This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families. Further investigation is needed, along with long-term follow-up to assess possible sleeper effects.

BackgroundThe purpose of this study was to investigate current patterns of management and outcomes of intermittent distance exotropia [X(T)] in the UK.MethodsThis was an observational cohort study which recruited 460 children aged < 12 years with previously untreated X(T). Eligible subjects were enrolled from 26 UK hospital ophthalmology clinics between May 2005 and December 2006. Over a 2-year period of follow-up, clinical data were prospectively recorded at standard intervals from enrolment. Data collected included angle, near stereoacuity, visual acuity, control of X(T) measured with the Newcastle Control Score (NCS), and treatment. The main outcome measures were change in clinical outcomes (angle, stereoacuity, visual acuity and NCS) in treated and untreated X(T), 2 years from enrolment (or, where applicable, 6 months after surgery). Change over time was tested using the chi-square test for categorical, Wilcoxon test for non-parametric and paired-samples t-test for parametric data.ResultsAt follow-up, data were available for 371 children (81% of the original cohort). Of these: 53% (195) had no treatment; 17% (63) had treatment for reduced visual acuity only (pure refractive error and amblyopia); 13% (50) had non surgical treatment for control (spectacle lenses, occlusion, prisms, exercises) and 17% (63) had surgery. Only 0.5% (2/371) children developed constant exotropia. The surgically treated group was the only group with clinically significant improvements in angle or NCS. However, 8% (5) of those treated surgically required second procedures for overcorrection within 6 months of the initial procedure and at 6-month follow-up 21% (13) were overcorrected.ConclusionsMany children in the UK with X(T) receive active monitoring only. Deterioration to constant exotropia, with or without treatment, is rare. Surgery appears effective in improving angle of X(T) and NCS, but rates of overcorrection are high.

Health visitors and Clinical Medical Officers (CMOs) were trained in parent counselling and worked at home in a highly deprived area with parents of pre-school children with multiple psychosocial problems. Their basic aims were to establish a mutually respectful partnership and to support parents in managing their diverse problems. Detailed evaluation indicated that the Service was highly valued by both parents and referrers, and suggested significant changes, including: improvements in the severity of problems; increased parental self-esteem; decreased levels of parental stress and emotional difficulties; more positive constructions of their children; improvements in the home environment; and decreased child behavioural problems.

BackgroundThere is growing evidence that parenting programmes can improve parenting skills and thereby the behaviour of children exhibiting or at risk of developing antisocial behaviour. Given the high prevalence of childhood behaviour problems the task is to develop large scale application of effective programmes. The aim of this study was to evaluate the UK government funded implementation of the Parenting Early Intervention Pathfinder (PEIP). This involved the large scale rolling out of three programmes to parents of children 8-13 years in 18 local authorities (LAs) over a 2 year period.MethodsThe UK government's Department for Education allocated each programme (Incredible Years, Triple P and Strengthening Families Strengthening Communities) to six LAs which then developed systems to intervene using parenting groups. Implementation fidelity was supported by the training of group facilitators by staff of the appropriate parenting programme supplemented by supervision. Parents completed measures of parenting style, efficacy, satisfaction, and mental well-being, and also child behaviour.ResultsA total of 1121 parents completed pre- and post-course measures. There were significant improvements on all measures for each programme; effect sizes (Cohen's d) ranged across the programmes from 0.57 to 0.93 for parenting style; 0.33 to 0.77 for parenting satisfaction and self-efficacy; and from 0.49 to 0.88 for parental mental well-being. Effectiveness varied between programmes: Strengthening Families Strengthening Communities was significantly less effective than both the other two programmes in improving parental efficacy, satisfaction and mental well-being. Improvements in child behaviour were found for all programmes: effect sizes for reduction in conduct problems ranged from -0.44 to -0.71 across programmes, with Strengthening Families Strengthening Communities again having significantly lower reductions than Incredible Years.ConclusionsEvidence-based parenting programmes can be implemented successfully on a large scale in community settings despite the lack of concentrated and sustained support available during a controlled trial.

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The aim of this study was to explore the reasons why vulnerable women refuse to take part in early interventions. In-depth interviews were conducted with 19 women who refused to take part in an evaluation of an intensive home visiting programme. A number of themes were identified including perceptions about vulnerability, misperceptions about the service, misgivings about the service, and lack of trust. It is concluded that women who refuse to take part in early interventions are a diverse group, and that service providers need to take this diversity into account, if they are to improve uptake of services by vulnerable women. Service providers may also need to consider new ways of providing services.

The results of the study provide evidence to suggest that, within the context of regular home visits, specially trained home visitors can increase maternal sensitivity and infant cooperativeness and are better able to identify infants in need of removal from the home for child protection. The extent to which these benefits are 'worth' the societal cost of 3246 pounds per woman however is a matter of judgment.

Background  Care staff play a key role in identifying individuals with intellectual disabilities and additional mental health problems. Yet, few receive training in mental health, and evidence about the effectiveness of training is scant. Materials and Methods  A pre–post study is reported, using a mental health screen and a self‐report questionnaire to examine staff awareness of mental health problems and to measure whether training improved knowledge of psychopathology, attitudes towards mental health services and referral decisions. Results  Prior to training, deficits in awareness were evident. The Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS‐ADD) Checklist detected significant psychopathology in approximately one‐third of the individuals judged to have no mental health problems according to staff. Four months after the delivery of training, significant improvements in knowledge, attitudes and referral decisions were observed. Conclusion  Brief training interventions may improve awareness of mental health problems, but further research is needed to understand the referral process and to demonstrate the role of training in influencing actual staff behaviour.