Qualitative studies of the lived experiences of being in foster care: A scoping review protocol.

The aim of this scoping review is to provide an overview of the existing qualitative research concerning the lived experiences of children and young people currently in foster care. INTRODUCTION: Lived experience of foster care is an area of limited research. Studies tend to focus on foster caregiver retention rates, education performance outcomes, evaluations and policy development. Although these studies are important, they provide little insight into the everyday lives of those currently in foster care, which is likely to influence these previous areas of research. METHODS AND ANALYSIS: The scoping review will be guided by Arksey and O'Malley's approach to scoping studies. A systematic database search of PubMed, CINAHL and PsycINFO will be conducted followed by a systematic chain search of referenced and referencing literature. English-language peer-reviewed qualitative studies of children and young people currently in foster care will be included. We will exclude studies linked to transitioning out of foster care and studies with samples mixed with other types of out-of-home care. Mixed-methods studies will be excluded in addition to programme, treatment or policy evaluations. Following removal of duplicates, titles and abstracts will be screened, followed by a full-text review. Two researchers will independently screen references against inclusion and exclusion criteria using Covidence software. The quality of the included studies will be assessed by two independent reviewers using the appropriate Critical Appraisal Skills Programme checklist. ETHICS AND DISSEMINATION: Information gathered in this research will be published in peer-reviewed journals and presented at national and international conferences relevant to foster care services and quality improvement. Reports will be disseminated to relevant foster care agencies, where relevant. Ethical approval and informed consent are not required as this protocol is a review of existing literature. Findings from the included studies will be charted and summarised thematically in a separate manuscript.

Key features of adolescent inpatient units and development of a checklist to improve consistency in reporting of settings.

WHAT IS KNOWN ON THE SUBJECT?: Little is known about adolescent inpatient units, key features which define them, and how these essential services operate and deliver care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Adolescent inpatient unit studies are limited in their descriptions of settings in terms of how they operate and key features. The proposed preliminary checklist is a practical tool to assist clinicians, policy makers, and researchers when reporting to ensure comprehensive descriptions of adolescent inpatient settings. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This could be used to inform service design processes for inpatient and other mental health service models which is of critical importance in the context of reforms and implementation of these in Australia currently. Greater attention to operational models, services, and philosophies of practice will improve reporting and allow for the advancement of knowledge, comparison of study results, and a clearer direction for mental health nursing clinicians and researchers. ABSTRACT: Introduction Adolescent inpatient units care for vulnerable population groups; however, little is known about how these essential services operate and deliver care. Aims To examine the descriptions of adolescent mental health inpatient units in Australian and international research publications and to identify key features which were used to define them. A secondary aim was to develop a checklist to improve consistency when reporting on the operations and services delivered within adolescent mental health inpatient units (both public and private). Methods Five electronic databases (CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO) were systematically searched. We included studies that provided descriptions of operations and services within adolescent inpatient units where participants had a mean age between 12 and 25. Narrative synthesis was used to explore the similarities and differences between descriptions of settings. Results Twenty-eight studies were identified, which varied in their descriptions of adolescent inpatient units, providing inconsistent information to inform best practice. Discussion Studies lack consistency and comprehensive detail when describing the operational models within inpatient units, making interpretation challenging. Consequently, a preliminary checklist is proposed to improve reporting of adolescent inpatient units.

Executive Function Improves Following Acute Exercise in Adults with Down Syndrome.

The influence of exercise on brain function is an important topic, especially in persons with intellectual deficits. The aim of this study is to determine the effect of an acute bout of resistance training (RT) compared to assisted cycle therapy (ACT) and no training (NT) in adults with DS on cognitive function. Fourteen participants attended four sessions: a baseline assessment, an assisted cycling therapy (ACT) session, a resistance training (RT) session, and a session of no training (NT). In the RT session, the leg press, chest press, seated row, leg curl, shoulder press, and latissimus pulldown were performed. The ACT session consisted of 30 min of cycling and in NT session consisted of 20 min of board games. Inhibition was measured by the Erikson flanker task and cognitive planning was measured by the Tower of London test and both were administered prior to (pretest) and after each intervention (posttest). Our results showed that inhibition time improved more following RT and ACT than NT. There was also a significant difference between ACT and NT. For cognitive planning, improvements were seen following ACT and NT. In conclusion, an acute session of ACT demonstrated a significant trend towards improvements in executive functions in adults with DS which we interpreted using a model of neural changes and the cognitive stimulation hypothesis.

Experiences of an adolescent inpatient model of care: Adolescent and caregiver perspectives.

PROBLEM: Adolescent inpatient units have been studied regarding their effectiveness, yet little is known about the experiences of young people who are admitted and their caregivers. It is important to address this gap to understand adolescent inpatient models of care and therapeutic outcomes to maximize the benefit. Our aim was to explore adolescent and caregivers' experiences of an inpatient model of care (MoC) and perceived helpfulness. METHODS: A longitudinal prospective qualitative design was utilized. Semistructured interviews were conducted with 16 adolescents and 12 caregivers at T1 (admission), T2 (discharge), and T3 (6 months postdischarge). Data were analysed first thematically and then using trajectory analysis. Themes from the three time-points are presented from the combined perspectives of adolescents and caregivers. FINDINGS: Experiences described followed a recovery narrative consisting of three key phases which included, "waiting for help" (T1), "help arrived" (T2), and having "returned to regular life" (T3). The overarching trajectory theme was a "winding road to recovery." CONCLUSION: Findings provide insights into the lived experiences from adolescents who have had an inpatient stay and their caregivers of an adolescent-specific inpatient MoC. These findings can help conceptualize quality adolescent models of care for young people and their families.

A profile of adolescents admitted to a private inpatient unit and mental health outcomes.

OBJECTIVE: To characterise adolescents admitted to a voluntary adolescent inpatient unit and investigate treatment outcomes. METHOD: A retrospective cohort design was employed. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) pre- and post-admission scores were collected, measuring global functioning. Demographic variables such as age, gender, primary diagnosis, comorbidity and length of stay (LOS) were analysed. Data were collected from May 2017 to April 2018. All adolescents admitted to the inpatient unit were included. RESULTS: The majority of adolescents (n = 72; HoNOSCA data available on n = 57) were 16 years of age (26%), female (82%) and with a primary diagnosis of a mood disorder (57%). Most adolescents improved at the time of discharge. Self-injury and emotional symptoms had greater reductions according to clinician and adolescent-self-ratings (p < 0.01). Mean change (improvement) in HoNOSCA total score was 7.3 (SD 7.5) based on clinician ratings and 7.2 (SD 9.5) for adolescent-self-ratings. The mean LOS was 28 days (SD 15.8). CONCLUSIONS: The inpatient unit proved effective at meeting the needs of young people in terms of symptom stabilisation. Further research is needed to describe adolescent inpatient models of care, the operations and philosophies to better examine how these relate to treatment outcomes.

The unheard voice of the clinician: Perspectives on the key features of an adolescent inpatient model of care.

PROBLEM: Little has been reported from clinicians about the operations, interventions, and outcomes of inpatient units and how these comprise models of care in such units. The aim of this study was to explore an inpatient model of care in operation at the study site by defining key features of the model from the perspectives of clinicians. METHODS: Semi-structured face to face interviews were conducted with ten clinicians working in a private inpatient unit in Melbourne, Australia. Interview data were analyzed using thematic analysis. FINDINGS: Analysis resulted in the identification of three thematic features relating to containment, engagement, and therapy. These included (a) an environment conducive to containment, (b) adolescent engagement through shared experiences, and (c) dialectical behavior therapy embedded culture. CONCLUSIONS: The findings provide insights into often unheard clinician perspectives on what the key features of an adolescent inpatient model of care are. These features relate to the interventions that are currently offered on the unit and ways of working as informed by philosophies and practices. These findings should be used to improve clinical services and inform research aiming to articulate exemplary adolescent inpatient models of care. Furthermore, the findings provide guidance and practical information to commissioners, clinicians, and policy makers implementing models of care.

What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review.

Limited research exists regarding the therapeutic operations of adolescent mental health inpatient units, particularly in terms of nonpharmacological therapeutic interventions. This review collates what is known about reported nonpharmacological therapeutic interventions for young people admitted to general or non-disorder-specific adolescent mental health inpatient settings. A descriptive review of this nature was not located in the literature. The aim was to identify what is currently known about reported nonpharmacological therapeutic interventions. The purpose was to consider gaps and contribute to further work being undertaken in describing an exemplary inpatient model of care for adolescents. Sources included CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO. Studies included were those published in English, between the years 2000 and 2018. Exclusions included residential, community, outpatient, forensic settings, and studies detailing pharmacological interventions. Ten studies were identified. This descriptive review provides an objective foundation to inform an exemplary inpatient model of care currently being investigated. There is a critical need to understand these interventions to identify key components of an inpatient model of care. Such knowledge will provide guidance for future services seeking to create an exemplary model of care. Furthermore, these results can influence current practice by improving quality and delivery of inpatient care.

Protocol for a prospective, longitudinal mixed-methods case study: supporting a Model of Care for Healthier Adolescents (The MoCHA study).

INTRODUCTION: Improving mental healthcare for adolescents is a global policy priority. Despite demands for community-based services, many adolescents require more intensive interventions, such as an inpatient admission. This is typically at a point of crisis, often accompanied by intense emotional dysregulation, impairment of coping function and impulsivity. However, limited evidence exists on how best to support this group while they are in inpatient care, aside from pharmacological treatments which have a limited role in adolescents. Little is known about the models of care (MoC) offered in inpatient units, whether adolescents perceive these as helpful and the perspectives of caregivers and clinicians. Here, we describe a protocol which aims to explore and evaluate an inpatient MoC. METHODS AND ANALYSIS: We designed a longitudinal, mixed-methods, case study. The population consists of adolescents, caregivers and clinicians at a single inpatient unit in Melbourne, Australia. Standardised outcome measures, including semi- structured interviews, will be administered to adolescents at three time-points, T1 (admission), T2 (discharge) and T3 (6 months post discharge). Caregivers will also be interviewed at T1, T2 and T3. Clinicians will be interviewed once. The measures include: Life Problems Inventory, Quick Inventory of Depressive Symptomatology, Kessler Psychological Distress Scale and the Youth Self-Report. Health of the Nation Outcome Scales for Children and Adolescents will be collected at T1 and T2. Quantitative analysis will include descriptive statistics and paired t-tests summarising adolescents admitted to the unit, clinical characteristics and longitudinal data on symptomatology. Qualitative data will be analysed using both thematic and trajectory analysis. Data collection began in May 2017 and will cease with T3 interviews by October 2018. ETHICS AND DISSEMINATION.

Evaluating effectiveness in adolescent mental health inpatient units: A systematic review.

Adolescent mental health research is a developing area. Inpatient units are the most widely used acute element of adolescent mental health services internationally. Little is known about inpatient units, particularly when it comes to measuring improvement for adolescents. Clinical outcome measurement in the broad context has gathered momentum in recent years, driven by the need to assess services. The measurement of outcomes for adolescents who access inpatient care is critical, as they are particularly vulnerable and are often considered the most difficult to treat. Following the PRISMA guidelines, the aim of this review was to assess whether adolescent inpatient units are effective and understand how outcomes are measured. CINAHL, MEDLINE with Full Text, ERIC, PsycINFO, and Cochrane databases were systematically searched. Studies were included if the inpatient units were generic and adolescents were between the mean age of 12-25 years. Furthermore, studies published in English within the last ten years were included. Exclusions were outpatient and disorder-specific inpatient settings. A total of 16 studies were identified. Each study demonstrated effectiveness on at least one outcome measure in terms of symptom stabilization. However, several outcome measures were used and therefore inpatient units lack consistency in how they measure improvement. Inpatient units are effective for the majority of young people as they result in symptom stabilization. Whilst symptom stabilization can be achieved, future research examining the mechanism of change is needed.

Predictors of depression severity in a treatment-seeking sample / Predictores de la gravedad de la depresión en personas adultas que buscan tratamiento

Background/Objective: Depression is a common mental health disorder and an emerging public health concern. Few studies have investigated prevalence and predictors of depression severity in the Irish context. To investigate the relative contribution of known risk factors that predicts depression severity in a treatment-seeking sample of adults in Ireland. Method: As part of a randomised controlled trial of an internet-delivered intervention for depression participants (N=641) completed online screening questionnaires including BDI-II and information associated with common predictors of depression. Results: The mean score on the BDI-II was 24.13 (SD=11.20). Several factors were shown to predict greater severity of depression in the sample including female gender, younger age, unemployment, being single or partnered as opposed to married, previous diagnosis of depression, recent experience of life stressors. Alcohol use, recent losses, knowing a suicide completer, education level, type of employment and income level were not found to be significant. Conclusions: The study contributes to the profiling of the incidence and predictors of severity of depression in an Irish context. The results confirm some of the known risk factors and highlight the need for further research to be carried out on screening for depression and increasing access to interventions (AU)

Antecedentes/Objetivo: La depresión es uno de los trastornos de salud mental más comunes y un incipiente problema de salud pública. Pocos estudios han investigado la prevalencia y factores predictivos de su gravedad en el contexto irlandés. El objetivo del estudio fue investigar los factores de riesgo que predicen la gravedad de la depresión en una muestra de adultos en Irlanda en búsqueda de tratamiento. Método: Los participantes auto-referidos accedieron a una intervención en línea para la depresión. Los participantes (N=641) completaron cuestionarios, incluyendo el BDI-II e información asociada con predictores comunes de la depresión. Resultados: Se encontraron varios factores que predijeron la gravedad de la depresión: ser mujer, ser joven, estar desempleado, estar soltero o con pareja pero no casado, tener diagnóstico previo de depresión y experiencia reciente con factores vitales estresantes. Conclusiones: El estudio contribuye a la elaboración de perfiles de incidencia y factores predictivos en la gravedad de la depresión. Los resultados confirman algunos de los factores de riesgo conocidos y ponen de relieve la necesidad de nuevas investigaciones que lleven a cabo la detección de la depresión así como un mayor acceso a las intervenciones (AU)

From Design to Dissemination: Implementing Community-Based Participatory Research in Postdisaster Communities.

OBJECTIVES: To review how disasters introduce unique challenges to conducting population-based research and community-based participatory research (CBPR). METHODS: From 2007-2009, we conducted the Head-off Environmental Asthma in Louisiana (HEAL) Study in the aftermath of Hurricane Katrina in a Gulf Coast community facing an unprecedented triple burden: Katrina's and other disasters' impact on the environment and health, historic health disparities, and persistent environmental health threats. RESULTS: The unique triple burden influenced every research component; still, most existing CBPR principles were applicable, even though full adherence was not always feasible and additional tailored principles govern postdisaster settings. CONCLUSIONS: Even in the most challenging postdisaster conditions, CBPR can be successfully designed, implemented, and disseminated while adhering to scientific rigor.

Acceptability, satisfaction and perceived efficacy of "Space from Depression" an internet-delivered treatment for depression.

BACKGROUND: There are clear advantages to internet-delivered interventions for depression. Users' perspectives on the acceptability, satisfaction, and efficacy of an internet-delivered treatment for depression can inform future developments in the area. METHODS: Respondents (n = 281) were participants in an 8 week supported internet-delivered Cognitive Behaviour Therapy treatment for depressive symptoms. Self-report online questionnaires gathered quantitative and qualitative data on the user experience. PRINCIPLE FINDINGS: Most respondents were satisfied with the programme (n = 191), felt supported (n = 203), reported positive gains and impact resulting from use of the programme, and perceived these to be likely to be lasting effects (n = 149). Flexibility and accessibility were the most liked aspects. A small number of respondents felt their needs were not met by the intervention (n = 64); for this group suggestions for improvements centred on the programme's structure and how supporter feedback is delivered. CONCLUSION: Results will deepen the understanding of users' experience and inform the development and implementation of evidence-based internet-delivered interventions.

Predictors of depression severity in a treatment-seeking sample.

Background/Objective: Depression is a common mental health disorder and an emerging public health concern. Few studies have investigated prevalence and predictors of depression severity in the Irish context. To investigate the relative contribution of known risk factors that predicts depression severity in a treatment-seeking sample of adults in Ireland. Method: As part of a randomised controlled trial of an internet-delivered intervention for depression participants (N = 641) completed online screening questionnaires including BDI-II and information associated with common predictors of depression. Results: The mean score on the BDI-II was 24.13 (SD = 11.20). Several factors were shown to predict greater severity of depression in the sample including female gender, younger age, unemployment, being single or partnered as opposed to married, previous diagnosis of depression, recent experience of life stressors. Alcohol use, recent losses, knowing a suicide completer, education level, type of employment and income level were not found to be significant. Conclusions: The study contributes to the profiling of the incidence and predictors of severity of depression in an Irish context. The results confirm some of the known risk factors and highlight the need for further research to be carried out on screening for depression and increasing access to interventions.

Antecedentes/Objetivo:La depresión es uno de los trastornos de salud mental más comunes y un incipiente problema de salud pública. Pocos estudios han investigado la prevalencia y factores predictivos de su gravedad en el contexto irlandés. El objetivo del estudio fue investigar los factores de riesgo que predicen la gravedad de la depresión en una muestra de adultos en Irlanda en búsqueda de tratamiento. Método: Los participantes auto-referidos accedieron a una intervención en línea para la depresión. Los participantes (N = 641) completaron cuestionarios, incluyendo el BDI-II e información asociada con predictores comunes de la depresión. Resultados: Se encontraron varios factores que predijeron la gravedad de la depresión: ser mujer, ser joven, estar desempleado, estar soltero o con pareja pero no casado, tener diagnóstico previo de depresión y experiencia reciente con factores vitales estresantes. Conclusiones: El estudio contribuye a la elaboración de perfiles de incidencia y factores predictivos en la gravedad de la depresión. Los resultados confirman algunos de los factores de riesgo conocidos y ponen de relieve la necesidad de nuevas investigaciones que lleven a cabo la detección de la depresión así como un mayor acceso a las intervenciones.

Use of asthma control indicators in measuring inhaled corticosteroid effectiveness in asthmatic smokers: a systematic review.

OBJECTIVE: The objective of this review is to explore how current research measures the effectiveness of inhaled corticosteroids (ICS) in smokers with asthma. DATA SOURCES: PubMed, CINAHL and PsycINFO databases were searched for combinations of terms relating to asthma, tobacco use and ICS effectiveness. STUDY SELECTIONS: The search was limited to articles published between 2004 and 2015, in English language. Studies met inclusion criteria if reporting the use of guideline-based asthma control indicators to measure the therapeutic effects of ICS or ICS combination therapies. This review did not exclude articles based on study design. Data were extracted and summarized to describe how indicators were measured across studies in order to characterize and describe the effects of ICS in smokers. RESULTS: Thirteen studies were included in this review. Six of these 13 studies used only one indicator to measure asthma control in smokers and ICS was found to improve asthma in only one of six of these studies. Of studies evaluating combination therapy, three of four studies reported a therapeutic benefit to smokers. In these studies of combination therapy multiple indicators of control were measured to assess drug effects. CONCLUSIONS: To assess the therapeutic benefit of ICS drugs in smokers, multiple indicators should be measured to determine if current therapy is improving asthma control. Asthma therapy should then be adjusted based on the patient's current asthma status. The development of clinical treatment guidelines for asthmatic smokers may help clinicians make best-practice, evidence-based recommendations in order to optimize care for these patients.

Internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression: protocol for a randomized controlled trial.

BACKGROUND: Depression is a high prevalence disorder, displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. In Ireland 12-month prevalence of depression has been reported to be 10.3%. A large percentage of affected individuals have no medical diagnosis nor seek treatment. Cognitive Behavior Therapy (CBT) has established itself as an option for the treatment of depression. Many Irish adults with depression find it difficult to access evidence-based CBT, this is due to several factors, like stigma and costs. However, systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult.Stepped-care can increase access to evidence-based CBT. One option is tailored internet-delivered treatment programs. Preliminary research from Ireland needs now to include large-scale studies on effectiveness. Thus the current study seeks to examine the potential of an internet-delivered low-intensity treatment for symptoms of depression in an Irish adult community sample. METHOD/DESIGN: The study is a randomized controlled trial of an online CBT (iCBT) program for the treatment of adults with depressive symptoms. The trial will include an active treatment group and a waiting-list control group. The active condition will consist of 8 weekly modules of iCBT, with post-session feedback support. Participants in the waiting list will receive access to the treatment at week 8. Participants will complete the Beck Depression Inventory (BDI-II) and eligibility criteria will also apply. Primary outcomes are depressive symptoms. Secondary outcomes include quality of life indicators, significant events and satisfaction with online treatment. Data will be collected at baseline and at post-treatment, week 8, and at follow-up week 20 (3-months) and week 32 (6-months). Analysis will be conducted on the intention-to-treat basis. DISCUSSION: The study seeks to evaluate the effectiveness of an online delivered treatment for depression in a community sample of Irish adults with symptoms of depression. The study will be a first contribution and depending on the sample recruited the results may be generalizable to people with similar difficulties in Ireland and may therefore give insight into the potential of low-intensity interventions for Irish people with depressive symptoms. TRIAL REGISTRATION NUMBER: Current Controlled Trials ISRCTN03704676. DOI: 10.1186/ISRCTN03704676.

An evaluation of lecturer practitioners in Ireland.

Nursing continues to struggle to integrate the theoretical and clinical aspects of nurse education for the development of competent practitioners. Collaborative approaches to nurse education as well as the development of joint clinical-academic roles have had questionable success to date on merging the theoretical and clinical components of nursing. Lecturer practitioners' posts are new in Ireland. These posts were created as nurse educators were cognizant of the need for students to integrate theory to practice. The aim of the lecturer practitioner role was to increase the support for student nurses in both academia and practice. An evaluation of the impact of the lecturer practitioner role from three key perspectives was conducted in three Irish teaching hospitals in 2007. The results of this study suggest that as lecturer practitioners have both a clinical and academic remit they can integrate theory to practice through collaborative practice.

The effectiveness of the lecturer practitioner role in clinical practice: an Irish perspective.

BACKGROUND: Demands within academia such as teaching, publishing, research activity and generating grant income can make it difficult for nurse educators to protect time for clinical practice. In an effort to overcome this problem lecturer practitioner posts have been introduced with designated responsibilities in both clinical and educational settings. METHODS: Using a mixed method descriptive methodology student nurses and registered nurses completed a modified questionnaire to examine the impact of lecturer practitioners (LPs) in clinical practice. Focus groups were also conducted with lecturer practitioners themselves. RESULTS: The results identified that by having a clinical remit, LPs forged good relationships with student nurses and registered nurses in clinical practice, who considered the LP as being a learning resource with realistic expectations of the clinical environment. DISCUSSION: The results provide further evidence to support the continuation of nurse educators in clinical practice for their own development, their students and registered nurses.

Fathers' perspectives on the emotional impact of managing the care of their children with cystic fibrosis.

In this article, fathers' perspectives on the emotional impact of managing the care of their children with cystic fibrosis (CF) are examined. The constant worry of living with the unpredictability of CF was highlighted in this study, drawing on interviews with eight Irish fathers, who experienced difficulties communicating their concerns to others. Despite efforts at not dwelling on CF, fathers described being surrounded by constant reminders. To minimize the emotional impact of managing their children's care, fathers described living from day to day rather than looking into the future. These findings demonstrate the need for supportive interventions in helping fathers manage the emotional demands of caring for their children with CF.