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Mental health difficulties often start in childhood and the number of young people experiencing mental health difficulties [are] is rising, particularly since the Covid-19 pandemic. School-based programmes have been identified as an effective way to provide support for young people and present an opportunity to offer universal programmes, which can increase equity of access, facilitate resilience and reduce stigma. Whilst there is an emerging evidence of the benefits of preventive mental health programmes delivered in schools, there is a need for more robust evidence and methodological rigour in the development and descriptions of these programmes.\ud\udAcceptance and Commitment Therapy (ACT) is one approach that may be appropriate as a framework for preventing and reducing mental health difficulties in schools. This paper describes the content development of a UK-based universal school programme using ACT: the In-school Training in Emotional Resilience (InTER-ACT) programme. It describes the steps taken across the stages of content development, from planning the programme, delivering the programme in a school, receiving feedback and integrating the subsequent revisions. The final version of the programme, including summaries of session content, is provided.\ud\udConsistent with an ACT ethos, the personal values of the researchers, and the influence of these on the programme are discussed, providing a novel integration of methodical detail and authentic, reflective practice. This article provides a transparent and detailed overview of the iterative processes involved in developing the content of an evidence-based pastoral care programme in a way that is systematic, rigorous and responsive to teacher and pupil feedback.

A mother's propensity to refer to internal states during mother-child interactions is important for her child's developing social understanding. However, adolescent mothers are less likely to reference internal states when interacting with their children. We investigated whether young mothers' references to internal states are promoted by the Family Nurse Partnership (FNP) intervention, an intensive home-visiting programme designed to support adolescent mothers in England. We also investigated family, maternal, and child factors associated with young mothers' references to inner states during interactions with their children. Adolescent mothers (n = 483, aged ≤ 19 years when recruited in pregnancy) and their children participated in an observational substudy of a randomized controlled trial investigating the impact of FNP compared to usual care. Mother-child dyads were video-recorded during free play, and mothers' speech was coded for use of internal state language (references to cognitions, desires, emotions, intentions, preferences, physiology, and perception). We found no differences in mothers' use of internal state language between the FNP and usual care groups. A sample-wide investigation identified that other features of mothers' language and relationship status with the child's father were associated with internal state language use. Findings are discussed with reference to targeted interventions and implications for future research.La tendencia de la madre a referirse a los estados internos durante las interacciones madre-niño es importante para el desarrollo social cognitivo de su niño. Sin embargo, las madres adolescentes están menos propensas a referirse a los estados internos cuando interactúan con sus niños. Investigamos si la tendencia de las madres jóvenes a referirse a estados internos es promovida por la intervención de Asociación entre Familia y Enfermera (FNP), un programa intensivo de visitas a casa diseñado para apoyar a madres adolescentes en el Reino Unido. También investigamos factores de familia, maternos y del niño asociados con las interacciones de las jóvenes madres con sus niños. Las madres adolescentes (n = 483, edad ≤ 19 años) y sus niños participaron en un sub-estudio de observación, un ensayo controlado al azar que investigaba el impacto de FNP comparado con el cuidado usual. Las díadas madre-niño fueron grabadas en video durante el juego libre, y se codificó el habla de las madres en cuanto al uso del lenguaje de estados internos (referencias a cogniciones, deseos, emociones, intenciones, preferencias, fisiología y percepción). No encontramos diferencias en cuanto al uso del lenguaje de estados internos en las madres entre la FNP y los grupos de cuidado usual. Una muestra de investigación amplia identificó que otras características del lenguaje de las madres y condiciones de la relación con el padre del niño estaban asociadas con el uso del lenguaje de estados internos. Los resultados se discuten con referencia a intervenciones elegidas como objetivo e implicaciones para la futura investigación.La propension d'une mère à faire référence à ses états internes durant les interactions mère-enfant est importante pour le développement social et cognitif de son enfant. Cependant, les mères adolescentes sont moins à même de faire référence à leurs états internes dans leur interaction avec leurs enfants. Notre étude a porté sur si la propension des jeunes mères à faire référence à leurs états internes est promue par l'intervention Partenariat Famille Infirmières (en anglais Family Nurse Partnership, soit FNP), un programme intensif de visite à domicile conçu afin de soutenir les mères adolescentes au Royaume Uni. Nous avons également étudié les facteurs familiaux, maternels, et liés aux enfants, liés aux interactions des jeunes mères avec leurs enfants. Les mères adolescentes (n = 483, âgés ≤ 19 ans) et leurs enfants ont participé à une sous-étude observationnelle d'un essai contrôlé randomisé portant sur l'impact de la FNP comparé aux soins normaux. Les dyades mères-enfant ont été filmées durant un jeu libre et les paroles des mères ont été codées pour son utilisation de langage d’état interne (références aux cognitions, désirs, émotions, intentions, préférences, physiologie et perception). Nous n'avons trouvé aucune différence dans l'utilisation des mères du langage d’état interne entre le groupe FNP et les groupes de contrôle. Une étude de l’échantillon a révélé que d'autres traits du langage des mères et du statut de la relation avec le père de l'enfant étaient liés à l'utilisation de langage de l’état interne. Les résultats sont discutés par rapport aux interventions ciblées et aux implications pour les recherches futures.Beurteilung der Wirkungen einer von Familienpflegekräften geleiteten Intervention zur Bezugnahme junger Mütter auf innere Zustände Inwiefern sich eine Mutter bei den Interaktionen mit ihrem Kind auf innere Zustände bezieht, ist wichtig für die sozial-kognitive Entwicklung des Kindes. Bei adoleszenten Müttern ist es jedoch weniger wahrscheinlich, dass sie bei der Interaktion mit ihren Kindern auf innere Zustände bezugnehmen. Wir haben untersucht, ob durch die Familienpflegekraft-Partnerschaftsintervention (Family Nurse Partnership; FNP), ein intensives Hausbesuchsprogramm zur Unterstützung jugendlicher Mütter in Großbritannien, die Bezugnahme auf innere Zustände bei jungen Müttern gefördert werden kann. Ebenfalls untersuchten wir familiäre, mütterliche und kindliche Faktoren die mit der Interaktion junger Mütter mit ihren Kindern assoziiert sind. Die adoleszenten Mütter (n = 483, Alter ≤ 19 Jahre) und ihre Kinder nahmen an einer randomisierten kontrollierten Beobachtungsstudie teil, in der die Wirkung von FNP im Vergleich zur üblichen Betreuung untersucht wurde. Die Mutter-Kind-Dyaden wurden während eines freien Spiels auf Video aufgezeichnet und die Sprache der Mütter wurde hinsichtlich ihrer Bezüge auf interne Zustände codiert (Hinweise auf Kognitionen, Wünsche, Emotionen, Absichten, Vorlieben, Physiologie und Wahrnehmung). Zwischen der FNP-Gruppe und der Gruppe mit der üblichen Betreuung konnten hinsichtlich der Bezugnahme auf innere Zustände keine Unterschiede beobachtet werden. Eine stichprobenweite Untersuchung ergab, dass andere sprachliche Merkmale der Mutter und der Beziehungsstatus zum Kindesvater mit dem Gebrauch von Bezügen auf innere Zustände zusammenhingen. Die Ergebnisse werden hinsichtlich gezielter Interventionen und Implikationen für zukünftige Forschung diskutiert.若年母親の内的状態に関する言及への家族看護師主導介入の影響を評価する 母子相互交流時における母親の内的状態について言及する傾向は、乳幼児の社会的認知の発達に重要である。しかしながら、若年母親は自分の子どもとの相互交流時に内的状態について言及する傾向が弱い。我々は、若年母親が内的状態を言及する傾向が、ナース・ファミリー・パートナーシップ(FNP)介入−それは、英国における若年母親を支援するために考案された集中的な家庭訪問プログラム−によって促進されるかどうかについて研究した。また、家族、母親と乳幼児それぞれの、若年母親の自分の子どもとの相互交流に関連する要素について研究した。若年母親(n = 483, 年齢 ≤ 19歳)とその子どもは普通のケアに比較してFNPの影響を調査するランダム化比較試験の観察下位研究に参加した。母子親子は自由遊び時を録画され、母親の発言は内的状態言語(認知、欲望、情緒、意図、好み、生理、知覚の言及)の使用についてコード化された。FNPと普通のケア群との間の母親の内的言語の使用に差異はなかった。サンプル全体の調査は母親の内的言語とは違う言語と子どもの父親との関係性は、内的状態言語の使用に関連していることが同定された。 結果は対象を絞った介入についての言及と今後の研究での予想される結果について討論している。.母亲在母子互动过程中倾向于提及内在状态, 这对孩子的社会认知发展很重要。但是, 未成年母亲与其子女互动时却不太可能提及内在状态。我们调查了“家庭护士伙伴关系计划 (FNP) ”的干预是否促进了未成年母亲提及内在状态的倾向, 该干预是一项旨在支持英国未成年母亲的密集的家访计划。我们还调查了与年轻母亲及其孩子互动有关的家庭、母亲和儿童方面的因素。未成年母亲 (n = 483, 年龄≤19岁) 及其子女参加了一项观察性的子研究, 这是一项随机对照试验, 调查FNP与常规护理相比的影响。在自由活动期间, 母子二人组被录制了视频, 母亲的谈话被编码, 以记录其使用内在状态的语言 (涉及到认知、欲望、情绪、意图、偏好、生理和感知) 。我们发现FNP组和常规护理组的母亲在使用内在状态语言方面没有差异。一项抽样调查显示, 母亲语言的其他特征以及与孩子父亲的关系状态都和内在状态语言的使用有关。研究结果将参考有针对性的干预措施和对未来研究的影响进行讨论。.تقييم أثر تدخل عائلي قائم على التمريض على إشارات الأمهات الشابات إلى حالاتهم النفسية الداخلية يعتبر ميل الأم للإشارة إلى الحالات النفسية الداخلية أثناء التفاعلات بين الأم والطفل مهم للنمو المعرفي الاجتماعي لطفلها. ومع ذلك، فإن الأمهات المراهقات أقل احتمالا للإشارة إلى الحالات الداخلية عند التفاعل مع أطفالهن. لقد حققنا فيما إذا كان ميل الأمهات الشابات إلى الإشارة إلى الحالات النفسية الداخلية يزداد من خلال تدخل شراكة العائلة والتمريض (FNP)، وهو برنامج مكثف للزيارات المنزلية يهدف إلى دعم الأمهات المراهقات في المملكة المتحدة. كما قمنا بتحري العوامل الأسرية والأمومية والعوامل المرتبطة بتفاعل الأمهات الشابات مع أطفالهن. شاركت الأمهات المراهقات (العدد = 483، البالغات من العمر ≤ 19 سنة) وأطفالهن في دراسة فرعية قائمة على الملاحظة وهي تجربة معشاة ذات شواهد تبحث في تأثير تدخل شراكة العائلة والتمريض FNP مقارنة بالرعاية المعتادة. تم تسجيل فيديوهات لثنائيات الأم والطفل الفيديو خلال اللعب الحر، وتم ترميز خطاب الأمهات في استخدام لغة الحالة الداخلية (إشارات إلى المعرفة، والرغبات، والعواطف، والنوايا، والتفضيلات، والعوامل الفسيولوجية والإدراك). لم نجد أي اختلافات في استخدام الأمهات للغة الحالة الداخلية بين FNP ومجموعات الرعاية المعتادة. وقد تبين من تحقيق على نطاق العينة أن السمات الأخرى للغة الأمهات وحالة العلاقة مع والد الطفل ترتبط باستخدام لغة الحالة الداخلية. وتناقش النتائج بالإشارة إلى التدخلات المستهدفة وتطبيقات البحوث المستقبلية.

ObjectivesMeasure effectiveness of family nurse partnership (FNP) home-visiting programme in reducing maltreatment and improving maternal health and child health, developmental and educational outcomes; explore effect moderators, mediators; describe costs.DesignFollow-up of BB:0–2 trial cohort (ISRCTN:23019866) up to age 7 years in England using record linkage.Participants1618 mothers aged 19 years or younger and their firstborn child(ren) recruited to BB:0–2 trial at less than 25 weeks gestation and not mandatorily withdrawn from trial or opted out. Intervention families were offered up to a maximum of 64 home visits by specially trained nurses from pregnancy until firstborn child was 2 years old, plus usually provided health and social care support. Comparator was usual care alone.Outcome measuresPrimary outcome: state-verified child-in-need status recorded at any time during follow-up. Secondary outcomes: referral to social services, child protection registration (plan), child-in-need categorisation, looked-after status, recorded injuries and ingestions any time during follow-up, early childcare and educational attendance, school readiness and attainment at key stage 1 (KS1), healthcare costs.ResultsMatch rates for 1547 eligible children (1517 singletons, 15 sets of twins) were 98.3% (NHS Digital) and 97.4% (National Pupil Database). There was no difference between study arms in the proportion of children being registered as in need (adjusted OR 0.98, 95% CI 0.74 to 1.31), or for any other measure of maltreatment. Children in the FNP arm were more likely to achieve a good level of development at reception age (school readiness) (adjusted OR 1.24, 95% CI 1.01 to 1.52). After adjusting for birth month, children in FNP arm were more likely to reach the expected standard in reading at KS1 (adjusted OR 1.26, 95% CI 1.02 to 1.57). We found no trial arm differences for resource use and costs.ConclusionsFNP did not improve maltreatment or maternal outcomes. There was evidence of small advantages in school readiness and attainment at KS1.Trial registration numberISRCTN23019866.

Context & Objectives The Controlled Antenatal Thyroid Screening (CATS) study was the first randomized controlled trial to investigate effects of treating suboptimal gestational thyroid function (SGTF) on child cognition. Since observational studies indicated that SGTF may also increase symptoms of autism and attention-deficit/hyperactivity disorder (ADHD), the CATS cohort was used to investigate whether treatment of mothers affected their children’s behavior. Design & Participants Mothers (N = 475) completed 3 questionnaires: the Strengths and Difficulties Questionnaire (SDQ), the Child ADHD Questionnaire, and the Social Communication Questionnaire (SCQ, used as a screen for autism spectrum disorder [ASD]), about their children (mean age 9.5 years). Group comparisons of total scores, numbers of children above clinical thresholds, and association between high maternal free thyroxine (FT4) (> 97.5th percentile of the UK cohort, “overtreated”) and child neurodevelopment were reported. Results There were no differences in total scores between normal gestational thyroid function (GTF) (n = 246), treated (n = 125), and untreated (n = 104) SGTF groups. More children of treated mothers scored above clinical thresholds, particularly the overtreated. Scores were above thresholds in SDQ conduct (22% vs 7%), SCQ total scores (7% vs 1%), and ADHD hyperactivity (17% vs 5%) when comparing overtreated (n = 40) and untreated (N = 100), respectively. We identified significantly higher mean scores for SDQ conduct (adjusted mean difference [AMD] 0.74; 95% confidence interval [CI], 0.021-1.431; P = 0.040, effect size 0.018) and ADHD hyperactivity (AMD 1.60, 95% CI, 0.361-2.633; P = 0.003, effect size 0.028) comparing overtreated with normal-GTF children. Conclusions There was no overall association between SGTF and offspring ADHD, ASD, or behavior questionnaire scores. However, children of “overtreated” mothers displayed significantly more ADHD symptoms and behavioral difficulties than those of normal-GTF mothers. Thyroxine supplementation during pregnancy requires monitoring to avoid overtreatment.

Background: Women with obesity are at a greater risk of experiencing complications during the antenatal, intrapartum and postpartum periods. Despite many \ud studies of weight management interventions in pregnancy, systematic reviews have demonstrated limited effectiveness, demonstrating a need to increase the focus \ud on preconception health and build a greater awareness of the association between preconception health and maternal and child outcomes. Much of the research in \ud pre-conception weight loss has been with very specific populations or has been small-scale. The aim of the Plan-it study is to establish if it is acceptable and feasible \ud to conduct a study that asks women with overweight/ obesity (BMI of 25 or over) to delay removal of LARC to participate in a targeted pre-pregnancy weight loss \ud intervention. \ud Methods: The study will take a concurrent mixed methods approach incorporating use of routine NHS data and qualitative data collection and analysis across two \ud work-packages: the first will establish the feasibility of defining and understanding the population through routine data and the second will provide an understanding \ud of the feasibility and acceptability to stakeholders (LARC users and practitioners) of incorporating a pre-pregnancy weight loss intervention, in addition to identifying \ud potentially suitable weight loss interventions and the theories underpinning them. The findings from the two work packages will contribute to a final report, which \ud will delineate the key design elements of a future trial or identify the barriers that currently prevent such a trial taking place. \ud Discussion: The preconception period provides an opportunity to intervene with a weight loss intervention in women with overweight/ obesity. The findings of this \ud study will contribute to the evidence base for weight management in the preconception period and provides information, critical to consider, when developing a future \ud intervention and associated feasibility trial

Maternal depression is associated with adverse child outcomes including antisocial behaviour (ASB). Prospective longitudinal studies have focused on the timing and cumulative exposure to maternal depression to further delineate the association and mechanisms of effect. The objective of this systematic review was to synthesise and evaluate the findings of longitudinal studies of maternal depression and offspring antisocial behaviour. Three databases were searched (Psychinfo, Web of Science, and Medline). Twenty of 5936 studies met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme criteria [Critical Appraisal Skills Programme (2017) CASP (cohort observation checklist). https://casp-uk.net/wpcontent/uploads/2018/01/CASP-Cohort-Study-Checklist.pdf]. Results of individual studies were highly varied, using diverse analytical approaches and not all studies explored the independent effects of different episodes. Only three studies examined hypothesised mechanisms. Prenatal, postnatal, and later episodes of depression were all predictive of antisocial outcomes. One particular time period of depression exposure did not emerge as more predictive of offspring ASB than another. However, measures of maternal depression after the perinatal period were limited and typically included a one-off assessment of mothers’ depressive symptoms that was concurrent to the assessment of offspring ASB. When cumulative exposure to maternal depression and specific timing effects were measured within the same study it was cumulative exposure that conferred the greatest risk for offspring ASB—particularly when this exposure began during the perinatal period. Findings are discussed in terms of limitations in the literature and highlight the need for future research to examine the biological and environmental mechanisms that underpin associations between maternal depression and offspring antisocial behaviour during different stages of development.

Introduction: Approximately 60,000 (9/100) infants are born into water annually in the UK and this is likely to increase. Case reports identified infants with water inhalation or sepsis following birth in water and there is a concern that women giving birth in water may sustain more complex perineal trauma. There have not been studies large enough to show whether waterbirth increases these poor outcomes. The POOL Study [ISRCTN 13315580] plans to answer the question about the safety of waterbirths among women who are classified appropriate for midwifery-led intrapartum care. Methods and Analysis: A cohort study with a nested qualitative component. Objectives will be answered; using retrospective and prospective data captured in electronic NHS maternity and neonatal systems. The qualitative component aims to explore factors influencing pool-use and waterbirth; data will be gathered via discussion groups, interviews and case studies of maternity units. Ethics and Disseminations: The protocol has been approved by NHS Wales Research Ethics Committee (18/WA/0291) the transfer of identifiable data has been approved by Health Research Authority Confidentiality Advisory Group (18CAG0153). Study findings and innovative methodology will be disseminated through peer-reviewed journals, conferences and events. Results will be of interest to the general public, clinical and policy stakeholders in the UK and will be disseminated accordingly. Strengths and Limitations of the Study: • Using large retrospective and prospective datasets concomitantly provides six years’ data over a three-year study period. • Ability to look at all neonatal outcomes and treatments across the wide geographical range and number of units. • Using existing, routine data enhanced by prospective data to investigate the safety of waterbirth across a range of outcomes. • Data collected will only represent users of Wellbeing-Software’s EuroKing® maternity software system. • Allocation is not random, so unmeasured confounding is possible.

Around half of pregnant women in the United Kingdom are overweight or obese. The antenatal period provides an opportunity for encouraging women to adopt positive lifestyle changes, and in recent years, this has included development of strategies to support women in avoiding excessive gestational weight gain. The objective of this interventional cohort study was to incorporate individualised gestational weight monitoring charts supported by motivational interviewing (MI)‐based conversations into midwifery‐led antenatal care and assess potential of the intervention for further development and evaluation. The study setting was a community midwifery team within a large maternity unit. The study explored the facilitators and barriers to engagement with the intervention as experienced by women and midwives; 52 women were recruited, of whom 48 were included in the analysis. A single training session was found adequate to prepare midwives to use antenatal weight charts but was insufficient to result in the incorporation of motivational interview techniques into clinical practice. We did not find sufficient evidence to recommend effectiveness testing of this intervention, and there is currently insufficient evidence to support reintroducing regular weighing of pregnant women into UK antenatal care. Given the public health importance of reducing rates of obesity, future interventions aimed at controlling gestational weight gain should continue to be developed but need to include innovative strategies particularly for women who are already obese or gain weight above that recommended.

The focus of this chapter is on the relatively limited numbers of individual-level intervention approaches in pediatric diabetes populations. We provide an overview of “stand-alone” individual-level interventions for children and young people that have been described in the published literature while also including some multicomponent interventions where the work with the individual comprises the most significant part of the intervention design. The interventions are presented in three main sections: psychotherapeutic approaches which occur in addition to routine care (e.g., cognitive behavior therapy and motivational interviewing), individual interventions within routine care (e.g., goal setting, preconception counselling), and telemedicine. The fit between intervention model, the developmental stage of the young person, and the context of the wider system is discussed. Teams need a menu of approaches to enable them to offer long-term support, and individual approaches have their place on that menu, alongside family and community interventions. To optimize outcomes, it is important that the wider context within which the young person is managing their diabetes care is not neglected when offering such support.

Maternal mental health problems during pregnancy and the postnatal period are a major public health issue. Despite evidence that symptoms of both depression and anxiety are common during pregnancy and the postpartum, the impact of maternal anxiety on the child has received relatively less attention than the impact of maternal depression. Furthermore, the evidence base for the direct impact of maternal anxiety during pregnancy and the postpartum on children’s emotional outcomes lacks cohesion. The aim of this systematic review is to summarise the empirical evidence regarding the impact of maternal prenatal and postnatal anxiety on children’s emotional outcomes. Overall, both maternal prenatal and postnatal anxiety have a small adverse effect on child emotional outcomes. However, the evidence appears stronger for the negative impact of prenatal anxiety. Several methodological weaknesses make conclusions problematic and replication of findings is required to improve the identification of at-risk parents and children with appropriate opportunities for intervention and prevention.

The Controlled Antenatal Thyroid Screening (CATS) study investigated treatment of suboptimal gestational thyroid function (SGTF) on childhood cognition and found no difference in intelligence quotient (IQ) at 3 years between children of treated and untreated SGTF mothers. We have measured IQ in the same children at age 9.5 years and included children from normal gestational thyroid function (normal-GTF) mothers.One examiner, blinded to participant group, assessed children's IQ (Wechsler Intelligence Scale for Children, Fourth Edition UK), long-term memory, and motor function (Developmental Neuropsychological Assessment II) from children of 119 treated and 98 untreated SGTF mothers plus children of 232 mothers with normal-GTF. Logistic regression explored the odds and percentages of an IQ85 in the groups.There was no difference in IQ85 between children of mothers with normal-GTF and combined SGTF, i.e., treated and untreated (fully adjusted odds ratio [OR] = 1.15 [95% confidence interval (CI) 0.52, 2.51]; P = 0.731). Furthermore, there was no significant effect of treatment [untreated OR = 1.33 (95% CI 0.53, 3.34); treated OR = 0.75 (95% CI 0.27, 2.06) P = 0.576]. IQ85 was 6.03% in normal-GTF, 7.56% in treated, and 11.22% in untreated groups. Analyses accounting for treated-SGTF women with free thyroxine97.5th percentile of the entire CATS-I cohort revealed no significant effect on a child's IQ85 in CATS-II. IQ at age 3 predicted IQ at age 9.5 (P0.0001) and accounted for 45% of the variation.Maternal thyroxine during pregnancy did not improve child cognition at age 9.5 years. Our findings confirmed CATS-I and suggest that the lack of treatment effect may be a result of the similar proportion of IQ85 in children of women with normal-GTF and SGTF.

Objective\ud To identify factors influencing the use of birth pools.\ud \ud Design\ud Online discussion groups and semi-structured interviews, analysed thematically.\ud \ud Setting\ud United Kingdom.\ud \ud Participants\ud 85 women and 21 midwives took part in online discussion groups; 14 medical staff participated in interviews.\ud \ud Findings\ud Factors influencing the use of birth pools were grouped into three overarching categories: resources, unit culture and guidelines, and staff endorsement. Resources encompassed pool availability, efficiency of pool use and availability of waterproof cardiotocograph equipment. Unit culture and guidelines related to eligibility criteria for pool use, medicalisation of birth and differences between midwifery-led and obstetric-led care. Staff endorsement encompassed attitudes towards pool use.\ud \ud Key conclusions\ud Accessibility of birth pools was often limited by eligibility criteria. While midwifery-led units were generally supportive of pool use, obstetric-led units were described as an over-medicalised environment in which pool use was restricted and relied on maternal request.\ud \ud Implications for practice\ud Midwives can improve women's access to birth pools by providing information antenatally and proactively offering this as an option in labour. Maternity units should work to implement evidence-based guidelines on pool use, increase pool availability (even where there appears to be low demand), and enhance awareness amongst medical staff of the benefits of water immersion.

Objectives\udThis review examines home visiting programmes that specifically provide home based support to vulnerable, socially disadvantaged women who are either pregnant or have recently become a new parent. Home visiting programmes often report multiple outcomes. The purpose of this review is to systematically summarise how effective home visiting programmes are at improving young children's language development.\ud\udData sources\udA comprehensive search of four online databases (Embase, Emcare, Psycinfo and Medline) between 1990 and 2020 was conducted, as well as a hand search of the references of relevant studies.\ud\udReview method\udStudies were screened with N = 11 meeting the inclusion/exclusion criteria. The risk of bias of each study was assessed. To enable comparisons between home visiting programmes, relevant data was extracted using an adapted version of the Cochrane Public Health Group Data Extraction and Assessment Template.\ud\udResults\udMost of the home visiting programmes had been established in America. Six of the eleven studies reported positive language outcomes for children. Where statistical data was reported, the magnitude of the difference between the intervention and control groups represented small effect sizes. Nine different language measures were used, reporting on varying domains of language development rendering comparisons across programmes difficult. Most studies failed to report the duration of home visits, though studies which started prenatally showed the most promise in improving children's language development.\ud\udConclusion\udHome visiting programmes targeted at socially disadvantaged women and their children have the potential to positively influence the language development of the child. This review highlights that not all home visiting programmes measure the impact that the programme has on children's language development, and not all home visiting programmes achieve positive language outcomes. Initiating visits prenatally may help towards the improvement of children's language development. Future evaluations of home visiting programmes should explore this finding further, consider the language assessment tools selected, and improve on the reporting of their language results.

Background\ud \ud The Family Nurse Partnership (FNP) programme was introduced to support young first-time mothers. A randomised trial found FNP added little short-term benefit compared to usual care. The study included a comprehensive parallel process evaluation, including focus groups, conducted to aid understanding of the introduction of the programme into a new service and social context. The aim of the focus groups was to investigate views of key health professionals towards the integration and delivery of FNP programme in England.\ud \ud \ud Methods\ud \ud Focus groups were conducted separately with Family Nurses, Health Visitors and Midwives at trial sites during 2011–2012. Transcripts from audio-recordings were analysed thematically.\ud \ud \ud Results\ud \ud A total of 122 professionals participated in one of 19 focus groups. Family Nurses were confident in the effectiveness of FNP, although they experienced practical difficulties meeting programme fidelity targets and considered that programme goals did not sufficiently reflect client or community priorities. Health Visitors and Midwives regarded FNP as well-resourced and beneficial to clients, describing their own services as undervalued and struggling. They wished to work closely with Family Nurses, but felt excluded from doing so by practical barriers and programme protection.\ud \ud \ud Conclusion\ud \ud FNP was described as well-resourced and delivered by highly motivated and well supported Family Nurses. FNP eligibility, content and outcomes conflicted with individual client and community priorities. These factors may have restricted the potential effectiveness of a programme developed and previously tested in a different social milieu. Building Blocks ISRCTN23019866 Registered 20/04/2009.

Trauma to the labia occurs in up to 49% of vaginal births1. Trauma to the perineal body resulting from childbirth is well defined using widely used categories, and recommended management of perineal body trauma is based on high level evidence. Currently no similar evidence exists to inform the classification or management of labial trauma. This is reflected in variation in clinical practice with some practitioners favouring suturing of labial trauma, whilst others favour healing by secondary intention. A survey of practice was undertaken in three NHS organisations, over a five-week period in 2019 with data collected on 332 vaginal births. Overall, 47.3% (n=157) of women sustained labial trauma, of whom 29.3% (n=46) sustained trauma described as involving skin and underlying tissues. Of the labial trauma which involved skin and underlying tissues 76.0% (n=35) was sutured and the remainder unsutured. The survey confirmed a lack of consistency in practice and the need for further research to inform care for women.

Summary Background Many countries now offer support to teenage mothers to help them to achieve long-term socioeconomic stability and to give a successful start to their children. The Family Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the USA and introduced into practice in England that involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained family nurses. We aimed to assess the effectiveness of giving the programme to teenage first-time mothers on infant and maternal outcomes up to 24 months after birth. Methods We did a pragmatic, non-blinded, randomised controlled, parallel-group trial in community midwifery settings at 18 partnerships between local authorities and primary and secondary care organisations in England. Eligible participants were nulliparous and aged 19 years or younger, and were recruited at less than 25 weeks' gestation. Field-based researchers randomly allocated mothers (1:1) via remote randomisation (telephone and web) to FNP plus usual care (publicly funded health and social care) or to usual care alone. Allocation was stratified by site and minimised by gestation ( vs ≥16 weeks), smoking status (yes vs no), and preferred language of data collection (English vs non-English). Mothers and assessors (local researchers at baseline and 24 months' follow-up) were not masked to group allocation, but telephone interviewers were blinded. Primary endpoints were biomarker-calibrated self-reported tobacco use by the mother at late pregnancy, birthweight of the baby, the proportion of women with a second pregnancy within 24 months post-partum, and emergency attendances and hospital admissions for the child within 24 months post-partum. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN23019866. Findings Between June 16, 2009, and July 28, 2010, we screened 3251 women. After enrolment, 823 women were randomly assigned to receive FNP and 822 to usual care. All follow-up data were retrieved by April 25, 2014. 304 (56%) of 547 women assigned to FNP and 306 (56%) of 545 assigned to usual care smoked at late pregnancy (adjusted odds ratio [AOR] 0·90, 97·5% CI 0·64–1·28). Mean birthweight of 742 babies with mothers assigned to FNP was 3217·4 g (SD 618·0), whereas birthweight of 768 babies assigned to usual care was 3197·5 g (SD 581·5; adjusted mean difference 20·75 g, 97·5% CI −47·73 to 89·23. 587 (81%) of 725 assessed children with mothers assigned to FNP and 577 (77%) of 753 assessed children assigned to usual care attended an emergency department or were admitted to hospital at least once before their second birthday (AOR 1·32, 97·5% CI 0·99–1·76). 426 (66%) of 643 assessed women assigned to FNP and 427 (66%) 646 assigned to usual care had a second pregnancy within 2 years (AOR 1·01, 0·77–1·33). At least one serious adverse event (mainly clinical events associated with pregnancy and infancy period) was reported for 310 (38%) of 808 participants (mother–child) in the usual care group and 357 (44%) of 810 in the FNP group, none of which were considered related to the intervention. Interpretation Adding FNP to the usually provided health and social care provided no additional short-term benefit to our primary outcomes. Programme continuation is not justified on the basis of available evidence, but could be reconsidered should supportive longer-term evidence emerge. Funding Department of Health Policy Research Programme.

Fostering Changes is an in-service training program for foster carers designed to enhance carer skills, coping strategies and carer-child relationships. The training program has been evaluated in a randomised controlled trial comparing Fostering Changes to usual care.To conduct a qualitative process evaluation drawing on stakeholder perspectives to describe the logic model of Fostering Changes, identify potential mechanisms of impact of the program and enhance understanding of the trial results.Participants were stakeholders in the Fostering Changes program delivered in Wales, UK including foster carers invited to attend the program (18 attendees, eight non-attendees), two program developers, five trainers, 12 social workers who attended or recruited to the program.Total population sampling with qualitative data collection methods. Qualitative data were subject to thematic analysis.A logic model summarising the program resources, activities and anticipated outcomes was generated. Implementation themes were quality of training, setting and group composition. Mechanisms of impact were identified with themes falling into two categories, group process and skills development. Potential barriers to effectiveness included a poor fit between the carer needs and the program in relation to levels of challenge being faced, age-appropriate content and responsiveness. Contextual factors were also relevant, including the existing relationship between foster carers and the agency and the perceived value of training.Although the group aspects of the program were well received, the program itself did not help foster carers deal with more complex challenges and needed to be more targeted in terms of carers needs and circumstances.

Background\ud\udMany looked after young people in Wales are cared for by foster or kinship carers, usually as a consequence of maltreatment or developmentally traumatising experiences within a family context. Confidence in Care is a pragmatic unblinded individually randomised controlled parallel group trial evaluating a training programme to improve foster carer self-efficacy, when compared to usual care.\udObjective\ud\udTo determine whether group-based training improves foster carer self-efficacy.\udParticipants and setting\ud\udParticipants are foster carers, currently looking after children aged 2+ years for at least 12 weeks. Carers from households where one or more carer had previously attended the training were not eligible. Sixteen local authorities and three independent fostering providers in Wales took part.\udMethods\ud\udThe primary outcome measure was the Carer Efficacy Questionnaire assessed at 12 months. Secondary outcomes included the Strengths and Difficulties Questionnaire, Quality of Attachment Questionnaire, Carer Defined Problems Scale, Carer Coping Strategies, placement moves.\udResults\ud\ud312 consented foster carers were allocated to FC (n = 204) or usual care (n = 108) group. 65.3 % of FC group participants attended sufficient training sessions (8/12, including sessions three and four). There were no differences in carer-reported self-efficacy at 12 months (adjusted difference in means (95 % CI): -0.19 (-1.38 to 1.00)). Small differences in carer-reported child behaviour difficulties and carer coping strategies over time favoured the intervention but these effects diminished from three to 12 months. No other intervention effects were observed.\udConclusions\ud\udAlthough well-received by participants, training was associated with small and mostly short-term benefit for trial secondary outcomes.\ud\ud Previous article

An uncontrolled study with process evaluation was conducted in three U.K. community maternity sites to establish the feasibility and acceptability of delivering a novel breastfeeding peer‐support intervention informed by motivational interviewing (MI; Mam‐Kind). Peer‐supporters were trained to deliver the Mam‐Kind intervention that provided intensive one‐to‐one peer‐support, including (a) antenatal contact, (b) face-to‐face contact within 48 hr of birth, (c) proactive (peer‐supporter led) alternate day contact for 2 weeks after birth, and (d) mother‐led contact for a further 6 weeks. Peer‐supporters completed structured diaries and audio‐recorded face‐to‐face sessions with mothers. Semi-structured interviews were conducted with a purposive sample of mothers, health professionals, and all peer‐supporters. Interview data were analysed thematically to assess intervention acceptability. Audio‐recorded peer‐support sessions were assessed for intervention fidelity and the use of MI techniques, using the MITI 4.2 tool. Eight peer‐supporters delivered the Mam‐Kind intervention to 70 mothers in three National Health Service maternity services. Qualitative interviews with mothers (n = 28), peer‐supporters (n = 8), and health professionals (n = 12) indicated that the intervention was acceptable, and health professionals felt it could be integrated with existing services. There was high fidelity to intervention content; 93% of intervention objectives were met during sessions. However, peer‐supporters reported difficulties in adapting from an expert‐by‐experience role to a collaborative role. We have established the feasibility and acceptability of providing breastfeeding peer‐support using a MI‐informed approach. Refinement of the intervention is needed to further develop peer‐supporters' skills in providing mother‐centred support. The refined intervention should be tested for effectiveness in a randomised controlled trial.

Background: Motivational Interviewing (MI) is a person-centred counselling approach to behaviour change which is increasingly being used in public health settings, either as a stand-alone approach or in combination with other structured programmes of health promotion. One example of this is the Family Nurse Partnership (FNP) a licensed, preventative programme for first time mothers under the age of 20, delivered by specialist family nurses who are additionally trained in MI. The Building Blocks trial was an individually randomised controlled trial comparing effectiveness of Family Nurse Partnership when added to usual care compared to usual care alone within 18 sites in England. The aim of this process evaluation component of the trial is to determine the extent to which Motivational Interviewing skills taught to Family Nurse Partnership nurses were used in their home visits with clients. Methods: Between July 2010 and November 2011, 92 audio-recordings of nurse-client consultations were collected during the 'pregnancy' and 'infancy' phases of the FNP programme. They were analysed using The Motivational Interviewing Treatment Integrity (MITI) coding system. Results: A competent level of overall MI adherent practice according to the MITI criteria for 'global clinician ratings' was apparent in over 70 % of the consultations. However, on specific behaviours and the MITI-derived practitioner competency variables, there was a large variation in the percentage of recordings in which "beginner proficiency" levels in MI (as defined by the MITI criteria) was achieved, ranging from 73.9 % for the 'MI adherent behaviour' variable in the pregnancy phase to 6.7 % for 'percentage of questions coded as open' in the infancy phase. Conclusions: The results suggest that it is possible to deliver a structured programme in an MI-consistent way. However, some of the behaviours regarded as key to MI practice such as the percentage of questions coded as open can be more difficult to achieve in such a context. This is an important consideration for those involved in designing effective structured interventions with an MI-informed approach and wanting to maintain fidelity to both MI and the structured programme. Trial registration: Current Controlled Trials ISRCTN23019866Registered 20/4/2009.

Objectives We compared the US-derived Family Nurse Partnership (FNP) home visiting programme when added to usually provided health and social care for first-time teenage mothers, to usual care alone. We aimed to: establish the nature of usual care, measure service usage and assess performance bias in core usual care services. Design Within trial process evaluation. Local professionals completed a survey mapping local health and social care services in seven domains. This focused on services available to young women, especially those relevant to pregnant teenagers. Descriptive data were assessed thematically to establish the range of services. Quantitative data collection with FNP supervisors enumerated service provision by site. Services identified were included in main participant trial follow-up interviews at four time points to quantify usage. Usage was described descriptively by domain. We explored predictors of health visitor visits. Setting 18 partnerships of local authority and healthcare organisations in England. Outcomes Descriptive framework of services. Rates of service usage reported by trial participants. Results 161 separate services were identified, with multiple service models in each domain, broadly categorised as universal or specialist (eg, for teenage mothers). FNP supervisors identified 30–63 universal services per site and 22–67 specialist services. Use of core maternity care services was similar across trial arms and with only small differences in use of health visiting services. Participants accessed a wide range of services. Women who had ever been homeless, who had a higher subjectively defined social status, and poorer mental health received more visits from a health visitor. Conclusions The large number of services available to teenage mothers in England may limit the incremental benefit achievable through enhanced home visiting. There was little evidence of compensatory practice, such as additional care for women in the usual care arm. Measuring usual care when trialling complex interventions is challenging and essential. Trial registration number NCT23019866.

Individual, social, and economic circumstances faced by teenage mothers can challenge a successful start for children and interrupt mothers' long-term socioeconomic stability. The Family-Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the United States and introduced into practice in England. Family-Nurse Partnership involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained family nurses. This study aimed to assess the effectiveness of providing the program to teenage first-time mothers on infant and maternal outcomes up to 24 months after birth. A pragmatic, nonblinded, randomized controlled, parallel-group trial was conducted in community midwifery settings at 18 partnerships between local authorities and primary and secondary care organizations in England. Eligible participants were nulliparous, aged 19 years or younger, living within the catchment area of a local FNP team, of less than 25 weeks' gestation, and able to provide consent and speak English. Field-based researchers randomly allocated mothers (1:1) via remote randomisation (telephone and Web) to FNP plus usual care (publicly funded health and social care) or to usual care alone. Allocation was stratified by site and minimized by gestation (=16 weeks), smoking status (yes vs no), and preferred language of data collection (English vs non-English). Primary outcomes were tobacco use at late pregnancy (34–36 weeks' gestation), birth weight, emergency attendances, and hospital admissions for the infant within 24 months of birth, as well as the proportion of women with a second pregnancy within 24 months postpartum. Between 2009, and 2010, 3251 women were screened. After enrolment, 823 women were randomly assigned to receive FNP and 822 to usual care. The mean (SD) birth weight of 742 babies with mothers assigned to FNP was 3217.4 (618.0) g, whereas birth weight of 768 babies assigned to usual care was 3197.5 (581.5) g (adjusted mean difference, 20.75 g; 97.5% confidence interval [CI], -47.73 to 89.23). It was found that 587 (81%) of 725 assessed children with mothers assigned to FNP and 577 (77%) of 753 assessed children assigned to usual care attended an emergency department or were admitted to hospital at least once before their second birthday (adjusted odds ratio, 1.32; 97.5% CI, 0.99-1.76). The results of the study indicate that adding FNP to the usually provided health and social care provided no additional short-term benefit to our primary outcomes. The continuation of the program is not justified on the basis of available evidence, but could be reconsidered should supportive longer-term evidence emerge.

AimsThe aim of this study was to explore from the perspectives of key stakeholders involved in the pathway to diagnosis, the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood.MethodsQualitative interviews and free‐text analyses were undertaken in 21 parents with a child diagnosed with type 1 diabetes, 60 parents without a child diagnosed with type 1 diabetes, 9 primary healthcare professionals, 9 teachers and 3 community diabetes liaison nurses. Data were analysed thematically and 30% double coded.ResultsTwo key themes were identified, namely the importance of widespread awareness and knowledge and seeking healthcare professional help. Parents with a child diagnosed with type 1 diabetes described seeking opinions from a number of individuals prior to seeking health professional help. Healthcare professionals recognized the rarity of the condition and the need for it to be kept on their “radar”, to ensure they considered it when examining an unwell child. The process of obtaining a primary healthcare appointment was identified as potentially playing a crucial role in the diagnostic process. However, most parents with a child diagnosed with type 1 diabetes described receiving an appointment on the day they sought it.ConclusionsKnowledge and awareness of type 1 diabetes in childhood remain limited in the general population and misconceptions persist relating to how children present with this serious condition. An effective community‐based intervention to raise awareness amongst key stakeholders is required to ensure children receive a timely diagnosis once symptomatic.

Background Acceptability is an important aspect of the quality of health interventions and also has implications for the feasibility of future implementation. Process evaluations of complex interventions often assess the acceptability of interventions through qualitative interviews with participants, addressing participants’ experience of, satisfaction with and preferences for treatment/services received. Acceptability can be influenced by multiple aspects of an intervention and its context. This paper reflects on two process evaluations which produced complex findings on acceptability: the Delivering Early Care In Diabetes Evaluation (DECIDE) study, a trial of home vs. hospital care following a diagnosis of Type I diabetes (T1D) in children, and the Seal or Varnish (SoV) study which compared fluoride varnish and fissure sealant dental treatments to prevent caries in children. Methods In the DECIDE study, semi-structured interviews with 11 (pairs of) parents and seven children were conducted 15–20 months post-diagnosis about their experience of hospital or home care immediately following diagnosis of T1D. In the SoV study, all children completed a ‘smiley face’ acceptability questionnaire immediately after treatment. In addition, paired semi-structured interviews were conducted with children at the beginning (50 children) and end (32 children) of the intervention, within a few days of receiving treatment. Interviews were divided evenly between trial arms; questions included experience of and acceptability of the interventions, diabetes management (DECIDE) and management of dental health (SoV). Results In the DECIDE study, most interviewees wanted to be randomised to the ‘home’ arm initially but expressed a retrospective preference for whichever trial arm they had been in. This shift in preference may have been influenced by ‘positive attitude’ coping strategies adopted by families. In the SoV study, acceptability immediately post-treatment was related to which treatment was received, but acceptability in the week following treatment was strongly i nfluenced by wider aspects of treatment such as receiving a sticker and there was little difference in overall acceptability by trial arm. Perceptions of overall treatment may have been influenced by the intervention being delivered through a well-established, child-friendly dental service in a school setting. Conclusion Both studies found that acceptability of an intervention can change over time, and indicated that participant restructuring of acceptability can be influenced by wider contextual factors of the intervention. Implications for future research are that the timing of data collection on acceptability may influence findings, and that acceptability (and implications for future implementation) should be interpreted in relation to intervention context.

Background Postpartum Psychosis is a severe mental health condition following childbirth, with a psychosis and associated mood disturbance. Research to date has primarily focused on mothers’ experiences, and on identifying risk factors, aetiology, and intervention efficacy. Within both research and clinical communities, there has been little acknowledgement of partners’ experiences of Postpartum Psychosis, nor the important support role that partners can provide. The aim of this study was to consider the lived experiences of partners of women who have had Postpartum Psychosis, and the impact that it has had on their lives and relationships. Methods Participants (N = 8) were partners recruited through the charity Action on Postpartum Psychosis. Partners completed an in-depth, semi-structured interview regarding their experiences of Postpartum Psychosis. Interpretative Phenomenological Analysis was used to analyse the interview transcripts. Results Seven superordinate themes emerged from the interview data: loss; powerlessness; united vs. individual coping; hypothesising and hindsight; barriers to accessing care and unmet needs; managing multiple roles; and positive changes from Postpartum Psychosis. Conclusions These findings provide a rich illustration of the experiences of partners, including some previously unidentified findings relating to partner hypervigilance to signs of relapse and positive changes in their attitudes and relationships. Areas where support could be provided for partners are also highlighted. Electronic supplementary material The online version of this article (10.1186/s12884-018-2055-z) contains supplementary material, which is available to authorized users.

For young people trying to keep diabetes under control the behaviours can appear simple; e.g. following a healthy diet, regular self-monitoring and exercise. However, clinicians and parents are often frustrated by the gap between the ‘ideal’ and ‘reality’. Young people have conflicting motivations and pressures; a change in behaviour feels too big, the rewards too distant, the personal or financial costs too high, or maybe it was never their idea to change in the first place. Attention has turned to the potential of motivational interviewing in the paediatric setting, particularly with the adolescent age group. Motivational interviewing is a directive person-centred therapeutic style that invites individuals to explore ambivalence and find solutions that fit for them if they identify the situation as a problem. Early trials support the use of motivational interviewing in type 1 diabetes in adolescents, either as a stand-alone treatment or as an adjunct to other treatments where it can be a method of engaging patients in the programmes thus enabling the programmes to be more effective. This paper describes the core principles and key skills of motivational interviewing and offers clinical examples with young people and parents living with diabetes.

Having good intentions to engage in healthy behaviours, to change our lives in a positive direction and make substantial, lasting changes may not always translate into actions or behaviour that is maintained. Motivational Interviewing is a directive person-centred approach designed to explore ambivalence and activate motivation for change [Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behaviour. London: Guilford Press, 1991]. A key component of a motivational interviewing conversation is to acknowledge that clients have every right to make no change. It uses a guiding communication style which invites people to consider their own situation and find their own solutions to situations that they identify as problematic that are preventing change. Motivational Interviewing was first introduced in adult health addiction services in the early 1980s. It has developed in the physical health specialties, and in the last 20 years or so attention has turned to the potential of Motivational Interviewing in the paediatric setting and the challenges of using it in families with children at differing ages and developmental stages. This article summarizes studies published from 2006 to 2011 of Motivational Interviewing in individuals across the lifespan with type 1 and type 2 diabetes and obesity.

Aims To design, develop, and evaluate the feasibility of delivering a multi-component community based intervention to parents and primary health care professionals to raise awareness of the symptoms of Type 1 diabetes (T1D) in childhood in 3 adjoining borough counties of South Wales. Materials and Methods Parent and primary health care advisory groups were established to design the intervention. Qualitative interviews with stakeholders and parents assessed the acceptability, feasibility and any potential impact of the intervention. Results The parent component of the intervention developed was a re-useable shopping bag with the 4 main symptoms of T1D illustrated on the side, based on the road traffic system of red warning triangles and an octagon “stop” sign stating “Seek Medical Help”. Accompanying the bag was an A5 leaflet giving further information. Both were overwrapped with clear plastic and delivered to 98% (323/329) schools, equating to 101 371 children. The primary health care professional component was a dual glucose/ketone meter, single use lancets, stickers, the A5 parent leaflet displayed as a poster and an educational visit from a Community Diabetes Liaison Nurse. 87% (73/84) of GP practices received the intervention, 100% received the materials. The intervention was delivered within Cardiff, the Vale of Glamorgan and Bridgend. Qualitative analyses suggest that the intervention raised awareness and had some impact. Conclusion This study showed that it is feasible and acceptable to design, develop and deliver a community based intervention to raise awareness of T1D. There is some suggestion of impact but a definitive evaluation of effectiveness is still required.

Purpose The purpose of this study was to develop and test the feasibility of a parent-to-parent support intervention for parents whose child has recently been diagnosed with type 1 diabetes in the United Kingdom. Methods The research team conducted a formative evaluation, working with parents to design an individual-level parent-to-parent support intervention. Issues of recruitment, uptake, attrition, pattern of contact, and intervention acceptability were assessed. Results A US program was adapted in collaboration with a parents’ advisory group. Of 19 parents nominated as potential mentors by their pediatric diabetes specialist nurses, 12 (63%) volunteered and 11 continued for the 12-month intervention period. Thirty-three children were diagnosed with diabetes in the study period, with 25 families eligible to participate as recipients of the intervention; 9 parents from 7 of those families participated, representing 28% of those eligible. Feedback from parents and clinic staff identified peer support as a welcome service. Lessons were learned about the nature of the supporting relationship (eg, proximity, connectedness, and managing endings) that will enhance the design of future peer support programs. Conclusions Parent-to-parent support in the context of newly diagnosed childhood diabetes in the United Kingdom is feasible to deliver, with good engagement of mentors and clinic staff. The program was acceptable to parents who chose to participate, although uptake by parents whose child had been recently diagnosed was lower than expected. The results merit further investigation, including exploration of parent preference in relation to peer support.

This paper reports on a peer support programme founded on the principles of Motivational Interviewing, a counselling method with a focus on exploring and helping to resolve ambivalence about behaviour change. Working with the staff and pupils of Ysgol Gyfun Gymraeg Plasmawr in South Wales UK, (referred to as Plasmawr) this work incorporated a combination of observation, interviews with staff and focus groups with pupils to improve understanding of the key factors associated with the peer support programme. The information from these activities is synthesized within a logic model framework summarising the resources, activities, outputs, outcomes and impact. The results indicate that it is feasible and acceptable to stakeholders across the school community to base a peer support programme on Motivational Interviewing. In Plasmawr it would seem that there was a goodness of fit between the ethos, the programme and the training model. With this description of the programme in place it becomes possible to consi...

Aims: The aims of this study were to describe users’ experience of paediatric diabetes services to inform development of an intervention to improve communication between staff and patients in secondary care within a wider study (the DEPICTED Study). Methods: Methods adapted for paediatric settings were used to set up six audio-recorded focus discussion groups with a total of 32 participants. Transcriptions and notes were coded thematically (supported by NVivo software) and analytic themes developed with discussion between researchers. Results: Three main themes developed: the lack of two-way conversation about glycaemic control in clinic settings; the restricting experience of living with diabetes; and the difficult interactions around diabetes the children had with their schools. Doctors in particular were seen as struggling to link these themes of everyday life in their consultations with children and their parents. Children felt marginalized in clinics, despite active involvement in their own blood glucose management at home. Conclusions: Health professionals need to balance a requirement for good glycaemic control with realism and appreciation of their patients’ efforts. There is a need for a systematic approach to consulting, in particular using agenda setting to ensure that the issues of both the patient and the professional are addressed. A framework for a conceptual approach is discussed. How a patient is involved is as important as what is communicated during a consultation

Aims: To explore the experiences of young people and their carers during the transition from child to adult diabetes services. Methods; Longitudinal qualitative case studies of young people and carers undergoing transition in five different diabetes services in the UK. Results: When young people make the transition from child to adult diabetes services, it is assumed that they will also undergo a parallel transition away from dependence on parents to independent diabetes management. However, the lives of young people are characterized by interdependencies, which are facilitative of their diabetes management and which are not always reflected in healthcare policy and practice. This can lead to discontinuities of information and undermine mothers’ ability to continue to support their child into young adulthood. Mothers also lose contact with the service at a time when they are undergoing developmental challenges of their own and need support in adjusting to a new existence. Conclusions: There is a clear need to develop service structures

Motivational interviewing (MI) is a relatively new approach to counselling which has been developed largely in the addiction field. The method is patient-centred and helps resolve ambivalence about behaviour change whilst avoiding conflict and advice-giving by the clinician. This approach has qualities which seem particularly appropriate when dealing with teenagers. Recent evidence from clinical trials shows that motivational interviewing may be effective in facilitating healthier approaches to diet and exercise in young people and improved glycaemic control and quality of life in teenagers with diabetes. These findings suggest that MI has a role to play in the management of childhood chronic disease such as diabetes, but the future challenge is how to incorporate these principles into routine clinical practice given the general shortage of skilled, trained psychologists.

Introduction: The Department of Health figures indicate that 85,000 patients in England have home oxygen at an annual cost of about £120million (DOH, COPD Commissioning Toolkit, 2012.) It is thought that between 24% and 43% of oxygen that was ordered was not used or derived no clinical benefit. The NHS was charged for each patient who was supplied oxygen regardless whether it was used or not. This poor compliance led to waste. Home oxygen was ordered by healthcare professionals with no specialist training regarding home oxygen. Patients on oxygen were not regularly reviewed so their orders of oxygen were not changed according to their current need. Aims and objectives: The aim was to set up a specialist service to assess and review patients regarding home oxygen. Methods: The introduction of a specialist assessment and review service was to improve patient care, to educate patients and carers, to ensure patients are receiving an appropriate order of home oxygen and to reduce the annual spend. One Band 7 Physiotherapist was appointed to assess and review patients in Portsmouth. A new regional contract was started in 2012. Results: Since the setting up there have been service improvements and financial savings made. Conclusions: An assessment and review service ensures patients have the correct oxygen order and reduces waste initially . Home oxygen assessment and review service provides information to patients and their carers regarding home oxygen and give a central point of contact.

There is a growing professional concern regarding the existence of pro eating disorder (pro-ED) websites. Previous research investigating the impact of pro-ED websites has comprised analyses of website content and experimental exposure of mock pro-ED content with participants from non-clinical populations. The few studies involving the assessment of pro-ED website use in individuals with eating disorders have predominantly used online survey methodology. The findings from these studies suggest that pro-ED websites may have a detrimental impact on emotional and physical wellbeing. The present study sought to explore the function and impact of pro-ED websites in a clinical sample of individuals in treatment for an eating disorder. Participants were recruited through tier two community mental health teams and tier three specialist eating disorder services within two NHS Health Boards in South Wales. Individual face to face interviews were conducted with seven adult females receiving treatment for an eating disorder who had disclosed historic or current use of pro-ED websites. Constructivist Grounded Theory was used to analyse the data. Five key themes were identified within the interview transcripts: fear, cognitive dissonance, social comparisons, shame, and pro-ED website maintaining eating disordered behaviour. Pro-ED websites were often used to reduce a sense of social isolation, fuelled by stigma and shame associated with the eating disorder and use of pro-ED websites. Individuals experienced cognitive dissonance regarding their use of pro-ED websites, and the websites were often used to protect themselves from pressures to recover. The pro-ED websites appeared to offer a sense of support, validation and reassurance, whilst simultaneously reinforcing and maintaining eating disordered behaviour. Websites were often used to motivate food restriction, and were at times used as a method of punishment when individuals experienced self-criticism. The findings are discussed in relation to implications for eating disorder treatment services and recommendations for future research are outlined.

Diabetes is a chronic condition with a significant impact on short- and long-term health. In adolescence, diabetes management is further complicated by a complex interaction of physical and psychosocial factors which teenagers, parents and healthcare professionals often find difficult to manage. There are few indicators of practical and effective psychosocial interventions; however, motivational interviewing has been shown to be effective in a range of healthcare settings. This article describes the clinical application of ideas developed from two research studies looking at the effectiveness of motivational interviewing with teenagers with diabetes.

Aims: To obtain preliminary data on the impact of motivational interviewing, a counselling approach to behaviour change, on glycaemic control, wellbeing, and self-care of adolescents with diabetes. Methods: Twenty two patients aged 14–18 years participated in motivational interviewing sessions during a six month intervention. The effects of the intervention on HbA1c and a range of psychological factors were assessed. Results: Mean HbA1c decreased from 10.8% to 9.7% during the study and remained significantly lower after the end of the study. Fear of hypoglycaemia was reduced and diabetes was perceived as easier to live with. There were no other significant changes in the psychological measures. By contrast no reduction in HbA1c values was observed in a comparison group who did not receive the motivational interviewing intervention. Conclusion: The findings of this pilot study indicate that motivational interviewing may be a useful intervention in helping adolescents improve their glycaemic control. A larger, longer term randomised controlled study is indicated to clarify the mechanisms and extent of these benefits.