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Search Result: 64 Records found
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Personal assistance for older adults (65+) without dementia
  • Authors Paul Montgomery, Catriona Shatford, Evan Mayo-Wilson
  • Published date 2008-03-02
  • Coordinating group(s) Social Welfare
  • Type of document Review User abstract
  • Title Personal assistance for older adults (65+) without dementia
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2008.1
  • English

    Personal assistance offers people with impairments choice of service and greater quality of life

    Six new Campbell systematic reviews examine research on the effect of personal assistance for people with impairments and elderly people. Several studies, including a large US randomised controlled trial, suggest that personal assistance increases the quality of life for elderly people as well as younger people with impairments. The state of evidence may change as new studies emerge.

    A widely used intervention

    People who have muscular dystrophy, suffer from a brain injury or who have become frail with old age often have difficulties taking part in society on equal terms with others. An increasing number of people are born with physical or intellectual impairments or acquire them later in life. Furthermore, the elderly population is increasing. A great number of local-government authorities therefore offer personal assistance for people with impairments to help people take part in all parts of society. Personal assistance is customised support that may include help in all areas of life, including transportation, social activities, work, education, shopping, eating and hygiene. Personal assistance is offered in different forms in most western countries. This type of intervention is especially widespread in the Nordic countries, where personal assistance is often a statutory right.

    Six new Campbell systematic reviews have examined the effect of personal assistance on quality of life for people of all ages with physical and intellectual impairments.

    Can increase quality of life

    A very large US randomised controlled trial examined the effect of personal assistance on quality of life and user satisfaction in four out of the six target groups, namely children with intellectual impairments, adults with physical impairments, adults with both physical and intellectual impairments and older adults (65+). The study suggests that personal assistance has a positive effect on quality of life and user satisfaction for all four target groups. The positive outcomes for older adults (65+) in this trial are consistent with outcomes in three smaller studies using less rigorous designs. Furthermore, the positive outcomes for adults with physical and intellectual impairments are consistent with the outcomes in another small study.

    The US study randomised the participants to personal assistance or to other publicly-paid support (the control group). Participation in the trial was on a voluntary basis, that is, participants were themselves interested in having a personal assistant. Participants with a personal assistant became more satisfied with life. About half were very satisfied with the way they were spending their lives,

    whereas this was true for only just under one-third in the control group. Children with intellectual impairments experienced the greatest progress, as reported by their parents.

    These studies all aim to assess ’soft values’ (such as quality of life and user satisfaction) as well as hard outcomes, such as nursing home admission. They show that rigorous research designs, including randomised controlled trials, can measure impacts on all sorts of outcomes. Randomised controlled trials actually provide a very accurate picture of the effect on users’ quality of life and satisfaction.

    One among many interventions

    In the systematic reviews, personal assistance is defined as: support for at least 20 per week, in the user’s home, by a paid assistant other than a healthcare professional. The paid assistant is therefore typically trained and employed directly by the user. In many places, users form cooperatives to help train and pay assistants. These user groups may charge a fee to handle administrative duties like performing background checks and collecting taxes.

    All six systematic reviews emphasise that there might also be disadvantages from personal assistance. Frequent replacements, low salaries and lack of training and education of paid assistants may limit positive impacts. Furthermore, there is the risk that a personal assistant might reduce rather than enhance a user's self-sufficiency relative to alternative forms of support. To allow people to make best use of resources, policymakers might allow people to spend money on assistants, home modification, assistive devices, transportation, or whatever mix of services they feel would be most useful.

    More studies are needed

    Four of the systematic reviews, the outcomes of which are outlined above, examine the effects for four different groups: older adults (65+), adults with physical impairments, adults with physical and intellectual impairments, and children and adolescents with physical impairments. For these groups, the authors found studies with relevant, reliable and mutually consistent outcomes.

    However, for the two remaining systematic reviews, the authors did not find any relevant studies of a quality high enough to warrant inclusion in the reviews. These reviews hoped to examine the effect of personal assistance for children with physical impairments and children with both physical and intellectual impairments.

    All six systematic reviews observe that personal assistance schemes are increasingly popular. However, personal assistance can be organised in different ways, and other combinations of services might be ideal for certain groups of people. Further studies would help users and policymakers determine the best mix of service options.

Treatment foster care (TFC) for improving outcomes in children and young people
  • Authors Geraldine Macdonald, William Turner
  • Published date 2008-03-02
  • Coordinating group(s) Social Welfare
  • Type of document Review User abstract
  • Title Treatment foster care (TFC) for improving outcomes in children and young people
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2007.9
  • English

    Promising intervention gives new hope for severely troubled children

    Treatment foster care (TFC) is a promising, individually tailored program for children and youth who are at risk of placement in restrictive settings. The results of a Campbell/Cochrane review suggests that TFC can lead to a reduction in antisocial and criminal behaviour, time spent in locked settings and absconsions. There is some evidence of a positive impact on school attendance and homework completion.

    Avoiding multiple placements and locked settings

    Children and adolescents with severe difficulties are at high risk of multiple placements and of ending up in restrictive placements. These difficulties include antisocial behaviour, behavioural problems, psychological disorders, and abuse or neglect.

    As these young people are ‘hard to place’, many experience placement instability, and are at increased risk of finding themselves in locked settings, including psychiatric hospitals. Restrictive placements and placement instability can result in serious long-term adverse consequences (e.g. social exclusion) that can adversely impact on the social development of these children and adolescents, and on their educational potential and life chances.

    Finding appropriate and effective placements in home settings for these young people is difficult. Mainstream foster care or residential care placements are typically unable to easily access services to accommodate the acute needs and complex problems facing these young people, and foster carers themselves are normally unable to provide such expert support. Treatment foster care (TFC) is an intervention that aims to combine an out of home placement with specially trained foster carers, supported by a multidisciplinary professional team who provide an individually tailored program for each child.

    Findings

    The authors of this systematic review conclude that TFC appears to be a promising intervention. However they caution that the evidence of its effectiveness for each of the outcomes reported in the review is based on only one or two studies.

    Fewer criminal offences and less time spent in locked settings

    TCF appears to generate worthwhile reductions in antisocial and criminal behaviour. In two studies analyses of both short- and long-term effects suggest moderate reductions in the number of criminal referrals; i.e., young people who received TCF were less likely to have committed criminal offences than those in the control group receiving usual non-TCF treatment.

    Two studies reported a clinically and statistically significant reduction in the number of days spent in locked settings for the adolescents who receive a particularly intensive TFC intervention. Adolescents in these groups spent less time in locked settings compared to adolescents who did not receive TFC.

    In one of the studies, the results suggest that the management of young people by foster carers who provide consistent and predictable forms of discipline and close supervision, together with the separation of these young people from their delinquent peers, were key factors contributing to reductions in delinquent behaviour.

    The evidence suggests that TFC promotes stability. In one study delinquent boys receiving TFC not only spent more time in treatment over the long term but also more time at home.

    One study with chronic delinquent adolescent girls receiving intensive TFC reported that they attended school more often and were more likely to do their homework, than girls in the control group.

    Ingredients of TFC programs

    In the context of this review TFC is used as an umbrella term. Specialised foster care, ‘wrap-around’ foster care and multidimensional treatment foster care (MTFC) are all programs that fall under the term TFC. MTFC is an intensive variant of TFC with numerous add-on components.

    TFC programs are flexible and strive to accommodate the specific needs of the individual young person. Care for the young person takes place within a family setting and the number in any one placement is limited to two. Foster carers, the young person in placement and, where appropriate, their families receive support tailored to their needs. TFC programs are clearly described, tightly structured interventions designed to address the needs of the individual young person. They may include educational plans, set goals and regular assessments.

    Child services select foster carers, and give them specialised training in managing the behaviour and needs of the individual young person. Foster carers receive extensive professional support, supervision and consultation. Immediate access to crisis services is also available.

    Three MTFC studies and two less intensive TFC studies

    Five studies, with a total of 390 young people between the ages of 7 and 18, are included in the systematic review.

    Three studies involved intensive multi-dimensional TFC interventions. One of these studies focused exclusively on adolescent delinquent girls. The other two studies were TFC ‘light’ interventions with fewer components.

    The control groups in the studies received standard treatment, such as usual foster care and group based community programs. All of the studies are from the US. One should take care when generalising the evidence from this review, as four of the five studies were conducted in the same region (Oregon, US) and involved primarily mainly Caucasian young people.

    Program developers conducted all five studies. The authors recommend that independent researchers also conduct research.

Personal assistance for children and adolescents (0-18) with intellectual impairments
  • Authors Evan Mayo-Wilson, Paul Montgomery, Jane Dennis
  • Published date 2008-02-20
  • Coordinating group(s) Social Welfare
  • Type of document Review User abstract
  • Title Personal assistance for children and adolescents (0-18) with intellectual impairments
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2008.4
  • English

    Personal assistance offers people with impairments choice of service and greater quality of life

    Six new Campbell systematic reviews examine research on the effect of personal assistance for people with impairments and elderly people. Several studies, including a large US randomised controlled trial, suggest that personal assistance increases the quality of life for elderly people as well as younger people with impairments. The state of evidence may change as new studies emerge.

    A widely used intervention

    People who have muscular dystrophy, suffer from a brain injury or who have become frail with old age often have difficulties taking part in society on equal terms with others. An increasing number of people are born with physical or intellectual impairments or acquire them later in life. Furthermore, the elderly population is increasing. A great number of local-government authorities therefore offer personal assistance for people with impairments to help people take part in all parts of society. Personal assistance is customised support that may include help in all areas of life, including transportation, social activities, work, education, shopping, eating and hygiene. Personal assistance is offered in different forms in most western countries. This type of intervention is especially widespread in the Nordic countries, where personal assistance is often a statutory right.

    Six new Campbell systematic reviews have examined the effect of personal assistance on quality of life for people of all ages with physical and intellectual impairments.

    Can increase quality of life

    A very large US randomised controlled trial examined the effect of personal assistance on quality of life and user satisfaction in four out of the six target groups, namely children with intellectual impairments, adults with physical impairments, adults with both physical and intellectual impairments and older adults (65+). The study suggests that personal assistance has a positive effect on quality of life and user satisfaction for all four target groups. The positive outcomes for older adults (65+) in this trial are consistent with outcomes in three smaller studies using less rigorous designs. Furthermore, the positive outcomes for adults with physical and intellectual impairments are consistent with the outcomes in another small study.

    The US study randomised the participants to personal assistance or to other publicly-paid support (the control group). Participation in the trial was on a voluntary basis, that is, participants were themselves interested in having a personal assistant. Participants with a personal assistant became more satisfied with life. About half were very satisfied with the way they were spending their lives,

    whereas this was true for only just under one-third in the control group. Children with intellectual impairments experienced the greatest progress, as reported by their parents.

    These studies all aim to assess ’soft values’ (such as quality of life and user satisfaction) as well as hard outcomes, such as nursing home admission. They show that rigorous research designs, including randomised controlled trials, can measure impacts on all sorts of outcomes. Randomised controlled trials actually provide a very accurate picture of the effect on users’ quality of life and satisfaction.

    One among many interventions

    In the systematic reviews, personal assistance is defined as: support for at least 20 per week, in the user’s home, by a paid assistant other than a healthcare professional. The paid assistant is therefore typically trained and employed directly by the user. In many places, users form cooperatives to help train and pay assistants. These user groups may charge a fee to handle administrative duties like performing background checks and collecting taxes.

    All six systematic reviews emphasise that there might also be disadvantages from personal assistance. Frequent replacements, low salaries and lack of training and education of paid assistants may limit positive impacts. Furthermore, there is the risk that a personal assistant might reduce rather than enhance a user's self-sufficiency relative to alternative forms of support. To allow people to make best use of resources, policymakers might allow people to spend money on assistants, home modification, assistive devices, transportation, or whatever mix of services they feel would be most useful.

    More studies are needed

    Four of the systematic reviews, the outcomes of which are outlined above, examine the effects for four different groups: older adults (65+), adults with physical impairments, adults with physical and intellectual impairments, and children and adolescents with physical impairments. For these groups, the authors found studies with relevant, reliable and mutually consistent outcomes.

    However, for the two remaining systematic reviews, the authors did not find any relevant studies of a quality high enough to warrant inclusion in the reviews. These reviews hoped to examine the effect of personal assistance for children with physical impairments and children with both physical and intellectual impairments.

    All six systematic reviews observe that personal assistance schemes are increasingly popular. However, personal assistance can be organised in different ways, and other combinations of services might be ideal for certain groups of people. Further studies would help users and policymakers determine the best mix of service options.

Cognitive-behavioral treatment for anti-social behaviour in youth in residential treatment
  • Authors Bengt-Åke Armelius, Tore Henning Andreassen
  • Published date 2007-10-01
  • Coordinating group(s) Social Welfare
  • Type of document Review User abstract
  • Title Cognitive-behavioral treatment for anti-social behaviour in youth in residential treatment
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2007.8
  • English

    Treatment reduces criminal recidivism in young people

    Antisocial young people who have received cognitive behavioural therapy or other types of treatment in residential settings, do better than young people who have not been offered such treatment. Twelve months after leaving the residential setting, the risk of recidivism is reduced from 53% to 43%. These are the findings of a systematic Campbell/Cochrane review of the best international research in the field.

    Antisocial behaviour in youth is a serious problem

    Antisocial behaviour is characterised by thoughtless conduct and the lack of ability to accept the boundaries and requirements of society. Young people with antisocial behaviour find it difficult to meet their social obligations and become easily frustrated, aggressive or violent. They are likely to fall foul of the law and to become involved in drug and alcohol abuse.

    Around 5% of all adolescents demonstrate a persistent and extremely antisocial pattern early on. This group is thought to be responsible for 50-60% of all criminality carried out by young people. Some of these antisocial adolescents are treated via interventions in the family home, but many are placed in a residential setting during their youth.

    Over the years, many types of treatment have been tried on antisocial young people, but the results have not been encouraging. Placing young criminals together in an institution can have a directly negative effect on their behaviour. Family treatment or other types of treatment are often, therefore, favoured over placement in a residential setting. In this research review, Nordic researchers have studied whether cognitive behavioural therapy reduces the criminal behaviour of antisocial youth placed in residential settings.

    Cognitive behavioural therapy leads to a 10% reduction in recidivism

    The review shows that the young people who have received cognitive behavioural therapy do better 12 months after their release from the residential setting, than young people who have not received the treatment.

    Of the young people in the review who did not receive cognitive behavioural therapy, 53% had been convicted of criminality again 12 months after their release from the residential setting. For the young people who had received cognitive behavioural therapy, the figure was only 43%.

    In practice, this means that ten antisocial young people need to be treated with cognitive behavioural therapy to help one extra young person not to return to criminality.

    The results of the review also suggest a positive, but not significant, effect in the follow-ups at 6 and 24 months after release. The researchers emphasise that this may be due to the fact that few

    studies have been published regarding these follow-up times. Fewer studies mean fewer young people on which to base measurements, and the fewer people involved, the more difficult it becomes to differentiate between coincidences and a small positive effect.

    The study also shows that cognitive behavioural therapy is no more effective than other interventions such as “Attention Control”, “Stress Management Training” and discussion groups. This might suggest that the type of treatment that young people receive is not necessarily all-important, but rather the fact that they have been offered a type of treatment at all. This result is, however, based on only a few studies, and the possibility that new and larger studies could find a difference cannot therefore be ruled out.

    Cognitive behavioural therapy

    The general principle behind cognitive behavioural therapy is that our behaviour is closely linked to thoughts, images, convictions and attitudes. The treatment should therefore be aimed at both cognitive and behavioural aspects of the criminal behaviour and not just at one of these aspects.

    The treatment in the review consisted of different types of cognitive behavioural therapy and included both extensive programmes and less intensive programmes. The programmes do, however, always include both cognitive and behavioural aspects. The total treatment varied from a total of 20 hours to daily activities over a year.

    The young people who did not receive cognitive behavioural therapy participated in standard prison activities, different types of training schools or placement at a standard residential setting. In a few of the studies, a group was offered a type of treatment other than cognitive behavioural treatment.

    In the review, the effect was measured on whether the young people committed any form of criminality in the period after release from the residential setting. A search was also made for psychological and behavioural outcome measures, but there was insufficient data to comment on this in the studies included in the review.

    About the systematic review

    This review is a good example of the value of preparing a systematic review. The studies included in the review do not, in themselves, show any effect, as they each cover relatively few young people. However, by compiling the results, the researchers achieve a considerably more solid set of data, and are thereby able to detect a small, yet positive effect.

    The review covers twelve different studies, with a total of over 4,500 young people aged 12-22 (average age 15-16 years). The young people have, on at least one occasion, broken the law and have been placed in a residential setting due to antisocial behaviour. The residence may be both in a secure or non-secure setting. Residential settings also include prisons and prison-like institutions and other types of training schools that use a type of cognitive behavioural therapy.

    Most of the studies include only boys, but there are also studies with both sexes and one with girls only. The studies are from the US, Canada and Great Britain and were conducted from 1973 to 2005. The follow-up periods vary, but a report is made at 6, 12 and 24 months after the young people have left the residential setting.

    Recommendations for future research

    The review is a good example of the fact that other methods than randomised controlled trials also can contribute to give a qualified estimate of the effect of an intervention. Of the 12 studies, five are randomised controlled trials, while seven are trials whereby an alternative has been used to establish a control group. The researchers point out that, in future, register data can be used to measure the effects of this type of intervention.

Behavioural and cognitive-behavioural training interventions for assisting foster carers in the management of difficult behaviour
  • Authors William Turner, Geraldine M. Macdonald, Jane A. Dennis
  • Published date 2007-07-19
  • Coordinating group(s) Social Welfare
  • Type of document Review User abstract
  • Title Behavioural and cognitive-behavioural training interventions for assisting foster carers in the management of difficult behaviour
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2007.3
  • English

    Need for further research on cognitive-behavioural training interventions for foster carers

    There is a lack of evidence about the efficacy of behavioural or cognitive-behavioural training interventions for foster carers. The programmes are intended to assist foster carers in the management of the difficult behaviour of looked-after children and to provide competent care. However, a new Campbell/Cochrane review, supported by Nordic Campbell Center, finds no evidence of the efficacy of the programmes. On the contrary, there is a need to further investigate whether such programmes may be harmful to looked-after children.

    Looked-after children need more than stability alone

    Children placed with foster families have special needs. Many have complex problems which place heavy demands on foster carers and their ability to manage difficult behaviour. A stable and secure home environment is not enough.

    The idea behind the training programmes for foster carers is to increase their skills and thereby support the children and limit difficult behaviour. A number of programmes train foster carers to use cognitive-behavioural interventions, as this form of treatment has been shown to be effective in other contexts. Cognitive-behavioural training interventions combine specific child-rearing tools with cognitive techniques, which seek to correct the problematic thinking patterns of the child associated with dysfunctional behaviour.

    Based on the best research to date in this field, the review maps the effect of the programmes where carers are taught to use cognitive-behavioural training methods when dealing with the problematic behaviour of the looked-after children. The review covers six different studies. Four from the UK and two from the US, in which a total of 463 foster carers participated.

    Uncertainty about the effect

    The authors of the review can find no evidence about the efficacy of the programmes. They investigate the effect of the programmes on a total of 21 outcome measures concerning the looked-after child’s behaviour and psychosocial functioning, the psychological well-being of the foster carers and the stability of the placement. Only two of the studies in the review find effects in some of the criteria set:

    One study shows that the programmes provide carers with a moderately higher knowledge regarding different behavioural principles.

    On the other hand, another larger and better-conducted study indicates that the programmes may have a negative effect. The study finds a higher level of psychopathology among the children whose

    foster carers have received cognitive-behavioural training, than among children whose foster carers have not participated in the programmes.

    The same study also reports that the children whose foster carers have participated in programmes suffer from attachment disorders to a moderately higher degree than children whose foster carers did not take part in training.

    The authors of the review point out that it is not possible to reach any overall conclusion on the efficacy of the training of foster carers on the basis of the results.

    Are short programmes for foster carers adequate?

    There is no evidence to indicate that cognitive-behavioural training interventions are of benefit to the looked-after children or their foster carers. The authors consider that this should be explored with the complex problems of looked-after children in mind. Their emotional, psychological and social traumas are often so severe that the generally short programmes are unlikely to provide foster carers with the tools necessary to deal with the problems. In addition to longer, more intensive and more specialised programmes, the researchers propose that they should be supplemented with other interventions.

    About the systematic review

    The review includes six different studies of cognitive-behavioural training interventions for foster carers who take care of children aged between 0-18 years. All studies are based on randomised controlled trials or other trials that compare the groups which have participated in the intervention with a control group.

    Recommendations for future research

    The researchers point out that there are methodological weaknesses in all six studies, and that it is difficult to draw any certain conclusions. The need for further research in this area is therefore highlighted – especially as one study indicates possible negative effects on looked-after children.

    In continuation of the considerations regarding the intervention and the various psychosocial problems of the looked-after children, the researchers point out that future research should take into account the length and intensity of programmes and make a more specific distinction between which behavioural problems the foster carers participating should be assisted in managing.

School feeding for improving the physical and psychosocial health of disadvantaged students
  • Authors Elizabeth Kristjansson, Anna P. Farmer, Trisha Greenhalgh, Laura Janzen, Julia Krasevec, Barbara MacDonald, Jessie MacGowan, Alain Mayhew, Mark Petticrew, Vivian Robinson, Beverley J. Shea, Peter Tugwell, George A. Wells
  • Published date 2006-12-31
  • Coordinating group(s) Education, Social Welfare
  • Type of document Review
  • Title School feeding for improving the physical and psychosocial health of disadvantaged students
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2006.14
Interventions intended to reduce pregnancy-related outcomes among adolescents
  • Authors Lauren S. Scher, Rebecca A. Maynard, Matthew Stagner
  • Published date 2006-12-19
  • Coordinating group(s) Social Welfare
  • Type of document Review Plain language summary
  • Title Interventions intended to reduce pregnancy-related outcomes among adolescents
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2006.12
  • Records available in English, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    Teen pregnancy prevention programs are mostly ineffective – multi-component programs may work

    Teenagers who become pregnant, especially at a young age, face both immediate and long run negative consequences. Teen pregnancy prevention programs aim to reduce teenage pregnancy by promoting abstinence and using contraception. Evaluations show most programs evaluated fail to achieve these goals. However, there are reasons to continue evaluating pregnancy prevention programs as they evolve and the social context changes.

    What is the aim of this review?

    This Campbell systematic review examines the effectiveness of teenage pregnancy prevention programs in promoting abstinence, encouraging the use of contraception and reducing the likelihood of pregnancy among teens. The review summarise findings from 31 studies conducted in the United States or in developed countries with higher than average rates of unplanned teen pregnancy, such as Canada, England, New Zealand, and Australia.

    What did the review study?

    High rates of sexual activity, pregnancy and teen births, particularly in the United States, has led to a wide range of teenage pregnancy prevention initiatives, some emphasizing contraceptive use and others emphasizing abstinence as the primary means of reducing teen pregnancy rates.

    This review examines the effectiveness of teenage pregnancy prevention programs in lowering sexual activity rates, encouraging the use of contraception, and reducing pregnancy among teens.

    What studies are included?

    The review includes randomized controlled trials of teenage pregnancy prevention programs. Included studies focused on programs that primarily served youth between 11 and 18 years old. These programs included: one-time consultations, sex-education programs with an abstinence focus, sex-education programs with a contraception component, and multi-component youth development programs.

    The review includes 31 studies published prior to 2006, with include an aggregate sample size of over 37,000.

    What are the main results in this review?

    Taken together, the findings for each of the first three types of interventions- one-time consultations, sex education programs focused on contraception, and sex education programs focused on promoting abstinence- show no evidence of having reduced sexual activity or pregnancy rates among participating youth. The most promising results are for multi-component youth development programs, which resulted in modest reductions (six percentage points) in pregnancy rates among participants as compared with their control group counterparts. The impacts were larger for females than males.

    What do the findings in this review mean?

    When this review of randomized controlled trials was conducted, most of the programs evaluated were not achieving their intended goals of reducing pregnancy rates.

    However, these results should not be interpreted as evidence to eliminate prevention efforts, for several reasons: (1) the studied programs may not be typical; (2) the social context has changed quite substantially in the 10 years since this review was published; and (3) teen pregnancy remains as a problem warranting intervention. There is value in building on these findings when designing interventions and assessing the effectiveness of adopted strategies.

    How up-to-date is this review?

    The review authors searched for studies published until April 2006. This Campbell Systematic Review was published in October 2006.

  • Spanish

    Click on 'Download PDF' on the right to view the plain language summary in Spanish.

Work programmes for welfare recipients
  • Authors Geir Smedslund, Therese K. Dalsbø, Kåre Birger Hagen, Torill Johme, Mons Georg Rud, Asbjørn Steiro
  • Published date 2006-08-10
  • Coordinating group(s) Social Welfare
  • Type of document Review User abstract
  • Title Work programmes for welfare recipients
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2006.9
  • English

    An active labour-market policy has a minor positive effect

    Many countries have moved their strategies away from passive public assistance for the unemployed. Instead, the focus is on getting the unemployed off welfare benefits and into the regular labour market through various approaches, including vocational training, job offers and competency upgrading. A new Campbell review based on comprehensive studies from the USA and Canada shows that active labour-market programmes have a minor positive effect. They result in a slight increase in the likelihood that the unemployed person will find employment, that earnings will increase and that welfare payments will be reduced. They also reduce the likelihood that the unemployed person will remain on long-term welfare.

    From passive public assistance to active labour-market programmes

    A change in labour-market policy has taken place in many developed countries away from passive public assistance towards various types of active programmes. It is hoped that this change will get the unemployed off welfare and into the regular labour market. The idea behind the active programmes is that by offering the unemployed jobs and training – on special terms – they can strengthen their qualifications, their attachment to the labour market and their opportunities to participate in the mainstream labour market.

    This Campbell Review is the most comprehensive study to date that measures the effects of this type of programme. The review gathers and analyses the most sound knowledge in the field and provides an assessment of the effects of active labour-market programmes in relation to a group comprised mainly of uninsured, unemployed, single mothers on welfare. The review is based on studies of 73 assessments of 46 programmes with 412,000 participants.

    Positive effects on income and employment

    This review shows that there are minor positive effects when it comes to employment and earnings for participants in active labour-market programmes.

    An analysis of the participants’ situations two years after participation in the programme shows an increase from 58% to 61% in the likelihood that they will have found work. It also shows a reduction from 72% to 68% in the likelihood that they will have remained on welfare.

    The proportion of participants who achieve higher earnings and lower welfare payments is not large. But the participants who find work do experience a change in their income that is so major that participants in the programme can generally expect a 25% increase in earnings and a 14% reduction in welfare payments.

    Another way to examine the effects of active labour-market programmes is by asking: “How many people need to take part in an active programme before one extra person finds employment?” – and the answer is 33. That is, the decision-makers can weigh the costs of 33 people in activation against the positive effects of one extra person in employment.

    Broad-spectrum activation policy

    Almost all of the 46 programmes assessed in this review cover more than one type of labour-market programme of the kind that are prevalent in the Nordic labour market policies.

    The main focus of about 60% of the programmes is on participants finding non-subsidised employment as quickly as possible (upgrading via employment), while the main focus of the remaining programmes is on education and training (upgrading before employment). The findings of this review suggest that focusing on employment rather than on education and training has a greater impact.

    In almost 80% of the programmes participation is mandatory, while in the remaining programmes participation is voluntary. This assessment suggests that voluntary programmes work better than mandatory.

    The review points out that programmes which include job-search assistance generally have a positive effect. However, it is not possible to establish an independent positive effect of the other individual components of the 46 programmes covered in this review:

    • Job placement services
    • Case work
    • Time limits on welfare benefits
    • Other financial incentives
    • Childcare
    • Transportation assistance

    Participants: Single mothers on public assistance

    The participants in the 46 programmes reviewed are almost entirely single mothers (90%). This is because of the relatively high threshold for access to the American welfare system: Adults are expected to take care of themselves, but as a special support measure for children, the system helps single providers. This is one of the most significant differences compared to the welfare systems in the Nordic countries, where the group on public assistance is far more heterogeneous.

    The majority (80%) of the participants are divided equally between blacks and whites, while the remaining 20% come from other ethnic groups. Almost half have an upper-secondary school education or higher.

    The analysis in this research review suggests that the effects of active labour-market programmes are generally greater for men than for women. The effects are also slightly greater for ethnic minorities than for the ethnic white majority.

    Success criteria: Employment and higher income

    The initial objective of this review was to study a wide variety of success criteria. However, ultimately it was only possible to study the following four most common criteria in all the studies:

    • Proportion in non-subsidised employment – the more the better
    • Proportion on public assistance – the fewer the better
    • Welfare payments – the lower the better
    • Earnings – the higher the better

    The quality of this information is relatively good, because it is mainly based on information from administrative registries.

    412,000 participants, 73 assessments and 46 programmes

    This review is based on a study of a large number of high-quality systematic reviews of effects. They assess different programmes that each comprise different combinations of active labour-market policy programmes, and that involve a very large number of participants. This means that the findings in this review represent the most sound and reliable knowledge in the area to date.

    44 programmes are from the USA and the two others are from Canada. Some US programmes are assessed in several different states, while others are assessed in several different counties within the same state. In general, the effects of the same programme vary measurably according to geographic location. This highlights the significance of local conditions for the magnitude of the effects.

    Canada, which resembles the Nordic countries, shows better effects than the USA

    There are several crucial differences between the Nordic and the US welfare systems. These differences affect whether the findings from one system can be applied to the other. For instance, the welfare systems in the Nordic countries have a relatively low threshold for participation. And practically all unemployed have the right to receive some type of assistance. In contrast, the assistance programmes in the US welfare system have a relatively high threshold for participation.

    Thus, the group of participants in the US programmes is far more homogeneous (unemployed, single mothers without unemployment insurance) than the group of unemployed on public assistance in the Nordic countries.

    The Canadian welfare system is somewhere in-between the US and the Nordic systems. It is therefore worth noting that the two Canadian assessments included in the review generally have somewhat better effects than the 44 US programmes.

Independent living programmes for improving outcomes for young people leaving the care system
  • Authors Charles Donkoh, Paul Montgomery, Kristen Underhill
  • Published date 2006-06-21
  • Coordinating group(s) Social Welfare
  • Type of document Review User abstract
  • Title Independent living programmes for improving outcomes for young people leaving the care system
  • See the full review https://onlinelibrary.wiley.com/doi/abs/10.4073/csr.2006.8
  • English

    Independent living programmes for young people leaving the care system – training in adult life skills

    Independent Living Programmes (ILPs) are designed to aid young people, who have spent time in care, in their transition into independent adulthood. This intervention is used in Denmark with inspiration from the US and Britain. A new Campbell/Cochrane review concludes that there is little evidence to show the effectiveness of ILPs and therefore recommends that more research be carried out in this area. The existing studies, however, indicate that intervention is effective in a number of areas, but inferences cannot be drawn from these due to the use of relatively weak methods of evaluation.

    Difficult start to adult life for young people leaving the care system

    Young people, who have spent time in care, do not generally do as well as youth in the general population. They are less likely to have received a good education, experience higher levels of unemployment, are more dependent on public assistance, face higher rates of homelessness, have poorer mental and physical health, and are more likely to come into contact with the criminal justice system. In order to provide them with better opportunities when leaving the care system, in their transition into independent adulthood, local authorities offer them support and assistance, otherwise known as ILPs. But there is a great deal of uncertainty regarding the effectiveness of such intervention.

    The objective and methodology of this Campbell/Cochrane Review

    This Campbell/Cochrane Review has the objective of assessing the effectiveness of offering ILPs to young people leaving the care system, an organised programme upon when they leave the care system.

    The authors of the review have conducted an exhaustive and systematic search for studies on the effectiveness of ILPs. Eighteen studies were found; however, reliable inferences cannot be drawn from these studies due to their weak methodology. No randomised controlled trials were found to show the effectiveness of ILPs. This type of study is normally a safer method of carrying out reliable effect measurements.

    The authors cannot therefore reach any final conclusion on the effectiveness of ILPs.

    Among the eighteen studies there is, however, a smaller group of eight studies which have used control groups in their study methodology. In the absence of more solid studies, they represent the best information available at this present time. The studies were subsequently assessed by the authors of the review outside the framework of the review itself. Read more about this assessment in the section ’The best information available at this time’ below.

    No 100% reliable documentation of the effectiveness of ILPs

    The review concludes that there is not adequate documentation of the effectiveness of ILPs. The studies available have been conducted in such a way as to rule out the possibility of reaching reliable conclusions on whether ILPs work in the areas covered by the review: Educational attainment, employment, housing, health status and “other objectives for the knowledge and behaviour of young people’

    The best information available at this time

    As previously mentioned the authors of the review refer, in a separate article, to eight studies which were not included in the review itself. They were all, however, carried out as control group studies and, in the article, the authors write that in the absence of more solid studies, these studies can help to provide both researchers and practicians with information on the effectiveness of ILPs.

    In a review of the eight studies, the authors take a closer look at which areas of the lives of the young people are affected by ILP intervention:

    Educational qualifications: The majority of the eight studies show that the young people participating in the ILPs are more likely to successfully complete compulsory education and technical training.

    Employment: Several of the studies conclude that more young people participating in ILPs than in the control groups have employment (both full-time and part-time). One study also shows that young people participating in ILPs are quicker to find full-time employment than the control groups.

    Housing: All eight studies show better results for young people participating in ILPs where housing is concerned. They are more likely to live alone, they are more self-supporting, they have more stable housing and there are fewer homeless among those who have participated in ILPs.

    Health status: Here the prevalence of teenage parenthood, the extent of various types of abuse and the physical health of the young people have been looked at. The eight studies do not, however, provide any clear conclusions on whether ILPs have an effect on this measurement of success.

    Other objectives for the young people’s knowledge and behaviour: Here the young people's skills in money management have been measured, as has their knowledge about the opportunities and resources available in the public system. Their dependency on public assistance was assessed, as was any involvement with the criminal justice system. But here too, the eight studies fail to provide an indication of the effectiveness of ILPs.

    Which young people does the review focus on?

    The Campbell/Cochrane Review has opted to look at studies of young people leaving care systems at their country’s statutory age of discharge. The review has not included studies which assess ILPs aimed specifically at young people with special needs, such as young people with physical or learning disabilities, teenage parents, young offenders and those in psychiatric institutions. This is due to the fact that that there could be considerable variation in the outcome of ILPs across the various groups of young people.

    The Campbell/Cochrane review is based on American and British outcome studies. Despite exhaustive information retrieval, outcome studies from other countries were not found. The 18 studies deal with the so-called ’Independent Living Programmes’.

    Independent Living Programmes – training in adult life skills

    Independent Living Programmes is a collective designation for an organised process with a wide range of measures designed to strengthen the personal development and social skills of young people. This might involve training in communication, conflict resolution and anger management. The programmes can also help young people to decide which educational path they wish to follow, to apply for jobs, become aware of the resources available to them in the public system, manage their household finances and to learn to cook, clean etc.

Speech and language therapy interventions for children with primary speech and language delay or disorder
  • Authors James Law, Zoe Garrett, Chad Nye
  • Published date 2005-11-13
  • Coordinating group(s) Social Welfare
  • Type of document Review User abstract
  • Title Speech and language therapy interventions for children with primary speech and language delay or disorder
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2005.5
  • English

    This article is based on the Campbell Review: Law J, Garett Z, Nye C: Speech and language therapy interventions for children with primary speech and language delay or disorder. The Campbell Collaboration 2003. This article is written by the Nordic Campbell Centre. The article has been approved by the authors of the review. Published October 2006

    Speech and language therapy can help children with expressive phonological and expressive vocabulary difficulties

    It is important to offer help to children with expressive phonological and expressive vocabulary difficulties. If these problems are not addressed, this can have serious implications for their general well-being, development and learning. Speech and language therapy can help these children.

    Research has shown that it can be beneficial to involve normal language peers in the therapy process. They can serve as positive role models. This is the finding of a Campbell Review which also shows that it has no bearing on the effectiveness of language and speech therapy whether the children participate in groups or individually.

    Language and life quality

    International research has shown that approx. six per cent of all children have general speech and language difficulties. This may involve receptive and expressive vocabulary difficulties, difficulty in constructing sentences (syntax) and expressive phonological difficulties. For a number of these children, these problems will have no lasting effect on their future development. But for 30-60 per cent, these difficulties will continue into their adolescence and on into adult life. For these children, receptive and expressive vocabulary difficulties and expressive and receptive phonological difficulties may have a negative effect on their quality of life in the form of poor school achievement, a lack of social skills and emotional and behavioural problems.

    Speech and language therapy works

    This Campbell Review concludes, on the basis of the available international studies in this field, that speech and language therapy generally has a positive effect on children with expressive phonological difficulties. The therapy also helps children who have a problem with their active vocabulary, i.e. children who have difficulty in using words they understand. Children, who have difficulty with active vocabulary alone, but no problem understanding and acquiring language, also benefit from speech and language therapy.

    Speech and language therapy for children who have difficulty in applying grammar and constructing sentences is, however, only thought to have a positive effect if the child does not have other significant receptive speech and language difficulties.

    It has no bearing on the effectiveness of speech and language therapy whether the children participate in groups or individually. The effectiveness of speech and language therapy focussing on sounds is the same whether carried out by a professional or a parent who has been trained to administer speech and language therapy. But it has been shown to have a positive effect if normal language peers are allowed to participate in the speech and language therapy.

    Finally there is some indication that the effectiveness of speech and language therapy is greater if it takes place over a period of more than eight weeks.

    Which children participated in the study?

    This Campbell Review is based on studies of children and adolescents with a diagnosis of primary speech and language delay/disorder, i.e. their difficulties cannot be accounted for by a condition such as autism, hearing impairment or social problems. The oldest child who participated in one of the studies was fifteen. Children with stutters or learned misarticulations were excluded from this review.

    1,500 children in 36 different studies

    The conclusions of the review are based on the results of a large number of studies, all written in English. Thirty-six studies were found, based on a total of 1,500 children involved in thirty-three randomised controlled trials.

    The thirty-six studies were chosen because they fulfilled the Campbell Review’s inclusion criteria with regards to who, what and why, and because the studies also complied with the minimum quality requirements of the review.

    Speech and language therapy in one

    The review does not differentiate between different types of speech and language therapy. The most important criterion is that the therapy should have the objective of improving the child’s understanding and pronunciation of sounds. Therapy that focuses on the treatment of receptive speech and language skills may be more resistant to improvement

    What success criteria does the review there focus on?

    The review assesses the effectiveness of speech and language therapy on the basis of the following measurements of success:

    1. Improved use and understanding of speech.
    2. Improved use and understanding of words (vocabulary).
    3. Improved grammar and sentence construction, where differentiation is made between what the child knows and understands and what he/she is able to use.

    Consequences for research

    Even though speech and language therapy can help children with expressive phonological difficulties and expressive vocabulary difficulties, there is a general need for more research in this area. The Campbell Review emphasizes, for example, the need to clearly define the interventions in advance. This would make it easier to explain and understand any variations in the results.

    It has also been suggested that more research should be carried out into how the results of the intervention of therapy in the case of learning difficulties can be optimised. There is also a need for greater knowledge about when it is the best time to initiate the treatment; as early as possible, or when the child is mature enough for change?

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