Suchergebnisse

The use of economic evaluation in relatively complex areas of health and social care has been limited. The level of complexity is influenced by the nature of the problems and interventions under evaluation, being dependent upon the degree of user involvement and the complexity of the inputs and outcomes. Complexity does not preclude the achievement of a good quality economic evaluation, but it can add significant difficulties. Efforts must be made to ensure scientific validity of evaluations, whilst recognising that the complexity inherent in many health and social care interventions may require deviations from and additions to traditional evaluation models. Fundamentally, the net effect will be the need for more time and money than would perhaps be required for the evaluation of a simpler intervention.

Managing Children's Homes focuses on leadership, effective management, the allocation of resources, and ensuring positive outcomes for young people in residential care. The book develops an interdisciplinary understanding of what needs to be taken into account when establishing and maintaining good practice on behalf of young people living in children's homes. The authors explain the considerable variation in quality achieved by children's homes and how this relates to management style, working environment and staff structures. The skills and qualities that make effective managers of homes are

Background: Serious parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents. Improving the lives of these children is a political and public health concern. Objectives: To conduct an evidence synthesis of the clinical effectiveness, cost-effectiveness and acceptability of community-based interventions for improving QoL in children of parents with serious mental illness (SMI). Data sources: Nineteen health, allied health and educational databases, searched from database inception to May 2012, and supplemented with hand searches, reference checking, searches of grey literature, dissertations, ongoing research registers, forward citation tracking and key author contact. Review methods: Inclusion criteria required >= 50% of parents to have SMI or severe depression confirmed by clinical diagnosis or baseline symptoms. Children were Results: Three trials targeted mothers/the children of mothers with psychotic symptoms. Children were Limitations: Included trials were of poor or unclear quality with inadequate randomisation or allocation concealment, possible attrition biases and incomplete outcome reporting. Meaningful analysis was challenged by clinical and methodological heterogeneity and insufficient data for subgroup comparisons. Children's self-reports were lacking and evidence of effect remains biased towards parent-based interventions for severely depressed mothers of infants. Generalisability to other diagnoses, older children and children of fathers with SMI is unclear. A lack of high-quality economic data prevented economic modelling. Conclusion: Evidence for community-based interventions to enhance QoL in children of SMI parents is lacking. The capacity to recommend evidence-based approaches is limited. Rigorous development work is needed to establish feasible and acceptable child-and family-based interventions, prior to evaluating clinical effectiveness and cost-effectiveness via a randomised controlled trial (RCT). A substantial programme of pilot work is recommended to underpin the development of feasible and acceptable interventions for this population. Evaluations should incorporate validated, child-centred QoL outcome measures, high-quality cost data and nested, in-depth acceptability studies. New age-appropriate instruments that better reflect the life priorities and unique challenges faced by children of parents with SMI may need to be developed.

Abstract
Purpose
This study aimed to explore how pregnant women who experience Domestic Violence and Abuse (DVA) and men who commit DVA understand the impact of their childhood environment on their relationships with their children and co-parents, and how a DVA psychological intervention may shape their parenting.

Methods
Repeated individual qualitative interviews were conducted with pregnant mothers and fathers who reported DVA and were taking part in a psychological intervention to address DVA. Interviews were carried out at the start (during pregnancy) and end of the intervention (two years post-childbirth). Reflexive Thematic Analysis was used to analyse interviews.

Results
56 interviews (26 mothers; 13 fathers) were analysed. Five themes were identified: (1) Acknowledging childhood experiences of DVA; (2) The scars of traumatic experiences; (3) Challenging the silencing of abuse; (4) The transmission of parenting styles and behaviours from one generation to another; (5) Becoming the best parent one can be. The intergenerational transmission of violence was identifiable in most narratives. Despite this, several participants described skills they acquired during the intervention (e.g., emotional regulation strategies) as assisting in interrupting violence and improving their relationships with their children.

Conclusions
Participants who acknowledged having encountered childhood abuse recognised it as one of several risk factors for DVA in adulthood. They also discussed the potential for trauma-informed interventions to address the intergenerational transmission of violence and poor parenting practices.

Background: The needs of children in care are a government priority, yet the evidence base for effective interventions to support the emotional wellbeing of children in care is lacking. Research suggests that supporting the carer-child relationship, by promoting the carer's reflective parenting, may be an effective approach to improving the wellbeing of these children. Methods: The study comprises a definitive, superiority, two-armed, parallel, pragmatic, randomised controlled trial, with embedded process evaluation and economic evaluation, and an internal pilot, to evaluate the effectiveness, and cost-effectiveness, of the Reflective Fostering Programme. Randomisation is at the individual level using a 1:1 allocation ratio. The study is being conducted in local authority sites across England, and is targeted at foster carers (including kinship carers) looking after children aged 4 to 13. Consenting participants are randomly allocated to the Reflective Fostering Programme (intervention arm) in addition to usual support or usual support alone (control arm). The primary outcome is behavioural and emotional wellbeing of the child 12 months post-baseline, and secondary outcomes include the following: foster carer's level of stress, quality of life, reflective capacity, compassion fatigue and burnout, placement stability, the quality of the child-carer relationship, child's capacity for emotional regulation, and achievement of personalised goals set by the carer. Discussion: A feasibility study has indicated effectiveness of the Programme in improving the child-carer relationship and emotional and behavioural wellbeing of children in care. This study will test the effectiveness and cost-effectiveness of implementing the Reflective Fostering Programme as an additional aid to the support already available to local authority foster carers. Trial registration: ISRCTN 70832140.