Research Review: Economic evidence for interventions in children's social care: revisiting the What Works for Children project

Evidence about the cost‐effectiveness of interventions in children's services can help decision‐makers make more efficient use of scarce resources. We returned to six somewhat disparate interventions on which we had collated research evidence identified by service planners and practitioners as relevant to the well‐being of children in the course of the Economic and Social Research Council‐funded What Works for Children project. These are home visiting, parenting, cognitive–bahavioural therapy, mentoring, traffic calming and breakfast club interventions. We aimed to explore the nature and extent of evidence on cost‐benefit and cost effectiveness for these measures. We conducted searches for studies that looked at the costs as well as the effectiveness of the six interventions and found 24 studies matching our inclusion criteria. The studies were diverse in terms of study design and economic methods (including economic modelling and willingness to pay). Studies relating to parenting programmes and traffic calming gave the most positive indication that the interventions may be cost‐effective for the outcomes in question. The remainder of the studies did not give a clear picture, in large part because of a lack of demonstration that the intervention was effective.     

Children living with their grandparents: resilience and wellbeing

Downie JM, Hay DA, Horner BJ, Wichmann H, Hislop AL. Children living with their grandparents: resilience and wellbeing
Int J Soc Welfare 2010: 19: 8–22 © 2009 Curtin University of Technology, Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. A non‐comparative design and mixed‐methods approach was used to examine the resilience and wellbeing of 20 children in the full‐time care of their grandparents. A self‐report measure of self‐concept and emotional wellbeing, and a semi‐structured interview were used to explore the personal experiences and impact of children living with their grandparents. Scores derived from the self‐report measure indicated that the children's self‐worth and emotional health were within the range expected of children of comparative age and sex. Qualitative data, however, suggested a complex emotional environment and a continuum of responses. Analysis revealed three themes that captured broad issues around Emotional health, Material factors, Current issues and Past experiences and Coping strategies. The results of the study reveal the ongoing concerns associated with the children's family circumstances, as well as the notable adaptation and resilience of the children in managing their life experiences.     

Flexible estimates of tumour incidence for intermediately lethal tumours in a typical long-term animal bioassay

The estimation of the incidence of tumours in an animal carcinogenicity study is complicated by the occult nature of the tumours involved (i.e. tumours are not observable before an animal's death). Also, the lethality of tumours is generally unknown, making the tumour incidence function non-identifiable without interim sacrifices, cause-of-death data or modelling assumptions. Although Kaplan–Meier curves for overall survival are typically displayed, obtaining analogous plots for tumour incidence generally requires fairly elaborate model fitting. We present a case-study of tetrafluoroethylene to illustrate a simple method for estimating the incidence of tumours as a function of more easily estimable components. One of the components, tumour prevalence, is modelled by using a generalized additive model, which leads to estimates that are more flexible than those derived under the usual parametric models. A multiplicative assumption for tumour lethality allows for the incorporation of concomitant information, such as the size of tumours. Our approach requires only terminal sacrifice data although additional sacrifice data are easily accommodated. Simulations are used to illustrate the estimator proposed and to evaluate its properties. The method also yields a simple summary measure of tumour lethality, which can be helpful in interpreting the results of a study.     

Addressing the midwifery workforce crisis: evaluating an employment model for undergraduate midwifery students at a tertiary maternity hospital in Melbourne, Australia

Background and aims

In Victoria, maternity services are under significant strain due to increased numbers of women giving birth and critical workforce shortages. Hospitals have experienced challenges in adequately staffing maternity units, particularly on postnatal wards. In 2008, a tertiary maternity hospital in Melbourne introduced a model where undergraduate midwifery students were employed as Division 2 nurses (SMW_Div2) (enrolled nurses), to work in the postnatal area only. This study explored the pilot employment model from the perspective of the SMW_Div2 and hospital midwives.

Methods

A web-based survey was administered to hospital midwives and the SMW_Div2s in the employment model in January 2010. The survey explored the views of midwives and SMW_Div2s regarding the perceived impact of the model on workforce readiness, recruitment and retention, and clinical competence and confidence.

Findings

Forty-seven of 158 midwives (30%) and five of nine SMW_Div2s employed in the model responded to the survey. Both groups considered the model to have benefits for the organisation, including increased: student workforce readiness; clinical confidence and competence; and organisational loyalty. Both groups also considered that the model would facilitate: workforce recruitment; a teaching and learning culture within the organisation; and enhanced partnerships between students, hospitals and universities. Caution was expressed regarding workload and the need for ongoing support for SMW_Div2s working in the model.

Discussion and conclusion

SMW_Div2s and midwives were positive about the introduction of the paid employment model at the Women's. The findings are consistent with evaluations of similar programs in the nursing setting. The employment model has potential short and long term individual and organisational advantages, which is important in the context of increasing births and workforce shortages. Progression of such models will be contingent on the collaboration and cooperation of the various stakeholders involved in maternity workforce and education.     

Health Staff Responses to Domestic and Family Violence: The Case for Training to Build Confidence and Skills

ABSTRACT

Domestic and family violence (DFV) is a serious, worldwide public health concern and the literature suggests that women who have experienced violence identify health care providers as the professionals they would most trust with disclosure of abuse. Social work is well positioned to respond to women presenting in hospitals after experiencing DFV and in advocating for systems and policy initiatives to support health staff in becoming adequately trained and supported to detect and respond appropriately. This paper reports on research that surveyed health staff in two hospitals in Queensland, Australia, to identify what DFV training they had received, whether this training increased their knowledge, skills and confidence to address DFV and what services they would access to support women presenting with DFV. The results showed that the respondents were an experienced staff group who had worked in the health sector for 10–20 years but despite having access to State-based training, the majority of them had not completed any in-house training and only 12% had received face-to-face training, and when they did undertake training, it was usually only a two-hour session. Seventy-five per cent of respondents would refer to their hospital-based social worker and 40% would make referrals to other support services, primarily social work.

IMPLICATIONS

• Hospitals need to prioritise, commit to, and resource appropriate and regular training to better equip health staff to identify and respond to DFV.

• Training needs to build the knowledge and skills of staff members to address their confidence to intervene and offer support.

• Social work can provide an important role in advocating and developing training and procedures to sustain health staff members’ capacity to respond appropriately to DFV.

     

Index insurance and climate risk management: Addressing social equity

Fair distribution of benefits from index insurance matters. Lack of attention to social equity can reinforce inequalities and undermine the potential index insurance holds as a tool for climate risk management that is also pro‐poor. The aims of this article are to: (a) examine social equity concerns raised by index insurance in the context of climate risk management, (b) consider how greater attention can be paid to social equity in index insurance initiatives, and (c) reflect on the policy challenges raised by taking social equity into account as a mechanism for climate risk reduction. The article draws on learning from the CGIAR's Research Program on Climate Change, Agriculture and Food Security (CCAFS) and presents the cases of the Index Based Livelihoods Insurance (IBLI) and Agriculture and Climate Risk Enterprise Ltd. (ACRE) in East Africa. It proposes a framework for unpacking social equity related to equitable access, procedures, representation and distribution within index insurance schemes. The framework facilitates identification of opportunities for building outcomes that are more equitable, with greater potential for inclusion and fairer distribution of benefits related to index insurance. The article argues that systematically addressing social equity raises hard policy choices for index insurance initiatives without straightforward solutions. Attention to how benefits and burdens of index insurance are distributed, suggests the unpalatable truth for development policy that the poorest members of rural society can be excluded. Nevertheless, a focus on social equity—facilitated by the framework—opens up opportunities to ensure index insurance is linked to more socially just climate risk management. At the very least, it may prevent index insurance from generating greater inequality. Taking social equity into account, thus, shifts the focus from agricultural systems in transition per se to systems with potential to incorporate societal transformation through distributive justice.     

The ableism elephant in the academy: a study examining academia as informed by Australian scholars with lived experience

Abstract

The academy should be a welcoming environment for people with disability. Across Australia, however, there is a current shortage of programmes supporting people with disability to develop their careers as researchers. This article critically investigates current practice and experiences concerning universities and the employment and career development of people with disability as advised by the literature, and how this practice aligns with the lived experiences of several of our authors. Our review of the literature utilising Scopus, PsycINFO and ProQuest databases found a deficiency of research attention on this topic, with only 16 relevant articles identified. This paucity of literary evidence has been augmented in the article by personal stories shared by four of its authors. By focusing on evidence-based measures with potential to support disability employment and career pathways throughout universities in Australia and elsewhere, this article challenges leaders to address ableism and to advance a more inclusive academy.     

The role of evidence in nutrition policy‐making in Ethiopia: Institutional structures and issue framing

Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with most cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policy‐making adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change can come about within different country settings. This article examines multi‐sectoral nutrition policy‐making from the health sector perspective, specifically focusing on different sectoral perspectives and the role and use of evidence within this. Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong co‐ordinating infrastructure. In December 2014 we undertook 23 in‐depth semi‐structured interviews with stakeholders from key health sector organizations, along with a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organizations and academic researchers. Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. While multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition resting with the health sector was reinforced by the nature of evidence collected. This study of nutrition policy‐making in Ethiopia highlights the complex interaction of evidence within different conceptualisations of policy problems and responses. Despite Ethiopia's strategic framework and its progress in achieving terms of nutrition targets, it shares the challenge of countries elsewhere in addressing nutrition as a multi‐sectoral issue.