Service users as the key to service change? The development of an innovative intervention for excluded young people.

BACKGROUND: Excluded young people, especially those affected by street gangs, often have complex unmet needs and high levels of health and social inequalities. This paper outlines the development of Music & Change, an innovative and comprehensive intervention accessible to young people, which aimed to holistically meet the mental health and other needs of its participants and ultimately to reduce offending rates. Its central principle was coproduction and partnership with its potential users. METHOD: The setting was an inner-city housing estate; the core group of participants was 15 young people aged 16-22 years. The intervention used contemporary music skills (e.g. DJ-ing and lyric writing) and other coproduced project activities as a vehicle to build relationships with practitioners and address young people's multiple needs. Data were gathered using a focused ethnography, largely from field notes, and analysed using thematic analysis in order to ascertain users' perceptions of its delivery. RESULTS: Young people identified six key principles of the intervention, such as the need for consistent relationships with trusted staff, mental health support to be wrapped round other youth-led activities and local service delivery within their safe territories. CONCLUSIONS: Music & Change was valued by young people who do not easily engage with professionals and services. The findings led to the development of the 'Integrate' model, which is using these coproduced principles to underpin several new pilot projects that aim to address the health and social inequalities of excluded young people.

The Adolescent Mentalization-based Integrative Treatment (AMBIT) approach to outcome evaluation and manualization: adopting a learning organization approach.

AMBIT (Adolescent Mentalization-Based Integrative Treatment) is a developing team approach to working with hard-to-reach adolescents. The approach applies the principle of mentalization to relationships with clients, team relationships and working across agencies. It places a high priority on the need for locally developed evidence-based practice, and proposes that outcome evaluation needs to be explicitly linked with processes of team learning using a learning organization framework. A number of innovative methods of team learning are incorporated into the AMBIT approach, particularly a system of web-based wiki-formatted AMBIT manuals individualized for each participating team. The paper describes early development work of the model and illustrates ways of establishing explicit links between outcome evaluation, team learning and manualization by describing these methods as applied to two AMBIT-trained teams; one team working with young people on the edge of care (AMASS - the Adolescent Multi-Agency Support Service) and another working with substance use (CASUS - Child and Adolescent Substance Use Service in Cambridgeshire). Measurement of the primary outcomes for each team (which were generally very positive) facilitated team learning and adaptations of methods of practice that were consolidated through manualization.

Teaching action sequences after brain injury: a comparison of modelling and moulding techniques.

OBJECTIVE: To compare the relative effectiveness of a modelling and a moulding instructional technique for teaching action sequences to participants with brain injury in rehabilitation settings. DESIGN: Randomized crossover design. SETTING: Regional Neurological Rehabilitation Unit. SUBJECTS: Sixteen participants with an acquired brain injury undergoing early inpatient rehabilitation. INTERVENTION: Participants were instructed to recall two different sequences of seven hand movements after a short (5 minutes) and longer delay (30 minutes). Participants were taught the sequences using moulding and modelling techniques. MAIN OUTCOME MEASURE: Participants' recall of the sequence measured after the short and longer delay for each instructional technique. RESULTS: Participants recalled the sequence after the longer delay (30 minutes) significantly more accurately (Z = 1.91, P =0.028) when taught using the modelling instructional technique (mean 2.63, SD 1.55) compared to the moulding technique (mean 1.56, SD 1.63). There were no significant differences between the participants' recall scores after a short delay. Participants who scored lower on a delayed memory subtest of a neuropsychological test benefitted more from the modelling technique. CONCLUSION: The use of a modelling instructional technique to teach brain-injured participants an action sequence during their rehabilitation may be more effective for their longer term performance than a moulding instructional technique.

Gesture and speech integration: an exploratory study of a man with aphasia.

BACKGROUND: In order to comprehend fully a speaker's intention in everyday communication, information is integrated from multiple sources, including gesture and speech. There are no published studies that have explored the impact of aphasia on iconic co-speech gesture and speech integration. AIMS: To explore the impact of aphasia on co-speech gesture and speech integration in one participant with aphasia and 20 age-matched control participants. METHODS & PROCEDURES: The participant with aphasia and 20 control participants watched video vignettes of people producing 21 verb phrases in three different conditions, verbal only (V), gesture only (G), and verbal gesture combined (VG). Participants were required to select a corresponding picture from one of four alternatives: integration target, a verbal-only match, a gesture-only match, and an unrelated foil. The probability of choosing the integration target in the VG that goes beyond what is expected from the probabilities of choosing the integration target in V and G was referred to as multi-modal gain (MMG). OUTCOMES & RESULTS: The participant with aphasia obtained a significantly lower multi-modal gain score than the control participants (p<0.05). Error analysis indicated that in speech and gesture integration tasks, the participant with aphasia relied on gesture in order to decode the message, whereas the control participants relied on speech in order to decode the message. Further analysis of the speech-only and gesture-only tasks indicated that the participant with aphasia had intact gesture comprehension but impaired spoken word comprehension. CONCLUSIONS & IMPLICATIONS: The results confirm findings by Records ( 1994 ) that reported that impaired verbal comprehension leads to a greater reliance on gesture to decode messages. Moreover, multi-modal integration of information from speech and iconic gesture can be impaired in aphasia. The findings highlight the need for further exploration of the impact of aphasia on gesture and speech integration.

Effects of dietary management of phenylketonuria on long-term cognitive outcome.

BACKGROUND: Phenylketonuria (PKU) is associated with dopaminergic depletion in the dorsolateral prefrontal cortex and abnormalities of myelination. Both mechanisms may lead to deficits in cognitive functioning. Studies of cognitive outcome in children treated with PKU at an early stage have suggested that there are benefits in remaining on diet into adolescence. AIM: To assess the nature and extent of any cognitive deficits in adults treated at an early stage with PKU who had discontinued their diets in adolescence. METHOD: 25 patients (aged 18-38 years) who were diagnosed early and had discontinued their diets in adolescence were compared with 25 adults (aged 18-38 years) with PKU on continuous diet, and with a healthy control group (n = 45). RESULTS: The groups differed significantly on accuracy (p = 0.007) and speed (p = 0.001) of performance on an n-back working memory task and on speed of performance (p = 0.001) on a flanker inhibitory task, but not on flanker accuracy, object alternation learning or perceptual judgement tasks (all p>0.05). The off-diet group performed significantly below the on-diet group on n-back accuracy (p = 0.007) and flanker speed (p = 0.05), and significantly below the control group on n-back speed (p = 0.002) and flanker speed (p = 0.001). CONCLUSION: The findings suggest that although discontinuing diet in adolescence appears disadvantageous compared with remaining on continuous diet, any deficits are relatively subtle.