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Purpose: The purpose of this paper is to provide a literature review on what is known about unpaid family carers who are at risk of or have experienced abuse from the people they provide care for and relevant policy/legal and practice responses for affected family carers. Design/methodology/approach: A literature search was carried out to locate literature relating to unpaid family carers who are at risk of or have experienced abuse from the people they provide care for. This also incorporated grey literature, including policy guidance and law, to determine the existing knowledge base, gaps in practice and areas that might require further research. Findings: The findings suggest that although carer harm is serious, it is under-researched. In addition, the unique needs of unpaid family carers who are at risk of or have experienced abuse, violence and harm from the people they provide care for are subsumed in safeguarding policy/law processes and practice under the auspices of the protection of "adults at risk" rather than the protection of "carers at risk". Research limitations/implications: It is important that those who support unpaid family carers who are at risk of abuse and harm know about their unique safeguarding needs and concerns to offer appropriate support. It is also apparent that policy and law need to address the gap in provision relating to the unique safeguarding concerns involving the abuse of unpaid family carers by the people they provide care for. This paper is based on this literature review and not on other types of research. Originality/value: The paper provides insights into what is known about the abuse of unpaid family carers by the people they provide care for, and the policy/legal and practice responses to affected unpaid family carers. It contributes to the body of knowledge on carer abuse and safeguarding carers from abuse and harm. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons. Design/methodology/approach: In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described. Findings: The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce. Research limitations/implications: The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice. Practical implications: The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork. Originality/value: To the best of the authors' knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the dynamics of "identity leadership" with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients. Design/methodology/approach: A social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments' perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months. Findings: The results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas. Research limitations/implications: More than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity. Originality/value: This quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS. [ABSTRACT FROM AUTHOR]

Purpose: Many countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to reduce health inequalities. Integration is supported by population health management (PHM) which links data across health and care organisations to inform service delivery. It is not well-understood how PHM can help ICSs reduce health inequalities. This paper describes development of a programme theory to advance this understanding. Design/methodology/approach: This study was conducted as a mixed-methods process evaluation in a local ICS using PHM. The study used Framework to analyse interviews with health and care professionals about a PHM tool, the COVID-19 vaccination uptake Dashboard. Quantitative data on staff Dashboard usage were analysed descriptively. To develop a wider programme theory, local findings were discussed with national PHM stakeholders. Findings: ICS staff used PHM in heterogeneous ways to influence programme delivery and reduce inequalities in vaccine uptake. PHM data was most influential where it highlighted action was needed for "targetable" populations. PHM is more likely to influence decisions on reducing inequalities where data are trusted and valued, data platforms are underpinned by positive inter-organisational relationships and where the health inequality is a shared priority. Originality/value: The COVID-19 pandemic accelerated a shift toward use of digital health platforms and integrated working across ICSs. This paper used an evaluation of integrated data to reduce inequalities in COVID-19 vaccine delivery to propose a novel programme theory for how integrated data can support ICS staff to tackle health inequalities. [ABSTRACT FROM AUTHOR]

Purpose: This service evaluation aims to understand the experiences of service users (SUs) who accessed an early intervention in psychosis (EIP) service during the Coronavirus pandemic using qualitative and quantitative methodologies and compare these to a previous pre-pandemic study conducted within the same service (Watkins et al., 2018). Design/methodology/approach: This paper collated experiences of individuals accessing an EIP service to inform service development. Questionnaires and individual interviews were conducted to provide quantitative and qualitative data. Descriptive statistics and T-test confidence intervals were created from the results and compared to findings of Watkins et al. (2018). Interviews were transcribed verbatim and analysed using Braun and Clarke's (2006) thematic analysis. Findings: Data showed participants were largely satisfied with all areas of the service with "work or education", "living skills", and "addictions" scoring highest. Though participants reported no overall dissatisfaction, satisfaction levels dropped in "social activities" compared to the findings of Watkins et al. (2018), perhaps due to the national restrictions put in place to manage the spread of Coronavirus during this time. Interview analysis identified three themes of importance consistent with prior literature, highlighting the importance of relationships and validation during recovery. Research limitations/implications: This evaluation did not consider whether participants had accessed the service prior to the pandemic or only during, meaning that some participants could have a point of comparison with the service pre-pandemic, whereas others might not. Similarly, the participants were not the same as those of the Watkins et al.'s (2018) evaluation, meaning that direct comparisons of pre- and post-pandemic experiences were not possible. In addition, this evaluation collected data at only one time point early in the pandemic; therefore, it is unknown if client experiences of services differed as the pandemic and restrictions continued over time. Originality/value: The Covid-19 pandemic has been an unprecedented challenge for health services, and the effects of this are becoming widely reported. This evaluation of clinical services offers a valuable perspective of service user experience of receiving mental health services during a global health crisis further offering a comparison to pre-pandemic services and the experiences of those who used them. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of "upstreamist", health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department. Design/methodology/approach: Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of "upstreamist" system leadership to advance the integration of health care. Findings: Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with "upstreamist" system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED. Research limitations/implications: At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services. Practical implications: This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps. Originality/value: To the best of the authors' knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop "Esther" patient-centred approaches in the design of integrated health and care services. [ABSTRACT FROM AUTHOR]

Purpose: The Village model, most extensively developed in the USA, is an innovative response to ageing populations and older adults who wish to remain living independently within their community. The "Urban Villages" participatory action research study aimed to test the potential of the Village model to work with groups of older adults in two economically deprived, inner-city neighbourhoods in Manchester, UK. Design/methodology/approach: Participatory methods were used to work with residents to, first, adapt the Village model to the Manchester setting, and second, to develop and deliver community projects that supported ageing in place. The study aimed to involve marginalised individuals and groups in the co-design, leadership and implementation of the projects. Ethnographic methods were applied to observe and reflect on the development of "Urban Villages". Interviews and focus groups were organised to gather the views of the residents involved in the community projects. Findings: Residents were supported to develop and test seven projects, all aimed at reducing social isolation and supporting ageing in place. The study provides new insights into challenges related to co-production with older people in deprived neighbourhoods. These challenges are presented under the following headings: individual capacity and expectations; collective capacity including communication and knowledge; and the capacity of place. Originality/value: To date, only a limited amount of literature is available showing how co-production with older adults can be realised when working with marginalised groups and deprived communities. The paper explores the potential of participatory approaches to develop age-friendly initiatives through strengthening the capacity of older adults to age in place. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the use of an innovative resilience-building training programme delivered to NHS Safeguarding Leads and other participating professionals over a five-month period concluding in March 2019. The developers used knowledge and expertise in both the fields of psychology and drama-based learning to promote comprehension, retention and a capacity for using and conveying these strategies to other health-care workers. Design/methodology/approach: Attendees were given pre- and post-questionnaires to examine the effectiveness of the training in terms of understanding the stages of burnout, developing an awareness of personal risk factors that may be associated with potential burnout and their perceptions of the confidence they have in both evaluating their personal resilience and using acquired skills and coping techniques that they may apply to their personal and professional lives. A Wilcoxon Signed Ranks test was administered, to assess the significance of the difference between pre- and post-training scores. Findings: Following the training, participants reported statistically significant improvements relating to their understanding of terms, including "burnout". They also reported an increased awareness of their personal risk factors associated with burnout and felt more resilient having completed the training. Statistically significant changes were reported in all of these areas, with the drama element of the training being commended on about one third of all feedback forms where, with the post-test results, a narrative (unscored) opportunity for feedback was sought. Research limitations/implications: The authors note that a long-term follow-up of retention and use of this training was not undertaken, though they consider that, post-pandemic, this necessary training can be reinitiated and that, as with other professional initiatives, video-engagement technology may be, through innovative efforts, merged with these effective training techniques as an option for future training applications. Practical implications: To the best of the authors' knowledge, this training programme was the first of its kind to use a psychologically underpinned drama-based didactic approach to build resilience and protect against burnout. The results of this paper show that this training used an effective and efficient medium for successfully meeting these primary objectives. Social implications: It is considered that using a similar training approach would be effective in building resilience and preventing burnout in health-care professionals. Originality/value: This paper evaluates the effectiveness of an innovative resilience-building training programme drawing upon the field of psychology and drama-based learning to support safeguarding professionals within the NHS. [ABSTRACT FROM AUTHOR]

Purpose: In lieu of a cure, the idea that dementia might be preventable through risk-factor moderation has latterly gained popularity. Prevention research is an evolving field that will likely undergo significant shifts in the near future. This paper aims to engage with that future as it is imagined in the present. Design/methodology/approach: This study explores the futures envisaged by dementia prevention researchers in the UK, based on interviews with six practitioners at the forefront of the field. Findings: Participants foresaw a pivot away from "dementia prevention" toward "brain health", and advocated for blended policy, community and lifestyle interventions. They were excited by the prospects for a lifecourse dementia hypothesis to inform new interventions but uncomfortable with the ethics of early intervention. Originality/value: These findings complicate simplistic depictions of prevention researchers as pursuing responsibilised lifestyle approaches. [ABSTRACT FROM AUTHOR]

Purpose: The first purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SAR) and accompanying thematic analysis. A second purpose is to rebalance the narrative about adult safeguarding and self-neglect by highlighting two case studies where the practice was informed by SAR and the evidence-base of best practice. Design/methodology/approach: Further published reviews are added to the core data set, drawn from the websites of Safeguarding Adults Boards (SAB). Thematic analysis is updated using the four domains used previously. Two case studies are presented, using the four domains of direct practice, team around the person, organisational support and governance, to demonstrate that positive outcomes can be achieved when practice and support for practitioners align with the evidence-base. 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. The case studies are illustrative examples of what can be achieved and signpost SABs and SAR authors to question what enables and what obstructs best practice. Research limitations/implications: A national database of reviews completed by SABs has been established (https://nationalnetwork.org.uk) with the expectation that, in time, this will become a comprehensive resource. It is possible, however, that this data set is incomplete. Drawing together the findings from the reviews nonetheless builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Although individual reviews might comment on good practice alongside shortfalls, no published SARs have been found that were commissioned specifically to learn lessons from what had worked out well. More emphasis could be given to what might be learned from such cases. Practical implications: Answering the question "why" remains a significant challenge for SAR not only where concerns about how agencies worked together prompted review but also where positive outcomes have been achieved. 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 case studies with positive outcomes might enable learning about what enables positive system change. Originality/value: The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence base for practice. The paper presents two case studies where practice and the context within which practitioners were working closely aligned to the evidence-base for best practice. The paper suggests that SABs and SAR authors should focus explicitly on what enables and what obstructs the realisation of best practices. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore service-user perspectives of sensory approaches introduced and promoted by the trauma and self-injury service within the National High Secure Healthcare Service for Women (NHSHSW) at Rampton Hospital. Design/methodology/approach: This cross-sectional descriptive study used a semi-structured questionnaire, which was devised for this evaluation and included both open and closed questions. The data collected were then analysed using descriptive statistics and thematic analysis. Findings: The paper evaluates the current use of sensory approaches within the NHSHSW. Sensory approaches were widely used across the service, with essential oils being the most commonly used sensory approach. The use of sensory approaches can be understood according to the following three themes: independence, accessibility and self-regulation. The self-regulation theme contained three sub-themes as follows: safety-seeking, relaxation and reducing distress. The evaluation also highlighted barriers to using sensory approaches and sought service-user feedback as to how these may be overcome. Practical implications: Participants' feedback informed changes to practice, such as introducing sensory approaches to service-users earlier in their care pathway and increasing the accessibility of sensory items. These approaches may be of relevance to service provision in other forensic or inpatient settings. Originality/value: This paper offers a unique contribution to the current literature with its focus on using sensory approaches to ameliorate trauma symptoms, in the context of a forensic setting. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach: The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings: The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications: The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications: This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value: This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs. [ABSTRACT FROM AUTHOR]

Purpose: Relational dynamics between patients and staff in forensic settings can be complicated and demanding for both sides. Reflective practice groups (RPGs) bring clinicians together to reflect on these dynamics. To date, evaluation of RPGs has lacked quantitative focus and a suitable quantitative tool. Therefore, a self-report tool was designed. This paper aims to pilot The Relational Aspects of CarE (TRACE) scale with clinicians in a high-secure hospital and investigate its psychometric properties. Design/methodology/approach: A multi-professional sample of 80 clinicians were recruited, completing TRACE and attitudes to personality disorder questionnaire (APDQ). Exploratory factor analysis (EFA) determined factor structure and internal consistency of TRACE. A subset was selected to measure test–retest reliability. TRACE was cross-validated against the APDQ. Findings: EFA found five factors underlying the 20 TRACE items: "awareness of common responses," "discussing and normalising feelings;" "utilising feelings," "wish to care" and "awareness of complicated affects." This factor structure is complex, but items clustered logically to key areas originally used to generate items. Internal consistency (α = 0.66, 95% confidence interval (CI) = 0.55–0.76) demonstrated borderline acceptability. TRACE demonstrated good test–retest reliability (intra-class correlation = 0.94, 95% CI = 0.78–0.98) and face validity. TRACE indicated a slight negative correlation with APDQ. A larger data set is needed to substantiate these preliminary findings. Practical implications: Early indications suggested TRACE was valid and reliable, suitable to measure the effectiveness of reflective practice. Originality/value: The TRACE was a distinctive measure that filled a methodological gap in the literature. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore whether a United Kingdom (UK) clinical psychology training programme (the programme) was effective in producing graduates who are confident in leadership, within the context of the National Health Service and reflecting the British Psychological Society's views of leadership. Design/methodology/approach: Mixed methods design surveys were administered to prospective-, current- and alumni trainee clinical psychologists on the programme, enquiring about their view of leadership, motivation to lead (MtL) and aspects of the course that are helpful and which need further development. Data collected from 92 individuals were analysed using content and thematic analysis (TA). Findings: From the TA, three themes were identified concerning the meaning of leadership as follows: professional identity, Improving the quality of services (team; organisations and wider context), professional skills. Overall, participants thought leadership was important to the role of a clinical psychologist, with prospective trainees reporting that the desire to develop as leaders influenced their decision to apply to the programme. Moreover, participants felt confident in leadership skills and that the training programme helped develop their leadership skills, with the alumni participants demonstrating a greater MtL. Placements, group study and specific modules were identified as contributing to the development of their leadership skills, but participants felt more teaching on leadership is needed. Recommendations have been suggested to improve the development of leadership skills on the programme. Research limitations/implications: The research was undertaken on a small cohort of trainees based in the UK. Practical implications: Participants were motivated to become clinical leaders but this motivation needed to be nurtured and developed particularly through structured placement and teaching experience. Originality/value: This service evaluation is the only audit of the leadership of the programme and the findings will contribute to the existing body of reviews in this area. [ABSTRACT FROM AUTHOR]

Purpose: In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes. Design/methodology/approach: Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature. Findings: ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised. Practical implications: This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as "agents", "stewards" or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems. Originality/value: The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the prevalence and characteristics of dysphagia among adults with intellectual disabilities (ID) referred to speech and language therapy for swallow assessment, providing information on the demographic characteristics, referral trends, co-occurring health conditions and reasons for referrals highlighting the complex health-care needs of this population. Design/methodology/approach: This study used a standardised patient data extraction method over a six-month period involving 74 adults with ID referred to speech and language therapy for swallow assessment. Findings: This study revealed a high prevalence of dysphagia among adults with ID referred to speech and language therapy for swallow assessment. Increasing age and severity of ID were associated with an increased likelihood of swallowing difficulties. Co-occurring health conditions such as mobility difficulties, epilepsy and gastrointestinal conditions were prevalent, suggesting that adults with ID and swallowing difficulties are often living with complex health conditions. Choking incidents and hospital admissions were primary reasons for referral. Research limitations/implications: This study stresses the pressing need for strategies to mitigate risks associated with choking incidents and hospital admission among this vulnerable population. Possible limitations include a reliance on referral and the focus being on a single service over a short period which may limit generalisation to the wider ID population. Practical implications: This study emphasises the need to understand each person's unique profile of health needs and the value of a specialised speech and language therapy service. Social implications: The importance of increasing awareness among caregivers and medical experts is highlighted. Originality/value: The findings underscore the importance of tailored assessment, caregiver involvement and heightened interdisciplinary awareness to effectively manage dysphagia in individuals with ID. [ABSTRACT FROM AUTHOR]

Purpose: Recovery Colleges were developed to support the recovery of people with mental health difficulties through courses co-produced by professionals and people with lived experience. This study aims to examine the use of Recovery Colleges to support people with dementia. Design/methodology/approach: A survey was circulated to UK Recovery College and memory service staff, exploring provision, delivery and attendance of dementia courses. Open responses provided insight into participant views about recovery in post-diagnostic support and the practicalities of running dementia courses. Findings: A total of 51 Recovery College staff and 210 memory service staff completed the survey. Twelve Recovery College dementia courses were identified across the UK. Three categories emerged from the qualitative data: post-diagnostic support, recovery in the context of dementia, challenges and areas of innovation. Originality/value: This study highlights the benefits and practicalities of running Recovery College courses with people with dementia. Peer-to-peer learning was seen as valuable in post-diagnostic support but opinions were divided about the term recovery in dementia. [ABSTRACT FROM AUTHOR]

Purpose: The number of university students exhibiting mental health concerns have surged considerably in the past decade. Amongst a number of potential contributing factors, this study aims to assess the role of a broader societal phenomenon; the shift in emphasis in our interactions from the physical to the virtual environments. Specifically, a decrease in nature contact and a contrasting increase in smartphone use are identified as two pathways in which this shift may impact negatively on mental health. Previous research evidences both facets as consistent correlates of depression, although limited research extends these associations to the student population or attempts to establish an interaction between the two. Design/methodology/approach: The current study recruited a sample of 380 first-year undergraduate students, via an online survey, to assess if problematic smartphone use (SAS-SV) and nature contact (NCQ) were significant predictors of depression (PHQ-9). Findings: Nature contact frequency and smartphone use were significant predictors of depression. Originality/value: This is the first study to concurrently assess the impact of smartphone use and nature contact in a student population. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to co-develop a Frailty, Health and Care Needs Assessment (FHCNA) questionnaire for people experiencing homelessness and explore the feasibility of its use by non-clinical staff in homeless hostels. Design/methodology/approach: The FHCNA, aimed at identifying frailty and other health and care priorities for people experiencing homelessness, was co-designed in workshops (online and in person) with homelessness and inclusion health staff. Its feasibility was tested by staff and their clients in two hostels, with pre- and post-study focus groups held with hostel staff to gain input and feedback. Findings: The FHCNA was co-developed and then used to collect 74 pairs of resident and key worker inputted data (62% of eligible hostel residents). The mean age of clients was 48 years (range 22–82 years). High levels of unmet need were identified. Over half (53%) were identified as frail. Common concerns included difficulty walking (46%), frequent falls (43%), chronic pain (36%), mental health issues (57%) and dental concerns (50%). In total, 59% of clients reported difficulty in performing at least one basic activity of daily living, while only 14% had undergone a Care Act Assessment. Hostel staff found using the FHCNA to be feasible, acceptable and potentially useful in facilitating explorations of met and unmet health and social care needs of hostel clients. By identifying unmet needs, the FHCNA has the potential to support staff to advocate for access to health and social care support. Originality/value: To the best of the authors' knowledge, this is the first study to co-develop and feasibility test a questionnaire for use by non-clinically trained staff to identify frailty and other health and care needs of people experiencing homelessness in a hostel setting. [ABSTRACT FROM AUTHOR]

Purpose: Long COVID is a complex and highly heterogeneous condition with a variable symptom profile, and calls have been made for an integrated care approach to be taken for its management. To date, no studies have explored speech and language therapy services or needs associated with long COVID. This service evaluation aimed to gauge the level of demand on speech and language therapy services for individuals with long COVID in the UK; their clinical needs, the organisational arrangements of services and the barriers and facilitators of delivering quality care. Design/methodology/approach: A service evaluation was undertaken via distribution of an online survey to speech and language therapists (SLTs) receiving referrals for individuals with long COVID. Analysis was completed using descriptive statistics, with thematic analysis to evaluate qualitative data. Findings: One hundred and eleven SLTs responded. Eighty-six percent were seeing individuals with long COVID in their "everyday" service, in uni- or multi-disciplinary teams, without any "dedicated" resource. Dysphagia and dysphonia were the most reported symptoms. Most respondents (66.7%) indicated the individuals they were seeing were of working age, and that an individuals' speech and language therapy needs were impacting their wellbeing. Perceived barriers to quality care included fragmented and non-integrated care pathways. Multi-disciplinary and integrated working was a key enabler. Originality/value: This study provides novel insights into the current speech and language therapy needs of and care pathways for individuals with long COVID in the UK SLTs have unique expertise and are integral to supporting individuals with long COVID and should be a part of integrated care teams. [ABSTRACT FROM AUTHOR]

Purpose: Resilience can protect against workplace stress, benefit psychological wellbeing and promote effective clinical practice in mental health professionals. The purpose of this study was to consider the feasibility and acceptability of resilience training for trainee mental health professionals based on the skills-based model of personal resilience (Baker et al., 2021). The study also aimed to explore the impact of the training on resilience, wellbeing and burnout. Design/methodology/approach: In a within-subject 10-week follow-up study, mixed methods were used to evaluate the one-day resilience training for trainee mental health professionals working in services in the UK. Findings: The intervention was found to be acceptable to attendees, with high levels of satisfaction reported. Resilience was evaluated through self-report measures at three-time points. Resilience scores at follow-up were significantly higher than pre- and post-intervention scores. The secondary outcomes of wellbeing and burnout did not significantly improve. Research limitations/implications: Preliminary support was found for the feasibility and acceptability of resilience training for trainee mental health practitioners. Audience-specific adaptations and follow-up groups to aid skills practice and implementation may further enhance benefits to resilience. Resilience interventions may supplement practitioner training to improve resilience. Resilience is associated with higher wellbeing and lower burnout. The impact of resilience training on overall wellbeing and burnout remains uncertain; however, newly learned resilience skills may take time to benefit wellbeing. Originality/value: A key contribution of this study is to provide evidence regarding the feasibility of implementing the skills-based model of personal resilience, outlined in Baker et al. (2021), in a learning environment. [ABSTRACT FROM AUTHOR]

Purpose: Many mental health clinicians have delivered services digitally in response to the COVID-19 pandemic. Emerging research suggests that, despite some initial discomfort, therapists appear to adjust to remote working. The purpose of this study is to explore the views of clinicians working within a fully digital organisation towards digital service provision. Design/methodology/approach: Clinicians (N = 52) providing digital mental health assessments and treatments at Healios anonymously completed a mixed-methods questionnaire. Findings: In all, 85% of participants enjoyed working remotely and 71% thought they would continue to work online over the next 5–10 years. Of the participants, 40% reported low confidence in online work's efficacy before working remotely, but 96% reported confidence at the time of questionnaire completion: suggesting confidence increased with experience. An exploratory "inverted" factor analysis generated a two-factor solution, grouping clinicians into two factors based on key views. Factor 1 was predominantly characterised by satisfaction with training received and factor 2 by quality of technical experiences (encountering problems less often and greater personal confidence in resolving them). Qualitative feedback described some benefits of, and barriers to, digital service provision. Clinicians reflected on a perceived change in cultural norms, with more openness to digital services following the COVID-19 pandemic. On a personal level, teletherapy was viewed more favourably with increased personal experience. Originality/value: Clinicians' confidence in providing services digitally is discussed, with reference to how this may be affected by extent of remote working experience and availability of technical support. Staff well-being within the digital workspace is also discussed. [ABSTRACT FROM AUTHOR]

Purpose: Borderline personality disorder (BPD) is a controversial psychiatric diagnosis. Despite an increasing amount of research looking at the BPD diagnosis when applied to young people, there is limited understanding of the key viewpoints of mental health professionals working with young people in the UK. This research aims to use Q-methodology to contribute to understanding the multiple views of the diagnosis. Design/methodology/approach: Q-statements about views of the BPD diagnosis were selected from relevant journals, internet sites and social media platforms and were validated by a Q-methodology research group, the research supervisors and an online group of individuals with BPD. Q-sorts were then used to explore the viewpoints of 27 mental health professionals in the UK working with children and adolescents. Analysis of the data was completed using Q-methodology analysis software. Findings: Three main factors emerged from the data, explaining 66% of the variance. Of the 27 participants, 24 loaded onto these three factors, defined as: harmful not helpful; language and optimism; and caution and specialist services. Three Q-sorts did not load significantly onto any one factor. Originality/value: There appears to be at least three ways of understanding the BPD diagnosis for young people. It may be useful for clinicians to consider and share their own viewpoint, be open to difference and formulate difficulties from an individual perspective. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to co-design a falls prevention education programme with aged care home residents and staff and evaluate its feasibility. The intention of providing the education programme was to assist residents to stay safe and mobile whilst reducing their risk of falling. Design/methodology/approach: A two-phase mixed methods participatory design using a resident (n = 6) and care staff (n = 5) consumer engagement panel, pre- and post-programme resident (n = 35) survey and semi-structured care staff interviews (n = 8) was undertaken in two countries. Findings: A poster, brochure, video and staff education guide featuring 12 safety messages depicting fall prevention behaviours were co-designed. Residents, supported by staff, perceived the falls prevention education programme as enjoyable and informative, but there were no significant differences in capability, opportunity or motivation. However, several residents were observed enacting fall prevention behaviours such as "If I feel unwell, I'll ring the bell" and waiting for staff assistance. Challenges to programme demand, acceptability and implementation which may have impacted residents' exposure and engagement with the programme were identified, along with recommendations to improve feasibility. Practical implications: When developing falls prevention education programmes partnering with residents and staff, providing choices to meet personal and aesthetic preferences along with frequent, shorter duration learning opportunities are important for translating education messages into actions. Originality/value: The use of bespoke resources, novel rhymes, positive messages emphasising safety and co-designing with residents themselves was a welcomed point of programme difference. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the contribution of adult social work in integrated teams in the UK. Design/methodology/approach: The study design was realist, evaluation research using a mixed methods approach. Data collection methods included interviews and focus groups. Types of social work activities were extracted from older adults' case records and used to calculate costs of care. The presence or absence of indicators of care quality was recorded using the same sample of case records. Data were collected from three primary care teams in which social work was integrated. They were compared with data from three social-work-only teams in the same districts. Narrative data was analysed thematically. Inferential and descriptive statistics were used to compare costs and care quality. Findings: When social work was embedded or attached to a primary care team, costs of care delivery were lower than in their social-work-only team and more indicators of good quality care outcomes were recorded. Results suggest that embedding social work in integrated primary care teams contributes to cost-effective, quality care for older people if certain conditions for integration are met. Originality/value: This is the first study to triangulate three data sources to quantify the social work contribution to integrated primary health care teams for older adults. [ABSTRACT FROM AUTHOR]

Purpose: Stigma reduction is an important public health challenge because of the large morbidity and mortality associated with some forms of substance use. Extreme stigma can lead to dehumanisation of target groups, who are ascribed with lesser humanity. The authors examined whether there was blatant and subtle dehumanisation of people who use heroin, and if these were associated with levels of support for non-discriminatory drug policy. Design/methodology/approach: A cross-sectional online study using a UK convenience sample (n = 307 [75.2% female, mean age 28.6 ± 12.2 years]) was conducted. Participants completed assessments of blatant (Ascent of Humans [AoH] scale) and subtle (an emotion attribution task) dehumanisation and a bespoke measure assessing support for non-discriminatory drug policies. Other measures controlled for stigma towards people who use drugs (PWUD) and moral disgust. Findings: There was greater blatant dehumanisation of people who used heroin compared to the general population and other potentially stigmatised reference groups, including people who use cannabis. The authors also found evidence of subtle dehumanisation, and people who used heroin were rated as being less likely to feel uniquely human emotions, less likely to feel positive emotions and more likely to feel negative emotions. Blatant dehumanisation was associated with significantly lower probability of support for non-discriminatory drug policy. Social implications: Dehumanisation may present significant challenges for stigma reduction initiatives and in fostering public support for drug policy and treatment. Denial of the humanity of this group could be used to justify discriminatory policies or relative deprioritisation of support services in funding decisions. Activities that seek to "rehumanise" PWUD, including social inclusion, and encouraging compassionate media representations that portray the lived experiences of substance use may be useful areas of future work. Originality/value: This is the first study to investigate blatant and subtle dehumanisation of people who use heroin, and how this relates to public support for drug policy. [ABSTRACT FROM AUTHOR]

Purpose: Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. "the authors evaluate" whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care. Design/methodology/approach: The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London. Findings: Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub. Research limitations/implications: Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub. Practical implications: Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams. Social implications: Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems. Originality/value: The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims. [ABSTRACT FROM AUTHOR]