The NewCan Practice
 Framework: Using Risk and
 Resilience to work at the
 interface between
 Professional Expertise and
 Parental Knowledge and
 Experience in Child and
 Adolescent Mental Health
 Susan Croom and Susan Procter
 This paper describes the NewCan1 practice framework that is designed to enable
 professionals from a range of agencies (health care, education, social services) to
 utilise evidence on risk and protective factors in child and adolescent mental
 heath (CAMH) in order that they can:
 . assess the child and family needs using a common evidence base and shared
 language to communicate across all agencies involved in the care of the child;
 . enhance local capacity to respond to the needs of these children by identify
 ing resources/services available locally which can enhance protective factors
 and reduce risk;
 . develop a plan of intervention shared by all agencies involved in the care of
 the child, including the child?s contribution and that of their family/carers to
 the realisation of the plan.
 The framework was designed to help practitioners across agencies to identify the
 most effective combination of universal, targeted and clinical services for each
 child/family and community that can be configured to respond to the risk and
 protective factors within the local socio-cultural context. This paper describes
 the development of the framework and includes some preliminary experiences
 from professionals and parents who have used the framework in practice.
 1NewCan reflects the origins of the practice framework which was developed in Newcastle upon Tyne
 UK based on study visits to Canada. It can be accessed at http://online.northumbria.ac.uk/faculties/
 hswe/research/nmahp/camh.htm
 CPRA114802 (NT)
 PRACTICE VOLUME 17 NUMBER 2 (June 2005)
 ISSN 0950-3153 print/1742-4909 online/05/020117?14
 ? 2005 British Association of Social Workers
 DOI: 10.1080/09503150500148198
Keywords: risk factors; protective factors; resilience; common assessment for
 child and adolescent mental health; multi-agency working; capacity
 Background
 Current evidence points to the existence of a spectrum of child and adolescent
 mental health (CAMH) problems, from mild to moderate, characterised by
 disruptive behaviour, social withdrawal and poor social integration to more
 severe diagnosable disorders (Mental Health Foundation 1999). The overall
 prevalence of children falling within this spectrum in the UK is recognised to be
 20 per cent, of which 10 per cent experience more severe diagnosable conditions
 (Mental Health Foundation 1999, Meltzer et al. 2000). Extensive research in the
 field of CAMH has identified a range of risk factors that increase vulnerability to
 developing CAMH problems and disorders and resilience factors, which protect
 against the onset of problems or disorders even in conditions of adversity (see Box
 The practice framework is different from other holistic tools in that it is
 designed to facilitate collaborative work with vulnerable young people and
 their families by identifying and building on existing strengths and
 reducing risks in order to do this it:
 1. Identifies risk factors/needs/vulnerabilities which could suggest that
 the young person has developed/is at risk of developing mental health
 problems.
 2. Identifies strengths/protective factors which can protect the young
 person against developing CAMH problems.
 3. Facilitates joint negotiation and understanding of mutually agreed and
 acceptable plans for reducing the young person?s risk/needs and
 promoting their strengths/resilience with young people, professionals
 and (if possible) their families. This is achieved using strategies which
 are evidence based, acceptable and feasible for both young people,
 their families (if applicable) and professionals within the realities of
 the situation as experienced by all parties.
 Provides a detailed assessment and systematic plan for an individualised
 pathway of care, which can be disseminated across the tiers of service
 provision and across agencies to enable a joint understanding and planning
 for the young person, who maybe in a cycle of chronic vulnerability.
 Box 1. The NewCan Practice Framework for CAMH
 118 CROOM AND PROCTER
Two, Wallace et al. 1995, Pearce 1993). The impact of these factors on the
 mental health of children appears to depend on the accumulation of risk factors
 at an individual, family and community level to which a child/family is exposed
 (Meltzer et al. 2000, Offord et al, 1989). Consequently, the goal of intervention is
 to change the balance between the adverse effects of risk factors and the
 beneficial effects of resilience factors. Increasing the effectiveness of protective
 factors for a child and family may be as important as decreasing the effects of risk
 factors (Rae Grant et al. 1989).
 In response to this evidence, a plethora of community initiatives have been
 introduced; these include: proactively providing recreation and/or extra health
 Risk Factors
 (increase the probability of a child developing a mental health problem)
 In the child: genetic influences; learning disability; developmental delay;
 difficult temperament; physical illness, communication problems; aca-
 demic failure and low self-esteem.
 In the family: overt parental conflict; family breakdown; inconsistent
 discipline; hostile relationships; failure to adapt to a child?s changing
 needs; abuse; parental psychiatric illness; criminality; death and loss.
 In the community: socio-economic disadvantage; homelessness; discrimi-
 nation.
 Resilience Factors
 (allow the child to thrive despite adversity)
 In the child: easy temperament; secure attachment; positive attitude;
 good communication skills; being a planner with a belief in control;
 humour; religious faith; the capacity to reflect; being female; high
 intelligence.
 In the family: include at least one good parent-child relationship;
 affection, supervision and authoritative discipline; support for education;
 supportive marriage with an absence of severe discord.
 In the community: a wider supportive network; good housing; high
 standards of living; high morale; school with strong academic and non-
 academic opportunities; range of positive sport and leisure activities.
 Box 2. Risk and resilience factors identified in the literature
 THE NEWCAN PRACTICE FRAMEWORK 119
visitor/public health nursing home visiting (Browne et al. 1999) parenting
 programmes to increase social networks, improving relationships in the family
 system, family problem solving and parental effectiveness (Cunningham et al.
 1995, Webster-Stratton 1998), promoting a positive school milieu and ethos
 (Ofsted 1999), and social skills/nurture groups in schools and family centres
 (Bennathan and Boxall 1996). A range of such interventions is being developed
 in communities and localities and in some cases are being augmented through
 Sure Start programmes. Many of these initiatives reflect the creative efforts of
 practitioners responding to their own interpretations of local need (Offord et
 al. 1998). However, these tend to remain as discrete uni-professional or single-
 agency interventions targeted at an individual rather than community level.
 Despite a series of policy recommendations (Health Advisory Service 1995,
 Audit Commission 1999, Mental Health Foundation 1999, Department for
 Education and Skills 2003) the risk and resilience literature has not been
 applied or integrated into a multi-agency context, possibly leading to
 systematic joint CAMH assessments; nor has it been used to develop joint
 agency working in practice with families, children and young people in ways
 that can incorporate them into the decision making on how they perceive their
 strengths and needs.
 An illustrative example of this approach is the introduction of parenting
 groups, identified as one of the most effective ways of addressing the complex
 issues in CAMH described above. There is substantive evidence to support the
 efficacy of parenting groups in the UK (Pugh and Smith 1996). However, low
 utilisation by those at greatest risk (Cunningham et al. 1995) and high drop-out
 rates (Webster-Stratton and Hammond 1990) remain as problems, raising
 questions about the potential of parenting groups to make a population impact
 through changing the risk/resilience profile of the local community and thus
 raising questions about the cost-effectiveness of such groups in the UK cultural
 context. It is estimated that about 80 per cent of those children most in need do
 not receive extra support (Bickman and Rog 1995). If there is to be any substantial
 change in the population profile of CAMH, then universal and targeted
 interventions must succeed in maximising utilisation.
 Historically, the contribution of a service or professional group has often been
 reduced to simplistic single variables that do not reflect the sophisticated process
 underpinning interventions necessary in order to restore/maintain a healthy
 balance of risk and resilience factors (for example, with health, the impact of
 service contribution is often evaluated through number of bed days /number of
 community visits/waiting time targets; in the case of schools it is educational
 attainment and with social services it can be child protection allocations). Such
 variables reflect specific professional or organisational functions independently
 from the totality of needs presented by the service user (which include a holistic
 set of health, education and psychosocial variables).
 Reactive interventions deal with a particular impairment but do not tend to
 deal with the interaction of health and psychosocial factors related to chronic
 vulnerability. A reactive response may thus lead clients to seek inappropriate
 120 CROOM AND PROCTER
(and often expensive services) to cope with psychosocial needs, which could
 often be dealt with more effectively (and more economically) through
 comprehensive preventative/early intervention services, which aim to optimise
 individual, family and community strengths. Debates about which community-
 based interventions to introduce, how to free up resources from services already
 over-stretched, given the high level of demand highlighted above and how to
 assess need and measure effectiveness of changes, all serve to reinforce the
 development of existing single agency services or the introduction of isolated
 community initiatives to the detriment of the most vulnerable sections of the
 population. This paper describes how a multi-agency practice framework was
 developed to achieve a common understanding of local need across agencies as a
 preliminary process towards the implementation of more evidence-based service
 provision. The research aimed to iteratively develop, with a range of professional
 agencies and vulnerable clients, a jointly understood, agreed, evidence-based
 and contextually relevant practice framework which facilitates systematic
 assessment and effective, culturally sensitive responses designed to reduce risk
 factors and promote resilience factors.
 Methodology
 Action research was used as the primary methodology. This starts from a belief
 that knowledge about human situations can be generated from our commitment
 to practical situations and that our practical involvement can in itself create the
 understanding that our circumstances require (Winter and Munn-Giddings 2001).
 Action research involves an iterative process of practical decision making and
 evaluative reflection (Meyer 2000). For the purposes of this research it was
 important that the methodology could accommodate the following issues:
 1. how to optimise resources by capitalising on the cumulative knowledge base
 (synthesised from both empirical and experiential evidence) which can
 inform practitioners in their daily practice;
 2. how to increase capacity in the system by creating a democratic exchange
 between evidence from the published literature and evidence from
 experiential knowledge and skills across the professional/client interface.
 An initial practice framework was derived from the literature on risk and
 resilience in CAMH and was used as the basis for a series of teaching sessions,
 focus groups and parenting groups. The risk and resilience framework was
 distributed to participants who were asked to describe critical incidents from
 their current practice/parenting experience. Each critical incident was
 analysed to see if the application of the practice framework identified new
 and novel ways of working that reduced risk and increased resilience. The
 Practice Framework was iteratively developed through this process of data
 collection and analysis
 THE NEWCAN PRACTICE FRAMEWORK 121
Data collection Health, Social Care and Educational Professionals
 Four multi-professional focus groups were held (see Table 1). During the same
 period, 47 health visitors attending the CAMH module were introduced to the
 practice framework during teaching sessions. Many of the Health Visitors piloted
 the practice framework during their weekly practice and reported back at
 subsequent teaching sessions.
 Data Collection Parents
 Simultaneously, a series of parenting groups were held in which parents were
 engaged as co-researchers. A population of 75 parents met the inclusion criteria
 of this study in terms of having a child who had behaviour problems that were
 severe enough to interfere with their everyday functioning and to cause
 significant distress to the child and family for a period of more than a month.
 Fifty parents agreed to be involved. Twenty-five parents attended at least 80 per
 cent of the sessions (see Table 2). Table 3 provides an overview of the social
 characteristics of the 25 parents who attended at least 80 per cent of the
 parenting groups. The first author and a colleague facilitated the parenting
 groups. Following ethical approval, informed consent was obtained, the
 parenting groups were tape-recorded and the data transcribed.
 Table 1 Range of Professionals who participated in at least one focus group
 Professional role Number from each
 profession participating
 Health visitors who had completed the CAMH
 module
 4
 Special educational needs coordinators 4
 Head teachers 2
 Health Visitors who had not taken the
 module (including 2 involved in Sure Start
 programmes)
 6
 Social worker 1
 Child protection officer 1
 University lecturers 2
 Educational psychologist 1
 Speech and language specialist specialising
 in CAMH
 1
 Psychiatrist 1
 School nurses 3
 CAMH nurses 3
 Learning disability nurse 1
 122 CROOM AND PROCTER
Finding Professionals
 Practitioners identified the multi-agency expertise needed to develop an
 effective practice pathway to work together to reduce needs and promote
 strengths and then plan effective ways of integrating and implementing them in
 the total system. Several key themes emerged:
 The need for the different agencies to be aware of each other?s opportunities
 and constraints, including their time constraints, to enable them to be freed up
 for practice development and the time needed to undertake what was perceived
 as a lengthy assessment process:
 . Teachers described how limited their time is as a result of national curriculum
 demands. This restricts the degree of staff development time that can be
 devoted to the use and application of the framework. However, they also saw
 the practice framework as an opportunity systematically to identify and
 Table 2 Parent participation in parenting groups
 Analysis of attendance
 Number of
 parents invited
 Number who
 agreed to
 attend
 Numbers who
 attended at least
 1 session
 Numbers who
 completed
 71 56 42 (1 father only) 25 (100% female)
 Table 3. Characteristics of parents
 Social characteristics
 Proportion of those who
 completed group (N = 25)
 Owner occupied house 4%
 Educational qualifications beyond 16 0%
 Living on benefits 96%
 Single parents 84%
 Perceived that school was supportive to
 parents and children
 4%
 Perceived that social services were
 supportive
 0%
 Perceived to be getting effective help from
 voluntary services
 8%
 Extended social network support from family 12%
 Social network support friends etc. 24%
 Children diagnosed with ADHD 8 children = 28%
 Difficulties with harassment from neighbours 100%
 Low self esteem 92%
 Being treated for depression 20%
 THE NEWCAN PRACTICE FRAMEWORK 123
document their huge range of interactions with vulnerable pupils and their
 families.
 . Health workers found this to be a crucial way forward for their practice: ?it?s
 just like having the light bulb switched on for what I?ve been trying to do all of
 these years.? All professionals agreed that using this tool systematically was
 helpful in communicating their level of involvement with client and outcome:
 ?I feel I have a lot to contribute, but until I used this [practice framework], I
 know that I often used to leave it out.? Systematically assessing children and
 families using the attributes of the practice framework was found to be
 helpful; e.g. ?I had never worked explicitly with temperament as a risk factor,
 and was a bit nervous about discussing it with the family, but it was great. It
 seemed to make real sense to them and they realised how much they could do
 with X (child) by just understanding what he needed.?
 . Social Services described how they needed to lead the ?National Assessment
 Framework for Children and Families in Need? (Department of Health, Home
 Office, Department for Education and Employment 2000), which also uses a
 model of strengths and needs as it was social workers who would be
 accountable for the ?initial? and ?core? assessments.
 As a result of these findings, the following joint decisions were made:
 1. Educational and health professionals would use the framework as a way of
 underpinning their joint work with the family and to aid the decision making
 about whether to refer a child to more specialist services. Social services
 would use the framework as the initial assessment to provide systematic
 information on the risk and resilience profile, to indicate what input has been
 provided and also what could continue to be provided if the social worker had
 then to go on and undertake a core assessment.
 2. Practitioners from all agencies unanimously felt that there were wider
 organisational and systemic implications for the successful implementation
 of a comprehensive multi-agency assessment, response and evaluation. The
 following were identified:
 (a) All practitioners recognised that the underpinning theory of risk and
 resilience had not been an integral part of their training but that it was
 essential if practitioners were to use the framework effectively.
 (b) Developing a common language across the professional groups required
 considerable work and commitment and was time-consuming. This was
 particularly highlighted with reference to ?risk?. Social services tended
 to interpret ?risk? as ?risk of child abuse?. Health professionals tended
 to interpret it as the increased likelihood of developing problems/
 disorders. ?Risk? did not appear to be an integral part of school
 language. Another major difference was the interpretation of
 problems. Schools and social services referred to emotional and
 behavioural problems rather than health problems or disorders. Such
 language differentiation seemed to arise from the differing profes-
 124 CROOM AND PROCTER
sional perspectives, education, experiences and assumptions. The
 Special Educational Needs Coordinators were helpful in refining the
 tool so that teacher knowledge and skills could be maximised. They
 made suggestions about the need to include information on signs of
 vulnerability or strengths which could be observed in the school
 system, e.g. age appropriate; separation from parents; ability to learn
 new skills; peer relationships in school; responding to rules. Addition-
 ally, signs of bullying should be looked for.
 (c) It was agreed that it was crucial to acknowledge and identify these
 differences and that the application of risk/vulnerabilities/needs and
 resilience/protective factors/strengths provided a common language
 as all professionals were attempting to promote strengths and reduce
 needs. It was also felt that the use of strengths and needs would be
 more acceptable to clients as all individuals have strengths and needs,
 irrespective of their position.
 Findings from Parents
 The parents? experiences highlighted that in order to achieve a sustained
 increase in systemic capacity to support children with behavioural problems, it
 was necessary to engage parents as partners, to acknowledge their experiences
 and expertise as carers and to actively respond to their need for psychosocial
 support to fulfil their demanding role. The parents? experiences indicated their
 current isolation:
 My life stopped, when X was born. . .. I don?t bother going to friends any more,
 because I?m too embarrassed and I can?t bear dealing with his behaviour and how
 other people look at him and react to him. . . I thought I was the only one going
 through this. (Group 6, Parent 1)
 I try to go the supermarket late at night before the kids go to bed, so that if they
 play up, I don?t have such a big audience. (Group 2, Parent 3)
 and the marginalisation of their children in mainstream services:
 You?re OK as long as your child can do as they?re told?but if they?re a bit
 different or find it hard to sit for the right amount of time or do the same as the
 others, then they don?t stand a chance?they get labelled as naughty and difficult
 and they start to get blamed for everything. (Parent 1, Cohort 1)
 They won?t let him be treated like an individual . . . differently . . . I say . . . just
 leave him alone if he throws a wobbler . . . he needs some time and then he gets
 over it, but they say they can?t let the other children see him getting away with
 his behaviour?I can?t get through to them. (Parent 3, Cohort)
 He always gets the blame?even if he isn?t there! (Parent 1, Cohort 2)
 THE NEWCAN PRACTICE FRAMEWORK 125
Parents felt that they had to cope with their deep sense of chronic powerlessness
 to get appropriate help in the system. This disempowerment led to feelings of
 pessimism and helplessness:
 I?ve been banging me head off a brick wall for years trying to get someone to see
 me bairn?s got problems?they just think it?s me. (Group 2, Parent 1)
 I?ve really had to fight to get anything done. (Group 1, Parent 2)
 The hardest part is when they you feel they won?t accept your child has problems
 and they?re just judging you. (Group 3, Parent 3)
 I sit and worry about how he will turn out. . . which prison he will be in. (Group 6,
 Parent 2)
 The power differentials between parents and professionals seemed to be
 maintained through ?legitimated knowledge?, i.e. that professionals were
 qualified, had certificates and had been to university.
 I feel they?re all judging me. (Group 2, Parent 1)
 When you?re with the doctors and psychologists, it?s like you?ve got to go up to
 their level because they can?t come down to ours. (Group 6, Parent 3)
 It?s like?you?re the pupils?we?re the experts. (Group 4, Parent 2)
 I felt like I was a guinea pig. (Group 4, Parent 3)
 You feel as though you?ve got to be on your best behaviour. (Group 7, Parent 1)
 I was at a meeting at the [Child mental health unit]?I was terrified. They never
 asked me how I was feeling. (Group 8, Parent 2)
 I feel as though they?ve just read books?they know that children can have
 tantrums but only mothers can really experience it, but I don?t know how to
 explain what it?s like. (Group 6, Parent 3)
 I don?t feel as though they?re interested in what I?ve got to say . . . yet I?m the
 mother. (Group 4, Parent 3)
 Parents helped to highlight that a potential consequence of ?expert professionals?
 making decisions without consultation with parents/children (none of the parents
 across the cohorts felt they had ever been consulted about their opinions or
 experiences prior to the group) was that services were currently prescribed on
 the basis of what they can offer rather than being responsive to the presenting
 needs of the parents/children.
 Eventually the social workers came out and I thought?thank God?we?re getting
 somewhere. I wanted help with a break. I was at the end of me tether. On me
 126 CROOM AND PROCTER
own, four kids and him like he is. I couldn?t believe it - they measured me house
 up for a new bath. He?s got slight spina bifida, but I can cope with that and so can
 he. He runs around with the rest of them. . .I didn?t want help with that. They
 couldn?t help with any support with him, but I?m getting a new bath! (Group 4,
 Parent 4)
 I wanted some help to cope with him and a break for me. I didn?t feel I could go
 on. We went to family therapy, but didn?t find it helpful and then they offered us
 this carers? scheme, but I had to drive him 20 miles there and back for 2 hours?
 that was no break to me. I just had to wait in the car until he?d finished- it was
 exhausting. (Group 5, Parent 2)
 I got help for a while?I saw X at the [specialist CAMH unit] but then I was
 discharged because they felt I was doing OK at the time and now I?m here because
 the problems are really always with you.
 The data from the parents indicated how disenfranchised they felt as service
 users. Their expertise and experiences were not recognised and used by
 professionals; instead, professionals tried to fit the family needs into prede-
 termined prescribed frameworks of service provision almost regardless of
 relevance. Meeting these parents? needs requires social action to transform the
 current hegemony of professional knowledge, from one in which parents feel
 excluded from accessing ?specialist knowledge? and from engaging in the
 knowledge production process, to a state which maximises both professional
 and carer knowledge and skills.
 The current pressure to maintain the status quo of professional hegemony was
 highlighted when the problems which parents identified such as ?mother blame?
 and the psychosocial solutions they proposed such as increased availability of
 recreation and respite for their children, were found to be supported by
 published research but had not been acknowledged or translated into action via a
 change in practice or service provision. The parents identified the critical value
 of the opportunity to engage with other parents in a group, where they can
 develop a joint consciousness and the confidence to critique the prescribed
 responses dictated by experts and service planners.
 Conclusion
 In response to these findings the NewCan Practice Framework (Croom 2001)
 was developed, which synthesises the research findings into an action plan,
 responding to the parents? identified need to be listened to, have access to
 ?specialist information?, engage in the decision making on the best way to
 respond to and evaluate their needs, and have a mechanism for feeding their
 knowledge and insights back to providers. It also provides a common language
 that can be used to communicate across professional groups and between
 parents and professionals from different agencies, thus reducing multiple
 assessments.
 THE NEWCAN PRACTICE FRAMEWORK 127
Figur
 e
 1.
 Compariso
 n
 of
 practitione
 rresponse
 st
 o
 parental/chil
 d
 nee
 d
 befor
 e
 an
 d
 afte
 rimplementatio
 n
 of
 th
 e
 NewCa
 n
 Practic
 e
 Framewor
 k
 128 CROOM AND PROCTER
Figure 1 compares the service response to needs experienced by both parents,
 children and practitioners at the start of this research with the new approach
 developed as a result of working through the practice framework. It illustrates
 how the framework is designed to enable both parents and practitioners
 systematically to assess strengths and vulnerabilities and to identify individual,
 family and community resources that promote strengths and reduce vulnerability.
 Working through the process enables practitioners and parents to identify the
 evidence base for existing service provision, for gaps in local provision and for
 evidence of local unmet need. It therefore provides a systematic approach to the
 collection and collation of evidence to inform local planning and service delivery
 systems.
 Funding to undertake a rigorous evaluation of the effectiveness of the practice
 framework that would meet the high standards of rigour required by the
 evidence-based health care movement has not been available, despite several
 attempts to acquire it. A multi-professional educational module has been
 developed to support the implementation of the practice framework. This has
 been accessed mainly by School Nurses and Health Visitors but some Social
 Workers and Teachers have also attended. The Framework is being used in
 Newcastle upon Tyne, Middlesbrough and Teeside by Health Visitors and School
 Nurses who have successfully completed the supporting module. Their experi-
 ences of using the practice framework are being documented and will form the
 basis of an evaluation.
 References
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 Bennathan, M., and M. Boxall. 1996. Effective intervention in Primary Schools. London:
 David Fulton Publishers.
 Bickman, L., and D. Rog. 1995. Children?s mental health services: Research, policy and
 evaluation. London: Sage Publications.
 Browne, G., C. Byrne, J. Roberts, and A. Gafni. 1999. Benefiting all the beneficiaries of
 social assistance. National Academies of Practice Forum 1(2): 132?42.
 Croom, S. 2001. The NewCan Practice Framework: Practice Framework for Working jointly
 with Parents and Young People to identify Child and Adolescent Mental Health (CAMH)
 Issues and how to reduce the likelihood of CAMH problems and to build on the strengths
 of the young person, family and the community they live in.
 Cunningham, C., R. Bremner, and M. Boyle. 1995. Large Group community based parenting
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Meltzer, H., R Gatward, and R. Goodman. 2000. Mental health of children and adolescents
 in Great Britain, Office of National Statistics. HMSO. Office of National Stats.
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 Offord, D. R., M. H. Boyle, J. E. Fleming, H. Munroe Blum, and I. Rae Grant. 1989. Ontario
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 Ofsted 1999. Principles into practice: Effective Education for pupils with emotional and
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 programmes. London: Family Policies Studies Centre.
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 for Clinical services. Canadian Journal of Psychiatry 34: 492?9.
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 social care. London. Routledge.
 Biographical Notes
 Susan Procter is Professor of Primary Health Care Research. Correspondence to:
 Public Health and Primary Care Unit, St Bartholomew?s School of Nursing and
 Midwifery, City University, Philpot Street, London EC1 2EA, UK. Tel: + 44
 (0)020 7040 5964, e-mail S.Procter@city.ac.uk
 Correspondence to1 ??????
 130 CROOM AND PROCTER
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