most frequent type of final placement for children in both cohorts was with their parent(s) followed by placements with relatives or friends. Impact: The original evaluation was widely quoted and circulated, because it showed that the 26 week target could be achieved without compromising justice and thoroughness, as long as there is proper regard for flexibility. The researchers have continued to disseminate the key messages through publications and presentations at professional and academic conferences. The researchers now aim to disseminate the information about what happens after proceedings

Justice, speed and thoroughness in child protection court proceedings: messages from England

This paper reports and assesses the outcomes of a pilot programme in London to reduce the duration of child protection court proceedings. The initiative, known as the ‘Tri-borough Care Proceedings Pilot’, was intended to reduce the usual duration to 26 weeks, ahead of national moves in that direction. The paper locates the issue of court delay in a wider political and child welfare context, highlighting the dilemmas of balancing principles of family autonomy and child safety, support and protection, thoroughness and speed, welfare practices and court processes. It compares the policy, legal and court contexts in the USA and England, showing that what might appear at first sight a local initiative actually relates to a much wider, long-lasting and international debate about how to reach important decisions about children in a reasonable timescale. The paper concludes that there will always be, and must always be, tensions between the courts, national government and local welfare agencies. The pilot shows that greater speed can be achieved by a concerted effort from all the agencies, but at the same time the division of powers and responsibilities is a bedrock for protecting individual rights in liberal democratic societies. Welfare and legal practitioners alike need to appreciate this tension in child protection policy and practice, and resist recrimination when there are differences of opinion. Knowing that other countries face the same challenges can help to promote a more realistic and sophisticated understanding of the dilemmas and the implications for practice, and so help to bring about better decisions for children

Behavioural activation interventions for depressed individuals with a chronic physical illness: a systematic review protocol

© 2013 Harris et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Depression is common in people with chronic physical illness and is associated with worse medical outcomes. Cognitive behavioural therapy and problem solving improve depression, although usually have small to moderate effects among people with chronic physical illness. Behavioural activation interventions for depression, which aim to increase positive reinforcement from the environment by encouraging individuals to increase pleasant/rewarding activities, have been reported to be equivalent to cognitive behavioural therapy. However, the effectiveness of behavioural activation interventions for depression in individuals with chronic physical illness are unclear. The aims of this systematic review are to identify the extent to which different forms of behavioural activation have been used as a treatment for depression in this population, examine the effectiveness of the interventions, and identify any adaptations which have been made specifically to the interventions for individuals with a range of chronic physical illnesses. Methods/Design: Electronic databases will be systematically searched using terms relevant to behavioural activation and depression, and the subset of studies in people with chronic physical illnesses will be identified by manual searching. References and citations of eligible studies will be searched and experts in this field will be contacted to identify additional papers. All study designs will be included in this review to allow for a more extensive identification of the extent of different forms of behavioural activation interventions. The different forms of behavioural activation and the specific chronic physical health conditions for which this intervention has been used will be reviewed narratively. For the effectiveness of the interventions, if sufficient randomised controlled trials have been undertaken the results will be meta-analysed. Non-randomised studies will be narratively synthesised and adaptations to the interventions will also be narratively reviewed. Discussion: The findings will inform the design, development and subsequent evaluation of a behavioural activation intervention for depression in people with a chronic physical illness. PROSPERO registration number: CRD42013004500.University of Exeter, College of Life and Environmental Sciences PhD Studentshi

The association between perseverative negative cognitive processes and negative affect in people with long term conditions: a protocol for systematic review and meta-analysis

BACKGROUND: Depression is common in people with long term conditions (LTCs) and is associated with worse medical outcomes. Understanding the mechanisms underpinning this relationship could help predict who is at increased risk of adverse medical outcomes, and lead to the development of novel interventions. Perseverative negative cognitive processes, such as worry and rumination, involve repetitive and frequent thoughts about oneself and one's concerns. These processes have been associated with negative affect, and also adverse medical outcomes. The results of prospective studies, which would allow causal inferences to be drawn, are more equivocal however. Furthermore, the majority of studies have been conducted in physically healthy individuals, and we do not know to what extent these findings will generalise to people with LTCs. METHODS/DESIGN: Electronic databases will be searched using a search strategy including controlled vocabulary and text words related to perseverative negative cognitive processes (such as worry and rumination) and negative affect (including depression and anxiety). Records will be hand-searched for terms related to LTCs. Citation and bibliography searching will be conducted, and authors of included studies will be contacted to identify unpublished studies. Studies will be included if they contain a standardised measure of the prospective association between perseverative negative cognitive processes and negative affect, or vice versa, in people with LTCs. Narrative and meta-analytic methods will be used to synthesize the data collected. DISCUSSION: This review will identify and synthesise studies of the prospective association between perseverative negative cognitive processes and negative affect among people with LTCs. The findings will help to identify whether worry and rumination could cause depression and anxiety in people with LTCs, and might indicate whether perseverative negative cognitive processes are appropriate targets for treatment.University of Exeter Medical School - PhD Studentshi

Genome cartography through domain annotation

The evolutionary history of eukaryotic proteins involves rapid sequence divergence, addition and deletion of domains, and fusion and fission of genes. Although the protein repertoires of distantly related species differ greatly, their domain repertoires do not. To account for the great diversity of domain contexts and an unexpected paucity of ortholog conservation, we must categorize the coding regions of completely sequenced genomes into domain families, as well as protein families

THoR: a tool for domain discovery and curation of multiple alignments

We describe a tool, THoR, that automatically creates and curates multiple sequence alignments representing protein domains. This exploits both PSI-BLAST and HMMER algorithms and provides an accurate and comprehensive alignment for any domain family. The entire process is designed for use via a web-browser, with simple links and cross-references to relevant information, to assist the assessment of biological significance. THoR has been benchmarked for accuracy using the SMART and pufferfish genome databases

Guideline and indicators for Target 6.6 of the SDGs: “Change in the extent of waterrelated ecosystems over time”

This guideline provides supporting information to assist with implementation of monitoring procedures for Target 6.6 indicator, which focuses on protecting and maintaining water-related ecosystems

Psychosocial predictors of health-related quality of life and health service utilisation in people with chronic low back pain

Psychological and social factors have been shown, separately, to predict outcome in individuals with chronic low back pain. Few previous studies, however, have integrated both psychological and social factors, using prospective study of clinic populations of low back pain patients, to identify which are the most important targets for treatment. One hundred and eight patients with chronic low back pain, newly referred to an orthopaedic outpatient clinic, completed assessments of demographic characteristics, details of back pain, measures of anxiety and depression (Hospital Anxiety and Depression Scale, HADS), fearful beliefs about pain (Fear Avoidance Beliefs Questionnaire), social stresses (Life Events and Difficulties Schedule) and physical aspects of health‐related quality of life [SF‐36 Physical Component summary Score scale (PCS)]. Six months later subjects completed the SF‐36 PCS and the number of healthcare contacts during follow‐up was recorded. Independent predictors of SF‐36 PCS at 6‐month follow‐up were duration of pain [(standardised regression coefficient (β) = −0.18, p = 0.04), HADS score (β) = −0.27, p = 0.003] and back pain related social difficulties (β = −0.42, p < 0.0005). Number of healthcare contacts over the 6 months ranged from 1 to 29, and was independently predicted by perceived cause of pain [Incident Rate Ratio (IRR) = 1.46, p = 0.03], Fear Avoidance Beliefs about work (IRR = 1.02, p = 0.009) and back pain related social difficulties (IRR = 1.16, p = 0.03). To conclude, anxiety, depression, fear avoidance beliefs relating to work and back pain related stresses predict impairment in subsequent physical health‐related quality of life and number of healthcare contacts. Interventions targeting these psychosocial variables in clinic patients may lead to improved quality of life and healthcare costs

Psychological interventions to improve psychological well-being in people with dementia or mild cognitive impairment: systematic review and meta-analysis protocol

Open Access ArticleINTRODUCTION: Dementia and mild cognitive impairment are associated with an increased risk of depression, anxiety, psychological distress and poor mental health-related quality of life. However, there is a lack of research examining the evidence base for psychological interventions targeting general psychological well-being within this population. Furthermore, there is little research relating to the design of randomised controlled trials examining psychological interventions for dementia and mild cognitive impairment, such as effective recruitment techniques, trial eligibility and appropriate comparators. METHODS AND ANALYSIS: Systematic review of electronic databases (CINAHL; EMBASE; PsychInfo; MEDLINE; ASSIA and CENTRAL), supplemented by expert contact, reference and citation checking, and grey literature searches. Published and unpublished studies will be eligible for inclusion with no limitations placed on year of publication. Primary outcomes of interest will be standardised measurements of depression, anxiety, psychological distress or mental health-related quality of life. Eligibility and randomisation proportions will be calculated as secondary outcomes. If data permits, meta-analytical techniques will examine: (1) overall effectiveness of psychological interventions for people with dementia or mild cognitive impairment in relation to outcomes of depression, anxiety, psychological distress or mental health-related quality of life; (2) clinical and methodological moderators associated with effectiveness; (3) proportions eligible, recruited and randomised. ETHICS AND DISSEMINATION: Ethical approval is not required for the present systematic review. Results will inform the design of a feasibility study examining a new psychological intervention for people with dementia and depression, with dissemination through publication in peer-reviewed journals and presentations at relevant conferences. TRIAL REGISTRATION NUMBER: CRD42015025177.National Institute for Health Research (NIHR