"They Tarred Me with the Same Brush": Navigating Stigma in the Context of Child Removal.

Child removals are increasing in England and Wales. Family court involvement is particularly common among women with multiple disadvantages, and the rates are higher in economically marginalised areas. This article aims to explore women's narratives of child removal within life stories of homelessness and examines how stigma, power and State surveillance manifest in their experiences. Data drawn from qualitative interviews with 14 mothers in the north-east of England who had experienced the removal of their children through the family courts are explored within the wider context of a neoliberal political agenda of "troubled families", and in particular, "deviant mothers". The participants describe how stigma structured their interactions with social services. Despite the known poor outcomes associated with child removal for both mothers and children, professional involvement often tapers off afterwards, with little support for mothers. Drawing on women's accounts, we seek to illuminate their experiences of child removal and enhance our understanding of how stigma plays out in statutory settings, further entrenching social exclusion and ultimately increasing health inequalities.

Social capital and women's narratives of homelessness and multiple exclusion in northern England.

Women experiencing three or more co-occurring issues (homelessness, substance misuse, mental health) are a highly vulnerable population associated with multimorbidity. Taking women's life stories of trajectories into social exclusion in the north of England as its focus, this paper aims to explore the complexity of social contexts in which women navigate extreme health inequalities. Of the few studies that have examined women's experiences of homelessness through the lens of social capital, most have focused on network size, rather than the quality and influence of the relationships which precipitate or contextualise experiences of social exclusion. We utilise case studies to offer a theoretically-grounded analysis which illustrates the relationship between social capital and homelessness within this population. Our results illustrate how structural contexts, and specifically social capital accrual and social bonding processes particularly pertinent to women can act to both ameliorate and perpetuate social exclusion. We conclude by arguing that health inequalities cannot be tackled as single-issue processes but instead are multi-layered and complex.

Effects of the COVID-19 pandemic on reading performance of second grade children in Germany.

In education, among the most anticipated consequences of the COVID-19 pandemic are that student performance will stagnate or decline and that existing inequities will increase. Although some studies suggest a decline in student performance and widening learning gaps, the picture is less clear than expected. In this study, we add to the existing literature on the effects of the COVID-19 pandemic on student achievement. Specifically, we provide an analysis of the short- and mid-term effects of the pandemic on second grade reading performance in Germany using longitudinal assessments from over 19,500 students with eight measurement points in each school year. Interestingly, the effects of the pandemic established over time. Students in the first pandemic cohort even outperformed students from the pre-pandemic cohorts and showed a tendency towards decreased variances during the first lockdown. The second pandemic cohort showed no systematic mean differences, but generally had larger interindividual differences as compared to the pre-pandemic cohorts. While the gender achievement gap seemed unaffected by the pandemic, the gap between students with and without a migration background widened over time-though even before the pandemic. These results underline the importance of considering effects of the pandemic across cohorts, large samples, and fine-grained assessments. We discuss our findings considering the context-specific educational challenges and in terms of practical implications for teachers' professional development.

Shaky Student Growth? A Comparison of Robust Bayesian Learning Progress Estimation Methods.

Monitoring the progress of student learning is an important part of teachers' data-based decision making. One such tool that can equip teachers with information about students' learning progress throughout the school year and thus facilitate monitoring and instructional decision making is learning progress assessments. In practical contexts and research, estimating learning progress has relied on approaches that seek to estimate progress either for each student separately or within overarching model frameworks, such as latent growth modeling. Two recently emerging lines of research for separately estimating student growth have examined robust estimation (to account for outliers) and Bayesian approaches (as opposed to commonly used frequentist methods). The aim of this work was to combine these approaches (i.e., robust Bayesian estimation) and extend these lines of research to the framework of linear latent growth models. In a sample of N = 4970 second-grade students who worked on the quop-L2 test battery (to assess reading comprehension) at eight measurement points, we compared three Bayesian linear latent growth models: (a) a Gaussian model, (b) a model based on Student's t-distribution (i.e., a robust model), and (c) an asymmetric Laplace model (i.e., Bayesian quantile regression and an alternative robust model). Based on leave-one-out cross-validation and posterior predictive model checking, we found that both robust models outperformed the Gaussian model, and both robust models performed comparably well. While the Student's t model performed statistically slightly better (yet not substantially so), the asymmetric Laplace model yielded somewhat more realistic posterior predictive samples and a higher degree of measurement precision (i.e., for those estimates that were either associated with the lowest or highest degree of measurement precision). The findings are discussed for the context of learning progress assessment.

International Perspectives on Understanding and Improving Teachers' Data-Based Instruction and Decision Making: Introduction to the Special Series.

This article serves as an introduction to the special series, Data-Based Instruction and Decision-Making: An International Perspective. In this series, we bring together international researchers from both special and general education to address teachers' use (or non-use) of data for instructional decision making. Via this special series, we aim to increase understanding of the challenges involved in teachers' data-based instructional decision making for students with or at-risk for learning disabilities, and to further the development of approaches for improving teachers' ability to plan, adjust, and adapt instruction in response to data.

Effects of Data-Based Decision-Making on Low-Performing Readers in General Education Classrooms: Cumulative Evidence From Six Intervention Studies.

In most general education classrooms in Germany, students with and without special educational needs are taught together. To support teachers in adapting instruction to these heterogeneous classrooms, we have developed learning progress assessment (LPA) and reading instructional materials, the Reading Sportsman (RS), in line with the theoretical framework of data-based decision-making, which has led to beneficial effects in several studies. However, data from these studies have not been analyzed to examine effects for low-performing readers. Data within and across six quasi-experimental studies conducted by our team in Grades 2 to 4 were reanalyzed to examine the effects of LPA on students whose reading fluency scores were at or below the 25th percentile (n = 1,346 students from 264 classes). In each study, students had been assigned to a control group (with business-as-usual instruction), an LPA group only, or an LPA-RS group (i.e., with teachers provided with LPA and the RS). Separate multilevel regression results were integrated by means of meta-analytical methods to investigate the consistency of results. Overall, findings from the single studies indicated no positive effects of LPA with or without the RS compared with the control group. The integrated analyses showed small positive effect trends on reading fluency and intrinsic reading motivation.

Rehabilitation and transition in military veterans after limb-loss.

PURPOSE: This study aims to explore the physical, psychological and social wellbeing of veterans who have experienced limb-loss and to ascertain the factors that contribute to the ability of veterans to maintain their independence at various stages in their lives. METHODS: Sixty two life-story interviews were conducted with 32 veterans (aged between 40 and 95) who had experienced limb-loss either during or after military service. RESULTS: Three overarching superordinate themes and related sub-themes were generated from a detailed Framework Analysis "Barriers to transition" describes issues related to employment, legal support and compensation, stigma and loss of identity. "Disparity of care" highlights the issues related to military and civilian care and prosthetics service user experience. The final superordinate theme, "Enduring challenge of limb loss," considers stoicism, dealing with pain, mobility, physical isolation and social networks. CONCLUSIONS: The outcomes offer an opportunity to shape future health and social care policy around the requirements of veterans who have experienced limb-loss by understanding the complexity, and ascertaining the factors that contribute to, maintaining long-term independence.Implication for RehabilitationThe outcomes offer an opportunity to shape future health and social care policy around the requirements of veterans who have experienced limb-loss by understanding the complexity, and ascertaining the factors that contribute to rehabilitation and maintaining long-term independence.

'Everything takes too long and nobody is listening': Developing theory to understand the impact of advice on stress and the ability to cope.

Shrinking state spending in the UK has been accompanied by a profound restructuring of the welfare system, leading to financial insecurity for many people, culminating in extreme stress and serious deterioration of physical and mental health. Theory surrounding the impact of welfare advice on stress is lacking; this paper undertakes an in depth exploration of the experiences of stress among welfare advice seekers, considering these in light of existing substantive theories of stress and coping to generate new insight. A thematic analysis explored the experiences of stress in welfare advice seekers. Four overarching themes and twelve subthemes emerged. They are further understood utilising traditional theories of stress (Transactional Model of Stress and Coping and the Conservation of Resources theory), which then underpin the development of a 'Stress Support Matrix' and a holistic theory related specifically to welfare, stress and coping.

How Much g Is in the Distractor? Re-Thinking Item-Analysis of Multiple-Choice Items.

Distractors might display discriminatory power with respect to the construct of interest (e.g., intelligence), which was shown in recent applications of nested logit models to the short-form of Raven's progressive matrices and other reasoning tests. In this vein, a simulation study was carried out to examine two effect size measures (i.e., a variant of Cohen's ω and the canonical correlation RCC) for their potential to detect distractors with ability-related discriminatory power. The simulation design was adopted to item selection scenarios relying on rather small sample sizes (e.g., N = 100 or N = 200). Both suggested effect size measures (Cohen's ω only when based on two ability groups) yielded acceptable to conservative type-I-error rates, whereas, the canonical correlation outperformed Cohen's ω in terms of empirical power. The simulation results further suggest that an effect size threshold of 0.30 is more appropriate as compared to more lenient (0.10) or stricter thresholds (0.50). The suggested item-analysis procedure is illustrated with an analysis of twelve Raven's progressive matrices items in a sample of N = 499 participants. Finally, strategies for item selection for cognitive ability tests with the goal of scaling by means of nested logit models are discussed.

Exposing the impact of intensive advice services on health: A realist evaluation.

Attention has turned to welfare advice as a potential health and social care intervention. However, establishing direct evidence of health impact has proven difficult. This is compounded by the need to understand both the facilitative contexts and mechanisms through which this impact occurs. This study investigated if, how and in which circumstances an intensive advice service had an impact on stress and well-being (as precursors to health impacts), for clients attending a branch of Citizens Advice, located in the North East of England. A mixed methods realist evaluation of three intensive advice services offered by Citizens Advice (CA) was operationalised in five phases: (a) Building programme theories, (b) refining programme theories, (c) Development of a data recording tool, (d) Testing programme theories with empirical data, (e) Impact interviews. This paper focuses on phase 4. The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Perceived Stress Scale (PSS) were completed by 191 clients, with a 91% follow-up rate (data collected: February 2016 to March 2017). Twenty-two CA clients participated in interviews (data collected: October 2015 to November 2016). The PSS indicated a significant decrease in stress from initial consultation to approximately 4-6 weeks post advice from 31.4 to 10.3 (p < 0.001) and the WEMWBS indicated a significant increase in client well-being from a mean of 26.9 to 46.5 (p < 0.001). Nine refined programme theories are presented which combine the qualitative and quantitative analysis; they are underpinned by three abstract theories: Capabilities model, The Decision to Trust Model, and Third Space. An explanatory framework is presented covering the micro, meso, and macro levels of CA. Use of a stress and well-being lens has allowed insight into the precursors of health in those receiving intensive advice. Using these measures whilst explaining contextual and mechanistic properties, begins to build a complex and real picture of how advice services impact on health.

Lay health advisers: scoping the role and intervention landscape.

The use of lay health advisers has become an established approach within public health, in particular for impact on health inequalities and engaging socially excluded groups. Evidence on how differences in terms of the multiple role dimensions impact the outcomes of programs is limited. This creates ambiguity for decision makers on which roles should be implemented in different contexts for different needs. This paper applies realist logic to an inquiry to explore the mechanisms that may operate in lay-led intervention models and understand how, why, and in what respect these lead to particular outcomes. It draws on a project focusing on health-related lifestyle advisers and further insights gained from a subsequent related project about outreach with traveler communities. Analysis highlights multiple and potentially interacting aspects of lay health-adviser roles that may influence their success, including characteristics of lay health advisers, characteristics of target populations, purpose or intent of interventions, and how advice is given. A model is proposed from which to examine the contexts and mechanisms of lay health advisers that may impact outcomes, and is subsequently applied to two examples of reported lay health-adviser interventions. The combination of skills and characteristics of lay health advisers must be considered when planning which interventions might be appropriate when targeting specific needs or target populations. Focus only on the peer/layperson distinction may overlook other potentially important skills and mechanisms of action integral to lay health-adviser roles.

Care planning for long-term conditions ­ a concept mapping.

OBJECTIVE: This article focuses on approaches within clinical practice that seek to actively involve patients with long-term conditions (LTCs) and how professionals may understand and implement them. Personalized care planning is one such approach, but its current lack of conceptual clarity might have impeded its widespread implementation to date. A variety of overlapping concepts coexist in the literature, which have the potential to impair both clinical and research agendas. The aim of this article is therefore to explore the meaning of the concept of care planning in relation to other overlapping concepts and how this translates into clinical practice implementation. METHODS: Searches were conducted in the Cochrane database for systematic reviews, CINHAL and MEDLINE. A staged approach to conducting the concept mapping was undertaken, by (i) an examination of the literature on care planning in LTCs; (ii) identification of related terms; (iii) locating reviews of those terms. Retrieved articles were subjected to a content analysis, which formed the basis of our concept maps. (iv) We then appraised these against knowledge and experience of the implementation of care planning in clinical practice. RESULTS AND CONCLUSIONS: Thirteen articles were retrieved, in which the core importance of patient-centredness, shared decision making and self-management was highlighted. Literature searches on these terms retrieved a further 24 articles. Our concept mapping exercise shows that whilst there are common themes across the concepts, the differences between them reflect the context and intended outcomes within clinical practice. We argue that this clarification exercise will allow for further development of both research and clinical implementation agendas.

Looking after yourself: Clinical understandings of chronic-care self-management strategies in rural and urban contexts of the United Kingdom and Australia.

OBJECTIVES: This article reports on the outcomes of two similar projects undertaken during 2011-2012 in Australia (Rural Northern New South Wales) and the United Kingdom (Urban Northern United Kingdom) that sought to identify the strategies that health professionals employ to actively involve patients with chronic conditions in the planning and delivery of their care. In particular, this study explored understandings and contexts of care that impacted on the participants' practices. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care. METHODS: An ethnomethodological design was used, as ethnomethodology does not dictate a set of research methods or procedures, but rather is congruent with any method that seeks to explore what people do in their routine everyday lives. Focus groups and interviews were employed to explore the strategies used by a range of primary health-care providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. RESULTS: Data from both studies were synthesised and analysed thematically, with the themes reflecting the context, similarities and differences of the two studies that the participants felt had either facilitated or blocked their efforts to support their clients to adopt self-care strategies. CONCLUSION: Supporting patients/clients to engage in actively self-managing their health-care needs requires changes to clients' and clinicians' traditional perspectives on their roles. The barriers and enablers to supporting clients to manage their own health needs were similar across both locations and included tensions in role identity and functions, the discourse of health-care professionals as 'experts' who deliver care and their level of confidence in being facilitators who 'educate' clients to effectively manage their health-care needs, rather than only the 'providers' of care.

Cost-effectiveness of health-related lifestyle advice delivered by peer or lay advisors: synthesis of evidence from a systematic review.

BACKGROUND: Development of new peer or lay health-related lifestyle advisor (HRLA) roles is one response to the need to enhance public engagement in, and improve cost-effectiveness of, health improvement interventions. This article synthesises evidence on the cost-effectiveness of HRLA interventions aimed at adults in developed countries, derived from the first systematic review of the effectiveness, cost-effectiveness, equity and acceptability of different types of HRLA role. METHODS: The best available evidence on the cost-effectiveness of HRLA interventions was obtained using systematic searches of 20 electronic databases and key journals, as well as searches of the grey literature and the internet. Interventions were classified according to the primary health behaviour targeted and intervention costs were estimated where necessary. Lifetime health gains were estimated (in quality-adjusted life years, where possible), based on evidence of effectiveness of HRLAs in combination with published estimates of the lifetime health gains resulting from lifestyle changes, and assumptions over relapse. Incremental cost-effectiveness ratios are reported. RESULTS: Evidence of the cost-effectiveness of HRLAs was identified from 24 trials included in the systematic review. The interventions were grouped into eight areas. We found little evidence of effectiveness of HRLAs for promotion of exercise/improved diets. Where HRLAs were effective cost-effectiveness varied considerably: Incremental Cost effectiveness Ratios were estimated at £6,000 for smoking cessation; £14,000 for a telephone based type 2 diabetes management; and £250,000 or greater for promotion of mammography attendance and for HIV prevention amongst drug users. We lacked sufficient evidence to estimate ICERs for breastfeeding promotion and mental health promotion, or to assess the impact of HRLAs on health inequalities. CONCLUSIONS: Overall, there is limited evidence suggesting that HRLAs are cost-effective in terms of changing health-related knowledge, behaviours or health outcomes. The evidence that does exist indicates that HRLAs are only cost-effective when they target behaviours likely to have a large impact on overall health-related quality of life. Further development of HRLA interventions needs to target specific population health needs where potential exists for significant improvement, and include rigorous evaluation to ensure that HRLAs provide sufficient value for money.