Primary-school-based art therapy: exploratory study of changes in children’s social,emotional and mental health

ABSTRACT

AIM: This exploratory mixed methods study aimed to inform future research by investigating if teachers and children from one primary school perceived any changes in children’s social, emotional and mental health difficulties following art therapy and if so, what the children perceived as helpful about the sessions. METHODS: The study included 45 children and 10 class teachers within one UK primary school. The researchers analysed routine questionnaires from teachers and a children's evaluation interviews, triangulating these with data from a teacher focus group. RESULTS: The findings show significant and medium effect sizes for positive teacher-rated changes in children’s overall stress, conduct, hyperactivity, and procsocial behaviour and a large effect on perceived impact of children’s difficulties on their lives. Teacher-rated emotional distress and peer problems showed small changes that did not reach statistical significance. The positive changes were corroborated by the teachers' and children's qualitative reports. Aspects of art therapy which children found particularly helpful were; making and thinking about art; expressing, thinking and learning about thoughts and feelings; and sessions being fun. CONCLUSION: The study highlighted perceived positive changes and no negative changes in children’s SEMH difficulties. However, future research is necessary to examine clinical effectiveness.

Plain-language summary

In this article we describe a research study which aimed to explore if teachers and children perceived any changes to children’s social, emotional or mental health difficulties after the children attended art therapy within their primary school. We were also interested in learning from the children if they thought anything in particular had been helpful about their art therapy sessions in order to inform future research and the development of this particular approach to art therapy.

The art therapists asked the class teachers to fill out a Strengths and Difficulties Questionnaires at the beginning and end of art therapy. The class teachers also attended a focus group so we could learn more about their general observations of the children before and after attending art therapy. The art therapists also interviewed the children to learn if they perceived any changes since coming to art therapy and if so, what in particular they thought had helped bring about these changes.

We found that statistical analysis of the questionnaire scores mostly agreed with what the teachers and children said and that there was generally some positive change to the social, emotional and mental health difficulties the children had been experiencing. The teachers also let us know that some of the children still had residual problems. The children emphasised that making and thinking about art along with expressing, thinking and learning about thoughts and feelings had been particularly helpful. It was also important to the children that the sessions were fun.

In conclusion, the teachers and children in this primary school perceived art therapy as helpful to the children and that it merits further research in order to develop the approach used by the art therapists and to see if it is effective in larger research studies including more children, schools and art therapists.     

Perspectives on anticipated quality-of-life and recommendations for neonatal intensive care: a survey of neonatal providers

Objective: Explore associations between neonatal providers’ perspectives on survival, quality of life (QOL) and treatment recommendations.

Methods: Providers attending a workshop on neonatal viability were surveyed about survival, perceived QOL and treatment recommendations for marginally viable infants. We assessed associations between estimated survival and perceived QOL and treatment recommendations.

Results: In the 44 included surveys, estimates of survival and QOL varied widely. Maximum care was recommended 80% of the time when anticipated QOL was high, versus 20% when anticipated QOL was low (p?<?0.001). Adjusted for confounders, odds of recommending maximum intervention were 4.4 times higher when anticipated QOL was high (95% CI 1.9 – 10.2, p?=?0.001).

Conclusions: The perspectives of practitioners who provide care to critically ill neonates regarding potential survival and QOL vary dramatically and are associated with the treatments those practitioners recommend. Practitioners should take care to avoid basing treatment recommendations on their own perspectives if they are not well aligned with those of the parents.     

Disorder in Ho2Ti2−xZrxO7: pyrochlore to defect fluorite solid solution series

Pyrochlore (A₂B₂O₇) is an important, isometric structure-type because of its large variety of compositions and structural derivatives that are generally related to different disordering mechanisms at various spatial scales. The disordering is key to understanding variations in properties, such as magnetic behavior or ionic conduction. Neutron and X-ray total scattering methods were used to investigate the degree of structural disorder in the Ho₂Ti_2−xZr_xO₇ (x = 0.0–2.0, Δx = 0.25) solid solution series as a function of the Zr-content, x. Ordered pyrochlores (Fd$\bar{3}$m) disorder to defect fluorite (Fm$\bar{3}$m) via cation and anion disordering. Total scattering experiments with sensitivity to the cation and anion sublattices provide unique insight into the underlying atomic processes. Using simultaneous Rietveld refinement (long-range structure) and small-box refinement PDF analysis (short-range structure), we show that the series undergoes a rapid transformation from pyrochlore to defect fluorite at x ≈ 1.2, while the short-range structure exhibits a linear increase in a local weberite-type phase, C222₁, over the entire composition range. Enthalpies of formation from the oxides determined using high temperature oxide melt solution calorimetry support the structural data and provide insight into the effect of local ordering on the energetics of disorder. The measured enthalpies of mixing are negative and are fit by a regular solution parameter of W = −31.8 ± 3.7 kJ mol⁻¹. However, the extensive short-range ordering determined from the structural analysis strongly suggests that the entropies of mixing must be far less positive than implied by the random mixing of a regular solution. We propose a local disordering scheme involving the pyrochlore 48f to 8a site oxygen Frenkel defect that creates 7-coordinated Zr sites contained within local weberite-type coherent nanodomains. Thus, the solid solution is best described as a mixture of two phases, with the weberite-type nanodomains triggering the long-range structural transformation to defect fluorite after accumulation above a critical concentration (50% Ti replaced by Zr).

Combined neutron and X-ray total scattering with calorimetric measurements of the solid solution series Ho₂Ti_2−xZr_xO₇ reveals a complex order–disorder transition across short, intermediate, and long length scales induced by chemical substitution.     

Hand hygiene technique

Hand hygiene is an essential component of effective infection prevention programmes. Good technique, ensuring that all surfaces of the hands receive contact with the decontaminating agent, has been accepted for many years and is acknowledged in current guidelines. However, hand hygiene technique is seldom incorporated into research studies and audits designed to increase compliance. As a result, numerous unanswered questions remain concerning this aspect of hand hygiene.     

Influence of a ward-based pharmacist on the medication quality of geriatric inpatients: a before–after study

Background Despite several international studies demonstrating that ward-based pharmacists improve medication quality, ward pharmacists are not generally established in German hospitals. Aim We assessed the effect of a ward-based clinical pharmacist on the medication quality of geriatric inpatients in a German university hospital. Method The before-after study with a historic control group was conducted on the geriatric ward. During the control phase, patients received standard care without the involvement of a pharmacist. The intervention consisted of a clinical pharmacist providing pharmaceutical care from admission to discharge. Medication quality was measured on admission and discharge using the Medication Appropriateness Index (MAI). A linear regression analysis was conducted to calculate the influence of the intervention on the MAI. Results Patients in the intervention group (n?=?152, mean 83 years) were older and took more drugs at admission compared to the control group (n?=?159, 81 years). For both groups, the MAI per patient improved significantly from admission to discharge. Although the intervention did not influence the summated MAI score per patient, the intervention significantly reduced the MAI criteria Dosage (p?=?0.006), Correct Directions (p?=?0.016) and Practical Directions (p?=?0.004) as well as the proportion of overall inappropriate MAI ratings (at least 1 of 9 criteria inappropriate) (p?=?0.015). Conclusion Although medication quality was already high in the control group, a ward-based clinical pharmacist could contribute meaningfully to the medication quality on an acute geriatric ward.

     

Late referral for end-stage renal disease: a region-wide survey in the south west of England.

BACKGROUND: The proportion of patients referred for renal replacement therapy (RRT) at a late stage of disease appears to be similar to that first described nearly 20 years ago. This study investigated the current scale of the problem in a large region in England, identifying the prior health care, patient characteristics, referral pattern, and outcomes of those accepted onto RRT. METHODS: Three hundred and sixty-one (88%) out of 411 patients accepted for RRT in six renal units in the South and West Region of the UK between 1 June 1996 and 31 May 1997 were studied retrospectively. We examined the history of chronic renal failure, referral path to nephrologist, management of chronic renal failure (CRF) and patient outcomes. Patients were categorized as 'late' if they were referred to the renal unit either within 4 months or within 1 month of requiring RRT. RESULTS: One hundred and twenty-four (35%) patients were referred within 4 months of RRT, and 84 (23%) within 1 month. The main differences between patients referred later and other patients was seen for those referred within 1 month. These patients were older and had more co-morbidity, significantly worse laboratory parameters at the start of RRT, were less likely to have received standard treatments for CRF, had less permanent dialysis access in place at the start of RRT (18% vs 47%, P=0.001), and had a significantly longer hospital stay (18 vs 10 days, P=0.001). Seventy-four (19%) patients died in the first 6 months: 27 (32%) in the 1-month group, 46 (16%) in all others (P=0.002). We found no evidence that patients referred late had defaulted from nephrology follow-up or had an excess of rapidly progressive disease. Though data were incomplete, there was evidence of prior CRF of over 1 year in all late referral groups. CONCLUSION: Nearly a quarter of patients are referred for specialist nephrology treatment at a very late stage, within 1 month of RRT. They are less likely to receive interventions that could alter the progression of CRF or reduce its associated co-morbidity, have a worse clinical state at the start of RRT, longer hospitalization and poorer survival. These differences were much less marked for those referred within 1-4 months of starting RRT, although this is an insufficient time to prepare for RRT. Further research is needed to determine the missed opportunities for more proactive diagnosis and management of CRF.