Adult Stakeholders Research Articles

Stakeholder Perceptions of the Effects of a Public School-Based Theatre Program for Children with ASD

Arts programs are often credited with helping children with autism spectrum disorders (ASD) gain cognitive and social skills. As with all claims of transfer from experience in the arts to abilities in non-arts domains, empirical evidence is mixed, and often criticized for both imprecise methodologies and a lack of connection back to the art form itself. Exact measurement of programs’ mechanisms and effects are rare. To investigate the effect of theatre experiences for children with ASD, we completed a systematic study of adult stakeholders of a large, school-based, successful musical theatre program. We found stakeholders emphasized modeling, routines, and relaxation as useful strategies, endorsing that the program built imitation, motor abilities and turn-taking skills. These observations raise questions for standard theories of the effects of arts that focus and accentuate only higher order social and emotional or academic skills, and emphasize the importance of including stakeholders in theorizing and measuring the effects of arts programs for all populations.

Children’s participation in research on sensitive topics: addressing concerns of decision-makers

ABSTRACTAlthough there is general agreement about children’s engagement in social research, some researchers continue to experience challenges when seeking approval and support for children’s participation from a range of adult stakeholders, particularly when the research involves a sensitive topic. These challenges may reflect different perspectives, conflicting interests, needs or expectations. This paper explores factors that influence the decision-making of key stakeholder groups, including Human Research Ethics Committees, parents and organisational representatives. Building on the kind of objective, rational reasoning that underpins much ethical decision-making, the findings, from interviews with 42 participants across stakeholder groups, draw attention to influential issues grounded in perceptions of: the institution and researcher undertaking the research; the project itself; children’s characteristics and contexts. Collectively, such issues point to the critically important role of mutually respectful relationships between researchers and stakeholders as the basis for designing and implementing ethical research that gives close attention to stakeholder concerns.

"Keeping Control": A user-led exploratory study of mental health service user experiences of targeted violence and abuse in the context of adult safeguarding in England.

The situation for people with mental health problems as a group of disabled people who experience targeted violence and abuse is a complex one. Disabled people, particularly those with mental health problems, are at higher risk of targeted violence and hostility with few effective evidence‐based prevention and protection strategies. Achieving effective safeguarding for adults with mental health problems is characterised by differential attitudes to and understandings of abuse by safeguarding practitioners, as well as systemic issues arising from multi‐agency working. “Keeping Control” was a 16‐month user‐led, co‐produced exploratory qualitative study into service user experiences of targeted violence and abuse that was examined in the context of Care Act 2014 adult safeguarding reforms in England. User‐controlled interviews of mental health service users (N = 23) explored their experiences and concepts of targeted violence and abuse, prevention and protection. Preliminary findings from these interviews were discussed in adult safeguarding and mental health stakeholder and practitioner focus groups (N = 46). The data were also discussed via two facilitated Twitter chats (responses N = 585 and N = 139). Mental health service users’ experiences and concepts of risk from others, vulnerability and neglect can be different to those of practitioners but should be central to adult safeguarding. Histories of trauma, multi‐factorial abuse; living with fear and stigma as well as mental distress; the effects of “psychiatric disqualification” and individual blaming should be addressed in adult safeguarding in mental health. Fragmented responses from services can mean a person becomes “lost in the process”. Staff can feel disempowered, afraid or lacking in confidence to “speak up” for individuals in complex service systems with poor communication and lines of accountability. Adult safeguarding practitioners and stakeholders need to be confident, accessible and respond quickly to service users reporting incidents of targeted violence and abuse particularly in closed environments such as wards or supported housing.

Exploring community stress and empowerment among stakeholders and youth in an urban community

ABSTRACTCommunity-level stress, such as pervasive substance abuse and violence, can yield negative health and mental heath outcomes for youth from disadvantaged communities. Community empowerment is a process whereby community members work together to increase control in their community. This qualitative inquiry analyzed in-depth interviews with adult stakeholders (n = 17) as well as focus group interviews with token youth (n = 85) to explore perceptions of community stress and empowerment in one disadvantaged locale. Each of the 102 total participants helped interrogate the research questions: What does it mean to live in a stressed community? How might youth and adults perceive themselves capable of impacting a stressed community’s quality of life? Emergent themes, which include a nod to the utility of coalition building, are explored. Implications for policy, practice, and future research are also discussed.

An absent presence: separated child migrants’ caring practices and the fortified neoliberal state

ABSTRACT This paper explores the ambivalent positioning of separated child migrants in the UK with a focus on the care that they provide for each other. Drawing on interview data with state and non-state adult stakeholders involved in the immigration-welfare nexus, we consider how children’s care practices are viewed and represented. We argue that separated children’s caring practices assume an absent presence in the discourses mobilised by these actors: either difficult to articulate or represented in negative and morally-laden terms, reflective of the UK’s ‘hostile environment’ towards migrants and advanced capitalist constructions of childhood. Such an examination sheds light on the complex state attempts to manage the care and migration regimes, and the way that care can serve as a way of making and marking inclusions and exclusions. Here we emphasise the political consequences for separated child migrants in an age of neoliberal state retrenchment from public provision of care and rising xenophobic nationalism.

The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery.

We conducted a small-scale implementation study that integrated The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-a multifaceted knowledge translation intervention designed to improve the vaccination experience at school-within the school vaccination program. Mixed methods design, including a controlled clinical trial and focus group interviews. The experimental group included five schools whereby CARD™ was implemented. The control group included five schools whereby no changes were made. Focus groups were held at the end of the school year. For nurses trained in CARD™, additional focus groups were held at CARD™ training and after the first round of vaccine clinic visits. Outcomes included vaccination rate at school and adult stakeholder perceptions. Altogether, 323 students attended study schools. Fifty-five nurses, school staff, and parents participated in 15 focus groups. The school vaccination rate did not differ (P>0.05) between groups for round 1 clinics (76% versus 77%) or round 2 clinics (68% versus 70%). Participants reported acceptability, appropriateness, feasibility, and satisfaction with CARD™. Experimental group nurses were able to integrate CARD™ within usual activities, including clinic planning, student education, and clinic-day set-up and student vaccinations. Students in experimental schools were described by nurses and school staff as more prepared and less fearful during vaccinations. Nurses reported that CARD™ built on their practice; they had higher confidence in their ability to assess pain and fear and higher satisfaction with their ability to manage it. Nurses also reported improved collaboration with students and with each other. All stakeholder groups recommended continuing CARD™. Some additional time was required, primarily related to clinic planning activities and data collection for study purposes. CARD™ is a promising new approach for improving the delivery of vaccinations at school. Exploration of approaches to increase parental reach and monitoring of vaccination uptake rate over time are recommended.

A Qualitative Evaluation of Impact and Implementation of a Theater-Based Sexual Health Intervention in Los Angeles High Schools

Although theater-based interventions have emerged as an innovative health education platform, more research is needed to understand how these interventions work and to identify factors that make them successful and replicable in adolescent populations. This paper discusses the first research project conducted on High School Sex Squads (HSSS), which use monologues, skits, songs, dance, spoken word, and other forms of performance art to approach broad topics related to sex, sexuality, and gender. Using focus groups with students and key informant interviews with adult stakeholders, this pilot study explores HSSS with a dual focus on program implementation and impact on High School Sex Squad members. These findings will be translated to real-life program improvement to ensure optimal implementation as the program continues to expand.

Invasive lionfish in the Mediterranean: Low public awareness yet high stakeholder concerns

A lionfish invasion in the Western Atlantic has been one of the most ecologically harmful fish invasions to date. Experience there has shown that its management is most effective when the public and stakeholders are involved. The lionfish (Pterois miles) has recently invaded the Mediterranean, spreading at an alarming rate. To understand lionfish knowledge and perceptions, questionnaire surveys were conducted with a representative cross section of the adult general public (via telephone) and stakeholders (via organised meetings) in Cyprus. Results from 300 public surveys revealed limited awareness about the lionfish but strong support for its local management. Men and older respondents showed stronger support compared to women and younger respondents, respectively. Results from 108 stakeholder revealed high level of awareness and almost unanimous support for management measures. The majority had not experienced any effects from the recent lionfish invasion, but some reported negative impacts such as limited access to dive sites, ecosystem damage and fishing gear destruction. Few stakeholders perceived benefits of this invasive species, e.g. to dive tourism or as a food source. Almost all stakeholders expressed a willingness to get involved in lionfish management, but only around half would consider personal consumption, or sports incentives as good incentives for their participation. Encouragement from scientists through coordination, training and support was suggested as an essential part of effective management strategy. The results of this study can inform an efficient adaptive management process across the Mediterranean region and assist future engagement of citizen scientists in lionfish control and mitigation.

Suicide among Guyanese youth: Barriers to mental health help-seeking and recommendations for suicide prevention

ABSTRACT The current study sought to better understand barriers to mental health help-seeking for suicide, as well as elicit input on recommendations for suicide prevention and intervention efforts for Guyanese youth. Participants included 17 adult stakeholders (i.e., teachers, administrative staff, and school-allied community workers) and 40 students at a secondary school in Guyana who participated in focus groups and interviews, respectively. Data were analyzed using a grounded theory approach. Themes related to perceptions of barriers to mental health help-seeking included shame and stigma about mental illness, fear of negative parental response to mental health help-seeking, and limited awareness and negative beliefs about mental health services. Themes related to recommendations for adolescent suicide prevention in Guyana included the need for culturally informed prevention efforts, the importance of integrating such efforts within schools, and the role of government and community organization in suicide prevention efforts. Findings have implications for the development and tailoring of suicide prevention efforts for Guyanese youth.

A Qualitative Study on Parental and Community Stakeholder Views of the Link between Full-Day Kindergarten and Health in Southern Nevada.

Studies show that children who attend full-day kindergarten (FDK) experience both academic and developmental benefits compared to children who attend half-day programs. Sectors outside of health, such as education, can have important intended and unintended impacts on health. The purpose of this qualitative study was to understand perceptions of parental and other stakeholders in Southern Nevada (USA) about the education–health link, and to understand priorities regarding how FDK access could affect health. Two 90-minute focus groups were conducted with 14 adult stakeholder participants representing parents, current and former teachers, and community members. Transcripts were analyzed using conventional content analysis. Eight major themes and several subthemes emerged; findings related to each are discussed. ‘Access’ was mentioned most frequently (n = 43), followed by ‘Time’ (n = 25), and ‘Lifetime educational attainment’ (n = 17). Participants were overall in favor of expanding access to FDK and felt that FDK could improve social skills, increase the amount of physical activity, and provide additional time for educators to detect additional learning disabilities when compared to half-day programs. Although the purpose was to understand priorities related to the education–health link, participants spent little time discussing this, suggesting this association is not inherently considered. Health and education stakeholders should collaborate to increase awareness, as this link may serve as an upstream approach to downstream effects on population health outcomes.

Indian Adolescents’ Perspective of Childhood Abuse and Neglect as Reflected Through Narratives and Drawings

The study explores thoughts, feelings, and beliefs of victims about their experiences of abuse and neglect and how therapeutic intervention encourages disclosure. Narrative accounts given by 15 Indian adolescents during therapeutic interventions were analyzed by the Descriptive-Phenomenological-Psychological Perspective, which evoked three themes. The first theme explains how coping styles and personal resources contribute to the victims’ dealing with trauma. The second theme explores to whom, when, and in what circumstances victims prefer to disclose. The third theme explains how “time” is perceived in the light of trauma. Results suggest that the Indian sociocultural system acts as a mold to shape the victim’s perception and belief system, and causes confusion about whether the incident was at all abusive. Initiation to help victims should come from their parents and from adult stakeholders outside the family.

Priorities and preferences for school-based mental health services in India: a multi-stakeholder study with adolescents, parents, school staff, and mental health providers.

Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs. We completed semi-structured interviews and focus group discussions with adolescents (n=191), parents (n=9), teachers (n=78), school counsellors (n=15), clinical psychologists/psychiatrists (n=7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers. All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents. SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.

Title: what about my voice? Autistic young girls’ experiences of mainstream school

ABSTRACTRecognition of inclusion in mainstream schools for all people with disabilities is enshrined in the Convention on the Rights of Persons with Disabilities (CRPD). General Comment 4 on Article 24 (Right to inclusive education) of the CRPD provides a concept of inclusion and its core features which we discuss here. Article 7 of the same enjoins state parties to give young people’s opinions and views ‘due weight’ on matters that affect them. Despite calls to gather their views on education to better inform policy and practice, autistic young people have been largely missing from the research, girls most notably. Research on the efficacy of mainstream inclusion and the educational experiences of autistic young people has focused mainly on the perspectives of adult stakeholders such as parents, teachers and classroom assistants. Inspired by Article 7 of the CRPD, we present the educational experiences of two teenage girls with Asperger’s Syndrome in a mainstream setting in the UK with respect to the school environment, teachers, the curriculum and peers. The findings from semi-structured interviews and a number of participatory methods reveal that girls reported feelings of exclusion, isolation and anxiety. We discuss these findings in the light of the concept of inclusion provided in the General Comment and conclude with the girls’ recommendations on how to include people with ASD in mainstream settings.

Practice and lived experience of menstrual exiles (Chhaupadi) among adolescent girls in far-western Nepal

BackgroundMenstrual exile, also known as Chhaupadi, is a tradition of “untouchability” in far-western Nepal. Forbidden from touching other people and objects, women and girls are required to live away from the community, typically in a livestock shed, during menstruation. We assessed the lived experiences of Chhaupadi among Nepalese adolescent girls in the far-western Achham district of Nepal, observed the safety and sanitation of their living spaces during Chhaupadi, and assessed the perceptions of local adult stakeholders towards the practice of Chhaupadi.MethodsWe collected data from 107 adolescent girls using a self-administered survey in two local schools in Achham. We also conducted a focus group discussion with seven girls, held key informant interviews, and observed the girls’ living spaces during Chhaupadi, using a checklist. Descriptive statistics of the quantitative survey and thematic analyses of qualitative interviews are presented.ResultsThe majority of the girls (n = 77, 72%) practiced exile, or Chhaupadi, during their menstruation, including 3 (4%) exiled to traditional Chhau sheds, 63 (82%) to livestock sheds, and 11 (14%) to courtyards outside their home. The remaining girls (n = 30, 28%) stayed inside the house, yet practiced some form of menstrual taboos. Of the 77 observed living spaces where the girls stayed during exile, only 30% (n = 23) had a toilet facility. Most exiled girls (97.4%) were restricted from eating dairy products. Participants reported having various psychological problems, including lonliness and difficulty sleeping while practicing Chhaupadi. Three of the girls were physically abused; nine were bitten by a snake. Notably high proportions of the living spaces lacked ventilation/windows (n = 20, 26%), electricity (n = 29, 38%), toilets (n = 54, 70%) and a warm blanket and mattress for sleeping (n = 29, 38%). Our qualitative findings supported our quantitative results.ConclusionsChhaupadi has been condemned by human rights organizations. While the government has banned the practice, implementation on the ban is proceeding slowly, especially in far-western Nepal. Thus, as a temporary measure, public health professionals must work towards promoting the health and safety of Nepalese women and girls still practicing Chhaupadi.

"We make a direct impact on people's lives": Youth empowerment in the context of a youth-led participatory budgeting project.

Participatory budgeting [PB] is a democratic process whereby community members determine how to spend governmental funds. Youth-led PB is relatively new, occurring in select U.S. cities. During youth-led PB, youth collect ideas, develop proposals, and advertise community improvement projects for which they, citywide, cast deciding votes. The study examined opportunities for the empowerment youth at each stage of a youth-led PB project. Data collection included individual interviews with 31 youths and adult stakeholders, 3 focus groups with youths, and 7 observations of meetings. The data were analyzed using consensual qualitative research methods. Findings align well with the psychological empowerment literature and demonstrate several opportunities for empowerment throughout the PB project, including feeling in charge of the process, understanding and allocating resources, and influencing positive community change. Findings also demonstrate potential barriers to empowerment, including understanding bureaucratic decision making, and influencing policy. PB is relevant to furthering our understanding of the empowerment of youth. The youths who participated in the present study expressed feelings of competence, purpose, and an ability to use the skills learned to engage fellow youths in the PB process. Additional empirical research is needed to examine the dimensions of empowerment at each stage of the PB process.

Locked down apps versus the social media ecology: Why do young people and educators disagree on the best delivery platform for digital sexual health entertainment education?

This article reports on focus groups exploring the best way to reach young men with vulgar comedy videos that provide sexual health information. Young people reported that they found the means by which the material was presented – as a locked down app – to be problematic, and that it would better be delivered through social media platforms such as YouTube. This would make it more ‘spreadable’. By contrast, adult sex education stakeholders thought the material should be contained within a locked down, stand-alone app – otherwise it might be seen by children who are too young, and/or young people might misunderstand the messages. We argue that the difference in approach represented by these two sets of opinions represents a fundamental stumbling block for attempts to reach young people with digital sexual health materials, which can be understood through the prism of different cultural forms – education versus entertainment.

Adult stakeholder perceptions of 4th grade participation in children’s forest environmental education programming

An environmental education (EE) consortium located in the pacific northwest United States coalesced an external evaluation team to research its K-5 EE programming. The purpose of this article is to describe one phase of this program evaluation process including the exploration of adult stakeholder perceptions of EE programming accessed by 4th grade children. The author highlights the goals of the consortium and the context for the program evaluation, and the relevant literature addressing adult perspectives on EE is reviewed. The study framing, method, and qualitative results are reported. Findings suggest that adult stakeholders perceived positive impacts from 4th grade participation in EE, though the programming was viewed as being most beneficial to children coming from economically disadvantaged families. Implications for EE practice and research are discussed.

Orchestrating experts’ assumptions and children’s values in the design of Virtual Heritage experiences

Abstract The roles that children are allowed to play in the co-design of an interactive experience are strongly influenced and determined by the views of designers and other adult stakeholders on childhood, as well as by their expectations of children’s skills and cognitive capacities. In this paper, we contrast these assumptions in the design of a Virtual Heritage experience for guided school visits at an archaeological site. The goal of our study was to analyse different viewpoints of adult stakeholders in order to find new strategies that balance power relations between adults and children. The study was carried out in the context of the preliminary design stage of an interactive learning experience for a bomb shelter dating from the Spanish Civil War, known as “Refugi 307”. Our analysis reveals some of the reasons behind the assumptions of adult stakeholders. These outcomes were our starting point for defining strategies that can establish collective values among adult stakeholders and enrich the range of roles of children in a design process.

Care and the Influence of Student-Adult Stakeholder Interactions on Young Black Men's College Aspirations

Students' college aspirations precede any decision they may make to apply and enroll in college. College aspirations broadly refer to the formal development of specific plans made by a young person to position themselves to enroll in a four-year college or university after high school. Regular, ongoing interaction with college-educated adults is one important approach for transmitting messages that positively influence young people's college aspirations. This article is an examination of young Black men's descriptions of their interactions with adult stakeholders (e.g., administrators, teachers, professional support staff, etc.), and the influence of those interactions on shaping these young men's ambitions to attend college. Data sources for this phenomenological study include one semi-structured in-depth interview with ten college-aged young Black men from a large midwestern city. Findings reveal the significance of care in adult stakeholder-student interactions, and specific messages about college, for sparking these young Black men's aspirations to attend a four-year college or university. The implications of interactions with youth of color that translate culturally responsive versions of care are discussed.

Engaging older adults to inform diabetes medication adherence mobile application selection

Background: Medication nonadherence is a significant health concern that disproportionately affects older adults. Aging is often associated with comorbidities including diabetes and more complex drug regimens that can impact compliance. Objectives: To explore smartphone use among older adults with diabetes to evaluate potential medication adherence application preferences. Methods: This case report describes a series of stakeholder-engaged discussions with 11 older adults ages 60 years and older and 4 health care providers (HCPs), from a rural and small metropolitan community, in the southeastern United States. The Technology Acceptance Model led a conversation guide. Results: Older adults had smartphone devices. When considering use of the 2 applications, older adults and HCPs indicated preference for the Medisafe application. Conclusions: On the basis of advice of an older adult and HCP stakeholder sample, plans are underway to select a medication adherence application for future research.