Language impairment and comorbid vulnerabilities among young people in custody.

BACKGROUND: While the prevalence of language and communication difficulties among young people in custody is well established, holistic understanding of the complexity and co-occurrence of additional vulnerabilities among this population are rare. METHODS: Ninety-three young people in a young offenders institution in England were assessed using the Comprehensive Health Assessment Tool, the Test of Word Knowledge, and a range of additional assessments of communication, cognition, and neurodevelopmental difficulties. RESULTS: Forty-seven percent of the young people demonstrated an aspect of language skills significantly below the population average, with more than one in four identified as having impairment. Only one in four of those with an impairment had previously accessed speech and language services. Language needs were associated with difficulties with social communication and nonverbal cognition, as well as higher risk of self-harm and substance misuse. CONCLUSIONS: Earlier identification of language difficulties requires routine assessment of young people at risk of engagement in offending behavior. Where language difficulties are identified, holistic assessments of needs should be undertaken. There is a need for speech and language therapy provision within youth justice services, as well as in other services accessed by young people at risk of engagement in offending.

A systematic scoping review of speech and language therapists' public health practice for early language development.

BACKGROUND: There have been calls for speech and language therapists (SLTs) to work within a public-health framework to support language development. Innovative practice is reported, but the range of services remains unknown. Furthermore, the potential impact of public health practice in speech and language therapy on early child development is also currently unknown. A new method in SLT research, systematic scoping reviews enable greater breadth of focus than traditional systematic reviews when identifying innovative practice. AIM: To report scope and critically appraise evidence of family-focused health-promotion practice for early language development in this area. METHODS & PROCEDURES: Using the Cochrane Public Health Group scoping review framework, data from reports of health-promotion practice with families of children aged 0-3 years were extracted and critically appraised on service delivery, information, reach and evaluation. MAIN CONTRIBUTION: Group-based service delivery was the most popular form of service delivery. There were limited reports on the information given in services and on their reach. Questionnaires were the most popular reported evaluation method. Quality of evaluations was poor due to lack of replicability and experimental control in the studies reported. CONCLUSIONS & IMPLICATIONS: This method of systematic review has highlighted the scope of health-promotion practice in speech and language therapy and also demonstrated the lack of evidence for its effectiveness on child language development. It is argued that systematic scoping reviews are valuable for scoping innovative practice in areas where either there is a lack of robust evidence or there is a high level of heterogeneity in practice or evaluation. To support clinician appraisal of available evidence, recommendations are given for development of questionnaire appraisal and for categorization of evidence levels on summary databases.

Supporting staff to respond effectively to informal complaints: findings from an action research study.

AIM AND OBJECTIVE: To understand how nurses and midwives manage informal complaints at ward level. BACKGROUND: The provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service in the UK to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives. DESIGN: Collaborative action research. METHODS: Four phases of data collection and analysis relating to primarily one National Health Service trust during 2011-2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust. RESULTS: Three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems. CONCLUSIONS: Current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints. RELEVANCE TO CLINICAL PRACTICE: Robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience.

Gatekeeping access to the midwifery unit: Managing complaints by bending the rules.

While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way, the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gatekeeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values.

Women's attitude towards the use of complementary and alternative medicines (CAM) in pregnancy.

BACKGROUND: the popularity of non-prescription, over-the counter (OTC) medicines, vitamins, minerals, homoeopathic remedies and herbal supplements (CAM) has grown significantly in recent years. However, we have limited knowledge relating to why pregnant women use CAM and how this may relate to the provision of maternity care. Using an interview approach this study explored the nature of over-the-counter and complementary medicines use in a sample of pregnant women. METHODS: this interview study formed part of a larger self-administered questionnaire survey on the extent of CAM use in pregnancy at large NHS Trust in England. The questionnaire provided the opportunity for women to complete a contact information reply slip if they were happy for follow-up interview. Audio recorded, face to face interviews were undertaken with a sample of 10 women. RESULTS: the reasons the women who were interviewed gave for using CAM broadly fell into two areas centred essentially on the contrasting advantages of CAM and disadvantages of conventional medicine. Doctors or midwives were rarely informed about the use of CAM medicines during pregnancy. CONCLUSION: the women saw CAM as outside of biomedicine and part of a holistic approach to health and well-being over which they are able to maintain their personal control. Non-disclosure of CAM use was common, a feature of which, appears to be some health-care professionals' lack of realisation of the importance, to women, of a holistic approach to their health, key to which is a desire to retain control over decisions associated with their well-being.