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Foster children are at disproportionate risk of adverse outcomes throughout the life course. Public policy prioritizes permanency (exiting foster care through reunification with birth parents, adoption, or legal guardianship) to promote foster youths’ healthy development and well-being, but little empirical evidence indicates that permanency, including its most preferred form—reunification—promotes positive outcomes. Using multi-system, statewide longitudinal administrative data, we employed logistic and mixed-effects regression to examine educational attainment and earnings among former foster youth in early adulthood. We found that youth who aged out of care had significantly higher odds of graduating high school and enrolling in college than did reunified youth and youth who exited to guardianship, and they had similar odds as adopted youth. Earnings were similar across groups. Among aged-out (but not reunified) youth, odds of high school graduation and average earnings were higher for youth who spent more time in foster care prior to age 18. Overall, results suggest that permanency alone is insufficient to promote foster youths’ educational and economic attainment.

The prevalence of incarceration in the United States is increasingly well known. The prevalence of family involvement with child protective services (CPS) is less understood, though, and there is limited research examining links between incarceration and CPS involvement. Here, we describe the incidence and prevalence of incarceration and CPS involvement in the United States and outline reasons that the same individuals and families may be at risk for involvement in both systems. We then use unique longitudinal data from Wisconsin to describe intergenerational and intragenerational overlap in the two systems. Specifically, we calculate (1) the proportion of all CPS-involved children who have an incarcerated parent; (2) the proportion of incarcerated adults who have a CPS-involved child; (3) the proportion of incarcerated young men and women who were involved in the CPS system as adolescents; and (4) the proportion of CPS-involved adolescents who subsequently became incarcerated. We conclude with a discussion of directions for future research and implications for practice and policy.

Objective: Welfare-reform research has treated the Temporary Assistance for Needy Families (TANF) program as a homogenous work program despite the commonality of exemptions from work requirements. To address this shortcoming, we compare program and economic outcomes between three groups of TANF participants: work-exposed (workers), work-exempt to care for an infant (new mothers), and work-exempt due to a disability (participants with a disability). Method: Using 2006 administrative data for a cohort of Wisconsin TANF entrants (N = 682), we describe differences in individual characteristics, TANF participation, and work and income patterns between groups. We use discrete-time regression models to examine the between-group correlates of exiting TANF and exiting TANF to work. Results: Descriptive analyses reveal significant differences between groups in individual characteristics and TANF, work, and income patterns. On average, new mothers have more education and work experience, fewer and shorter TANF spells, and greater earnings and income in the year following TANF entry compared to other participants. Discrete-time regression analyses, however, suggest that pre-entry education and work experience are the strongest predictors of employment outcomes. Conclusions: To address the diversity of outcomes between TANF groups, policymakers should consider program alternatives such as disability and paid-leave programs.

We analyze the role of newly integrated data from the child support and child welfare systems in seeding a major policy change in Wisconsin. Parents are often ordered to pay child support to offset the costs of their children's stay in foster care. Policy allows for consideration of the “best interests of the child.” Concerns that charging parents could delay or disrupt reunification motivated our analyses of integrated data to identify the impacts of current policy. We summarize the results of the analyses and then focus on the role of administrative data in supporting policy development. We discuss the potential and limitations of integrated data in supporting cross-system innovation and detail a series of complementary research efforts designed to support implementation.

BackgroundThe Improving the Wellbeing of people with Opioid Treated CHronic pain (I-WOTCH) randomised controlled trial found that a group-based educational intervention to support people using strong opioids for chronic non-malignant pain helped a significant proportion of people to stop or decrease opioid use with no increase in pain-related disability. We report a linked process evaluation of the group-based intervention evaluated in comparison to a usual-care control group that received a self-help booklet and relaxation CD.MethodsWe interviewed 18 intervention facilitators, and 20 intervention and 20 control participants who had chronic non-malignant pain and were recruited from general (family) practices in the UK. Quantitative data included change mechanism questions on the trial questionnaires which explored motivation, expectations and self-efficacy. Fidelity was assessed by listening to a sample of audio-recorded group sessions and nurse consultations. Quantitative and qualitative data were integrated using ‘follow a thread’ and a mixed-methods matrix.FindingsFour overarching themes emerged: (1) the right time to taper, (2) the backdrop of a life with chronic pain, (3) needing support and (4) the benefits of being in a group. Delivery fidelity was good, adherence (83%) and competence (79%) across a range of intervention groups. Staff delivering the intervention found three typical responses to the intervention: resistance, open to trying and feeling it was not the right time. The group experience was important to those in the intervention arm. It provided people with a forum in which to learn about the current thinking about opioid usage and its effects. It also gave them examples of how feasible or personally relevant coming off opioids might be.ConclusionThe process evaluation data showed that the I-WOTCH intervention was well delivered, well received and useful for most interviewees. Being ‘the right time’ to taper and having support throughout tapering, emerged as important factors within the context of living with chronic pain.Trial registration numberISRCTN49470934.

ObjectivesTo describe the design, development and pilot of a multicomponent intervention aimed at supporting withdrawal of opioids for people with chronic non-malignant pain for future evaluation in the Improving the Wellbeing of people with Opioid Treated CHronic pain (I-WOTCH) randomised controlled trial.DesignThe I-WOTCH intervention draws on previous literature and collaboration with stakeholders (patient and public involvement). Intervention mapping and development activities of Behaviour Change Taxonomy are described.SettingThe intervention development was conducted by a multidisciplinary team with clinical, academic and service user perspectives. The team had expertise in the development and testing of complex health behaviour interventions, opioid tapering and pain management in primary and secondary care, I.T programming, and software development—to develop an opioid tapering App.ParticipantsThe I-WOTCH trial participants are adults (18 years and over) with chronic non-malignant pain using strong opioids for at least 3 months and on most days in the preceding month.OutcomesA multicomponent self-management support package to help people using opioids for chronic non-malignant pain reduce opioid use.Interventions and resultsReceiving information on the impact of long-term opioid use, and potential adverse effects were highlighted as important facilitators in making the decision to reduce opioids. Case studies of those who have successfully stopped taking opioids were also favoured as a facilitator to reduce opioid use. Barriers included the need for a ‘trade-off to fill the deficit of the effect of the drug’. The final I-WOTCH intervention consists of an 8–10 week programme incorporating: education; problem-solving; motivation; group and one to one tailored planning; reflection and monitoring. A detailed facilitator manual was developed to promote consistent delivery of the intervention across the UK.ConclusionsWe describe the development of an opioid reduction intervention package suitable for testing in the I-WOTCH randomised controlled trial.Trial registration numberISRCTN49470934.

IntroductionThe Improving the Wellbeing of people with Opioid Treated CHronic Pain (I-WOTCH) randomised controlled trial uses a multicomponent self-management intervention to help people taper their opioid use. This approach is not widely used and its efficacy is unknown. A process evaluation alongside the trial will help to assess how the intervention was delivered, looking at the dose of intervention received and the fidelity of the delivery. We will explore how the intervention may have brought about change through the experiences of the participants receiving and the staff delivering the intervention and whether there were contextual factors involved.Methods and analysisA mixed methods process evaluation will assess how the processes of the I-WOTCH intervention fared and whether these affected the outcomes. We will collect quantitative data, for example, group attendance analysed with statistical methods. Qualitative data, for example, from interviews and feedback forms will be analysed using framework analysis. We will use a ‘following a thread’ and a mixed methods matrix for the final integrated analysis.Ethics and disseminationThe I-WOTCH trial and process evaluation were granted full ethics approval by Yorkshire and The Humber—South Yorkshire Research Ethics Committee on 13 September 2016 (16/YH/0325). All data were collected in accordance with data protection guidelines. Participants provided written informed consent for the main trial, and all interviewees provided additional written informed consent. The results of the process evaluation will be published and presented at conferences.Trial registration number ISRCTN49470934; Pre-results.

IntroductionOver the last two decades, the use of opioids for the treatment of chronic pain in England has steadily increased despite lack of evidence of both long-term effectiveness in pain relief and significant, well-documented physical and mental adverse events. Guidelines recommend tapering when harms outweigh benefits, but the addictive nature of opioids hinders simple dose-reduction strategies. Improving the Well-being of people with Opioid Treated CHronic pain (I-WOTCH) trial tests a multicomponent self-management intervention aimed to help patients with chronic non-malignant pain taper opioid doses. This paper outlines the methods to be used for the economic analysis of the I-WOTCH intervention compared with the best usual care.Methods and analysisEconomic evaluation alongside the I-WOTCH study, prospectively designed to identify, measure and value key healthcare resource use and outcomes arising from the treatment strategies being compared. A within-trial cost-consequences analysis and a model-based long-term cost-effectiveness analysis will be conducted from the National Health Service and Personal Social Service perspective in England. The former will quantify key parameters to populate a Markov model designed to estimate the long-term cost and quality-adjusted life years of the I-WOTCH intervention against best usual care. Regression equations will be used to estimate parameters such as transition probabilities, utilities, and costs associated with the model’s states and events. Probabilistic sensitivity analysis will be used to assess the impact of parameter uncertainty onto the predicted costs and health outcomes, and the resulting value for money assessment of the I-WOTCH intervention.Ethics and disseminationFull ethics approval was granted by Yorkshire & The Humber—South Yorkshire Research Ethics Committee on 13 September 2016 (16/YH/0325). Current protocol: V.1.7, date 31 July 2019. Findings will be disseminated in peer-reviewed journals, scientific conferences, newsletters and websites.Trial registration numberInternational Standard Randomised Controlled Trial Number (49 470 934); Pre-result.

IntroductionChronic non-malignant pain has a major impact on the well-being, mood and productivity of those affected. Opioids are increasingly prescribed to manage this type of pain, but with a risk of other disabling symptoms, when their effectiveness has been questioned. This trial is designed to implement and evaluate a patient-centred intervention targeting withdrawal of strong opioids in people with chronic pain.Methods and analysisA pragmatic, multicentre, randomised controlled trial will assess the clinical and cost-effectiveness of a group-based multicomponent intervention combined with individualised clinical facilitator led support for the management of chronic non-malignant pain against the control intervention (self-help booklet and relaxation compact disc). An embedded process evaluation will examine fidelity of delivery and investigate experiences of the intervention. The two primary outcomes are activities of daily living (measured by Patient-Reported Outcomes Measurement Information System Pain Interference Short Form (8A)) and opioid use. The secondary outcomes are pain severity, quality of life, sleep quality, self-efficacy, adverse events and National Health Service (NHS) healthcare resource use. Participants are followed up at 4, 8 and 12 months, with a primary endpoint of 12 months. Between-group differences will indicate effectiveness; we are looking for a difference of 3.5 points on our pain interference outcome (scale 40 to 77). We will undertake an NHS perspective cost-effectiveness analysis using quality adjusted life years.Ethics and disseminationFull approval was given by Yorkshire & The Humber - South Yorkshire Research Ethics Committee on 13 September, 2016 (16/YH/0325). Appropriate local approvals were sought for each area in which recruitment was undertaken. The current protocol version is 1.6 date 19 December 2018. Publication of results in peer- reviewed journals will inform the scientific and clinical community. We will disseminate results to patient participants and study facilitators in a study newsletter as well as a lay summary of results on the study website.Trial registration number ISRCTN49470934; Pre-results.