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A review of Aboriginal and Torres Strait Islander content within an accredited paramedicine degree curriculum was undertaken as part of major course review and ongoing evaluation of the program. The aim of which was to ensure the course content was appropriate and relevant to Aboriginal and Torres Strait Islander communities. All content and teaching activities were audited where specific content was explored and noted. Findings were presented to a review team where good practice was highlighted and areas for development were addressed. This has encouraged staff to seek opportunities to embed content in both clinical and non-clinical skills, knowledge teaching and experiences. In addition to encouraging further review of other diverse communities.

Introduction:The 2019-2020 “Black Summer” bushfires in Australia focused the attention of the nation on the critical role that volunteer firefighters play in the response to such a disaster, spurring a national conversation about how to best support those on the frontline. The objective of this research was to explore the impact of the Black Summer bushfires on volunteer firefighter well-being and to investigate how to deliver effective well-being support.Methods:An explorative qualitative design underpinned by a phenomenological approach was applied. Participant recruitment followed a multi-modal sampling strategy and data were collected through semi-structured, in-depth interviews.Results:Qualitative data were collected from 58 participants aged from 23 to 61-years-of-age (average age of 46 years). All self-reported as volunteer firefighters who had responded to the Black Summer bushfires in Australia. Just over 80% of participants were male and the majority lived in the Australian states of New South Wales (65%) and Victoria (32%). All participants reported impact on their well-being, resulting from cumulative trauma exposure, responding to fires in local communities, intense work demands, minimal intervals between deployments, and disruption to primary employment. In regard to supporting well-being, four key themes emerged from data analysis: (1) Well-being support needs to be both proactive and reactive and empower local leaders to “reach in” while encouraging responders to “reach out;” (2) Employee Assistance Programs (EAPs) should not be the only well-being support option available; (3) The sharing of lived experience is important; and (4) Support programs need to address self-stigmatization.Conclusion:Participants in this research identified that effective well-being support needs to be both proactive and reactive and holistic in approach.

Revitalizing Residential Care for Children and Youth: Cross-National Trends and Challenges addresses the question of how societies with developed welfare and social service systems assess current needs and future directions in their residential child and youth care sectors. This includes dealing with historical concerns raised about the placement of children and youth in residential care settings, as well as identifying innovative strategies that offer new pathways for the integration of this often-neglected sector of service within the broader area of child welfare. Each of the 16 countries selected for inclusion is examined through a common matrix that provides information about the current policy context, key trends and initiatives, characteristics of children and youth served, preparation of residential care personnel, promising programmatic innovations, and present strengths and challenges. Individual country analyses are supplemented by regional exemplars of innovative residential programs and practice in areas such as family engagement, helping youth with the transition from care to community, promising model programs, and reflections on recent policy reform initiatives. In addition to takeaways from each country, the book’s closing chapter identifies specific implications for policy reform, empirical research, and residential program innovation. What sets this book apart is its systematic cross-national appraisal of residential care for children and youth with an eye toward identifying innovative policies and practices undergirded by research. In so doing, it offers a unique contribution to the international child welfare literature.

This chapter documents a declining use of residential care in England in favor of foster family care when out-of-home care is needed. It also discusses recent policy reviews and reform efforts that incentivize innovative residential practice. Research on placement outcomes and child and youth characteristics is also provided. The chapter concludes with a standardized matrix that provides information on the current policy context, key trends and initiatives, characteristics of children and youth served, preparation of residential care personnel, promising programmatic innovations, and present strengths and challenges. Growth in private (for profit) residential care is noted, as is an increase in unregulated placement.

This final chapter synthesizes the main findings from the 16-country cross-national review of residential care for children and youth. Major topics include differing rates of use for residential care, characteristics of children and youth served, contextual elements and policy developments, quality factors in residential care, and education and training strategies. The authors conclude with some general recommendations for future improvement of residential child and youth care, including policy initiatives, research, and promising pathways for innovation. The authors urge a more nuanced and better specified conceptualization of residential care. They make the case for continued and expanded cross-national analysis of residential care provision in future.

Chapter 1 sets the parameters for the editors’ view of “residential care for children and youth” and offers a working definition of the same viewed in the context of legal, administrative, and children’s rights within an organized child welfare system. The editors make clear the rationale for their choice of a range of countries with developed welfare systems, while acknowledging a far more diverse range of residential settings viewed in worldwide context. The contributors to this volume share a commitment to a high-quality, revitalized residential service sector grounded both in research and commonly shared values such as partnership with families and residential practice that is close to the rhythms of diverse and vital community life. This does not mean “one size fits all,” but rather that we can learn much from the often subtle ways in which culture and tradition create the niches within which residential services are formed, sustained, and changed.

Introduction:In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches.Methods:The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded.Results:A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia.Discussion:Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later.Conclusion:Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.

Foster carers characterise a highly diverse workforce that shares the choice to provide a home and family for children who can no longer reside with their family. This diversity makes supporting and providing for carers’ training needs a complex task for fostering services. Understanding what might influence their engagement in training would be useful. This article outlines themes related to foster carers’ engagement with social pedagogy, using data from the Head, Heart, Hands (HHH) programme evaluation. Analysis of interviews with seventy-six foster carers over a period of three years is presented. The emerging themes were used to devise an illustrative typology of receptiveness to training. The themes relate to the perceived impact of HHH on their practice and compatibility with the existing children’s social care (CSC) system. The article explores the factors that may influence foster carers’ positioning within the typology. The contributions that such a typology might make to the wider evidence base across CSC, in terms of the implementation and potential impacts of intervention, are discussed.

Introduction: First responders are at greater risk of mental ill health and compromised well-being compared to the general population. It is important to identify strategies that will be effective in supporting mental health, both during and after the first responder’s career. Methods: A scoping review was conducted using the PubMed database (1966 to October 1, 2020) and the Google Scholar database (October 1, 2020) using relevant search terms, truncation symbols, and Boolean combination functions. The reference lists of all relevant publications were also reviewed to identify further publications. Results: A total of 172 publications were retrieved by the combined search strategies. Of these, 56 met the inclusion criteria and informed the results of this overview paper. These publications identified that strategies supporting first responder mental health and well-being need to break down stigma and build resilience. Normalizing conversations around mental health is integral for increasing help-seeking behaviors, both during a first responder’s career and in retirement. Organizations should consider the implementation of both pre-retirement and post-retirement support strategies to improve mental health and well-being. Conclusion: Strategies for supporting mental health and well-being need to be implemented early in the first responder career and reinforced throughout and into retirement. They should utilize holistic approaches which encourage “reaching in” rather than placing an onus on first responders to “reach out” when they are in crisis.

In order to be successful and have high standards of animal welfare, modern zoos strive to regularly modify, improve, and build animal enclosures and visitor areas. However, these periods of development could result in temporary durations of sub-optimal welfare for animals housed nearby. In this study, we monitored the behavior of three Asiatic lions (Panthera leo persica) prior to, during, and following a period of construction on a nearby building. Our results provide evidence that welfare may have been temporarily reduced during the construction period. Compared to the pre-construction period, the male exhibited an increase in pacing behavior and all three lions reduced the time they spent resting. We infer that the most significant negative stimulus related to the construction was sound and/or ground vibrations, as a physical barrier ruled out stress from visual stimuli. The behavioral response to the construction work was relatively short-lived and no long-term changes were observed one year on. This research highlights the importance of measuring animal behavior around events outside routine husbandry, and considering animal welfare on an individual basis. Finally, this work adds to the body of literature surrounding the impacts of construction on animal wellbeing and outlines some suggestions for potential mitigation.

Introduction University life can be daunting, especially for those transferring directly from high school. Previous research has found higher education students are at increased risk of mental health issues than the general population. Paramedic students have the usual concerns regarding study, in addition to the potential to be exposed to confronting emergency medical situations during clinical placements. The study aim was to examine whether the presence of a wellness dog had any impact on paramedicine undergraduate students self-reported emotional wellbeing. Methods A wellness dog (named ‘Watson’) was available on alternating weeks for 15 minutes at the beginning of lectures for three individual units. Each unit corresponded to a different year group of paramedic undergraduate students. A brief emotional experience scale was completed at the beginning of each lecture. Comparisons were made between Watson being present versus absent to gauge differences in students’ emotional wellness. Focus groups were run at the end of semester to further explore perceptions of Watson's impact on emotional wellbeing. Results A total of 89 participants were included in the study. Participant emotional wellbeing was found to be higher on ‘Watson present’ weeks compared to ‘Watson absent’ weeks (pConclusion The presence of a wellness dog appears to have a beneficial impact on undergraduate paramedic students’ emotional wellbeing. Further research is required to explore whether the presence of a wellness dog affects physiological indicators of stress, attrition rates and class attendance.

At Chester Zoo, it is not only the keepers who are taking care of the animals. Statistical methods are used to promote animal welfare and to preserve and protect endangered species.

Modern zoos strive to improve standards of animal management, husbandry and welfare of their animals as part of a continual evaluation process. Elephants (Elephantidae) have received particular attention in recent years due to the challenge of providing environments which promote natural behavior and opportunities for social interaction. A number of measures have been proposed to measure wellbeing, with sleep quality increasingly being used. Sleep is a vital aspect of life for cell replenishment as well as optimal development of young. Sleep deprivation can lead to immunosuppression and illness; therefore animal managers have a responsibility to ensure they reduce the potential for disturbance through noise, light, or other environmental factors. The social environment also plays an essential role in wellbeing, particularly for species that live in multi-generational family units. In this study the nocturnal behavior of a multi-generational captive herd was observed to determine impacts of husbandry changes on sleep duration and bout length (measured as recumbent rest). As expected, average total duration of sleep was higher in younger elephants and rates were comparable to those reported in other studies of Asian elephants. Overnight access to an outdoor paddock in warmer weather increased overall average bout length of sleep in the herd. Average total duration of sleep also increased for the herd following the movement of an unrelated adult female who had previously shown weak bonds with other herd members. This indicates that social compatibility is a vital component of elephant welfare, impacting not only behavioral interactions but sleep quality and duration.

Objective: To evaluate recent high school graduates' opinions on mandatory cardiopulmonary resuscitation (CPR) training in the high school curriculum as a solution to improving bystander CPR rates. Methods: Participants completed questionnaires assessing their CPR training history during their high school education, their willingness to learn CPR during their high school years and their opinion on making CPR training mandatory for high school curricula. Results: Of the 178 participants in this study, 60% had undertaken CPR training during their high school education. Of those who had not undertaken CPR training, 75% reported that they would have been willing to learn CPR had they been provided with the opportunity. A total of 97% of participants were in support of mandatory CPR training in high school education. Conclusion: Implementing mandatory CPR training in high school education would be embraced by students. Implications for public health: Findings of this study support our recommendation to implement mandatory CPR training in the high school curriculum. This will likely increase the number of bystanders in the community who would spontaneously administer CPR, thereby improving outcomes for patients experiencing out‐of‐hospital cardiac arrest.

Introduction Paramedics are exposed to significant and cumulative stressors that contribute to poor mental health. The provision of effective and engaging mental health support is essential in improving overall wellbeing. Many ambulance services have adapted their available support services to reflect this need. However, there remains limited research into the perceived efficacy of these services and barriers that limit uptake from paramedics. Methods Paramedics and ambulance volunteers from Australia and New Zealand were invited to complete an online survey consisting of a series of Likert-scale and open-ended response questions. The well-validated Kessler Psychological Distress Scale was also incorporated into the online survey. Results A total of 184 participants completed the survey. A total of 50 (27%) participants reported high/very high levels of psychological distress. Participants exposed to at least one adverse event while working reported higher psychological distress scores than those that had not. Just over half (51%) of all participants disagreed/strongly disagreed there was no stigma associated with seeking mental health support from paramedic colleagues and 54% of participants disagreed/strongly disagreed there was no stigma from managerial staff. Conclusion These findings suggest paramedics are at a greater risk of psychological distress than the general population. This is particularly problematic given there is a clear perception of ongoing stigma among paramedics associated with the utilisation of mental health support services. Future research should explore methods for reducing stigma and encouraging help-seeking behaviours in this vulnerable population throughout all phases of an emergency service workers career.

This article presents the findings from a critical review of cost-effectiveness research in children's social care. With a focus on the past 20 years (since 2000), the review aims to assess the use and consistency of definitions relevant to evaluating cost-effectiveness such as financial input (costs) and outcomes, and to review and summarise learnings from cost-effectiveness studies in the English children's social care system. We included both academic and grey literature and identified 61 relevant publications for inclusion. The results are organised according to three themes: costs, outcomes and cost-effectiveness. We identified that a large proportion of studies contained a discussion on cost, spend or unit cost, and an equal proportion of articles concerned outcomes of service, benefit to children or quality of service provided. The number of studies discussing cost-effectiveness, cost–benefit or economic evaluation was considerably smaller. The findings highlight substantial gaps in the literature, with a disproportionate focus on stating the problem in terms of cost pressures, and very little robust evidence about cost-effectiveness. Furthermore, the article sets out methodological limitations and indicates a lack of transparency in many of the report studies. We conclude that as a result of the gaps and limitations it is difficult for policymakers and other stakeholders in children's services to make evidence-informed decisions about the best use of their limited resources.

Objective: A substantial body of research exists regarding vicarious trauma (VT) exposure among helping professionals across disciplines and settings. There is limited research, however, on exposure to VT in qualitative researchers studying traumatized populations. The objective of this study was to explore the experiences of qualitative researchers who study traumatized populations and to identify potential protective strategies for reducing the risk of VT. Methods: The study utilized a qualitative methodological design. Focus groups and in-depth interviews were conducted using a semi-structured script. Thematic analysis was conducted to identify both risk factors and protective factors associated with VT. A sample of 58 research participants were recruited using a multimodal recruitment strategy. Results: Using thematic analysis, the following key themes emerged: exposure to primary trauma, the impact of stigma, organizational context, individual context, and research context. The opportunity for posttraumatic growth was also identified. Conclusion: Qualitative researchers of traumatized populations need to recognize the potential for VT and implement appropriate protection strategies from the risk of VT. The development of policies and guidelines that recognize the importance of both self-care and plan for researcher safety and well-being is a potential strategy for building researcher resilience and preventing VT.

Introduction:Emergency service (ambulance, police, fire) call-takers and dispatchers are often exposed to duty-related trauma, placing them at increased risk for developing mental health challenges like stress, anxiety, depression, and posttraumatic stress disorder (PTSD). Their unique working environment also puts them at-risk for physical health issues like obesity, headache, backache, and insomnia. Along with the stress associated with being on the receiving end of difficult calls, call-takers and dispatchers also deal with the pressure and demand of following protocol despite dealing with the variability of complex and stressful situations.Methods:A systematic literature review was conducted using the MEDLINE, PubMed, CINAHL, and PsychInfo databases.Results:A total of 25 publications were retrieved by the search strategy. The majority of studies (n = 13; 52%) reported a quantitative methodology, while nine (36%) reported the use of a qualitative research methodology. One study reported a mixed-methods methodology, one reported an evaluability assessment with semi-structured interviews, one reported on a case study, and one was a systematic review with a narrative synthesis.Discussion:Challenges to physical health included: shift-work leading to lack of physical activity, poor nutrition, and obesity; outdated and ergonomically ill-fitted equipment, and physically confining and isolating work spaces leading to physical injuries; inadequate breaks leading to fatigue; and high noise levels and poor lighting being correlated with higher cortisol levels. Challenges to mental health included: being exposed to traumatic calls; working in high-pressure environments with little downtime in between stressful calls; inadequate debriefing after stressful calls; inappropriate training for mental-health-related calls; and being exposed to verbally aggressive callers. Lack of support from leadership was an additional source of stress.Conclusion:Emergency service call-takers and dispatchers experience both physical and mental health challenges as a result of their work, which appears to be related to a range of both operational and support-based issues. Future research should explore the long-term effects of these physical and mental health challenges.

Introduction:In the years following the September 11, 2001 terrorist attacks in New York (USA), otherwise known as 9/11, first responders and recovery workers began experiencing a range of physical and mental health challenges. Publications documenting these provide an important evidence-base identifying exposure-related health challenges associated with environmental exposures from the World Trade Center (WTC) site and describe the key lessons learned regarding both physical and mental health challenges (including symptoms and defined conditions) from the 9/11 disaster response.Methods:A systematic literature review was conducted using the MEDLINE, PubMed, CINAHL, and PsychInfo databases (September 11, 2001 to September 11, 2018) using relevant search terms, truncation symbols, and Boolean combination functions. Publications were limited to journal articles that documented the physical or mental health challenges of 9/11 on first responders or recovery workers.Results:A total of 156 publications were retrieved by the search strategy. The majority (55%) reported a quantitative methodology, while only seven percent reported the use of a qualitative research methodology. Firefighters were the group of responders most frequently reported in the literature (35%), while 37% of publications reported on research that included a mix of first responders and recovery workers. Physical health was the focus of the majority of publications (57%). Among the challenges, respiratory issues were the physical health condition most frequently reported in publications, while posttraumatic stress disorder (PTSD) was the most frequent mental health condition reported on. Publications were published in a broad range of multi-disciplinary journals (n = 75).Discussion:These findings will go some way to filling the current gap in the 9/11 evidence-base regarding the understanding of the long-term health challenges for first responders and recovery workers.

Given the significant mental health issues affecting our paramedics, there exists an urgent need to promote positive mental health and well-being among future cohorts of student paramedics. This study investigated the preparedness of student paramedics for the mental health challenges of the profession and explored the coping strategies used by experienced paramedics.The study was conducted in two parts. Part A comprised of two surveys which were developed and administered to 16 course coordinators and 302 students of the 16 accredited undergraduate paramedicine courses across Australia and New Zealand. The survey aimed to identify the perceived need for preparation within the curriculum. In addition, the anticipations, confidence and fears of student paramedics, Course Coordinators and paramedics were also collected as a means to explore the preparedness through self-evaluation, reflection and discussion.Part B included twenty semi-structured interviews with experienced paramedics, from Australia and New Zealand. The interviews were conducted to gain an understanding of their experiences and the mental health coping strategies they employed, as well as capture the advice they would give to student paramedics. Results from the interviews were validated by three focus groups comprised of six paramedics each, representative of the geographic spread.Results suggest there is widespread recognition for the need to include preparation for the mental health challenges of the profession, within accredited undergraduate paramedic courses, with 100% of course coordinators and 97% of students recognising this need.The interviews with paramedics provided valuable insights into the experiences and strategies used to aid the survival of the paramedics throughout their careers. Within the interviews, 70% of participants expressed a sincere love for the paramedic role, and 70% identified black humour as the coping strategy most used by themselves and colleagues. In addition, extensive advice was given to students based upon the paramedics’ lived experiences. This advice comprised of three themes; support, health and the profession. These findings were mapped against the aims of Australia’s current Mental Health Policy to provide evidence-based and policy-informed guidelines for the integration of positive mental health strategies into undergraduate paramedicine curricula.Preparing student paramedics for the mental health challenges of the profession could be advantageous. One way to achieve this is through the inclusion of key content within the undergraduate curriculum by utilising the relatable data collected on anticipation, confidence, fears and the advice offered by the veteran paramedics can be integrated. These lived experiences are highly credible and an opportunity for veterans to contribute positively to the future of paramedicine.

In this debate article, we provide our thoughts and reflections on the issues and uses of Therapeutic Residential Care (TRC) in child welfare systems in the US and England. We highlight the issues associated with the lack of clarity of how TRC is defined and when and how it is used. The premise for the article is that some of our most vulnerable young people are living in residential homes without there being a sufficient evidence base to understand whether their needs are being adequately met, or the best outcomes are being achieved. We set out some suggested elements to try to progress debates and decisions that will ultimately improve the services and placements that are provided.

What is the ideological direction of the judges appointed by President Donald Trump during his first four years in office? To answer this question we analyzed 395 U.S. district court decisions handed down by 87 judges appointed to the federal trial court bench by President Trump. These decisions were studied along with over 117,000 opinions by over 2,400 judges published in the Federal Supplement from 1932 through 2020. We find that judges appointed by Trump are significantly more conservative than judges appointed by other Republican presidents in recent decades. In particular, the Trump judges are much more conservative in the areas of civil liberties/rights and labor/economic regulation than judges appointed by any previous Republican or Democrat dating back to JFK.

The purpose of this paper is to examine similarities and differences in recent English and U.S. initiatives which impact the residential child care sector. The English section summarizes the cataly...

There is a prevalent view in England that family-based care is the preferred placement option for children placed in out-of-home care. Nonetheless, it is acknowledged that for some young people res...

Introduction Bystander cardiopulmonary resuscitation (CPR) can be performed by any member of the public who witnesses a cardiac arrest and has the knowledge, training and skills to perform it. Even though bystander CPR has been shown to greatly improve the victim's chance of survival, its training and performance rates are alarmingly low. Methods One potentially effective intervention to tackle this issue is to implement mandatory CPR training programs in high schools. We undertook in-depth qualitative interviews with 28 recent Australian high school graduates. The interviews were transcribed and then analysed, with participants’ answers used to draw conclusions on the acceptability of mandatory CPR high school training. Results Results suggested those that had undertaken basic first aid training in high school would be more open and confident to perform bystander CPR. Among those who had not undertaken training, cost and access were identified as the key barriers. Regardless of whether participants had or had not previously undertaken training, they understood the importance of CPR for the treatment of cardiac arrest victims. Conclusion Among our sample, there was overwhelming support for the concept of mandatory CPR training being implemented in high schools. Should such a program be applied, there is the potential for this to have an impact on bystander CPR provision, and hence cardiac arrest survival rates, within the wider Australian community.

In their new book, Paul M. Collins, Jr. and Matthew Eshbaugh-Soha examine if, how, and when presidents publicly discuss specific Supreme Court decisions. Given the background that both authors brin...

While there are many studies that examine the adverse effects of behavior problems among children in out-of-home care, evidence to understand the cumulative evidence of factors that may change such behavioral paths is limited. Research indicates that children in out-of-home care tend to have higher levels of internalizing and externalizing symptoms, conduct disorders, depression levels, and suicidal behavior compared to children in the general population. To effectively mitigate the risk of behavioral maladjustment, it is important to determine variables that may change behavioral paths, and lead to better outcomes. To address this evidence gap, this study presents a narrative systematic review to examine the quantitative evidence on factors associated with behavioral development of children in out-of-home care. Findings from a total of 146 studies were extracted to investigate what the longitudinal trajectories of behavior problems for children in out-of-home care look like and what variables are associated with particular developmental paths. Results indicated that various individual and ecological variables significantly influence the level of problem behavior that developed over time. Evidence gaps, implications and recommendations for researchers, policy makers and practitioners are presented.

Within a context of substantial adoption policy reform in England, this paper explores post adoption support. Findings from a small-scale survey of 22 local authorities in England and interviews with 11 adoption practitioners (from 11 of the authorities that completed the survey) are presented and related national policy discussed. The paper argues that support should continue postmatching a child with their adoptive parent(s) and that this should be the norm rather than the exception. It also emphasizes the need to improve the availability of and access to post adoption support in a timely manner.

Introduction This study explores the preparedness of undergraduate student paramedics for the mental health challenges of the paramedic profession from the perspective of course coordinators and their students. Methods Two surveys were developed and administered to course coordinators and students of the 16 undergraduate degree paramedicine courses across Australia and New Zealand. Sixteen course coordinators and 302 students responded. Results Results illustrate there was widespread recognition for the need to include preparation for the mental health challenges of the profession within undergraduate courses. Furthermore, most course coordinators and students had a preference for this topic to be taught using multiple teaching modes with particular preference for teaching the topic via discussion and activity based education. Teaching the topic as a standalone unit was supported by more than a third of course coordinators (43%) and a third of students (32%). Conclusion Six themes were identified as positive by anticipants: caring for people, high acuity work, diversity of work and patients, making a difference to patients and their families, using clinical skills and knowledge and engaging with the community. Students were most confident about communicating with patients and using clinical skills and knowledge. Students were least confident about clinical decision making and the most commonly cited fear was making a clinical mistake. A significant proportion of students (16%) feared for their personal mental wellbeing and 14% reported they were least confident about personal mental health within the profession.

In many developed countries around the world residential care interventions for children and adolescents have come under increasing scrutiny. Against this background an international summit was organised in England (spring 2016) with experts from 13 countries to reflect on therapeutic residential care (TRC). The following working definition of TRC was leading: "Therapeutic residential care involves the planful use of a purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialization, support, and protection to children and youth with identified mental health or behavioural needs in partnership with their families and in collaboration with a full spectrum of community based formal and informal helping resources". The meeting was characterised by exchange of information and evidence, and by preparing an international research agenda. In addition, the outlines of a consensus statement on TRC were discussed. This statement, originally published in English and now reproduced in a Dutch translation, comprises inter alia five basic principles of care that according to the Work Group on Therapeutic Residential Care should be guiding for residential youth care provided at any time.

This paper utilizes data gathered as part of an exploratory study to assess the costs and impact of the Common Assessment Framework (CAF), to examine the impact that the lead professional role had on families and workers. The study found that both families and workers believed the lead professional to be central to the CAF process, providing a range of support, coordinating multi-agency responses to need and acting as a single point of contact between families and workers. The paper highlights the need for consideration to be given to inter-agency working, data sharing, training for workers and the capacity implications for those taking on the role. The extent to which the lead professional might be more integrated into the continuum of support for vulnerable children and families is also examined. The paper highlights the need to consider the lead professional's role in not only preventing the need for more intensive services, such as those provided by statutory social work, but also maintaining outcomes achieved once a child protection plan is closed, or a child is reunified with his or her birth family after a period of being in care. The implications of the findings for policy and practice are discussed.

Introduction:The mental health challenges encountered by paramedics have received much attention in recent years. This attention has particularly focused on high rates of stress, depression, anxiety, and post-traumatic stress disorder. This heightened awareness of the high incidence of mental illness, which has at times tragically resulted in the suicide of serving and former paramedics, is stimulating the address of mental health within the paramedic profession. It is now time to call on paramedic educators to prepare student paramedics for the mental health challenges associated with a career in the emergency medical services.Aim:To explore the preparedness of student paramedics for the mental health challenges of the paramedic profession and identify the coping strategies used by veteran paramedics to successfully meet these challenges.Methods:Twenty semi-structured interviews with veteran paramedics from Australia and New Zealand were conducted.Results:Advice from veteran paramedics was comprised of three key themes: support, health, and the profession.Discussion:The findings of the study indicate that the preparation of student paramedics for the mental health challenges of the paramedic profession throughout the undergraduate curriculum could be advantageous. The advice offered by veteran paramedics can be included within undergraduate paramedic curricula and delivered by sharing the personal experiences of the veteran paramedics. These experiences are highly credible and sharing them offers an opportunity for veterans to contribute positively to the future of paramedicine. Guidelines for their inclusion in the undergraduate paramedic curriculum should be prepared to facilitate knowledge translation and to encourage the development of conscious coping strategies by student paramedics during their learning phase. Further research is needed to raise awareness in this area, with a specific focus on preparing paramedic students to cope with mental health challenges related to undergraduate degree programs, and how they feel about commencing their career as a paramedic.

UnlikethemassiveliteratureaboutUSSupremeCourtconfirmationbattles,littlehasbeenwrittenaboutlowerfederalcourtconfirmationfights.However,inthepast20yearsmuchhasbeenwrittenaboutthelowerfederalcourtconfirmationprocess.Here,wetakestockofthepoliticalscienceliteratureinthisareaandhighlightwherescholarlyinterestappearstobegoing.BelievingacontemporaryassessmentofthestateofthefieldshouldbeofinterestandusetoscholarsofAmericanpolitics,wedissecttherecentempir-icalliteratureandoffersuggestionsforfutureresearch.Mostimportantly,weofferaone-stopshopforrecentliteratureforscholarsinterestedinthistopic. M uchhasbeenwrittenbyscholarsofAmericanpoliticsaboutUSSupremeCourtconfirma-tionbattles,buttheliteratureonlowerfed-eral court confirmation fights is relativelylessbountiful.However,duringthepasttwodecades, presidential, legislative, and public law scholars haveincreasinglyfocusedonthelowercourtconfirmationprocess(e.g.,Allison1996;BasingerandMak2010;Goldman1993;HartleyandHolmes1997;HartleyandHolmes2002;Primo,Binder,andMaltz-man2008;Scherer,Bartels,andSteigerwalt2008;Sollenberger2010).Areviewoftherecentliteraturerevealsthattherearemoresurveyreports(e.g.,Goldman,Slotnick,andSchiavoni2011),lawreviewarticles(e.g.,Brand2010;Tobias2010),andopinionpieces(e.g.,Bendery2011)thanmorecomplexquantitativeanalysesoflower-courtconfirmationfights.Moreover,theresearchresultsgeneratedbytheliteraturearewidelydivergent,and,attimes,inconsistent.ResearchonSupremeCourtnominationandconfirmationbat-tleswilllikelykeepitsdominancebothintheacademicliteratureandinthepopularpress.However,inthelasttwodecades,thepolitical salience of lower federal court nominations has alsoincreased.Confirmationbattleshavereceivedwiderpresscover-ageasdemonstratedbytherecentcasesofGoodwinLiuandCai-tlinHalligan.Inaddition,thefailuretofillvacancieshasdrawnattention.Asofspring2013,about10%ofallfederaljudgeshipswerevacant,partlybecausepartisanpoliticsinthenation’scapi-tal(McMillion2013;Seib2013).Theincreasedattentiontolowercourtnomineesovertheyearsandtheincreasedresearchonthetreatmentofthesenominationsrequireacriticalreviewoftheempiricalliteratureandeffortstounderstandthedivergenceorinconsistencysometimesproducedbythisliterature.Buildingonrecentresearchregardingdelayinconfirmationoflowerfederalcourtjudges(e.g.,Holmes,Shomade,andHartley2012;Primo,Binder, and Maltzman 2008; Scherer, Bartels, and Steigerwalt2008),wereviewtherecentempiricalliteratureandoffersugges-tionsforfutureresearch.Mostsignificantly,weofferaone-stopshopofsortsforscholarsofAmericanpoliticstogainacompre-hensiveunderstandingoftherecentliterature.

PurposeIn England in recent years, concerns have been raised about the proportion of time social workers and other frontline children's social care practitioners spend carrying out desk‐based, administrative activities. This article aims to report time use activity data from front line workers on the amount of time spent on different activities to support children in need (as defined by the 1989 Children Act).Design/methodology/approachThe data were collected from a range of sources including focus groups, event records (diaries completed by practitioners) and online surveys.FindingsThe proportion of time spent on direct and indirect activities varies according to the types of process. Those associated with ongoing support have the highest proportion of direct activity, whereas those associated with decision making, especially if a one‐off activity, have the highest proportion of administrative activities. The greater the needs of the child, the more direct and indirect support was given, but there was some variation across social work teams. But the activities of social workers are interconnected, making it difficult to provide conclusive evidence, but the concern about the imbalance between direct work and administrative tasks seems justified.Research implications/limitationsThe findings highlight the complexity of exploring how social workers spend their time and how the proportion of time spent on direct and indirect activities is determined by the needs and circumstances of children and their families.Practical implicationsWider contextual practice issues are also explored including the recent increases in referrals to children's social care and the use of electronic recording systems.Originality/valueThe breakdown of the activities using the approach outlined in the article increases transparency in understanding how social workers spend their time.