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1
Evans, Kathryn, Peter Tyrer, Naresh Gandhi, Alwyn Lamont, and Phil Harrison-Read. "Importance of local differences in comparing hospital and community psychiatric services." Epidemiologia e psichiatria sociale. Monograph Supplement 6, S1 (April 1997): 137–44. http://dx.doi.org/10.1017/s1827433100000903.
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Most of the studies that are frequently cited as examples of effective comprehensive community care, (i.e. they reduce the demand for hospital beds without any loss in treatment efficacy (Stein & Test, 1980; Hoult & Reynolds, 1984; Muijen et al., 1992) were carried out before the introduction of the Care Programme Approach (CPA) in 1991 (Department of Health, 1990) which at present only applies to England. As the CPA derives from these earlier studies the discrepancies between hospital and community based aftercare might be expected to become less, as now all services in England are expected to include a significant community element. However, there can still be important differences between those services focusing on community care as the main priority and those in which the hospital system is paramount.The psychiatric services in the area covered by North West London Mental Health Trust (NWL Trust) represented a natural test of these two approaches as they had parallel hospital and community based teams covering the same catchment areas respectively, North Paddington, in Westminster and Brent, in outer London.At this point it is useful to provide more detailed description of the two geographical areas at the time of the study and the community and hospital based teams that were involved.
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Wilkinson, Greg. "Mental Health Services Planning." Bulletin of the Royal College of Psychiatrists 9, no. 7 (July 1985): 138. http://dx.doi.org/10.1192/s0140078900022161.
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A timely conference on Mental Health Services Planning, organized jointly by the Royal College of Psychiatrists and the Department of Health and Social Security, took place in London in March 1985. The conference concentrated on difficulties associated with the implementation of government policies for mental health service planning in England and Wales. Particular emphasis was given to the problems of transition from hospital-based services to community-based services.
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Goddard, Chris. "The organised abuse of children in rural England: The response of Social Services, Part Two." Children Australia 19, no. 4 (1994): 49–51. http://dx.doi.org/10.1017/s1035077200004272.
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Cronin, Simon. "The Practice of Pharmacy in England." Drug Intelligence & Clinical Pharmacy 20, no. 10 (October 1986): 808–11. http://dx.doi.org/10.1177/106002808602001022.
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The practice of pharmacy in England is described. Community pharmacies have a contract with the Department of Health and Social Security to fill National Health Service prescriptions. A large proportion of the general public obtain their prescriptions free. Funding for the health service comes from taxes and automatic contributions from employers and employees. Aspects of hospital pharmacy practice and salaries are discussed, e.g., a junior pharmacist may expect to earn between $9000 and $12 000. There is very little unit-dose dispensing, and many hospitals are unable to provide 24-hour services. Hospital pharmacies function with fewer pharmacists than their U.S. counterparts, utilizing larger numbers of technicians. Clinical pharmacy practice centers around drug monitoring (ward pharmacy). Pharmocokinetic services are provided in a few places. Master of science degrees in clinical pharmacy are available. However, the future of clinical pharmacy practice in England depends on staffing levels and competition between and acceptance from other health disciplines.
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Yacoub, Evan, Ian Hall, and Jane Bernal. "Secure in-patient services for people with learning disability: is the market serving the user well?" Psychiatric Bulletin 32, no. 6 (June 2008): 205–7. http://dx.doi.org/10.1192/pb.bp.107.018523.
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Medium-secure care services developed in England following the Butler report (Home Office & Department of Health and Social Security, 1975). They were established to address the major gap in provision between high-secure and local mental health services. However, the development of special secure services for offenders with a learning disability has largely been neglected (Snowden, 1995). People with learning disability who require secure in-patient care are often placed in remote and costly units because suitable local facilities do not exist. Such placements do not usually accord with user and carer wishes.
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Fisher, Jenny, Susan Baines, and Mary Rayner. "Personalisation and the Co-operative Tradition." Social Policy and Society 11, no. 4 (May 28, 2012): 507–18. http://dx.doi.org/10.1017/s1474746412000218.
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There is growing interest in how enterprises based on co-operative values can help to meet needs relating to welfare and re-energise public services. The objective of this article is to examine critically the intersection of personalised adult social care services and the co-operative tradition, which emphasises mutual aid and value-led enterprise. We do this by retelling the story of personalisation through a co-operative lens, and ground this reading in case studies of two new co-operative enterprises that were supported under a Department of Health programme in England (2006–2009) intended to demonstrate how personalised adult social care could be extended by developing collaborative, co-operative organisational forms.
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NEWMAN, JANET, CAROLINE GLENDINNING, and MICHAEL HUGHES. "Beyond Modernisation? Social Care and the Transformation of Welfare Governance." Journal of Social Policy 37, no. 4 (October 2008): 531–57. http://dx.doi.org/10.1017/s0047279408002201.
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AbstractThis article reflects on the process and outcomes of modernisation in adult social care in England and Wales, drawing particularly on the recently completed Modernising Adult Social Care (MASC) research programme commissioned by the Department of Health. We begin by exploring the contested status of ‘modernisation’ as a descriptor of reform. We then outline some of the distinctive features of adult social care services and suggest that these features introduce dynamics likely to shape both the experiences and outcomes of policy ambitions for modernisation. We then reflect on the evidence emerging from the MASC studies and develop a model for illuminating some of the dynamics of welfare governance. Finally, we highlight the emerging focus on individualisation and on user-directed and controlled services. We argue that the current focus of modernisation involves a reduced emphasis on structural and institutional approaches to change and an increased emphasis on changes in the behaviours and roles of adult social care service users. This focus has implications for both the future dynamics of welfare governance and for conceptions of citizenship.
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Simpson, Donald, Eunice Lumsden, and Rory McDowall Clark. "Pre-school practitioners, child poverty and social justice." International Journal of Sociology and Social Policy 35, no. 5/6 (June 8, 2015): 325–39. http://dx.doi.org/10.1108/ijssp-10-2013-0101.
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Purpose – Several ideas exist about social justice and how inequalities can be tackled to help families and children in poverty. The Coalition government released the UK’s first Child Poverty Strategy in 2011. Pervaded by neoliberal ideology, the strategy mentions “empowering” pre-school services and practitioners within the childcare market “to do more for the most disadvantaged” (Department for Work and Pensions (DWP) and Department for Education (DfE) 2011, p. 35). The purpose of this paper is to bring to light how Early Childhood Education and Care (ECEC) practitioners across England have engaged with policy discussions and adopted expectations concerning their place in addressing child poverty. Design/methodology/approach – Using a phenomenological qualitative research design the paper draws upon 30 interviews with pre-school practitioners in three geographic areas of England. All interviewees worked with families and children in poverty and were senior ECEC practitioners within their pre-school settings. Findings – Many interviewees shared the Coalition’s construction of child poverty as a problem of “troubled” parenting. These views pervaded their interaction with parents and intersected with the regulatory influence of “policy technologies” to influence their practice within a context of austerity cuts. This limited practitioners’ poverty sensitivity and their promotion of social justice. Therefore this paper concludes by critiquing the contribution which ECEC practitioners can make to addressing child poverty. Practical implications – The findings suggest there may be a need for poverty proofing toolkits in the pre-school sector. Originality/value – This paper provides a rare insight into how pre-school practitioners have engaged with, adopted and adapted assumptions about their role within policy discussion over child poverty and the promotion of social justice.
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Emmott, Emily H., Matthew A. Jay, and Jenny Woodman. "Cohort profile: Children in Need Census (CIN) records of children referred for social care support in England." BMJ Open 9, no. 2 (February 2019): e023771. http://dx.doi.org/10.1136/bmjopen-2018-023771.
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PurposeThe Children in Need Census (CIN) is a case-based administrative dataset on children referred to social care services in England. CIN includes information on the ‘needs’ of children, and whether they received social care support. Local and national government bodies in England currently use CIN for evaluation purposes. Data are accessible to researchers under certain conditions, allowing researchers to investigate the health implications of adverse childhood experiences. However, CIN suffers from lack of metadata, meaning it can be challenging for researchers to process and interpret data, particularly if researchers are unfamiliar with the English children’s social care system. To address this issue, we provide the background to CIN and describe the available data from 2008 to 2016.ParticipantsCIN is derived from case records held by English local authorities on all children referred to children’s social care for a ‘needs assessment’, regardless of whether they are eventually assessed as ‘in need of social care support’. Local authorities submit these case records to the UK Department for Education for collation. CIN holds information on an estimated 2.76 million children from October 2008 to March 2016. Since 2013/2014, just under 900 000 children have been recorded in the CIN annually, equivalent to around 8% of children in England (annual prevalence). Approximately, 650 000 children enter or renter the dataset each year, equivalent to 5% of children in England (annual incidence).Data summaryOf the estimated 2.76 million children in the data, 50% are male and 47% female. 45% are referred to children’s social care services due to abuse or neglect. 10.7% of children in CIN went onto a child protection plan, meaning they were judged to be (at risk of) suffering significant harm.Future plansCIN data collection is annual and ongoing. Data from the most recent census period typically become available for researchers in the following Spring.
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REED, JAN, MARGARET COOK, GLENDA COOK, PAMELA INGLIS, and CHARLOTTE CLARKE. "Specialist services for older people: issues of negative and positive ageism." Ageing and Society 26, no. 6 (October 19, 2006): 849–65. http://dx.doi.org/10.1017/s0144686x06004855.
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This paper reports findings of a study in 2004 of the development of specialist services for older people in the National Health Service (NHS) in England, as recommended in the Department of Health's National Service Framework for Older People (NSF-OP). The study was funded by the Department of Health as part of a programme of research to explore the Framework's implementation. Information was collected through a questionnaire survey about the nature of specialist developments at three levels of the NHS: strategic health authorities (SHAs), provider Trusts, and service units. This produced an overview of developments and a frame from which to select detailed case studies. Analysis of the survey data showed that there were variations in the way that the NSF-OP was being interpreted and implemented. In particular, there was inconsistency in the interpretation of the NSF-OP's anti-ageism standard; some concluded that the strategy discouraged services exclusively for older people, others that it encouraged dedicated provision for them. The tension between creating age-blind and age-defined services was played out in the context of existing service structures, which had been shaped over decades by many local and national influences. These conceptual and historical factors need to be taken into account if services are to change, as developments are shaped by ‘bottom-up’ local processes as well as ‘top-down’ policy initiatives. In particular, the tension inherent in the NSF-OP between negative and positive ageism, and its varied interpretations at local levels needs to be taken into account when evaluating progress in implementation.
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Howard, Louise. "Psychotic disorders and parenting - the relevance of patients' children for general adult psychiatric services." Psychiatric Bulletin 24, no. 9 (September 2000): 324–26. http://dx.doi.org/10.1192/pb.24.9.324.
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Patients with psychotic disorders are often assumed to be sub-fertile, and when patients do have children, any child care concerns are usually passed on to social services. The children of patients with psychotic disorders may not, therefore, be of major concern to the responsible medical officer, and community mental health services have not been developed with families in mind. Routine statistics on psychiatric patient episodes do not include information on patients' children – a question covering this issue was included in the pilot draft of the Mental Health Minimum Data Set (approved for England by the Department of Health in September 1999), but was dropped because clinical professionals were reluctant to record this information, as they did not consider it relevant in this context (personal communication, G. Glover, 2000).
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Saini, Pooja, Jason McIntyre, Rhiannon Corcoran, Konstantinos Daras, Clarissa Giebel, Elizabeth Fuller, Jane Shelton, et al. "Predictors of emergency department and GP use among patients with mental health conditions: a public health survey." British Journal of General Practice 70, no. 690 (December 17, 2019): e1-e8. http://dx.doi.org/10.3399/bjgp19x707093.
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BackgroundHigh demand for health services is an issue of current importance in England, in part because of the rapidly increasing use of emergency departments (EDs) and GP practices for mental health conditions and the high cost of these services.AimTo examine the social determinants of health service use in people with mental health issues.Design and settingTwenty-eight neighbourhoods, each with a population of 5000–10 000 people, in the north west coast of England with differing levels of deprivation.MethodA comprehensive public health survey was conducted, comprising questions on housing, physical health, mental health, lifestyle, social issues, environment, work, and finances. Poisson regression models assessed the effect of mental health comorbidity, mental and physical health comorbidity, and individual mental health symptoms on ED and general practice attendances, adjusting for relevant socioeconomic and lifestyle factors.ResultsParticipants who had both a physical and mental health condition reported attending the ED (rate ratio [RR] = 4.63, 95% confidence interval [CI] = 2.86 to 7.51) and general practice (RR = 3.82, 95% CI = 3.16 to 4.62) more frequently than all other groups. Having a higher number of mental health condition symptoms was associated with higher general practice and ED service use. Depression was the only mental health condition symptom that was significantly associated with ED attendance (RR = 1.41, 95% CI = 1.05 to 1.90), and anxiety was the only symptom significantly associated with GP attendance (RR = 1.19, 95% CI = 1.03 to 1.38).ConclusionMental health comorbidities increase the risk of attendances to both EDs and general practice. Further research into the social attributes that contribute to reduced ED and general practice attendance rates is needed.
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FERNÁNDEZ, JOSÉ-LUIS, JEREMY KENDALL, VANESSA DAVEY, and MARTIN KNAPP. "Direct Payments in England: Factors Linked to Variations in Local Provision." Journal of Social Policy 36, no. 1 (December 21, 2006): 97–121. http://dx.doi.org/10.1017/s0047279406000390.
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Direct payments have moved to the heart of the government's drive for increased user choice. At the same time, implementation has remained disappointing. This article explores the demand, supply and related factors associated with patterns of local variability in uptake and intensity of care package provision. Statistical analyses are conducted for key client groups – people with physical disabilities, older people, people with learning disabilities and people who use mental health services – using data for England from 2000–01 to 2002–03. The results suggest that direct payments variability reflects a complex array of factors, both within and beyond the control of local public actors. In particular, while local policy preferences appear to shape the extent of direct payments growth, the results also demonstrate that understanding levels of activity requires attention to local circumstances.I see direct payments, personal cash budgets, and other ways of extending choice and control as key to developing social care for the twenty-first century (Parliamentary Under Secretary of State for Community Care, Department of Health, 2004).
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Walker, Ian F., Jude Stansfield, Lily Makurah, Helen Garnham, Claire Robson, Cam Lugton, Nancy Hey, and Gregor Henderson. "Delivering national public mental health – experience from England." Journal of Public Mental Health 18, no. 2 (June 17, 2019): 112–23. http://dx.doi.org/10.1108/jpmh-06-2018-0032.
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Purpose Mental health is an emerging health policy priority globally. The emphasis on closing the treatment gap in psychiatric services is now being complemented by an increasing focus on prevention and health promotion. The purpose of this paper is to describe the programmes and delivery of public mental health in England led by Public Health England (PHE), an arms-length body of the Department of Health and Social Care. Design/methodology/approach This technical paper outlines the general approach PHE has taken in delivering national work in public mental health and describes several key areas of work: children and young people, suicide prevention, workplace and workforce, strategic engagement with stakeholders, data and information and evidence synthesis. Findings A description of the various programmes and guidance documents that PHE have produced are described and referenced, which form a substantial body of work in public mental health. Practical implications The outputs from PHE may assist in informing the approach to public mental health that other government agencies could consider adopting. The resources described and signposted within this technical paper are publicly available for readers. Originality/value England is one of a small group of countries that have a track record in delivering public mental health at a national level. This paper gives a unique and detailed insight into this work.
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Forsyth, Bunny, and Paul Winterbottom. "Beds, budgets and burdens: Learning disability expenditure v. workload across English health authorities." British Journal of Psychiatry 181, no. 3 (September 2002): 200–207. http://dx.doi.org/10.1192/bjp.181.3.200.
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BackgroundFollowing the closure of asylums and widespread changes in the population distribution of people with learning disabilities, there has been little investigation of changing expenditure requirements of health authorities in England.AimsTo compare expenditure on learning disability health services across England with the burden of services regionally, as estimated by numbers of people with learning disabilities.MethodA national database was set up using data from the National Audit Commission and the Department of Health. The spend/burden ratio was calculated and correlation tests for likely causes of inequality were applied.ResultsThere is widespread discrepancy from the median spend/burden ratio of £10 260 per person with learning disability. There is a positive correlation between ratios and levels of net exports of people funded by their local authority social services to reside ‘out of area’. Comparative underspending occurs in rural areas.ConclusionsThere are inequalities in levels of spending on learning disability services. Comparison of regions suggests resources may not be allocated fairly. Health authorities should ensure that population increases are mirrored by appropriate adjustments in expenditure.
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James, Elaine. "Rights-Based Social Work and the Named Social Worker for Adults with Learning Disabilities: A Policy Intervention 50 Years in the Making." British Journal of Social Work 51, no. 4 (February 23, 2021): 1259–76. http://dx.doi.org/10.1093/bjsw/bcab036.
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Abstract There has been a renewed interest in professional and academic discourse in the reconceptualisation of social work with adults as a human rights-based approach. This is compatible with the social model of disability, which philosophically adult social workers make claims to align with. This was recently argued for when the Department of Health in England piloted a named social worker for adults with learning disabilities, whose behaviour challenged services. This paper discusses the conceptualisation of rights-based practice, its relevance and appropriateness for contemporary social work policy. Drawing on the recognition theory literature, it shall be shown that the meta-theory of rights-based practice may have relevance to contemporary social work practice with adults with learning disabilities. The paper shall also consider the renewed interest in normative reconstruction in social work practice and influencing factors such as drives towards individualism and marketisation. It will consider how these impacted on the adoption into UK policy of social work as a positive intervention to address structural inequalities, perhaps more accurately described as disablism, experienced by adults with learning disabilities, which ultimately is concluded to be a ‘wicked problem’.
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Glover, Gyles. "How much English health authorities are allocated for mental health care." British Journal of Psychiatry 175, no. 5 (November 1999): 402–6. http://dx.doi.org/10.1192/bjp.175.5.402.
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The authors of the King's Fund report on London's mental health services (Johnson et al, 1997) argued that the formula used by the Department of Health to allocate resources to health authorities fails to meet the needs of inner cities. It is difficult to explore this issue because the principal allocation to district health authorities is set out as a single figure, with no subdivisions for separate clinical areas. This differs from local government finance, where annual allocations are itemised in a report detailing both major components (education, social services and road maintenance), and subdivisions of these (House of Commons, 1998). However, in the process used by the Department of Health to calculate health service allocations, several areas of clinical work, including the care of the mentally ill and learning disabled, receive distinct consideration. An annual publication sets out the detail (NHS Executive, 1998). Slight reworking allows the identification of implied allocations for the following clinical areas: general and acute; mental illness and learning disability; and other community care. This paper outlines the methodology and shows the allocations to health authorities in England for 1990–2000.
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Robson, C. E. "Your supported lodgings." Psychiatric Bulletin 15, no. 5 (May 1991): 270–71. http://dx.doi.org/10.1192/pb.15.5.270.
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Supported lodgings are an important means of achieving the successful rehabilitation and resettlement of the chronically mentally ill into the community (Anstee, 1978, 1985). In a survey of 15 psychiatric hospitals in England and Wales, it was estimated that 9.3% of the long-stay patients (i.e. in-patients from one to five years) under 65 years of age were ideally suited to less supervised accommodation outside the hospital. In Gloucestershire the Supported Lodging Scheme is provided by the Psychiatric Social Services Department. It was started to enable ‘new’ and ‘old’ long-stay patients at Coney Hill and Horton Road hospitals to be settled in the community. Now any psychiatric or mentally handicapped patient can also enter the scheme if appropriate.
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Thompson, S., and P. Crome. "Intermediate care." Reviews in Clinical Gerontology 11, no. 3 (August 2001): 205–7. http://dx.doi.org/10.1017/s0959259801011315.
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The proportion of older people in our society is increasing more rapidly than any other section of the population. This group uses health and social services more than the young do and this is reflected in the NHS and social service budgets from recent years. For example, 40% of the NHS budget was spent on patients over 65 years in 1998. The much-heralded National Service Framework (NSF) for Older People, recently published by the Department of Health in England, was therefore awaited with much anticipation by all sections of the community concerned with older people’s health. This document is described as the ‘key vehicle for ensuring that the needs of older people are at the heart of the government’s reform programme for health and social services’. It has as its first and fundamental standard ‘rooting out age discrimination’. The sections on prevention and treatment of stroke, general hospital care, the management of falls and mental health have been generally well received and when implemented fully are likely to be beneficial to older people. Some areas such as the treatment of care home residents have not been addressed in nearly enough detail. In contrast, one particular section, that on ‘Intermediate Care’, has been heavily criticized, including a fierce attack by two of the United Kingdom’s leading geriatricians.
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Perez-Montejano, R., E. Finch, and K. Wolff. "FC03-05 - An evaluation of service provision by community drug treatment services for opioid dependent pregnant drug users in England and Wales." European Psychiatry 26, S2 (March 2011): 1826. http://dx.doi.org/10.1016/s0924-9338(11)73530-1.
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IntroductionOver the last decade a series of guidelines and recommendations have been published in the UK by the Department of Health, the Home Office, Professional and Non-Professional bodies. However, an optimal strategy and consensus in the management and care of opioid dependent pregnant users has yet to be established.ObjectivesDetermination of existing methods for identifying and managing pregnancy in opioid users prescribed methadone by NHS Treatment Services and regional differences.AimTo survey the management, treatment and follow-up of pregnant opioid users prescribed methadone by Drug Treatment Services in England and Wales.MethodsIn 2006 a POSTAL survey was conducted among 223 Community Drug Treatment Services (CDTS).ResultsSixty-six percent of CDTS responded to the survey (n = 154/233). A Chi-square, Mann_Whitney U Test and/or Kruskal-Wallis analysis revealed significant differences in the composition of CDTS and service provision across regions. Half of CDTS (55.3%) provided a methadone dosage regime lower than that recommended for non-pregnant drug users. There were also significant variations on how professionals approached the management of pregnant opioid users. CDTS with an addiction specialist were significantly more likely (p < .01) to advocate high doses of methadone whereas those with a midwife, obstetrician or social worker involved were more likely (p < .05) to suggest low dose methadone and/or detoxification.ConclusionsService provision for pregnant opioid users is comprehensive but there is still variability in some aspects of the treatment received. The way in which methadone is prescribed is not always optimal. Further work is required in this area.
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Wright, Fay. "Multi-Purpose Residential Homes: A Fair Deal for Residents?" Ageing and Society 14, no. 3 (September 1994): 383–404. http://dx.doi.org/10.1017/s0144686x00001641.
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ABSTRACTThe paper reports on a study carried out in 1990 for the Department of Health looking at the development of local authority multi-purpose residential homes for elderly people in England and Wales. A national survey showed that one in five public sector residential homes for elderly people would soon be multi-purpose. This proportion could be expected to increase in the 1990S. Many of these homes had become the centre for virtually all the community support services for elderly people in the neighbourhood. Despite some obvious management advantages in making use of residential home facilities for older people in the community, there have to be serious reservations about a multi-purpose model. Case studies in six multi-purpose homes suggest that residents themselves may gain little or nothing from this arrangement. Few interact with elderly people from the neighbourhood in the day centre. So much activity on the premises meant that invasions of residents' privacy and space were common.
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Glover, Gyles, Sebastian Fox, and Chris Hatton. "General hospital care for people with intellectual disabilities." Tizard Learning Disability Review 21, no. 1 (January 4, 2016): 43–49. http://dx.doi.org/10.1108/tldr-10-2015-0040.
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Purpose – The purpose of this paper is to explore the extent of compliance of commissioners and providers of hospital services in England with their duty under equalities legislation to be aware of patients with intellectual disabilities as a first step to making appropriate provision for their consequent specific needs. Design/methodology/approach – National survey of healthcare commissioners undertaken as part of an annual learning disabilities services audit. Findings – In total, 41.4 per cent of local areas were unable to supply information about numbers of people with intellectual disabilities among those admitted to hospital, 46.7 and 48 per cent, respectively, could not supply this information about out-patient and accident and emergency department attenders. Figures supplied by those able to provide data varied very substantially and overall were so low as to suggest considerable numbers had been missed. Research limitations/implications – The study is testing what local health commissioners are able to find out from hospitals. The authors do not know the accuracy of the data they reported. Practical implications – The study suggests approaching half of healthcare commissioners in England have little or no information about the extent of proper adjustment of hospital care for people with intellectual disability in their area. Their responsibility to assure this has been repeatedly asserted by government. Social implications – The study indicates a need for more work to improve hospital care for people with intellectual disabilities. Originality/value – This was a government sponsored national study to which local healthcare commissioners were expected to contribute.
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Allen, Thomas, Kieran Walshe, Nathan Proudlove, and Matt Sutton. "Do performance indicators predict regulator ratings of healthcare providers? Cross-sectional study of acute hospitals in England." International Journal for Quality in Health Care 32, no. 2 (November 14, 2019): 113–19. http://dx.doi.org/10.1093/intqhc/mzz101.
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Abstract Objective To determine whether a large set of care performance indicators (‘Intelligent Monitoring (IM)’) can be used to predict the Care Quality Commission’s (CQC) acute hospital trust provider ratings. Design The IM dataset and first-inspection ratings were used to build linear and ordered logistic regression models for the whole dataset (all trusts). This was repeated for subsets of the trusts, with these models then applied to predict the inspection ratings of the remaining trusts. Setting The United Kingdom Department of Health and Social Care’s Care Quality Commission is the regulator for all health and social care services in England. We consider their first-inspection cycle of acute hospital trusts (2013–2016). Participants All 156 English NHS acute hospital trusts. Intervention(s) None. Main Outcome Measure(s) Percentage of correct predictions and weighted kappa. Results Only 24% of the predicted overall ratings for the test sample were correct and the weighted kappa of 0.01 indicates very poor agreement between predicted and actual ratings. This lack of predictive power is also found for each of the rating domains. Conclusion While hospital inspections draw on a much wider set of information, the poor power of performance indicators to predict subsequent inspection ratings may call into question the validity of indicators, ratings or both. We conclude that a number of changes to the way performance indicators are collected and used could improve their predictive value, and suggest that assessing predictive power should be undertaken prospectively when the sets of indicators are being designed and selected by regulators.
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Coid, Jeremy, Paul Bebbington, Rachel Jenkins, Traolach Brugha, Glyn Lewis, Michael Farrell, and Nicola Singleton. "The National Survey of Psychiatric Morbidity among Prisoners and the Future of Prison Healthcare." Medicine, Science and the Law 42, no. 3 (July 2002): 245–50. http://dx.doi.org/10.1177/002580240204200309.
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It has long been known that psychiatric disorders are highly prevalent among prisoners (Coid, 1984; Gunn et al., 1991; Maden et al., 1995; Joukamaa, 1995; Bland et al., 1998; Lamb and Weinberger, 1998). However, the Survey of Psychiatric Morbidity Among Prisoners in England and Wales (Singleton et al., 1998) represents a considerable advance on earlier surveys. By using the same standardized psychiatric assessment procedures, and similar questions on medication, service use and social functioning, its findings can be compared with previous national surveys of adults living in private households (Meltzer et al., 1995), residents in institutions (Meltzer et al., 1996), homeless persons (Gill et al., 1996), and with the forthcoming household survey in England, Wales and Scotland. It should also inform the future organisation of healthcare for prisoners, following recent recommendations from a joint Home Office/Department of Health Working Party that Health Authorities must work with prisons in their catchment areas to carry out joint health needs assessments, agree prison healthcare improvement strategies and jointly plan and commission services (HM Prison Service and NHS Executive 1999). The ultimate test of the survey will be whether it provides a benchmark to evaluate the future effectiveness of the new policy changes.
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Hilton, Claire. "Psychogeriatrics in England: Its Route to Recognition by the Government as a Distinct Medical Specialty,c.1970–89." Medical History 60, no. 2 (March 14, 2016): 206–28. http://dx.doi.org/10.1017/mdh.2016.4.
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Demographic trends, and older people over 65 years disproportionately occupying beds in psychiatric hospitals, pointed to their increasing clinical needs. Clinical work with older people often required different skills from work with younger people. ‘General psychiatrists’, nominally working with adults of all ages, usually had little interest in working with older people. By 1977, it was clear to clinical leaders in the field of psychogeriatrics that official recognition of their specialty by the government was essential to ensure service development. Official recognition would provide the means to collect data to identify gaps in services, to obtain information on the implementation of government guidance and to advocate for resources, including ensuring high quality training posts for doctors wanting to specialise in the field. Doctors have traditionally taken the lead in creating new medical specialties, and psychogeriatrics was no exception. However, support fluctuated towards the specialty from the leadership of the Royal College of Psychiatrists. Health service leaders who did not undertake work with older people, were incredulous that others wished to do so. Negotiations between the Royal College of Psychiatrists and the Department of Health and Social Security about recognising psychogeriatrics were convoluted and prolonged. Recognition was achieved in 1989, following intervention by the Royal College of Physicians of London.
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Watts, Rob. "Book Review Department : PHILLIP INSTITUTE OF TECHNOLOGY SCHOOL OF SOCIAL WORK — PENELOPE HALL'S SOCIAL SERVICES OF ENGLAND AND WALES (Edited by John Mays, Anthony Forder and Olive Keidan) Routledge Kegan Paul, 1983: £5.95, 342 pp." International Social Work 28, no. 1 (January 1985): 49–51. http://dx.doi.org/10.1177/002087288502800107.
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Racher, Anna, and Isabelle Brodie. "Joining the dots? Tackling child exploitation during Covid-19." Journal of Children's Services 15, no. 4 (October 12, 2020): 275–85. http://dx.doi.org/10.1108/jcs-07-2020-0036.
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Purpose This paper aims to report on findings from action research undertaken in response to the Covid-19 pandemic by the Tackling Child Exploitation Support Programme (TCESP), a Department for Education funded programme that provides support to local areas in improving their strategic approach to child exploitation and extra-familial harm. Design/methodology/approach The research included a scoping review of the literature, and focus groups with programme staff, strategic leaders and professionals from different services across England. To provide a strategic lens, findings were then considered in relation to TCE’s “Joining the dots” framework, which encourages examination of the relationships between different forms of child exploitation. Findings The action research highlighted the emerging and tentative nature of the knowledge base relating to child exploitation and extra-familial harm in the context of Covid-19. Findings revealed that there had been innovation in the use of digital methods and direct working, integration of practical support with other forms of service delivery and in partnership working, and also considerable variation in approach across different local areas. Practical implications Strategic leaders need to use the evidence emerging from lockdown as a basis for further interrogation of emerging data alongside the views of young people, families and communities and their wider workforce. This includes new information about changing patterns of exploitation. Digital delivery and innovation need to be supported by clear strategic guidance, based on review of the evidence regarding increased digital communication and its impact. New partnerships developed between services, data sharing and innovative ways of working that have taken place during lockdown need to be monitored and evaluated for quality and impact. Originality/value The action research findings offer a snapshot of practice regarding child exploitation and extra-familial harm at a mid-point in the Covid-19 lockdown in England and Wales.
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Holloway, Frank. "Risk: more questions than answers." Advances in Psychiatric Treatment 10, no. 4 (July 2004): 273–74. http://dx.doi.org/10.1192/apt.10.4.273.
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The rise of the risk industry in psychiatry in England and Wales can be given a precise date: 17 December 1992. That was the day that Christopher Clunis, a man who had been in contact with psychiatric services for some 6 years, murdered Jonathan Zito in an unprovoked attack. This tragedy received enormous publicity and resulted in a flurry of activity within the Department of Health. As a result of the moral panic surrounding Clunis, which crystallised long-term trends, the assessment and management of risk became a central focus of mental health policy and practice (Holloway, 1996). Risk remains a core issue, and indeed mental health services have come to be seen as a key element in a strategy for public protection that aims to keep people who are identified as a potential risk to others off the streets. (We await, with some professional trepidation, the legislation that will provide a sufficiently broad definition of mental illness to fully legitimate this social role.) Mental health staff are now required by government policy and their employers to assess an ever-expanding range of risks – most recently, following the Victoria Climbié Inquiry (House of Commons Health Committee, 2003), risks to dependent children, generally with the aid of unvalidated risk assessment tools. Increasingly, mainstream mental health services are being expected to provide interventions for people whose presenting problems are risky behaviours (or even risky feelings) rather than to offer treatment for mental illness.
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Bell, Kerry, Belen Corbacho, Sarah Ronaldson, Gerry Richardson, Kerry Hood, Julia Sanders, Michael Robling, and David Torgerson. "Costs and consequences of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial." F1000Research 8 (September 13, 2019): 1640. http://dx.doi.org/10.12688/f1000research.20149.1.
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Background: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention programme delivered to teenage mothers which was originally introduced in England in 2006 by the Department of Health and is now provided through local commissioning of public health services and supported by a national unit led by a consortium of partners. The Building Blocks (BB) trial aimed to explore the effectiveness and cost-effectiveness of this programme. This paper reports the results of an economic evaluation of the Building Blocks randomised controlled trial (RCT) based on a cost-consequence approach. Methods: A large sample of 1618 families was followed-up at various intervals during pregnancy and for two years after birth. A cost-consequence approach was taken to appraise the full range of costs arising from the intervention including both health and social measures of cost alongside the consequences of the trial, specifically, the primary outcomes. Results: A large number of potential factors were identified that are likely to attract additional costs beyond the implementation costs of the intervention including both health and non-health outcomes. Conclusion: Given the extensive costs and only small beneficial consequences observed within the two year follow-up period, the cost-consequence model suggests that the FNP intervention is unlikely to be worth the substantial costs and policy makers may wish to consider other options for investment. Trial registration: ISRCTN23019866 (20/04/2009)
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Carlile, Anna. "Finding Space for Agency in Permanent Exclusion from School." Power and Education 1, no. 3 (January 1, 2009): 259–69. http://dx.doi.org/10.2304/power.2009.1.3.259.
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This article aims to examine the experiences of pupils and professionals who are affected by permanent exclusion (what used to be called being expelled) from school. An ethnographic study conducted during the author's employment as a Pupil Support Officer within secondary schools and the children's services department of an urban local authority in England explores the idea that professionals may be forced to make inequitable decisions about including or excluding pupils in the face of powerful competition between the politically unchallengeable concepts of tolerance, inclusivity, attainment, and choice. The article argues that the tensions of multi-agency working are focused within what will be described as the contested space of the young person's ‘extended body’. However, whilst the contested nature of this space renders it vulnerable to negative description and to the biased judgements of authoritarian power, it also offers itself as a space for emancipatory self description by the young person and for the expression of agency on the part of those professionals working for social justice.
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Tracy, Derek K., Dan W. Joyce, and Sukhwinder S. Shergill. "Kaleidoscope." British Journal of Psychiatry 207, no. 4 (October 2015): 367–68. http://dx.doi.org/10.1192/bjp.207.4.367.
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Life expectancy in England is related to income (and in London, it can be mapped by a resident's nearest tube station1). The arrival of a new government offers the opportunity to review the impact of earlier policies designed to reduce health inequality. A new report from the King's Fund2 has updated Michael Marmot's 2010 publication, Fair Society, Healthy Lives, and using a wider range of determinants of lifestyle and health, has found that income-related inequalities in life expectancy have improved since that report. Department of Health policies in the 2000s appear to have contributed to this, although reductions in child and pensioner poverty and improvements in employment and social housing have also impacted positively. Nevertheless, unemployment, housing deprivation, and binge drinking remain key factors in lowering life expectancy. The King's Fund report argues that a more nuanced and integrated policy response for the NHS and other public services will be required by the new government to continue to reduce inequality, but recognises that implementation in an era of austerity poses challenges, particularly for the most vulnerable.
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Collinson, Robert, Alice Diver, and Sharon McAvoy. "Clients, clinics and social justice." Higher Education, Skills and Work-Based Learning 8, no. 3 (August 13, 2018): 323–36. http://dx.doi.org/10.1108/heswbl-03-2018-0037.
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PurposeThe purpose of this paper is to present a case study of an innovative, three-module pathway designed by the Department of Law and Criminology at Edge Hill University (England) in 2014. In addition to supporting the work of its campus pro-bono law clinic, the first-two modules aim to enhance and evidence the legal skills of EHU’s undergraduate LLB students, to embed a deeper awareness of the (legal) ethics needed for sustainable legal practice (within PRME), and to highlight the increasing need for socially responsible advocates, able to defend the rights of marginalised, vulnerable clients.Design/methodology/approachThe critical analysis of the content and scope of an innovative, work-based learning LLB module pathway, which furthers the aim of the UN Global Compact and the PRME, and ties them firmly to socio-legal issues and advocacy involving recent jurisprudence.FindingsThe case law used within the modules, and the practical work of the students in the campus law clinic, are relevant to social justice issues and to the promotion of PRME values—they promote awareness of human rights principles, highlight the importance of access to legal services and provide students with knowledge of legal ethics. Enhanced employability skills flow from this.Research limitations/implicationsThis is a narrow case study but still provides a useful analysis of an innovative, PRME relevant module pathway. The model mirrors international trends in clinical legal education and also offers a template for other law schools keen to promote the concept of ethical, just legal practice.Practical implicationsThe paper posits that enhanced employability can flow from real world tasks such as advocacy for marginalised or disadvantaged groups and presents an exemplar for other law schools wishing to embed ethics/clinical law practice into their curriculum.Social implicationsThe paper highlights how the campus law clinic serves the public in a deprived region—it raises awareness of human rights and of social justice issues. It has the potential to feed into litigation on social welfare issues (housing, social security, child welfare, etc.).Originality/valueThe discussion of the human rights case law that is used in the Year 2 “bridging module” (which prepares students for working in the law clinic in their final year) is particularly relevant and is analysed in detail, highlighting how this module pathway is aimed at promoting PRME and UN Global Compact principles.
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Duncan, Fiona H., Mike McGrath, Cleo Baskin, David Osborn, Jen Dykxhoorn, Eileen F. S. Kaner, Shamini Gnani, et al. "Delivery of community-centred public mental health interventions in diverse areas in England: a mapping study protocol." BMJ Open 10, no. 7 (July 2020): e037631. http://dx.doi.org/10.1136/bmjopen-2020-037631.
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BackgroundPublic mental health (PMH) is a global challenge and a UK priority area for action. However, to progress, practitioners require a stronger evidence base regarding the effectiveness of approaches, particularly regarding promotion and prevention through community-centred interventions. In addition, policy-makers need to understand what is being delivered, particularly in areas of high need, to identify promising practices or gaps in PMH provision. Finally, and importantly, the public need better information regarding what approaches and services are available to them. We report a protocol designed to (1) identify the types of community-centred interventions used in purposively selected diverse geographical areas of England to improve PMH outcomes and (2) describe the type, target population, content and outcome measures of each intervention.Methods and analysisFive local authority areas of England were selected based on either high social deprivation or differing ethnic population statistics and geographical locations. Community-centred interventions in each area will be identified through: (1) desk-based data capture from standardised searches of publicly-available information (eg, policy, strategy and intervention advertising), (2) established professional networks and service contacts, (3) chain-referral sampling of individuals involved in local mental health promotion and prevention and (4) peer researchers, who will use their personal experience and local knowledge to help identify potentially relevant organisations. Data on the key features of the interventions will be extracted from individuals either by structured interviews or by electronic questionnaires with information regarding the intervention(s) of which they have knowledge. Initial data analysis will involve tabulating descriptive information and grouping interventions according to intervention type, target population, risk/protective factor and intended primary outcome. A descriptive comparison will be made between selected geographical areas.Ethics and disseminationEthical approval was obtained from Durham University’s Department of Sport and Exercise Sciences Research Ethics Committee. We plan to disseminate our findings at relevant conferences, meetings and through peer-reviewed journals. We also plan to disseminate to the public and intervention providers through social media and/or newsletters.
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Downs, Johnny M., Tamsin Ford, Robert Stewart, Sophie Epstein, Hitesh Shetty, Ryan Little, Amelia Jewell, et al. "An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data." BMJ Open 9, no. 1 (January 2019): e024355. http://dx.doi.org/10.1136/bmjopen-2018-024355.
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ObjectivesCreation of linked mental health, social and education records for research to support evidence-based practice for regional mental health services.SettingThe Clinical Record Interactive Search (CRIS) system was used to extract personal identifiers who accessed psychiatric services between September 2007 and August 2013.ParticipantsA clinical cohort of 35 509 children and young people (aged 4–17 years).DesignMultiple government and ethical committees approved the link of clinical mental health service data to Department for Education (DfE) data on education and social care services. Under robust governance protocols, fuzzy and deterministic approaches were used by the DfE to match personal identifiers (names, date of birth and postcode) from National Pupil Database (NPD) and CRIS data sources.Outcome measuresRisk factors for non-matching to NPD were identified, and the potential impact of non-match biases on International Statistical Classification of Diseases, 10th Revision (ICD-10) classifications of mental disorder, and persistent school absence (<80% attendance) were examined. Probability weighting and adjustment methods were explored as methods to mitigate the impact of non-match biases.ResultsGovernance challenges included developing a research protocol for data linkage, which met the legislative requirements for both National Health Service and DfE. From CRIS, 29 278 (82.5%) were matched to NPD school attendance records. Presenting to services in late adolescence (adjusted OR (aOR) 0.67, 95% CI 0.59 to 0.75) or outside of school census timeframes (aOR 0.15, 95% CI 0.14 to 0.17) reduced likelihood of matching. After adjustments for linkage error, ICD-10 mental disorder remained significantly associated with persistent school absence (aOR 1.13, 95% CI 1.07 to 1.22).ConclusionsThe work described sets a precedent for education data being used for medical benefit in England. Linkage between health and education records offers a powerful tool for evaluating the impact of mental health on school function, but biases due to linkage error may produce misleading results. Collaborative research with data providers is needed to develop linkage methods that minimise potential biases in analyses of linked data.
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Simpson, Graeme, and Ani Murr. "Reconceptualising Well-being: Social Work, Economics and Choice." Culture Unbound 6, no. 4 (October 1, 2014): 891–904. http://dx.doi.org/10.3384/cu.2000.1525.146891.
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In this paper we examine the intersection of well-being, agency and the current political and economic structures which impact on social work with adults and in doing so contribute to ‘interpreting and mapping out the force fields of meaning production’ (Fornäs, Fredriksson & Johannisson 2011: 7). In it we draw upon Sointu’s (2005) work which identified the shift from conceptualising well-being in terms of ‘the body politic’ to conceptualising it in terms of ‘the body personal’ and identified parallels with understanding well-being in English social work. There has been a shift in the nature of social work in the United Kingdom in how the question of agency has been addressed. For many years this was through the traditional notion of autonomy and self-determination (Biestek 1961) and later collective approaches to welfare and services (Bailey & Brake 1975). The development of paradigms of mainly personal empowerment in the 1980s and 1990s (Braye & Preston-Shoot 1995) saw social work become less associated with collective engagement in welfare and more concerned with the enhancement of individual well-being (Jordan 2007). Whilst the rhetoric of well-being, in contemporary English social work, continues to include autonomy and self-determination, this is focused primarily upon the narrower concepts of independence and choice (Simpson 2012).
The UK Department of Health’s A Vision for Adult Social Care: Capable Communities and Active Citizens (DoH 2010) is the template for national social care policy to which all Local Authorities in England had to respond with an implementation plan. This paper draws on a documentary analysis of two such plans drafted in 2012 in the wake of an ‘austerity budget’ and consequent public expenditure reductions. The analysis considers the effect of economic imperatives on the conceptualisation of individual choices and needs in the context of Local Authorities’ responsibilities to people collectively. A concept of ‘reasonableness’ emerges, which is used to legitimize a re-balancing of the ‘body personal’ and the ‘body politic’ in the concept of well-being with the re-emergence of an economic, public construction. Our discussion considers why this is happening and whether or not a new synthesised position between the personal and political is being developed, as economists and policy makers appropriate well-being for their ends.
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Adam, B., and R. N. Keers. "Exploration of the views of healthcare professionals working in a mental health trust in England on pharmacists as future approved clinicians: early findings." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i24. http://dx.doi.org/10.1093/ijpp/riab015.028.
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Abstract Introduction The 2007 amendment to the Mental Health Act (MHA) 1983 enabled various non-medical professionals to now qualify as approved clinicians (ACs); these included social workers, mental health and learning disability nurses, clinical psychologists and occupational therapists. [1–2] As ACs, these professionals can take on roles of clinical leadership whilst assuming responsibility for patients under the Act. Although mental health pharmacists have recognised specialist clinical roles and regularly work alongside these professionals in caring for patients, they are not presently permitted to practise as ACs. Aim This study sets out to investigate the views of healthcare professionals working in a mental health trust in England on this hitherto unexplored group of the mental health workforce as potential ACs. Methods Upon obtaining ethics approval, pharmacists, ACs and other experienced mental health professionals working in one mental health trust in England were approached via internal trust email to take part in a digitally audio recorded semi-structured interview to explore their views on pharmacists as potential ACs in future. A thematic analysis is being performed on the entire set of transcripts and an additional sentiment analysis will be applied to specific parts of the dataset. Results A total of 11 interviews were completed with 6 pharmacists, 4 medical ACs and 1 ‘other’ mental health professional thus far, with recruitment ongoing. Emerging themes included wide recognition among participants of highly valued key skills of pharmacists within mental health services provision, for instance their ability to access and appraise specialist literature as well as their analytical skills to apply expert knowledge to real-life cases. Participants identified unique challenges to pharmacists potentially becoming ACs in future, namely the traditional organisational structures whereby pharmacists are line managed and clinically supervised from within a pharmacy department which sits external to the clinical teams they typically work in, and the lack of pharmacists being fully embedded in interdisciplinary teams. Conclusion Since this is the first study of its kind to be conducted on a small cohort of participants working within one mental health trust in England, this qualitative study will likely highlight the need for further research to be carried out on the topic, such as data collection in several other NHS trusts as well as recruiting participants from the working group and other stakeholders involved in the most recent amendment of the Act. Whilst data collection and analysis are ongoing, initial findings help shed light on potential barriers and also possible solutions to these, as well as other opportunities for pharmacists wishing to assume higher leadership roles within mental health services in England. References 1. Barcham, C. Understanding The Mental Health Act Changes – Challenges And Opportunities For Doctors. BJMP. 2008;1 (2):13–17. 2. Oates, J., Brandon, T., Burrell, C., Ebrahim, S., Taylor, J. & Veitch, P. Non-medical approved clinicians: Results of a first national survey in England and Wales. International Journal of Law and Psychiatry. 2018;60:51–56.
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Pronovost, Peter J., and Jill A. Marsteller. "Creating a fractal-based quality management infrastructure." Journal of Health Organization and Management 28, no. 4 (August 18, 2014): 576–86. http://dx.doi.org/10.1108/jhom-11-2013-0262.
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Purpose – The purpose of this paper is to describe how a fractal-based quality management infrastructure could benefit quality improvement (QI) and patient safety efforts in health care. Design/methodology/approach – The premise for this infrastructure comes from the QI work with health care professionals and organizations. The authors used the fractal structure system in a health system initiative, a statewide collaborative, and several countrywide efforts to improve quality of care. It is responsive to coordination theory and this infrastructure is responsive to coordination theory and repeats specific characteristics at every level of an organization, with vertical and horizontal connections among these levels to establish system-wide interdependence. Findings – The fractal system infrastructure helped a health system achieve 96 percent compliance on national core measures, and helped intensive care units across the USA, Spain, and England to reduce central line-associated bloodstream infections. Practical implications – The fractal system approach organizes workers around common goals, links all hospital levels and, supports peer learning and accountability, grounds solutions in local wisdom, and effectively uses available resources. Social implications – The fractal structure helps health care organizations meet their social and ethical obligations as learning organizations to provide the highest possible quality of care and safety for patients using their services. Originality/value – The concept of deliberately creating an infrastructure to manage QI and patient safety work and support organizational learning is new to health care. This paper clearly describes how to create a fractal infrastructure that can scale up or down to a department, hospital, health system, state, or country.
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Romeu, Daniel, Elspeth Guthrie, Carolyn Czoski-Murray, Samuel Relton, Andrew Walker, Peter Trigwell, Jenny Hewison, et al. "Experiences of people seen in an acute hospital setting by liaison mental health services: responses from an online survey." BJPsych Open 7, S1 (June 2021): S346. http://dx.doi.org/10.1192/bjo.2021.907.
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AimsRecently the NHS has expanded the provision of liaison mental health services (LMHS) to ensure that every acute hospital with an emergency department in England has a liaison psychiatry service. Little work has been undertaken to explore first-hand experiences of these services. The aim of this study was to capture service users’ experiences of LMHS in both emergency departments and acute inpatient wards in the UK, with a view to adapt services to better meet the needs of its users.MethodThis cross-sectional internet survey was initially advertised from May-July 2017 using the social media platform Facebook. Due to a paucity of male respondents, it was re-run from November 2017-February 2018, specifically targeting this demographic group. 184 people responded to the survey, of which 147 were service users and 37 were service users’ accompanying partners, friends or family members. The survey featured a structured questionnaire divided into three categories: the profile of the respondent, perceived professionalism of LMHS, and overall opinion of the service. Space was available for free-text comments in each section. Descriptive analysis of quantitative data was undertaken with R statistical software V.3.2.2. Qualitative data from free-text comments were transcribed and interpreted independently by three researchers using framework analysis; familiarisation with the data was followed by identification of a thematic framework, indexing, charting, mapping and interpretation.ResultOpinions of the service were mixed but predominantly negative. 31% of service users and 27% of their loved ones found their overall contact with LMHS useful. Features most frequently identified as important were the provision of a 24/7 service, assessment by a variety of healthcare professionals and national standardisation of services. Respondents indicated that the least important feature was the provision of a separate service for older people. They also expressed that a desirable LMHS would include faster assessments following referral from the parent team, clearer communication about next steps and greater knowledge of local services and third sector organisations.ConclusionOur survey identified mixed responses, however service users and their loved ones perceived LMHS more frequently as negative than positive. This may be attributed to the recent governmental drive to assess, treat and discharge 95% of all patients seen in emergency departments within four hours of initial attendance. Additionally, dissatisfied service users are more likely to volunteer their opinions. The evaluation and adaptation of LMHS should be prioritised to enhance their inherent therapeutic value and improve engagement with treatment and future psychiatric care.
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Turnbull, Joanne, Gemma McKenna, Jane Prichard, Anne Rogers, Robert Crouch, Andrew Lennon, and Catherine Pope. "Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study." Health Services and Delivery Research 7, no. 26 (July 2019): 1–122. http://dx.doi.org/10.3310/hsdr07260.
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BackgroundPolicy has been focused on reducing unnecessary emergency department attendances by providing more responsive urgent care services and guiding patients to ‘the right place’. The variety of services has created a complex urgent care landscape for people to access and navigate.ObjectivesTo describe how the public, providers and policy-makers define and make sense of urgent care; to explain how sense-making influences patients’ strategies and choices; to analyse patient ‘work’ in understanding, navigating and choosing urgent care; to explain urgent care utilisation; and to identify potentially modifiable factors in decision-making.DesignMixed-methods sequential design.SettingFour counties in southern England coterminous with a NHS 111 provider area.MethodsA literature review of policy and research combined with citizens’ panels and serial qualitative interviews. Four citizens’ panels were conducted with the public, health-care professionals, commissioners and managers (n = 41). Three populations were sampled for interview: people aged ≥ 75 years, people aged 18–26 years and East European people. In total, 134 interviews were conducted. Analyses were integrated to develop a conceptual model of urgent care help-seeking.FindingsThe literature review identified some consensus between policy and provider perspectives regarding the physiological factors that feature in conceptualisations of urgent care. However, the terms ‘urgent’ and ‘emergency’ lack specificity or consistency in meaning. Boundaries between urgent and emergency care are ill-defined. We constructed a typology that distinguishes three types of work that take place at both the individual and social network levels in relation to urgent care sense-making and help-seeking.Illness workinvolves interpretation and decision-making about the meaning, severity and management of physical symptoms and psychological states, and the assessment and management of possible risks. Help-seeking was guided bymoral work: the legitimation and sanctioning done by service users.Navigation workconcerned choosing and accessing services and relied on prior knowledge of what was available, accessible and acceptable. From these empirical data, we developed a model of urgent care sense-making and help-seeking behaviour that emphasises that work informs the interaction between what we think and feel about illness and the need to seek care (sense-making) and action – the decisions we take and how we use urgent care (help-seeking).LimitationsThe sample population of our three groups may not have adequately reflected a diverse range of views and experiences. The study enabled us to capture people’s views and self-reported service use rather than their actual behaviour.ConclusionsMuch of the policy surrounding urgent and emergency care is predicated on the notion that ‘urgent’ sits neatly between emergency and routine; however, service users in particular struggle to distinguish urgent from emergency or routine care. Rather than focusing on individual sense-making, future work should attend to social and temporal contexts that have an impact on help-seeking (e.g. why people find it more difficult to manage pain at night), and how different social networks shape service use.Future workA whole-systems approach considering integration across a wider network of partners is key to understanding the complex relationships between demand for and access to urgent care.Study registrationThis study is registered as UKCRN 32207.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Banerjee, S. "Issues in pharmacological management of behavioural and psychological symptoms of dementia: English ministerial review of the use of antipsychotic drugs for people with dementia." European Psychiatry 26, S2 (March 2011): 2110. http://dx.doi.org/10.1016/s0924-9338(11)73813-5.
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IntroductionIn response to increasing concerns about the use of anti-psychotic drugs in dementia, the Department of Health in England commissioned an independent ministerial review.Aims and methodsThe report was based upon an expert review of policy and publications; systematic review of the benefits and harms; and new pharmacoepidemiology.ResultsThis review finds that these drugs are used too often in dementia and potential benefits are outweighed by their risks overall. It estimates 180,000 people with dementia receive antipsychotic medication in the UK per year. Of these, 20% (36,000) will derive some benefit. Negative effects directly attributable to antipsychotics equates to an additional 1,620 cerebrovascular adverse events (around half severe), and an additional 1,800 deaths per year. The report's analysis is that this overuse is a specific symptom of a general cumulative failure over the years in health and social care systems to develop an effective response to dementia.ConclusionsThe report contains 11 recommendations to reduce the use of these drugs to the level where benefit will outweigh risk. These include: making reduction a clinical governance priority; audit to drive down the level and up the quality of use of these drugs; specialist services to support primary care in its work in care homes and the community; research on alternatives to antipsychotic medication. The report estimates that, if this is implemented then we can reduce the rate of use of antipsychotic medication to a third of its current level safely over a 36 months.
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Shepherd, Elizabeth, Victoria Hoyle, and Elizabeth Lomas. "Project MIRRA: Memory - Identity - Rights in Records - Access." Comma 2020, no. 1-2 (August 1, 2021): 97–110. http://dx.doi.org/10.3828/comma.2020.6.
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Many people who grew up in care have gaps in their childhood memories and unanswered questions about their early lives. In the absence of family photos and stories they turn to records held by the local authorities and charities that looked after them. Accessing these records is a practically and emotionally challenging process. Response times are often long and the records received are redacted because they include confidential information about “third parties’” who are often family and carers. The language and ideas contained reflect the prejudices and assumptions of previous times. Some files are extremely long and confusing, whereas others only have a few pages to cover a whole childhood. Records may have been lost or destroyed altogether. Very few services are available to support people through the experience. MIRRA: Memory-Identity-Rights in Records-Access is a participatory action research project carried out at the Department of Information Studies at University College London since 2017 that explores these issues. It considered how child social care records have been created, kept and used in public and voluntary organizations in England from 1970 to the present. The research is co-produced with care leavers in partnership with The Care Leavers’ Association and reflects on how what it is recorded about a childhood can affect the individual concerned throughout their life. This article republishes edited blog posts produced during the research project. The original blogs in full are available at https://blogs.ucl.ac.uk/mirra/.
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Mackenzie, Ruth M., Louisa J. Ells, Sharon Anne Simpson, and Jennifer Logue. "Development of a core outcome set for behavioural weight management programmes for adults with overweight and obesity: protocol for obtaining expert consensus using Delphi methodology." BMJ Open 9, no. 2 (February 2019): e025193. http://dx.doi.org/10.1136/bmjopen-2018-025193.
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IntroductionWeight management interventions in research studies and in clinical practice differ in length, advice, frequency of meetings, staff and cost. Very few real-world programmes have published patient-related outcomes, and those that have published used different ways of reporting the information, making it impossible to compare interventions and further develop the evidence base. Developing a core outcome set for behavioural weight management programmes (BWMPs) for adults with overweight and obesity will allow different BWMPs to be compared and reveal which interventions work best for which members of the population.Methods and analysisAn expert group, comprised of 40 people who work in, refer to, or attend BWMPs for adults with overweight and obesity, will be asked to decide which outcomes services should report. An online Delphi process will be employed to help the group reach consensus as to which outcomes should be measured and reported, and which definitions/instruments should be used in order to do so. The first stage of the Delphi process (three rounds of questionnaires) will focus on outcomes while the second stage (three additional rounds of questionnaires) will focus on definition/instrument selection.Ethics and disseminationEthical approval for this study has been received from the University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee. With regard to disseminating results, a report will be submitted to our funding body, the Chief Scientist Office of the Scottish Government Health Department. In addition, early findings will be shared with Public Health England and Health Scotland, and results communicated via conference presentations, peer review publication and our institutions’ social media platforms.
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Llewellyn, Sue, Naomi Chambers, Sheila Ellwood, Christos Begkos, and Chris Wood. "Patient-level information and costing systems (PLICSs): a mixed-methods study of current practice and future potential for the NHS health economy." Health Services and Delivery Research 4, no. 31 (October 2016): 1–156. http://dx.doi.org/10.3310/hsdr04310.
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BackgroundTraditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in patient-level information and costing systems (PLICSs). Monitor (the economic regulator for health care) proposes that PLICS data will now form the basis for mandatory prices for health-care services across all care settings.ObjectiveOur main aim was to investigate the use of PLICSs.MethodsWe surveyed all English foundation trusts and NHS trusts, and undertook four case studies of foundation trusts. Three trusts were generalist and one was specialist. We also surveyed commissioning support units to explore the potential for PLICSs in commissioning.FindingsThe most significant use of PLICSs was cost improvement within the trusts. There was only modest utilisation of PLICSs to allocate resources across services and settings. We found that trusts had separate reporting systems for costs and clinical outcomes, engendering little use for PLICSs to link cost with quality. Although there was significant potential for PLICSs in commissioning, 74% of survey respondents at trusts considered their PLICS data to be commercially sensitive and only 5% shared the data with commissioners. The use of PLICSs in community services was, generally, embryonic because of the absence of units of health care for which payment can be made, service definitions and robust data collection systems. The lack of PLICS data for community services, allied with the commercial sensitivity issue, resulted in little PLICS presence in collaborative cross-organisational initiatives, whether between trusts or across acute and community services. PLICS data relate to activities along the patient pathway. Such costs make sense to clinicians. We found that PLICSs had created greater clinical engagement in resource management despite the fact that the trust finance function had actively communicated PLICSs as a new costing tool and often required its use in, for example, business cases for clinical investment. Operational financial management at the trusts was undertaken through service line reporting (SLR) and traditional directorate budgets. PLICSs were considered more of a strategic tool.ConclusionsBoth PLICSs and SLR identify and interrogate service line profitability. Although trusts currently cross-subsidise to support loss-making areas under the tariff, they are actively considering disinvesting in unprofitable service lines. Financial pressure within the NHS, along with its current competitive, business-oriented ethos, induces trusts to act in their own interests rather than those of the whole health economy. However, many policy commentators suggest that care integration is needed to improve patient care and reduce costs. Although the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. London: The Stationery Office; 2012) requires both competition and the collaboration needed to achieve care integration, the two are not always compatible. We conclude that competitive forces are dominant in driving the current uses of PLICSs. Future research should interrogate the use of PLICSs inNew Care Models – Vanguard Sites(NHS England.New Care Models – Vanguard Sites. NHS England; 2015) and initiatives to deliver the ‘Five Year Forward View’ (Monitor and NHS England.Reforming the Payment System for NHS Services: Supporting the Five Year Forward View. London: Monitor; 2015).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Buyan, Rowena Catipay, Jill Aylott, and Duncan Carratt. "Improving an acute oncology service (AOS) through collaborative leadership." Leadership in Health Services 33, no. 3 (May 22, 2020): 265–77. http://dx.doi.org/10.1108/lhs-12-2019-0078.
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Purpose Over half of adults under the age of 65 years will be diagnosed with cancer at some point in their lives (Ahmad et al., 2015). Demand for services is outstripping the capacity in the NHS, as 77% of NHS Trusts are unable to start treatment within 62 days (Baker, 2019; NHS England, 2019). Side effects of treatment can be life threatening (Tsai et al., 2010) with many patients attending ED; however, these can be managed through a hospital’s Acute Oncology Service (AOS). This paper aims to explore a collaborative leadership approach to improve services for patients [Rubin et al., 2015; Department of Health (DOH), 2012]. Design/methodology/approach A case study of an AOS in an NHS Trust was the focus for the development of a strategy of ‘Collaborative’ leadership, with the aim to increase the engagement of a wide network of clinical and non-clinical stakeholders in a review of the AOS. The case study identified the level of effectiveness of the service since its inception in 2012. Using a quality improvement methodology (Deming 2000; Health Foundation, 2011; Aylott, 2019) resulted in learning and increased collaboration between clinical and non-clinical staff. Findings Action learning processes revealed that AOS staff had been frustrated for some time about the dysfunction of the current process to manage the increased demand for the service. They reported their perceptions and frustrations with the current process of referral and patient discharge. Data revealed alerts from the Emergency Department (ED) to AOS resulted in 72% of patients inappropriately referred, with an over representation of patients who had a previous existing cancer condition. Clinical engagement with the data informatics manager (DC) revealed a need to improve data quality through improvements made to the database. Research limitations/implications Increasing demand for cancer services requires a continuous need for improvement to meet patient needs. Cancer waits for diagnostic tests are at their highest level since 2008, with 4% of patients waiting over 6 weeks to be tested compared to the tested target of 1% (Baker, 2019). This paper draws on data collected from 2017 to 2018, but a continuous review of data is required to measure the performance of the AOS against its service specification. Every AOS team across the NHS could benefit from a collaborative learning approach. Practical implications Clinical services need collaborative support from informatics to implement a Quality Improvement methodology such as the IHI Model for Improvement (IHI, 2003). Without collaboration the implementation of a quality improvement strategy for all NHS Trusts will not come to fruition (Kings Fund, 2016). Quality Improvement Strategies must be developed with a collaborative leadership implementation plan that includes patient collaboration strategies (Okpala, 2018), as this is the only way that services will be improved while also becoming cost effective (Okpala, 2018). Social implications In the UK, 20-25% of new cancer diagnoses are made following an initial presentation to the ED (Young et al., 2016). Cancer-related attendances at ED had a higher level of acuity, requiring longer management time and length of stay in ED. With cancer care contributing to 12% of all hospital admissions, an increase of 25% over the past two decades (Kuo et al., 2017) the AOS will need continued collaboration between clinical staff, informatic managers, patients and all stakeholder organisations to continuously improve its services to be “fit for purpose”. Originality/value This case study reports the innovative collaborative work between a Medical Oncologist, an NHS Trust Informatics manager and a QI academic facilitator. The Health Foundation and Kings Fund have identified the continued challenges presented to the NHS in the transformation of its services, with the Health Foundation (2011) reporting the need for more collaborative working between clinicians and non-clinicians to drive improvement. This model of collaboration creates a new way of working to drive improvement initiatives and sets out a rationale to develop this model further to involve patients. However, this will call for a new way of working for all.
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Snooks, Helen A., Rebecca Anthony, Robin Chatters, Jeremy Dale, Rachael Fothergill, Sarah Gaze, Mary Halter, et al. "Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate." Health Technology Assessment 21, no. 13 (March 2017): 1–218. http://dx.doi.org/10.3310/hta21130.
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BackgroundEmergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services.ObjectivesTo compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use.DesignCluster randomised controlled trial.ParticipantsParticipating paramedics at three ambulance services in England and Wales were based at stations randomised to intervention or control arms. Participants were aged 65 years and over, attended by a study paramedic for a fall-related emergency service call, and resident in the trial catchment areas.InterventionsIntervention paramedics received a clinical protocol with referral pathway, training and support to change practice. Control paramedics continued practice as normal.OutcomesThe primary outcome comprised subsequent emergency health-care contacts (emergency admissions, emergency department attendances, emergency service calls) or death at 1 month and 6 months. Secondary outcomes included pathway of care, ambulance service operational indicators, self-reported outcomes and costs of care. Those assessing outcomes remained blinded to group allocation.ResultsAcross sites, 3073 eligible patients attended by 105 paramedics from 14 ambulance stations were randomly allocated to the intervention group, and 2841 eligible patients attended by 110 paramedics from 11 stations were randomly allocated to the control group. After excluding dissenting and unmatched patients, 2391 intervention group patients and 2264 control group patients were included in primary outcome analyses. We did not find an effect on our overall primary outcome at 1 month or 6 months. However, further emergency service calls were reduced at both 1 month and 6 months; a smaller proportion of patients had made further emergency service calls at 1 month (18.5% vs. 21.8%) and the rate per patient-day at risk at 6 months was lower in the intervention group (0.013 vs. 0.017). Rate of conveyance to emergency department at index incident was similar between groups. Eight per cent of trial eligible patients in the intervention arm were referred to falls services by attending paramedics, compared with 1% in the control arm. The proportion of patients left at scene without further care was lower in the intervention group than in the control group (22.6% vs. 30.3%). We found no differences in duration of episode of care or job cycle. No adverse events were reported. Mean cost of the intervention was £17.30 per patient. There were no significant differences in mean resource utilisation, utilities at 1 month or 6 months or quality-adjusted life-years. In total, 58 patients, 25 paramedics and 31 stakeholders participated in focus groups or interviews. Patients were very satisfied with assessments carried out by paramedics. Paramedics reported that the intervention had increased their confidence to leave patients at home, but barriers to referral included patients’ social situations and autonomy.ConclusionsFindings indicate that this new pathway may be introduced by ambulance services at modest cost, without risk of harm and with some reductions in further emergency calls. However, we did not find evidence of improved health outcomes or reductions in overall NHS emergency workload. Further research is necessary to understand issues in implementation, the costs and benefits of e-trials and the performance of the modified Falls Efficacy Scale.Trial registrationCurrent Controlled Trials ISRCTN60481756 and PROSPERO CRD42013006418.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 13. See the NIHR Journals Library website for further project information.
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Fitzpatrick, Joanne M., Anne Marie Rafferty, Shereen Hussein, Ivanka Ezhova, Sinead Palmer, Richard Adams, Lindsay Rees, Sally Brearley, Sarah Sims, and Ruth Harris. "Protecting older people living in care homes from COVID-19: a protocol for a mixed-methods study to understand the challenges and solutions to implementing social distancing and isolation." BMJ Open 11, no. 8 (August 2021): e050706. http://dx.doi.org/10.1136/bmjopen-2021-050706.
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IntroductionOlder people living in residential and nursing care homes often have complex needs and are at high risk of poor health outcomes and mortality, especially if they contract COVID-19. Care homes use infection prevention and control measures such as social distancing and isolating residents to protect them from COVID-19. The care home sector has stated that implementing social distancing and isolation when caring for residents is a significant challenge. This paper presents the protocol of a mixed-methods study to explore and understand the real-life experiences of implementing social distancing and isolation of residents in care homes for older people from the perspective of residents, families/friends and staff working in and with care homes. The study aims to develop a toolkit of resources for health and care delivery now and for future outbreaks of infectious diseases.Methods and analysisThe study will be conducted in three phases. Phase 1 is a rapid review of evidence to collate knowledge on the mechanisms and measures used by care homes and long-term facilities to socially distance and isolate older people or control the spread of other infectious and contagious diseases. The review results will contribute to participant interviews in phase 2 and toolkit development in phase 3. Phase 2 will involve case studies with six care homes in England, involving the conduct of individual interviews with residents, families and friends, and staff, collection of care home policies and protocols related to social distancing and isolation for residents, and routinely collected care home data. A focus group with a purposive sample of external key informants will also be conducted. Phase 3, synthesising findings from phases 1 and 2, will inform the codesign of a toolkit of resources for residents, families/friends and care homes.Ethics and disseminationThe study has been approved by Coventry and Warwick Research Ethics Committee (20/WM/0318). To maximise impact, we will work closely with the Study Committees and the Patient and Public Involvement group to ensure the findings reach key stakeholders, including residents, families/friends, care homes, commissioners and organisations representing care home providers. We will disseminate the study outputs in peer-reviewed and professional journals, at professional conferences and via other knowledge transfer activities with the care home sector, and resident and carer organisations. The toolkit comprising evidence-informed guidance and resources and a mosaic film will be hosted on a project webpage.Registration detailsThis project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (Project reference NIHR132541). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.PROSPERO registration numberCRD42021226734.
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Robling, Michael, Fiona Lugg-Widger, Rebecca Cannings-John, Julia Sanders, Lianna Angel, Sue Channon, Deborah Fitzsimmons, et al. "The Family Nurse Partnership to reduce maltreatment and improve child health and development in young children: the BB:2–6 routine data-linkage follow-up to earlier RCT." Public Health Research 9, no. 2 (February 2021): 1–160. http://dx.doi.org/10.3310/phr09020.
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Background The short-term effectiveness (to 24 months post partum) of a preventative home-visiting intervention, the Family Nurse Partnership, was previously assessed in the Building Blocks trial (BB:0–2). Objectives The objectives were to establish the medium-term effectiveness of the Family Nurse Partnership in reducing maltreatment and improving maternal health (second pregnancies) and child health, developmental and educational outcomes (e.g. early educational attendance, school readiness); to explore effect moderators and mediators; and to describe the costs of enhancing usually provided health and social care with the Family Nurse Partnership. Design Children and their mothers from an existing trial cohort were followed up using routine data until the child was 7 years of age. Setting This study was set in 18 partnerships between local authorities and health-care organisations in England. Participants The participants were mothers [and their firstborn child(ren)] recruited as pregnant women aged ≤ 19 years, in local authority Family Nurse Partnership catchment areas, at < 25 weeks’ gestation, able to provide consent and able to converse in English. Participants mandatorily withdrawn (e.g. owing to miscarriage) from the BB:0–2 trial were excluded. Interventions The intervention comprised up to a maximum of 64 home visits by specially trained family nurses from early pregnancy until the firstborn child was 2 years of age, plus usually provided health and social care support. The comparator was usual care alone. Main outcome measures The primary outcome measure was child-in-need status recorded at any time during follow-up. The secondary outcomes were as follows: (1) referral to social services, child protection registration (plan), child-in-need categorisation, looked-after status, recorded injuries and ingestions at any time during follow-up; (2) early child care and educational attendance, school readiness (Early Years Foundation Stage Profile score) and attainment at Key Stage 1; and (3) health-care costs. Data sources The following data sources were used: maternally reported baseline and follow-up data (BB:0–2), Hospital Episode Statistics data (NHS Digital), social care and educational data (National Pupil Database) and abortions data (Department of Health and Social Care). Results There were no differences between study arms in the rates of referral to social services, being registered as a child in need, receiving child protection plans, entering care or timing of first referral for children subsequently assessed as in need. There were no differences between study arms in rates of hospital emergency attendance, admission for injuries or ingestions, or in duration of stay for admitted children. Children in the Family Nurse Partnership arm were more likely to achieve a good level of development at reception age (school readiness), an effect strengthened when adjusting for birth month. Differences at Key Stage 1 were not statistically different, but, after adjusting for birth month, children in the Family Nurse Partnership arm were more likely to reach the expected standard in reading. Programme effects were greater for boys (Key Stage 1: writing); children of younger mothers (Key Stage 1: writing, Key Stage 1: mathematics); and children of mothers not in employment, education or training at study baseline (Key Stage 1: writing). There were no differences between families who were part of the Family Nurse Partnership and those who were not for any other outcome. The differences between study arms in resource use and costs were negligible. Limitations The outcomes are constrained to those available from routine sources. Conclusions There is no observable benefit of the programme for maltreatment or maternal outcomes, but it does generate advantages in school readiness and attainment at Key Stage 1. Future work The trajectory of longer-term programme benefits should be mapped using routine and participant-reported measures. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.
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BIK, Olesya. "COMPETENCE-BASED APPROACH TO TRAINING SOCIAL WORKERS IN WORKING WITH CHILDREN FROM FAMILIES IN DIFFICULT LIFE CIRCUMSTANCES." Cherkasy University Bulletin: Pedagogical Sciences, no. 2 (2020): 177–82. http://dx.doi.org/10.31651/2524-2660-2020-2-177-182.
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The family is recognized in the international community as the best condition for the survival, protection and development of children, the main center of society, the natural environment for humans. As has been repeatedly noted, the efforts of the state and the public should be con-centrated at the well-being of the family, creating conditions for the protection of its rights in society and the rights of family members. Today, there is an urgent need not only for social support for a family that has certain problems in its life, but also for special work with families who find them-selves in difficult life circumstances and have more serious psychosocial problems, such as systematic violations of human rights. Such families are traditionally dealt with by law enforcement agencies, human rights are protected by law, but prosecution cannot be the only approach, since our main goal must be to preserve the integrity of the family (its family feelings, ties). First of all, long-term socio-pedagogical work aimed at re-education, training of its members in new techniques and methods of interaction should be carried out. International experience shows that majority of govern-mental social programs are focused on families. Existing family life adaptation programs in the United States are designed for families at different stages of development, each targeting different types of family issues. One more program - "Intensive course for adults on raising children”. In England there is a John Barnes program, which aims to work with children in families experiencing a crisis. The job of a social worker or a teacher is to study such a family, tosimulate the change in relations between its members, tohelp in adaptation, to train parents in self-control. Teach them and their children how to set strategic and supporting goals. Help to overcome obstacles without corporal punish-ment. In Croatia, children, who exhibit deviant behavior, are engaged in “peer-to-peer” school mediation programs, while specialists work with parents, revealing the shortcomings of family psycho-emotional and educational dynamics. Professional social activity is currently intensifying and improving in Ukraine. Therefore, the social education sys-tem must be flexible, mobile, respond quickly to changes in social policy and the social sphere, the needs of individuals and society as a whole. The education of students majoring in "Social Work" at the National University "Lviv Polytechnic" is determined by the Canadian-Ukrainian model of training of social workers, adapted to national conditions and needs. In terms of pro-fessional competencies in working with children and fami-lies, such training includes the acquisition of knowledge and practical experience. This further gives the opportunity to develop their own innovative programs, based on experi-ence gained on the problems and needs of the client. The most widely represented is the cycle of profession-ally oriented disciplines, which includes a 90-hour course "Social work with children and families." The content of the discipline covers all the main aspects of the social worker's work with this category of clients: from the concept of fami-ly, its functions and role in the child's life and identifying aspects of family risk of crisis, to the processes of interven-tion and improvement of children's social security. Particu-lar attention in the subject is paid to topics of deviantology, causes, manifestations and types of deviant behavior. The section "Interventions" covers such topics as: the functions of a social worker; theoretical principles of family counseling; methods and forms of family counseling; pro-fessional intervention focused on the family; institutional model of care for abused and neglected children; preventive measures. The study of the "Improvement of children's social security service" topic includes a mandatory study of possible changes in the system of services and possible ways of policy formation in the field of social security. A characteristic feature of the training of social workers according to the Canadian-Ukrainian model is the teaching of professionally-oriented disciplines in the form of integrat-ed classes, which are divided into two main categories: lecture-practical and lecture-laboratory. Students' educational activities are diversified by excur-sions to social services, video classes, participation in vol-unteer actions, educational conferences, trainings, work of the international scientific-practical seminar organized at the Department of SR, meetings with well-known experts in the field of social work, etc. According to the concept of training specialists in the field of social work, the leading place in this process is occupied by practical training of students. The cycle of practical training of students includes different types of practical educational activities of students: internships within the semesters, organized by "blocks", and educa-tional and research workshops conducted on the basis of social services, lasts 4 semesters (years of study 3rd and 4th) and occurs once a week during a full working day. The workshop aims, in particular, to develop students' skills to carry out scientific research, during which they have the opportunity to collect the necessary empirical material to perform individual tasks in professionally-oriented disci-plines that have a research nature, and writing term papers and dissertations. When performing the tasks of educational practice and educational-research workshop, students have a real oppor-tunity to apply the acquired knowledge, skills and abilities in professionally- oriented, fundamental and other disci-plines.
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Sumner, Mhairi, and Bernie Quinn. "From concierge to Superman: perceptions of the contemporary hotel concierge in Edinburgh." International Journal of Culture, Tourism and Hospitality Research 11, no. 2 (June 5, 2017): 243–54. http://dx.doi.org/10.1108/ijcthr-03-2016-0030.
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Purpose The purpose of this study is ascertain if the hotel concierge service will continue to be relevant in a technological world where consumers have increasing access to information about their destination. To trace the origins of the hotel concierge, their route into the profession and establish whether the profession is geographically localised. Their role within the hotel, working philosophy, core values and characteristics were considered in relation to creating and delivering an experiential service encounter. Design/methodology/approach Eleven participants were selected who worked on the concierge desk in four- and five-star hotels in Edinburgh. All were male, aged between 20 and 64 years old; nine were Scottish, six of whom were from Edinburgh, one from Wales and one from England. Six respondents were members of The Golden Keys Society. A qualitative approach was adopted with semi-structured interviews designed around key themes identified in the literature review. Findings No feelings of servility or inferiority were documented in the host/guest relationship. Comparisons were made between the contextual setting and the appearance and manner of the respondents with that of a “performance”. The uniform was deemed to facilitate feelings of empowerment analogous to having superpowers. Technology has been adopted by the concierge department as a tool, but is considered to be ancillary to their personal recommendation and network of business and personal contacts and collaborators. Research limitations/implications Changes in the demographics of people travelling and discounted rates being offered in four- and five-star hotels has resulted in general perceptions of a less elite clientele. This may have implications for the future of concierge services. Practical implications The internet seems to have opened up this profession to enable concierges to effectively operate in a location they are not indigenous to. The personal recommendations that the concierge provides through their own knowledge are used in conjunction with technology, but are not in imminent danger of being replaced by it. It may prove beneficial for the hotel to provide some training for older members of staff to keep up with technological developments. This study could prove useful to service providers who aim to gain competitive advantage by elevating their level of guest service to exceed guest expectations through emulating the personalised service that the concierge can offer. Social implications The socio-cultural issues within this study are important. Internet technology is generally perceived to be the panacea of all contemporary communication ills in the twenty-first century. The authors however propose that the concierge is the last bastion of front-line service personnel who are still approached for their individual, sometimes unique, knowledge that cannot be found online. Originality/value This study contributes to an area of interest that lacks contemporary research due to the natural gatekeeping that occurs within this “closed” environment.
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Featherstone, Katie, Andy Northcott, Jane Harden, Karen Harrison Denning, Rosie Tope, Sue Bale, and Jackie Bridges. "Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study." Health Services and Delivery Research 7, no. 11 (March 2019): 1–92. http://dx.doi.org/10.3310/hsdr07110.
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Background The acute hospital setting has become a key site of care for people living with dementia. The Department of Health and Social Care recognises that as many as one in four acute hospital beds in the UK will be occupied by a person living with dementia at any given time. However, people living with dementia are a highly vulnerable group within the hospital setting. Following an acute admission, their functional abilities can deteriorate quickly and significantly. Detailed research is required to understand the role and needs of health-care staff caring for this patient population and to explore what constitutes ‘good care’ for people living with dementia within the acute setting. Objectives The focus of this study was a common but poorly understood phenomenon within the acute setting: refusal and resistance to care. Our research questions were ‘How do ward staff respond to resistance to everyday care by people living with dementia being cared for on acute hospital wards?’ and ‘What is the perspective of patients and their carers?’. Design This ethnography was informed by the symbolic interactionist research tradition, focusing on understanding how action and meaning are constructed within a setting. In-depth evidence-based analysis of everyday care enabled us to understand how ward staff responded to the care needs of people living with dementia and to follow the consequences of their actions. Setting This ethnography was carried out on 155 days (over 18 months) in 10 wards within five hospitals across England and Wales, which were purposefully selected to represent a range of hospital types, geographies and socioeconomic catchments. Participants In addition to general observations, 155 participants took part directly in this study, contributing to 436 ethnographic interviews. Ten detailed case studies were also undertaken with people living with dementia. Results We identified high levels of resistance to care among people living with dementia within acute hospital wards. Every person living with dementia observed within an acute hospital ward resisted care at some point during their admission. Limitations Limitations identified included the potential for the Hawthorne or researcher effect to influence data collection and establishing the generalisability of findings. Conclusions Ward staff typically interpreted resistance as a feature of a dementia diagnosis, which overshadowed the person. However, resistance to care was typically a response to ward organisation and delivery of care and was typically rational to that person’s present ontology and perceptions. In response, nurses and health-care assistants used multiple interactional approaches that combined highly repetitive language with a focus on completing essential care on the body, which itself had a focus on the containment and restraint of the person in their bed or at their bedside. These approaches to patient care were a response to resistance but also a trigger for resistance, creating cycles of stress for patients, families and ward staff. The findings have informed the development of simple, no-cost innovations at the interactional and organisational level. A further study is examining continence care for people living with dementia in acute hospital settings. Funding The National Institute for Health Research Health Services and Delivery Research programme.