strong support for the peer model of delivery but in the current climate of continued budget cuts, NHS Boards and Local Authorities may be cautious to direct funding to ASSIST because it only covers one risk behaviour. Currently and previously there has been other versions of ASSIST (sexual health, physical activity, drugs). Given the very low prevalence of smoking now in the target age group, using the ASSIST model in relation to these other behaviours may be particularly important. It is worth highlighting that a feasibility trial of the ASSIST model as applied to drug prevention (ASSIST +Frank and Frank friends) has just concluded, conducted by some of the authors of this report. Plans are now underway to seek funding for one component of this from NIHR for a larger trial. Early results look promising. School staff and stakeholders were also interested in how the ASSIST model could address multiple behaviours in one intervention, but this may be far more challenging to deliver. Investigating how/if the ASSIST model could be developed to address more than one risk behaviour is an important area for further research.
Smoking rates in Scottish adolescents have declined in recent years, particularly in the 15 year old cohort, with 30% of boys and girls smoking regularly (defined as smoking at least one cigarette per week) in 1996 compared to just 7% in 2015 1 . However, it is estimated that between 2010 and 2011 a total of 207,000 young people aged 11-15 started smoking in the UK. The estimated number of children who start to smoke daily in the UK is: 463 in England, 55 in Scotland, 30 in Wales and 19 in Northern Ireland (Hopkinson et al 2014). This will have a significant impact on future health and life expectancy.
This section illustrates a logic model for the early strategic planning of the Trust. It serves as a tool for the research team in understanding which areas were key focal points, identified during early set-up of the Trust. The research team looked to capture evidence against these components of children’s services prioritised by the strategic leadership team early on in the establishment of the Trust. The model was developed as a tool to guide the evaluation approach and with the expectation we it would be refined across the evaluation. With the move away from a whole-systems processevaluation and ongoing iterations in the Trusts’ strategy and activities it was not feasible nor desirable to develop a model with a grounded theory underpinning it. This model is separate from the models of service delivery planning (see Appendix 2) as it solely represents the early strategy within the Trust. Given the complexity, volume and pace of change in the establishment of the Trust the model was unable to explicitly link what changes made led to what children’s services leadership had expected to achieve.
In order to gather a more in-depth understanding of the reform implementationprocess, a series of school case studies were undertaken between October and November 2015, focussing on the experiences of eight schools. The visits were followed up by telephone interviews with seven of the eight headteachers in April 2016 to explore whether the reforms had become embedded. The case studies consisted of qualitative interviews with headteachers and other senior school leaders (such as deputy and assistant
The evaluation of the project supporting unemployed or single parents in the United Kingdom reported positive outcomes on the way policy operates.. The flexible, person-led approach was welcomed by all stakeholders and participants. However, the foreseen employment outcomes were challenging particularly in rural areas which suffer from poor infrastructure. In Germany, two evaluations were carried out with the first one concluding that targets were not achieved for 2016, and that the process of recruiting enterprises for the consultation was underestimated in terms of the high costs incurred and the time required. The evaluation recommended revising the indicator system and setting more realistic targets for the remaining period and improving the overall cooperation process. The second evaluation on women and careers provided a positive assessment of the counselling activities, as well as the data quality.
Individual and group interviews were held with key stakeholders in NHS Orkney to determine the needs of both the organisation and the individual advanced practitioners. Based on these identified needs, a virtual learning resource was developed. Further individual interviews were held with the advanced practitioners to ensure that the resource was appropriate and amendments were made based on the outcome of this evaluation. The resource was developed jointly by staff from NHS Orkney and the School of Nursing and Midwifery, Robert Gordon University, with external support in relation to the e-learning technology and clinical skills filming.
To ensure the robustness of the results, several alternative approaches to the modelling and matching were undertaken. Specifically, we replicated the analysis by reducing the interval of intervention to 1 month (to remove the possibility of confusing histories with outcomes); matched the treatment and counterfactual groups using information on labour market status during the 1-month interval in which careers support was received by the treatment group (to limit the impact of unobservables); and undertook a range of falsification tests to compare the evolution of labour outcomes of two groups not in receipt of the National Careers Service (the original counterfactual and a 'pseudo' counterfactual generated by matching the original treatment group with an adjusted (higher) level of employment and a new counterfactual group). This final element was undertaken to address the extent of regression to the mean 3 . The preferred
The importance of time is partly a matter of the processes involved in moving beyond the early innovators to reach a critical mass of practitioners. It is also a matter of the phases of learning and implementation that need to be passed through in order to embed the learning strategies in systems and institutions. This is formalised in the New Zealand “Learning and Change Network” strategy into four phases of development;; (i) establishing infrastructure to operate as a network, (ii) profiling the current learning environment to understand student achievement challenges and agree on change priorities, (ii) implementing a plan to address the change priorities, and (iv) sustaining useful changes and agreeing on next steps. The strategy in Victoria (Australia) to make a significant difference to outcomes in the Western Metropolitan Region was also designed around four big phases: initiation; early implementation; relentless implementation; deepening learning. Only by reaching the final phase can the benefits of the change fully be seen. This also warns against looking to evaluate programmes early when no time has elapsed for change properly to embed; the results of such evaluations are bound to be disappointing.
National suicide prevention strategies commonly in- clude training of health and social care professionals in suicide risk assessment and management [19–22] and STORM training was implemented across Scotland for clinical staff as one of a suite of training packages in response to the Scottish Government Choose Life initiative. This was a multifaceted programme launched in 2006 in an attempt to reduce the suicide rate in Scotland, which, at that time, was higher than else- where in the UK [23, 24]. Choose Life included the explicit aim of ensuring that ‘more than 50% of front- line NHS staff had received at least one specific course on suicide intervention’ (http://www.chooselife.net/ Training/index.aspx). The four approaches employed by Choose Life were STORM (the subject of the present study and specifically aimed at front line healthcare staff), Applied Suicide Intervention Skills training (ASIST) (https://www.livingworks.net/asist/), Suicide Alertness for Everyone (safeTALK) (https://www.living- works.net/safetalk/) and Mental Health First Aid (SMHFA) . TTT programmes have been widely employed internationally to implement these and other suicide prevention training initiatives. Suicide prevention is a global public health priority, with a need for acquisi- tion of skills throughout health and community services, not only specialist mental health care . It thus requires training to be both widely disseminated across systems and locally implemented.
6.20 One case study looked at the role of an education support officer funded at LA level who was responsible for arranging alternative curriculum provision and visits to colleges and learning events for LAC and previously LAC. Teachers felt they would be difficult to organise themselves as they did not have the necessary strategic oversight or the time to arrange visits and chase the return of consent forms for all pupils. The post-holder also conducted a lot of work with foster carers, ensuring that they were informed and aware of support being offered and ensuring they were upskilled to better support their child with their education; liaised closely with social services and mental health services to ensure the wider needs of children were met; and contributed to the evaluation and monitoring activities undertaken by the LACE coordinator’s team on individual LAC.
Progressing this shift was challenging to sites for a number of reasons Sites inability to break up the block contracts was a key barrier If providers were not willing to change the conditions of their contract then commissioners felt limited in what they could do To address this in a number of sites the commissioners engaged in conversations with their providers to consider new ways of service provision in particular allowing bespoke packages of care Once site commented that they aligned the work of IPC with the local service transformation plan STP In that way statutory providers could not refuse to discuss changes to the contract as this was part of the wider local transformation of services Getting provider buy in was a lengthy process and contributed to the delay in making progress in the shift
Many of the fathers experienced some difficulty in applying for PLP. One father explained that he and his partner went to Centrelink and filled in the application there and then, with the whole process being completed in about an hour and with little effort. This case was an exception. Amongst the other fathers, two main recurring issues emerged. Firstly, the eligibility process requires the mother to first claim and be eligible for PLP, and then if she wishes, transfer some or all of the payment to her eligible partner. Where payments are being transferred, both mothers and fathers have to complete the claim and be eligible before all or part of the payment can be transferred to fathers. Each member of the couple needs to establish their individual eligibility in relation to the work, income, residency and primary carer tests, and provide other details required for payments to be made. There was some confusion over this process, for example, the perception was that the fathers had to fill in the application in the mother’s name and then have it transferred to them (one mother did this and was subsequently told an application would also need to be completed in the father’s name). Then fathers were confused by the requirement to have consent from the mother to take the PLP. The claim process for fathers was sometimes complicated, for example by Centrelink staff contacting a mother’s employer about registering instead of noting that the father was taking the whole of the PLP. The second key issue was a perceived lack of knowledge amongst Centrelink staff about the correct procedure to follow when fathers take PLP. In addition, Centrelink staff provided conflicting advice to the fathers about how best to proceed with the application. Each time a father (or their partner) phoned a helpline they would talk to a different person, who often detailed a different explanation of what to do. Typically the fathers’ applications only really progressed once they had a dedicated Centrelink staff member tracking its progress and when the father (or his partner) could contact that individual directly.
commissioned by the Scottish Government to develop and deliver a response. This aligned with the Scottish Government’s ongoing commitment to modernising the Children’s Hearing system in order to promote greater participation of children, young people and their families throughout their engagement in the process and improve their longer-term outcomes. A series of 13 half-day events were developed and delivered by CELCIS and Clan Childlaw comprising one symposium for strategic managers, four middle-managers’ seminars and eight practice development seminars for front-line practitioners. These events were delivered across mainland Scotland between late April 2014 and December 2014. In addition to this, a seminar for front-line practitioners was delivered to staff in Shetland as part of a staff development day.
Decisions to remove children from their birth families and to place them for adoption are not taken lightly. One of the key principles of the Children (Scotland) Act 1995 is that of minimal intervention, or the ‘no order’ principle. This establishes that no requirement or order should be made unless a Children’s Hearing or the Sheriff consider that ‘it would be better for the child that the requirement or order be made than that none should be made at all.’ (Section 16.3). Operating under the principle of minimal intervention, practitioners will remove children from their families only in the most serious and/or recurring cases.
The quality audit and review process involved a primarily quantitative questionnaire but Over2You volunteers explained how they were able to use it as a guide for a broader set of qualitative discussions about health and care services. This illustrates how quantitative measures of quality, whilst important, can mask important qualitative detail about people's experience of services and how they can be improved. Volunteers were keen to emphasise the importance of service users' stories and narratives in explaining how services could and should be changed, and would have liked more opportunities to capture these during the audit and review process.
Across the various sources of data collection with young people, evaluation findings suggest that LGBTQ youth feel strongly about the invisibility of LGBTQ identities within mainstream school and college settings. This may link to the importance they placed upon having LGBTQ friends, which for some were lacking. They specifically identified wanting support related to sex, relationships and coming/being ‘out’ . This evidences the lack of appropriate SRE provided in schools (and to a certain extent the NHS), but also the pressures that may be placed upon LGBTQ friendships striving to fill this gap. This supports the provision of services to up-skill and build capacity for LGBTQ peer support. The LGBTQ young people who participated in the evaluation often had no expectations of learning about (LGBTQ) sex and relationships from school, and low expectations about intimate relationships. In particular, they identified the lack of role models and (positive) images of LGBTQ relationships in the media and wider society that left many of them unclear about what to expect in a relationship. The fact that even a small number thought it was ‘sometimes’ or ‘totally OK’ to hit a partner is testament to this. In this context, the potential value of Selfies work was clear, and participants valued the opportunity to come together and discuss LGBTQ relationships. Where support was lacking elsewhere, LGBTQ young people tended to turn to LGBT organisations and groups, or ‘learnt from experience’.
The small neighbourhood focus of the Children's Community in Pembury supports close engagement with the community and there is a sense that lead agencies know their communities very well. Pembury is a vibrant and active community, and the Children's Community benefits from the involvement of an engaged residents steering group. This is very positive. At this point the evaluation has not gathered the views of these stakeholders in relation to their impact and influence on the Children's Community, although documentary evidence and minutes of meetings confirms their influence on shaping interventions. Those stakeholders who were interviewed were aware that the Children's Community needs to continue to be proactive in its approach to community engagement and to look beyond the 'usual suspects' to ensure continued co-production with a wide range of community representatives. Many of the early interventions have developed case worker approaches and one to one support to families and young people. These approaches, which focus on developing integrated and holistic services are integral to the work of the Children's Community in Pembury and are beginning to be embedded across a range of service areas. A recent example includes the Ready for School project which is working across early years, primary school and family support. There are also interventions supporting parents and young people. There is a developing portfolio of services for children and families in the area, and some emerging evidence of positive outcomes for beneficiaries. A challenge for the Children's Community going forward is to gather evidence around successful approaches and to build a consolidated pipeline of support across all stages of children's lives. A strategic stakeholder explained:
The positioning of The Key within an existing offer of service provision was also important in relation to successful delivery. It has been recognised that non-statutory services are ideally placed to provide holistic support for women with complex needs (Radcliffe et al 2013). The importance of providing a non-judgemental and non-stigmatising service was also important for the success of The Key. A recent report suggests that interventions with young women must work in different ways to statutory bodies; as young women often have a deep-seated mistrust of helping professionals who have failed them in the past (McNeish and Scott, 2014). Young women see specialist workers within women-centred
Ofsted’s thematic report ‘The Sexual Exploitation of Children: It couldn’t happen here, could it?’ (Ofsted, 2014b) included amongst its recommendations that local authorities and partners should ensure the availability of therapeutic support for exploited or at risk young people and that professionals should be enabled to build stable, trusting and lasting relationships with such young people. The design of the SYEP programme was inspired by discussions with Dr Charlie Howard and some emerging evidence from her work with MAC-UK delivering mental health interventions to young people involved in antisocial or gang-related activity in North London. The project had developed a model called ‘Integrate’ that aimed to take evidence-based approaches to mental health and apply them in new ways, by taking mental health workers out of the clinic and putting them at the heart of group activities led by the young people themselves. Evaluation by the Centre for Mental Health provided evidence that the first such project had been effective in providing mental health interventions and supporting young people’s wellbeing (MAC-UK, 2012).