Partnership as conversation: why partnerships are condemned to talk and what they need to talk about

Participants and observers regularly complain that multi-agency partnerships are “talking shops,” engaged in constant discussion which gets in the way of “doing” the work of partnership. In this paper we engage with and criticize this characterization. Drawing on ideas from the Cultural Theory of Mary Douglas, we argue that true multi-agency partnerships are structurally condemned to talk. Instead of criticizing this talk and contrasting it with “doing” we should see it as a critical part of the doing of partnership. We should therefore concentrate on organizing and structuring partnership talk in order to move things forward rather than trying to minimize it. In the second half of the paper we therefore put forward a proposal for how partnership talk should be organized into five “conversations” concerning the principles, policies, processes, practices and politics of partnership. While we can make no predictions for the outcome of these conversations in any given case, we can, we believe, establish some necessary preconditions for effective interaction. We illustrate our arguments drawing on a range of empirical work in education and wider public services reform

Investigating the role of language in children's early educational outcomes

Most children develop speech and language skills effortlessly, but some are slow to develop these skills and then go on to struggle with literacy and academic skills throughout their schooling. It is the first few years of life that are critical to their subsequent performance.\ud This project looks at what we know about the early communication environment in a child’s first two years of life, and the role this plays in preparing children for school using data from a large longitudinal survey of young people (ALSPAC - the Avon Longitudinal Study of Parents and Children).\ud It examines the characteristics of the environment in which children learn to communicate (such as activities undertaken with children, the mother’s attitude towards her baby, and the wider support available to the family) and the extent to which this affects a child’s readiness for school entry (defined as their early language, reading, writing, and maths skills that they need in school).\ud \ud Key Findings:\ud •\ud There is a strong association between a child’s social background and their readiness for school as measured by their scores on school entry assessments covering language, reading, maths and writing.\ud •\ud Language development at the age of 2 years predicts children’s performance on entry to primary school. Children’s understanding and use of vocabulary and their use of two or three word sentences at 2 years is very strongly associated with their performance on entering primary school.\ud •\ud The children’s communication environment influences language development. The number of books available to the child, the frequency of visits to the library, parents teaching a range of activities, the number of toys available, and attendance at pre-school, are all important predictors of the child’s expressive vocabulary at 2 years. The amount of television on in the home is also a predictor; as this time increased, so the child’s score at school entry decreased.\ud •\ud The communication environment is a more dominant predictor of early language than social background. In the early stages of language development, it is the particular aspects of a child’s communication environment that are associated with language acquisition rather than the broader socio-economic context of the family.\ud •\ud The child’s language and their communication environment influence the child’s performance at school entry in addition to their social background. Children’s success at school is governed not only by their social background; the child’s communication environment\ud before their second birthday and their language at the age of two years also have a strong influence

Indirect language therapy for children with persistent language impairment in mainstream primary schools : outcomes from a cohort intervention

A manualized language therapy developed via a randomized controlled trial had proved efficacious in the short-term in developing expressive language for mainstream primary school children with persistent language impairment. This therapy had been delivered to a predetermined schedule by speech and language therapists or speech and language therapy assistants to children individually or in groups. However, this model of service delivery is no longer the most common model in UK schools, where indirect consultancy approaches with intervention delivered by school staff are often used. A cohort study was undertaken to investigate whether the therapy was equally efficacious when delivered to comparable children by school staff, rather than speech and language therapists or speech and language therapy assistants. Children in the cohort study were selected using the same criteria as in the randomized controlled trial, and the same manualized therapy was used, but delivered by mainstream school staff using a consultancy model common in the UK. Outcomes were compared with those of randomized controlled trial participants. The gains in expressive language measured in the randomized controlled trial were not replicated in the cohort study. Less language-learning activity was recorded than had been planned, and less than was delivered in the randomized controlled trial. Implications for 'consultancy' speech and language therapist service delivery models in mainstream schools are outlined

A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence

Background: Opioid dependence is a chronic condition with substantial health, economic and social costs. The study objective was to conduct a systematic review of published health-economic models of opioid agonist therapy for non-prescription opioid dependence, to review the different modelling approaches identified, and to inform future modelling studies. Methods: Literature searches were conducted in March 2015 in eight electronic databases, supplemented by hand-searching reference lists and searches on six National Health Technology Assessment Agency websites. Studies were included if they: investigated populations that were dependent on non-prescription opioids and were receiving opioid agonist or maintenance therapy; compared any pharmacological maintenance intervention with any other maintenance regimen (including placebo or no treatment); and were health-economic models of any type. Results: A total of 18 unique models were included. These used a range of modelling approaches, including Markov models (n = 4), decision tree with Monte Carlo simulations (n = 3), decision analysis (n = 3), dynamic transmission models (n = 3), decision tree (n = 1), cohort simulation (n = 1), Bayesian (n = 1), and Monte Carlo simulations (n = 2). Time horizons ranged from 6 months to lifetime. The most common evaluation was cost-utility analysis reporting cost per quality-adjusted life-year (n = 11), followed by cost-effectiveness analysis (n = 4), budget-impact analysis/cost comparison (n = 2) and cost-benefit analysis (n = 1). Most studies took the healthcare provider’s perspective. Only a few models included some wider societal costs, such as productivity loss or costs of drug-related crime, disorder and antisocial behaviour. Costs to individuals and impacts on family and social networks were not included in any model. Conclusion: A relatively small number of studies of varying quality were found. Strengths and weaknesses relating to model structure, inputs and approach were identified across all the studies. There was no indication of a single standard emerging as a preferred approach. Most studies omitted societal costs, an important issue since the implications of drug abuse extend widely beyond healthcare services. Nevertheless, elements from previous models could together form a framework for future economic evaluations in opioid agonist therapy including all relevant costs and outcomes. This could more adequately support decision-making and policy development for treatment of non-prescription opioid dependence

Attempting to validate the over/under triage matrix at a level I trauma center.

The Optimal Resources Document (ORD) mandates trauma activation based on injury mechanism, physiologic and anatomic criteria and recommends using the over/undertriage matrix (Matrix) to evaluate the appropriateness of trauma team activation. The purpose of this study was to assess the effectiveness of the Matrix method by comparing patients appropriately triaged with those undertriaged. We hypothesized that these two groups are different and Matrix does not discriminate the needs or outcomes of these different groups of patients.Trauma registry data, from 1/2013-12/2015, at a Level I trauma center were reviewed. Over and undertriage rates were calculated by Matrix. Patients with ISS ≥16 were classified by activation level (full, limited, consultation), and triage category by Matrix. Patients in the limited activation and consultation groups were compared to patients with full activation by demographics, injuries, initial vital signs, procedures, delays to procedure, ICU admission, length of stay, and mortality.7031 patients met activation criteria. Compliance with ACS tiered activation criteria was 99%. The Matrix overtriage rate was 45% and undertriage was 24%. Of 2282 patients with an ISS ≥16, 1026 were appropriately triaged (full activation), and 1256 were under triaged. Undertriaged patients had better GCS, blood pressure, and BD than patients with full activation. ICU admission, hospital stays, and mortality were lower in the undertriaged group. The under triaged group required fewer operative interventions with fewer delays to procedure.Despite having an ISS ≥ 16, patients with limited activations were dissimilar to patients with full activation. Level of activation and triage are not equivalent. The ACS-COT full and tiered activation criteria are a robust means to have the appropriate personnel present based on available pre-hospital information. Evaluation of the process of care, regardless of level of activation should be used to evaluate trauma center performance.Level III Therapeutic and Care managementThis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal

Vitamin D Status and Bone Mineral Density in Female Collegiate Dancers and Cheerleaders

Bone mineral density reflects an athlete’s cumulative history of energy availability, physical activity, and menstrual status, as well as nutritional and environmental factors. Although sports with high-impact loading are associated with higher bone mineral density than low-impact or non-impact sports, confounding variables are differences in the athletes’ body size and sport-specific training. The purpose of this study was to determine if bone mineral density (BMD) and vitamin D status are different between two groups of female collegiate athletes who have comparable body size/weight requirements, but who engage in qualitatively different training regimens. Full body, spine and dual femur BMD was assessed by dual energy X-ray absorptiometry (DXA) in members of a university pep-dance team (n = 10) or cheer team (n = 9), ages 18-22. Plasma vitamin D status was assessed by ELIZA. There was no significant difference between the groups for total body BMD (1.23 g/cm2 dance vs 1.22 g/cm2 cheer, P = 0.70), spine BMD (1.39 g/cm2 dance vs 1.36 g/cm2 cheer, P = 0.72) or dual femur BMD (1.20 g/cm2 dance vs 1.11 g/cm2, P = 0.23). Insufficient serum vitamin D status (20-32 ng/mL) was found in 74% of the athletes (27 ± 4 ng/mL, dance and 25 ± 8 ng/mL, cheer). In addition, estimated daily vitamin D and calcium intakes were less than the RDA for both dancers and cheerleaders. Despite nutritional insufficiencies, BMD was not significantly different between the low-impact activity pep dance team and high-impact activity cheer team, suggesting that the type of physical activity was not as important for BMD in these athletes as participating in 20+ hours a week of physical activity, which could have counteracted the negative effects of the nutrient insufficiencies on their bone health