This article describes the development and application of a wrap-around, multidisciplinary, brain-based, developmental and attachment-focussed intervention for children who have experienced significant trauma in the context of their early life. It outlines the presentation of the children and families who are referred to the service and the model of treatment that they receive. In doing so, it identifies the core components underpinning Neuro-Physiological Psychotherapy (NPP) and links the application of the integrative model to research and practice in the field of neuroscience and attachment and to the use of therapeutic approaches that are beneficial to maltreated children and their adoptive parents. It highlights the need for a neuro-sequential approach that impacts all aspects of the child's life in the effort to redress the impact of developmental trauma with the aim of improving their overall functioning and their ability to develop healthy relationships into the future.

Research into the effectiveness of therapeutic interventions for older children who have experienced multiple forms of trauma within the context of their early development is scant. This article explores the effectiveness of Neuro-Physiological Psychotherapy (NPP): a wrap-around multi-disciplinary, neuro-sequential, attachment-focussed intervention for children and families who present with multiple, clinically significant, emotional and behavioural difficulties. In total, 31 young people and their adoptive parents took part in the study. Baseline measures were repeated and parents and children interviewed. An assessment of the parent/child relationship and child attachment was undertaken but not analysed for this article. Analysis of the repeated measures received statistically significant changes in behavioural regulation, metacognitive executive functioning and externalising and internalising difficulties, alongside an improvement in thought and social problems. An analysis of the parent interviews provided positive results in terms of the children's engagement in education, an absence of further mental health diagnosis or involvement in the criminal justice system. Further hypotheses are posited regarding the impact of the treatment and further research into the effectiveness of the model outlined.

Research has established the benefits of early warnings signs monitoring in the prevention of relapse for individuals with psychosis. This study explored staff views (n = 8) of the implementation of an early warning signs clinic within a day hospital of an adult mental health service. A qualitative methodology using focus groups was adopted and content analysis was used to discover themes arising from the data. Overall, the data indicated a positive view of the early warning signs clinic, with benefits for clients, staff and their relationship; and for service delivery and resources. The clinical and service implications are discussed.

More than 100 employees and contractors working for the Shell Petroleum Development Company (SPDC), Nigeria, were kidnapped at work in the Niger Delta in 1999 and 2000. Shell Hospitals in the Niger Delta also dealt with 55 cases of gun shot wounds in the same period although most were third parties. The company has a duty of care to ensure that the health aspects of kidnapping are appropriately managed and that a best practice is developed. There is no doubt that any insinuation of negligence in this area could become a significant liability issue particularly if it is perceived that there has been a failure to give the highest priority to the Health, Safety, and Security of employees and contractors. The paper will discuss Post Traumatic Stress Disorder (PTSD): its definition, diagnostic features and management. In developing a best practice the Medical Department of SPDC, Nigeria, has defined its role in the company emergency response plan and effective liaison with duty managers so that the victims of kidnapping come to the hospital immediately on release. Depending on the duration of the kidnapping and the conditions in which the victims were held appropriate medical screening and counselling takes place. Arrangements are made for follow up. The effectiveness of this procedure was tested by a questionnaire sent out to 50 victims. A brief description of some of the pitfalls of managing high velocity bullet wounds will also be given. During the years 1999 and 2000 over 100 employees and contractors working for the company were kidnapped at work by those whose prime motive was apparently financial extortion. Many were released the same day but there were some who were held for up to three weeks, often at gun point and in very basic conditions. 83 were seen on release in the company hospitals in either Warri or Port Harcourt. Fortunately, there were no fatalities, A Health Management Problem How and why did the company medical department become involved.? First. it became apparent, as the kidnapping activity rapidly gathered momentum that a basic Health Risk Assessment (HRA) for field workers would surely identify kidnapping as a health hazard. Health risks, both physical and psychological would have to be assessed and suitable controls put in place to limit health risks where possible. This process was even more important as the company had already defined a Hazards and Effects Management Process (HEMP) within its Health Safety and Environment Management System. (HSE-MS) Secondly, if you choose to ignore a health management process that is in place and harm to an employee results from not following this process then there may well be a significant medico legal issue focusing on negligence. Furthermore, the company has a clearly stated policy that it gives the highest priority to the Health, Safety, and Security of employees, Contractors and Members of the Public. In addition, doctors have a common law duty of care to their patients who, in our case, are the employees. Let us not hand it to lawyers on a plate. Thirdly, are there any guidelines relating to kidnapping for those professions who are required to undergo periodic medical examinations or to report changes in health status to maintain their professional licence?. In June 1997 the Civil Aviation Authority in UK issued a circular concerning the psychological effects that traumatic events can cause.(1) Among these traumatic events it listed high jacking and being threatened with fire arms. The recommendation was that any pilot exposed to any of the listed events should be withdrawn from flying duty immediately so that appropriate assessment can take place.

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