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Purpose: This paper aims to outline the initial pilot use of the client complexity matrix (CCM), an outcome measure developed for an NHS Adult Intellectual Disabilities Intensive Support Team (IST) in the West Midlands of England. Design/methodology/approach: A mixed method approach was used to report the results and evaluate the use of the CCM within this IST. The CCM was trialled for six months between January 2022 and June 2022. CCM scores pre and post IST intervention were analysed via t-test, and qualitative feedback from clinicians is detailed. Findings: Analysis suggests the CCM captures service success showing a significant decrease in complexity and risk post-intervention. Qualitative comments from clinicians were generally positive; however, there were requested changes regarding specific presentations, use of labels/language and for a digital version. Research limitations/implications: The tool is not co-constructed with the client. Because of this IST's caseload, the sample size was small. Only one clinician was asked to complete the CCM pre and post intervention. Future use of the measure will encourage two clinicians to complete the measure to evidence its inter-rater reliability. Each client's specific presentation was not explicitly analysed here. Practical implications: The CCM will be updated using the feedback from clinicians and from the peer review process. Research that examines the generalisability of this measure to other IST services would be beneficial. Originality/value: The CCM appears to fill a gap in outcome measurements for this IST service which looks at breadth and depth of client complexity and risk. [ABSTRACT FROM AUTHOR]

Purpose: The paper examines three English research papers on self-neglect, from 1957, 1966 and 1975, discussing them in the context of more recent thinking and the statutory framework in England. Design/methodology/approach: In reviewing the three research papers, developments and points of continuity in the field of self-neglect were identified and are discussed in this paper. Findings: In light of the findings of the three articles, the present paper traces some of the classificatory refinements in this field that have taken place since the papers were published, notably in respect of hoarding and severe domestic squalor. Some of the difficulties in making judgements about behaviour thought to breach societal norms are described, and the challenges practitioners face in intervening in cases, particularly where the person concerned is refusing assistance, are examined. Originality/value: By drawing on the historical research context, the paper contributes to our current understanding of the field of self-neglect. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to argue for a strengthening of the relational aspect of social work and for initiatives that involve local people and local communities.Design/methodology/approach A think piece based on observations of the current situation and supporting evidence.Findings Social work has become distanced from those whom it seeks to help. Case management and risk assessment need to be complemented by a more human approach based on positive relationships between professionals and service users.Originality/value An informed discussion on the future of social work. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present a mixed methods study of child criminal exploitation (CCE), particularly in the form of "county lines", in three local authorities in southeast England. The data is analysed using a framework constructed from two relevant contextual and relational theories to understand experiences of CCE and the safeguarding responses undertaken to protect young people from harm. Design/methodology/approach: Data were drawn from a survey (n = 118); interviews (n = 5) and focus groups (n = 15) with professionals; interviews with parents (n = 4); and from secondary analysis of eight interviews with young people affected by criminal exploitation. The analytic framework was applied to the data to answer two research questions: what is the role and significance of young people's interactions with peers, parents and professionals in their CCE trajectories; and how do professionals understand and address risks within contexts in which young people are exposed to CCE? The mixed methods data collected by the authors were coded and analysed using this framework. Findings: Although professionals were aware of contexts and relational power dynamics, the situated and temporal nature of CCE remained overlooked within safeguarding systems. Professionals required more space, time and support to fully and flexibly engage with young people and their families to increase safety. Originality/value: There is limited research available that critically examines safeguarding responses to CCE in diverse geographic and cultural contexts. This paper contributes a critical account of how professionals might create connections and opportunities for change with young people, identifying structural constraints within practice systems alongside emerging examples of effective practice. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the links between being lonely and isolated, and increased risks of abuse for adults with care and support needs. Design/methodology/approach: Thematic analysis was used to explore features of loneliness and social isolation present in South Yorkshire Safeguarding Adults Reviews (SARs) published since 2014. Findings: Ten out of fifteen SARs indicated there had been issues of loneliness and/or social isolation for the person who was the subject of the SAR. Research limitations/implications: The limitations of this paper are that it only included SARs from the South Yorkshire area. Future research should explore national and international perspectives on these issues. Practical implications: Safeguarding Boards should include actions to address loneliness and social isolation as part of prevention strategies and services to develop approaches that can minimise or prevent abuse before it occurs. Practitioners should routinely explore whether the people they work with feel lonely and/or isolated and support people to take appropriate action to mitigate these risks. Originality/value: This paper uses the existing body of literature about loneliness and social isolation to explore the risks of abuse and neglect for adults with care and support needs. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to apply critical legal analysis to laws, policies and reforms focused on special educational needs (SEN) and equality in England and to suggest a Neurodiversity spectrum statement. Design/methodology/approach – The paper reviews current legal and policy initiatives in SEN, together with recent reforms in equality law. Findings – While past and current policies may have laudable aims, tensions such as a lack of integration of education, health and social services have had prejudicial outcomes for children with SEN, their families/carers, and the professionals involved. Originality/value – Legal reforms promise to remedy some problems, but must be underpinned by adequate resourcing, appeal procedures, and remedies which foster the enforcement of legal duties. Some resources for families with children with SEN are noted. [ABSTRACT FROM AUTHOR]

Purpose: Secure children's homes (SCHs) restrict the liberty of young people considered to be a danger to themselves or others. However, not all young people referred to SCHs find a placement, and little is known about the outcomes of the young person after an SCH or alternative placement. The purpose of this paper is to understand which characteristics most likely predict allocation to an SCH placement, and to explore the outcomes of the young people in the year after referral. Design/methodology/approach: A retrospective electronic cohort study was conducted using linked social care data sets in England. The study population was all young people from England referred to SCHs for welfare reasons between 1st October 2016 to 31st March 2018 (n = 527). Logistic regression tested for differences in characteristics of SCH placement allocation and outcomes in the year after referral. Findings: In total, 60% of young people referred to an SCH were allocated a place. Factors predicting successful or unsuccessful SCH allocation were previous placement in an SCH (OR = 2.12, p = 0.01); being female (OR = 2.26, p = 0.001); older age (OR = 0.75, p = 0.001); and a history of challenging behaviour (OR = 0.34, p = 0.01). In the year after referral, there were little differences in outcomes between young people placed in a SCH versus alternative accommodation. Originality/value: The study raised concerns about the capacity of current services to recognise and meet the needs of this complex and vulnerable group of young people and highlights the necessity to explore and evaluate alternatives to SCHs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to interrogate and develop the conceptualisation of discriminatory abuse in safeguarding adults policy and practice beyond the current interpersonal definition. The paper draws on Safeguarding Adults Reviews (SARs) that refer to discriminatory abuse or safeguarding practice with adults who have care and support needs and protected characteristics. Design/methodology/approach: A search of the national network repository of SARs identified 27 published reviews for inclusion. The contents were thematically analysed to understand how discrimination was experienced in these cases. Fricker's "Epistemic Injustice" theory was adopted as a conceptual framework, informing the analysis of findings. Findings: Evidence from SARs provides a challenge to the interpersonal emphasis on language and behaviour in national policy. Although the reviews acknowledge that interpersonal abuse occurs, a close reading spotlights practitioner and institutional bias, and inattention to social, structural and contextual factors. The silence on these matters in policy provides a narrow frame for interpreting such abuse. This suggests significant potential for epistemic injustice and signals a need to acknowledge these social, structural and contextual factors in safeguarding practice. Originality/value: Discriminatory abuse is an under-researched and under-utilised category of abuse in safeguarding adults practice. The paper adopts Fricker's theory of "Epistemic Injustice" to highlight the silencing potential of current policy approaches to discriminatory abuse to suggest a more inclusive and structural framing for safeguarding practice with those targeted due to their protected characteristics. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda. Design/methodology/approach: This is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022. Findings: Of 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work. Originality/value: This paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the use and content of written guidance produced by mental health services in England and Wales describing hospital leave for informally admitted patients. Design/methodology/approach: Guidance on leave was requested from National Health Service (NHS) mental health trusts in England and health boards in Wales (n = 61) using a Freedom of Information submission. Data were analysed using content analysis. Findings: In total, 32 organisations had a leave policy for informal patients. Policies varied considerably in content and quality. The content of policies was not supported by research evidence. Organisations appeared to have developed their policies by either adapting or copying the guidance on section 17 leave outlined in the Mental Health Act Codes of Practice for England and Wales (Department of Health, 2016; Welsh Government, 2016). Definitions of important terms, for example, leave and hospital premises, were either absent or poorly defined. Finally, some organisations appeared to be operating pseudo-legal coercive contracts to prevent informal patients from leaving hospital wards. Research limitations/implications: Research should be undertaken to explore the impact of local policies on the informal patient's right to life and liberty. Practical implications: All NHS organisations need to develop an evidence-based policy to facilitate the informal patient's right to take leave. A set of national standards that organisations are required to comply with would help to standardise the content of leave policies. Originality/value: To the best of the author's knowledge, this is the first study to examine the use and content of local policies describing how informal patients can take leave from hospital. [ABSTRACT FROM AUTHOR]

Purpose: Local Safeguarding Adults Board (SAB) policies, procedures, guidance and related documents on self-neglect were gathered and analysed, to map what approaches are being taken across England. This paper aims to identify areas of divergence to highlight innovations or challenges faced by SABs. Design/methodology/approach: Self-neglect documents were identified by searching SAB websites. Data were extracted into a framework enabling synthesis and comparison between documents. Findings: This paper reports on how English SAB documentation defines self-neglect, treats executive capacity, lays out pathways for self-neglect cases, advises on refusal of service input and multi-agency coordination and draws on theories or tools. Greater coherence in understanding self-neglect has developed since it was brought within safeguarding in 2014; however, variation remains regarding scope, referral pathways and threshold criteria. Research limitations/implications: This review was limited to published SAB documentation at one point in time and could not consider either the wider context of safeguarding guidance and training or implementation in practice. Practical implications: This review provides an overview of how SABs are interpreting national guidance and guiding practitioners. The trends and areas of uncertainty identified offer a resource for informed research and policy-making. Originality/value: To the best of the author's knowledge, this is the first systematic survey of SAB self-neglect policies, procedures and guidance since self-neglect was included under safeguarding. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider the role of the Mental Health Act (MHA) 1983 in safeguarding adults at risk of abuse and neglect. The author has undertaken a thematic review of Safeguarding Adults Reviews (SARs) commissioned in England and Adult Practice Reviews (APRs) commissioned in Wales where the MHA 1983 was a central aspect to the review. Design/methodology/approach: Reviews were included based on specific determinants, following analysis of SARs, APRs and executive summaries. This should not affect the credibility of the research, as themes were identified in conjunction with analysis of literature regarding use of the MHA in the context of adult safeguarding. Consequently, this review has been underpinned by evidence-based research in the area of study. Findings: The interaction between statutes, such as the MHA 1983 and Care Act 2014, signify challenges to professionals, with variable application of mental health legislation in practice. Research limitations/implications: Lack of a complete national repository for review reports means that it is likely that the data set analysis is incomplete. It was noted that limitations to this research include the fact that Safeguarding Adults Boards in England may not publish SAR reports or may choose to publish an executive summary or practice brief instead of the full SAR report, therefore limiting the scope of disseminating learning from SARs, as this is difficult to achieve where the full report has not been published. The author aimed to mitigate this by undertaking comprehensive searches of Local Authority and SAB websites, in addition to submitting Information requests to ensure that this research encompassed as many relevant review reports as possible. Originality/value: This is an important and timely topic for debate, given that the UK Government is proposing reform of the MHA 1983. In addition, existing thematic reviews of SARS tend to be generalised, rather than specifically focused on the MHA. [ABSTRACT FROM AUTHOR]

Purpose: The skillsets of science, technology, engineering and mathematics (STEM) graduates are widely recognised to be important for economic prosperity. At the same time, it is broadly accepted that in England there is a need to increase the number of people studying STEM degree courses and working in STEM. However, despite decades of interventions post-16, STEM participation rates remain lower than projected requirements. Some research reports suggest a lack of positive attitudes towards these subjects and aspirations amongst some social groups. As these debates continue, official reports such as those released by the Department for Education show these patterns from the labour market and higher education (HE) extend to both attainment and participation in science and math in school. Design/methodology/approach: In this paper, the authors summarise the authors' findings from the analysis of official reports, policy documents and major research reports focussing on attainment in school science and math and post-compulsory STEM participation. Findings: The authors identify the problematic ways in which STEM subject choices are made across the student life cycle and then discuss how the leaky pipeline metaphor can be ambiguous and needs to be used with caution. Research limitations/implications: Some aspects identified here warrant further research and will be of particular interest to researchers, practitioners and policymakers. Originality/value: In this new report, the authors identify the problematic ways in which STEM subject choices are made across the student life cycle in England and then discuss how the leaky pipeline metaphor can be ambiguous and needs to be used with caution. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to explore the contribution of safeguarding adult reviews (SARs) to the contemporary stories of what social work practice is and what social workers should do. Evidence of this contribution is sought by analysis of SARs as publicly available documents capturing contemporary social work alongside considering social worker's views of these reports. Design/methodology/approach: This paper presents two components of the wider research study as follows: documentary analysis exploring discussions of social work practice held within a sample of SARs xD;xA; and analysis of focus groups and semi-structured interviews established to explore the knowledge, experience and views of front-line social workers in relation to SARs. Findings: It is suggested that social workers locate the value of SARs within the arena of learning and development often celebrating the SAR processes in bringing agencies together more so than the actual report. This paper argues that SARs hold considerable power in their ability to present a narrative about contemporary social work in England, and that social workers themselves can be wary of this power. Research limitations/implications: The research is limited by the scope of the data which includes a sample of SARs from one geographical area and data collected from social workers who volunteered to participate. Practical implications: This paper draws on the evidence gathered and presents some recommendations to support the potential for SARs to positively enhance social work identity and practice. Social implications: This paper explores the stories about social work that are found within a sample of SARs and seeks to explore how these stories fit with the stories that social workers themselves share about SARs. Originality/value: There has been considerable research interest in SARs; however, to date there has not been a research exploration of the impact of SARs on professional social work and front-line social workers in practice. This paper presents early findings and analysis from research in progress as part of a Doctorate of Social Work Study at University of East London who provided ethical approval and supervisory support. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the perceptions and experiences of a group of extra care tenants, who, as novice internet users, began to maintain their social relationships online. Housing transitions in later life may jeopardise existing social relationships, leading to loneliness and social isolation. More recently, Covid-19 restrictions have limited familial face-to-face contact and wider social interactions. Thus, extra care tenants, who are not already online, may benefit from acquiring internet skills. This paper aims to enhance understanding of the participants' transition from novices to experienced internet users and the impact on their social relationships and sense of self. Design/methodology/approach: A longitudinal, hermeneutic phenomenological study was conducted over eight months in two extra care housing schemes in north east England. Ten participants (56–98 years) with age-related physical, sensory and cognitive losses were recruited to the study. A series of semi-structured interviews and participant diaries captured the participants' experience as they developed internet skills and communicated online. Findings: All participants, including a blind individual, learnt to communicate online. Personalised adaptive strategies, peer support, training and management involvement facilitated internet uptake. Participants felt their social relationships were supported, and they regained biographical continuity, through being and feeling they belonged in the modern digital world. Originality/value: The online experiences of extra care tenants are rarely voiced. Their perceptions may assist others to engage online, maintaining social connections, which could otherwise be lost. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to evaluate pre- and post-formulation findings with multi-disciplinary staff within two secure children's homes (SCHs) in the North East of England. Design/methodology/approach: Multi-disciplinary staff teams involved in formulation across two SCHs were administered pre- and post-formulation questionnaires. The pre- and post-formulation questionnaires focused on five domains: knowledge; confidence; motivation; understanding; and satisfaction with treatment plan. Findings: A total of 338 pre- and post-formulation questionnaires were administered across 43 formulation meetings. The highest proportion of formulation attendees were: residential staff (44%); mental health staff (17%); case managers (12%); and education staff (9%). Paired samples t-tests showed significant post-formulation improvements across all domains including: knowledge [t(337) = 22.65, p < 0.001]; confidence [t(337) = 15.12, p < 0.001]; motivation [t(337) = 8.27, p < 0.001]; understanding [t(337) = 19.13, p < 0.001]; and satisfaction [t(337) = 18.81, p < 0.001]. Research limitations/implications: The SECURE STAIRS framework has supported formulation developments across the Children and Young People's Secure Estate. Preliminary findings within two SCHs suggest multi-disciplinary staff teams find psychologically informed formulation beneficial. Future directions are considered including future evaluation of young person involvement in formulation meetings. Originality/value: There is a notable lack of existing research within the child and young people secure estate evaluating the impact of SECURE STAIRS trauma-informed care developments including the impact of team formulation. This paper adds to the evidence base. [ABSTRACT FROM AUTHOR]

Purpose: The disproportionate representation in juvenile justice systems of children who are, or have been, in the care of the state is a major cause of concern internationally. However, the experiences of this particular group are largely absent from both policy debates and the international research base. This paper aims to correct that deficit by exploring the lived experiences of residential care, justice-involved children. Design/methodology/approach: An interpretivist investigation of care experienced children's perceptions of their experiences, involving semi-structured interviews with a purposive sample of 19 children in England who were simultaneously in residential care and subject to youth justice supervision. Data were analysed using thematic content analysis. Findings: Care-experienced children described how their experiences of residential care environments and regimes have undermined their sense of how they see themselves, now and looking to the future. Against this background of disrupted identity, they also reported stigmatising interactions with staff that leave them feeling labelled both as a generic "looked-after child" and as a "bad kid". Research limitations/implications: The findings are based on the perceptions of a group of children in the criminal justice system, which, although reflecting the experiences of those with negative outcomes, may not be representative of all children in residential care. Practical implications: The findings have implications for those responsible for the care and development of care-experienced children, as well policymakers concerned with reducing the numbers of care-experienced children in youth justice. Those responsible for the care and development of care-experienced children should consider steps to reduce how factors outlined here disrupt a child's sense of self and introduce criminogenic labelling and stigma. Originality/value: Despite a number of studies seeking to understand why the number of care experienced children in the youth justice system is disproportionate, there is very little empirical work that seeks to understand the experiences and perceptions of children currently both in care and the criminal justice system. This paper seeks to correct this deficit, by detailing how children who are both in residential care and subject to youth justice supervision view their care experiences. The implications of this for policy, practice and further research are then explored. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them. Design/methodology/approach: IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned. Findings: There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning. Practical implications: This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research. Originality/value: To the best of the authors' knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally. [ABSTRACT FROM AUTHOR]

Purpose: This commentary explores the challenges and themes enumerated by the associated article "Why am I still in hospital? Evaluation of delayed discharges from two learning disability assessment and treatment units in England". This commentary broadens and outlines the research's background, premise and potential impact. This paper aims to critically examine the evidence on this subject. Design/methodology/approach: This commentary considers the attitudes to inpatient care for people with learning disabilities in the past decade and outlines a possible compact for the future. Findings: Contrary to popular and emotive beliefs that using specialist inpatient psychiatric settings for people with learning disabilities is universally a poor practice, there are defined occasions when such settings are needed and imperative in the clinical pathway. If people with learning disabilities can access inpatient settings at the right time for the right reason, psychiatric outcomes could be improved. Timely discharge is imperative and currently lacking due to a lack of suitable engagement mechanisms between inpatient settings and the community. Thus, evidence-based outcome tools are essential to facilitate appropriate discharge. Originality/value: There is an ongoing debate on the value and utility of specialist inpatient psychiatric units for people with learning disabilities. This commentary provides a balanced, evidence-based insight into this discussion. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider some possible reasons for the relatively high rate in Wales of children looked after by local authorities. Design/methodology/approach: Selected potential explanations for Wales having higher rates were tested against aggregate data from published 2021 Government statistics. Wales was compared with England and English regions for area deprivation, local authority spending, placements at home and kinship foster care. Descriptive statistics were produced, and linear regression was used where appropriate. Findings: Wales has higher overall children looked-after rates and a bigger recent increase in these than any English region. Deprivation in Wales was higher than in most English regions. However, a smaller percentage of Welsh variation in local authority looked-after rates was explained by deprivation than was the case for England. Spending on preventative services has increased in recent years in Wales whilst decreasing in England, and there was not a clear relationship between spending on preventative services and the looked-after rate. Wales had a higher rate of care orders placed at home and more children per head of population in kinship foster care than any English region. Some of the explanations that have been suggested for Wales's particularly high looked-after rates seem to be supported by the evidence from aggregate data and others do not. Practice variation is likely to also be an important part of the picture. Originality/value: This is an original comparison of Wales, England and English regions using aggregate data. More fine-grained analysis is needed using individual-level data, multivariate analysis and qualitative methods. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present findings from a mixed-methods study on the impact that COVID-19 has had on adult safeguarding. The research sought to explore the challenges and opportunities presented by COVID-19 to both frontline and non-frontline professionals working in adult safeguarding. Design/methodology/approach: A mixed-methods project was undertaken comprising a literature review, survey, semi-structured interviews and a small number of freedom of information requests. This paper presents the findings predominantly from the survey and interviews. Findings: Unsurprisingly, COVID-19 has presented a variety of challenges for professionals working in adult safeguarding. The themes that occurred most often were the day-to-day changes and challenges, relationships across sectors, information and navigating the ethical questions in safeguarding. Originality/value: To the best of the authors' knowledge, the findings represent the first focused qualitative mixed-method study aimed at understanding more about the impact the pandemic has had on adult safeguarding through the eyes of those professionals working in that field. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to underline the importance of using a collaborative approach when designing and adapting a post diagnostic psychosocial intervention of cognitive stimulation therapy (CST) for people with intellectual disability and dementia. Design/methodology/approach: As part of a service improvement, a manual of CST was adapted, for delivery in clinical practice. A qualitative co-production method allowed participants with a lived experience to provide regular feedback relating to the development of the adapted CST manual and intervention programme. This feedback was used to make continual development changes to the CST manual. Findings: The study demonstrated co-production with those who provide care is valuable in adapting psychosocial therapies for people with an intellectual disability and dementia. Additional findings identified the need for carer education in ageing, dementia care and the physical health needs for older people with intellectual disability. Originality/value: To the best of the authors' knowledge, this is the first study that has used a co-production approach with families and carers in adapting a group therapy programme for people with an intellectual disability. This paper underlines the need for post diagnostic clinical interventions for people with dementia and those who provide care. [ABSTRACT FROM AUTHOR]

Purpose: This paper reviews changing government policy on adult education in England over the past 20 years and the funding regimes affecting adult and community learning and union-led learning, which play a major role in learning opportunities for socially excluded adults. Design/methodology/approach: A review and analysis of extant literature, informed by previous involvement in the sector and ongoing collaborations. Findings: Two decades ago, adult education in England provided a variety of learning opportunities for people who either had limited qualifications or who needed to reskill for whatever reason. Access to those opportunities has been reduced just when it is most needed. Research limitations/implications: This is a review and viewpoint paper based on experience in England, the limitations of which are discussed in the concluding section. Notwithstanding the institutional specificities of adult education in England, many of the implications are generic and have wider relevance beyond this country context. Practical implications: Economic recovery post-coronavirus (COVID) and Brexit will require more access to adult education so people can prepare for labour market re-integration. The practical implication of extending provision in adult education to support labour market integration of vulnerable workers is relevant to most countries. Originality/value: This paper takes a holistic view of adult education, with particular attention to adult and community learning and union-led learning. [ABSTRACT FROM AUTHOR]

Purpose: This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based charity) perinatal support in two prison settings in England. The initiative involved the provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters. Design/methodology/approach: A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n = 9); audio recorded interviews (n = 33) with prison and health-care staff, women in prison, peer supporters and BC staff; analysis of existing routinely collected data by BC and notes undertaken during regular meetings (n = 10) with the BC Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software. Findings: BC provided instrumental/practical support, emotional support, information support, signposting to services and advocating for women to the prison concerning their perinatal needs and rights. Key themes revealed that support had an impact on the lives of perinatal women by creating a safe place characterised by meaningful interactions and women-centred approaches that facilitated access to wider care and support. The service made a difference by empowering women and providing added value for peer supporters, prison, health-care and BC staff. Key enablers and strategies for the care of perinatal women and the delivery of perinatal support are also detailed. Originality/value: Through longitudinal data and the involvement of a range of stakeholders, this study evidences the subtleties of support provided by BC and the potential it has to make a difference to perinatal women in prison and those volunteering or working within the prison system. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to demonstrate that the eventual legalisation of assisted dying in England and Wales should extend to persons deprived of liberty, as well. Design/methodology/approach: Using a relational view of dignity strengthens the argument that the need to protect the dignity of persons deprived of liberty requires the extension of the legalisation of assisted dying to persons deprived of liberty once generally achieved in England and Wales. Findings: Three aspects make dignity a relational concept – dignity being attributed by society, dignity working as a restraint on others and dignity requiring specific behaviours. All these elements support the claim that assisted dying should be available to persons deprived of liberty, once legalised in England and Wales. Originality/value: Both the legalisation of assisted dying for persons deprived of liberty and the concept of relational dignity have to date found little attention. With a legalisation of assisted dying being debated in England and Wales, it is pertinent to discuss its application to persons deprived of liberty, who would undoubtedly not automatically benefit from a future Assisted Dying Act. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe a literature review and online survey to explore the provisions and support for people living with dementia in housing with care (HwC) settings within England. Design/methodology/approach: An initial scoping literature review was conducted to synthesise the evidence relating to residents living with dementia in HwC settings and informed the development of an online survey distributed to HwC housing managers to explore the provisions, policies, procedures and support services relating to people living with dementia in HwC settings. Findings: The findings provided a picture of HwC settings in England and the residents, particularly those living with dementia, in terms of policies and procedures, reasons for moving into HwC, reasons for denying entry, reasons for leaving, positive outcomes, staff knowledge and training, environmental design, challenges and successes. Research limitations/implications: The survey responses were from a self-selected sample of HwC providers and scheme/village managers; thus, it may be the case that the settings involved were doing more to support residents living with dementia. It should also be appreciated that the responses were based on the perceptions of the individual staff members completing the survey, not those of the HwC residents. Originality/value: This study presented a picture of the current state of provisions and support for people with dementia within HwC settings in England, providing an essential platform from which to undertake targeted research to help shape future provision and enabling housing providers to assess their current schemes within the wider context. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England. Design/methodology/approach: The MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed. Findings: Results showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions. Originality/value: This project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the concept and practice, of dignity as understood and experienced by older adults and district nursing staff. The paper adds a new, nuanced, understanding of safeguarding possibilities in the context of district nursing care delivered in the home. Design/methodology/approach: The research used an ethnographic methodology involving observations of care between community district nursing clinicians and patients (n = 62) and semi-structured interviews with nursing staff (n = 11) and older adult recipients of district nursing care (n = 11) in England. Findings: Abuse is less likely to occur when clinicians are maintaining the dignity of their patients. The themes of time and space are used to demonstrate some fundamental ways in which dignity manifests. The absence of dignity offers opportunities for abuse and neglect to thrive; therefore, both time and space are essential safeguarding considerations. Dignity is influenced by time and how it is experienced temporally, but nurses are not allocated time to "do dignity", an arguably essential component of the caregiving role, yet one that can become marginalised. The home-clinic exists as a clinical space requiring careful management to ensure it is also an environment of dignity that can safeguard older adults. Practical implications: District nurses have both a proactive and reactive role in ensuring their patients remain safeguarded. By ensuring care is delivered with dignity and taking appropriate action if they suspect abuse or neglect, district nurses can safeguard their patients. Originality/value: This paper begins to address an omission in existing empirical research regarding the role of district nursing teams in delivering dignified care and how this can safeguard older adults. [ABSTRACT FROM AUTHOR]

Purpose: With the growth of entrepreneurship education adoption in higher education institutions (HEIs), the importance of assessments as a tool to gauge and enhance learning is of utmost importance. The purpose of this paper is to examine the influence and appropriateness of current assessment methods for engineering and technology students in Nigerian and British HEIs. Design/methodology/approach: The study employs a qualitative research method with a case study approach to investigate the impact and suitability of assessment methods currently used within entrepreneurship education in Nigeria and England. Findings: The results reveal that lecturers across both countries believed that assessment methods currently in use were appropriate, but were not uniform in its influence on learning. However, students were unanimous in that most assessment methods currently used were not effective at enhancing their learning, not very appropriate, and were not a good judge of their work and effort. The results were used in building a framework to understand the importance of assessment methods in entrepreneurship education. Originality/value: In light of the inadequate literature, this paper covers an acute gap in the field. This will allow policymakers and different interested parties to reassess the development of suitable assessment methods to involve students as key stakeholders. [ABSTRACT FROM AUTHOR]

Purpose: Whilst recruitment and retention of high-quality staff is vital to providing a good service, at the time of the evaluations, Kent, Surrey and Sussex (KSS) was the only area of the UK without a Higher Specialist Training (HST) scheme in intellectual disability (ID). The purpose of this project was to identify barriers to recruitment and support the need for change. Design/methodology/approach: This evaluation included conducting interviews with 16 practitioners in the region with links to ID to consider the gaps in training and find solutions. Findings: Four themes were identified, namely, good experiences are important to recruiting people into the ID field; bad experiences or lack of exposure to people with ID are likely to prevent engagement with this field; there is an ongoing need for specialist psychiatrists in ID services; and there is a developing need for specialists in neurodevelopmental disorders. Finally, the challenge means we need to think differently about developing a workforce. Seven recommendations to support workforce delivery in KSS were developed. Originality/value: This paper highlights an important rationale for ongoing need for HST in ID work and also reasons to engage people in this field. This has not been undertaken in the ID field in this way previously. [ABSTRACT FROM AUTHOR]

Purpose: Health policies in England highlight the need for child and adolescent mental health services (CAMHS) to embed new knowledge in practice, yet evidence remains scarce about the services' ability to learn from the external environment. This paper aims to present a critical analysis of the CAMHS' ability to implement new knowledge through the lens of absorptive capacity, an organisation's ability to identify, assimilate and use new valuable knowledge. Design/methodology/approach: Sixteen semi-structured interviews were conducted with staff from the CAMHS department of a mental health organisation in England to explore the services' absorptive capacity. Findings: Professionals were identified having an impact on the main absorptive capacity components in the following ways: professional background and perceived reliability of knowledge sources appeared to affect knowledge identification; informal communication was found to facilitate knowledge assimilation and exploitation; trust was found to enable knowledge exploitation, particularly between senior management and frontline professionals. At an organisational level, team meetings and internal reporting were identified as enablers to knowledge assimilation and exploitation, while organisational hierarchy and patient data management systems were identified as barriers to knowledge assimilation. No organisational processes were found regarding knowledge identification, indicating an imbalanced investment in the main components of absorptive capacity. Practical implications: Investing in these underpinning factors of absorptive capacity can assist CAMHS with capitalising on new knowledge that is valuable to service provision. Originality/value: This study offers novel insights into the learning ability of CAMHS through the lens of absorptive capacity. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service. Design/methodology/approach: Three services in England were contacted via email and telephone to collect data on their service provision. They were asked about the average age of individuals when receiving a baseline assessment, frequency of follow-up assessment, assessment instruments used and descriptive aspects of their services. Findings: All three services offered proactive dementia assessment services to people with Down's syndrome (DS), with one service providing systematic screening via the GP. None offered proactive screening to people with intellectual disabilities who did not have a diagnosis of DS. All offered reactive assessment to this population if they experienced a decline in function. Services differed in terms of age at which baseline assessments were offered, frequency of follow-up and instruments used. Originality/value: To the best of the authors' knowledge, this is the first paper to compare dementia assessment provision between different services in England. [ABSTRACT FROM AUTHOR]

Purpose: The outbreak of the severe acute respiratory syndrome coronavirus 2 virus and subsequent COVID-19 illness has had a major impact on all levels of society internationally. The extent of the impact of COVID-19 on prison staff and prisoners in England and Wales is unknown. Testing for COVID-19 both asymptomatic and symptomatic, as well as for antibodies, to date, has been minimal. The purpose of this paper is to explore the widespread testing of COVID-19 in prisons poses philosophical and ethical questions around trust, efficacy and ethicacy. Design/methodology/approach: This paper is both descriptive, providing an overview of the widespread testing of COVID-19 in prisoners in England and Wales, and conceptual in that it discusses and argues the issues associated with large-scale testing. This paper provides a discussion, using comparative studies, of the issues associated with large-scale testing of prisoners across the prison estate in England and Wales (120 prisons). The issues identified in this paper are contextualised through the lens of COVID-19, but they are equally transferrable to epidemiological studies of any pandemic. Given the prevalence of COVID-19 globally and the lack of information about its spread in prisons, at the time of writing this paper, there is a programme of asymptomatic testing of prisoners. However, there remains a paucity of data on the spread of COVID-19 in prisons because of the progress with the ongoing testing programme. Findings: The authors argue that the widespread testing of prisoners requires careful consideration of the details regarding who is included in testing, how consent is gained and how tests are administered. This paper outlines and argues the importance of considering the complex nuance of power relationships within the prison system, among prisoner officers, medical staff and prisoners and the detrimental consequences. Practical implications: The widespread testing of COVID-19 presents ethical and practical challenges. Careful planning is required when considering the ethics of who should be included in COVID-19 testing, how consent will be gained, who and how tests will be administered and very practical challenges around the recording and assigning of COVID-19 test kits inside the prison. The current system for the general population requires scanning of barcodes and registration using a mobile number; these facilities are not permitted inside a prison. Originality/value: This paper looks at the issues associated with mass testing of prisoners for COVID-19. According to the authors' knowledge, there has not been any research that looks at the issues of testing either in the UK or internationally. The literature available details countries' responses to the pandemic rather and scientific papers on the development of vaccines. Therefore, this paper is an original review of some of the practicalities that need to be addressed to ensure that testing can be as successful as possible. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. It also explores whether lessons are being learned from the findings and recommendations of an increasing number of reviews on self-neglect cases. Design/methodology/approach: Further published reviews are added to the core data set, mainly drawn from the websites of safeguarding adults boards (SABs). Thematic analysis is updated using the domains used previously. The domains and the thematic analysis are grounded in the evidence-based model of good practice, reported in this journal previously. Findings: Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. Multiple exclusion homelessness and alcohol misuse are prominent. Some SABs are having to return to further cases of self-neglect to review, inviting scrutiny of what is (not) being learned from earlier findings and recommendations. Research limitations/implications: The national database of reviews commissioned by SABs remains incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. National Health Service Digital annual data sets do not enable the identification of reviews by types of abuse and neglect. However, the first national analysis of SARs has found self-neglect to be the most prominent type of abuse and/or neglect reviewed. Drawing together the findings builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Practical implications: Answering the question "why" remains a significant challenge for SARs. The findings confirm the relevance of the evidence-base for effective practice but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of research and other published SARs might assist with answering the "why" question. Greater scrutiny is needed of the impact of the national legal, policy and financial context within which adult safeguarding is situated. Originality/value: The paper extends the thematic analysis of available reviews that focus on study with adults who self-neglect, further reinforcing the evidence base for practice. Propositions are explored, concerned with whether learning is being maximised from the process of case review. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy. Design/methodology/approach: A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores. Findings: Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size. Originality/value: This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the significant and high death toll of COVID-19 on care home residents and social care staff in England and Wales. These mortality figures, alongside differential treatment of residents and staff during the pandemic, are conceptualized as a form of structural abuse. Arguments are made for the inclusion of structural abuse as a separate category of elder abuse. Design/methodology/approach: This paper is predominantly conceptual but it also draws on available secondary data, such as mortality statistics, media reports and developing research. Findings: The lack of appropriate personal protective equipment, paucity of guidance and high mortality rate among care home staff and residents during the pandemic is indicative of social discourses that, when underpinned by ageism, reflect structural elder abuse. Research limitations/implications: The research is limited by its focus on a specific time period and its recency. It is also limited in not being based on primary empirical research but it remains exploratory and conceptual and provides a base for ongoing research in this area. Social implications: If structural elder abuse was to be included in classifications, it demands a rethink of social and health-care services and the policies and practices associated with them and reinforces the government message that safeguarding is everyone's business. Originality/value: Research concerning the effects and impact of COVID-19 are still in their early stages. However, the central element of originality in the paper concerns the linking of practices, policies and underlying social assumptions and structural, or societally ingrained, elder abuse. [ABSTRACT FROM AUTHOR]

Purpose: Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors' knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach: This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings: There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service. Practical implications: Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a "healthy" level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people's functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value: This paper evaluates a young person's functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to set out to share the reflections of safeguarding adult board managers as they worked through what is likely to be just the first wave of the coronavirus COVID-19 pandemic. Design/methodology/approach: The paper draws on the experience of small number of safeguarding adult board managers who have provided reflections from practice. Findings: This paper illustrates just some of the responses developed by safeguarding adult board managers and their boards to continue to deliver the work of safeguarding those at risk of abuse and harm in the face of unprecedented impact of the coronavirus COVID-19 pandemic on a key aspect of the safeguarding adult system in England. Originality/value: The reflections reported here are not intended to offer a representative commentary on the experiences of those who oversee and manage safeguarding adults' boards. It is intention to provide a flavour of some of the challenges and dilemmas faced and some of the creative solutions to address them used by one group of adult safeguarding practitioners. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present an analysis of a "county lines" safeguarding partnership in a large city region of England. A critical analysis of current literature and practice responses to "county lines" is followed by the presentation of an analytical framework that draws on three contextual and social theories of (child) harm. This framework is applied to the partnership work to ask: are the interconnected conditions of criminal exploitation of children via "county lines" understood?; do interventions target the contexts of harm?; and is social and institutional harm acknowledged and addressed? Design/methodology/approach: The analytical framework is applied to a data set collected by the author throughout a two-year study of the "county lines" partnership. Qualitative data collected by the author and quantitative data published by the partnership are coded and thematically analysed in NVivo against the analytic framework. Findings: Critical tensions are surfaced in the praxis of multi-agency, child welfare responses to "county lines" affected young people. Generalising these findings to the child welfare sector at large, it is proposed that the contextual dynamics of child harm via "county lines" must be understood in a broader sense, including how multi-agency child welfare practices contribute to the harm experienced by young people. Originality/value: There are limited peer-reviewed analyses of child welfare responses to "county lines". This paper contributes to that limited scholarship, extending the analysis by adopting a critical analytic framework to a regional county lines partnership at the juncture of future national, child welfare responses to "county lines". [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the barriers to accessing mental health support for people experiencing multiple disadvantage along with some potential solutions for attempting to overcome these. It draws on evidence and learning from 12 voluntary sector-led partnerships in England funded by the National Lottery Community Fund's Fulfilling Lives programme. Design/methodology/approach: Qualitative research was undertaken with frontline staff, senior leaders, volunteers, beneficiaries and stakeholders from Fulfilling Lives partnerships. This comprised focus groups (21 participants) and individual face-to-face interviews (41 participants), both of which explored barriers and local solutions to accessing statutory mental health services. Following a thematic analysis of transcripts, research participants and stakeholders were invited to a face-to-face workshop to review and validate emerging findings (34 participants). Findings: People experiencing multiple disadvantage face significant barriers in accessing support for their mental health. These include a complex system that is difficult to navigate, long waiting lists, high eligibility thresholds and models of support that lack flexibility. Fulfilling Lives partnerships have had the funding and the flexibility to trial different approaches. Promising solutions to barriers include the use of navigators, person-centred support and multi-agency networks and training. However, overcoming systemic barriers remains the most difficult challenge. Originality/value: Fulfilling Lives was a rare example of substantial and long-term (eight years) funding to work with people experiencing multiple disadvantage. This provided a unique opportunity to try different approaches and gather learning. The programme evaluation provides insights into the experiences of people facing multiple disadvantage and those who support them and offers evidence-based suggestions for policy and practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to highlight the findings of this research. A research paper was published in October 2021 highlighting results of freedom of information (FOI) requests sent to National Health Service (NHS) Trusts in England. The FOI requests asked for the number of incidents of sexual assault reported by hospitals where the victim was aged over 60 and the alleged perpetrator was a member of staff. Design/methodology/approach: The methodology involved sending FOI requests to all 206 NHS hospital Trusts in England requesting information on reported incidents of sexual assault against patients over 60 years old from 2016/17 to 20/21, where the alleged perpetrator was a member of staff (including agency staff). Along with the number of reports, the FOI request also asked for the sex of the victim and alleged perpetrator, whether the incident was reported to police, the outcome of the police investigation and whether any internal disciplinary processes were followed. Findings: Of the hospitals that responded with some data (others were nil return), 56 individual reports meeting the criteria of the FOI were identified. A further 19 hospitals advised that they held reports of such incidents but, under general data protection regulations, they were unable to disclose exact numbers, but they were less than 5, some hospitals said less than 10, so the research can only count one for each of these. The resulting findings are that there were at least 75 reports of sexual assault on patients over 60 by hospital staff in the past five years. The findings also show that whilst the majority of victims were female, 30% were male and that a disappointing number were reported to police – only 16. Of these, 14 were closed as "No Further Action" by the police. Originality/value: Whilst there has been some research into sexual violence against older people, most notably by Dr Hannah Bows, the issue of sexual assault happening whilst in hospital perpetrated by hospital staff has not been studied. [ABSTRACT FROM AUTHOR]

Purpose: Strategic socio-political views are notably scarce among contemporary discourses on the causes of abuse of vulnerable older people in care and nursing homes. This paper aims to catalyse higher order consideration and discussion of one socio-political characteristic that has relevance to the issue of abuse, that is, the market-like environment in which care and nursing homes in England operate. In doing so, the paper argues that the now firmly established but imbalanced "quasi-market" of care that has developed over many years fosters conditions under which both poor care and abuse are more likely to occur. The evidence presented in the paper focusses primarily on the rise to dominance of for-profit care home provision and the contraction of public sector provision. The paper does not examine in detail the characteristics and market presence of the not-for-profit sector because it has not held a numerically significant market share either historically or contemporarily. Design/methodology/approach: Outcomes of the marketisation of the care home sector that has its origins in the political landscape prevailing in 1979 and thereafter, along with the concurrent development of its regulation and oversight, are narrated and analysed. From this, a mythos of the motives behind the transition to a market-like economy that has taken place over four decades is developed and used to explain how prevailing market conditions contribute to the perpetuation of poor care and abuse. Findings: In the opinion of the author, there are identifiable consequences arising from the evolution of the current care economy that dispel the beliefs that providing care by means of current market-like arrangements is advantageous, that the independent regulation and monitoring of such a market is unproblematic and effective, and that the "consumers" in this market are exercising personal choice, in accord with classical economic theory. Practical implications: The paper offers the opportunity for the reader to consider how the development of a "quasi" market of care and nursing home services that has come to be dominated by for-profit private providers, and that is subject to ineffective oversight, may have contributed to conditions where abuse is more likely to occur and endure. Originality/value: This is a conceptual paper that explores the consequences of the creation of the market-like economy of care in which care and nursing homes now operate and suggests that it is time for prevailing market conditions to be re-visited and subjected to remedial strategic intervention. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe the current situation in relation to restrictive interventions, and some actions that could be taken to reduce them. The quality of care provided by inpatient services for people with intellectual disabilities has come under increasing scrutiny in recent years – from Winterbourne View in 2011 to Whorlton Hall in 2019, there has been increasing concern that admission to hospital does not always result in a good outcome for the patients. For some people, it has resulted in further deterioration in their physical and mental health, separation from families and supports and reduced probability of living as part of their community. This is in spite of knowledge and evidence of what good practice looks like. Design/methodology/approach: This paper examines the extent to which inpatient services deliver good practice in treatment and care and, where this is not happening, the extent to which they are subject to effective governance. Findings: People admitted to inpatient services can be at risk of poor-quality care and the overuse of restrictive interventions. There is guidance available that addresses what should be in place for them to receive high-quality care and treatment, and this clearly is available to many people. However, others can find themselves placed in increasingly restrictive environments and in circumstances where their human rights are at risk of being breached. There is increasing evidence that these services do not follow good practice guidance in terms of staff skills, development and implementation of effective care plans and governance arrangements that address these issues. Regulators, commissioners and managers could, and should, focus on these issues to ensure that the most vulnerable receive the care and treatment they need while in hospital. Originality/value: Service providers are aware of the difficulties in developing alternative community services. This places even more importance on the need to ensure that care and treatment in hospital is of a good standard, and that the use of restrictive interventions is minimised. McGill et al. (this issue) describe the features of a capable environment and it may be that hospitals consider that the requirements are unlikely to be implemented effectively in a ward/unit setting. However, a shift of focus in doing this could result in a reduction in restrictive interventions and a better experience – potentially for both the staff and the patients. And families could have some reassurance that their relative was receiving the best quality care and treatment, and that their human rights were being upheld. [ABSTRACT FROM AUTHOR]

Purpose: There is interest in promoting health in prison from governmental levels, but, to date, understanding how best to do this is unclear. This paper argues that nuanced understanding of context is required to understand health promotion in prison. The purpose of the paper is to examine the potential for empowerment, a cornerstone of health promotion practice, in high-security prison establishments.Design/methodology/approach: Independent prison inspections, conducted by Her Majesty's Inspectorate of Prisons for England and Wales, form a critical element in how prisons are assessed. Documentary analysis was undertaken on all eight high-security prison reports using framework analysis.Findings: Analysis revealed elements of prison life which were disempowering and antithetical to health promotion. While security imperatives were paramount, there were examples where this was disproportionate and disempowered individuals. The data show examples where, even in these high-security contexts, empowerment can be fostered. These were exemplified in relation to peer approaches designed to improve health and where prisoners felt part of democratic processes where they could influence change.Practical Implications: Both in the UK and internationally, there is a growing rhetoric for delivering effective health promotion interventions in prison, but limited understanding about how to operationalise this. This paper gives insight into how this could be done in a high-security prison environment.Originality/value: This is the first paper which looks at the potential for health promotion to be embedded in high-security prisons. It demonstrates features of prison life which act to disempower and also support individuals to take greater control over their health. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine reform of mental health legislation in England and Wales. It covers the period from the introduction of the 1983 MHA to the proposed reforms outlined in the Wessley Review that was published in December 2018. Design/methodology/approach: This is a literature-based project. Findings: Reform of the mental health legislation reflects two potentially conflicting strands. One is the state's power to incarcerate the "mad", and the other is the move to protect the civil rights of those who are subject to such legislation. The failures to development adequately funded community-based mental health services and a series of inquiries in the 1990s led to the introduction of Community Treatment Orders in the 2007 reform of the MHA. Research limitations/implications: The development of mental health policy has seen a shift towards more coercive approaches in mental health. Practical implications: The successful reform of the MHA can only be accomplished alongside investment in community mental health services. Originality/value: The paper highlights the tensions between the factors that contribute to mental health legislation reform. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents the results of a thematic analysis of safeguarding adults reviews (SARs) where homelessness was a factor to illuminate and improve safeguarding practice and the support of adults who are homeless in England. Design/methodology/approach: SARs were identified from a variety of sources and a thematic analysis was undertaken using data extraction tables. Findings: In addition to identifying shortcomings in inter-agency co-operation, SARs highlighted a failure to recognize care needs and self-neglect among people with experience of homelessness and evidenced difficulties in engagement between professionals and people with experience of homelessness. Research limitations/implications: The authors may have failed to find some SARs in this category (there is no central registry). SARs vary in quality and in detail; some were not full reports. The approach to people's experience of homelessness was broad and covered more than the circumstances of people who were rough sleeping or living on the streets. Originality/value: This paper contributes to the current practice debates and policy initiatives in respect of homelessness and safeguarding in England. It may have wider relevance in the rest of the UK and internationally. [ABSTRACT FROM AUTHOR]

Purpose: With the temporary housing of rough sleepers in response to the Covid-19 emergency, some commentators have been tempted to believe that the rising population of rough sleepers in the UK has finally been reversed. This paper aims to examine the choices made by persistent rough sleepers and how far they are influenced by the perverse incentives of social policies, in order to challenge the view that they sleep rough out of choice. Design/methodology/approach: Evidence for this paper is derived from two teams of frontline service providers with routine familiarity with the rough sleeping population: a street outreach team and a team of support workers working with adults with multiple and complex needs. Primary data from focus groups were combined with the secondary analysis of both numerical and narrative accounts routinely recorded by both teams. Findings: The exercise of agency by persistent rough sleepers is constrained by a mixed baggage of complex needs, past negative risk assessments, limited resources and regulatory deterrents to generate choices to reject help that appear irrational. These need to be understood if recent policy initiatives to end rough sleeping are to be effective. Originality/value: The paper draws on the experience and comprehensive records of practitioners with intimate knowledge of the rough sleeping population. It extends narrative accounts of causes by focusing on key choices to show how the perverse incentives of policy combine with personal factors to incline rough sleeping to persist. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe and discuss both the early implementation of a US mental health intervention for young children in the context of its introduction to a pilot site in a London borough and the progress made in establishing a randomised controlled trial (RCT). Design/methodology/approach: This paper describes an evaluation of a new intervention and the learning that followed in terms of its implementation and future evaluation. Qualitative data were collected from a range of stakeholders and practitioners through interviews and small group discussions. These interviews focussed on both of these issues, with particular reference to the proposal to conduct an RCT. Findings: The findings of this evaluation add to the evidence on how best to support new initiatives that have been introduced from other settings and countries to embed in a receiving site and the optimal timing and feasibility of conducting an RCT. At the end of the feasibility study, which took place within the year of the service being introduced and which was only open to clients for six months of this year the conclusion was that an RCT at that point was neither possible nor desirable. Over the following years, the commitment of the judiciary to examine if there was a way to make an RCT study in respect of this intervention meant that a template was established that may well have broader application. Research limitations/implications: At a time when there is an increasing demand for evidence on effective interventions this paper makes a valuable contribution to the development of RCTs in general and specifically in the family court arena. It also recommends that attention must also be paid to the time, which is needed to implement and establish interventions and then to test them. Practical implications: This paper highlights the need to establish realistic timescales not only around the implementation of initiatives but also for their evaluation. Originality/value: This study breaks new ground in considering implementation challenges in the court and children's services' context. It brings to the fore the important role of the judiciary in approving new processes. [ABSTRACT FROM AUTHOR]

Purpose: Traditional understandings of financial abuse are limited to particular situations and people who have close access to vulnerable adults. This paper aims to add to a debate that intends to push the boundaries of the understanding of financial abuse further. In particular, it seeks to add to the understanding of what financial abuse might look like and who the perpetrators of such abuse can be. In so doing, it seeks to offer greater protection to the vulnerable. Design/methodology/approach: Focusing on exploring the minutes of Church of England disciplinary tribunals, held to provide accountability for clergy, this paper considers how the church seeks to represent and construct the victims of financial abuse. Findings: The paper identifies that the victims of financial abuse are whitewashed out of the tribunal minutes and discovers that the disciplinary tribunal is solely concerned with the financial loss afforded by the church. This discovery offers a new context in which it is possible to explore the competing interest in, what has been regarded as, the "legitimate assets" of older parishioners. It provides an example of how organisations and individuals compete for them. Originality/value: This paper adds to the debate about the everyday nature of financial abuse and when and where it might take place. It provides an opportunity to reconsider potential offenders and the means by which abuse might be reduced. In exploring how the financial abuse of potentially vulnerable people can be reframed so that it is hidden by process and procedure, this paper offers an insight into the means by which it is possible to promote transparency and greater accountability. [ABSTRACT FROM AUTHOR]

Purpose: Concerns about the overuse, misuse and potential abuse of restrictive interventions used to manage people who may exhibit behaviour described as challenging led to revised guidance in England. The purpose of this paper is to examine the implementation of this guidance in organisations providing services for people with learning disabilities. Design/methodology/approach: A survey collected data from professionals, on leadership, data use, staff issues and post-incident review. Findings: Most senior leaders were seen as acting on the guidance. Data collected were regarded as generally accurate, but less than half of the managers were seen as likely to respond to consistently high or increasing use of restrictive practices. Frontline staff and managers were seen as very significant for reducing restrictive practices. Uncertainty was shown regarding the goals and activities needed to provide post-incident review. Research limitations/implications: This exploratory survey may be useful for organisations wanting to audit their implementation of government policy and/or for research on a wider scale to indicate how well societies are implementing policy to reduce restrictive practices. Further research on the survey's validity and reliability is required. Practical implications: Further action is needed to encourage all organisations to implement best practice and government policy. This survey showed that some organisations appear to be committed to and potentially achieving reductions in restrictive practices. Originality/value: This paper describes the first survey designed to evaluate organisational efforts to implement an important policy initiative. [ABSTRACT FROM AUTHOR]