As finances become more restricted in these countries, there is a debate about whether resources should be targeted more clearly on children – for example towards low income families, to special needs and disability, to those displaying developmental delay, to those with a different home language to the local one, and/or to those in need of child protection. All the case study countries were implementing some form of targeted services alongside their universal offer. This is a significant shift in policy, as countries like Denmark and Estonia have traditionally seen their universal offer as able to meet all needs. These targeted services were offered on top of the existing universal offer to increase access for these low participation groups: a policy of progressive universalism, except in the Netherlands which appears to be shifting to a more wholesale focus on targeted groups of children. Some countries target geographically, and others target children and families with particular characteristics. For example, in Belgium, there are incentives for increasing services in regions where there is an imbalance in service availability as well as targeted interventions to support newly arrived families, low income families, and children with special educational needs or disabilities. Belgium is also working to improve its data information systems in the earlyyears and health sector, using individualised data to better track system imbalances and inequalities in access and availability.
Families also receive a home visit from a midwife or nurse shortly after the birth, following which they attend a child health clinic at least nine times in the first year. After a year, visits are reduced to every 6/12 months until school age, when the school healthcare system then takes over. School healthcare system: All children are seen annually by a school nurse, with more intensive medical check-ups b being provided in years one, five and eight. The system takes a whole-child approach, and considers both physical and mental health. The latter is aimed at identifying at the earliest opportunity any emerging child mental health issues, and refer them if needed to other services such child guidance or family counselling centres or more specialist mental health services if appropriate. There has also been significant coverage of the Finnish baby box scheme, which helps to promote both support for children and equality. All first time
The investment banking industry seems more oriented towards medium-sized and larger firms (more than 100 employees) in North America, while in Europe small and medium-sized firms (fewer than 1.000 employees) dominate; this is partly due to the inclusion in the sample of organizations created mainly for tax optimization purposes. In particular, many institutions incorporate a subsidiary (with very little staff compared to headquarters) in countries with a favorable tax treatment of their typical sources of income. While comparing costs and revenues across size classes makes little sense, given the vastly different horizons of firms belonging to different size brackets, for this globalized sector interesting evidence can be drawn from cross-country comparisons. North American medium-sized investment banks seem to have higher costs per employee than their European counterparts (respectively $314,000 and $210,000), but their employees seem more productive ($171,000 of net income per worker versus $91,000 in Europe). In terms of return on equity, European banks are ahead once again (16.2 percent versus 10.8 percent for their North American competitors) (see Table 6).
undoubtedly spot gaps. Though we have tried to capture as much as possible of what is currently known about the outcome areas we were asked to address, we do not claim to have conducted an exhaustive survey of each outcome area. Time did not permit this. This is why we do not follow the convention of systematic reviews of providing detailed commentaries about the precise numbers of studies found, the number excluded, and those included. Rather, we were asked to apply rigorous research skills to the task of taking an overview, and then to apply our professional judgement to answer the question: what is effective? Wherever possible we have avoided equivocation. Where it seemed to us that on balance there is a consensus in the literature, we have allowed ourselves to tend towards the definitive rather than the cautious in our conclusions. This is not to say we have intentionally stretched the evidence further than it can go, but where we feel there is reasonable clarity, we have said so. The bullet-pointed summary boxes at the end of each commentary exemplify this approach. However, we remind readers that our judgements are offered in the context of, and as a contribution to, an ongoing professional debate about what works: we do not claim to deliver up the gospel in this field. This is a fast developing area of practice, and in common with others researching in this field, we recognise that all our conclusions may need to be revisited in the fullness of time. Lastly, it was apparent throughout the process of sorting the evidence on outcomes that behind any discussion of impact lurks the issue of how interventions are implemented. Implementation (or ‘process’) issues are of paramount importance in the field, and many a well-designed service has fallen at the first hurdle of getting parents through the doors in the first place. There is much practice wisdom now (and a considerable body of literature) about ‘how to’ deliver services to families, yet relatively little hard evidence that would pass muster, scientifically speaking, to back up the assertions made by the many writers in this field. We have thus gathered together a summary of process factors about which there appears to be the greatest degree of consensus, backed up wherever possible with robust research evidence, and this can be found after the outcome commentaries, in Section Four.
There is evidence that flexible work conditions enable better reconciliation of work and care and lead to a lower chance of not being in employment. For example, EU experts conclude that the work-life balance of working carers is better in countries with various part-time work arrangements and flexible working time (Bouget et al., 2016). Flexible working helps accommodate caring responsibilities and limits the consequences of providing care on employment (Da Roit & Naldini, 2010; Colombo et al., 2011). Arksey and Glendinning (2008) found that flexible working hours were critical to the successful combination of work and caregiving. Similar findings were reported in a small-scale study by Arksey and colleagues (2005), a report by the Social Protection Committee on long-term care (Social Protection Committee, 2015) and recent evidence reviews for Foresight (Hoff, 2015; Nazroo, 2015). Flexible working increases the chances of remaining in employment or extends the employ- ment trajectory (e.g. Pavalko & Henderson, 2006; Arskey & Moree, 2008; HSISC, 2010; Mooney & Statham, 2002; Age UK, 2012; Ikeda, 2017). Flexible working hours lower the chances of reduced hours of work for carers in Australia and the UK (Bouget et al., 2016). There is also some evidence that flexible working mitigates the mental and physical effects on the health of carers, with the effect larger for women (Earle & Heymann, 2011).
One particular limitation relates to the lack of statis- tical summary of effectiveness (meta-analysis) although we would argue that not only did the heterogeneity of interventions and outcomes preclude this type of ana- lysis, but also, in exploring the complexity of the area a strength of evidence approach was beneficial. Included studies highlighted the challenges in identifying causal relationships between models of integrated care, and ser- vice delivery impacts [76, 87, 120 – 122]. In view of this challenge, we used strength of evidence ratings to sum- marise where greater or lesser certainty existed in the lit- erature, considering quality, volume and consistency of the evidence identified. Reporting strength by volume of studies ( “ vote counting ” ) may be imperfect, primarily in- dicating where there has been research activity. In ex- ploring consistency as well as volume when assessing strength of evidence, we have sought to some extent to mitigate this limitation.
37 Scully-Russ, 2013; 263). This difficulty in codification makes it difficult to design appropriate training packages. Challenges identified at both sites included difficulties with finding expertise to deliver training; the issues of synchronising training with demand growth (often in relatively specialised positions); the technical level of the training being unsuitable for low-skilled workers who might need additional basic skills support as a pre-requirement; and, in one site there was also a difficulty in finding jobs in which to place those who had been trained. The research suggests that green jobs often do not tend to have particularly low barriers to entry and therefore can be difficult for those in poverty to access. The author also cites the seasonal nature of some green jobs (in particular those which do have lower barriers to entry) as calling into question the extent to which all green jobs are good jobs. A second example, also from the US, is the Emerald Cities Collaborative (ECC) a workforce intermediary designed to support linking disadvantaged groups to careers in the green building sector (Fairchild, 2014). The programme engages employers in the green construction, infrastructure and energy sectors which are targeted areas of growth. There is a diversity of jobs in the sector including energy auditors, solar panel installers, weatherisation technicians, plumbers, insulators, glazers, electricians, and labourers. The ECC is a partnership structure which includes the employers working in green industries, unions, community organisations, and research and technical assistance providers. The programme created apprenticeship routes through building and construction trade unions which were designed to connect participants to high quality training opportunities and to support entrance into long-term career opportunities. The ECC provides a range of programme support including funding, project management, training and certification, infrastructure development assistance and a local hire planning service. However there is little evidence as to what the impact of these activities has been.
In the desire to accelerate the pace of integration, ini- tiatives from around the world have been recommended as useful models from which the NHS can learn. However, some authors have emphasised that it is impera- tive to consider contextual differences before implement- ing the same models in different services and location . While it is important to learn from the international lit- erature, positive outcomes reported in these international models may not be assumed in a UK setting, requiring careful scrutiny of potentially differing effects. There have been calls for greater clarity regarding precisely how inte- gration may impact on outcomes . Doubts regarding the ability of new models to deliver expected benefits have also recently been voiced, with a report from the National Audit Office concluding that progress towards integration has been slower and less successful than envisaged . A systematic review published in 2017 examined initiatives to move care from hospitals to the community, and simi- larly concluded that anticipated cost savings could not be assumed .
The aim of this supplementary outline study was to survey the youth homelessness interventions in place in Wales, and to locate these in the context of the internationalevidencereview. The mapping exercise did not review whether the individual interventions used by local authorities had been evaluated, by the local authorities themselves or independently. The mapping considers interventions specifically for young people from the age of 16 up to 25 (although a minority of interventions include young people from the age of 14). Services/interventions provided for all people facing homelessness which can be accessed by young people were not included unless there is a specific element targeted to young people.
Countries that have the lowest rates of homelessness in the world, such as Finland and Denmark, have invested heavily in affordable housing (O'Sullivan, 2017). Internationalevidence demonstrates that lower rates of homelessness are correlated with increased investments in affordable housing (e.g., Fitzpatrick and Stephens, 2007; Pleace, Teller, and Quilgars, 2011), suggesting that this should be a key priority for any government seeking to reduce homelessness. Studies also indicate that homelessness can be dramatically reduced through targeted housing subsidies (Culhane et al, 2011; Quigley and Raphael, 2002). Such findings suggest that multiple strategies are needed to increase the availability of affordable housing for young people experiencing housing precarity. Finland has adopted a unique approach to this challenge, developing a youth-specific housing system (operated by the Finnish Youth Housing Association) that provides housing and counseling to young people transitioning to independence (age 18-29 years) (Pleace et al, 2015).
In this section, we study the effects of the introduction of a mandatory identification system on financial access and intermediation relying on a difference-in-difference analysis (DID). The evaluation of the effect of a binary treatment (or program) is an intensively studied problem (see for a review, Imbens and Wooldridge (2009)). To check the robustness of our results, we account for three main problems associated with applying a standard DID analysis to a data set like ours: positive serial correlation in error terms; asymmetric sizes of control and treatment group (with the latter being small); and selection of appropriate control groups. In all these cases, standard DID estimates and associated standard errors may lead to wrong conclusions about the significance levels of the treatment effects. Specifically, in the following, we first apply the methodology suggested by Bertrand et al. (2004), henceforth abbreviated with BDM, we then back up our results using a method developed by Conley and Taber (2009) and by Abadie et al. (2009), henceforth ADH, for different country cases. Unfortunately, in a number of countries, a mandatory identification system was either introduced at the beginning of our period of investigation (2000-2001) or at the
Most of the internationalevidence we found focussed on class size for children in their first few years of primary school. For example, Finn (2002) investigated the impact of class-size reduction in grades K-3 (the equivalent of Y1-Y4 in England), drawing similar conclusions. This and other studies we reviewed make extensive reference to the STAR project, one of the most famous studies on the subject and one that, similarly, looks at the transition between earlyyears and primary school. One particularly significant conclusion reached by STAR is that the timing and continuation of class-size reduction matter. In fact, Finn (2002) stated that ‘The most recent analyses of STAR data show that the greatest initial impact on student achievement is obtained when students enter reduced-size classes in kindergarten or Grade 1. Pupils who attended small classes for at least three years had significant sustained benefits through Grade 8; the carry-over effects of fewer than three years were mixed. [In addition,] The STAR results do tell us about one alternative reduced-ratio arrangement: a full-size class with a full-time teacher aide does not work. Alternative class configurations, such as team-taught classes or classes with support teachers for reading and math instruction, need their own research to evaluate whether or not they offer viable options to increase student achievement’ (p. 51). These conclusions make up a strong evidence base in favour of small classroom sizes, being a controlled scientific experiment.
Our first review on integratedearly care and education found that the ‘integration’ was far too loosely described – even in recent UK studies such as that of Sammons et al. (2003) – to be able to draw very firm conclusions. For example, the Sammons study argued that hours of care were a marginal issue in relation to educational outcomes and chose not to investigate it as a variable. Using evidence drawn mainly from USA and Scandinavian studies, it was clear that full-time education and care provision for children before preschool age produced good outcomes for the children; but that the policy situation in the UK was too complex for this information to be of any direct use in current debates. The second review, young children and armed conflict, noted the extreme logistic and ethical difficulties in carrying out research in this area, but concluded that precisely because of the vulnerability of the children, it was important to have good evidence. The evidence available tended to support the view that what was most likely to support such vulnerable children was ‘normalization’, being able to get on with their lives, rather than specific psycho-social programmes. The third review, as we have stated, only found three longitudinal studies, all from the USA. On close scrutiny, the evidence was variable and open to a variety of interpretations. The main cost–benefit analysis in two of the three studies were based on estimates of savings arising from the reduced likelihood of crime in the intervention group; but the third study found no differences in crimes committed between the intervention and control groups. In addition the studies were highly context specific, that is, African American children in ghettoized neighbourhoods.
In order to match intervention to need while optimizing development, various public health models have been pro- posed, such as the universal/selective/indicated preventive approach . Preventive universal interventions are intended to support healthy development for all chil- dren, whereas selective approaches target children with high lifetime or imminent risk (e.g., Head Start pro- grams for poor families, home visitation). Indicated in- terventions target children already displaying minimal but detectable symptoms which may become major identifiable disorders. A fourth emerging level of inter- vention is for treating specific identifiable disorders in preschoolers and their families. Many new treatments are emerging and undergoing a first wave of evidential scrutiny at all levels of intervention. Some of these ther- apies are established treatments in older age groups that have been modified to account for developmental differ- ences (e.g., cognitive behavior therapy for younger chil- dren) whereas other interventions have been specifically designed to address risk factors specific to the earlyyears (attachment-based therapies to target changing parent-infant interactions or parental sensitivity). While this schema has some intuitive appeal, the field in gen- eral is still struggling to match what interventions will mitigate which risk factors in order to produce the best developmental outcomes.
» PRCI is seeing an increasing interest and expansion of its research programs that address Subsea Pipeline Integrity Management and assessment. In 2012, PRCI completed several projects and other activities related to subsea pipelines, including sponsoring workshops and becoming a member of Deepstar to promote coordination with other stakeholders with subsea interests. A cornerstone of PRCI’s 2012 subsea program was the completion of Industry Guidelines for Subsea Pipeline Integrity Management (SPIM). The guidelines provide operators with a comprehensive, systematic, and integrated management approach for subsea pipeline systems for any stage of field life, and the tools and information needed to support effective allocation of resources and improve the integrity and safety of subsea pipeline systems. Subsea pipeline operators now have a consistent, structured approach and one complete guidance document that addresses integrity and considers risk across an entire subsea field system. The final report includes graphics that diagram the components that are included in the program and those that are outside the limits of the study.
EBM does have limitations for successful implementation in preclinical years. This can be broadly divided into institutional limitations and student factor. It has always been a challenge to introduce EBM in the basic science program. Basic science is a foundation of clinical medicine and integrates comprehensive study of different systems and processes necessary for normal health as well as deviation, potentially resulting in disease. Basic science has limited exposure to clinical setting and real time simulations experience. Basic science is limited within the boundary of acquiring concepts and knowledge to step up in clinical rotations. As such practical approach, patient interaction and clinical decision within standard quality of care are traditionally part of the clinical medicine, clinically oriented curriculum should be the main focus in basic science. Therefore, curriculum should incorporate comprehensive integrated teaching methods in accordance with best evidence. Staff shortage and lack of confidence in tutors is another limitation to successful implementation of EBM in medical schools. Capable and trained faculty members with conceived knowledge of basic science medicine and clinical experience are necessary to establish a casual interaction and generate motivation in the classroom.
In relation to earlyyears services, the Early Support Pathfinders, which were established to provide support to families with younger disabled children, emerged as a very successful initiative. A national evaluation identified substantial improvements in multi-agency planning and delivery, better co-ordination of on-going support for families, and making straightforward and smooth the processes of referral and initial assessment (Young et al, 2006). The evaluation found that where there were more agencies and cross-agency services involved, then more families tended to become involved in Early Support-related activity. The evaluation concluded that the Early Support philosophy was as much a key driver for change as specific working practices. In some cases, the Early Support philosophy enabled Pathfinders to leave behind previous structures of ineffective joint working. In other sites, shared understanding allowed effective structures of joint working to be enhanced. Co-location of services did not emerge as a significant driver for improved inter-agency working from the perspective of professionals, but parents identified benefits in terms of ease of access, practicality, speed and flexibility of
Service specifications set out the commissioner’s requirements of services in terms of outcomes to be achieved, performance measures and service models and other details of delivery. Despite a growing focus on shared outcomes, specifications for services in the earlyyears such as children’s centres or health visiting tend to be individual for that service being commissioned rather than integrated with wider provision. In time, greater consideration may need to be given to development of integrated service specifications, which reflect integrated processes and systems. Health visitors are currently commissioned by NHS England using a national service specification, although local variation is encouraged to reflect local additions and differences. Plymouth and Greater Manchester are already working closely with their NHS England Area Teams to explore more sophisticated integration models that will be possible when responsibilities for children’s public health commissioning for 0–5-year-olds transfers to LAs in 2015.