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LSE has developed LSEThis document is the author's final manuscript version of the journal article, incorporating any revisions agreed during the peer review process. Some differences between this version and the publisher's version remain. You are advised to consult the publisher's version if you wish to cite from it. Cost-Effectiveness of Individual versus Group Psychotherapy for SexuallyAbused Girls AbstractChildren who have been sexually abused may suffer from emotional and behavioural difficulties. Recent research found that individual and group psychotherapy have similar outcomes. In this study we compare the costs and cost-effectiveness of the two therapies and support for carers. Subjects were recruited to two clinics in London and randomly allocated to treatments. Total mean costs of individual therapy were found to be £1246 greater than for group therapy. Costs as they would apply in routine practice were relatively unchanged. Group therapy was thus more cost-effective than individual therapy. Carefully considering the impact of different therapies could allow more treatment to be offered from available staff resources and budgets.

Introduction While relatively rare events, abrupt disruptions in heroin availability have a significant impact on morbidity and mortality risk among those who are heroin dependent. A heroin shortage occurred in Coast Province, Kenya from December 2010 to March 2011. This qualitative analysis describes the shortage events and consequences from the perspective of heroin users, along with implications for health and other public sectors. Methods As part of a rapid assessment, 66 key informant interviews and 15 focus groups among heroin users in Coast Province, Kenya were conducted. A qualitative thematic analysis was undertaken in Atlas.ti. to identify salient themes related to the shortage. Results Overall, participant accounts were rooted in a theme of desperation and uncertainty, with emphasis on six sub-themes: (1) withdrawal and strategies for alleviating withdrawal, including use of medical intervention and other detoxification attempts; (2) challenges of dealing with unpredictable drug availability, cost, and purity; (3) changes in drug use patterns, and actions taken to procure heroin and other drugs; (4) modifications in drug user relationship dynamics and networks, including introduction of risky group-level injection practices; (5) family and community response; and (6) new challenges with the heroin market resurgence. Conclusions The heroin shortage led to a series of consequences for drug users, including increased risk of morbidity, mortality and disenfranchisement at social and structural levels. Availability of evidence-based services for drug users and emergency preparedness plans could have mitigated this impact.

A B S T R A C T Intervention in support of the current carers is seen as an important part of a treatment package for sexually abused girls. This article, one element of a comparative treatment trial, describes the characteristics and backgrounds of the current carers, the nature of the help provided to them and their responses to the help. One of the main aims of involving and supporting carers was to try to ensure regular attendance of the girls in the therapy and this was largely achieved. Although there were no simple relationships between help for the carers and treatment outcome for the girls, a strong association was found between a positive attitude by the birth mothers toward the treatment and improvement in the girls. The possible reasons for this are discussed together with practice and research considerations when planning dual interventions to attend to the needs of the girls and their carers.K E Y W O R D S child sexual abuse; group work; psychotherapy; support for carers; treatment evaluation T H I S A RT I C L E covers one aspect of an intervention study which compared the effectiveness of individual treatment with group treatment for sexually abused girls. The trial was set up at the Tavistock Clinic in association with other child and adolescent treatment teams in North and South London (Trowell, Berelowitz, & Kolvin, 1995). The main project set out to investigate whether the adverse effects of child sexual abuse could be ameliorated and whether treatment outcomes differed according to the type of intervention. The full details of the design, descriptions of the two modes of treatment and measurement of problems in the girls cannot be reproduced here, but the essential features are summarized briefly. The initial assessment sample consisted of 81, 6-14-year-old (mean age 10.3 years) girls who had disclosed contact sexual abuse within the last two years and who were symptomatic and thought to be suitable for psychotherapy. The majority of the girls were Caucasian (63%), one-tenth were of Black Caribbean origin, and another tenth were of mixed heritage. The remainder (17%) were of Mediterranean, Oriental or Asian origin. About half were abused by 'a parent figure' and half by others.

There is considerable interest in the recruitment, training and retention of workers in the field of mental health, as evidence shows significant problems in the retention of highly qualified professionals in this field. Large numbers leave, some leaving the professions for other careers as a result of burnout, caused in part by the emotional burden of work in stressful and emotionally charged environments. We propose a training approach in which students are encouraged to reflect on their own emotional responses to such stressful and upsetting situations. We argue that this approach, in allowing them to be more at ease with themselves, would make them both more available to the emotional experiences of their patients, and in turn enhance their own resilience and capacity to survive stressful situations.We took for our study a cohort of trainees from The Tavistock Clinic in London, a major training institution providing post-graduate mental health courses based in psychoanalytic and systemic theory. We aimed to investigate what the students reported to be the key components in these trainings to enhance their capacity to manage in their demanding and highly stressful work environments, alongside ordinary human experience. The trainees were from a range of backgrounds and included doctors, psychologists, social workers and teachers. The courses had in common the following elements: small work discussion groups providing an opportunity to reflect on their work in practice, lectures on background theory, tutorials, and small seminar groups to which they brought ongoing observations of young children in ordinary settings. Some also had the opportunity to undertake supervised clinical work in the Clinic.We used a detailed qualitative questionnaire to elicit the trainees' expectations and experience of the trainings. In addition, all participants completed the 30-item General Health Questionnaire (GHQ), and some took part in the Adult Attachment Interview, later rated for Reflective Function.