Need for comprehensive management of frailty at an individual level: European perspective from the advantage joint action on frailty.

OBJECTIVES: ADVANTAGE Joint Action is a large collaborative project co-founded by the European Commission and its Member States to build a common understanding of frailty for Member States on which to base a common management approach for older people who are frail or at risk of developing frailty. One of the key objectives of the project is presented in this paper; how to manage frailty at the individual level. METHODS: A systematic review of the literature was conducted, including grey literature and good practices when possible. RESULTS: The management of frailty should be directed towards comprehensive and holistic treatment in multiple and related fields. Prevention requires a multifaceted approach addressing factors that have resonance across the individual's life course. Comprehensive geriatric assessment to diagnose the condition and plan a personalized multidomain treatment increases better outcomes. Multicomponent exercise programmes, adequate protein and vitamin D intake, when insufficient, and reduction in polypharmacy and inadequate prescription, are the most effective strategies found in the literature to manage frailty effectively. CONCLUSION: Frailty can be effectively prevented and managed with a multidomain intervention strategy based on comprehensive geriatric assessment.

Outcomes of short course interprofessional training in domestic violence and child protection.

The interrelationship between domestic violence and child protection is well established, yet deficiencies in interprofessional collaboration have been reported and training is advocated as a solution. This study evaluates the outcomes of short interagency and interprofessional training in domestic abuse. Participants' attitudes and knowledge were assessed using a self-report scale and compared in a double-baseline time-series design. Participants (N = 177) were recruited from a range of agencies in England. There were consistent, statistically significant improvements in participants' attitudes, knowledge, and self-confidence between the start and end of course (p < .001). The long-term outcomes of training and the implementation of learning, however, remain uncertain.

The organisation of interagency training to safeguard children in England: a case study using realistic evaluation.

BACKGROUND: Joint training for interagency working is carried out by Local Safeguarding Children Boards in England to promote effective local working to safeguard and promote the welfare of children. PURPOSE: This paper reports on the findings of the outputs and outcomes of interagency training to safeguard children in eight Local Safeguarding Children Boards. METHODS: A review of Local Safeguarding Children Board documentation, observations of Local Safeguarding Children Board training sub-group meetings and a series of interviews with training key stakeholders in each Local Safeguarding Children Board were used to assess how partner agencies in the Local Safeguarding Children Boards carried out their statutory responsibilities to organise interagency training. 'Realistic Evaluation' was used to evaluate the mechanisms by which a central government mandate produced particular inter-agency training outputs (number of courses, training days) and joint working outcomes (effective partnerships), within particular Local Safeguarding Children Board contexts. RESULTS: The 'mandated partnership' imposed on Local Safeguarding Children Boards by central government left little choice but for partner agencies to work together to deliver joint training, which in turn affected the dynamics of working partnerships across the various sites. The effectiveness of the training sub group determined the success of the organisation and delivery of training for joint working. Despite having a central mandate, Local Safeguarding Children Boards had heterogeneous funding and training arrangements. These resulted in significant variations in the outputs in terms of the number of courses per 'children in need' in the locality and in the cost per course. CONCLUSIONS: Interagency training which takes account of the context of the Local Safeguarding Children Board is more likely to produce better trained staff, effective partnership working, and lead to better integrated safeguarding children services.