Reading for Wellbeing (RfW) is a pilot initiative, aimed at improving mental health and well-being through supporting access and increasing opportunities to read for pleasure. RfW was implemented across six North-East local authorities in England and employed Community Reading Workers to support access to books and reading for targeted populations. The current study used realist methodology to understand context, potential mechanisms of action, acceptability and reported outcomes. Data generation and analysis were conducted iteratively, using focus groups, interviews and observations. The analysis of the collated data highlighted that a positive attitude towards reading and a desire for social connections were significant motivators for engagement with RfW. This paper postulates eight programme theories relating to that context, which describe key mechanisms within RfW linked to engagement with reading, well-being, connections and practice. The paper concludes that previous notions of positivity associated with reading for pleasure enable participants to experience RfW as a positive social encounter. This positive social encounter enhances participants’ multiple resistance resources such as increased sense of self-efficacy and connectedness that could impact on their sense of well-being.

Mental health problems are the leading cause of childhood disability worldwide, resulting in poor outcomes for children and young people that persist into adulthood. It is essential that those young people most at risk of developing mental health problems receive effective preventative interventions. Whilst there have been a number of systematic reviews which have examined the effectiveness of secondary prevention interventions for specific groups of children and young people, or to address identified mental health concerns, no review has engaged with the breadth of this literature. We conducted a systematic review of systematic reviews to map this complex field of secondary preventative interventions and identify effective interventions to prevent mental health problems in children and adolescents aged 3–17 years. The review protocol was registered on PROSPERO. We searched five electronic databases from inception to February 2023. The certainty of the evidence was appraised using the AMSTAR 2. We included 49 unique systematic reviews each including between 2 and 249 (mean 34) unique studies; the majority of which were reviews which included only or mostly randomised controlled trials (70

Children in care of the state are amongst the most disadvantaged in society. They have often experienced adverse childhood experiences leading to their care entry including abuse and neglect. Longitudinal data suggests problems children in care of the state experience within adolescence persist into adulthood, showing “a continuing legacy of adversity.” Emerging literature shows that edge of care interventions can bring about benefits. These interventions support families to meet their child’s needs and prevent, or reduce, the likelihood of children going into care. However, it is not clear how or why these interventions work. It is important to develop this understanding to inform the development of effective, theory-informed practice to benefit this population. We reviewed and synthesised published literature to expose mechanisms by which interventions may promote and support family preservation for children at the edge of care. Our synthesis uses a realist approach to examine mechanisms by which interventions, in various contexts, can promote and support family preservation for children at the edge of care. Previous work by the team shaped the initial search strategy and in line with RAMESES realist review guidelines, no restrictions were placed on the types of study to be included in the synthesis. From 7,530 potentially relevant references identified, 61 papers were included in final extraction. Extracted data was themed, prior to developing narrative and formulating programme theories. Effective edge of care service operation seemed to be based on four core programme theories pertaining to the need for family skills training, home-based delivery, dedicated worker, and rapid response to need.

PurposeMental health champions (MHCs) and young health ambassadors (YHAs) are two innovative public health interventions. MHCs are practitioners who work in schools and other youth settings and aim to be the "go to" person for mental health in these settings. YHAs are a linked parallel network of young people, who champion mental health and advocate for youth involvement, which was co-produced with young people across all stages of development implementation. This paper aims to identify the potential benefits, barriers and facilitators of these interventions.Design/methodology/approachSemi-structured qualitative interviews (n = 19) were undertaken with a purposive sample of n = 13 MHCs, and n = 6 YHAs, between June 2021 and March 2022. Interviews were audio-recorded, transcribed, anonymised and then analysed following a thematic approach. Ethical approval was granted by Newcastle University's Faculty of Medical Sciences Ethics Committee.FindingsThe findings are organised under five key themes: motivating factors and rewards for MHCs and YHAs; outcomes for children and young people (CYP) and others; impact on youth settings and culture; facilitators of successful implementation; and implementation challenges and opportunities.Practical implicationsThese findings are intended to be of relevance to practice and policy, particularly to those exploring the design, commissioning or implementation of similar novel and low-cost interventions, which aim to improve mental health outcomes for CYP, within the context of youth settings.Originality/valueThe interventions reported on in the present paper are novel and innovative. Little research has previously been undertaken to explore similar approaches, and the individual experiences of those involved in the delivery of these types of interventions.

Many countries are reforming long-term care to deal with the social risks created by demographic and social change. However, the passage of legislation is often followed by a new set of challenges as policy is implemented. This article examines England’s Care Act 2014 through Compton and ‘t Hart’s criteria of policy endurance to demonstrate the importance of assessing effectiveness at multiple time points. Early success in ‘implementation readiness’ was followed by the abandonment or dilution of key commitments. Yet, the Act’s foundational principles – well-being, prevention and capping private spending – continue to shape care policy, much as its original supporters hoped.

Background Children and young people (CYP) who have experienced statutory care are among the most disadvantaged in society and have higher prevalence of mental disorders than the general population. This has been linked to experience of significant childhood adversity including abuse and neglect. Despite indications of high levels of mental health and wellbeing needs in this group, there remains a paucity of empirical research exploring this issue. With an increased chance of experiencing a range of poor health outcomes, it is imperative that key factors for supporting positive development in this group are identified. The aim of this qualitative study was to identify risk and protective factors associated with mental health and wellbeing of care experienced CYP from the perspective of children’s social care and mental health practitioners. Methods We conducted four focus groups with 23 practitioners from four local authorities (the organisations responsible for the provision of public services within a geographical area) between April and May 2022. A semi-structured topic guide exploring the nature, risk and protective factors of mental health and emotional wellbeing was used. Social care and mental health practitioners were purposively sampled by profession so that the final sample included representation from children’s welfare service including early help, community safeguarding teams and those working with children in care/out of home placements. Data were thematically analysed following an iterative six-step analysis approach and informed by the four levels of the socio-ecological model (SEM). Results At the individual level, risk factors included the CYP’s emotional health and functioning and included what practitioners described as the sense of shame. Interpersonal level risk factors were the most recurrent risk highlighted during the discussions. They included interactions and influence of the CYP’S personal relationships and adversity within the home environment. At the community level, risk factors consisted of the characteristics of the settings and institutions that increased the risk of the CYP developing mental health and wellbeing difficulties, particularly the school setting. At the societal level, risk factors included broader societal factors like poverty and unemployment. Practitioners maintained that not all care experienced CYP developed mental health difficulties, particularly if they possessed or developed certain protective factors, for example secure attachments and supportive networks. Conclusion Our study provides evidence suggesting that risk factors for mental health and wellbeing in care experienced CYP operate on multiple, interconnected levels of the SEM. It is imperative that support interventions take this into account and strengthen protective factors like secure attachments and supportive networks when developing interventions for care experienced CYP.

Background Evidence is building around the therapeutic value of reading for pleasure, with a growing number of studies finding positive links between reading and health, particularly mental well-being. Reading for Wellbeing is a pilot intervention, supporting access to books and reading in socially deprived areas, with the aim of promoting health and wellbeing. Community Reading Workers facilitate the intervention across six North East local authorities. This presentation derives data from a wider evaluation of the Reading for Wellbeing project which asked, what in Reading for Wellbeing works, for whom and in what circumstances? Methods The evaluation used a realist approach to understand context, potential mechanisms of action, acceptability, and outcomes. It involved: Rapid realist evidence synthesis of the evidence on reading initiatives to refine theoretical understanding of underlying causal mechanisms which support or inhibit successful promotion of mental and physical health. Data extracted from 45 studies. Qualitative methods were employed between July 2021 to November 2022 including, observations at project implementation meetings and delivery sessions (approx. 41 hours), theory-driven interviews and focus groups with practitioners (n=17) and participants (n=49). Data was analysed in Nvivo, using initial programme theories as a coding framework, which was developed iteratively as the data was being collected and analysed. Results 13 initial programme theories identified at the start of the evaluation were refined and consolidated using empirical data and substantive theories. Data was constructed under four core emergent themes: (1) reading habits; (2) effects on the individual; (3) group effects; and (4) role of the workers. Conclusion Using a realist approach, the evaluation identified prior attitudes to reading form a key context for participation. Participation in the project enabled salutogenic pathways via effecting sense of coherence and connection. This realist evaluation of the Reading for Wellbeing project enabled the development of a nuanced understanding of the workings of the intervention, particularly around the key contexts that affect participation and its impact pathways for improving wellbeing. While contributing to knowledge on salutogenic conditions related to reading for pleasure, the findings present valuable insights into key contexts affecting participation, which can inform development and implementation of similar interventions.

The policy implementation process is often overlooked when policy is introduced potentially leading to policy failure. This is particularly relevant in complex policy areas where there is a lack of collaborative policy-making and where implementation is in dispersed governance. This paper discusses the findings of a study examining a novel policy implementation support programme developed by the English Department of Health for the Care Act 2014, the most significant changes to the provision of social care for 60 years. Given the complexity of the changes, the Department of Health and its key partners introduced an Implementation Support Programme to increase the likelihood of effective implementation. As part of a suite of research studies, we examined the effectiveness of the implementation support programme in helping local authorities, responsible for social care delivery, implement the key Care Act priorities. We found that the support programme was effective in supporting 'implementation readiness' particular in situations where the context and policy itself are complex. We found that while important for the delivery of policy, such support programmes do not necessarily in themselves guarantee successful implementation. However, future evaluations of policy should include examining how the implementation is, or is not supported, in order to fully understand reasons for policy success and failure.

Recent studies have provided important initial insights into the relational and micropolitical dimensions of coach educators’ and coach developers’ work. However, there remains a paucity of inquiry addressing how sporting organisations prepare these members of their workforce to achieve desired goals and objectives. This research uses realist evaluation and normalisation process theory to examine a bespoke ‘reality grounded’ learning initiative that targeted the professional judgements and decision making of experienced coach developers. This rigorous, longitudinal, and theoretically informed approach allowed for the generation of rich, causal, explanations of ‘what has worked within this learning initiative, for whom, and under what circumstances’. Specifically, the study provides original and significant insights into the interconnections between (a) new ways of thinking, organising and acting, (b) already existing, socially patterned, knowledge and practices, and (c) positive and sustainable changes in everyday professional practice; something that has been largely absent in the wider coach education literature base to date. The research concludes that the programme entails more a transfer of knowledge from tutors to coach developers. Importantly, this intervention also aided (a) the development of a coach developer community, (b) facilitated the exchange of information and ideas between peers and, ultimately, (c) impacted on coach development practices and behaviours.

Research consistently demonstrates the over-representation of young people with speech, language and communication needs within the youth criminal justice system, with estimates suggesting this population accounts for up to 90% of young people who offend. Acknowledgement and understanding of these individual-based needs, along with identified service delivery adaptation(s) (where necessary) are required to ensure all young people, regardless of needs experienced, can effectively engage with, and have their voices heard, within the context of Youth Offending Services. By using a realist approach, qualitative interviews with stakeholders (n = 15) are used to explore service conditions required to incorporate speech, language and communication provision within a Youth Offending Service. Specifically, the research provides original and significant insights into the interconnections between understanding of speech, language and communication, service delivery models and engagement with young people. Seven themes pertaining to delivery requirements within youth offending settings were identified. From these themes, explanations in the form of programme theories are postulated detailing core service delivery conditions required in youth offending settings to address speech, language and communication need. These include, increased understanding of speech, language and communication; unpicking terminology and becoming communication friendly; staff cohesion prompting learning together; and co-construction approach to service delivery. The core approach underpinning these postulated programme theories was an increased awareness of speech, language and communication issues by youth offending staff. This increased awareness is evidenced to lead to an adaptation of behaviours and practices by staff which in turn increases engagement with young people.

Background Local government (LG) is ideally placed to influence the determinants of public health (PH) and reduce inequalities, but opportunities are routinely missed. Aims and objectives The aim of the Local Authority Champions of Research (LACoR) study was to explore ways to embed a culture of evidence use in LG. Methods Five linked work packages were undertaken using mixed methods. In this paper, we report data from semi-structured interviews with UK local authority (LA) staff (n=14). Findings Findings show a changing culture of LG: embedded researchers can enhance connectivity and interaction, build linkages, use levers of influence, and learn alongside LG navigators. Understanding the diverse microcultures of evidence use in LG is critical. Research champions can help to navigate the social, financial, political and regulatory context of LG and academia, influencing change dynamically as opportunities emerge. Discussion Changing organisational subcultures is ambitious and unpredictable given the complexities of, and variability in, local contexts. Cumulative changes appear possible by recognising existing assets, using relational approaches to respond to LG priorities. In-house capacity remains underestimated and underutilised in efforts to embed evidence use in LG decision making. Co-located embedded researchers can use contextually specific knowledge and relationships to enhance evidence use in LG in collaboration with system navigators. Conclusions There is a need for academics to adapt their approach, to take account of the context of LG to achieve meaningful health and social impacts with LG and test the contribution of embedded approaches to wider system change.

Background Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the 'whole-system', has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services. Methods A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches. Results Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components. Conclusions The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies.

Background Co-production of research evidence is valued by local government to improve effective decision-making about public services in times of austerity. However, underlying structural issues of power (so-called ‘dark shadows of co-production’) challenge this ambition with limited evidence on how to embed research use sustainably. In this paper we reflect on mechanisms for increasing co-production in local government. Methods This paper presents findings from a Health Foundation funded research project that explored how a culture of evidence use to improve population health could be embedded in UK local government. Five linked work packages were undertaken using mixed methods. In this paper, we report the views of UK local authority staff who participated in four workshops ( n = 54), informed by a rapid literature review and an online scoping survey. Results We identified five themes that facilitate public health evidence use in local government: (1) new governance arrangements to integrate national and local policies, (2) codifying research evidence through local system-wide approaches and (3) ongoing evaluation of programmes, and (4) overcoming political and cultural barriers by increasing absorptive capacity of Local Authorities to embed co-produced knowledge in their cognitive structures. This requires adaptive governance through relationship building between academic researchers and Local Authority staff and shared understanding of fragmented local policy making, which are supported by (5) collective spaces for reflection within local government. Conclusions Creating collective spaces for reflection in between government departments allows for iterative, interactive processes of co-production with external partners that support emergence of new governance structures to socially action the co-produced knowledge in context and build capacity for sustained evidence use.

Context: Policy implementation is an often overlooked stage when policy is introduced. Too often the result is policy failure caused by overly optimistic expectations, implementation in dispersed governance, inadequate collaborative policy-making, and the vagaries of the political cycle.The Care Act 2014 introduced the most significant change in social care law in England for 60 years. Given the complexity of the changes, the Department of Health and Social Care and its key partners introduced an Implementation Support Programme (ISP) to increase the likelihood of smooth implementation.Objective: To assess the impact of the ISP on local implementation of the Care Act and develop a framework for understanding the requirements of a successful ISP.Methods: Analysis was undertaken of the relevant theoretical and conceptual literature in addition to a review of support programmes for other national policies. The empirical study of the impact of the Care Act’s ISP, conducted in six local authorities, focused on three levels of activity that shaped outcomes: national, regional and local. Data were collected through interviews with key stakeholders at each level.Findings: The ISP enjoyed several successes including: helping to secure policy legitimacy, developing stakeholder engagement, sustaining political support, and ensuring the readiness of local implementation agencies.Limitations: The empirical research was confined to six English local authorities which limits drawing general conclusions applicable to the whole country.Implications: Little evidence exists on the value of ISPs. The research goes some way to closing the gap and offers provisional messages on their value to policy-makers and practitioners.

BackgroundThe transition of public health from NHS to local government in England raises new challenges for evidence-informed policy and practice in the context of austerity. The aim of the Local Authority Champions of Research (LACoR) study is to test new methodological approaches to evidence use in local government to address public health priorities, using a whole-system approach.MethodsThis collaborative, UK-based, mixed-methods study includes a rapid review of published literature; a scoping survey of current practice in UK local authorities (LAs) supporting evidence-informed decision making; workshops held in three case study sites with LA staff (n=49); qualitative interviews with stakeholders (n=14), and learning from an embedded researcher working in local government. Participants gave written consent to take part. Workshop and fieldwork notes were written up and interview data were recorded and transcribed. Data generated were combined and analysed using thematic analysis. A prototype logic model will be shared, illustrating the current, and potential, application of research in local government. This study was approved by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University's Research Ethics Committee.FindingsResults from the literature review and qualitative interviews will be presented alongside the logic model and practical examples of how a system-wide approach can promote evidence use in local government to improve population health and wellbeing. Our findings highlight a changing culture in local government, which requires a different approach from academia to take account of the multiple types of evidence used, a tendency to prioritise local data, and a desire for longer-term, collaborative relationships with academia. Greater use of co-located, embedded researchers was seen to facilitate understanding of the systems, structures, and political context of decision making in local government, drawing on the skills and expertise of LA staff. Despite pressures on capacity, there is willingness to engage in co-produced research studies that create space to work together to identify realistic evidence-informed solutions.InterpretationThe strength of this study is its transdisciplinary, collaborative approach, and methodological innovation. The findings have the potential to promote transformational change in both academia and local government, recognising that insights are gathered from a small number of LAs. The logic model will be tested and refined in further research.FundingThe Health Foundation.