The number of disability related support services controlled and run by disabled people themselves has increased significantly in the UK and internationally over the past forty years. As a result, ...greater user involvement in service provision and delivery is a key priority for many western Governments. This book provides the first comprehensive review and analysis of these developments in the UK.
Drawing on evidence from a range of sources, including material from the first national study of user-controlled services, this book provides a critical evaluation of the development and organisation of user-controlled services in the UK and identifies the principal forces - economic, political and cultural - that influence and inhibit their further development. It summarises and discusses the policy implications for the future development of services and includes an up-to-date and comprehensive literature and research review.
"Independent futures" is essential reading for academics and students on a range of courses including: health and social care; social work; allied health professions, such as nursing, occupational therapy and speech therapy; social policy; sociology; and psychology. It will also be of interest to practitioners and policy makers who need a reliable overview of current policy and critical analysis of key issues affecting future policy and practice.
Background
Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking.
Objectives
The review addresses the following hypotheses:
1. ...Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.
2. Individual counselling is more effective than self‐help materials in promoting smoking cessation.
3. A more intensive counselling intervention is more effective than a less intensive intervention.
Search methods
We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with counsel* in any field in May 2016.
Selection criteria
Randomized or quasi‐randomized trials with at least one treatment arm consisting of face‐to‐face individual counselling from a healthcare worker not involved in routine clinical care. The outcome was smoking cessation at follow‐up at least six months after the start of counselling.
Data collection and analysis
Both authors extracted data in duplicate. We recorded characteristics of the intervention and the target population, method of randomization and completeness of follow‐up. We used the most rigorous definition of abstinence in each trial, and biochemically‐validated rates where available. In analysis, we assumed that participants lost to follow‐up continued to smoke. We expressed effects as a risk ratio (RR) for cessation. Where possible, we performed meta‐analysis using a fixed‐effect (Mantel‐Haenszel) model. We assessed the quality of evidence within each study using the Cochrane 'Risk of bias' tool and the GRADE approach.
Main results
We identified 49 trials with around 19,000 participants. Thirty‐three trials compared individual counselling to a minimal behavioural intervention. There was high‐quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self‐help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% confidence interval (CI) 1.40 to 1.77; 27 studies, 11,100 participants; I2 = 50%). There was moderate‐quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (nicotine replacement therapy) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I2 = 0%). There was moderate‐quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I2 = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences.
Authors' conclusions
There is high‐quality evidence that individually‐delivered smoking cessation counselling can assist smokers to quit. There is moderate‐quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention.
OBJECTIVES:Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover ...enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them.
DESIGN:Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data.
SETTING:Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents.
SUBJECTS:Clinicians from 21 sites.
MEASUREMENT AND MAIN RESULTS:Ten enablers and nine barriers to implementation of “ICU follow-up clinics” were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of “peer support groups” were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising.
CONCLUSIONS:Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.
All across America, angry fathers are demanding rights. These men claim that since the breakdown of their own families, they have been deprived of access to their children. Joining together to form ...fathers' rights groups, the mostly white, middle-class men meet in small venues to speak their minds about the state of the American family and, more specifically, to talk about the problems they personally face, for which they blame current child support and child custody policies. Dissatisfied with these systems, fathers' rights groups advocate on behalf of legal reforms that will lower their child support payments and help them obtain automatic joint custody of their children.
InDefiant Dads, Jocelyn Elise Crowley offers a balanced examination of these groups in order to understand why they object to the current child support and child custody systems; what their political agenda, if enacted, would mean for their members' children or children's mothers; and how well they deal with their members' interpersonal issues concerning their ex-partners and their role as parents. Based on interviews with more than 150 fathers' rights group leaders and members, as well as close observation of group meetings and analysis of their rhetoric and advocacy literature, this important book is the first extensive, in-depth account of the emergence of fathers' rights groups in the United States. A nuanced and timely look at an emerging social movement,Defiant Dadsis a revealing investigation into the changing dynamics of both the American family and gender relations in American society.
Each year millions of Americans enroll in commercial and self-help weight loss programs. Health care providers and their obese patients know little about these programs because of the absence of ...systematic reviews.
To describe the components, costs, and efficacy of the major commercial and organized self-help weight loss programs in the United States that provide structured in-person or online counseling.
Review of company Web sites, telephone discussion with company representatives, and search of the MEDLINE database.
Randomized trials at least 12 weeks in duration that enrolled only adults and assessed interventions as they are usually provided to the public, or case series that met these criteria, stated the number of enrollees, and included a follow-up evaluation that lasted 1 year or longer.
Data were extracted on study design, attrition, weight loss, duration of follow-up, and maintenance of weight loss.
We found studies of eDiets.com, Health Management Resources, Take Off Pounds Sensibly, OPTIFAST, and Weight Watchers. Of 3 randomized, controlled trials of Weight Watchers, the largest reported a loss of 3.2% of initial weight at 2 years. One randomized trial and several case series of medically supervised very-low-calorie diet programs found that patients who completed treatment lost approximately 15% to 25% of initial weight. These programs were associated with high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years. Commercial interventions available over the Internet and organized self-help programs produced minimal weight loss.
Because many studies did not control for high attrition rates, the reported results are probably a best-case scenario.
With the exception of 1 trial of Weight Watchers, the evidence to support the use of the major commercial and self-help weight loss programs is suboptimal. Controlled trials are needed to assess the efficacy and cost-effectiveness of these interventions.
Background: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self‐help group involvement can reduce their patients' health care costs in the ...first year after treatment, but such initially impressive effects may wane over time. This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance‐dependent patients who were strongly encouraged to attend 12‐step self‐help groups were sustained at 2‐year follow‐up.
Methods: A 2‐year quasi‐experimental analysis of matched samples of male substance‐dependent patients who were treated in either 12‐step–based (n=887 patients) or cognitive‐behavioral (CB, n=887 patients) treatment programs. The 12‐step–based programs placed substantially more emphasis on 12‐step concepts, had more staff members “in recovery,” had a more spiritually oriented treatment environment, and promoted self‐help group involvement much more extensively than did the CB programs. The 2‐year follow‐up assessed patients' substance use, psychiatric functioning, self‐help group affiliation, and mental health care utilization and costs.
Results: As had been the case in the 1‐year follow‐up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12‐step (49.5%) versus CB (37.0%) programs. Twelve‐step treatment patients had 50 to 100% higher scores on indices of 12‐step self‐help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12‐step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).
Conclusions: Promoting self‐help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self‐help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.
Mindfulness-based interventions (MBIs) are increasingly suggested as therapeutic approaches for effecting substance use and misuse (SUM). The aim of this article is to review current evidence on the ...therapeutic efficacy of MBIs for SUM. A literature search was undertaken using four electronic databases and references of retrieved articles. The search included articles written in English published up to December 2011. Quality of included trials was assessed. In total, 24 studies were included, three of which were based on secondary analyses of previously investigated samples. Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. Some preliminary evidence also suggests that MBIs are associated with a reduction in craving as well as increased mindfulness. The limited generalizability of the reviewed findings is noted (i.e., small sample size, lack of methodological details, and the lack of consistently replicated findings). More rigorous and larger randomized controlled studies are warranted.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This study aims to examine the effectiveness of the Self-Help Group (SHG) intervention in smoking prevention among adolescents.
This study was carried out in 2 Junior High Schools in Aceh Besar using ...a quasi-experimental method, which was conducted in the intervention and the control groups with a pre-post design. The number of samples was determined based on power analysis with medium effect size and power (0.08) with 40 respondents per group. After randomizing the schools, a total of 40 students who met the criteria were randomly selected for each school. The data were collected by using a self-report questionnaire, consisting of knowledge, as well as smoking attitudes, intentions, and behavior. The SHG intervention consist of 6 sessions, each of which was conducted per week with a duration of 40-60 minutes per session. The data were analyzed using descriptive and inferential statistics.
The results of statistical tests using the Mann-Whitney and t-test showed that there was an effect of the SHG intervention on knowledge (p-value 0.043), attitude (p-value 0.001), intention (p-value 0.029), and behavior (p-value 0.003). The average score of knowledge was higher in the SHG intervention group than in the control group, while the average score of attitude, smoking intention and behavior was lower in the SHG intervention group than in the control group.
Health practitioners, specifically community nurses are suggested to implement SHG interventions as one of the strategies for preventing smoking among adolescents.
Background. Although mutual support and self-help groups based on shared experience play a large part in recovery, the employment of peer support workers (PSWs) in mental health services is a recent ...development. However, peer support has been implemented outside the UK and is showing great promise in facilitating recovery.
Aims. This article aims to review the literature on PSWs employed in mental health services to provide a description of the development, impact and challenges presented by the employment of PSWs and to inform implementation in the UK.
Method. An inclusive search of published and grey literature was undertaken to identify all studies of intentional peer support in mental health services. Articles were summarised and findings analysed.
Results. The literature demonstrates that PSWs can lead to a reduction in admissions among those with whom they work. Additionally, associated improvements have been reported on numerous issues that can impact on the lives of people with mental health problems.
Conclusion. PSWs have the potential to drive through recovery-focused changes in services. However, many challenges are involved in the development of peer support. Careful training, supervision and management of all involved are required.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Microfinance is a widely promoted developmental initiative to provide poor women with affordable financial services for poverty alleviation. One popular adaption in South Asia is the Self-Help Group ...(SHG) model that India adopted in 2011 as part of a federal poverty alleviation program and as a secondary approach of integrating health literacy services for rural women. However, the evidence is limited on who joins and continues in SHG programs. This paper examines the determinants of membership and staying members (outcomes) in an integrated microfinance and health literacy program from one of India's poorest and most populated states, Uttar Pradesh across a range of explanatory variables related to economic, socio-demographic and area-level characteristics.
Using secondary survey data from the Uttar Pradesh Community Mobilization project comprising of 15,300 women from SHGs and Non-SHG households in rural India, we performed multivariate logistic and hurdle negative binomial regression analyses to model SHG membership and duration.
While in general poor women are more likely to be SHG members based on an income threshold limit (government-sponsored BPL cards), women from poorest households are more likely to become members, but less likely to stay members, when further classified using asset-based wealth quintiles. Additionally, poorer households compared to the marginally poor are less likely to become SHG members when borrowing for any reason, including health reasons. Only women from moderately poor households are more likely to continue as members if borrowing for health and non-income-generating reasons. The study found that an increasing number of previous pregnancies is associated with a higher membership likelihood in contrast to another study from India reporting a negative association.
The study supports the view that microfinance programs need to examine their inclusion and retention strategies in favour of poorest household using multidimensional indicators that can capture poverty in its myriad forms.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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