Beyond AOPs: A Mechanistic Evaluation of NAMs in DART Testing.

New Approach Methodologies (NAMs) promise to offer a unique opportunity to enable human-relevant safety decisions to be made without the need for animal testing in the context of exposure-driven Next Generation Risk Assessment (NGRA). Protecting human health against the potential effects a chemical may have on embryo-foetal development and/or aspects of reproductive biology using NGRA is particularly challenging. These are not single endpoint or health effects and risk assessments have traditionally relied on data from Developmental and Reproductive Toxicity (DART) tests in animals. There are numerous Adverse Outcome Pathways (AOPs) that can lead to DART, which means defining and developing strict testing strategies for every AOP, to predict apical outcomes, is neither a tenable goal nor a necessity to ensure NAM-based safety assessments are fit-for-purpose. Instead, a pragmatic approach is needed that uses the available knowledge and data to ensure NAM-based exposure-led safety assessments are sufficiently protective. To this end, the mechanistic and biological coverage of existing NAMs for DART were assessed and gaps to be addressed were identified, allowing the development of an approach that relies on generating data relevant to the overall mechanisms involved in human reproduction and embryo-foetal development. Using the knowledge of cellular processes and signalling pathways underlying the key stages in reproduction and development, we have developed a broad outline of endpoints informative of DART. When the existing NAMs were compared against this outline to determine whether they provide comprehensive coverage when integrated in a framework, we found them to generally cover the reproductive and developmental processes underlying the traditionally evaluated apical endpoint studies. The application of this safety assessment framework is illustrated using an exposure-led case study.

Health promotion in an Australian Aboriginal community: the Growing Strong Brains® toolkit.

AIM: The aim of this paper is to describe the implementation and evaluation of the Growing Strong Brains® (GSB) toolkit in a remote Aboriginal community in Western Australia (WA) over a 2-year period, 2018-2019. BACKGROUND: Ngala, a community service organisation in WA, developed the GSB toolkit in 2014, a culturally appropriate and interactive resource to build knowledge of early childhood development within Aboriginal communities. This was in response to evidence that a higher percentage of children in Aboriginal communities were developmentally vulnerable compared to the rest of the population. The GSB toolkit promotes awareness and understanding of early brain development pre-birth and in the early years of a child's life. METHODS: The project was underpinned by participatory action research (PAR). Reflective PAR review cycles (n = 5) monitored local community engagement, navigated challenges and utilised community strengths. Fifty-nine local service providers attended a 2-day formal training. Data were collected by using various methods throughout the project, including feedback following training, focus groups, surveys, one-on-one interviews using yarning techniques and reflective feedback from the Project Lead. FINDINGS: Establishing local Aboriginal project staff was pivotal to the success of the project. When delivering services for and with Aboriginal people, it is essential that cultural competence, safety and decision-making is carried through from planning to implementation and evaluation, and involves genuine, respectful and authentic relationships. Sufficient time allocation directed towards building relationships with other service providers and local community members needs to be considered and built into future projects.The Growing Strong Brains® project is embedded within the local community, and anticipated implementation outcomes were achieved. The support of the local people and service providers was beyond expectation, enabling the building of local capacity, and the development of a common understanding of the key messages from the GSB toolkit to allow integration throughout all levels of the community. This project has been important to build on the strategies necessary to introduce, implement and evaluate the GSB toolkit in other remote Aboriginal communities.

Highly Insulated Wall Systems with Exterior Insulation of Polyisocyanurate under Different Facer Materials: Material Characterization and Long-Term Hygrothermal Performance Assessment.

The application of exterior insulation in both new construction and retrofits is a common practice to enhance the energy efficiency of buildings. In addition to increased thermal performance, the rigid insulation can serve to keep the sheathing board warm and serve as a water-resistive barrier to keep moisture-related problems due to condensation and wind-driven rain. Polyisocyanurate (PIR) rigid boards have a higher thermal resistance in comparison to other commonly used exterior insulation boards. However, because of its perceived lower permeance, its use as exterior insulation is not very common. In this study, the hygrothermal property of PIR boards with different facer types and thicknesses is characterized. The material data obtained through experimental test and extrapolation is used in a long term hygrothermal performance assessment of a wood frame wall with PIR boards as exterior insulation. Results show that PIR with no facer has the smallest accumulated moisture on the sheathing board in comparison to other insulation boards. Walls with a bigger thickness of exterior insulation perform better when no vapor barrier is used. The PIR exterior insulation supports the moisture control strategy well in colder climates in perfect wall scenarios, where there is no air leakage and moisture intrusion. In cases where there is trapped moisture, the sheathing board has a higher moisture content with PIR boards with both aluminum or fiberglass type facers. An innovative facer material development for PIR boards can help efforts targeting improved energy-efficient and durable wall systems.

Handover from operating theatre to the intensive care unit: A quality improvement study.

BACKGROUND: Transitioning a patient from the operating theatre (OT) to the intensive care unit (ICU) is a dynamic and complex process. Handover of the critically ill postoperative patient can contribute to procedural and communication errors. Standardised protocols are means for structuring and improving handover content. Both have been shown to be effective in reducing information omission and improve communication during this transition period. OBJECTIVES: The aim of this uncontrolled before and after study was to improve handover processes and communication about the care for critically ill patients transferred from OT to ICU. METHODS: Thirty-two OT to ICU handovers (16 before and 16 after implementation) were observed. Using a structured tool, we documented who was present, participated in, and initiated handover during ICU admission. Where and when handover was performed, information provided, distractions and interruptions, and handover duration were also recorded. Unstructured field notes and diagrams provided information on staff interaction. Following implementation, semistructured interviews with 27 participants were conducted to understand participants' perceptions of intervention acceptability and to determine factors influencing intervention implementation and spread. FINDINGS: Following implementation, a "hands-off" approach was observed with fewer technical tasks completed during handover (43.8% before implementation vs 12.5% after implementation) without an increase in handover time. A single, multidisciplinary handover most often led by the anaesthetist was observed after implementation. Despite these improvements, the use of the physical checklist was not observed in practice, and an situation, background, assessment, recommendation (SBAR) format was not followed. Anaesthetists leading the handover did not view the handover checklist as being beneficial to their practice although some nurses were observed to use the checklist as a prompt for additional information. CONCLUSIONS: A single, multidisciplinary handover demonstrated improvement in handover practice despite low uptake of the protocol checklist. Further information is required to inform targeted strategies to improve uptake and sustainability although broader interdisciplinary engagement and commitment may be helpful.

Are Different Professionals Ready to Support Children of Parents with Mental Illness? Evaluating the Impact of a Pan-European Training Programme.

A training package (pre-tested in a pilot phase) about supporting children who have parents with a mental illness and/or with substance misuse (COPMI) was developed and delivered to 131 different professionals from six different European Countries. A questionnaire about importance, awareness and competence on the issue (8 items on knowledge and 15 items on skills) was developed and completed by participants before and after the training. The training was evaluated by participants as generally very successful in terms of improving the importance, awareness and competence of their knowledge and skills, with a statistically significant difference in the pre-/post-analyses (no decreases occurred). Different professional groups performed differently in the pre-training self-rating scores. The participants in some countries were mainly drawn from one professional group (i.e. teachers in Finland, social workers in Germany and psychologists in Poland). It was found that stigma was considered an extremely important concern even before the training, whilst country-specific legal issues were not taken into proper account in the training. Some possibilities for further refinement of the training programme are suggested.

Needs, expectations and consequences for children growing up in a family where the parent has a mental illness.

The lack of pan-European guidelines for empowering children of parents with mental illness led to the EU project CAMILLE - Empowerment of Children and Adolescents of Mentally Ill Parents through Training of Professionals working with children and adolescents. The aim of this initial task in the project was to analyse needs, expectations and consequences for children with respect to living with a parent with mental illness from the perspective of professionals and family members. This qualitative research was conducted in England, Finland, Germany, Italy, Norway, Poland and Scotland with 96 professionals, parents with mental illness, adult children and partners of parents with mental illness. A framework analysis method was used. Results of the study highlighted that the main consequences described for children of parental mental illness were role reversal; emotional and behavioural problems; lack of parent's attention and stigma. The main needs of these children were described as emotional support, security and multidisciplinary help. Implications for practice are that professionals working with parents with mental illness should be aware of the specific consequences for the children and encourage parents in their parental role; multi-agency collaboration is necessary; schools should provide counselling and prevent stigma.

Mechanistic understanding of molecular initiating events (MIEs) using NMR spectroscopy.

Toxicological risk assessments in the 21st century are increasingly being driven by the Adverse Outcome Pathways (AOP) conceptual framework in which the Molecular Initiating Event (MIE) is of fundamental importance to pathway progression. For those MIEs that involve covalent chemical reactions, such as protein haptenation, determination of relative rates and mechanisms of reactions is a prerequisite for their understanding. The utility of NMR spectroscopy as an experimental technique for effectively providing reaction rate and mechanistic information for early assessment of likely MIE(s) has been demonstrated. To demonstrate the concept, model systems exemplifying common chemical reactions involved in the covalent modification of proteins were utilized; these involved chemical reactions of electrophilic species (representing different mechanistic classes) with simple amine and thiol nucleophiles acting as surrogates for the reactive groups of lysine and cysteine protein side chains respectively. Such molecular interactions are recognized as critical mechanisms in a variety of chemical and drug toxicities, including respiratory and skin sensitization and liver toxicity as well as being the key mechanism of action for a number of therapeutic agents.

Criterion Validation Testing of Clinical Metrology Instruments for Measuring Degenerative Joint Disease Associated Mobility Impairment in Cats.

INTRODUCTION: Degenerative joint disease and associated pain are common in cats, particularly in older cats. There is a need for treatment options, however evaluation of putative therapies is limited by a lack of suitable, validated outcome measures that can be used in the target population of client owned cats. The objectives of this study were to evaluate low-dose daily meloxicam for the treatment of pain associated with degenerative joint disease in cats, and further validate two clinical metrology instruments, the Feline Musculoskeletal Pain Index (FMPI) and the Client Specific Outcome Measures (CSOM). METHODS: Sixty-six client owned cats with degenerative joint disease and owner-reported impairments in mobility were screened and enrolled into a double-masked, placebo-controlled, randomized clinical trial. Following a run-in baseline period, cats were given either placebo or meloxicam for 21 days, then in a masked washout, cats were all given placebo for 21 days. Subsequently, cats were given the opposite treatment, placebo or meloxicam, for 21 days. Cats wore activity monitors throughout the study, owners completed clinical metrology instruments following each period. RESULTS: Activity counts were increased in cats during treatment with daily meloxicam (p<0.0001) compared to baseline. The FMPI results and activity count data offer concurrent validation for the FMPI, though the relationship between baseline activity counts and FMPI scores at baseline was poor (R2=0.034). The CSOM did not show responsiveness for improvement in this study, and the relationship between baseline activity counts and CSOM scores at baseline was similarly poor (R2=0.042). CONCLUSIONS: Refinements to the FMPI, including abbreviation of the instrument and scoring as percent of possible score are recommended. This study offered further validation of the FMPI as a clinical metrology instrument for use in detecting therapeutic efficacy in cats with degenerative joint disease.

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats.

The robust advances in pain management for companion animals underlie the decision of AAHA and AAFP to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines for Dogs and Cats . The 2015 guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual-patient basis. The guidelines include both pharmacologic and nonpharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention, and treatment of pain in animals. Postsurgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Degenerative joint disease is one of the most significant and under-diagnosed diseases of cats and dogs. Degenerative joint disease is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats. These guidelines support veterinarians in incorporating pain management into practice, improving patient care.

2015 AAHA/AAFP pain management guidelines for dogs and cats.

RATIONALE: The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge. RELEVANCE: Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care. APPROACHES: The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals. EVIDENCE BASE: The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats.

Prevalence of onychectomy in cats presented for veterinary care near Raleigh, NC and educational attitudes toward the procedure.

OBJECTIVE: The current prevalence of onychectomy (declawing) in cats is unknown, and education regarding the procedure appears to vary greatly among veterinary schools. The purpose of this project was to determine the prevalence of onychectomized cats near Raleigh, NC and to document the frequency and style (laboratory or lecture) with which the procedure is taught in USA veterinary schools. ANIMALS: One thousand seven hundred ninety four cats ranging in age from 8 days to 21 years, of which 938 (52.3%) were female and 1719 (95.8%) were sterilized. METHODS: Data were collected over a 10-week period regarding cats seen for appointments in five veterinary facilities (two cat-only, two general, and one tertiary). Data collection included signalment and onychectomy status. During this time, 28 veterinary schools were polled regarding education of veterinary students in onychectomy. RESULTS: Three hundred and seventy four (20.8%) cats had undergone onychectomy. A significantly higher percentage of declawed cats were seen in the general practices compared with the other practice types (p < 0.030). Younger cats had a higher rate of onychectomy (p < 0.001). Twenty-six veterinary schools responded to the survey (93%). Fourteen (54%) of the responding schools did not include in their core curriculum a lecture or surgical laboratory providing instruction in the onychectomy procedure. CONCLUSIONS AND CLINICAL RELEVANCE: Almost 21% of cats seen in veterinary hospitals near Raleigh, NC were declawed. Less than 50% of veterinary schools in the USA include a mandatory lecture or laboratory to teach the procedure. There appears to be a discrepancy between the popularity of the onychectomy procedure and the emphasis placed on relevant instruction in veterinary schools in the USA.

Evaluation of the clinical use of tepoxalin and meloxicam in cats.

Medical records where tepoxalin (Zubrin) or meloxicam (Metacam) were prescribed in cats were reviewed and data extracted. Comparisons were performed for exploring changes between pre- and post-non-steroidal anti-inflammatory drug course laboratory tests. Seventy-nine medical records fit the inclusion criteria (n = 57 and n = 22, tepoxalin and meloxicam, respectively). The median dosages administered were 13 and 0.029 mg/kg(/)day (tepoxalin and meloxicam, respectively). Median prescription durations were 11 (2-919) and 93 (4-1814) days for tepoxalin and meloxicam, respectively. Suspected adverse events were reported for tepoxalin (9%, 5/57 cats) and meloxicam (18%, 4/22 cats) a median of 774 and 448 days, respectively, after the prescription started. For cats prescribed meloxicam, there were several statistically significant changes for serum biochemistry and hematology parameters, but median values were within normal limits. These valuable clinical data suggest that tepoxalin and meloxicam are well tolerated in the clinical setting at the doses prescribed in this study.

A new model of autism spectrum disorder assessment and diagnosis by multiagency community-based teams in primary schools.

BACKGROUND: National guidelines stress the importance of early diagnosis of autism spectrum disorder (ASD). This pilot investigated the feasibility and acceptability of assessing children in their community. METHOD: The pilot study was carried out from August 2007 to January 2009, and the roll-out of the programme started in 2010 and is currently underway. Workers undertook assessments and made a group decision about diagnosis; participant observation of these team meetings explored the decision-making process. Semistructured interviews and focus groups explored the views of parents and professionals. RESULTS: Seventeen children took part in the study: six were diagnosed with ASD; three as not ASD, and eight were referred for further assessment. The model was found acceptable to parents and workers. CONCLUSIONS: With detailed consideration of administration, information, communication and training requirements, this approach has the potential to increase early diagnosis of ASD and reduce demand for specialist assessment.

Owner-assessed indices of quality of life in cats and the relationship to the presence of degenerative joint disease.

This study evaluated the types of items owners consider important to their cats' quality of life (QoL). We hypothesized that items contributing to QoL in cats are predominantly items requiring mobility. The objectives of the study were to describe the types of items considered important by owners for their cats' QoL; to describe the proportion of these items that involve mobility; to evaluate what patient factors, including severity of degenerative joint disease (DJD), affect this distribution; and to evaluate whether the proportion of QoL items involving mobility chosen by owners is different in cats presenting for a DJD study compared with a randomly selected population. A total of 830 client-generated items were evaluated. Regardless of DJD status, 40% of items listed by owners involved mobility, while 60% were 'inactive' items, rejecting our hypothesis. This highlights the need to assess non-active items that owners consider to constitute QoL to fully assess the impact of diseases like DJD and, therefore, the success of therapeutic interventions.

Item generation and design testing of a questionnaire to assess degenerative joint disease-associated pain in cats.

OBJECTIVE: To determine the items (question topics) for a subjective instrument to assess degenerative joint disease (DJD)-associated chronic pain in cats and determine the instrument design most appropriate for use by cat owners. ANIMALS: 100 randomly selected client-owned cats from 6 months to 20 years old. PROCEDURES: Cats were evaluated to determine degree of radiographic DJD and signs of pain throughout the skeletal system. Two groups were identified: high DJD pain and low DJD pain. Owner-answered questions about activity and signs of pain were compared between the 2 groups to define items relating to chronic DJD pain. Interviews with 45 cat owners were performed to generate items. Fifty-three cat owners who had not been involved in any other part of the study, 19 veterinarians, and 2 statisticians assessed 6 preliminary instrument designs. RESULTS: 22 cats were selected for each group; 19 important items were identified, resulting in 12 potential items for the instrument; and 3 additional items were identified from owner interviews. Owners and veterinarians selected a 5-point descriptive instrument design over 11-point or visual analogue scale formats. CONCLUSIONS AND CLINICAL RELEVANCE: Behaviors relating to activity were substantially different between healthy cats and cats with signs of DJD-associated pain. Fifteen items were identified as being potentially useful, and the preferred instrument design was identified. This information could be used to construct an owner-based questionnaire to assess feline DJD-associated pain. Once validated, such a questionnaire would assist in evaluating potential analgesic treatments for these patients.

Cross-sectional study of the prevalence of radiographic degenerative joint disease in domesticated cats.

OBJECTIVE: To determine the prevalence of radiographic signs of degenerative joint disease (DJD) in a randomly selected sample of domestic cats. STUDY DESIGN: Prospective observational study. ANIMALS: Client-owned cats. METHODS: Cats (n=100) from a single practice and equally distributed across 4 age groups (0-5; 5-10; 10-15, and 15-20 years old) were randomly selected (regardless of heath status) and sedated for orthogonal radiographic projections of all joints and the spine. Quasi-Poisson regression analysis was used to investigate the relationship between patient demographics, blood biochemistry, hematologic and urine analysis variables, and DJD severity. RESULTS: Most (92%) cats had radiographic evidence of DJD; 91% had at least 1 site of appendicular DJD and 55% had > or = 1 site of axial column DJD. Affected joints in descending order of frequency were hip, stifle, tarsus, and elbow. The thoracic segment of the spine was more frequently affected than the lumbosacral segment. Although many variables were significantly associated with DJD, when variables were combined, only the association between age and DJD was significant (P<.0001). For each 1-year increase in cat age, the expected total DJD score increases by an estimated 13.6% (95% confidence interval: 10.6%, 16.8%). CONCLUSION: Radiographically visible DJD is very common in domesticated cats, even in young animals and is strongly associated with age. CLINICAL RELEVANCE: DJD is a common disease of domesticated cats that requires further investigation of its associated clinical signs.

The effects of body weight, body condition score, sex, and age on serum fructosamine concentrations in clinically healthy cats.

BACKGROUND: Serum fructosamine (SF) concentrations depend on plasma glucose concentrations and are used to evaluate glycemic control in animals with diabetes mellitus (DM). Despite the strong association between obesity and DM, the effects of body weight (BW) and body condition on SF concentrations in clinically healthy cats have not been reported. OBJECTIVE: The aim of the study was to evaluate the effects of BW, body condition score (BCS), sex, and age on SF concentrations in healthy cats. METHODS: BW, BCS, and SF concentrations were determined in 84 clinically healthy client-owned cats (50 neutered males, 33 spayed females, and 1 intact female) of known age. The cats were enrolled prospectively in the study. RESULTS: Mean BW, median BCS, and mean SF concentrations for the 84 cats were 5.4 kg, 5/9, and 268.7 ± 45.5 µmol/L (range 197-399), respectively. BW was weakly but significantly correlated with SF (r=.26; P=.02), whereas BCS was not. Cats weighing >5.4 kg and cats with BCS>5/9 had higher mean SF concentrations compared with cats weighing <5.4 kg and cats with BCS <5/9, respectively. Cats categorized as normal weight to obese by BW (BW ≥ 4.0 kg) had higher mean SF concentrations compared with cats categorized as lean (BW< 4.0 kg). For domestic shorthair cats, the same was true for BCS: cats with BCS ≥ 4/9 had higher mean fructosamine concentrations than those with BCS<4/9. Male cats had significantly higher mean SF concentrations compared with female cats (285.1 ± 45.3 vs 244.5 ± 33.9 µmol/L, P<.001). Age did not affect mean SF concentrations. CONCLUSIONS: BW is positively correlated with SF concentration, and lean cats have lower SF concentrations than normal and obese cats. In contrast to previous reports, mean SF concentrations were higher in male cats than in female cats, even when males and females were matched based on BW, BCS, and age.

Meniscal mineralization in domestic cats.

OBJECTIVE: To (1) determine prevalence of radiographically detectable meniscal mineralization in domestic cats and (2) to evaluate the association between meniscal mineralization and degenerative joint disease (DJD). STUDY DESIGN: Prospective study. ANIMALS: Client-owned cats (n=100) and 30 feline cadavers. METHODS: Randomly selected client-owned cats were used to determine the prevalence of meniscal mineralization. Stifles from feline cadavers were used to evaluate the relationship between meniscal mineralization (using high-resolution X-ray), radiographic DJD, and cartilage damage. Menisci were evaluated histologically. RESULTS: Forty-six percent of the client-owned cats had meniscal mineralization detected in 1 or both stifles. Pain scores were not significantly different between stifles with meniscal mineralization and those with no radiographic pathology (P=.38). Thirty-four of 57 cadaver stifles had meniscal mineralization, which was always located in the cranial horn of the medial meniscus. Percentage mineralization of the menisci was significantly correlated with the cartilage damage score of the medial femoral (r(2)=0.6; P<.0001) and tibial (r(2)=0.5; P<.0001) condyles as well as with the total joint cartilage damage (r(2)=0.36; P<.0001) score and DJD score (r(2)=0.8; P<.0001). CONCLUSION: Meniscal mineralization is a common condition in domestic cats and seems to indicate medial compartment DJD. CLINICAL RELEVANCE: Clinical significance of meniscal mineralization is uncertain. Further work is needed to determine if the meniscal mineralization is a cause, or a consequence of joint degeneration.

The Effectiveness of a Community Intensive Therapy Team on Young People's Mental Health Outcomes.

BACKGROUND: UK-wide concerns about availability, cost, efficacy and inappropriate use of psychiatric inpatient provision for adolescents have led to the development of new models of intensive community based care. METHOD: This paper describes the Fife Intensive Therapy Team (FITT) model and provides an analysis of HoNOSCA (Health of the Nation Outcomes Scale for Children and Adolescents) data for 57 patients to evaluate the effectiveness of the service. RESULTS: Following intervention by the FITT, a substantial and significant reduction in HoNOSCA scores was recorded. CONCLUSIONS: The apparent success of the model has implications for the future development of acute mental health services for young people.