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Purpose: The purpose of this paper is to report on the content of local policies on engagement and observation written by National Health Service (NHS) organisations in England and Wales. Design/methodology/approach: Engagement and observation policies were obtained from all (n = 61) NHS mental health trusts in England and health boards in Wales via a Freedom of Information Act 2000 request. Data were analysed using content analysis. Findings: All organisations had a specific policy referring to either "observation and engagement" or "observation". The policies varied considerably in quality, length, breadth and depth of the information provided. Significant variations existed in the terminology used to describe the different types of enhanced observation. Inconsistencies were also noted between organisations regarding: which members of the clinical team could initiate, increase, decrease and terminate observation; who could undertake the intervention (for example students); and the reasons for using it. Finally, despite rhetoric to the contrary, the emphasis of policies was on observation and not engagement. Research limitations/implications: This research has demonstrated the value of examining local policies for identifying inconsistencies in guidance given to practitioners on the implementation of engagement and observation. Further research should be undertaken to explore the impact of local policies on practice. Practical implications: Local policies remain variable in content and quality and do not reflect contemporary research. There is a need to produce evidence-based national standards that organisations are required to comply with. Originality/value: To the best of the author's knowledge, this is the first research in 20 years examining the local policy framework for the implementation of engagement and observation. [ABSTRACT FROM AUTHOR]

Purpose: Electronic medical case files of male prisoners in a category B prison in London were studied to establish a prevalence during an eight-month period of the use of and the reasons for prescribing gabapentinoids in prison and also to establish prescribing standards in prison and compliance with these. In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants, particularly tricyclic antidepressants such as amitriptyline, was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination. The paper aims to discuss these issues.Design/methodology/approach: A retrospective, SystmOne case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1,500 prisoners; Average turnover of prisoners up to 6,000 per year), to establish practice standards related to the prescription of Gabapentinoids in the prison and determine compliance with these.Findings: In total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. In 51 cases (47 per cent) gabapentinoids were prescribed with an opioid substitute. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners.Practical Implications: The initiation of gabapentinoids in prison should be avoided. For prisoners who are also receiving opioid substitutes or are abusing opiates, it may be unsafe to continue on gabapentinoids. Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well.Social Implications: Risk of dependance on gabapentinoids including risk of mortality when taken with opioids and opioid substitutes.Originality/value: This is an original study conducted at a category B prison in London. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore and compare the motivations and expectations that older people have when choosing to move into either a private or housing association (HA) extra care housing (ECH) scheme, and any effects this had on its residents. Design/methodology/approach: This qualitative study is based on findings from four HA schemes in Tower Hamlets, London, and one private scheme in Warwickshire. Eight semi-structured interviews were conducted with five women and three men of varying backgrounds, from schemes managed by different associations and companies. Interview transcripts were coded and analysed thematically. Findings: All residents moved into ECH in response to deteriorating health. However, almost all residents had felt obliged to move by others, generally their children. Few residents had any expectations of ECH on arrival, but many developed high expectations of an increased sense of independence and security and of an improved social life. ECH appeared to be beneficial for residents' health and well-being. Research limitations/implications: The inability to recruit an equal number of people from HA and private scheme, alongside the small sample size, may compromise the external validity of any conclusions drawn from any comparisons. Practical implications: This research identifies a lack of knowledge about ECH among the general population and offers insight into areas of poor management within ECH schemes which could be improved. Social implications: Inadequacies in the ECH model could be attributed to failures in the current health and social care system. Differences between expectations and perceptions of HA vs private schemes should be acknowledged and responded to. Originality/value: This is a rare example of research exploring the relationships between ECH residents' motivations and expectations (Hillcoat-Nallétamby and Sardani, 2019), and between those in HA vs private schemes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.Design/methodology/approach: A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).Findings: Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.Originality/value: Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to put the findings of the Secure, Accessible, Friendly and Equal (SAFE) Housing study, which explored older LGBT* people’s housing concerns, preferences and experiences, in a sociological context.Design/methodology/approach The SAFE Housing study was based on a mixed methods research design that included focus groups and an online survey conducted in two areas of England. The paper draws heavily on the theoretical concept of social capital to help to understand and explain the findings.Findings Findings are grouped into three broad themes: safety, comfort and trust; connections and community; and imagining the future.Originality/value This is the first time that an older LGBT housing study has used social capital theory to interpret its findings. This shows how a focus on issues of trust, social networks and connections is expedient to avoid reductive approaches in research, policy and practice to older LGBT* people’s housing choices, preferences and expectations that concentrate on the individual. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to identify the particular characteristics and strengths of mainstream undergraduate and postgraduate university education for social workers.Design/methodology/approach A brief summary of the establishment of the honours degree or M-level qualification as the requirement for registration as a social worker in England is followed by a summary of the main aspects of “mainstream” social work courses. The values underpinning a “student” rather than a “trainee” route into social work are explored and some limited comparisons made with recently introduced fast-track specialist programmes. Where relevant, the student experience is contrasted with that of fast-track specialist trainees.Findings The paper concludes with a discussion of the potential impact on the social work profession and on agencies providing social work services of the cuts over the past few years in the numbers of students on “generalist” mainstream social work programmes.Research limitations/implications This is a conceptual paper. It recognises that more information is available on long-established university programmes than on the more recently available fast-track routes into social work and cites relevant research.Practical implications The paper points to the changing balance between numbers entering social work in England via mainstream and fast-track specialist programmes and argues for a fuller debate amongst all stakeholders as to whether this change is in the interest of the profession and those who need social work services.Social implications The author argues that the unequal level of funding between the different entry routes into social work is distorting choice (for students and future employers) between fast-track specialist and mainstream social work education. It is hypothesised that differences between the curricula and learning experiences of the two routes may have an impact on the social work service available to vulnerable people across age and needs groups. It also points to a potentially negative impact on social work education and the knowledge base of the reduction in numbers of academics with both social work practice experiences and research qualifications.Originality/value This is an original paper that draws on the author’s experience and the published research and grey literature cited. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to expose and dispel some outdated dilemmas and straw men that have drawn attention away from debates of substance in social work. The paper presents what Frontline believes to be the substantive dilemmas facing the social work profession, as it looks into the future.Design/methodology/approach The paper draws on the insights and experiences of the past four years during which Frontline has been innovating in the field of social work education and leadership development.Findings Building a better social work system requires addressing several important questions, namely, whether social work; first, is a practical or intellectual task; second, is a generic or specialist profession; third, focuses on social or therapeutic change; fourth, requires bureaucrats or change agents; and fifth, involves measuring inspections or measuring outcomes.Originality/value The paper sets out the key dilemmas facing the social work profession, which must be debated and addressed in order to build a better social work system. [ABSTRACT FROM AUTHOR]

Purpose How might the profession of child protection social work be “future proofed”, i.e. remain intact and of value beyond its present existence? The paper aims to discuss this issue.Design/methodology/approach This is a discussion/“think piece” paper, in which the author argues that foregrounding the art and science of helping relationships is a way forward. Recognising and promoting the centrality of helping relationships is the direction in which the author believes (or is it hopes?) social work should head, because “more of the same” is not, in the author’s view, possible to sustain for much longer. Treading the well-worn but pot-holed path of box-ticking, endless risk assessment and perfunctory statutory visiting is likely to lead to continuing problems retaining social workers and, for those who do stay, increased burnout, compassion fatigue and secondary trauma, each of which interrupts or delays the development of working alliances with family members.Findings Growing reliance on thresholds and checklists to assess risk has served to increase referrals. As a result, social workers spend much of their time on triaging and filtering rather than working with the children and families that most need help and protection. Further, it is not what is in the practitioner’s toolkit that matters: rather, it is a defined set of personal skills and qualities that tips the balance to achieve lasting change. Thus, in order to “future proof” social work, we would do well to deepen our understanding of how helping relationships can lead to lasting change. Supporting social workers in this work is not just the responsibility of individual practitioners and their professional bodies, action also needs to be taken at governmental and managerial levels.Originality/value This is a discussion/“think piece”. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to discuss the underlying assumption that social workers need reflective supervision specifically, as opposed to managerial or any other form of supervision or support, and to consider whether our focus on the provision of reflective supervision may be preventing us from thinking more broadly and creatively about what support local authority child and family social workers need and how best to provide it.Design/methodology/approach The paper provides an argument based on the author’s own research and a selective review of the literature.Findings Reflective supervision has no future in local authority child and family social work because: first, there is no clear understanding of what reflective supervision is; second, there is no clear evidence for its effectiveness; and third, sizeable proportion of local authority child and family social workers in England do not receive reflective supervision and many never have.Originality/value The paper challenges the received wisdom about the value of reflective supervision and advocates exploring alternative models for supporting best practice in child and family social work. [ABSTRACT FROM AUTHOR]

Purpose In the past 40 years, both health policy and educational policy in England have adopted commitments to reducing socially created inequalities. However, an inequalities perspective has only begun to emerge in relation to child protection, and child welfare services more widely. The purpose of this paper is to chart evidence of these green shoots of a new policy direction which focusses on two aspects: equalising service provision and outcomes for looked after children.Design/methodology/approach The paper provides an analysis of trends in policies as expressed in official documents, research studies and policy statements.Findings The paper outlines the argument for a more comprehensive approach to addressing inequalities in child protection and child welfare services, and concludes by suggesting some implications for policy and practice.Originality/value The paper develops the concept of an inequalities perspective in child protection and outlines key implications. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an analysis of the changes in child protection policy and practice in England over the last 30 years, in particular to critically analyse the nature and impact of the “refocusing” initiative of the mid-1990s.Design/methodology/approach Policy analysis.Findings While the period from the mid-1990s until 2008 can be seen to show how policy and practice attempted to build on a number of the central principles of the “refocusing” initiative, the period since 2008 has been very different. Following the huge social reaction to the death of Peter Connelly, policy and practice moved in directions quite contra to the “refocusing” initiative’s aims and aspirations such that we can identify a refocusing of “refocusing”. Such developments were given a major impetus with the election of the Coalition government in 2010 and have been reinforced further following the election of the Conservative government in May 2015.Originality/value The paper places the changes in child protection policy and practice in England in their political and economic contexts and makes explicit how the changes impact on the role and responsibilities of professionals, particularly social workers. [ABSTRACT FROM AUTHOR]

Purpose The inclusion of modern slavery in the Care Act 2014 as a form of abuse means that the subject of modern slavery is now included in the remit of adult safeguarding in England. The purpose of this paper is to discuss the background to the Modern Slavery Act 2015 and its provisions.Design/methodology/approach A policy analysis was undertaken in 2016 drawing on research and commentary related to the interface between modern slavery and adult safeguarding.Findings There is little material as yet focussing on adult safeguarding and modern slavery but the inclusion of modern slavery in this area of practice and organisations will require practitioner responses, organisational collaboration and revisions of data collection and analysis. Newspaper accounts of criminal charges under the Modern Slavery Act 2015 may be important first evidence of the interface potentially between modern slavery and adults at risk of abuse and neglect that are the focus of adult safeguarding concern.Practical implications Information about modern slavery may provide relevant background and contextual detail for adult safeguarding communities, furnishing links and resources for this new area of their work.Originality/value This paper is likely to be of interest to policymakers, researchers and practitioners in examining their new duties under the Care Act 2014 and the Modern Slavery Act 2015, and to wider public and private bodies considering their responsibilities in responses to modern slavery more broadly. [ABSTRACT FROM AUTHOR]

Purpose Notwithstanding heightened awareness of the issues faced by homeless people, the notion that homelessness is the result of individual failings and weaknesses persists. The purpose of this paper is to challenge that perception by giving voice to this marginalised group and exploring the mechanisms through which they made and remade as homeless and may be protected.Design/methodology/approach Semi-structured interviews (n=23) were carried out with a sample of homeless people who had accessed a range of homelessness services in the study area.Findings It is argued that largely deprived of the private sphere, which arguably renders them in most need of public space, homeless people find themselves most subject to scrutiny, surveillance, social disapprobation and exclusion.Research limitations/implications The authors reiterate that rather than simply being associated with rooflessness, homelessness is as a function of ongoing geographical marginalisation and social alienation.Practical implications The authors suggest that dedicated spaces for homeless people to occupy during the day continue to be in need of development because, whilst not unproblematic, they can disrupt processes associated with homelessness.Social implications Further resources should be directed towards homelessness and the issues that arise during daytime for homeless people.Originality/value The paper supports the literature which highlights the spatial practices by which stigmatised groups come to be separated from mainstream society. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focusses on the emergence of ideas about outcomes-based commissioning (OBC) in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing.Design/methodology/approach The review of strategic and operational commissioning in adult social care in England (and Scotland in brief) is based on both policy documents and a review of the literature, as are the sources addressing OBC in adult social care particularly in extra care housing settings.Findings The core of this paper focusses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding, increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in other relevant settings.Originality/value Addressing the implementation of OBC in adult social care in England in the context of extra care housing. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report on findings from an evaluative research study which looked at a timed intervention model of practice comprising of up to 24 weeks of intensive meetings with adult service users set up by one local authority in England, to prevent and delay the need for care and support. A particular focus of this paper is on adults who hoard.Design/methodology/approach The study employed a mixed-methods design, consisting of interviews with service users (n=13), social workers (n=3), social work managers (n=2) and stakeholders from external services and agencies (n=6). It included a costing analysis of staff time and an analysis of goals of service users and “satisfaction with life” self-report questionnaires (n=20), completed at pre- and post-intervention stages.Findings There was evidence that social workers used strengths, relationship-based and outcome-based focused approaches in their work. The techniques used by social workers to engage, achieve change and assess effectiveness with service users varied. These techniques included the use of photographs to enable the service user to map and assess their own progress over time, encouraging hoarders to declutter and reclaim their living space. The service users valued the time the social workers spent with them and the way that they were treated with sensitivity and respect.Research limitations/implications The study focused on one local authority in England; there was no comparison group. This, and the small sample size, means that statistical generalisations cannot be made and only limited conclusions can be drawn from the quantitative data.Originality/value The paper provides insights into the work undertaken by social workers with adults who hoard. It contributes to the body of knowledge on effective social work interventions with adults who hoard. [ABSTRACT FROM AUTHOR]

Purpose The increased involvement of adults at risk in the safeguarding process has become a prominent issue within English safeguarding policy. However, there is evidence to suggest that actual levels of involvement are still low. The purpose of this paper is to present findings from a PhD study in relation to the benefits of advocacy in supporting this involvement in adult safeguarding for older people.Design/methodology/approach Participants in the study included advocates and social workers who had experience of working with older people through the safeguarding process within two North East England local authorities. A critical realist approach through in-depth interviews was taken with all the participants.Findings The research findings in relation to the benefits of advocacy in supporting older people going through safeguarding processes are reported. The practical limitations and factors which help and hinder advocacy support within the process are also considered. The theoretical implications for power, empowerment, and advocacy are also explored.Research limitations/implications A key limitation of this research is that it did not include older people who had been through safeguarding amongst the participants.Practical implications Key implications for practice and policy are discussed.Originality/value The paper provides an overview and critique of empowerment in adult safeguarding and the role that advocates play in promoting this key principle. [ABSTRACT FROM AUTHOR]

Purpose The perspectives of people with dementia and their care partners regarding “extra care” housing are currently unknown. The purpose of this paper is to report findings of a consultation study exploring the perceived barriers and facilitators of a relocation to extra care housing, from the perspective of people living with dementia, and their care partners.Design/methodology/approach Fieldwork consisted of paired or 1-1 interviews and small focus groups with potential users of an alternative model of extra care support for people living with dementia in the South of England. The consultation took place between June and August 2013. The interviews and focus groups were audio recorded, transcribed verbatim. The transcripts were analysed thematically.Findings Benefits of extra care were identified as the opportunity for couples to remain living together for longer, creating a supportive, dementia-friendly community, and a reduction in the strain experienced by the care partners. Barriers centred on a sense of loss, stress and uncertainty. Living and caring at home was perceived as preferable to shared care.Research limitations/implications The findings presented here have limited generalisability for two reasons. First, the shared care approach consulted on was very specific. Second, the participants form a purposive sample and as such are not representative of a wider population. Despite best intentions, the voice of people with dementia, are underreported in this consultation. Only one person with early on-set dementia was interviewed and the remaining two people with dementia were interviewed alongside their care partner.Practical implications The findings cast doubt on the viability of extra care facilities, designed for couples living with dementia, if extra care continues to be conceptualised and marketed as a preventative lifestyle choice. The findings indicate the value of consulting with people with dementia, and their care partners, when designing new forms of housing with care specifically for people living with dementia.Social implications The findings of this consultation exemplify the wish of couples living with dementia to remain together, in what they perceive to be “home”, for as long as possible. Couples living with dementia are therefore unlikely to wish to move into an extra care facility as a lifestyle choice option, early into their journey with dementia. This raises questions about the suitability of extra care, as a form of housing with care, for couples living with dementia.Originality/value This paper contributes to the body of literature, exploring the feasibility of new and innovative alternative care and housing options, for people with dementia. This paper is one of the first to explore extra care as a housing and social care option for couples with dementia. [ABSTRACT FROM AUTHOR]

Purpose Opinion is divided on whether a new power of entry should be introduced for social workers in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk in England who have decision-making capacity. The purpose of this paper is to investigate the prevalence and circumstances of situations where access to an adult at risk is denied or difficult and what helps those in practice. The study consists of a literature review, a survey of adult safeguarding managers and interviews with social care staff in three case studies of local authorities. As part of the contextual literature review, during 2014 the authors located parliamentary debates on the subject and this paper reports on their analysis.Design/methodology/approach Following approaches were used in historical research, documentary analysis was carried out on transcripts of parliamentary debates available online from Hansard, supplemented by other materials that were referenced in speeches and set in the theoretical context of the representations of social problems.Findings The authors describe the content of debates on the risks and benefits of a new right to access for social workers and the role of parliamentary champions who determinedly pursued this policy, putting forward three unsuccessful amendments in efforts to insert such a new power into the Care Act 2014.Research limitations/implications There are limits to a focus on parliamentary reports and the limits of Hansard reporting are small but need to be acknowledged. However, adult safeguarding research has surprisingly not undertaken substantial analyses of political rhetoric despite the public theatre of the debate and the importance of legislative initiatives and monitoring.Originality/value This paper adds to the history of adult safeguarding in England. It also offers insight into politicians’ views on what is known/unknown about the prevalence and circumstances of the problems with gaining access to adults with capacity where there are safeguarding concerns and politicians’ views on the merits or hazards of a power of access. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore experiences of team culture, structure and function of an intensive support service (ISS) within the context of the recent service guidance “Building the Right Support” (NHS England, Local Government Association and Association of Directors of Adult Social Services, 2015). Reflections on the Hampshire and Southampton ISS set up in 2010 are discussed with a view to informing a debate about frameworks for ISS services nationally.Design/methodology/approach A reflective piece, drawing on experience and case examples.Findings This paper describes that a key function of an ISS is making individuals safe and this is significantly assisted by using shared team formulation, which can enable information and perspectives to be shared between and within teams as rapidly as possible. Further, a case is made for recognising the importance of inter-disciplinary practice, as the Southampton and Hampshire ISS has removed the “old fashioned” demarcations that led to individuals seeing a “procession” of different professionals from different disciplines. This relates to team structure, but importantly is about a culture of holding a shared identity based on positive behavioural support values, rather than a traditional uni-disciplinary perspective.Practical implications ISS models are being proposed by NHS England and this paper suggests some important practical aspects.Originality/value Limited literature exists examining the team culture within ISSs, which contributes to desired outcomes for service users. This paper opens a debate about structural and functional aspects of service delivery in this service model. [ABSTRACT FROM AUTHOR]

Purpose First, the authors summarise arrangements expected from general practice (GP) surgeries, to optimize their safeguarding adults role. Second, using case-based discussions, the authors present specific safeguarding pathways (through which the authors have produced a downloadable interactive app) that the authors have developed to help Derbyshire GPs respond appropriately to safeguarding adults concerns. Third, the authors present the Derbyshire clinical commissioning Groups’ (CCG) approach to seeking assurance from their GPs that they have effective safeguarding adults arrangements in place. The paper aims to discuss these issues.Design/methodology/approach The authors have based the paper on relevant current UK legislation and national guidance, the local approach to seeking assurance from GP surgeries; the authors adjusted the pathways on the basis of feedback received from eight out of 103 (7.76 per cent response rate) Derbyshire GP safeguarding leads who responded to an e-mail containing draft pathways.Findings Primary care staff are ideally placed to identify safeguarding adults issues and to act to protect those who are at risk of abuse or neglect.Originality/value The authors are unaware of any other paper that does all of the following: summarises policies GP surgeries should implement regarding safeguarding adults; details core competencies required of GPs regarding safeguarding adults; presents how CCGs can seek assurance from GP surgeries regarding safeguarding adults; and presents straightforward pathways for specific safeguarding adults scenarios. In one paper, now published in the British Journal of General Practice, the authors presented a generic safeguarding adults pathway. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present an analysis of media reactions to the BBC Television Panorama programme, Behind Closed Doors’ and to set this in the context of interviews with care staff about their reflections on publicity about poor practice in the care sector.Design/methodology/approach This paper reports on an analysis of media reactions to recent exposé of abuse in social care in England and data from an interview-based study of care workers. The interviews were analysed to consider the impact of such media reports on staff and to explore their views of action that might be need to be taken about care failings.Findings There are mixed reactions to exposé of poor care on television and to the debates that precede and follow their broadcast. Debates occur in print and on television, but also in social media. The particular exposé of care home practices by the Panorama programme, Behind Closed Doors, led to debate in England about the potential role of covert cameras in care homes. The interviews revealed that while care staff are affected by scandals in the media about social care, they do not necessarily focus on themes that the media stories subsequently highlight. Overall some are disenchanted while others have ideas of what needs to change to improve practice. Care staff consider that there remain problems in raising concerns about practices and some staff feel unable to stay in workplaces where they have made complaints.Research limitations/implications The care workers interviewed may not be representative of the sector and they may have wished to provide socially acceptable answers to the researchers. Practice was not observed.Practical implications Local Safeguarding Adult Boards may wish to develop a communications strategy to deal with requests for reactions to media reports locally and nationally. Safeguarding practitioners may wish to prepare for increased referrals following media coverage of poor care in their areas. They may later be able to use media reports to discuss any local differences of interpretation over matters such as prosecutions for abuse. Trainers and educationalists may wish to clarify the importance given by care providers to raising concerns, the ways in which difficult conversations can be held, and the protections available to whistle-blowers or those raising concerns – with local examples to provide assurance that this is not mere rhetoric.Originality/value Television reports of problems with social care attract wide media interest but the authors know very little about how care workers respond to depictions of their work and their occupational grouping. This paper links media and expert commentator reactions to television exposé with data acquired from interviews with those on the frontline of care. [ABSTRACT FROM AUTHOR]

Purpose: Signs of Safety (SoS) is a strengths-based approach to child protection casework that has been widely adopted in countries across the world. The purpose of this paper is to report on a study that aimed to synthesise the many evaluations of SoS that have been conducted to assess their strengths and limitations. The intention is to identify the aspects which should be explored further and those that remain unexamined to inform future evaluations. Design/methodology/approach: The study collated and then examined many of the evaluations that are in the public domain as well as some of those that were conducted within agencies and have not been made publicly available. Findings: At the present time (early 2019), the evidence base for SoS is limited. Independent, robust research needs to be undertaken over time to build on the studies that have been conducted. New research must be designed to fill gaps and be capable of producing the evidence required and it must address its own limitations. Originality/value: This study is the most comprehensive contemporary review of the evaluations of SoS that have been conducted to the best of the authors' knowledge. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to consider the existing evidence base regarding community services for people with learning disabilities in the context of transforming care (TC).Design/methodology/approach Reflections and commentary on the provision of community services for people with learning disabilities following Washington et al.'s article on admissions and discharges from assessment and treatment units in England.Findings The existing evidence base pertaining to community learning disability teams in the UK is dated, sparse and methodologically weak. A greater focus on researching community services for people with learning disabilities is needed in order to inform best practice guidelines.Originality/value The success of the TC agenda is contingent on the provision of high quality community services. However, the focus has been on discharging individuals from hospital, rather than the support available to them once they leave. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to evaluate whether two regional intellectual disability (ID) assessment and treatment (A&T) units in England were meeting the recommended length of stay stipulated by the Learning Disability Professional Senate, in line with the Transforming Care (TC) agenda. A secondary purpose of the study was to evaluate the reasons for admissions and delayed discharges in order to inform how to reduce these.Design/methodology/approach A retrospective evaluation of 85 admissions across two A&T units was conducted over a three-year period (2013–2016) following publication of the TC agenda.Findings There were 85 admissions compared to 71 discharges. Of the 85 admissions, 11 were readmissions. The most common factors thought necessary to prevent admission were early support for care providers or alternative service provision. There were barriers to discharge in over half of admissions; the main reason was a lack of suitable service provision.Practical implications The study suggests that providing specific support or training to care providers could prevent (re)admission and ensure shorter admissions. Further research to establish reasons for the reported lack of suitable providers would be beneficial.Originality/value This study provides current admission and discharge rates for regional A&T units, as recommended by the TC national guidance. It also provides potential reasons underlying preventable admissions and delayed discharges and therefore indicates what might be necessary to prevent admissions and reduce the length of inpatient stays for people with ID and/or autism. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe how, as part of a national initiative led by NHS England and key partners, it is transforming lives by helping people with a learning disability, autism or both to live more independent and better quality lives in their own home rather than spending many years in hospital unnecessarily.Design/methodology/approach The methodology applied was to capture the real experience of a person with a learning disability, autism or both who successfully moved from long-term hospital care to home. This was achieved through developing a narrative story by capturing their experiences in their own words and the words of the individual's support team who made this life changing event possible.Findings This story shows how with the right planning and support, people with a learning disability can live in their own homes, gain their independence and be supported to take risks.Originality/value This is an original case study that has not been published previously and has been written for the sole purpose of this journal. [ABSTRACT FROM AUTHOR]

Purpose The programme – Stopping the over-medication of people with an intellectual disability, Autism or Both (STOMP) is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants and multiple psychotropic drug use. The purpose of this paper is twofold: Part 1 is to present the history and background to the use of psychotropic drugs in intellectual disabilities, autism or both; and Part 2 presents the progress with the STOMP programme.Design/methodology/approach The review tracks the various concerns, guidelines and attempts to tackle the issue of over medication of people with intellectual disability autism or both.Findings The review identifies that despite the many studies and guidelines associated with the prescribing of psychotropic drugs for people with an intellectual disability, autism or both the practice is common. Programmes that minimise the use of psychotropic drugs involve a full use of the multidisciplinary team and an availability of alternative methods of managing challenging behaviours.Originality/value STOMP is part of an English national agenda – Transforming care. The English Government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities, autism or both who have a mental illness or whose behaviour challenges services. This review identifies many studies, programmes and guidelines associated with psychotropic drug use for people with an intellectual disability, autism or both. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate the operation of multidisciplinary team (MDT) meetings within a forensic hospital in England, UK.Design/methodology/approach Mixed methods, including qualitative face to face interviews with professionals and service users, video observations of MDT meetings and documentary analysis. Data were collected from 142 staff and 30 service users who consented to take part in the research and analysed using the constant comparison technique of grounded theory and ethnography.Findings Decisions taken within MDT meetings are unequally shaped by the professional and personal values and assumptions of those involved, as well as by the power dynamics linked to the knowledge and responsibility of each member of the team. Service users’ involvement is marginalised. This is linked to a longstanding tradition of psychiatric paternalism in mental health care.Research limitations/implications Future research should explore the nuances of interactions between MDT professionals and service users during the meetings, the language used and the approach taken by professionals to enable/empower service user to be actively involved.Practical implications Clear aims, responsibilities and implementation actions are a pre-requisite to effective MDT working. There is a need to give service users greater responsibility and power regarding their care.Originality/value While direct (video) observations were very difficult to achieve in secure settings, they enabled unmediated access to how people conducted themselves rather than having to rely only on their subjective accounts (from the interviews). [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine how the role in offender mental health for the probation service described in policy translates into practice through exploring staff and offenders' perceptions of this role in one probation trust. In particular, to examine barriers to staff performing their role and ways of overcoming them. Design/methodology/approach Qualitative secondary analysis of data from semi-structured interviews with a purposive sample of 11 probation staff and nine offenders using the constant comparative method. Findings Both staff and offenders defined probation's role as identifying and monitoring mental illness amongst offenders, facilitating access to and monitoring offenders' engagement with health services, and managing risk. Barriers to fulfilling this role included limited training, a lack of formal referral procedures/pathways between probation and health agencies, difficulties in obtaining and administering mental health treatment requirements, problems with inter-agency communication, and gaps in service provision for those with dual diagnosis and personality disorder. Strategies for improvement include improved training, developing a specialist role in probation and formalising partnership arrangements. Research limitations/implications Further research is required to explore the transferability of these findings, particularly in the light of the recent probation reforms. Originality/value This is the first paper to explore how staff and offenders perceive probation's role in offender mental health in comparison with the role set out in policy. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe and discuss the pilot Making Safeguarding Personal (MSP) project that ran in three London boroughs in England in 2014-2015. The project aimed to help local authority social work practitioners better engage with adults at risk at the beginning, middle and end of safeguarding work and to develop a more outcomes focused approach to safeguarding. Design/methodology/approach – Three adult social care teams volunteered to take part in the MSP pilot for four months, November 2014-February 2015. They were closely supported through telephone conferencing, bespoke training and individual mentoring. Evaluative data were collected from the participating teams about their work and the MSP change processes to assist in further implementation. Findings – The findings suggested that staff felt that the open discussions with adults at risk that were encouraged by the MSP initiative enabled safeguarding to be more effective and provided a better basis of support for adults at risk. The support from the project team was appreciated. Staff reported their own increased confidence as a result of involving adults at risk in decisions about their situations and risks of harm. They also reported their increased awareness of cross-cutting subjects related to adult safeguarding, such as domestic abuse and working with coercive and controlling behaviours. Permission to exercise greater professional discretion to make responses more considered, rather than the need to adhere to time-limited imperatives, was received positively. Staff felt that this enhanced discussions about resolution and recovery with adults at risk although it required greater expertise, more extensive managerial support, and more time. These were available in the pilot. Research limitations/implications – The MSP pilot was confined to three teams and took place over four months. The numerical data reported in this paper are provided for illustrative purposes and are not statistically significant. As with other evaluations of implementation, the data provided need to be set in the local contexts of population profiles, care settings and the reporting source. The pilot also took place during the early implementation of the Care Act 2014 which affected the context of practice and training. The views of adults at risk were not collected. There is a risk of bias in that participants may have wished to convey positive views of MSP to their colleagues. Practical implications – The paper indicates a need for the roll out of MSP philosophy and MSP approaches to be communicated with other agencies supporting adults at risk and for project support of some form to continue. It will be important to see if the overall enthusiasm, support and motivation reported by the pilot teams when taking a MSP approach in practice extend beyond a pilot period during which the staff received substantial support from a dedicated Professional Standards Safeguarding Team. Many of those staff participating in the pilot perceived the MSP approach as a return to core social work principles and welcomed putting these into practice. Originality/value – The paper provides details of one pilot in which the feasibility of the MSP approach was tested by supporting three frontline teams working in different contexts. The pilot suggests that the level and type of support offered to the pilot teams were effective in a variety of practice settings. It draws attention to the need for the MSP concept and approach to be shared with other agencies and for implementation support to continue beyond initial pilot period. [ABSTRACT FROM AUTHOR]

Purpose – There are currently no national adult safeguarding outcome measures that focus on people who have been through an adult safeguarding investigation in England. There is a need for local authorities (LAs) and their partners to be able to measure whether the services provided to adults at risk of abuse and neglect are effective. The paper aims to discuss these issues. Design/methodology/approach – This paper describes the cognitive testing phase of a study to develop and implement a standardised adult at risk outcome measure in adult safeguarding for use by LAs in England. An outcome measure (a set of seven survey questions administered in a face to face interview) was cognitively tested in three LAs with adults at risk (or their carers/advocates) for whom an investigation of abuse had been concluded (n=40), with the aim of assessing whether it was commonly understood. A set of guidance notes was designed and LA staff (n=12) who assisted with the survey were interviewed about its usability and the feasibility of administering the survey. Findings – The survey questions required modifications to improve their reliability, validity and comparability. LA staff also suggested improvements were needed in the guidance document and survey. LA managers, adults at risk (and their relatives/carers/advocates) were willing to be involved in the survey and it was considered feasible to proceed with piloting the measure. Originality/value – The development of this unique survey is of interest to those working in adult safeguarding, user involvement, survey management and outcome measurement in LAs. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to determine the incidence of the use of section 135(1) of the Mental Health Act 1983 in a London borough and describe the main features of the population subject to that section. Design/methodology/approach – Uses of section 135(1), hospital stay, and demographic data were gathered from service and patient records over one year. Means, medians, modes and standard deviation were calculated for interval data. Nominal data were cross-tabulated and the chi square test applied where appropriate. Study data were compared to census and national hospital data; the significance of proportional population differences were calculated using the Z-test. Findings – In total, 63 uses of section 135(1) were recorded. It was primarily used with people with psychotic diagnoses (79 per cent), and was used predominantly in black populations, and among people aged 40-54. People admitted to hospital after section 135(1) use who had psychosis diagnoses had median spells in hospital that were double the corresponding national median. Research limitations/implications – Total uses of section 135(1) in the borough equated to 25 per cent of the national total for all section 135 admissions recorded in 2012/2013. Hospital statistics in England focusing on admissions alone may fail to reflect a more widespread use of this section. Further research is required to confirm and develop the findings of this small scale study. Practical implications – The repeated use of this section is suggested as a marker for reviewing practice and resource allocation to prevent or shorten hospital admissions for people with psychosis diagnoses. Originality/value – This paper highlights gaps in NHS data collection in England relevant to policy makers, mental health service providers, and the police service. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to summarise the results of a review of the literature linking parental involvement in their child’s education to attainment at or before primary school. Design/methodology/approach – The search involved nine electronic databases supplemented by other sources, and yielded 4,898 apparently relevant reports. Of these, 127 were reports of attempted evaluations to see whether enhancing parental involvement led to higher attainment outcomes for children. Findings – None of these studies was a large, robust evaluation. The overwhelming majority (121/127) reported research with serious limitations, and they were almost equally divided between those claiming success and those saying that the intervention had been ineffective or harmful. Of the remaining six, three offered positive outcomes, and these were generally complex interventions in which parental involvement was only part of a package of measures taken to improve results. Originality/value – Therefore, the paper has three main messages for an area where practice and policy interventions abound. Research has to improve greatly. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the relationships between the characteristics of the home learning environment (HLE) and students’ academic attainments in secondary school in England at age 14 and 16. Design/methodology/approach – This research study uses multilevel statistical models to investigate the strength and significance of relationships between various measures of the HLE at ages three, six, 11 and 14, and students’ academic attainment in secondary school. Findings – Multilevel models show that early years HLE and specific dimensions of later HLE are positive predictors of students’ later academic attainment at age 14 and 16, when the influence of various individual, family and neighbourhood characteristics are controlled. Originality/value – The paper presents unique findings on the role of the HLE in shaping students’ academic success at secondary school, including a range of measures of the HLE obtained at different ages. The results show that the early years HLE measured at age three continues to show effects on later attainment, over and beyond the effects of later HLE and other significant influences such as family socio-economic status and parents’ qualification levels. [ABSTRACT FROM AUTHOR]

Purpose – Transition from education to adult life is a stated policy aim for young people with learning disabilities. The purpose of this paper is to examine the extent to which 16-18-year olds with learning disabilities or autistic spectrum disorder are remaining in state school education beyond the minimum school leaving age. Design/methodology/approach – A tabulation from the Department for Education Children and Early Years Data Unit for 2014, combined with School Census data and age-specific population estimates, allowed us to compare the rates of children identified as having moderate, severe or profound/multiple learning difficulties (MLD, SLD, PMLD), or autistic spectrum disorder (ASD) in state education at the ages of 16-18 years vs five to 15 years. Findings – For all types of need analysed in the paper, the rate of children in state school dropped considerably at the ages of 16-18 years: 10 per cent of the rates of children with MLD, 62 per cent of children with SLD, 49 per cent of children with PMLD and 23 per cent of children with ASD at ages five to 15 years were in state education at ages 16-18 years. Almost all young people aged 16-18 years in state education with SLD or PMLD were in special schools, compared to just over half of young people with MLD or ASD. For all these figures, there was considerable regional variation. Social implications – Substantial numbers of children with learning disabilities or ASD do not remain in post-16 state education, with wide regional variations that do not seem to correspond to regional variations in need or national policy concerning transition. Originality/value – This is the first data set to examine this issue. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a commentary on “A summary of government initiatives relating to employment for people with learning disabilities in England”. Design/methodology/approach – In her paper, Blamires outlines the development of policy in employment for people with learning disabilities. This commentary explores whether this policy development is having any impact. Findings – The statistics indicate that development of policy does not appear to be making a difference. It is concluded that this is about how it is being implemented and the time it takes for policy to have an impact. What is needed to fully implement these changes is a huge cultural shift, changing people’s mindset about what people with learning disabilities can achieve. Originality/value – This paper provides an individual perspective on the impact of policy on the lives of people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose – This commentary takes Marsland et al.’s paper about services at risk of becoming abusive to the people they support, as a platform to consider issues around implementation science and its role in minimising this risk. The paper aims to discuss this issue. Design/methodology/approach – The commentary is a selected review of implementation science. The research is used to define implementation, identify prerequisites, selectively review methods and comment on fidelity. Findings – The commentary proposes that implementation science has an important role in ensuring evidence-based practice transfers from research to disability services. Originality/value – The commentary offers a viewpoint based on combined research evidence and clinical practice. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a synthesis of current and previous government policies and strategies, in relation to people with learning disabilities and employment, to facilitate a better understanding of the current situation and future challenges. Design/methodology/approach – A search was completed to identify government policies relating to the employment of people with learning disabilities. Key policies were identified and their impact was discussed in the paper. Findings – It appears there is a necessity to identify how successful pilot projects can be replicated on a national scale, with clear targets and measures and initial financial support to set up these services. Alongside this there is a need for interventions targeting not just employers, but the general population, educating people about the importance of including and valuing people with learning disabilities in the workforce. Originality/value – It is important that policy is analysed and the impact of it is assessed to determine whether more action is necessary. This paper adds updates to some of the issues discussed in Melling et al.’s (2011) paper about “Supported employment for people with learning disabilities”. [ABSTRACT FROM AUTHOR]

Purpose – At a time when funding arrangements are under review, the purpose of this paper is to come to a better understanding of victim needs and to inform future developments of services in England and Wales. Design/methodology/approach – This paper is based on qualitative data gathered from a series of interviews with 33 individuals working with victims of crime in one police area in England and Wales. Findings – Better practice and outcomes were associated in respondent’s accounts with the multi-agency working and end to end case management of needs associated with some victims of rape and domestic abuse assessed as high risk of harm. Research limitations/implications – Small-scale qualitative study. Practical implications – It is argued Police and Crime Commissioners (PCCs) should explore mechanisms for extending such services to more victims of crime and ensuring better co-ordination of service delivery. Originality/value – From October 2014 onwards PCCs are set to take over responsibility for funding victim services in England and Wales. Though not an uncontroversial development, this sets the context for practice with victims to be considered afresh and accordingly this paper explores the needs of victims and how they are met in one police and crime area. [ABSTRACT FROM AUTHOR]

Purpose – The critical potential of hospital discharge policies and practices to ameliorate the health and social care needs of homeless people has become the focus of considerable interest in England. Central to this rise in policy formation and practice development is an acute understanding of the multiple exclusions homeless people face in navigating public health and social care systems. In ways small and large this nascent landscape is serving to redefine and reshape hospital arrangements for homeless people, and opening-up new ways to deliver care across clinical, social and therapeutic boundaries. The purpose of this paper is to seek to add empirical vigour and theoretical rigour to this unfolding policy and practice terrain. Design/methodology/approach – This paper draws on findings from a case study concerned with exploring and explaining how statutory and voluntary sector organisations use specialist hospital discharge policies and practices to coordinate pathways of care for homeless people. Findings – This paper illustrates how people affected by homelessness and ill-health are routinely denied access to statutory housing support, social work assessments and district nursing provision through acts of institutional gatekeeping and professional abrogation. Originality/value – This paper makes an important contribution to understandings of the connections between hospital discharge arrangements for homeless people and statutory housing, social work and district nursing provision. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper was to establish the extent to which safeguarding procedures in North Somerset identified and reviewed outcomes for the alleged adult at risk. The project aimed to address whether outcomes could be achieved and what steps need to be taken to make the experience of safeguarding personal. Design/methodology/approach – Three social care teams with a responsibility for following up safeguarding referrals were asked to participate in the work and provide feedback on cases completed within the project timeframe. Data were gathered centrally on specific forms and through focus group discussions with social workers. Findings – The findings confirmed the need for a change in practice to ensure safeguarding procedures are personal. Research limitations/implications – The number of completed cases in the timeframe of the project was small and this limits the conclusions. Practical implications – The paper identifies change needed to training and recording systems and recognises that further work is needed to embed the learning from this work and explore the implementation of alternative approaches. Originality/value – The paper establishes the extent to which existing safeguarding practice is outcome focused. [ABSTRACT FROM AUTHOR]

Purpose – The IAPT programme has been rolled out across England in the last ten years. Although undoubtedly many people have benefited from having greater access to psychological therapy there are several issues with the practicalities of Improving Access to Psychological Therapies (IAPT) and also with its ideology. The paper aims to discuss these issues. Design/methodology/approach – This is a personal reflection of working within the IAPT system for several years. Significant statements heard or interpretations of what has been said are presented alongside an analysis of the implications. Findings – A number of important concerns are presented. The overarching concept of the “McDonaldization” process is discussed as a way of encapsulating the IAPT experience; with its theoretical reliance on the medical model and the real world impact of tendering for services in the modern NHS. The impact of IAPT on cognitive behavioural psychotherapy is also highlighted. Originality/value – A lot has been written in the press and online about IAPT. Many of the criticisms seem to derive from people outside of the IAPT system, many of whom have their own personal or professional agenda for attacking IAPT and Cognitive Behavioural Therapy (CBT); often the criticisms are uninformed. This paper is a reflection of working within the IAPT system and not just an uninformed critique of CBT. Several concerns are raised that without remedy may seriously hold back the progress that psychological therapy has made in recent years. [ABSTRACT FROM AUTHOR]

Purpose – As well as working with people who have serious mental health problems, mental health nurses have to maintain a values-based approach to their interactions with mental health service users. However, some have suggested that students and newly qualified nurses are unprepared for this role. The purpose of this paper is to explore perceptions of practising mental health nurses, third year mental health nurse students and lecturers about how well students are being prepared for practice. Design/methodology/approach – A two-phase phenomenological study within a mental health nurse training institution and with staff from a Mental Health Trust in England. The study collected questionnaire responses from 87 participants (42 third year mental health nurse students, 39 practising mental health nurses and six nurse lecturers). A Likert scale questionnaire with written feedback produced data that formed the schedule for ten subsequent focus groups with 41 participants from the above categories. Focus group data were analysed using a process of interpretive phenomenological analysis. This led to the development of three main study themes. The transition from student to registered nurse is difficult, the importance of learning from experience, violence and aggression is difficult to manage, working effectively with victims of sexual abuse or those who have a diagnosis of personality disorder is difficult. Findings – Whilst the study found some evidence to suggest the development of positive values there is a perception that newly qualified mental health nurses lack confidence in other important areas. Participants also expressed doubt about whether it was possible to prepare someone for practice completely. Another finding was that the relationship between student and the mentor is critical to the quality of practice learning. Research limitations/implications – Study limitations are that this is a small selection of participants from one particular area. The researcher attempted to ensure that this study has internal validity. However, it is possible to question the extent to which findings may apply to other areas. Therefore, this study may be most useful to others as a basis for the discussion and comparison of these issues within mental health nurse educators. Practical implications – The need to encourage proactive learning approaches in students is emphasised. Universities should facilitate the sharing of clinical learning experiences as well as developing realistic training in the management of violence and aggression. It is possible to question how well nurses are prepared to work with the physical health needs of service users. Originality/value – This paper gives information about mental health nurse preparation for practice, which will be of value to training organisations as well as to employers of newly qualified mental health nursing staff. [ABSTRACT FROM AUTHOR]

Purpose -- Winterbourne and Mid-Staffordshire scandals have had a significant impact on how Care Quality Commission inspects and regulates intellectual disability services (IDS). The purpose of this paper is to describe the changes and development of regulation of these services and future work. Design/methodology/approach -- The paper is a descriptive paper. Findings -- A new regulatory model is currently implemented for IDS. It has been developed in consultation with patients, carers, providers and other stakeholders. There will be ongoing development and refinement of the inspection methodology. Originality/value -- This is an original descriptive paper which will provide useful information to readers on how the regulatory process works in IDS. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to analyse in detail the findings from 40 serious case reviews (SCRs) involving adults who self-neglect, and to consider the commissioning and reporting of such inquiries in the context of accountability that also involves the Coroner and the Local Government Ombudsman. Design/methodology/approach - This study comprised a cross-case analysis of 32 SCRs, using a four-layer design of the adult and their living context, the team around the adult, the organisations around the team, and the Local Safeguarding Board around the organisations. Findings - Available reports tend towards description of events rather than appraisal of what influenced practice. They highlight the challenges in cases of self-neglect practice, including person-centred approaches, capacity assessment and securing engagement. Familiar themes emerge when the spotlight turns to professional and organisational networks, namely information-sharing, supervision, recording and compliance with procedures and legal rules. Some Local Safeguarding Adults Boards found the process of conducting and then using serious case reviews for service improvement challenging. Research limitations/implications - The cross-case approach to thematic analysis focuses on reports into situations where outcomes of professional and organisational intervention had been disappointing. Nonetheless, the themes derived from this analysis are similar to other research findings on what represents best practice when working with cases involving self-neglect. Practical implications - The paper identifies learning for the effective commissioning and conduct of SCRs, and for service improvement with respect to practice with adults who self-neglect. Originality/value - The paper offers further detailed analysis of a large sample of SCRs that builds the evidence-base for effective practice with adults who self-neglect and for efficient management of process of commissioning and conducting SCRs. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to highlight the role of housing in adult safeguarding under the Care Act (2014) in England. Design/methodology/approach – The paper provides a summary of the implications for housing organisations and their staff of adult safeguarding under the Care Act. The implications, underpinned by the six safeguarding principles, are explained within a summary of the legal and practice framework for safeguarding in England. Findings – The paper draws upon research by Imogen Parry (2014). It argues that past failings in adult safeguarding in England have placed it high on the housing agenda and that housing has a key role to play in adult safeguarding. Practical implications – Housing organisations need to be proactive partners in local multi-agency arrangements for adult safeguarding. Staff and contractors need to receive training in line with their role to raise awareness of their safeguarding responsibilities. Originality/value – The value of the paper is to increase and maintain awareness of the need for housing engagement in the adult safeguarding agenda. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to discuss the current context, scope and problems in the provision of work-integrated learning (WIL) in legal education and how the adoption transformative pedagogies in WIL which is offered in legal education can foster personal and social transformation in addition to enhancing lawyering skills. The paper draws on learning from Australia, England and the USA. Design/methodology/approach -- The backdrop of this conceptual paper is WIL and transformative education. The text begins with a critique of existing WIL frameworks and practices in legal education in Australia, England and the USA. This exposes a focus on skills enhancement at the expense of social and personal transformation. Drawing on transformative learning, the paper proposes practices which can be used in WIL offered in legal education to enhance personal and social transformation. Findings -- There is very little literature on how legal education and WIL in legal education can enhance personal and social transformation. Tensions continue to exist between the predominant aim of instilling the legal skills necessary to ensure that graduates are prepared for legal practice through WIL programmes and between the need to simultaneously enhance critical consciousness and social transformation necessary for active participation in social and professional life. Research limitations/implications -- More research is required on the best manner in which the ideals and practices of emancipatory education can be installed within WIL programmes so as to successfully reduce the tensions between the instilling of legal skills required to practice law and the need to train students to be holistic, critical and constructive thinkers. Practical implications -- The suggestions made in this paper provide a framework to adopt critical pedagogies in the provision of WIL in legal education. The theoeretical and practice-based suggestions presented in this paper are also relevant to other professional disciplines where personal transformation is desired. Originality/value -- The literature on legal education predominantly focuses on enhancing lawyering skills and competencies and there is an absence of the utilisation of transformative pedagogies in legal education generally and WIL offered in legal education. Drawing predominantly on the literature and practices relating to legal education in Australia and incorporating comparative insights from England and the USA, the paper contributes to the broader literature on transformative learning. Most significantly, the paper contributes specifically to the use of transformative pedagogies in WIL offered in legal education through the suggestion of practices relating to critical reflection and dialogue which are not commonly used in legal education. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to give a brief background to the Deprivation of Liberty Safeguards (DoLS), and studies which factors Best Interests Assessors consider when making a judgement on Deprivation of Liberty. It examines some of the reasons why professionals may be under-using DoLS, including lack of knowledge, complex processes and paperwork, and the pejorative nature of the word "deprivation", and looks at a possible way forward. Design/methodology/approach -- The paper looks at the evidence to the House of Commons and House of Lords Committees on the Mental Health Act and Mental Capacity Act, as well as previous and current research papers. It examines the nuances of difference between restriction and deprivation, and the cumulative impact of several restrictions, which may, in fact, amount to a deprivation, illustrated by case studies from the author's own practice. Findings -- It makes the case that health and social care professionals should err on the side of caution, by making precautionary DoLS applications, arguing that MCA DoLS is a forerunner of good practice, and that good care planning allied to judicious application of the MCA leads to better, more robust and more defensible decision making. Originality/value -- And it points the way to a possible future, citing the recommendations of the Select Committee on the MCA for a clearer link between DoLS and the principles underpinning the MCA, and for simplifying and clarifying the legislative provisions and the associated paperwork. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper was to identify safeguarding concerns for vulnerable adults, including exploring the implementation of safeguarding policy and procedures into practice. This was achieved by reviewing the content of reflective assignments written by pre-registration student nurses, identifying areas of concerns and proposing action plans. Design/methodology/approach -- A qualitative approach was initially utilised to scrutinise a random 10 per cent sample of work, which was thematically analysed. From this, an audit tool was devised and then applied to evaluate a 35 per cent sample of work from the following cohort of students. Approval and consent was gained. Findings -- From the initial 10 per cent sample, themes emerged around: practice issues; areas for student's development and marking or assessment issues. The standardised audit tool was devised and applied to a 35 per cent randomsample of work. This determined that students identified local safeguarding policies and procedures were being followed in the majority of placement areas, although application of the Mental Capacity Act remained inconsistent. Research limitations/implications -- The assessor feedback from the reflective assignments was not available to the reviewers, limiting the reviewers ability to identify if assessors had recognised and corrected any policy or practice issues that the student raised. Only assignments from the adult field of nursing were considered within the scope of this study. The authors recommend further empirical investigation into this area. Practical implications -- This paper offers knowledge that can be applied in practice within both academic and health care provider services that deliver and facilitate nursing education. It has generated an audit tool that can be utilised to evaluate the knowledge of pre-registration students and has resulted in the implementation of safeguarding adults policies within an academic institution. Originality/value -- Safeguarding adults concerns may be identified through studying pre-registration student assignments and promptly acting upon any concerns raised. Aspects of good practice can be acknowledged within health care provider services. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to review the recent literature on housing with care in England where a longitudinal approach has been adopted and to identify possible new research projects that focus on gaps in the existing literature. Design/methodology/approach – The review of the relevant research literature draws in part on an earlier overview of the broader literature on housing with care, part of an NIHR School for Social Care Research project, Adult Social Services Environments and Settings (ASSET). Findings – The literature review suggests that the findings from longitudinal studies on housing with care in England have usually been based on administrative sources (such as assessments) rather than the primary focus being on the voice of residents and frontline staff. It is therefore suggested that further studies are required to reflect the views of everyday life in housing with care settings. Research limitations/implications – This literature review and the longitudinal qualitative framework for undertaking further inquiry forms the basis for a major bid for funds from the NIHR School for Social Care Research. This is a collaborative endeavour between the University of Bristol’s School for Policy Studies, the Association for Dementia Studies at the University of Worcester, the Personal Social Services Research Unit at the University of Kent and the Housing and Learning Improvement Network. The limitations of this paper reflect the paucity of past investigations on the contribution of social care to the quality of life of elderly residents in extra care housing. Practical implications – As noted above, the reviews of this draft paper have helped to determine the form of the bid for research funds. Informal discussions with commissioners and providers of extra care housing for older people indicate that access for fieldwork along the lines proposed should not prove to be a major barrier. One of the important implications is to add to the weight of evidence about the working conditions of care staff in extra care housing. The research is likely to highlight both good and poor practices, not least with consequences for the quality of life of elderly residents. Social implications – As indicated above, the paper draws attention to the need for a longitudinal qualitative study on the contribution of social care to the quality of life of older residents in extra care housing. Such a study would focus both on the details of everyday lives experienced by residents and the interaction in this setting between frontline staff and residents. In the context of major demographic change in the UK and planned further substantial cuts in public expenditure, this research is of high relevance for both policy and practice in this field of social care. Originality/value – The review indicated a reliance on administratively derived information about residents rather than focusing on the voice of residents and frontline staff. Future longitudinal research should pay attention to the latter. [ABSTRACT FROM AUTHOR]

Purpose – Homelessness often results from the loss of social networks and individuals are tested in being able to sustain or develop new positive social networks necessary to rebuild lives. The purpose of this paper is to present findings from an exploratory study which investigated how different agencies and professionals support people experiencing multiple exclusion homelessness (MEH) to develop and maintain their social networks amid other competing priorities, such as reducing substance misuse and re-offending. Design/methodology/approach – The study was undertaken in England 2010-2011 in three case study sites. Data were collected in 76 interviews with practitioners and managers, from disciplines including housing support, social work, criminal justice, mental health and substance misuse services. Totally, 56 interviews and five focus groups were also undertaken with people with experiences of MEH. Data were analysed thematically. Data from one site in particular permitted a focus on personal relationships and social networks which were seen as beneficial but also potentially problematic. These data are drawn upon to reflect on the implications for housing providers and practitioners. Findings – While multiple factors had often led to the loss of social networks among homeless people, findings revealed that practitioners working with homeless people may be able to promote existing social networks, such as partnerships, help develop new ones, and support people withdrawing from less positive relationships. The authors conclude that practitioners should be alert to structural changes that threaten social networks and may need to enhance skills in creating opportunities to foster existing positive relationships in direct work with their clients and in collaboration with other professionals. The need to be careful of blurring professional boundaries is also observed. Practical implications – This paper suggests approaches that may encourage practitioner reflection and commissioning practice in achieving good outcomes for people with experiences of MEH by highlighting the importance of social networks and the potential for practitioners to foster supportive relationships. Originality/value – This paper considers the often under-researched area of day-to-day engagement with social networks and the implications of working to support these as part of the role of homelessness services. While drawing primarily on recent research in England the themes raised will have wider relevance to housing and care services generally. [ABSTRACT FROM AUTHOR]