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Background Children with intellectual disabilities are likely to present with challenging behaviour. Parent mediated interventions have shown utility in influencing child behaviour, although there is a paucity of UK research into challenging behaviour interventions in this population. NICE guidelines favour Stepping Stones Triple P (SSTP) as a challenging behaviour intervention and this trial aims to evaluate its clinical and cost effectiveness in preschool children with moderate to severe intellectual disabilities. Methods This trial launched in 2017 at four sites across England, with the aim of recruiting 258 participants (aged 30–59 months). The Intervention Group receive nine weeks of SSTP parenting therapy (six group sessions and three individualised face to face or telephone sessions) in addition to Treatment as Usual, whilst the Treatment as Usual only group receive other available services in each location. Both study groups undergo the study measurements at baseline and at four and twelve months. Outcome measures include parent reports and structured observations of behaviour. Service use and health related quality of life data will also be collected to carry out a cost effectiveness and utility evaluation. Discussion Findings from this study will inform policy regarding interventions for challenging behaviour in young children with moderate to severe intellectual disabilities. Trial registration number Clinicaltrials.gov, NCT03086876. Registered 22nd March 2017, https://clinicaltrials.gov/ct2/show/NCT03086876.

For adult survivors of adverse childhood experiences, primary care is the entryway to treatment of post-traumatic stress disorder (PTSD). It is estimated 25% of adult primary care patients have PTS...

Introduction: Underrecognition of trauma exposure and PTSD has a significant impact on psychiatric health, physical health, and health behaviors. The purpose of this study is to explore barriers and opportunities for trauma screening in primary care. Methods: Primary care physicians (PCPs) and their patients were interviewed about the acceptability of trauma screening and brief treatment in primary care. Interview transcripts were coded and analyzed for themes using Atlas v. 7.0. Results: Data showed PCPs informally screen for trauma but were hampered by organizational constraints including time, availability of behavioral health providers, and knowledge of trauma-informed-care practices. Most patients with trauma history met with behavioral health providers during their lifetimes, but still did not believe it was the PCPs' role to address trauma exposure, had fears of "appearing crazy," or were ambivalent about seeking treatment. Discussion: Findings suggest an enormous complexity involved in screening for trauma in primary care service delivery. Trauma screening appears to work best within the course of relationship building where patients can begin to see that their physician is capable of playing an important role in managing trauma, depression, and PTSD symptoms. We address how trauma discussion can take place within existing trauma informed care guidelines. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID)., The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Drs. Thombs and Benedetti were supported by Fonds de recherche du Qu´ebec–Sant´e (FRQS) researcher salary awards. Dr. Levis was supported by a FRQS Postdoctoral Training Fellowship. Ms. Lyubenova was supported by theMitacs Globalink Research Internship Program. Ms. Neupane was supported by G.R. Caverhill Fellowship from the Faculty of Medicine, McGill University. Dr. Wu was supported by a FRQS Postdoctoral Training Fellowship. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Mr. Bhandari was supported by a studentship from the Research Institute of the McGill University Health Centre. Ms. Azar was supported by a FRQS Masters Training Award. The primary study by Barnes et al. was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al. was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by de Figueiredo et al. was supported by Fundacão de Amparo à Pesquisa do Estado de São Paulo. The primary study by Tendais et al. was supported under the project POCI/SAU-ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. The primary study by Helle et al. was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. The primary study by Howard et al. was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Numbers RPPG-1210-12002 and RP-DG-1108-10012) and by the South London Clinical Research Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The primary study by Phillips et al. was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Nakic´ Radoˇs et al. was supported by the Croatian Ministry of Science, Education, and Sports (134-0000000-2421). The primary study by Quispel et al. was supported by Stichting Achmea Gezondheid (grant number z-282). The primary study by Rochat et al. was supported by grants from the University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Prenoveau et al. was supported by The Wellcome Trust (grant number 071571). The primary study by Stewart et al. was supported by Professor Francis Creed’s Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Tandon et al. was funded by the Thomas Wilson Sanitarium. The primary study by Tran et al. was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The primary study by Vega-Dienstmaier et al. was supported by Tejada Family Foundation, Inc, and Peruvian-American Endowment, Inc. No other authors reported funding for primary studies or for their work on this study.

Background: The aim of the study was to evaluate Initial Assessment (IA), a new system for managing referrals. The system is designed to: reduce waiting times, reduce ‘did not attend’ (DNA) rates, and improve multidisciplinary team working and team morale, compared to the existing referral procedure. Method: A comparison was made between a child mental health service using IA and a second centre using the existing system over a 6-month period, based on administrative records, a child functioning measure, staff and user questionnaires. Results: The Initial Assessment system was associated with a significantly shorter average waiting time for the first appointment (9 weeks) and a lower DNA rate (10%) in the intervention centre. The populations seen under the new and existing systems were similar in terms of the severity of cases. Staff reported a positive impact overall on team working and team morale, despite a reported individual increase in time pressure; users reported acceptance of the system. Conclusions: Findings suggest that the increase in team morale and support from colleagues associated with the new system may have mediated against any negative impact of the increased time pressure. Substantial cost savings to the NHS are indicated.

In the latter part of the 20th century evidence was accumulating about the effectiveness of various intervention programmes for young children in disadvantaged families. Some small-scale interventions were evaluated by randomised control trials as in the case of the Abecedarian project (Ramey et al., 2000), the High/ Scope Perry Preschool Project (Schweinhart, Barnes, & Weikart, 1993) and evaluations of home visiting (e.g. Olds, 1997). Others were evaluated by quasi-experimental methods as with the large-scale Head Start project (e.g. Barnett, 1995; Kresh, 1998). Despite some weaknesses in the evidence for large-scale interventions, the accumulating evidence of the benefits of early intervention was very influential in the planning and launch of the Sure Start programme (Glass, 2003), now known as Sure Start local programmes. Sure Start local programmes are central to the UK government’s policy for combating the adverse effects of poverty and disadvantage on young children and their families. Hence they have potentially great importance in the lives of hundreds of thousands of families and young children. By 2004 there will be 524 Sure Start local programmes in disadvantaged areas in England that will be serving over 300,000 children and their families. Scotland, Wales and Northern Ireland have their own Sure Start programmes. This initiative represents a unique approach to early intervention for children aged 0–4, their families, and communities. The aim of Sure Start is: To work with parents-to-be, parents and children, to promote the physical, intellectual and social development of babies and young children – particularly those who are disadvantaged – so that they can flourish at home and when they get to school, and thereby break the cycle of disadvantage for the current generation of young children. Sure Start local programmes are designed to be comprehensive, community-based projects adapted to local needs, and making maximal use of local expertise and enthusiasms. Such a focus on local autonomy may capitalise on shared concerns of people for their community (Oliver, Smith, & Barker, 1998). The issue of whether preventative interventions should be targeted or universal in application is dealt with by Sure Start by targeting distinct areas of disadvantage and making the services universal within those areas. In this way there are the advantages of economy associated with targeted interventions and also the stigma-free advantage of universal provision. While some research has reliably documented the benefits of early intervention, there has been much prevention work that has either not been evaluated or where evaluations are so flawed as to preclude meaningful conclusions (see Mrazek & Brown, 2002; WebsterStratton & Taylor, 2001). The Sure Start programme recognised the need for rigorous evaluation and after a competitive commissioning process the National Evaluation of Sure Start (NESS) was initiated. Rather than providing a specific service, Sure Start local programmes involve changes to existing services. Improved services and community functioning are presumed to lead to enhanced family and community functioning that in turn enhance child development. This approach raises the following questions for NESS. 1. Do existing services change? (How and, if so, for which populations and under what conditions?) 2. Are delivered services improved? (How, and if so, for which populations and under what conditions?) 3. Do children, families, and communities benefit? (How, and if so, for which populations and under what conditions?) This journal article is available at Research Online: http://ro.uow.edu.au/sspapers/1975 NESS addresses these questions through four core research components: (1) implementation evaluation that considers how programmes are operating and changing; (2) impact evaluation that considers effects of Sure Start local programmes upon children and families; (3) local context analysis that considers communities as units of analysis and how they function and change over time; and (4) cost-effectiveness analysis that examines economic return on investment of the Sure Start local programmes. The NESS team also provides technical support to smaller scale evaluations being conducted by local Sure Start programmes themselves. The four core research modules of the evaluation are described in turn.

Michael Robling and colleagues (Oct 13, p 146) are to be congratulated on conducting Building Blocks, a highly rigorous randomised controlled trial of the Family Nurse Partnership (FNP) programme in England, UK, and rightly highlighted the difficulty in showing changes similar to the US studies in a setting with comprehensive universal health services. The trial in the Netherlands, where FNP showed a positive effect on various primary outcomes, involved substantial adaptation of the programme to the local context, and was also more targeted in terms of risk.

ObjectiveThe aim of this study was to systematically review variables associated with initiation of trauma-centered cognitive-behavioral therapy (TC-CBT) among individuals with posttraumatic stress disorder (PTSD).MethodsPubMed, PsycINFO, Web of Science, Published International Literature on Traumatic Stress (PILOTS), and Scopus were searched in a systematic manner up to 2018, and 26 relevant studies were recovered and analyzed.ResultsThe average weighted initiation rate was 6% in larger hospital systems with a high rate of trauma and 28% in outpatient mental health settings (range 4%-83%). Older age (odds ratio [OR]=1.56, 95% confidence interval [CI]=0.51-1.61), female gender (OR=1.18, 95% CI=1.08-1.27), black or other racial-ethnic minority group (OR=1.16, 95% CI=1.03-1.28), Veterans Affairs PTSD service connection status (OR=2.30, 95% CI=2.18-2.42), mental health referral (OR=2.28, 95% CI=1.05-3.50), greater staff exposure to TC-CBT (OR=2.30, 95% CI=2.09-2.52), adaptability of TC-CBT to staff workflow (OR=4.66, 95% CI=1.60-7.72), greater PTSD severity (OR=1.46, 95% CI=1.13-1.78), and comorbid depression (OR=1.21, 95% CI=1.14-1.29) increased the likelihood of TC-CBT initiation, whereas delayed treatment reduced the likelihood of TC-CBT initiation (OR=0.93, 95% CI=0.92-0.95). Qualitative studies showed that mental health beliefs (stigma and lack of readiness), provider organizational factors (low availability, privacy issues), and patient lack of time (logistics) were perceived as barriers to initiation by patients and providers.ConclusionsTC-CBT initiation increased among patients who were older and female. Initiation was also higher among providers who had more exposure to TC-CBT in their work environment and when TC-CBT fit into their existing workflow.

Objectives: A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. Methods: Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. Results: Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. Conclusion: Different interviews may not classify major depression equivalently., This study was funded by the Canadian Institutes of Health Research (CIHR, KRS-140994). Ms. Levis was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Awards. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Dr. Wu was supported by an Utting Postdoctoral Fellowship from the Jewish General Hospital, Montreal, Quebec, Canada. Ms. Azar was supported by a Fonds de recherche du Québec - Santé (FRQS) Masters Training Award. Mr. Bhandari was supported by a studentship from the Research Institute of the McGill University Health Centre. The primary study by Alvarado et al. was supported by the Ministry of Health of Chile. The primary study by Barnes et al. was supported by a grant from the Health Foundation (1665/608). The primary study by Beck et al. was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the University of Connecticut Research Foundation. The primary study by Helle et al. was supported by the Werner Otto Foundation, the Kroschke Foundation, and the Feindt Foundation. Prof. Robertas Bunevicius, MD, PhD (1958–2016) was principal investigator of the primary study by Bunevicius et al. but passed away and was unable to participate in this project. The primary study by Couto et al. was supported by the National Counsel of Technological and Scientific Development (CNPq; Grant 444254/2014-5) and the Minas Gerais State Research Foundation (FAPEMIG; Grant APQ-01954-14). The primary study by Chaudron et al. was supported by a grant from the National Institute of Mental Health (Grant K23 MH64476). The primary study by Figueira et al. was supported by the Brazilian Ministry of Health and by the National Counsel of Technological and Scientific Development (CNPq; Grant 403433/2004-5). The primary study by de Figueiredo et al. was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo. The primary study by Tissot et al. was supported by the Swiss National Science Foundation (Grant 32003B 125493). The primary study by Fernandes et al. was supported by grants from the Child: Care Health and Development Trust and the Department of Psychiatry, University of Oxford, Oxford, UK, and by the Ashok Ranganathan Bursary from Exeter College, University of Oxford. Dr. Fernandes was supported by a National Institute for Health Research (NIHR) academic clinical fellowship. The primary study by Tendais et al. was supported under the project POCI/SAU-ESP/56397/2004 by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. The primary study by Fisher et al. was supported by a grant under the Invest to Grow Scheme from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. The primary study by Garcia-Esteve et al. was supported by Grant 7/98 from the Ministerio de Trabajo y Asuntos Sociales, Women's Institute, Spain. The primary study by Howard et al. was supported by the NIHR under its Programme Grants for Applied Research Programme (Grants RP-PG-1210-12002 and RPDG-1108-10012) and by the South London Clinical Research Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The primary study by Phillips et al. was supported by a scholarship from the National Health and Medical and Research Council (NHMRC). The primary study by Roomruangwong et al. was supported by the Ratchadaphiseksomphot Endowment Fund 2013 of Chulalongkorn University (CU-56-457-HR). The primary study by Naki c Radoš et al. was supported by the Croatian Ministry of Science, Education, and Sports. The primary study by Navarro et al. was supported by Grant 13/00 from the Ministry of Work and Social Affairs, Institute of Women, Spain. The primary study by Usuda et al. was supported by Grants-in-Aid for Young Scientists (A) from the Japan Society for the Promotion of Science (primary investigator: Daisuke Nishi, MD, PhD) and by an Intramural Research Grant for Neurological and Psychiatric Disorders from the National Center of Neurology and Psychiatry, Japan. Dr. Robertson-Blackmore was supported by a Young Investigator Award from the Brain and Behavior Research Foundation and NIMH Grant K23MH080290. The primary study by Rochat et al. was supported by grants from University of Oxford (HQ5035), the Tuixen Foundation (9940), the Wellcome Trust (082384/Z/07/Z and 071571), and the American Psychological Association. Dr. Rochat receives salary support from a Wellcome Trust Intermediate Fellowship (211374/Z/18/Z). The primary study by Rowe et al. was supported by the diamond Consortium, beyondblue Victorian Centre of Excellence in Depression and Related Disorders. The primary study by Comasco et al. was supported by funds from the Swedish Research Council (VR: 521-2013-2339, VR: 523-2014-2342), the Swedish Council for Working Life and Social Research (FAS: 2011-0627), the Marta Lundqvist Foundation (2013, 2014), and the Swedish Society of Medicine (SLS-331991). The primary study by Prenoveau et al. was supported by the Wellcome Trust (Grant 071571). The primary study by Stewart et al. was supported by Professor Francis Creed's Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester. The primary study by Su et al. was supported by grants from the Department of Health (DOH94F044 and DOH95F022) and the China Medical University and Hospital (CMU94-105, DMR-92-92, and DMR94-46). The primary study by Tandon et al. was supported by the Thomas Wilson Sanitarium. The primary study by Tran et al. was supported by the Myer Foundation who funded the study under its Beyond Australia scheme. Dr. Tran was supported by an early career fellowship from the Australian National Health and Medical Research Council. The primary study by Vega-Dienstmaier et al. was supported by Tejada Family Foundation, Inc. and Peruvian-American Endowment, Inc. The primary study by Yonkers et al. was supported by a National Institute of Child Health and Human Development grant (5 R01HD045735). Drs. Benedetti and Thombs were supported by FRQS researcher salary awards.

Background Child maltreatment is a significant public health problem. Group Family Nurse Partnership (gFNP) is a new intervention for young, expectant mothers implemented successfully in pilot studies. This study was designed to determine the effectiveness and cost-effectiveness of gFNP in reducing risk factors for maltreatment with a potentially vulnerable population. Methods A multi-site, randomized controlled, parallel-arm trial and prospective economic evaluation was conducted, with allocation via remote randomization (minimization by site, maternal age group) to gFNP or usual care. Participants were expectant mothers aged below 20 years with at least one live birth, or aged 20–24 years with no live births and with low educational qualifications. Data from maternal interviews at baseline and when infants were 2, 6 and 12 months, and video-recording at 12 months, were collected by researchers blind to allocation. Cost information came from weekly logs completed by gFNP family nurses and other service delivery data reported by participants. Primary outcomes measured at 12 months were parenting attitudes (Adult-Adolescent Parenting Index, AAPI-2) and maternal sensitivity (CARE Index). The economic evaluation was conducted from a UK NHS and personal social services perspective with cost-effectiveness expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. The main analyses were intention-to-treat with additional complier average causal effects (CACE) analyses. Results Between August 2013 and September 2014, 492 names of potential participants were received of whom 319 were eligible and 166 agreed to take part, 99 randomly assigned to receive gFNP and 67 to usual care. There were no between-arm differences in AAPI-2 total (7 · 5/10 in both, SE 0.1), difference adjusted for baseline, site and maternal age group 0 · 06 (95% CI − 0 · 15 to 0 · 28, p = 0 · 59) or CARE Index (intervention 4 · 0 (SE 0 · 3); control 4 · 7 (SE 0 · 4); difference adjusted for site and maternal age group − 0 · 68 (95% CI − 1 · 62 to 0 · 16, p = 0 · 25) scores. The probability that gFNP is cost-effective based on the QALY measure did not exceed 3%. Conclusions The trial did not support gFNP as a means of reducing the risk of child maltreatment in this population but slow recruitment adversely affected group size and consequently delivery of the intervention. Trial registration ISRCTN78814904. Registered on 17 May 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2259-y) contains supplementary material, which is available to authorized users.

Women with experience of being ‘looked after’ are more likely than their peers to become young mothers. There has been limited research investigating support for their needs. This study, embedded in a randomised trial of Group Family Nurse Partnership (gFNP), involved interviews with young mothers with care experience, Family Nurses delivering group gFNP, and health and social care professionals. This first qualitative study to explore the views of these varied stakeholders found consensus regarding young mothers’ social isolation and lack of trusting relationships but diversity in views about the potential of gFNP to meet their needs.

BackgroundFamily Nurse Partnership (FNP) is a home-based nurse home-visiting programme to support vulnerable parents. Group Family Nurse Partnership (gFNP) has similar aims and materials and was demonstrated to be feasible in implementation evaluations.ObjectivesTo determine whether or not gFNP, compared with usual care, could reduce risk factors for maltreatment in a vulnerable group and be cost-effective.DesignA multisite randomised controlled parallel-group trial and prospective economic evaluation, with eligible women allocated (minimised by site and maternal age group) to gFNP or usual care.SettingCommunity locations in the UK.ParticipantsExpectant mothers aged InterventionForty-four sessions of gFNP (14 during pregnancy and 30 in the first 12 months after birth) were offered to groups of between 8 and 12 women with similar expected delivery dates (the difference between the earliest and latest expected delivery date ranged from 8 to 10 weeks depending on the group) by two family nurses (FNs), one of whom had notified her intention to practise as a midwife.Main outcome measuresParenting was assessed by a self-report measure of parenting opinions, the Adult Adolescent Parenting Inventory Version 2 (AAPI-2), and an objective measure of maternal sensitivity, the CARE-Index. Cost-effectiveness was primarily expressed in terms of incremental cost per quality-adjusted life-year (QALY) gained.Data sourcesInterviews with participants at baseline and when infants were aged 2, 6 and 12 months. Cost information from nurse weekly logs and other service delivery data.ResultsIn total, 166 women were enrolled (99 to the intervention group and 67 to the control group). Adjusting for site and maternal age group, the intention-to-treat analysis found no effect of gFNP on either of the primary outcomes. AAPI-2 total was 7.5/10 [standard error (SE) 0.1] in both arms [difference also adjusted for baseline 0.08, 95% confidence interval (CI) –0.15 to 0.28;p = 0.50]. CARE-Index maternal sensitivity mean: intervention 4.0 (SE 0.3); control 4.7 (SE 0.4) (difference –0.76, 95% CI –1.67 to 0.13;p = 0.21). The sensitivity analyses supported the primary analyses. The probability that the gFNP intervention was cost-effective based on the QALY measure did not exceed 3%. However, in terms ofchangein AAPI-2 score (baseline to 12 months), the probability that gFNP was cost-effective reached 25.1%. A separate discrete choice experiment highlighted the value placed by both pregnant women and members of the general population on non-health outcomes that were not included in the QALY metric.LimitationsSlow recruitment resulted in smaller than ideal group sizes. In some cases, few or no sessions took place owing to low initial group size, and small groups may have contributed to attrition from the intervention. Exposure to gFNP sessions was below maximum for most group members, with only 58 of the 97 intervention participants receiving any sessions; FNs were experienced with FNP but were mainly new to delivering gFNP.ConclusionsThe trial does not support the delivery of gFNP as a means of reducing the risk of child abuse or neglect in this population.Future workA randomised controlled trial with modified eligibility to enable first-time mothers aged Trial registrationCurrent Controlled Trials ISRCTN78814904.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 9. See the NIHR Journals Library website for further project information.

Aims: Nurse home-visiting programs are employed to enhance the functioning of disadvantaged mothers and young children. Despite the key role played by nurses, there is little empirical evidence describing the views and experiences of nurses who deliver home-visiting programs. This study compared the views and experiences of nurses delivering home-visiting programs in England and South Australia. Methods: Participants were 108 nurses delivering the South Australian Family Home Visiting program (2008 – 2011), and 44 nurses delivering the Family Nurse Partnership program in England (2007 – 2009). Data were collected using a standard questionnaire that was completed by nurses in each country. The questionnaire asked nurses about their level of influence on program outcomes, approaches they used to retain maternal engagement with the home-visiting programs, barriers to effective program delivery and the effectiveness of supervision. Results: Both groups of nurses considered that their greatest influence was improving mothers’ confidence with parenting skills and increasing mothers’ knowledge about children's development. Each group identified quality of nurse-mother relationships as the factor most relevant to retaining maternal engagement. Other influential factors were flexibility of timing for visits and the capacity of the programs to meet specific needs of mothers.

OBJECTIVE: To examine the association between maternal prepregnancy BMI and cognitive performance in children at 5 and 7 years of age. METHODS: This is a secondary analysis of data from the Millennium Cohort Study, a prospective population based cohort of 19 517 children in the United Kingdom. Standardized cognitive assessments of children, involving components of the British Ability Scales, second edition and a number skills test, were performed at 5 and 7 years of age. Principal components analysis was used to identify a general cognitive ability factor (g) from individual test scores. Maternal prepregnancy BMI was retrospectively self-reported when children were 9 months old. Mixed-effects linear regression models were fitted, controlling for multiple socio-demographic factors, child’s birth weight, child’s BMI, maternal smoking, and maternal diabetes. Complete data were available for 11 025 children at 5 years, and 9882 children at 7 years. RESULTS: Maternal prepregnancy BMI was negatively associated with children’s cognitive performance (g) at age 5 (P = .0069) and age 7 (P < .0001). The overall effect size was modest: a 10-point increase in maternal BMI was associated with a decrease in cognitive performance of ∼1/10th of an SD at age 7. CONCLUSIONS: Maternal prepregnancy BMI is negatively associated with children’s cognitive performance, even after adjusting for multiple socio-demographic confounders and children’s BMI. The relationship appears to become stronger as children get older, although the overall effect size is modest. In utero fetal programming or residual confounding may explain these findings.

Background: Sure Start Local Programmes (SSLPs) are area-based interventions to improve services for young children and their families in deprived communities, promote health and development, and reduce inequalities. We therefore investigated whether SSLPs aff ect the wellbeing of 3-year-old children and their families.

PURPOSE: Neighborhood features have been linked with adult mental-health problems, particularly depression. A recent comprehensive review indicated structural neighborhood features derived from data sources such as the census may be less important predictors of mental health problems than social processes but that most studies lack multiple neighborhood measures. The aim of the study is to investigate relations between multiple neighborhood factors (observations, interviewer ratings, UK Census data) and maternal mental-health problems. METHODS: 14,700 mothers with 9-month-old infants living in 195 deprived neighborhoods in England were interviewed, neighborhoods were observed and census data on employment, ethnic background and housing tenancy utilized. RESULTS: Lower (interviewer-rated) neighborhood quality and lower neighborhood prosperity predicted more mother-reported mental-health problems net of family-level predictors. Contrary to expectations detailed observations did not contribute additionally. CONCLUSIONS: Neighborhood conditions, though not as important as family factors and maternal characteristics, are sufficiently important to consider when planning mental health services; they can be assessed at relatively low cost by census data or professionals' ratings.

Purpose– The purpose of this paper is to evaluate the feasibility of delivering the group family nurse partnership (gFNP) programme, which combines elements of the family nurse partnership (FNP) programme and Centering Pregnancy and is offered from early pregnancy to 12 months postpartum to mothers under 25.Design/methodology/approach– A mixed method descriptive feasibility study. Quantitative data from anonymised forms completed by nurses from November 2009 to May 2011 (pilot 1) and January 2012 to August 2013 (pilot 2) reporting referrals, attendance and client characteristics. Qualitative data collected between March 2010 and April 2011 (pilot 1) and November 2012 and November 2013 (pilot 2) from semi-structured interviews or focus groups with clients and practitioners.Findings– There were challenges to reaching eligible clients. Uptake of gFNP was 57-74 per cent, attendance ranged from 39 to 55 per cent of sessions and attrition ranged from 30 to 50 per cent. Clients never employed attended fewest sessions overall compared to those working full time. The group format and the programme’s content were positively received by clients but many struggled to attend regularly. FNP practitioners were positive overall but involving community practitioners (pilot 2) placed more stress on them.Research limitations/implications– Further feasibility and then cost and effectiveness research is necessary to determine the optimal staffing model.Practical implications– The content and style of support of the home-based FNP programme, available only to first time mothers under 20, could be offered to women over 20 and to those who already have a child.Social implications– A range of interventions is needed to support potentially vulnerable families.Originality/value– This new complex intervention lacks evidence. This paper documents feasibility, the first step in a thorough evaluation process.

This study looks at the delivery of the Family-Nurse Partnership (FNP) in England with interpreters. This home-visiting programme for vulnerable, young first-time mothers is known in the USA as the Nurse-Family Partnership (NFP). FNP is manualised with a number of fidelity targets and stretch objectives. This study covers the first two phases, pregnancy and infancy (up to 12 months). The programme relies on the development of a close nurse-client relationship. Interpreters can be a barrier for therapeutic work with vulnerable groups. The aims are to determine from quantitative and qualitative data whether the FNP programme can be delivered with fidelity in the presence of an interpreter and to explore issues concerned with the impact of interpreters on relationships. Statistical comparisons were made of delivery objectives over 2 years, from April 2007 to February 2009, in the 10 sites in England, spread across all nine Government Office Regions providing FNP. Forty-three clients had an interpreter at some point and 1261 did not. Qualitative interviews were conducted between April and May 2009 with 30 stakeholders (nurses, clients, interpreters). In relation to quantitative indicators, the percentage of planned content covered in visits was lower with interpreters (pregnancy 90% vs. 94%; infancy 88% vs. 93%) and both understanding and involvement of clients, as judged by nurses on 5-point scales, were lower (understanding, pregnancy 4.3 vs. 4.6, infancy 3.8 vs. 4.5; involvement, pregnancy 4.4 vs. 4.7, infancy 3.7 vs. 4.5). The interpreter was not thought by nurses to impede the development of a collaborative client-nurse relationship unless the interpreter and client became too close, but some nurses and clients reported that they would rather manage without an interpreter. Some stress was noted for nurses delivering the programme with an interpreter. More research is needed to determine the extent to which interpreters accurately convey the programme's strength-based approach.

The aims of this article are to highlight the issues that are relevant to the implementation of a rigorously evidence‐based programme of support, the Nurse Family Partnership programme, into a national system of care. Methods used are semi‐structured interviews with families in receipt of the programme in the first 10 sites, with the nursing staff, with members of the central team guiding the initiative and with other professionals. Analyses of data collected during programme delivery evaluate fidelity of delivery. The results indicate that the programme is perceived in a positive light and take‐up is high, with delivery close to the stated US objectives. Issues pertaining to sustainability are highlighted ‐ in particular, local concerns about cost set against long‐term rather than immediate gains. However, local investment is predominantly strong, with creative methods being planned for the future. Overall, the study shows that within an NHS system of care it is possible to deliver a targeted evidence‐based programme.

164 Background: Supporting emotional, psychological, financial and spiritual well-being of patients has been shown to have a positive impact on quality of life and patient experience. Social workers in our outpatient cancer center are responsible for completing new patient assessments at the start of chemotherapy treatment to provide early access to psychosocial support services. Assessments are to be completed within three weeks of the patient’s first chemotherapy treatment. Connecting with patients early in the care experience allows social workers to proactively assist with education, support and link patients to vital resources. Methods: Completed assessments were tracked and from October through December 2017. The social workers leveraged the use of data analytics and a team based approach to increase the number of new patient assessments completed within the first 3 weeks of chemotherapy. Weekly 30-minute huddles were held using problem solving methods, including brain storming, cause and effect diagrams, force ranking, and polling. Results: A team identified 39 potential causes to why 65.14% of patients were not receiving assessments within the first 3 weeks of chemotherapy treatment. Potential causes were grouped and themed. Work prioritization, inconsistent methods of identifying patients receiving chemotherapy for the first time, and lack of visual management to monitor progress of this metric were identified as key objectives for improvement. Countermeasures were developed and implemented; a dashboard was created to analyze the first time treatment assessment completion percentages by disease group and standardizing the process of notifying social workers of patients in need of an assessment. Social worker assessment completion rates improved from 34.78% (December 2017) to 75.35% (April 2018). Conclusions: This project demonstrates the value of utilizing problem solving, visual management, and data analytics for continuous quality improvement projects related to clinical care and processes. Cross-disciplinary collaboration should be explored with the use of visual tools and other resources to facilitate communication that is understood by all disciplines.

Background: Increasing recognition of the importance of maternal mental health and early parenting in optimising the later mental health of the child has given rise to new ways of working during the perinatal period. Aims: The objective of this review is to identify effective health-led interventions to support parents, parenting and the parent-infant relationship during the perinatal period,(1) and beyond. Method: A systematic search of key electronic databases was undertaken to identify secondary and primary sources of data addressing the research question. Twenty-four reviews addressed the effectiveness of interventions delivered during the postnatal period in promoting closeness and sensitive parenting, infant sensory and perceptual capabilities, and positive parenting, and in addressing infant regulatory problems, maternal mental health problems, and parent-infant relationship problems. Conclusions: A number of methods of working are recommended as part of a model of progressive-universalism beginning ante-natally and continuing through the first two post-natal years, and beyond. The implications for universal, targeted and specialist healthcare services are explored, alongside the role and contribution of CAMHS practitioners.

Background Maternal depression can be detrimental to infant development. Structured home visiting initiated either in pregnancy or soon after the birth by a professional has led to better outcomes for mothers and their children but some vulnerable families may respond more favourably to a local volunteer. The value of volunteer support provided in the UK by Home-Start for maternal well-being is noted in qualitative studies, but there is no evidence of its impact from trials. The support is not structured and both the frequency and content of visits may vary. Methods A cluster randomized study allocated Home-Start local schemes to intervention or control conditions. Mothers in all areas were screened at routine health checks in late pregnancy. In intervention areas names of those scoring 9+ on the Social Disadvantage Screening Index were passed to Home-Start to be offered a volunteer. Not all those offered the support accepted the offer. In control areas no support was offered. Research assessments were conducted at 2 and 12 months. The outcomes were major or minor depression occurring between 2 and 12 months (Structured Clinical Interview for Diagnostic and Statistical Manual – Third Edition – Revised) and depression symptoms at 12 months (Edinburgh Postnatal Depression Scale). Three groups were compared: supported, case-matched controls and those offered but not receiving support. Results Almost one-third experienced depression during the time period. Volunteer support had no identifiable impact on the emergence of maternal depression from 2 to 12 months or on depression symptoms when infants were 12 months. The major predictor of both was depression identified at 2 months. Conclusions It was not found that informal support initiated following screening for disadvantage in pregnancy reduced the likelihood of depression for mothers with infants.

The British government’s wish to eliminate the cycle of disadvantage for children from poor families led to Sure Start. The initiative set up 260 Sure Start Local Programmes (SSLPs) by 2001, which were expanded to 524 programmes within 2 years. SSLPs aimed to enhance the health and development of children under four and their families in deprived communities. SSLPs were area-based, with all children under four and their families in an area being eligible. This allowed efficient delivery of services without stigmatisation. SSLPs did not have a prescribed “protocol” of services. Instead, each SSLP had autonomy to improve and create services, with general goals and some specific targets but without specification of how services were to be delivered. The National Evaluation of Sure Start (NESS) undertook a multifaceted evaluation of SSLPs, and by 2005 research evidence led to a fundamental shift with SSLPs becoming Children’s Centres. The story of how this happened is discussed herein, with latest findings summarised.

Objective: To explore barriers to the involvement of community midwives in identifying women in early pregnancy as potential participants in the XX, a randomised controlled trial of a new intervention to provide health and parenting support to potentially vulnerable women.\ud \ud - Design: Descriptive qualitative investigation using semi-structured audio-recoded interviews.\ud - Setting: Community midwifery offices.\ud - Participants: Volunteer sample of 13 community midwives.\ud - Measurement: Themes derived from content analysis.\ud - Findings: Understanding of their role in the research process was unclear to many midwives. Confusion arose about the difference between potential participant identification and trial recruitment. There were concerns about the eligibility criteria and it was suggested that there was insufficient time during booking appointments, and sometimes insufficient information, to determine potential eligibility. Midwives had concerns about some aspects of the intervention, which incorporated routine midwifery care, and had expectations that women may not like a group programme. This may have led some not to mention the trial. They were, however positive about the programme's potential for beneficial impacts on mothers and infants.\ud - Key conclusions: Dedicated research midwives may be the best option if research studies need to identify potential participants early in pregnancy, so that they can communicate with all their colleagues.\ud - Implications for practice: If community midwives are asked to be involved in time-critical research they are likely to need additional local resources and support.

In an observational study of 31,257 children we investigated the effects of paternal age at the time of the child’s birth, paternal absence and non-biological fathers on children’s health. Results are per 5 year change in paternal age. Older fathers were associated with lower rates of unintentional injuries, odds ratio (OR)=0.966, P=0.0027. There was a quadratic association between paternal age and risk of hospital admission, β=0.0121, P=0.0109, with minimum risk at paternal age 37.7. Absent fathers were associated with increased risk of hospital admission, OR=1.19, Pβ=0.304, P=0.0024 (3 year olds), β>=0.697, Pβ=0.908, P

The study reported here aimed to evaluate the impact on parenting and the home environment of community volunteer home visiting offered during or soon after pregnancy to potentially vulnerable mothers. A cluster‐randomised study allocated Home‐Start schemes to intervention or comparison (existing services) conditions. Mothers were screened at routine health checks. Families in intervention and comparison areas were assessed at two and 12 months. The results showed that comparing families receiving support and those in comparison areas, there were few differences. There was a greater reduction in parent‐child relationship difficulties for supported families, but they offered their children fewer healthy foods. There was no evidence of enhanced parenting, organisation of the home environment or more appropriate use of health services. Comparing families receiving support with a second comparison group, living in intervention areas but not receiving support, no differences were found. The article concludes that a more structured approach may be required to make changes in parenting behaviour and the home environment.

Objective To survey the level of disclosure of conception method within families of children conceived by conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and to examine the factors that might influence parental attitudes and plans for disclosure. Design In-depth questionnaire. Setting Participants recruited through fertility clinics in the United Kingdom. Patient(s) Parents of children aged 5 to 6 years conceived by IVF/ICSI (n = 181; 51% survey response rate). Intervention(s) Mothers and fathers of IVF/ICSI-conceived children were sent questionnaires to complete and return in a postage-paid envelope. Main outcome measure(s) Responses to the questionnaire. Result(s) Most parents had told somebody about their child's method of conception, mostly close friends and family. Fewer (26% of mothers, 17% of fathers) had already discussed the child's mode of conception with their child. Fifty-eight percent of mothers and 57% of fathers intended to tell their child at some point. Sixteen percent of mothers and 21% of fathers were undecided. Four percent of fathers never wanted to discuss the subject with their child. Children were more likely to be told if conception was ICSI, rather than conventional IVF, and if an only child. Twenty-nine percent of undecided fathers and 36% of undecided mothers stated that they would tell their child if appropriate, child-friendly explanatory literature were available. Conclusion(s) The majority of parents wish to tell their child about their conception by IVF/ICSI at some point but are unsure as to the most appropriate timing and method of disclosure. Fertility clinics might have a role to play in providing the necessary support. Child-friendly literature might be helpful.

Objective. To date, very few studies have been conducted on the neurodevelopmental well-being of children conceived through intracytoplasmic sperm injection (ICSI). The limitations of these studies often include a lack of comparison with a demographically matched, naturally conceived (NC) group and the investigation of only very young children, with relatively small samples sizes. One study showed that there were no differences in IQ scores among ICSI-conceived, in vitro fertilization (IVF)-conceived, and NC children at 5 years of age. Unfortunately, psychomotor development was not assessed in that study. Because findings regarding these children's cognitive and motor development are inconclusive, the aim of this study was to shed more light on the cognitive and motor development of 5-year-old ICSI-conceived children. Methods. A total of 511 ICSI-conceived children were compared with 424 IVF-conceived children and 488 NC controls. Children were recruited in 5 European countries, ie, Belgium, Denmark, Greece, Sweden, and the United Kingdom. Participation rates ranged from 45% to 96% in the ICSI and IVF groups and from 34% to 78% in the NC group. Cognitive and motor development was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) and McCarthy Scales of Children's Abilities (MSCA) Motor Scale, respectively. The WPPSI-R consists of 2 major scales, ie, Verbal and Performance, each including 6 subtests. The 6 Performance Scale subtests are object assembly, geometric design, block design, mazes, picture completion, and animal pegs. The 6 Verbal Scale subtests are information, comprehension, arithmetic, vocabulary, similarities, and sentences. Scores on the Performance and Verbal Scale subtests are summed to yield the performance IQ (PIQ) and verbal IQ (VIQ), respectively. Scores on both the Performance Scale and the Verbal Scale yield the full-scale IQ (FSIQ). IQ scales have a mean score of 100 and a SD of 15. Each subtest has a mean score of 10 and a SD of 3. The MSCA consists of 6 scales, ie, Verbal, Perceptual-Performance, Quantitative, General Cognitive, Memory, and Motor Scale. In this study, only the Motor Scale was administered. This scale assesses the child's coordination during performance of a variety of gross- and fine-motor tasks. Leg coordination, arm coordination, and imitative action tests provide measures of gross-motor ability. Draw-a-design and draw-a-child assess fine-motor coordination, as revealed by the levels of hand coordination and finger dexterity. The mean score for this test is 50, with a SD of 10. Results. No differences were identified among ICSI, IVF, and NC children with respect to VIQ, PIQ, or FSIQ scores of the WPPSI-R. Furthermore, there were no differences between groups regarding the discrepancy between VIQ and PIQ scores. These results were not influenced by gender, country, or maternal educational level. However, in the subgroup of firstborn children with mothers who gave birth at an older age (33–45 years), NC children obtained significantly better VIQ and FSIQ scores than did children conceived through assisted reproductive technologies. These differences in VIQ and FSIQ scores between ICSI/IVF and NC children were relative, because NC children scored Conclusions. This study includes a substantial number of children from several European countries. Apart from a few interaction effects between mode of conception and demographic variables, no differences were found when ICSI, IVF, and NC scores on the WPPSI-R and MSCA Motor Scale were compared. Nevertheless, the aforementioned interaction effects could indicate that demographic variables such as maternal age at the time of the birth and maternal educational level play different roles in the cognitive development of IVF and ICSI children, compared with NC children. Additional research is needed to explore and verify this finding. Previous studies revealed that ICSI children, in comparison with NC children, more frequently obtained scores below 1 SD from the mean on 3 subtests of the Performance Scale (object assembly, block design, and mazes) or showed a trend of 5.2% of ICSI children, compared with 2.5% of IVF children and 0.9% of NC children, obtaining a score below 1 SD from the mean, but those findings were not confirmed in this study. Here no differences were found among the 3 groups in the numbers of children scoring below 1 SD from the mean on the VIQ, PIQ, and FSIQ tests and the Verbal and Performance Scale subtests. Motor development results were somewhat more conclusive. There were no differences between the scores of ICSI, IVF, and NC children on the MCSA Motor Scale. No interaction effects were found between mode of conception and demographic variables, indicating that these results are not influenced by gender, nationality, maternal educational level, or maternal age at the time of the birth. Furthermore, equal proportions of children in all 3 groups scored below 1 SD from the mean. The results of this study are reassuring for parents who conceived through ICSI (or IVF). The findings indicate that the motor and cognitive development of their offspring is very similar to that of NC children. However, demographic factors such as maternal educational level and maternal age at the time of the birth might play different roles in the cognitive development of ICSI and IVF children, compared with NC children.

The NHS has emphasised the need for rigorous evaluations of preventative home-visiting support (Bull and others, 2004) in building a public health evidence base. Interdisciplinary studies involving the NHS in any capacity are subject to ethical review by NHS Research Ethics Committees. However, the current process of ethical review does not respond flexibly to research conducted by non-NHS organisations. Through documentary analysis, this paper describes the experience of a non-clinical research evaluation of a family support service offered during pregnancy and the difficulties encountered in gaining ethical approval. Implications for social science research with minimal NHS involvement are discussed and recommendations for improvements suggested.

In a non-matched case-control study using data from two large national cohort studies, we investigated whether indicators of child health and development up to 7 years of age differ between children conceived using assisted reproductive technology (ART), children born after sub-fertility (more than 24 months of trying for conception) and other children. Information on ART use/sub-fertility was available for 23,649 children. There were 227 cases (children conceived through ART) and two control groups: 783 children born to sub-fertile couples, and 22,639 children born to couples with no fertility issues. In models adjusted for social and demographic factors there were significant differences between groups in rate of hospital admissions before the children were 9 months old (P=0.029), with the ART group showing higher rates of hospital admission than the no fertility issues control group, the sub-fertile control group being intermediate between the two. Children born after ART had comparable health and development beyond 9 months of age to their naturally conceived peers. This applied to the whole sample and to a sub-sample of children from deprived neighborhoods.

Objectives. The current study investigated (a) whether identifiable patterns of childcare arrangements from birth to 51 months exist and (b) whether these patterns moderate cognitive development from 18 months to 51 months in relation to maternal stimulation of language and infant difficult temperament controlling for SES and child gender.\ud Methods. Of the 1201 who participated in the Families, Children Childcare Study, 978 were included in the current study. Data were collected when children were 3, 18, 36 and 51 months old regarding their mother-reported childcare arrangements, mother-reported child temperament and objective tests of cognitive and language abilities. \ud Results. Six prevailing patterns of childcare arrangements were identified. Variations were found across these in predicting cognitive development. For all types, cognitive ability at 18 months influenced language ability at 36 months, which in turn influenced cognitive ability at 51 months. Cognitive scores at 18 months were directly and significantly influential on cognitive ability at 51 months only in the ‘maternal to centre-based care’ and ‘multi types’ patterns of childcare. Early and ongoing centre-based care predicted higher language ability at 36 months but its impact was not evident at 51 months. When girls entered centre-based care after they were 3 years old, their cognitive scores were negatively influenced. Low family SES was a risk factor for language ability at 36 months when children were not introduced to any non-parental care before the age of three years.\ud Conclusion. This study helped to understand that the particular childcare pathway from birth to the start of school interacts with family and child factors to contribute to child cognitive outcomes at 51 months. This information should be relevant to families as they make decisions about when to start or stop different types of child care during infancy and preschool years.

Summary Aim To compare the feeding patterns and difficulties of infants with congenital heart disease (CHD) and healthy controls. Information was gathered via parental questionnaires. Methods A matched case controlled study of 64 infants with CHD compared with 64 healthy controls. Results The main findings were: (1) Feeding patterns: mothers with infants with CHD used bottle-feeding as a first method of feeding their babies more often (CHD, 20%, controls, 2%); (2) Specific feeding difficulties: (a) infants with CHD were significantly more breathless when feeding (CHD = 16%, controls, 0%), (b) had more vomiting at mealtimes (CHD = 23%, controls = 11%), but (c) had significantly less spitting (CHD = 19%, controls, 41%); and (3) infants with CHD showed significantly reduced growth. Conclusions The feeding difficulties are related to the organic condition and not specific difficulties in mother–infant interaction. Professional support may be required for mothers of infants with CHD to maintain feeding routines and to deal with the difficulties that arise.

There is increased focus on using research evidence to guide clinical practice in the provision of child mental health services, to allocate resources and to make policy decisions. Emphasis has been placed on randomised controlled trials, which are clearly vital. However, given the complexity of children's lives and the multiple systems relevant to their care, it is important to consider alternative research designs and to think creatively about outcomes. In the context of difficulties with random allocation a number of quasi-experimental designs are described that may more closely reflect actual clinical work. In the context of ecological theory, the importance of taking a systems level approach to evaluation is highlighted, with examples from the US. Finally, the ways in which qualitative outcomes measures can be used to sensitively describe the effects of treatment are outlined, and their potential for giving voice to children and families as consumers of mental health services. These suggestions aim to lessen the tension between the requirements of the scientific investigations of treatment effectiveness and the realities of clinicians' daily experiences.

Commentary on : Robling M, Bekkers MJ, Bell K, et al. Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial. Lancet 2016;387:146–55.[OpenUrl][1][CrossRef][2][PubMed][3] Nurse Family Partnership (NFP) home visiting from pregnancy to 24 months post partum, guided by a manualised curriculum, has been shown in three randomised controlled trials (RCTs) to have multiple beneficial outcomes and to be a cost-effective way to decrease the risk of child abuse for children of young, psychologically vulnerable first-time mothers.1 NFP has also been shown to strengthen families through increased maternal employment and wider spacing of pregnancies, and has demonstrated a range of benefits for children through adolescence.2 The US-developed programme was introduced into England in 2007 (renamed Family Nurse Partnership, FNP) and a pragmatic, non-blinded RCT was launched in 2009. Eligible women (nulliparous, age >20 years, … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.volume%253D387%26rft.spage%253D146%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252815%252900392-X%26rft_id%253Dinfo%253Apmid%252F26474809%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(15)00392-X&link_type=DOI [3]: /lookup/external-ref?access_num=26474809&link_type=MED&atom=%2Febmed%2F21%2F4%2F145.atom

This chapter considers the crucial role that the teacher plays in supporting successful use of immersive technology in the classroom, focusing particularly on the use of an interactive, online, multiplayer videogame called Quest Atlantis. This chapter presents an account of successful strategies for integrating immersive technologies into teaching practice, such that the game does not replace the teacher, nor the teacher replace the game, but rather the two are integrated in their mutual support of student learning. The authors focus specifically on two distinct roles that teachers can play in leading whole-class discussions: attuning students to important concepts and connections in the game, and deepening opportunities to learn beyond what is afforded in game design. For each role, the authors present two contrasting cases with the goal of illuminating the central role that a teacher can play when integrating complex technologies into the classroom. Differences in the ways that teachers support their students while using games like Quest Atlantis are not trivial; it is argued that differences in teachers’ support of whole-class conversations can create dramatically different opportunities for students to learn.

There is mixed evidence about the predictive validity of the Griffiths mental developmental scales. This study aimed to assess the predictive value of developmental assessments of children in their second year using the Griffiths mental development scales for neuro-developmental status at five years using the Wechsler preschool and primary scale of intelligence, revised (WPPSI-R). In a longitudinal study 253 children were assessed in their second year of life using the Griffiths scales and again at five years using the WPPSI-R. The scores were compared and the predictability of the WPPSI-R outcome on the basis of Griffiths scores was assessed. The WPPSI-R full scale IQ and the performance IQ at age five could be predicted moderately by the Griffiths general quotient (GQ) and by the personal/social scale. The Griffiths GQ was not a significant predictor of verbal IQ at age 5. The Griffiths performance scale predicted subsequent WPPSI-R performance IQ, and marginally the Full Scale IQ. For the early identification of children at risk for language delay, the Griffiths scales may not be suitable. However, a shortened form would be useful to predict overall cognitive development from the second year to school entry, focussing on the personal-social and performance scales.

This study aimed to study the health of children born to mothers with chronic kidney disease. Twenty-four children born to mothers with chronic kidney disease were compared with 39 matched control children born to healthy mothers without kidney disease. The well-being of each child was individually assessed in terms of physical health, neurodevelopment and psychological health. Families participating with renal disease were more likely to be from lower socio-economic backgrounds. Significantly fewer vaginal deliveries were reported for mothers with renal disease and their infants were more likely to experience neonatal morbidity. Study and control children were comparable for growth parameters and neurodevelopment as assessed by the Griffiths scales. There was no evidence of more stress amongst mothers with renal disease or of impaired bonding between mother and child when compared to controls. However, there was evidence of greater externalizing behavioral problems in the group of children born to mothers with renal disease. Engaging families in such studies is challenging. Nonetheless, families who participated appreciated being asked. The children were apparently healthy but there was evidence in this small study of significant antenatal and perinatal morbidity compared to controls. Future larger multi-center studies are required to confirm these early findings.

A decade ago, the Cross-Departmental Review of Services for Young Children concluded that disadvantage among young children was increasing and it was more likely that poor outcomes could be prevented when early intervention was undertaken.1 The review also noted that current services were uncoordinated and patchy, and recommended that there should be a change in service design and delivery. It suggested that programmes should be jointly planned by all relevant bodies and be area based, with all children under 4 years old and their families in an area being clients. In July 1998, the then Chancellor of the Exchequer, Gordon Brown, introduced Sure Start, which is aimed at providing quality services for children under 4 years old and their parents.2 The original intent of the programme design was to focus on the 20% most deprived areas, which included around 51% of children in families with incomes 60% or less than the national median (official poverty line).3 Over 3 years, £542 million was made available, with £452 million designated for England. In England, 250 programmes were planned by 2001–2002to support 187 000 children, 18% of poor children under 4 years old. Typically, a programme was to include 800 children under 4 years old, with £1250 per annum per child at the peak of funding. Programmes were to run for at least 10 years with funding peaking at year 3 and declining from year 6 to none at year 10. Some funding would fall to local authorities, made available by “reshaping” services. This investment utterly transformed early-year services while representing a relatively small contribution from the perspective of treasury—just 0.05% of public expenditure. In this brief summary, we cover the history and impact of this ambitious initiative. While more than 40 reports and peer-reviewed publications have documented the different …

Book synopsis: Sure Start Local Programmes (SSLPs) were a major strategic effort by New Labour towards ending child poverty. By changing the way services were delivered to children under four and their families, through targeting and empowering highly deprived small geographic areas, SSLPs were intended to enhance child, family, and community functioning. Following five years of systemic research exploring the efficacy and impact of this grand experiment, this book pulls together the results of the extensive National Evaluation of Sure Start (NESS). It reviews the history of policies pertaining to child health and well being that preceded and set the stage for Sure Start. The book provides insight into how SSLPs were expected to function and how they actually operated, both in terms of their strengths and weaknesses, and their costs. The contributors: examine the nature of the communities in which these programmes were situated and how they changed over time; present the early effects of SSLPs on children and families, with evidence highlighting some small beneficial effects and some small deleterious ones; and extract specific features of SSLPs that contributed to whether individual programmes benefited children and families, providing a guide for the revision of programmes and policies. With a foreword from Naomi Eisdenstadt, former Director of the Sure Start Programme, and a concluding chapter by Prof. Sir Michael Rutter, member of the government's scientific advisory board overseeing NESS, the book provides a critique of SSLP policy and NESS.

Objective : To determine parents' experiences and perceptions of a support service for families with bereaved children, provided by a UK charity for cancer patients in seven hospices in the UK. Method : Individual interviews with 25 purposively selected parents. Results : Parents used the service for: advice and reassurance; support for their children while they grieved; and advice on ameliorating behavioural difficulties at home and school. Non-service users did not think formalised support was necessary or had other sufficient support. Nevertheless, important to parents in both groups was that the service existed so their children's needs were being or could be addressed. Children and their parents benefited from talking to a non-family member, and being involved in social events that reduced feelings of isolation. Conclusion : The hospice child bereavement service was offered as an integral part of palliative cancer care support. Future research could explore collaborative work between counsellors and other professionals. Pallative Medicine 2007; 21: 401—407

Objective To evaluate the effects of Sure Start local programmes (SSLPs) on children and their families. To assess whether variations in the effectiveness of SSLPs are due to differences in implementation. \ud \ud Design Quasi-experimental cross sectional study using interviews with mothers and cognitive assessment of children aged 36 months who speak English. \ud \ud Setting Socially deprived communities in England: 150 communities with ongoing SSLPs and 50 comparison communities. \ud \ud Participants Mothers of 12 575 children aged 9 months and 3927 children aged 36 months in SSLP areas; mothers of 1509 children aged 9 months and 1101 children aged 36 months in comparison communities. \ud \ud Outcome measures Mothers' reports of community services and local area, family functioning and parenting skills, child health and development, and verbal ability at 36 months. \ud \ud Results Differences between SSLP areas and comparison areas were limited, small, and varied by degree of social deprivation. SSLPs had beneficial effects on non-teenage mothers (better parenting, better social functioning in children) and adverse effects on children of teenage mothers (poorer social functioning) and children of single parents or parents who did not work (lower verbal ability). SSLPs led by health services were slightly more effective than other SSLPs. \ud \ud Conclusion SSLPs seem to benefit relatively less socially deprived parents (who have greater personal resources) and their children but seem to have an adverse effect on the most disadvantaged children. Programmes led by health services seem to be more effective than programmes led by other agencies.

Objective To assess laterality in a group of European children conceived with the help of assisted reproductive therapy, or naturally conceived. Design Prospective cohort study. Setting Five European countries. Population A total of 1525 five-year-old children divided into three groups according to conception status: naturally conceived; intracytoplasmic sperm injection (ICSI); in vitro fertilisation (IVF) group. Methods All children were assessed using the McCarthy Scale of Children's Abilities (Motor Scale) with additional items using a comb, a spoon and an indirect measure was made of the parental handedness scores, using a questionnaire. Main outcome measures Child handedness for drawing and writing. Results Observed handedness did not differ significantly between natural conception, IVF and ICSI in girls or boys, except for ICSI-conceived girls, fewer of whom were left-handed than the naturally conceived controls, 7.0%versus 12.4% (P < 0.05), however, this was close to the population norm of 8%. The degree of parental handedness did not significantly vary in the three groups. Conclusions Laterality, as assessed by handedness, may be marginally less common in girls conceived with assisted reproductive therapies than with children conceived naturally.

Objective: To identify factors influencing mothers' communication with their children about their diagnosis and initial treatment. Design: Cross-sectional cohort. Setting: Two breast cancer treatment centres. Subjects: Thirty-two women with Stage I or Stage II breast cancer with 56 school-aged children. Main outcome measures: Semistructured interview regarding timing and extent of communication with children from the time that a problem was first identified to initial treatment, and children's reactions. Results: Children were most likely to be told about their mother's illness after the diagnosis had been confirmed by biopsy but a minority were told nothing until after surgery and some nothing at all. The information children received did not necessarily include mention of cancer. Predictors of communication were child age, with older children being told earlier and more information, and maternal education, with children of more highly educated mothers being told less. Child gender was not related to communication. Conclusion: Mothers who are being investigated for breast cancer are likely to benefit from the opportunity to consult a supportive professional about communication with their children during all stages of their diagnosis and treatment, but particularly early on in the investigation when they are more reluctant to initiate discussions with their children. At later points, those with children of varying ages may need specific advice on ways to discuss their illness in relation to children's understanding.

Objective: To examine parents9 communication with their children about the diagnosis and initial treatment of breast cancer in the mother. Design: Qualitative interview study within cross sectional cohort. Setting: Two breast cancer treatment centres. Participants: 32 women with stage I or stage II breast cancer with a total of 56 school aged children. Main outcome measures: Semistructured interview regarding timing and extent of communication with children about the diagnosis and initial treatment of the mother9s illness, reasons for talking to children or withholding information, and help available and requested from health professionals. Results: Women were most likely to begin talking to their children after their diagnosis had been confirmed by biopsy, but a minority waited until after surgery or said nothing at all. Family discussion did not necessarily include mention of cancer. There was considerable consistency in the reasons given for either discussing or not discussing the diagnosis. The most common reason for not communicating was avoidance of children9s questions and particularly those about death. While most mothers experienced helpful discussion with a doctor concerning their illness, few were offered help with talking to children; many would have liked help, particularly the opportunity for both parents to talk to a health professional with experience in understanding and talking to children. Conclusions: Parents diagnosed with cancer or other serious illnesses should be offered help to think about whether, what, and how to tell their children and about what children can understand, especially as they may well be struggling themselves to come to terms with their illness.

It is becoming increasingly evident that paediatricians and general practitioners play a key role in assessing and treating children with mental health problems. A recent national survey in England and Wales found that paediatricians are probably treating more emotional and behavioural disorders in children and young people than any other single professional group and that, on average, this group of patients comprises one fifth of their referrals. 1 In one large survey in the UK, almost one quarter of 7‐12 year olds from a large urban area visiting their general practitioner had a psychiatric disorder, 2 and more than half of the children attending a child mental health clinic in a six month period had been referred by their general practitioner. 3 In the USA, a large study of 7‐11 year old children referred to paediatric clinics found that almost one quarter had a diagnosable mental health disorder, with a further 42% showing threshold disorders. 4

BACKGROUND: Evidence from the USA suggests that the home-based Family Nurse Partnership program (FNP), extending from early pregnancy until infants are 24 months, can reduce the risk of child abuse and neglect throughout childhood. FNP is now widely available in the UK. A new variant, Group Family Nurse Partnership (gFNP) offers similar content but in a group context and for a shorter time, until infants are 12 months old. Each group comprises 8 to 12 women with similar expected delivery dates and their partners. Its implementation has been established but there is no evidence of its effectiveness. METHODS/DESIGN: The study comprises a multi-site randomized controlled trial designed to identify the benefits of gFNP compared to standard care. Participants (not eligible for FNP) must be either aged < 20 years at their last menstrual period (LMP) with one or more previous live births, or aged 20 to 24 at LMP with low educational qualifications and no previous live births. 'Low educational qualifications' is defined as not having both Maths and English Language GCSE at grade C or higher or, if they have both, no more than four in total at grade C or higher. Exclusions are: under 20 years and previously received home-based FNP and, in either age group, severe psychotic mental illness or not able to communicate in English. Consenting women are randomly allocated (minimized by site and maternal age group) when between 10 and 16 weeks pregnant to either to the 44 session gFNP program or to standard care after the collection of baseline information. Researchers are blind to group assignment.The primary outcomes at 12 months are child abuse potential based on the revised Adult-Adolescent Parenting Inventory and parent/infant interaction coded using the CARE Index based on a video-taped interaction. Secondary outcomes are maternal depression, parenting stress, health related quality of life, social support, and use of services. DISCUSSION: This is the first study of the effectiveness of gFNP in the UK. Results should inform decision-making about its delivery alongside universal services, potentially enabling a wider range of families to benefit from the FNP curriculum and approach to supporting parenting. TRIAL REGISTRATION: ISRCTN78814904.

Objective: To assess relations between children’s health and development and maternal age.\ud \ud Design: Observational study of longitudinal cohorts.\ud \ud Setting: Millennium Cohort Study (a random sample of UK children) and the National Evaluation of Sure Start study (a random sample of children in deprived areas in England), 2001 to 2007.\ud \ud Participants: 31 257 children at age 9 months, 24 781 children at age 3 years, and 22 504 at age 5 years.\ud \ud Main outcome measures: Childhood unintentional injuries and hospital admissions (aged 9 months, 3 years, and 5 years), immunisations (aged 9 months and 3 years), body mass index, language development, and difficulties with social development (aged 3 and 5 years).\ud \ud Results: Associations were independent of personal and family characteristics and parity. The risk of children having unintentional injuries requiring medical attention or being admitted to hospital both declined with increasing maternal age. For example, at three years the risk of unintentional injuries declined from 36.6% for mothers aged 20 to 28.6% for mothers aged 40 and hospital admissions declined, respectively, from 27.1% to 21.6%. Immunisation rates at nine months increased with maternal age from 94.6% for mothers aged 20 to 98.1% for mothers aged 40. At three years, immunisation rates reached a maximum, at 81.3% for mothers aged 27, being lower for younger and older mothers. This was linked to rates for the combined measles, mumps, and rubella immunisation because excluding these resulted in no significant relation with maternal age. An increase in overweight children at ages 3 and 5 years associated with increasing maternal age was eliminated once maternal body mass index was included as a covariate. Language development was associated with improvements with increasing maternal age, with scores for children of mothers aged 20 being lower than those of children of mothers aged 40 by 0.21 to 0.22 standard deviations at ages 3 and 4 years. There were fewer social and emotional difficulties associated with increasing maternal age. Children of teenage mothers had more difficulties than children of mothers aged 40 (difference 0.28 SD at age 3 and 0.16 SD at age 5).\ud \ud Conclusion: Increasing maternal age was associated with improved health and development for children up to 5 years of age.

Aims There is a strong trend towards later childbearing.1 Older maternity is associated with increased risks of preterm labour, fetal malformations and fetal death, but there has been little research into the longer term welfare of offspring. We studied the effects of maternal age on the health and well-being of children age 9 months to 5 years. Methods The sample consisted of children in the Millennium Cohort Study2 and the National Evaluation of Sure Start Impact Study.3 Outcomes were: child has had an accident in the last year, child has had a hospital admission in the last year, child has had all recommended immunisations, child9s BMI and child9s BAS Naming Vocabulary Score. Outcomes were modelled using logistic and linear regression models, polynomial in maternal age. Models controlled for sex, age, parity, birth weight, breast feeding, ethnicity, lone parenting, paternal age, worklessness, income, mother9s education and social class. Models of child9s BMI controlled for maternal BMI. The sample size at 9 months was 31,257 (table 1). Results Older motherhood was associated with more favourable outcomes for accidents, hospital admissions, and naming vocabulary. Immunisation rates were better for older mothers at 9 months, and unrelated to maternal age at 3 years once the controversial MMR immunisation was discounted. Child9s BMI was unrelated to maternal age. Conclusions Offspring of older mothers have more favourable outcomes for some measures of health and well-being, once socio-economic factors associated with increased maternal age are controlled.