A Scoping Review of Mental Health and Wellbeing Outcome Measures for Children and Young People: Implications for Children in Out-of-home Care.

Purpose: One of the challenges for mental health research is the lack of an agreed set of outcome measures that are used routinely and consistently between disciplines and across studies in order to build a more robust evidence base for how to better understand young people's mental health and effectively address diverse needs. Methods: This study involved a scoping review of reviews on consensus of the use of mental health and wellbeing measures with children and young people. We were particularly interested to identify if there are differences in measures that are recommended for children and young people with care experience including those with developmental disabilities. Findings: We identified 41 reviews, of which two had a focus on child welfare settings, three on childhood trauma and 14 focused on children and young people with developmental disabilities. Overall, our review highlights a lack of consensus and a diversity of measures within the field. We identified 60 recommended measures, of which only nine were recommended by more than one review. Conclusions: Our review highlights the need for greater agreement in the use of mental health outcome measures. While our review highlights that there is value in identifying measures that can be used with any child or young person, researchers need to take into account additional considerations when working with children and young people with care experience and those with developmental disabilities, to ensure measures are accessible and sensitive to their life experiences.

Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study.

INTRODUCTION: Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support adolescents with ADHD, ecologically valid interventions that can be embedded in daily life to target the most proximal antecedents of these challenges are needed. Ecological momentary assessment (EMA) designs are ideally suited to meeting this need. METHODS AND ANALYSES: In the mental health in the moment ADHD study, we will use an EMA design to capture the daily life experiences of approximately 120 adolescents aged 11-14 years with a clinical diagnosis of ADHD and the same number of age-matched and gender-matched peers without a diagnosis of ADHD. We will combine this with comprehensive information gathered from online surveys. Analysing the data using techniques such as dynamic structural equation modelling, we will examine, among other research questions, the role of emotion regulation and peer problems in mediating the links between characteristics of ADHD and commonly co-occurring outcomes such as anxiety, depression and conduct problems. The results can help inform interventions to support improved peer functioning and emotion regulation for adolescents with ADHD. ETHICS AND DISSEMINATION: This study received a favourable ethical opinion through the National Health Service ethical review board and the University of Edinburgh PPLS Research Ethics panel. The results will be disseminated through journal publications, conferences and seminar presentations and to relevant stakeholders, such as those with ADHD, their families and clinicians.

Validation of the family focused mental health practice questionnaire in measuring health and social care professionals' family focused practice.

BACKGROUND: Parental mental illness is a major public health issue and there is growing evidence that family focused practice can improve outcomes for parents and their families. However, few reliable and valid instruments measure mental health and social care professionals' family focused practice. OBJECTIVES: To explore the psychometric properties of the Family Focused Mental Health Practice Questionnaire in a population of health and social care professionals. METHODS: Health and Social Care Professionals (n = 836) in Northern Ireland completed an adapted version of the Family Focused Mental Health Practice Questionnaire. Exploratory factor analysis was used to test the structure of the underlying dimensions in the questionnaire. The results, and theoretical considerations, guided construction of a model that could explain variation in respondents' items. This model was then validated using confirmatory factor analysis. RESULTS: Exploratory factor analysis revealed that solutions including 12 to 16 factors provided a good fit to the data and indicated underlying factors that could be meaningfully interpreted in line with existing literature. From these exploratory analyses, we derived a model that included 14 factors and tested this model with Confirmatory Factor Analysis. The results suggested 12 factors that summarized 46 items that were most optimal in reflecting family focused behaviours and professional and organizational factors. The 12 dimensions identified were meaningful and consistent with substantive theories: furthermore, their inter-correlations were consistent with known professional and organizational processes known to promote or hinder family focused practice. CONCLUSION: This psychometric evaluation reveals that the scale provides a meaningful measure of professionals' family focused practice within adult mental health and children's services, and the factors that hinder and enable practice in this area. The findings, therefore, support the use of this measure to benchmark and further develop family focused practice in both adult mental health and children's services.

What makes for effectiveness when starting early - Learning from an integrated school-based violence and abuse prevention programme for children under 12.

BACKGROUND: Integrated programmes addressing varying forms of violence and abuse are increasingly delivered to children under 12 but uncertainty remains about what should be delivered to whom, when and in what dose. OBJECTIVE: To examine the impact of Speak Out Stay Safe (SOSS) - an integrated prevention programme for children under 12 - and whether impact varied by age, gender and context. PARTICIPANTS AND SETTING: A representative UK sample of primary schools in receipt of SOSS was matched with comparison schools not receiving SOSS. At 6 months follow-up, 1553 children from 36 schools completed the survey. METHODS: The matched control study incorporated economic and process evaluations. Survey measures included: children's knowledge and understanding of different forms of violence and abuse, readiness to seek help, knowledge of sexual abuse, perceptions of school culture and health and wellbeing. Perceptions of children, teachers, and facilitators were captured. RESULTS: At 6 months, children aged 9-10 who received SOSS retained their improved knowledge of neglect and their ability to identify a trusted adult who they would tell about violence or abuse. Children aged 6-7 receiving a shorter version of the programme were less likely to benefit and boys made fewer gains than girls. SOSS improved the knowledge of children with low knowledge of abuse. School culture was closely associated with programme impact. CONCLUSION: School-based prevention programmes deliver benefits at low cost but should acknowledge and engage with the specific school context to achieve school readiness and embed programme messages.

Systematic Review and Meta-analysis: Group-Based Interventions for Treating Posttraumatic Stress Symptoms in Children and Adolescents.

OBJECTIVE: Trauma exposure in childhood is common and can lead to a range of negative mental health outcomes, including posttraumatic stress disorder (PTSD). In many settings, resources to address this distress are scarce. Group-based interventions require minimal resources and training, can be delivered by non-mental health specialists, and target larger numbers of children and adolescents. This meta-analysis sought to establish whether such an approach is an effective method for targeting PTSD symptoms and to identify potential moderators of effectiveness. METHOD: PubMed, PsycNET, and PTSDPubs were searched for randomized controlled trials that used a group-based PTSD intervention with children and adolescents aged 6 to 18 years. Data were extracted for PTSD symptoms and depression symptoms. A random-effects meta-analysis was conducted to obtain between-group pooled effect size estimates. This study was registered on PROSPERO (CRD42020187214). RESULTS: The initial search identified 9,650 studies, of which 42 were eligible for inclusion (N = 5,998). Children randomized to a group-based intervention had significantly lower PTSD symptoms after treatment compared with a control group, with a medium pooled effect (g = -0.55, 95% CI [-0.76, -0.35]). Group interventions were superior when compared with either active or passive controls, at follow-up, and for depression symptoms. There was a large amount of heterogeneity, but no evidence that this was explained by whether the intervention was delivered in a low- and middle-income or high-income country, included caregivers, or was universal or targeted. CONCLUSION: Group PTSD interventions, particularly cognitive-behavioral therapy-based interventions, are effective at targeting posttrauma distress in children and adolescents. There was evidence of effectiveness when delivered in highly complex and resource-scarce settings and to a range of trauma-exposed groups, including groups exposed to war/conflict, natural disasters, and abuse.

Risk and protective factors for children's psychopathology in the context of domestic violence - A study using nationally representative longitudinal survey data.

BACKGROUND: Little is known about the causal pathways through which domestic violence affects children's internalising, externalising and prosocial behaviours over time, and the role that risk and protective factors play in mediating and moderating direct effects. OBJECTIVE: We explored how different risk and protective factors affect children's psychopathology in the context of domestic violence. We focused on the mother and child bond and explored if this moderates or mediates the effect of domestic violence on children's internalising, externalising and prosocial behaviours. PARTICIPANTS AND SETTING: A prospective longitudinal nationally representative study of children in Scotland aged 6 to 13 years (N:2554). METHODS: Multivariate logit models, moderation and mediation analysis. RESULTS: Domestic violence exposure predicted higher internalising and externalising behaviours and lower prosocial skills (e.g. OR2.17, 95%CI 1.15-4.08 for externalising symptoms). Children with a strong mother-child bond had lower odds of internalising and externalising symptoms, and were more likely to manifest prosocial skills (OR4.14, 95%CI 3.09-5.55). We found evidence that the mother-child relationship both moderated and mediated the effect that domestic violence exposure had on children's internalising, externalising and prosocial scores. The mediation effect was strongest for prosocial behaviours, and strongest in cases where the abuse was less intense. CONCLUSIONS: We show how domestic violence directly and indirectly affects children, via the mother-child relationship. We propose a model which could explain how the mother-child bond both mediates and moderates the effect of domestic violence on children's psychopathology. Our findings suggest mothers need support to in turn support children in the context of domestic violence.

Data resource profile: the Edinburgh Child Protection Dataset - a new linked administrative data source of children referred to Child Protection paediatric services in Edinburgh, Scotland.

Introduction: Child maltreatment affects a substantial number of children. However current evidence relies on either longitudinal studies, which are complex and resource-intensive, or linked data studies based on social services data, which is arguably the tip of the iceberg in terms of children who are maltreated. Reliable, linked, population-level data on children referred to services due to suspected abuse or neglect will increase our ability to examine risk factors for, and outcomes following, abuse and neglect. Objective: The objective of this project was to create a linkable population level dataset, The Edinburgh Child Protection Dataset (ECPD), comprising all children referred to the Edinburgh Child Protection Paediatric healthcare team due to a concern about their welfare between 1995 and 2015. Methods: The paper presents the process for creating the dataset. The analyses provide examples of available data from the main referrals dataset between 1995 and 2011 (where data quality was highest). Results: 19,969 referrals were captured, relating to 11,653 children. Of the 19,969 referrals, a higher proportion were girls (54%), although boys were referred for physical abuse more often than girls (41% versus 30%). Younger children were more likely to be referred for physical abuse (35% of 0-4 year olds vs. 27% 15+): older children were more likely to be referred for sexual abuse (48% of 15+ years vs. 18% of 0-4 years). Most referrals came from social workers (46%) or police (31%). Conclusions: The ECPD offers a unique insight into the characteristics of referrals to child protection paediatric services over a key period in the history of child protection in Scotland. It is hoped that by making these data available to researchers, and able to be easily linked with both mother and child current and future health records, evidence will be created to better support maltreated children and monitor changes over time.

An agenda for future research regarding the mental health of young people with care experience.

Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high-quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under-studied populations; under-studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.

Intimate partner violence and child maltreatment in Scotland - Insights from nationally representative longitudinal survey data.

BACKGROUND: Research on child maltreatment in the context of intimate partner violence (IPV) rarely draws on nationally representative samples, and rarely accounts for maternal, paternal and child reports of parental aggression towards children separately. OBJECTIVE: We explore if living with IPV makes children more likely to be smacked or slapped by their parents. PARTICIPANTS AND SETTING: A prospective longitudinal and nationally representative child cohort study for Scotland (starting sample N:5217). METHODS: Questions for children at ages 2-7 include: maternal and paternal reports of aggression towards children; children's reports of being 'smacked' by parents; maternal reports of IPV. Multivariate logit models explore how maternal IPV is associated with child maltreatment, controlling for socio-economic confounders. RESULTS: In homes with a long-term abusive partner, children are more likely to have been smacked/slapped by the father (OR1.91, p ≤ 0.05), mother (OR1.84 p ≤ 0.05), and both parents (OR2.31, p ≤ 0.05). Maternal IPV frequency and intensity was incrementally associated with children's odds of being smacked/slapped (OR range 1.47-1.70, p ≤ 0.05). Ethnic minority boys were more likely (predicted probability of 42 % p ≤ 0.05) to have been smacked/slapped by their mother frequently compared to other children (predicted probability range: 19-27 %). CONCLUSIONS: When mothers report IPV, the extent and severity of the abuse is incrementally associated with children's experiences of parental aggression, and ethnic minority boys are far more at risk. Parental aggression should be understood within the context of the stresses associated with living with an abusive partner. We discuss the fragmented picture which surveys of children provide when interviewing mainly the mother.

Prevalence and Social Inequality in Experiences of Domestic Abuse Among Mothers of Young Children: A Study Using National Survey Data from Scotland.

Domestic abuse is a pernicious societal issue that has both short- and long-term consequences for those who are victimized. Research points to motherhood being linked to women's victimization, with pregnancy being a particular point of risk. Across UK jurisdictions, new legislation aims to extend the criminalization of domestic abuse to include coercive control. Less clear is the relationship between mothers' victimization of different "types" of abuse and other factors such as age, socioeconomic status, and level of education. The article makes an original contribution to knowledge by addressing these limitations of the existing literature. Using nationally representative data from a Scottish longitudinal survey (N = 3,633) into children's development this article investigates the social stratification of mothers' exposure to different types of abuse, including coercive control, physical abuse, and threats. Overall, 14% of mothers report experiencing any type of domestic abuse since the birth of the study child (age 6), of which 7% experienced physical abuse. Compared to mothers in the highest income households, mothers in the lowest income quintile were far more likely to experience any form of abuse (Logistic Regression, OR = 3.55), more likely to have experienced more types of abuse and to have experienced these more often (OR = 5.54). Age had a protective effect, with mothers aged 20 or younger at most risk of abuse (OR = 2.60 compared to mothers aged 40+). Interaction effects between age and income suggested that an intersectional lens may help explain the cumulative layers of difficulty which young mothers on low incomes may find themselves in when it comes to abusive partners. The pattern of social stratification remained the same when comparing different types of abuse. Mothers of boys were more likely to experience abuse, and to experience more types of abuse, more often. We reflect on how these findings could inform existing policy interventions.

Protocol for the RELATE trial: a feasibility and pilot randomised controlled trial of a low-intensity group intervention for young people in care with elevated posttraumatic stress symptoms.

INTRODUCTION: Young people in out-of-home care have often experienced trauma, such as direct maltreatment or witnessing violence. There is good evidence that rates of mental health difficulties are high in this group, including posttraumatic stress disorder (PTSD), a trauma-specific mental health outcome. There remains less evidence to guide how to effectively address elevated PTSD symptoms (PTSS) in these young people, particularly in ways that are feasible and scalable for stretched social-care and mental health services. METHODS AND ANALYSIS: This protocol describes a feasibility study comprising a pilot two-arm randomised controlled trial (RCT). Participants (N = 50) will be randomised to either (a) a group-based trauma-focused programme (Teaching Recovery Techniques), delivered by mental health practitioners both online and in-person, or (b) care-as-usual. Primarily, the trial aims to explore the key feasibility and protocol acceptability questions, including rates of recruitment and retention, as well as the acceptability of the intervention (particularly the online delivery format) to participants and services. In addition, outcomes including PTSS (primary clinical outcome), depression and functioning will be assessed at baseline (pre-randomisation), post-intervention and at a 3-month follow-up. ETHICS AND DISSEMINATION: Ethical approval has been received from the Health Research Authority (Wales REC1 Ref 20/WA/0100) and University, with further approval from the host trust and social care site. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04467320 . Registered on 13 July 2020.

Chemical novelty facilitates herbivore resistance and biological invasions in some introduced plant species.

Ecological release from herbivory due to chemical novelty is commonly predicted to facilitate biological invasions by plants, but has not been tested on a community scale. We used metabolomics based on mass spectrometry molecular networks to assess the novelty of foliar secondary chemistry of 15 invasive plant species compared to 46 native species at a site in eastern North America. Locally, invasive species were more chemically distinctive than natives. Among the 15 invasive species, the more chemically distinct were less preferred by insect herbivores and less browsed by deer. Finally, an assessment of invasion frequency in 2,505 forest plots in the Atlantic coastal plain revealed that, regionally, invasive species that were less preferred by insect herbivores, less browsed by white-tailed deer, and chemically distinct relative to the native plant community occurred more frequently in survey plots. Our results suggest that chemically mediated release from herbivores contributes to many successful invasions.

Tree diversity promotes growth of late successional species despite increasing deer damage in a restored forest.

The role of tree diversity in restored forests and its impact on key ecological processes like growth and resistance to herbivory has become increasingly important. We analyzed height growth and white-tailed deer Odocoileus virginianus browsing damage to saplings of 16 broadleaved tree species in a large-scale (13 ha) reforestation experiment in Maryland, USA, where we manipulated tree diversity in 70 1,225-m2 plots. After four growing seasons, higher plot-level tree richness led to increased deer browsing damage (i.e., associational susceptibility). Despite increased deer damage to saplings in mixed plots, tree richness had no overall effect on sapling height growth. However, diversity-height relationships were related to species functional traits. Light demanding species with large leaves and faster growth rates had reduced heights in mixtures, whereas shade-tolerant, slower-growing species generally had either increased or unchanged height growth in diverse tree communities, likely related to increased canopy closure in mixtures relative to monocultures. We show that tree diversity can improve growth of late successional species despite exacerbated mammalian herbivore damage. By facilitating the establishment of species with a range of life-history strategies, increased tree diversity may enhance ecosystem multi-functionality in the early stages of forest restoration.

Designing Prison-Based Parenting Programs to Maximize Their Outcomes.

Parenting programs are increasingly being offered in prison as governments seek to reduce the negative consequences of parental imprisonment and encourage desistance from crime. However, little is known about the design and delivery of such programs and how this may shape program effectiveness. This article seeks to address this gap by examining how the design and delivery of the Families Matter program for imprisoned adult fathers in Northern Ireland affected its ability to achieve its goals of improving family relationships and fathers' parenting skills. Examples of good practice are offered, as well as challenges that remain to be overcome. It is argued that more attention needs to be paid to the design and delivery of these programs if their ability to achieve long-term improvements in family relationships and parenting skills are to be improved.

Differential effects of biological invasions on coastal blue carbon: A global review and meta-analysis.

Human-caused shifts in carbon (C) cycling and biotic exchange are defining characteristics of the Anthropocene. In marine systems, saltmarsh, seagrass, and mangrove habitats-collectively known as "blue carbon" and coastal vegetated habitats (CVHs)-are a leading sequester of global C and increasingly impacted by exotic species invasions. There is growing interest in the effect of invasion by a diverse pool of exotic species on C storage and the implications for ecosystem-based management of these systems. In a global meta-analysis, we synthesized data from 104 papers that provided 345 comparisons of habitat-level response (plant and soil C storage) from paired invaded and uninvaded sites. We found an overall net effect of significantly higher C pools in invaded CVHs amounting to 40% (±16%) higher C storage than uninvaded habitat, but effects differed among types of invaders. Elevated C storage was driven by blue C-forming plant invaders (saltmarsh grasses, seagrasses, and mangrove trees) that intensify biomass per unit area, extend and elevate coastal wetlands, and convert coastal mudflats into C-rich vegetated habitat. Introduced animal and structurally distinct primary producers had significant negative effects on C pools, driven by herbivory, trampling, and native species displacement. The role of invasion manifested differently among habitat types, with significant C storage increases in saltmarshes, decreases in seagrass, and no significant effect in mangroves. There were also counter-directional effects by the same species in different systems or locations, which underscores the importance of combining data mining with analyses of mean effect sizes in meta-analyses. Our study provides a quantitative basis for understanding differential effects of invasion on blue C habitats and will inform conservation strategies that need to balance management decisions involving invasion, C storage, and a range of other marine biodiversity and habitat functions in these coastal systems.

Mangrove microclimates alter seedling dynamics at the range edge.

Recent climate warming has led to asynchronous species migrations, with major consequences for ecosystems worldwide. In woody communities, localized microclimates have the potential to create feedback mechanisms that can alter the rate of species range shifts attributed to macroclimate drivers alone. Mangrove encroachment into saltmarsh in many areas is driven by a reduction in freeze events, and this encroachment can further modify local climate, but the subsequent impacts on mangrove seedling dynamics are unknown. We monitored microclimate conditions beneath mangrove canopies and adjacent open saltmarsh at a freeze-sensitive mangrove-saltmarsh ecotone and assessed survival of experimentally transplanted mangrove seedlings. Mangrove canopies buffered night time cooling during the winter, leading to interspecific differences in freeze damage on mangrove seedlings. However, mangrove canopies also altered biotic interactions. Herbivore damage was higher under canopies, leading to greater mangrove seedling mortality beneath canopies relative to saltmarsh. While warming-induced expansion of mangroves can lead to positive microclimate feedbacks, simultaneous fluctuations in biotic drivers can also alter seedling dynamics. Thus, climate change can drive divergent feedback mechanisms through both abiotic and biotic channels, highlighting the importance of vegetation-microclimate interactions as important moderators of climate driven range shifts.

Priorities and strategies for improving disabled women's access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps.

BACKGROUND: Domestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies. METHODS: This multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen's model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women's access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach. RESULTS: The three most highly ranked barriers to women's access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women's fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were also considered very feasible. The qualitative analysis identified a range of psychosocial and environmental barriers experienced by this group of women in accessing maternity care. Congruent with the quantitative results, the main themes were lack of awareness and fear of disclosure. Key strategies were identified as demystifying disclosure and creating physical spaces to facilitate disclosure. CONCLUSIONS: The study supports findings of previous research regarding the barriers that women face in accessing and utilising maternity services, particularly regarding the issue of disclosure. But the study provides new evidence on the perceived importance and feasibility of strategies to address such barriers. This is an important step in ensuring practice-based acceptability and ease with which improvement strategies might be implemented in maternity care settings.

Forest Cover Estimation in Ireland Using Radar Remote Sensing: A Comparative Analysis of Forest Cover Assessment Methodologies.

Quantification of spatial and temporal changes in forest cover is an essential component of forest monitoring programs. Due to its cloud free capability, Synthetic Aperture Radar (SAR) is an ideal source of information on forest dynamics in countries with near-constant cloud-cover. However, few studies have investigated the use of SAR for forest cover estimation in landscapes with highly sparse and fragmented forest cover. In this study, the potential use of L-band SAR for forest cover estimation in two regions (Longford and Sligo) in Ireland is investigated and compared to forest cover estimates derived from three national (Forestry2010, Prime2, National Forest Inventory), one pan-European (Forest Map 2006) and one global forest cover (Global Forest Change) product. Two machine-learning approaches (Random Forests and Extremely Randomised Trees) are evaluated. Both Random Forests and Extremely Randomised Trees classification accuracies were high (98.1-98.5%), with differences between the two classifiers being minimal (<0.5%). Increasing levels of post classification filtering led to a decrease in estimated forest area and an increase in overall accuracy of SAR-derived forest cover maps. All forest cover products were evaluated using an independent validation dataset. For the Longford region, the highest overall accuracy was recorded with the Forestry2010 dataset (97.42%) whereas in Sligo, highest overall accuracy was obtained for the Prime2 dataset (97.43%), although accuracies of SAR-derived forest maps were comparable. Our findings indicate that spaceborne radar could aid inventories in regions with low levels of forest cover in fragmented landscapes. The reduced accuracies observed for the global and pan-continental forest cover maps in comparison to national and SAR-derived forest maps indicate that caution should be exercised when applying these datasets for national reporting.

Disabled women's experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study.

BACKGROUND: Women and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women's access to maternity care. METHODS: The aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen's model of healthcare use. The model was congruent with our interest in women's intended/actual use of maternity services and the facilitators and barriers impacting their access to care. Data were generated during 2013 using one-to-one interviews. RESULTS: Five women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences. CONCLUSIONS: Positive staff attitude and empowering women to have control over their own care is crucial in influencing women's access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for under-represented and silenced voices to be heard.

Decision making in child protection: An international comparative study on maltreatment substantiation, risk assessment and interventions recommendations, and the role of professionals' child welfare attitudes.

Child welfare professionals regularly make crucial decisions that have a significant impact on children and their families. The present study presents the Judgments and Decision Processes in Context model (JUDPIC) and uses it to examine the relationships between three independent domains: case characteristic (mother's wish with regard to removal), practitioner characteristic (child welfare attitudes), and protective system context (four countries: Israel, the Netherlands, Northern Ireland and Spain); and three dependent factors: substantiation of maltreatment, risk assessment, and intervention recommendation. The sample consisted of 828 practitioners from four countries. Participants were presented with a vignette of a case of alleged child maltreatment and were asked to determine whether maltreatment was substantiated, assess risk and recommend an intervention using structured instruments. Participants' child welfare attitudes were assessed. The case characteristic of mother's wish with regard to removal had no impact on judgments and decisions. In contrast, practitioners' child welfare attitudes were associated with substantiation, risk assessments and recommendations. There were significant country differences on most measures. The findings support most of the predictions derived from the JUDPIC model. The significant differences between practitioners from different countries underscore the importance of context in child protection decision making. Training should enhance practitioners' awareness of the impact that their attitudes and the context in which they are embedded have on their judgments and decisions.