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McGovern R, Smart D, Alderson H, Fouweather T, Kaner E. Promoting Alcohol Reduction in Non-Treatment Seeking parents (PAReNTS): a pilot feasibility cluster randomized controlled trial of brief alcohol interventions with parents in contact with child safeguarding services. Alcohol Alcohol 2024; 59:agad076. [PMID: 37950898 PMCID: PMC10783945 DOI: 10.1093/alcalc/agad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023] Open
Abstract
Many parents who come into contact with early help and children's social care services are risky drinkers. This study aimed to investigate the feasibility and acceptability of conducting a trial of brief alcohol interventions within this setting. We conducted a three-arm pilot feasibility cluster randomised controlled trial in the North-East of England. The additive interventions were: i) screening and a healthy lifestyle leaflet (control); ii) brief advice; iii) extended brief intervention. The trial was later reduced to two-arm due to the extended brief intervention being infeasible. Of the 1769 parents that were approached, 429 consented to be screened (24%), the majority were eligible to participate (n = 415; 97%), 147 of which (35%) scored ≥5 on the AUDIT-C screening tool. There were 108 parents (74%) who consented to participate in the trial (n = 50 control; n = 58 brief advice). Follow-up rates at 6 and 12-months were 61% and 43%. The TLFB30 was found to be a suitable tool to measure the primary outcome of heavy episodic drinking. Qualitative data showed that parents and practitioners largely found trial procedures to be acceptable, however, care should be taken when discussing alcohol risk with parents in this setting. Most of the a-priori success criteria were met in this pilot feasibility trial. The findings suggest that it may be feasible to conduct a two-arm randomised controlled trial of brief alcohol interventions to parents in contact with early help and social care. The TLFB30 was found to be a suitable tool to measure the primary outcome of heavy episodic drinking.
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Affiliation(s)
- Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Deborah Smart
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
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2
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Forbes C, Alderson H, Domoney J, Papamichail A, Berry V, McGovern R, Sevdalis N, Rankin J, Newburn M, Healey A, Easter A, Heslin M, Feder G, Hudson K, Wilson CA, Melendez-Torres GJ, Howard LM, Trevillion K. A survey and stakeholder consultation of Independent Domestic Violence Advisor (IDVA) programmes in English maternity services. BMC Pregnancy Childbirth 2023; 23:404. [PMID: 37264300 DOI: 10.1186/s12884-023-05731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Healthcare-based Independent Domestic Violence Advisors (hIDVA) are evidence-based programmes that provide emotional and practical support to service users experiencing domestic abuse. hIDVA programmes are found to improve health outcomes for service users and are increasingly delivered across a range of healthcare settings. However, it is unclear how hIDVA programmes are implemented across maternity services and the key facilitators and barriers to their implementation. The aim of this study was to identify; how many English National Health Service (NHS) Trusts with maternity services have a hIDVA programme; which departments within the Trust they operate in; what format, content, and variation in hIDVA programmes exist; and key facilitators and barriers of implementation in maternity services. METHODS A national survey of safeguarding midwives (Midwives whose role specifically tasks them to protect pregnant women from harm including physical, emotional, sexual and financial harm and neglect) within all maternity services across England; descriptive statistics were used to summarise responses. A World Café event (a participatory method, which aims to create a café atmosphere to facilitate informal conversation) with 38 national key stakeholders to examine barriers and facilitators to hIDVA programme implementation. RESULTS 86/124 Trusts (69%) with a maternity service responded to the survey; 59(69%) of respondents reported that they had a hIDVA programme, and 47(55%) of the hIDVA programmes operated within maternity services. Key facilitators to implementation of hIDVA programmes included training of NHS staff about the hIDVA role and regular communication between Trust staff and hIDVA staff; hIDVA staff working directly from the Trust; co-creation of hIDVA programmes with experts by experience; governance and middle- and senior-management support. Key barriers included hIDVA staff having a lack of access to a private space for their work, insecure funding for hIDVA programmes and issues with recruitment and retention of hIDVA staff. CONCLUSIONS Despite hIDVA programmes role in improving the health outcomes of service users experiencing domestic abuse, increased funding and staff training is needed to successfully implement hIDVA staff in maternity services. Integrated Care Board commissioning of acute and mental health trust services would benefit from ensuring hIDVA programmes and clinician DVA training are prioritised.
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Spencer L, Alderson H, Scott S, Kaner E, Ling J. 'The Addiction Was Making Things Harder for My Mental Health': A Qualitative Exploration of the Views of Adults and Adolescents Accessing a Substance Misuse Treatment Service. Int J Environ Res Public Health 2023; 20:5967. [PMID: 37297571 PMCID: PMC10253073 DOI: 10.3390/ijerph20115967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
The relationship between substance use and mental health is complex, and both constitute a global public health burden. In the UK, the estimated annual financial costs of alcohol-related harm and illicit drug use are GBP 21.5 billion and GBP 10.7 billion, respectively. This issue is magnified in the North East of England, where treatment access is low and a large proportion of individuals experience socioeconomic deprivation. The present study aimed to explore the experiences of adults and adolescents accessing a substance misuse treatment service in the North East, in order to inform policy makers, commissioners, and providers of substance misuse treatment and prevention. Semi-structured qualitative interviews were conducted with an opportunistic sample of n = 15 adult participants (aged 18 years and over) and n = 10 adolescent participants (aged between 13 and 17 years). Interviews were audio-recorded, transcribed, anonymised, and analysed thematically. Five key themes were identified: (1) initiation of substance use, (2) early life experiences, (3) the bi-directional relationship of mental health and substance use, (4) cessation of substance use, and (5) accessing treatment. Future preventative interventions should focus on providing support to individuals who have been exposed to adverse childhood experiences, with treatment provision for individuals experiencing co-occurring mental health and substance use issues taking a more holistic approach.
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Affiliation(s)
- Liam Spencer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (S.S.)
| | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (S.S.)
| | - Steph Scott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (S.S.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (S.S.)
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK
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Fakrogha P, Emem-Chioma P, Lewis D, Erekosima I, Poulikakos D, Alderson H, Ocheli E, Idoma E, Chinda I, Tebu O. WCN23-0658 AWARENESS AND ACCEPTANCE OF PERITONEAL DIALYSIS AMONG PATIENTS AND CARE GIVERS ATTENDING THE RENAL CLINIC OF UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL, NIGERIA. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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5
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McGovern R, Bogowicz P, Meader N, Kaner E, Alderson H, Craig D, Geijer-Simpson E, Jackson K, Muir C, Salonen D, Smart D, Newham JJ. The association between maternal and paternal substance use and child substance use, internalizing and externalizing problems: a systematic review and meta-analysis. Addiction 2023; 118:804-818. [PMID: 36607011 DOI: 10.1111/add.16127] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023]
Abstract
AIMS There is substantial evidence showing an association between parental substance use and child substance use and/or mental health problems. Most research focuses upon maternal substance use, with the influence of paternal substance use often being overlooked. We aimed to investigate the differential effects of maternal and paternal substance use upon children aged 0-18 years. METHODS We used systematic review methods to identify observational studies examining the association between either maternal or paternal substance use and child substance use and/or mental health problems. The odds ratio (OR) effect measure was used, for ease of computation. We used a random-effects model with the inverse variance method to meta-analyse the findings from eligible studies. RESULTS We included 17 unique studies with a total of 47 374 child participants. Maternal and paternal substance use were both associated with increased odds of child any drug use [OR = 2.09; 95% confidence interval (CI) = 1.53, 2.86; n = 12 349 participants; three studies and OR = 2.86; 95% CI = 1.25, 6.54; n = 5692 participants; three studies, respectively], child alcohol problem use (OR = 2.16; 95% CI = 1.73, 2.71; n = 7339 participants; four studies and OR = 1.70; 95% CI = 1.36, 2.12; n = 14 219 participants; six studies), child externalizing problems (OR = 1.81; 95% CI = 1.01, 3.22; n = 1748 participants; three studies and OR = 1.60; 95% CI = 1.18, 2.17; n = 2508 participants; six studies) and child internalizing problems (OR = 1.60; 95% CI = 1.25, 2.06; n = 1748 participants; three studies and OR = 1.42; 95% CI = 1.12, 1.81; n = 2248 participants; five studies). Child any alcohol use was associated with maternal substance use only (OR = 2.26; 95% CI = 1.08, 4.70; n = 28 691 participants; five studies). CONCLUSIONS Both maternal and paternal substance use are associated with child substance use and mental health problems.
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Affiliation(s)
- Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Bogowicz
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Meader
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Geijer-Simpson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Cassey Muir
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Domna Salonen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah Smart
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James J Newham
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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6
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Adams EA, Spencer L, Addison M, McGovern W, Alderson H, Adley M, McGovern R, Gilvarry E, Kaner E, O’Donnell A. Substance Use, Health, and Adverse Life Events amongst Amphetamine-Type Stimulant Users in North East England: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph19126996. [PMID: 35742245 PMCID: PMC9222392 DOI: 10.3390/ijerph19126996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
Amphetamine-type stimulants (ATS) are the second most commonly used class of illicit drugs globally, yet there is limited understanding of which factors contribute to different pathways of ATS use. We sought to compare current, former, and exposed non-ATS users’ substance use, mental/physical health, and adverse life experiences. A cross-sectional survey, using computer-assisted personal interview software, was conducted between June 2018 and March 2019 in North East England. Quota-based sampling was used to recruit 389 individuals (aged 18 to 68; 52.6% male): 137 current ATS users; 174 former users; and 78 exposed non-users. Standardized screening questionnaires captured current/prior substance use. Participants self-reported diagnoses of selected physical and mental health disorders and specific adverse life experiences. Analysis used descriptive statistics and comparative tests (including chi-square, Kruskal–Wallis and Mann–Whitney U). Early exposure to illicit substances, challenging mental health, and certain adverse life experiences (such as growing up in statutory care) were more common in individuals currently using ATS compared to those who had never used or stopped using stimulants. Multi-level interventions are needed that address the mental health, social, and economic needs of people with dependent drug use. These could include targeted efforts to support children growing up under care, integrated mental health and substance use support, and joined-up substance use interventions reflective of wider structural factors.
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Affiliation(s)
- Emma Audrey Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Liam Spencer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | | | - William McGovern
- Department of Social Work, Education and Community Studies, Northumbria University, Newcastle upon Tyne NE7 7XA, UK;
| | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Mark Adley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Eilish Gilvarry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
- Correspondence:
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7
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Alderson H, Kaner E, O’Donnell A, Bate A. A Qualitative Exploration of Stakeholder Involvement in Decision-Making for Alcohol Treatment and Prevention Services. Int J Environ Res Public Health 2022; 19:ijerph19042148. [PMID: 35206344 PMCID: PMC8871873 DOI: 10.3390/ijerph19042148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 01/27/2023]
Abstract
The concept of providing individuals with a ‘voice’ via stakeholder involvement has been advocated within English health care policy for several decades. Stakeholder involvement encourages people affected by an issue to contribute to planning and decision making regarding treatment and care, inclusive of providers and recipients of care. This paper explores stakeholder involvement in the design and delivery of public health alcohol services. A qualitative case study approach was adopted, including in-depth interviews with 11 alcohol commissioners, 10 alcohol service providers and 6 general practitioners plus three facilitated focus groups with 31 alcohol service users. Findings show that most participants were aware of, and could name, various methods of stakeholder involvement that they had engaged with; however, the extent and impact of stakeholder involvement in decision making are not transparent. It is essential that a deeper understanding is generated of the different roles that stakeholders can play within the entire decision-making process to maximise its utility.
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Affiliation(s)
- Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.K.); (A.O.)
- Correspondence:
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.K.); (A.O.)
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (E.K.); (A.O.)
| | - Angela Bate
- Coach Lane Campus West, Northumbria University, Newcastle upon Tyne NE7 7XA, UK;
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8
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Alderson H, Barrett S, Addison M, Burns S, Cooling V, Hackett S, Kaner E, McGovern W, Smart D, McGovern R. Parental intimate partner violence and abuse during the COVID-19 pandemic: Learning from remote and hybrid working to influence future support. Womens Health (Lond) 2022; 18:17455057221129399. [PMID: 36222319 PMCID: PMC9557270 DOI: 10.1177/17455057221129399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has exacerbated intimate partner violence and abuse. Incidents of intimate partner violence and abuse have increased as a result of household tensions due to enforced coexistence (multiple national lockdowns and working from home practices), economic stress related to loss of income, the disruption of social and protective networks and the decreased access to support services. This study aimed to understand how female survivors of parental intimate partner violence and abuse have experienced the adapted multi-agency response to intimate partner violence and abuse during the pandemic and consider learning from remote and hybrid working to influence future support. METHOD This study adopted a qualitative research design, utilizing semi-structured interviews and a focus group. Data collection took place between March and September 2021. In total, 17 female survivors of intimate partner violence and abuse took part in the project; we conducted the semi-structured interviews via telephone (n = 9) and conducted an online focus group (n = 8). RESULTS Findings identified that services for those experiencing intimate partner violence and abuse need to be innovative, flexible and adaptable and 'reach out' to survivors rather than waiting for survivors to 'reach in' and ask for support. Findings show that the digital space highlights 'missed opportunities' for engagement with both professionals and peers and the potential for digital poverty is a key implication, which risks entrenching existing inequalities. CONCLUSION In-depth consideration needs to be given to the design, delivery and evaluation of online interventions and provision of support to improve access and acceptability of services, maximize their effectiveness and to support the safety of survivors.
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Affiliation(s)
- Hayley Alderson
- Population Health Sciences Institute,
Newcastle University, Newcastle upon Tyne, UK
| | - Simon Barrett
- Population Health Sciences Institute,
Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Victoria Cooling
- County Durham and Darlington NHS
Foundation Trust, Darlington, UK
| | - Simon Hackett
- Population Health Sciences Institute,
Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute,
Newcastle University, Newcastle upon Tyne, UK
| | - William McGovern
- Department of Social Work, Education
and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Deborah Smart
- Population Health Sciences Institute,
Newcastle University, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Population Health Sciences Institute,
Newcastle University, Newcastle upon Tyne, UK
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9
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Spencer LP, Addison M, Alderson H, McGovern W, McGovern R, Kaner E, O'Donnell A. 'The Drugs Did For Me What I Couldn't Do For Myself': A Qualitative Exploration of the Relationship Between Mental Health and Amphetamine-Type Stimulant (ATS) Use. Subst Abuse 2021; 15:11782218211060852. [PMID: 34898985 PMCID: PMC8655440 DOI: 10.1177/11782218211060852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
Substance use and mental ill health constitute a major public health burden, and a key global policy priority is to reduce illicit and other harmful substance use. Amphetamine-type stimulants (ATS) are the second most used class of illicit drugs and a range of mental health issues have been documented amongst users. This paper explores the relationship between mental health and ATS use, through a thematic analysis of qualitative interviews with n = 18 current and former ATS users in England. The findings are presented by trajectory point of; (1) Initiation of ATS use; (2) continued and increased ATS use and (3) decreased and remitted ATS use. This work helps to develop understanding around the complex and bi-directional relationship between ATS use and mental health. Many ATS users lead chaotic lives and engage in multiple risk behaviours, however there is a need to better understand and conceptualise the dynamic interaction between different individual, social, environment and cultural factors that determine individuals’ mental health and substance use. There is no ‘one size fits all’ approach to prevention and treatment, and these findings highlight the need for more joined-up, tailored and holistic approaches to intervention development.
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Affiliation(s)
- Liam Patrick Spencer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - William McGovern
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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10
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Alderson H, Spencer L, Scott S, Kaner E, Reeves A, Robson S, Ling J. Using Behavioural Insights to Improve the Uptake of Services for Drug and Alcohol Misuse. Int J Environ Res Public Health 2021; 18:ijerph18136923. [PMID: 34203334 PMCID: PMC8297083 DOI: 10.3390/ijerph18136923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
In the U.K., 270,705 adults were in contact with drug and alcohol treatment services between April 2019 and March 2020. Within the same time period, 118,995 individuals exited the treatment system, and just over a third (36%) left treatment without completing it. The latter includes individuals declining further treatment and unsuccessful transfers between services. The aim of this study was to explore the factors that affect drug and alcohol treatment uptake within a drug and alcohol service in North East England. A mixed-methods approach was adopted. The exploration of factors affecting treatment uptake was captured through a behavioural insights survey and 1:1 in-depth qualitative interviews with service users within one council area within the North East of England. There were 53 survey participants, and a further 15 participants took part in qualitative interviews. We triangulated data sources to report consistencies and discrepancies in the data. Findings show that treatment services aiming to reduce missed appointments and increase retention rates need to implement several strategies. Consistently distributing appointment cards, using text message reminders, displaying a timetable presenting all treatment options, and displaying information in a format to ensure it is accessible to individuals with lower health literacy and reducing wait times for appointments will all improve appointment attendance.
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Affiliation(s)
- Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (H.A.); (S.S.); (E.K.)
| | - Liam Spencer
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (H.A.); (S.S.); (E.K.)
- Correspondence:
| | - Stephanie Scott
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (H.A.); (S.S.); (E.K.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (H.A.); (S.S.); (E.K.)
| | - Alison Reeves
- Hartlepool Borough Council, Civic Centre, Hartlepool TS24 8AY, UK; (A.R.); (S.R.)
| | - Sharon Robson
- Hartlepool Borough Council, Civic Centre, Hartlepool TS24 8AY, UK; (A.R.); (S.R.)
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK;
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11
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Alderson H, McGovern R, Copello A, McColl E, Kaner E, Smart D, McArdle P, Lingam R. Implementation Factors for the Delivery of Alcohol and Drug Interventions to Children in Care: Qualitative Findings from the SOLID Feasibility Trial. Int J Environ Res Public Health 2021; 18:ijerph18073461. [PMID: 33810478 PMCID: PMC8037471 DOI: 10.3390/ijerph18073461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
Young people in care have a four-fold increased risk of drug and alcohol use compared to their peers. The SOLID study aimed to deliver two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol) and improve mental health in young people in care. The study was carried out in 6 local authorities in the North East of England. Young people in care aged 12–20 years, who self-reported substance use within the previous 12 months were randomised to Motivational Enhancement Therapy, Social Behaviour and Network Therapy or control. In-depth 1:1 interviews and focus groups were used with young people in care, foster carers, residential workers, social workers and drug and alcohol practitioners to explore the key lessons from implementing the interventions. The Consolidated Framework of Implementation Research framed the analysis. Findings illustrated that the everyday interaction between individuals, service level dynamics and external policy related factors influenced the implementation of these new interventions at scale. We concluded that unless interventions are delivered in a way that can accommodate the often-complex lives of young people in care and align with the drug and alcohol practitioners’ and social workers priorities, it is unlikely to be successfully implemented and become part of routine practice.
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Affiliation(s)
- Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
- Correspondence:
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
| | - Alex Copello
- School of Psychology, The University of Birmingham, Birmingham B15 2TT, UK;
- Research Birmingham and Solihull Mental Health Foundation Trust, Birmingham B1 3RB, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
| | - Deborah Smart
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
| | - Paul McArdle
- CAMHS, Northgate Hospital, Morpeth, Northumberland NE61 3BP, UK;
| | - Raghu Lingam
- Population Child Health Research Group, School of Women and Children’s Health, Faculty of Medicine, University New South Wales, The Bright Alliance, High St & Avoca Street, Randwick, NSW 2031, Australia;
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McGovern R, Smart D, Alderson H, Araújo-Soares V, Brown J, Buykx P, Evans V, Fleming K, Hickman M, Macleod J, Meier P, Kaner E. Psychosocial Interventions to Improve Psychological, Social and Physical Wellbeing in Family Members Affected by an Adult Relative's Substance Use: A Systematic Search and Review of the Evidence. Int J Environ Res Public Health 2021; 18:1793. [PMID: 33673199 PMCID: PMC7918716 DOI: 10.3390/ijerph18041793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
It is estimated that over 100 million people worldwide are affected by the substance use of a close relative and often experience related adverse health and social outcomes. There is a growing body of literature evaluating psychosocial interventions intended to reduce these adverse outcomes. We searched the international literature, using rigorous systematic methods to search and review the evidence for effective interventions to improve the wellbeing of family members affected by the substance use of an adult relative. We synthesised the evidence narratively by intervention type, in line with the systematic search and review approach. Sixty-five papers (from 58 unique trials) meeting our inclusion criteria were identified. Behavioural interventions delivered conjointly with the substance user and the affected family members were found to be effective in improving the social wellbeing of family members (reducing intimate partner violence, enhancing relationship satisfaction and stability and family functioning). Affected adult family members may derive psychological benefit from an adjacent individually focused therapeutic intervention component. No interventions fully addressed the complex multidimensional adversities experienced by many families affected by substance use. Further research is needed to determine the effect of a multi-component psychosocial intervention, which seeks to support both the substance user and the affected family member.
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Affiliation(s)
- Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (D.S.); (H.A.); (E.K.)
| | - Debbie Smart
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (D.S.); (H.A.); (E.K.)
| | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (D.S.); (H.A.); (E.K.)
| | - Vera Araújo-Soares
- Faculty of Behavioural, Management and Social Science, University of Twente, 7522 Enschede, The Netherlands;
| | - Jamie Brown
- Institute of Epidemiology & Health, University College London, London WC1E 6BT, UK;
| | - Penny Buykx
- School of Humanities and Social Science, University of Newcastle, Callaghan 2308, Australia;
- School of Health and Related Research, The University of Sheffield, Sheffield S10 2TN, UK
| | | | - Kate Fleming
- Public Health Policy and Systems, Liverpool Centre for Addiction Research, University of Liverpool, Liverpool L69 3BX, UK;
| | - Matt Hickman
- Population Health Sciences Institute, University of Bristol, Bristol BS8 1TL, UK; (M.H.); (J.M.)
| | - John Macleod
- Population Health Sciences Institute, University of Bristol, Bristol BS8 1TL, UK; (M.H.); (J.M.)
| | - Petra Meier
- Institute of Health & Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (D.S.); (H.A.); (E.K.)
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13
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Alderson H, Kaner E, McColl E, Howel D, Fouweather T, McGovern R, Copello A, Brown H, McArdle P, Smart D, Brown R, Lingam R. A pilot feasibility randomised controlled trial of two behaviour change interventions compared to usual care to reduce substance misuse in looked after children and care leavers aged 12-20 years: The SOLID study. PLoS One 2020; 15:e0238286. [PMID: 32898141 PMCID: PMC7478815 DOI: 10.1371/journal.pone.0238286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Young people in state care, often due to abuse or neglect, have a four-fold increased risk of drug and alcohol use compared to their peers. AIM The SOLID study aimed to investigate the feasibility of a definitive randomised controlled trial, comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol), and improve mental health, in young people in care. METHODS We recruited young people in care aged 12-20 years, self-reporting substance use within the previous 12 months and residing in 1 of 6 participating local authority sites in the North East of England. Participants were randomised to either i. Motivational Enhancement Therapy (MET), ii. Social Behaviour and Network Therapy (SBNT) or iii. Control (usual care). All interventions were delivered by trained drug and alcohol workers. Follow-up data were collected 12 months post recruitment. Feasibility for trial progression was compared to pre-specified stop: go criteria (recruitment of 60% of eligible participants, 80% of participants attending 60% of offered sessions and retention of 70% of participants at 12 month follow up). RESULTS Of 1450 eligible participants, 860 (59%) were screened for drug and alcohol use by social workers, 211 (24.5%) met inclusion criteria for the trial and 112 young people (7.7%) consented and were randomised. Sixty of these 112 participants (54%) completed 12-month follow-up questionnaires. Only 15 out of the 76 (20%) participants allocated to an intervention arm attended any of the offered MET or SBNT sessions. CONCLUSION By reference to pre-specified stop: go criteria it is not feasible to conduct a definitive trial for SOLID in its current format. Despite co-designing procedures with staff and young people in care, the screening, referral and treatment pathway did not work here. Future work may require dedicated clinically embedded research resource to evaluate effectiveness of new interventions in services.
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Affiliation(s)
- Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- * E-mail:
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Alex Copello
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Paul McArdle
- Child and Adolescent, Mental Health Services, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, United Kingdom
| | - Deborah Smart
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Rebecca Brown
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Raghu Lingam
- Population Child Health Research Group, School of Women and Children’s Health, University New South Wales, Randwick, Australia
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Alderson H, Kaner E, Brown R, Howel D, McColl E, Smart D, Copello A, Fouweather T, McGovern R, Brown H, McArdle P, Lingam R. Behaviour change interventions to reduce risky substance use and improve mental health in children in care: the SOLID three-arm feasibility RCT. Public Health Res 2020. [DOI: 10.3310/phr08130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Looked-after children and care leavers (henceforth children in care) are young people placed under the care of local authorities, often because of a history of family abuse and/or neglect. These young people have significantly increased risk of substance use and mental health problems compared with peers.
Aim
The Supporting Looked After Children and Care Leavers In Decreasing Drugs, and alcohol (SOLID) trial aimed to investigate the feasibility of a definitive randomised controlled trial comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol) in and improve the mental health of children in care aged 12–20 years.
Methods
The study consisted of two phases: (1) a formative phase that adapted the motivational enhancement therapy and social behaviour and network therapy interventions for use with children in care and (2) a three-arm pilot randomised controlled trial (comparing motivational enhancement therapy, social behaviour and network therapy and usual care), and a linked process and economic (return on investment) evaluation. Trial feasibility was compared with prespecified STOP/GO criteria.
Setting
Six local authority areas in the north-east of England.
Participants
Children in care (aged 12–20 years) who screened positive for drug and/or alcohol use within the last 12 months were eligible for the trial. The formative and process evaluations included children in care, carers, social workers, and drug and alcohol workers.
Outcome measures
The primary outcomes were recruitment and retention rates at 12 months’ follow-up. Baseline and 12-month follow-up questionnaires measured self-reported drug and alcohol use, mental health and health-related quality of life. The process evaluation considered acceptability and engagement with the interventions and trial procedures.
Results
Formative findings (n = 65) highlighted the need for interventions to increase the emphasis on therapeutic relationships, use creative methods of engagement and support the identification of treatment goals wider than substance misuse. Within the randomised controlled trial, of 860 participants screened, 211 (24.5%) met the inclusion criteria. One hundred and twelve (53%) of the 211 eligible children were recruited and randomised. Just 15 of the 76 (20%) participants allocated to intervention attended any of the motivational enhancement therapy of social behaviour and network therapy sessions, and 60 (54%) participants completed the 12-month follow-up. The screening and recruitment of children in care required significantly more time and resource investment by researchers and children’s services than planned. The process evaluation (n = 116) demonstrated that, despite participants engaging in risky substance use, they did not often acknowledge this nor felt that they needed help. Children in care had complex, chaotic lives and children’s services departments were less research mature and extremely stretched; this, coupled with the multiple steps in the intervention pathway and study protocol, resulted in low adherence to the intervention and the trial.
Conclusions
The SOLID trial demonstrated successful engagement with children in care to adapt the motivational enhancement therapy and social behaviour and network therapy interventions. However, the pilot randomised controlled trial found that a definitive trial is not feasible. The current screen, refer and treat pathway for children in care did not work. There is an urgent need to radically rethink how we deliver therapeutic services for children in care. A pragmatic evaluation design, coupled with additional research resource for children’s services, is needed to evaluate these novel models of care at scale.
Trial registration
This study is registered as PROSPERO CRD42018098974 and Current Controlled Trials ISRCTN80786829.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hayley Alderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Brown
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah Smart
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Copello
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Tony Fouweather
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Heather Brown
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Paul McArdle
- Child and Adolescent Mental Health Services, Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Raghu Lingam
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
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McGovern R, Gilvarry E, Addison M, Alderson H, Geijer-Simpson E, Lingam R, Smart D, Kaner E. The Association Between Adverse Child Health, Psychological, Educational and Social Outcomes, and Nondependent Parental Substance: A Rapid Evidence Assessment. Trauma Violence Abuse 2020; 21:470-483. [PMID: 29739281 PMCID: PMC7243080 DOI: 10.1177/1524838018772850] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Between 5% and 30% of children in high-income countries live with a substance misusing parent, the majority of which is below dependent levels. However, little is understood about the impact of nondependent parental substance misuse upon children. METHODS We searched the international literature using rigorous systematic methods to identify studies examining parental substance misuse and adverse outcomes in children. The inclusion criteria were cross-sectional, longitudinal, case-control, and cohort studies; of children aged 0-18 years whose parents are high-risk substance misusers; reporting on their health, psychological, substance use, educational, and social outcomes. RESULTS We identified 36 papers (from 33 unique studies), most of which were assessed as being of medium to high methodological quality (N= 28). Parental nondependent substance misuse was found to be associated with adversity in children, with strong evidence of an association with externalizing difficulties (N = 7 papers, all finding an association) and substance use (N = 23 papers, all finding an association) in adolescents and some evidence of adverse health outcomes in early childhood (N = 6/8 papers finding an association). There is less evidence of an association between parental substance misuse and adverse educational and social outcomes. The body of evidence was largest for parental alcohol misuse, with research examining the impact of parental illicit drug use being limited. CONCLUSION Methodological limitations restrict our ability to make causal inference. Nonetheless, the prevalence of adverse outcomes in children whose parents are nondependent substance misusers highlights the need for practitioners to intervene with this population before a parent has developed substance dependency.
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Affiliation(s)
- Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Eilish Gilvarry
- Northumberland, Tyne and Wear Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michelle Addison
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hayley Alderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma Geijer-Simpson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Raghu Lingam
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Debbie Smart
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Brown R, Alderson H, Kaner E, McGovern R, Lingam R. "There are carers, and then there are carers who actually care"; Conceptualizations of care among looked after children and care leavers, social workers and carers. Child Abuse Negl 2019; 92:219-229. [PMID: 31005828 DOI: 10.1016/j.chiabu.2019.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Looked after children and care leavers (LACCL) are some of the most vulnerable and marginalized young people in our communities. Existing research demonstrates that this group often interprets care in terms of genuineness and tends to feel uncared for. Less work exists from the perspective of social workers and formal carers. OBJECTIVE This study aims to explore how care is perceived and practiced among LACCL and those with a duty of care for them. We use a theoretical lens of care ethics to compare and contrast understandings in order to explore how they affect the delivery and receipt of care. PARTICIPANTS & SETTING There were 44 participants from four local authorities in north-east England including nineteen LACCL aged 12-20, eight social workers, and nineteen formal carers. METHOD Twenty-eight semi-structured 1:1 interviews, four dyad interviews and three focus group interviews. RESULTS LACCL desired care that felt familial, went beyond minimum standards and involved understanding. Social workers had to manage LACCL expectations and build relationships by both rationing care according to role constraints whilst sometimes going 'above and beyond' statutory care. Carers conceptualized care in terms of dedication and discipline but felt limited in their ability to achieve care in this way. CONCLUSION Bridging different conceptualizations of care is necessary to achieve integrated support for these vulnerable young people whilst also helping them to develop key skills for later adult life. A deeper understanding of frameworks of care has implications for social worker and formal carer training and practice.
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Affiliation(s)
- Rebecca Brown
- Institute of Health and Society, Newcastle University, Medical Faculty, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Hayley Alderson
- Faculty of Medicine, University of New South Wales, Level 8, The Bright Alliance, High St & Avoca Street, Randwick, NSW 2031, Australia.
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Medical Faculty, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Medical Faculty, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Raghu Lingam
- Faculty of Medicine, University of New South Wales, Level 8, The Bright Alliance, High St & Avoca Street, Randwick, NSW 2031, Australia
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Alderson H, Brown R, Smart D, Lingam R, Dovey‐Pearce G. 'You've come to children that are in care and given us the opportunity to get our voices heard': The journey of looked after children and researchers in developing a Patient and Public Involvement group. Health Expect 2019; 22:657-665. [PMID: 31115138 PMCID: PMC6737768 DOI: 10.1111/hex.12904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/01/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022] Open
Abstract
Background Looked after children and care leavers (denoted as LAC) are often described as a ‘hard to reach' group of young people, and their voices are rarely sought to inform academic research. Methods This paper reports on experiences and reflections of a group of children and young people and academic researchers who developed a Patient and Public Involvement (PPI) group that was set up in the context of an ongoing health service intervention trial with LAC. Setting and participants Eighteen qualitative semi‐structured interviews were conducted with seven LAC, the participation officer within a North East Children in Care Council and the four researchers involved in developing and facilitating the PPI group. PPI sessions (n = 9) each approximately 1 hour in length were conducted over an 18‐month period. Analysis The qualitative interviews were transcribed verbatim. Thematic analysis was used to analyse the data, and direct quotes are used within the paper. Main outcomes The LAC used the PPI group to produce a 5‐minute video to highlight why they think young people should be involved in research. Overall findings suggested that it was feasible to develop a research‐related PPI group with LAC. Findings from the research were used to co‐develop ‘top tips' of working with vulnerable young people such as looked after children. Conclusion This paper has shown that PPI with LAC can be done if a co‐production approach to research is taken. It also suggests that assumptions regarding the capabilities of young people as researchers need to be re‐evaluated.
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Affiliation(s)
- Hayley Alderson
- Institute of Health and SocietyNewcastle UniversityNewcastle Upton TyneUK
| | - Rebecca Brown
- Institute of Health and SocietyNewcastle UniversityNewcastle Upton TyneUK
| | - Debbie Smart
- Institute of Health and SocietyNewcastle UniversityNewcastle Upton TyneUK
| | - Raghu Lingam
- Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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Alderson H, Brown R, Copello A, Kaner E, Tober G, Lingam R, McGovern R. The key therapeutic factors needed to deliver behavioural change interventions to decrease risky substance use (drug and alcohol) for looked after children and care leavers: a qualitative exploration with young people, carers and front line workers. BMC Med Res Methodol 2019; 19:38. [PMID: 30791874 PMCID: PMC6385417 DOI: 10.1186/s12874-019-0674-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Looked after children and care leavers have an increased risk of drug and alcohol use compared to their non-LAC peers. Despite high prevalence rates within this population, looked after children are reported to show low levels of engagement in services resulting in unmet needs emerging from substance use. This paper reports on the initial formative phase of a pilot feasibility randomised controlled trial; SOLID (Supporting Looked After Children and Care Leavers In Decreasing Drugs, and Alcohol) that aimed to adapt two evidence-based psychosocial interventions, Motivational Enhancement Therapy and Social Behaviour and Network Therapy, which will aim to reduce substance misuse by looked after children. Methods We conducted qualitative semi-structured interviews and focus groups with 19 looked after children aged 12 to 20 years old, 16 carers and 14 professionals across four local authorities in the North East of England. The data gathered were analysed and then presented within co-production workshops inclusive of 13 young people and 14 professionals (drug and alcohol practitioners and social workers). Findings were used to adapt and refine the interventions prior to the trial. Results Overall findings suggested that whilst original components of both interventions were feasible to deliver and acceptable, specific process areas were highlighted including: increased emphasis upon therapeutic relationships, the benefits of using creative non-traditional methods of engagement and identification of treatment goals wider than those narrowly focused on substance misuse. Conclusion This paper provides an example of methods used to collect multiple perspectives to refine and co-develop interventions to reduce drug and alcohol use in the specific population of looked after children. Trial registration ISRCTN80786829 (first registered 06.06.2016- prospectively registered).
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Affiliation(s)
- Hayley Alderson
- Institute of Health and Society, Newcastle University, Newcastle Upton Tyne, UK.
| | - Rebecca Brown
- Institute of Health and Society, Newcastle University, Newcastle Upton Tyne, UK
| | - Alex Copello
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle Upton Tyne, UK
| | - Gillian Tober
- Leeds Addiction Unit, 19 Springfield Mount, Leeds, UK
| | - Raghu Lingam
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle Upton Tyne, UK
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Alderson H, McGovern R, Brown R, Howel D, Becker F, Carr L, Copello A, Fouweather T, Kaner E, McArdle P, McColl E, Shucksmith J, Steele A, Vale L, Lingam R. Supporting Looked After Children and Care Leavers In Decreasing Drugs, and alcohol (SOLID): protocol for a pilot feasibility randomised controlled trial of interventions to decrease risky substance use (drugs and alcohol) and improve mental health of looked after children and care leavers aged 12-20 years. Pilot Feasibility Stud 2017; 3:25. [PMID: 28536655 PMCID: PMC5439153 DOI: 10.1186/s40814-017-0138-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Looked after children (LAC) and care leavers are young people who have been placed under the legal care of local authorities, in many instances due to a history of abuse and/or neglect. These young people have a significantly increased risk of substance use and mental disorder compared to their peers. The aim of the SOLID study is to assess the feasibility and acceptability of a definitive three-arm multi-centre randomised controlled trial (RCT) that compares the effectiveness of two interventions that aim to reduce risky drug and alcohol use and improve mental health among LAC aged 12 to 20 years with usual care. METHODS All LAC aged 12 to 20 years residing in four local authorities in North East England will be screened by their social worker for risky drug and alcohol use using the CRAFFT (Car, Relax, Alone, Forget, Friends and Trouble) screening tool. Those who score ≥2 will be invited to take part in the trial after further eligibility checks. Informed consent will be taken and baseline data collected. Participants will then be randomised into either (i) Motivational Enhancement Therapy, (ii) Social Behaviour and Network Therapy, or (iii) control-usual care. Follow-up data will be collected 12 months post-baseline. The baseline and follow-up questionnaires will measure self-reported drug and alcohol use, mental health and well-being and health-related quality of life. The follow-up will also collect data on placement stability and self-reported sexual, antisocial and criminal behaviour. Participants will also be asked about the use of health and social services. A detailed process evaluation, using both qualitative and quantitative methods, will be conducted and involve LAC, their carers, social workers and drug and alcohol practitioners. DISCUSSION Despite having an increased likelihood of risky substance misuse, there is a lack of evidence outlining specific interventions to decrease drug and alcohol use targeting LAC. This feasibility study will provide the information needed to develop a definitive trial. LAC will benefit from the results of this study and the further development of the interventions. TRIAL REGISTRATION ISRCTN80786829.
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Affiliation(s)
- Hayley Alderson
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Rebecca Brown
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Frauke Becker
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Louise Carr
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Alex Copello
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Tony Fouweather
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Paul McArdle
- Child and Adolescent Mental Health Services, Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Jubilee Road, Gosforth, Newcastle, NE3 3XT UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Janet Shucksmith
- Health and Social Care Institute, School of Health & Social Care, Teesside University, Middlesbrough, TS1 3BA UK
| | - Alison Steele
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Raghu Lingam
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
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Saunders MP, Alderson H, Chittalia A, Hughes S, James RD, Armstrong G, Swindell R, Scott NA. Preoperative radiotherapy for operable rectal cancer--is a lower dose to a reduced volume acceptable? Clin Oncol (R Coll Radiol) 2007; 18:594-9. [PMID: 17051949 DOI: 10.1016/j.clon.2006.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS A retrospective audit was carried out to determine the rate of local recurrence (recurrent tumour within the lesser pelvis or the perineal wound) in 88 rectal cancer patients treated with 20 Gy/four fractions of adjuvant preoperative radiotherapy and curative surgery. MATERIALS AND METHODS All patients were followed-up by clinical examination with rigid sigmoidoscopy at 6 monthly intervals if the rectum was intact, and computed tomography of the pelvis at 1, 2 and 5 years after surgery. In total, 171 patients with rectal cancer were identified under the care of one surgeon over a period of 11 years from May 1992 to April 2003. We excluded patients with rectal cancer from preoperative adjuvant radiotherapy if they had evidence at presentation of distant metastases, if they had fixed rectal tumours, were treated by local excision and had previous radiotherapy to the pelvis. On this basis, only 88 were considered for preoperative radiotherapy and curative resection with a median follow-up of 5.16 years. RESULTS The 5-year survival by stage was Dukes A 96%, Dukes B 65% and Dukes C 36%. Overall, four patients (of 88) developed a recurrence within the lesser pelvis or the perineal wound, giving a local recurrence of 4.2% at 3 years (from a Kaplan-Meier graph). CONCLUSIONS This single-centre audit suggests that a lower dose of radiotherapy to a smaller volume provides an acceptable local recurrence rate that compares very favourably with the well-publicised Swedish and Dutch trials of 25 Gy/five fractions. It was not the intention of this audit to suggest that this dose should be widely adopted. However, given the long-term gastrointestinal morbidity and risk of second malignancies, we advise caution when formulating even more intensive radiotherapy and chemoradiotherapy regimens for rectal cancer.
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Affiliation(s)
- M P Saunders
- Department of Clinical Oncology, Christie Hospital, Manchester, UK.
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Abstract
The placement of a rigid stent within an elastic vessel produces wave reflection sites at the entrance to and exit from the stent. The net haemodynamic effects of these reflections depend critically on the degree of stiffness of the stent and on its length and position within the diseased vessel, variables that have been found to affect the clinical performance of a stent. Here these effects are examined analytically, using a segmented tube model. The results indicate that the presence of the stent within the larger diseased vessel has the effect of producing higher pressure at the vessel entrance than that at exit. This pressure difference, when superimposed on the underlying pressure distribution within the vessel, has the net effect of actually aiding rather than impeding the flow, but the extent of this depends on the length and position of the stent. A short stent placed near the entrance of the diseased vessel may be favoured clinically for producing the least perturbation in the underlying haemodynamics and thus reducing the chance of restenosis, while a long stent placed near the exit may be favoured for producing a positive pressure difference and thus aiding the flow.
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Affiliation(s)
- H Alderson
- Department of Mathematical Sciences, University of New Brunswick, Saint John, Canada E2L 4L5
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Abstract
The question of whether the mechanical stiffness of a coronary bypass or that of a diseased coronary artery can have a significant effect on the hemodynamics in these vessels is addressed analytically, with emphasis on the effects of wave reflections. The analysis is based on a model of the vessels involved, and the results show the essential hemodynamic effects in each vessel. It is found that in the absence of a bypass graft, wave reflections resulting from a narrowing and stiffening of a diseased coronary artery have the effect of actually aiding the flow in the diseased vessel. In the presence of a bypass graft, however, the effects of wave reflections are reversed and become adverse to flow in both the bypass graft and the diseased coronary artery. A stiffer bypass moderates these effects and is therefore preferable to a more elastic bypass. The adverse effects also depend critically on the relative diameter of the bypass. Here the results indicate that a bypass of smaller diameter than that of the native coronary artery can moderate and even reverse the adverse effects of wave reflections resulting from the presence of the bypass.
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Affiliation(s)
- H Alderson
- Department of Applied Mathematics, University of Western Ontario, London, Ont., Canada N6A 5B7
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Alderson H. The Notification of Tuberculosis. West J Med 1901. [DOI: 10.1136/bmj.2.2118.283-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Alderson H. A Case of Cervical Ribs. West J Med 1897; 2:1638-1638.1. [DOI: 10.1136/bmj.2.1927.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alderson H. Small Pelves, their Consideration and Treatment. West J Med 1897. [DOI: 10.1136/bmj.1.1900.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Alderson H. Small Pelves: Their Consideration and Treatment. West J Med 1897. [DOI: 10.1136/bmj.1.1897.1195-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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