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Autism spectrum disorders (ASD) are associated with a substantial economic burden, but there is little evidence of the costs in the early years; the period in which children are increasingly likely to be diagnosed. We describe the services used by 152 children aged 24-60 months with autism, report family out-of-pocket expenses and productivity losses, and explore the relationship between family characteristics and costs. Children received a wide range of hospital and community services including relatively high levels of contact with speech and language therapists and paediatricians. Total service costs varied greatly (mean 430 British Pounds per month; range 53 British Pounds to 1,116 British Pounds), with some families receiving little statutory support. Higher costs were associated with increasing age and symptom severity.

The article talks about the complex leadership challenges facing the British National Health Service (NHS) amidst the nurses' strike in 2022.

Background: A small proportion of every nation's young people become sufficiently antisocial to come into contact with the criminal justice system. Many also have disorders of mental health or emotional well-being. Although countries vary in designating age of criminal responsibility, all must provide services for offenders, perhaps as young as 10, both to help them and safeguard their peers and the wider public.Aim: The aim of this article is to map the range of research required to support the development of satisfactory services for young mentally disordered offenders and identify knowledge gaps from a practitioner's perspective.Methods: Using a public health prevention framework, we identified the main streams of research pertinent to young, mentally disordered offenders and sought examples of each to consider the extent to which they have been used to inform service development in England.Findings: As in most countries, service development seems first driven by unusual, newsworthy cases. Overall, however, current English provision follows sound primary, secondary, and tertiary prevention principles with parallel tiers of service, including public health initiatives. Primary prevention and more specific treatments are likely to be informed by research findings, but service structure tends to emerge from a wider review base, including criminal justice, social and educational practitioner reviews, and also politics. Thus, services and populations of service users may change in advance of research evidence. Substantial reduction in numbers of young offenders in prison in England, for example, is clearly good in principle, but the intensity of need in the residual group is posing new challenges to which there are, yet, few answers.Conclusions: Although the last 15 years of coordinated service development in England has been broadly theoretically based, it has not been systematically assessed to establish what works best for whom. New problems emerging, such as new drugs of misuse, and new opportunities, such as technology for supporting and monitoring, require model studies. More research focusing on correlates of success is essential. [ABSTRACT FROM AUTHOR]

This paper concerns the apparent decentralization of decision-making in the UK that has accompanied the new coalition government. In particular, we are interested in the rise of Prime Minister Cameron’s public services initiative: ‘Big Society’, and one of its antecedents, ‘Total Place’. We suggest that while these remain sites of political contest, they provide an opportunity for rethinking why the leadership of change might be linked to a change of leadership. In effect, if these approaches are the answer to the problem of providing public services in an age of austerity, then we need to start the analysis by asking what the questions to these answers are. To unravel this point we briefly explain the background to these developments and then consider six questions that might help explain why the local nature of leadership matters. These questions are: what kind of problem are we looking at? What is the purpose of this organization? How does power operate in this place? Why is the local nature of knowledge critical? Is time a problem or an opportunity? And, finally, what kind of local space is this? We conclude by suggesting that the nature of local leadership matters because it constitutes similar problems differently. [ABSTRACT FROM PUBLISHER]

The article stresses the importance for trainees who wants to become members of the Royal College of Psychiatrist to have understanding of critic review, statistical methods and evidence-based practice.