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This paper presents a systematic literature review exploring the Family Group Conferencing experiences with racially minoritised families in England. The literature search identified eight qualitative studies that met the inclusion criteria. This review found that racially minoritised families felt that Family Group Conferencing was empowering and met their cultural needs at times, but suggested caution about how culturally adaptable the approach is for this population. We argue that FGC could be presented as an Indigenous model of engaging with family networks with relevance for social workers working with racially minoritised communities in England. We suggest that Family Group Conferencing aligns with aims of decolonisation and cultural competence and argue the need to explore how Indigenous knowledge can be valued more effectively in global social work debates. [ABSTRACT FROM AUTHOR]

People develop a sense of place, belonging and identity when a place affords tangible and intangible benefits like security, familiarity, shelter, food, work opportunities, and social interaction. Places form landscapes individually valued by people for these reasons. This paper describes Topic Modelling as a new grounded approach to assessing people's sense of place in a rural landscape affording special qualities for everyday working and living situations – the Peak District National Park, UK. This novel approach is applicable and scalable to any landscape, rural or urban, iconic, or everyday. Results of this study show that significant themes and phenomena not hypothesised at the initial research design stage can emerge from interview data. Examples include pro-environmental behaviours resulting from traditional farming practices, environmental benefits of the drystone-walling tradition, and attitudes towards rewilding initiatives. We argue that such phenomena arise from people's attachment to place and influence their behaviours. [ABSTRACT FROM AUTHOR]

This paper draws on the retrospective accounts of eight LGBT+ students aged 18–21 attending a university in Northern England. Using interpretivist methodology, qualitative research was conducted to explore how their sex and relationships education impacted upon their needs as a sexual and/or gender minority. An under-researched aspect of experience was also investigated: namely, how LGBT+ people learned about sex and relationships if not in a formal school setting. Two focus groups were used to examine these areas of interest and similar patterns in both groups were apparent. Themes such as the impact of heteronormative value systems, pornography as an educational resource, and the use of online Blogs and search engines as a source of alternative education were highlighted. Findings demonstrate how participants' experiences of sex and relationships education were largely non-inclusive and irrelevant to their needs. The paper concludes with practical suggestions to ensure subsequent generations of LGBT+ pupils receive a more inclusive educational experience, supported by approachable teachers who are comfortable and competent teaching the subject. [ABSTRACT FROM AUTHOR]

This paper examines police and national probation service (NPS) practitioners' experiences of utilising a dynamic risk management tool with registered sexual offenders (RSOs) in the community. The Active Risk Management System (ARMS) was designed as a multi-agency tool providing police with a dynamic tool for use with RSOs and the NPS with a sexual offender specific tool to support their original dynamic risk tool OASys (Offender Assessment System). Based on both quantitative and qualitative research with every police force and every NPS division in England and Wales, this paper highlights that despite a comprehensive adoption of ARMS within policing practice, the theoretical benefits of the ARMS tool have unfortunately not been realised. The resource implications of the tool's utilisation, the different needs and siloed working practices of the police and NPS as well as a staggered implementation of the tool across both agencies has presented challenges for the practical use of ARMS in both single and joint agency offender management. [ABSTRACT FROM AUTHOR]

This paper will explore the ways in which behaviour features in the accounts of 'off rolling' processes in schools in England volunteered by participants – senior school leaders, SENCos and parents, in an ongoing multi-stranded research project. In addition to analysing these accounts, this paper draws on contextual features and concepts such as parrhesia and authenticity in a probing of methodological considerations. The status of such accounts as data will also be considered given the high stakes accountability environment in which school principals strive to fulfil their legal remit in the field of inclusion. The trustworthiness of findings in qualitative research is more usually the focus of attention; however, our studies to date imply that some professionals carefully manage the image of their school and visibility of exclusionary practices to the detriment of students with mental health and behavioural issues. The methodological implications of conducting research in politicised and highly sensitive areas will be discussed. [ABSTRACT FROM AUTHOR]

A growing number of researchers are trying to provide explanations for continuity and change in drug policy in different contexts. Such research predominantly falls in the pluralist realm of public policy where various actors compete to have their policy proposals accepted. Using a critical framework called Policy Constellations (PC), developed by Stevens and Zampini, this paper attempts to explain reactions of the British Government to Novel Psychoactive Substances (NPS) between 2008 – 2016. Qualitative data comes from in-depth interviews with stakeholders (N = 15), including NGO workers, a former Home Secretary, drugs ministers, governmental advisors, a former senior police officer, former Deputy Drug Coordinator, and a former Advisory Council for the Misuse of Drugs (ACMD) member. Two 'constellations' competed in British NPS policy setting. The PC framework illustrates power imbalances between these competing stakeholders. Abstinence orientated actors (the conservative constellation) enjoyed strategic advantages and media power which allowed them to create a favourable policy setting. These advantages were not enjoyed by the liberal constellation who struggled to access the policy setting and influence policy developments. The prohibitive nature of the policy used to counter NPS can be explained with the domination of actors whose values align with the conservative constellation. [ABSTRACT FROM AUTHOR]

Children's experience of harm and abuse has a profound impact on their health and well-being. In response, school-based prevention programmes have been developed and delivered by external organisations with the aim of improving children's awareness and understanding of forms of harm and abuse which may affect them, encouraging them to seek help if needed. In September 2020, Relationships Education became statutory within the primary school curriculum in England and this ratification is likely to increase demand for externally delivered classroom-based programmes, which address the broad range of topics to be covered within this field. However, evidence is required to understand the impact and acceptability of such programmes. This paper presents qualitative findings from a larger mixed-methods study. Focus group discussions with 29 children explored their responses to one Healthy Relationships programme delivered to primary school children aged 10 and 11 in England. Analysis focuses specifically on responses to the topics of sexual abuse prevention and help-seeking. Children's widespread support for the programme indicates that topics are relevant and the opportunity to explore these issues is valued. However, for effective programme implementation, schools and parents need to be prepared, and prevention messages should continue to be embedded throughout children's school lives. [ABSTRACT FROM AUTHOR]

In the last ten years the use of the internet as a health resource has transformed, and while patients increasingly consult online resources for health decision-making, less is known about how healthcare professionals (HCPs) currently discuss decision-making with internet informed patients (IIPs). In this paper we examine how HCPs perceive IIPs and specifically how bringing online information into appointments can prompt different communicative strategies around decision-making. Ten HCPs with experience working across different healthcare roles, took part in semi-structured interviews and discussed their interactions with IIPs around decision-making. Vignettes based on descriptions of real patients bringing online health information to their HCPs were used to prompt further discussion. The analysis identified two themes in relation to communication: (i) being honest about information sources and (ii) from compliance to coconstruction: improving communication around decision-making. HCPs were overwhelmingly positive toward IIPs and encouraged patients to be transparent about their online searching to understand their motivations, priorities, and concerns. Although compliance remains part of the narrative, HCPs recognized practical ways in which discussing online health information could improve HCP-patient communication around shared decision-making. We discuss the findings in relation to early work on communicative strategies between HCP’s and patients bringing resources to their consultations. We argue that for HCPs the concept of the internet as a provider of health information is no longer seen as inherently damaging or risky. There is growing acceptance of pre-consultation internet searching with the caveat that any information sourced online should inform rather than dictate decision-making with HCPs. [ABSTRACT FROM AUTHOR]

This paper reports on a small-scale, qualitative study, located in England and Wales, with the goal of advancing fairer teacher representation. Deploying a positive lens, the research shines a light on the lived experiences of 12 individuals from Black, Asian and minority ethnic backgrounds, all of whom successfully entered the teaching profession for a period of up to 5 years before the study. Against the current backdrop of unfair teacher representation, the achievements of these individuals in becoming teachers are deconstructed and analysed, to determine whether there are any commonalities in their circumstances. Drawing on the theoretical frames of capital and critical race theory, the study aims to establish whether a set of protective factors exists that may have supported and facilitated their journey into teaching. The study finds that the achievements of these individuals in joining the teaching profession can be attributed, in part, to the nature of the cultural wealth each possesses. It concludes that these teachers, acting as critical pedagogues, are not the sole benefactors of their cultural wealth, with benefits afforded both the minority and majority population. In spite of intentions to frame the teachers' narratives positively, the study reveals troubling evidence of embedded racial processes, which serve to threaten the teachers' sense of belonging in the profession and inhibit others from joining. Recommendations to further boost teacher representation for minority groups are offered. [ABSTRACT FROM AUTHOR]

Social theorists have suggested relationship practice changes such as rising rates of nonmarital cohabitation imply external anchors are lifting with relations become increasingly individualized and fragile. These suppositions are in part based on theories of commitment which have taken conventional characteristics of marriage as a blueprint from which to compare. Reporting findings from an in-depth qualitative study in England, in this paper, what it means to be committed and how commitment is displayed within 10 long-term (15 plus years) couple relationships across forms (same-sex, opposite-sex, married, civil partnership, cohabitant) is explored. The findings challenge conventional signifiers by which cohabitants are deemed less committed than married couples. In line with the individualization thesis, couples described an importance attached to autonomy and equality. Instead of public promises for a lifetime together, sexual intimacy and financial interdependence, couples displayed commitment through mutual reciprocity. However, these' individualized' relationships were not sustained only to the extent of personal satisfaction. Moral consistency values to stick together through adversity, unless the relationship became unhealthy, signified what it meant to be committed; whether the relationship was formalized or not. Further research is needed to develop theories of commitment which better reflect the diversity of contemporary relationship practices. [ABSTRACT FROM AUTHOR]

Trans and non-binary youth (TNBY) face high levels of interpersonal and social adversity as well as disproportionate rates of mental health issues such as depression, self-harm and suicidal ideation. Among protective factors, context plays a key role. In addition to parental support, access to gender-affirming medical care begins to emerge as crucial for young people needed them. This paper compares, through thematic analysis, the experiences of TNBY with regard to access and experiences to care in Canada, Switzerland, England, and Australia. It identifies similarities and differences in barriers to access to care, as well as impacts of gender affirming care on young people and their well-being. The article concludes with a discussion on the importance of prompt and easier access to gender-affirming medical care, of training of professionals, and a hypothesis about the role of context in TNBY well-being. [ABSTRACT FROM AUTHOR]

Women receiving treatment for opioid use disorder have low levels of contraception use and high rates of unintended pregnancies, abortion and children being adopted or fostered. This paper aims to understand the relationship between contraceptive choice and power amongst women receiving Opioid Replacement Therapy (ORT). During 2016/17, semi-structured interviews were undertaken with 40 women (aged 22–49 years) receiving ORT in the South of England. Data relating to the latent concept of power were inductively coded and analysed via Iterative Categorisation. Power manifested itself through six interconnected 'fields': i. 'information about fertility and contraception'; ii. 'access to contraception'; iii. 'relationships with professionals and services'; iv. 'relationships with male partners'; v. 'relationships with sex work clients'; and vi. 'life priorities and preferences'. Each field comprised examples of women's powerlessness and empowerment. Even when women appeared to have limited power or control, they sometimes managed to assert themselves. Power in relation to contraceptive choice is multi-faceted and multi-directional, operating at both individual and structural levels. Informed decision-making depends on the provision of clear, non-judgemental information and advice alongside easy access to contraceptive options. Additional strategies to empower women to make contraceptive choices and prevent unplanned pregnancies are recommended. [ABSTRACT FROM AUTHOR]

This paper explores the exchange relationship between older conservation volunteers (aged over 50 years) and paid group organisers. Using qualitative interview data from seventeen adult volunteers and four organisers recruited from three conservation groups in the North West of England we argue that the psychological contract is important for understanding how organisations can manage and retain volunteers. Our findings highlight the importance of the psychological contract between volunteers and the group organiser, with each party recognising the mutual benefits they bring to the relationship. Participants' accounts revealed that they chose to take on the often physically challenging conservation work because the natural environment was important to them, but also because there was no obligation for them to attend. Thus, being a conservation volunteer allowed them to retain control over their voluntary time commitment and avoid the pressures of responsibility associated with having people depending upon them. At the micro-level, organisers appreciated the expectations and abilities of individual volunteers, managing and adjusting their own practices accordingly to encourage volunteer retention. We consider the implications of our research in terms of both volunteer and psychological contract theory and discuss the potential implications for organisations in terms of managing and retaining older volunteers. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

This small-scale qualitative study, involving commissioners of carers' services, contextualized in academic and other literature, adds to an understanding of groupwork for carers within the context of an English legal framework. Five commissioners, from different parts of England, participated in an online focus group. The dataset was analyzed thematically using a reflexive Thematic Analysis approach. Three themes were developed from the data. One theme indicated that differing understandings of the purpose of group activities for carers co-existed in each area and another that system-wide blocks meant that the choice of provider depends on factors like ability to risk-manage the contract value rather than skills needed to serve whole populations. This led to a third theme of commissioners attempting to "engineer" the development of successful groupwork. The findings suggest that Community Social Work is likely to be successful in working with carers but may face challenges within a quasi-market approach. [ABSTRACT FROM AUTHOR]

Health and social care integration has been promoted by successive governments as the answer to meeting increased need within limited budgets. However, there has been little research in the UK regarding Social Workers working in integrated health teams. This study explores how social work is perceived by a range of professionals working within three different models of integration in the same acute hospital in the South-East of England. The research team (all practicing social workers) used a mixed method approach - combining questionnaires and focus groups – to explore similarities and differences in the perception of the social work role held by professionals working within contexts which had different types or models of integration. Thematic analysis of the qualitative data identified five key themes. These included social workers: providing 'checks and balances' to health professionals, 'linking and bridging' between the hospital, the community and patients, holding 'mysterious knowledge', having 'strong interpersonal skills' and providing a 'function in team dynamics".We conclude by outlining recommendations for practice and further research, the limitations of our study and our approach to reflexivity as research practitioners. [ABSTRACT FROM AUTHOR]

This is a qualitative research study which investigates the curriculum decision-making of four primary school history subject-leaders in the North-West of England. A grounded theory approach was utilised. Semi-structured interviews were conducted with the subject-leaders and an audit of their schools' history curriculum completed. The curriculum was altered in response to the Colston statue toppling in three schools, the subject-leaders faced several challenges. Further research is needed to discover more about the role of primary history subject-leaders and the agency they can achieve as curriculum-makers. It is also argued that Black British history should be included in the History National Curriculum for England. [ABSTRACT FROM AUTHOR]

To explore how stroke survivors' expectations and understanding of Early Supported Discharge (ESD) helped them make sense of their experiences, and shaped their engagement with the service. Data were collected as part of a study of large-scale implementation of stroke ESD: the WISE realist mixed-methods study. Semi-structured interviews were conducted with five purposefully selected stroke survivors from six sites in England implementing stroke ESD (n = 30). Participants were aged 32–88 years (20 males). Interviews were audio recorded, transcribed verbatim and transcripts were analysed using reflexive thematic analysis. Three overarching themes were identified: (1) ESD as a post-stroke recovery tool, (2) desire to recover quickly, (3) psychosocial impact and support. Stroke survivors were uncertain about what to expect when they first entered the service, however, their experience of ESD exceeded their expectations and increased their engagement with the service. Stroke survivors especially valued the goal-oriented approach the team adopted. Rehabilitation at home was perceived as positive and practical, encouraging independence within real-life contexts. Psycho-social support played an important role in the stroke survivors' rehabilitation. Ensuring stroke survivors are fully informed about ESD and what to expect, optimises engagement with the services, improves experience and could enhance outcomes. Informing stroke survivors about what to expect from ESD services could optimise engagement and improve their experience. The provision of personalised and target focussed therapy at home improves stroke survivors' experience and could potentially accelerate recovery. Preparing stroke survivors early for discharge from ESD can reduce anxiety and enhance engagement with the service. [ABSTRACT FROM AUTHOR]

Covid-19 has had an especially detrimental impact on mental health of people with intersectional marginalized identities. Yet, research evidence on this impact is lacking, with efforts to generate it stymied by pandemic restrictions. To explore how a socially excluded gender minority group—transgender and non-binary (TGNB) prisoners—experienced, and coped with, the pandemic stressors. The data were collected via correspondence with 15 TGNB prisoners in England and Wales in April-October 2020 using an exploratory person-centred qualitative longitudinal approach and examined using reflexive organic thematic analysis. The pandemic and its restrictions to support structures and health care detrimentally impacted TGNB prisoners' mental health and wellbeing. TGNB prisoners experienced added stressors associated with their intersecting incarceration and gender minority positions, including prolonged solitary confinement and reduced access to gender-affirming health care. Environmental resources for problem-focused, emotion-focused, socially supportive and disengagement coping were reduced by the prison pandemic regime, with adaptive coping through positive distraction and engagement with TGNB/LGBTQ community particularly affected. During a pandemic and beyond, greater support and innovative practices are needed to improve the TGNB prisoners' access to gender-affirming care and to TGNB/LGBTQ community, to protect their mental health and wellbeing. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore how Norwegian female employees experience work-related alcohol use in British working life using cultural analysis. Explorative design with strategic population; in-depth interviews with eight female Norwegian employees working in London, in addition to field observation in two typical 'after-work' pubs in London. The data was analysed through bricolage: themes and subthemes were identified and Hall's theory of high- and low-context cultures and Bourdieu's concepts of capital and field were applied. The pub appeared to be a significant arena for Norwegian female employees in London to adapt to British working culture and work-related drinking. Four main themes emerged: (1) Breaking the code in communication at work, (2) Adjusting to English office 'etiquette' through pub visits, (3) Adhering to pub rules and developing strategies, and (4) Balancing after-work pub culture and family obligations. Navigating British pub culture demands cultural awareness to maintain one's work-related position and career progress, including balancing gender-specific expectations and contextual drinking culture. [ABSTRACT FROM AUTHOR]

Homelessness and heavy alcohol consumption are increasing global public health concerns. Homelessness is associated with poorer health outcomes, shorter life expectancy, and health risk behaviours. High levels of alcohol consumption intersect with the cause and effect of homelessness making this an important consideration for research. This is explored through a theoretical lens of recovery capital, referring to the resources required to initiate and maintain recovery, and is applied to both heavy alcohol consumption and homelessness. Life history calendars were utilised alongside semi-structured interviews to explore the impact that adverse life events had on alcohol consumption and living situations with 12 participants in contact with homelessness services in North-West England. The findings consider how social, health, and structural-related adverse life events were both a cause and effect of homelessness and increasing consumption of alcohol, which were further exacerbated by a lack of recovery capital. The authors argue for further consideration relating to the intersection of homelessness and high levels of alcohol consumption in relation to recovery capital. The findings have implications for policy and practice by demonstrating the need for relevant services to help individuals develop and maintain resources that will sustain recovery capital. [ABSTRACT FROM AUTHOR]

Onset of psychosis commonly occurs in adolescence, and long-term prognosis can be poor. There is growing evidence, largely from adult cohorts, that Cognitive Behavioural Therapy for Psychosis (CBTp) and Family Interventions (FI) can play a role in managing symptoms and difficulties associated with psychosis. However, adolescents have distinct developmental needs that likely impact their engagement and response to talking therapy. There is limited guidance on adapting CBTp to meet the clinical needs of under-eighteens experiencing psychosis. This educational clinical practice article details learnings from therapists and supervisors working with young people (aged 14–18 years) with psychosis during the Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) randomised clinical treatment trial, supplemented by findings from nested qualitative interviews with young people receiving CBTp. Suggested are given for tailoring CBTp assessment, formulation and interventions to meet the developmental and clinical needs of adolescents with psychosis. Developmentally appropriate techniques and resources described. Early indications from MAPS study indicate this developmentally tailored approach is an acceptable, safe and helpful treatment for young people with psychosis. Further research is needed to develop empirically grounded and evaluated CBTp for adolescents. [ABSTRACT FROM AUTHOR]

The aim of this study is to critique and extend psychological approaches to resilience by examining retrospective accounts of LGBT people in England who had directly experienced or witnessed events that were salient as significantly negative or traumatic. Pre-screening telephone interviews identified ten individuals who matched inclusion criteria (mean age: 39 years; range 26–62 years) as part of a larger study. Interviews were semi-structured and informed by a literature review undertaken at the start of the study. We identified three themes of that extend the resilience literature for LGBTQ+ people: (1) identifying and foregrounding inherent personal traits – how non-contextual inborn qualities or attributes needed external effort to be recognised and operationalised; (2) describing asymmetric sources of social support and acceptance – the importance of positive environment is unequally available to LGBT people compared to heterosexuals, and uneven within the LGBT group; and (3) blurring distinctions between resilience and coping – experiential approaches to moving beyond distress. We suggest that narratives of resilience in the accounts of LGBT people can inform the development of resilience promotion models for minoritized individuals and support movement away from deficit-focused approaches to health policy. [ABSTRACT FROM AUTHOR]

Pre-loss grief can be experienced by relatives before impending death; however, limited understanding exists about the impact of pre-loss grief on bereavement. This systematic review aimed to synthesize qualitative research evidence reporting adults' experiences of pre-loss grief within cancer care. Thirteen studies were selected, and three key themes identified. Findings indicate that relatives transitioned through lived experiences during end-stage cancer, and that meanings attached to these experiences influenced how they experienced pre-loss grief. Limited formal support was identified to navigate these experiences; however, context was seen as important, and skilled healthcare practitioners and physical environment were key to facilitating preparedness. [ABSTRACT FROM AUTHOR]

Evidence suggests that despite the popularity and influence of key health equity concepts, they often fail to shift the thinking and actions of health workforces towards the social and structural determinants of health inequalities. These findings tend to be attributed to institutional constraints, along with the role of influential discourses which promote a focus on individuals and behaviours. However, questions have also been raised about the clarity and utility of the concepts themselves, and the extent to which the language they use works (or indeed fails to work) in reorienting thinking and action. The purpose of this study was to explore how partners in an applied health research collaboration in England interpreted the popular 'upstream-downstream' story, and what it means to work 'upstream' to reduce health inequalities. Where participants were not familiar with its academic or technical usage, the story was taken to be a metaphor for prevention generally, or it prompted a root cause analysis of the more discrete ways in which inequalities were encountered in participants' research or work. Even in instances where participants did hold more socio-political perspectives, these were often not evoked by the metaphor itself. Two of the 18 participants were unable to equate the metaphor with particular actions or ways of working, while others found it to be a poor fit with how they understood inequalities. The study findings illustrate and explain the challenges that arise when technical metaphors from the health equity literature are opened-up to interpretation by wider audiences. [ABSTRACT FROM AUTHOR]

Physically or psychologically injured military veterans are motivated and benefited by physical activity or sport that may involve high levels of achievement. The aim of this study was to provide an in-depth insight into the impact of Competitive Motorsport (CM) on physically injured/disabled veterans' subjective well-being and in turn determine if it improves the quality of their lives. This is a qualitative study. Two sets of semi-structured interviews were conducted with 14 male British military veterans including a 6-month follow-up. All participants were subjected to a permanent, moderate or severe, physical injury/disability. Data were analysed in accordance with the principles of Thematic Analysis. Five key elements (familiar environment, team spirit, adrenaline rush, competition and equality) made CM a unique experience for physically injured/disabled veterans. Various psychological and physical benefits were found, including an increased sense of accomplishment, opportunity to socialise in a non-clinical environment, embracement of body image and adoption of a healthier lifestyle. Since physical activity and sport are among growing research on alternative interventions for military veterans, they deserve serious consideration as part of the treatment regimens and rehabilitation programmes to improve physically inured/disabled veterans' physical and mental health. Competitive Motorsport is an effective means of improving physical health and subjective well-being of physically injured/disabled military veterans. Multiple perceived psychological and physical benefits were identified over time, including motivation for living, embracement of body image and adoption of a healthier lifestyle. Competitive Motorsport deserves consideration as part of the treatment regimens and rehabilitation programmes to improve physically injured/disabled veterans' physical and mental health while facilitating transition to civilian life. [ABSTRACT FROM AUTHOR]

Undergoing an amputation is a life-altering experience that can involve a protracted and intensive period of care from a range of healthcare professionals. Amputation care within the NHS has historically been criticised. Here we seek to understand how patients are experiencing care by exploring their stories and identifying features of both high- and low-quality care. We analysed patient stories posted on the patient feedback site Care Opinion during the period 2018–2020 to examine how amputee patients (and their families) experience NHS care. Using thematic analysis, we identified four key themes. We found that patients' stories of undergoing an amputation as posted on Care Opinion give overwhelmingly positive feedback on their experiences. Patients report feeling well-supported by empathetic staff, and that the outcomes, in terms of quality of life and restoration of mobility, are beneficial. Time was a common feature within the posts we examined and negative experiences of care often related to untimeliness in a variety of ways. Care Opinion provides a useful and accessible resource for understanding how patients experience amputation care; analysis of stories posted there provides preliminary ideas of the features of "good care" from a patient-centred perspective. Patients undergoing amputations view professionalism of staff as important for good care. Timeliness is important to patients in seeing care in positive terms, ensuring patients are supported in their care during and after amputation in a timely manner is therefore important for achieving good rehabilitation care. Rehabilitation and related services supporting patients who have undergone amputations could usefully patient feedback sites as a means for further understanding the experiences of their patients and for improving services where necessary. [ABSTRACT FROM AUTHOR]

To continue growing the advanced clinical practitioner (ACP) role nationally, and similar roles internationally, there must be widely held trust in the level of practice and the roles worked in service by ACPs. This requires infrastructure to support ACPs through their training and ensure they are fit to qualify. This short report focuses on an evaluation of assessment processes in the acute sector in a county in England, to understand their feasibility and suitability. The qualitative research design was attendance at assessment panels and 17 semi-structured interviews with assessors and ACP trainees, from nursing, physiotherapy, paramedicine and operating department practice backgrounds based at two hospitals. Key themes identified through thematic analysis were the different approaches to assessment and the support required to engage effectively with assessment. One hospital had a well understood process, including ACPs with a clear identity. The other hospital had a credible assessment process that continues to be developed. The insights from this study enabled lessons to be drawn for those responsible for workforce development who are key to the future development of the ACP role and to ensure high standards of interprofessional care. [ABSTRACT FROM AUTHOR]

Sedentary behaviour (SB) is associated with negative health outcomes and is prevalent post-stroke. This study explored SB after stroke from the perspective of stroke service staff. Qualitative mixed-methods study. Non-participant observations in two stroke services (England/Scotland) and semi-structured interviews with staff underpinned by the COM-B model of behaviour change. Observations were analysed thematically; interviews were analysed using the Framework approach. One hundred and thirty-two observation hours (October - December 2017), and 31 staff interviewed (January –June 2018). Four themes were identified: (1) Opportunities for staff to support stroke survivors to reduce SB; (2) Physical and psychological capability of staff to support stroke survivors to reduce SB; (3) Motivating factors influencing staff behaviour to support stroke survivors to reduce SB; (4) Staff suggestions for a future intervention to support stroke survivors to reduce SB. Staff are aware of the consequences of prolonged sitting but did not relate to SB. Explicit knowledge of SB was limited. Staff need training to support stroke survivors to reduce SB. Sedentary behaviour in the community was not reported to change markedly, highlighting the need to engage stroke survivors in movement from when capable in hospital, following through to home. Stroke survivor sedentary behaviour is influenced, directly and indirectly, by the actions and instructions of stroke service staff in the inpatient and community setting. The built and social environment, both in the inpatient and community settings, may limit opportunities for safe movement and can result in stroke survivors spending more time sedentary. Stroke service staff appreciate the benefit of encouraging stroke survivors to stand and move more, if it is safe for them to do so. Staff would be amenable to encourage stroke survivors to reduce sedentary behaviour, provided they have the knowledge and resources to equip them to support this. [ABSTRACT FROM AUTHOR]

Musculoskeletal (MSK) first contact physiotherapy (FCP) is being rolled out in the National Health Service, but limited research exists on career pathways into MSK FCP, or on pre-and-post-registration educational preparation for the knowledge and skills that are required for musculoskeletal first contact physiotherapy. From the perspectives of existing MSK FCPs, the study sought to understand the pre-and-post-registration professional developmental journey into musculoskeletal first contact physiotherapy. Semi-structured interviews over the telephone were conducted with a self-selected and snowball sample of 15 MSK FCPs from across Britain. Framework analysis was used to analyze the interview transcripts. Four overarching themes were identified: (1) Decision to choose a career path as a MSK FCP; (2) Relevancy of pre-registration physiotherapy (PT) education for MSK FCP; (3) Relevancy of post-registration continuing professional development for MSK FCP, and; (4) Improving pre-registration PT education for the foundational knowledge and skills required to work in musculoskeletal first contact physiotherapy. Each overarching theme generated several subthemes. The research contributes to understanding the career pathway into the MSK FCP role and showed what relevant knowledge and skills were acquired for this role at pre-and-post registration levels. Findings will inform guidance for pre-registration PT curriculum development. [ABSTRACT FROM AUTHOR]

The importance of supervision is largely taken for granted within social work. Yet it can often seem as if policy-based descriptions of what supervision 'should be' are disconnected from the realities of practice. In this study, we sought to understand the perspectives of social workers and supervisors about what supervision is and what it is for. Interviews were undertaken with social workers (n = 56) and supervisors (n = 10) in one authority in England between September 2018 and March 2019. We identified three functions of supervision – accountability, emotional support and providing a different perspective. Supervisors were expected to be constantly available for their staff yet had insufficient time to engage in what they considered to be reflective discussions. Supervision was considered to be primarily a mechanism for worker accountability, with support and education being much more ad-hoc functions. These findings suggest that while workers are not wholly negative about case management approaches to supervision, there is a pressing need to define reflection more clearly and articulate what it looks like in practice and how else, if not via supervision, it can be enabled within statutory services for children and families. [ABSTRACT FROM AUTHOR]

Often perceived as a last resort, a care home move for a person living with dementia is often undertaken when all other options have been exhausted. Deciding the right or optimal time is to move remains an important question for many families. To investigate factors that are weighed up in deciding to make a care home move. Qualitative in-depth interviews with 21 family carers and 5 care home residents living with dementia in England. Thematic analysis was applied to all transcripts to extract key themes and sub-themes; a summation is provided here. Participants emotionally recollected an accumulation of stressors, exhausting other options of care, a risk/benefit analysis, wishes of person living with dementia, and a readiness to move as indicators of when a 'tipping point' was reached. They also felt strongly that early planning, prior experience of care homes, understanding funding arrangements and having support with decision-making would help. Deciding to move to a care home is complex, contextual and deeply personal. Early planning in the form of joining waiting lists, using day centres and respite services may help in creating relationships with intended care homes for the future. There is growing need for support with financial advice and funding arrangements, for both self- and publicly funded individuals. [ABSTRACT FROM AUTHOR]

Single-sided deafness presents communication challenges for adults. There are a range of care options, including CROS hearing aids, available but little is known about patient preferences for these interventions. The objective of this study was to understand the viewpoints of patients making decisions about audiological interventions they use. A constructivist worldview using thematic analysis to undertake a constant comparative analysis of 8 semi-structured interviews. Participants were recruited from Portsmouth Hospitals University NHS Trust audiology service in England. The results of the study describe ongoing iterative judgements being made by participants, informed by their access to information, effectiveness of audiological interventions, stigma, barriers to accessing care, and constant cost-benefit analyses being made. The key factors involved in decision-making by individuals with Single-sided deafness (SSD) are discussed. This study represents the first in-depth exploration of the individual's lifeworld related to which factors influence use of different audiological interventions by individuals with SSD. It highlights the complex and ongoing nature of how decisions are made by these individuals and identifies the need for greater information provision by clinicians, such as through use of a decision aid tool. [ABSTRACT FROM AUTHOR]

Hip precautions are movement restrictions that are often advised following primary total hip arthroplasty (PTHA) for osteoarthritis (OA), but there is limited evidence supporting their effectiveness in preventing dislocation. This study aimed to explore the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. Semi-structured interviews were conducted with therapists and surgeons at six centres using precautions and six centres not using precautions across secondary or tertiary NHS sites in England. Interviews were transcribed verbatim and thematically analysed. Interviews were conducted with fourteen surgeons and eighteen therapists. Of these clinicians, eight surgeons and ten therapists routinely advised precautions. Clinicians continued to use precautions to avoid dislocation by creating a boundary to movement, particularly important when dealing with patients who "push" these boundaries. Clinicians discontinued precautions because of a perceived negative impact on patients and the lack of supporting evidence. In the absence of a rise in dislocation rates for these centres, others have now changed practice. This study offers insight into the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. The use of precautions remains controversial and further work is required to determine whether or not they should be advised. Redesign of future rehabilitation pathways for primary total hip arthroplasty should take into account viewpoints from across the multidisciplinary team to aid decision making. Concern for patient behaviours, dislocation and litigation may be barriers to changing practice for rehabilitation after primary total hip arthroplasty. Clinicians may be discontinuing hip precautions because of known surgical advances, a perceived negative impact on patients and a lack of supporting evidence for historical practice. Individualised rehabilitation considerations are necessary for patients with risk factors that predispose them to dislocation after primary total hip arthroplasty, regardless of whether hip precautions are advised as standard at their given centre. [ABSTRACT FROM AUTHOR]

The quality of parent-child relationships during adolescence has the potential to impact adolescents' mental health. This study explored how seven dyads (parent-child) might experience a two-component intervention (Method of Levels therapy-MOL and a parent-child activity) over four months. Following this, six dyads were interviewed and a thematic analysis was conducted. The most helpful aspect of the intervention for participants was the opportunity to talk. The intervention facilitated helpful conversations that increased participants' awareness and broadened their perspective on the topics discussed. This process helped participants find solutions to their problems. Young people and parents reported that the Shared Goals activity helped them improve their communication and relationships. Young people stated that MOL allowed them to figure things out for themselves. [ABSTRACT FROM AUTHOR]

Police organisations have been slow with regards to the integration of services which are accessible and responsive to the needs of D/deaf citizens. This qualitative study explored the barriers which D/deaf citizens face when accessing police. It considered the impact of police initiatives designed to widen the avenues through which D/deaf people can contact them including information and communication technologies (i.e. Emergency SMS Text Services and Video Relay Services) and interpreters. The study involved focus groups with D/deaf citizens, interviews with police officers, and a review of police practices in England. The findings focus on cultural, technological and interactional barriers, and demonstrate that despite indications that members of this community are likely to be vulnerable in terms of victimisation, current policies, procedures and training do not address access requirements. This article looks at the barriers faced by D/deaf citizens when accessing police services. Age, ethnicity and disability impacted on D/deaf citizens' access to services and their use of technologies to contact the police. D/deaf citizens felt that more work needed to be done to raise greater deaf awareness amongst police officers and to avoid misunderstandings. Some improvements in police service provision have been made, but a better engagement strategy is needed to build D/deaf citizens' confidence in the police. The research recommends that when designing police services and technologies, the focus must include the needs of D/deaf citizens. [ABSTRACT FROM AUTHOR]

In the United Kingdom, 1.5 m partners, friends and family members provide substantial care and support to people experiencing mental health problems. Previous studies have focused on the experiences of such carers in community settings. This study focused on carers of those detained in inpatient settings under the Mental Health Act 1983 who maintain relationships via Section 17 (s.17) leave. Semi-structured telephone interviews with five carers were analysed thematically and identified that carers: struggled with the emotional impact of s.17 leave, experiencing anxiety, guilt, and stigma; experienced practical challenges and self-sacrificed in order to support s.17 leave; but reported positive impacts on the maintenance and development of their and the detained person's social identities and networks. However, these carers received very little support. Implications for social workers include the need to support carers before, during and after s.17 leave, through supporting their involvement in planning the leave, ensuring that escorted leave is staffed by those known to the carer, raising awareness of carer needs and referring carers for support and/or psychoeducation and a care needs assessment. Social workers are well-placed to take a holistic view and support carers in navigating the challenges that caring for somebody around s.17 leave can bring. [ABSTRACT FROM AUTHOR]

International research reveals underrepresentation and problems of retention, amongst care leavers in higher education, are universal. Drawing upon qualitative research in England, we highlight legacy as an under-explored and double-edged feature of care leavers' motivations to enter and persist in university study. While restricting access to the propulsive power of material resources, in the context of a widening participation policy mandate, our interviewees' care experiences also shaped an 'orientation framework' providing a strong desire to 'prove people wrong' through study. Supporting this orientation were examples of significant other relations; but interviewees' linked lives also meant the past could resurface in the present, resulting in strong emotional reactions. These could threaten orientation to university study by undermining self-reliance and fragile mental health. As the problem of care leavers' retention occurs across different higher education systems with varied structural and cultural specifics, it appears to transcend such issues. We conclude further study of the nuanced issue of legacy may help better elucidate the problem of retention and we advocate for 'corporate parenting' moving beyond an objective list approach to well-being. [ABSTRACT FROM AUTHOR]

A rising number of children are permanently excluded from school each year in England. Children's experiences of exclusion are underrepresented in the literature, effectively giving prominence to the views and interpretations of researchers. This qualitative study uses semi-structured interviews to explore the ways in which excluded children story their experience of school exclusion (N = 18). Thematic analysis was used to identify trends in the children's data, integrating key themes to develop an understanding of how children make sense of the exclusion situation. The main findings from this study are that excluded children tend to experience schools as misreading symptoms of social injustice, bullying, and special educational needs as misbehaviour and non-compliance. The children reported that exclusion behaviours were a communication of personal and social problems that were amplified by punitive school measures. Ways in which schools can implement these findings are discussed with key recommendations for employing these findings within schools and educational settings. [ABSTRACT FROM AUTHOR]

Caring for a child with a tracheostomy can be challenging for parents and learning to safely manage their child's airway can be frightening due to their child's breathing issues, complex diagnosis and the difficult decisions they have to make. The aim of this longitudinal narrative study was to tell the stories of parents whose child had a new tracheostomy. Twenty three narrative interviews were conducted with twelve parents from nine families at three time points over a 12 month period. Data were analyzed using a socio-narratological approach. The stories told how parents were able to 'hold their own' despite experiencing shock, emotional upheaval and uncertainty during the period of their child's surgery. 'Holding their own' was possible for parents because resilience played an important part of their journey. Parents continued to be resilient as they adapted to being at home and dealt with ongoing challenging and stressful circumstances. All of the parents told stories reflecting on and recognizing that there were times when they exhibited higher levels of resilience and times when their resilience was lower. Looking back on their experiences parents appreciated that they reframed their initial often negative views about their child's need for a tracheostomy into more positive understandings and a future orientated perspective. [ABSTRACT FROM AUTHOR]

A new diagnosis of Complex Post-traumatic Stress Disorder, CPTSD, is included in ICD-11 which was adopted in May 2019 by the World Health Organisation, WHO. In addition to the symptoms of PTSD, CPTSD includes emotional dysregulation, negative self-concept, and disturbances in relationships. It may be a helpful diagnosis for trauma survivors with experiences of human mistreatment such as torture and abuse. This study explores the views of patients in the community on psychotherapy for the diagnosis of CPTSD, taking a qualitative, participatory approach. Twenty-four former patients from an NHS secondary mental health service in London interviewed each other about their treatment. Participants also collaborated in data analysis. All had a diagnosis of PTSD, with additional symptoms of CPTSD identified at assessment. The key factor in recovery was rebuilding relationships, beginning with the therapist. Groupwork was helpful in promoting relationships with others, as it may result in shame reduction. Involvement in the wider community through peer support groups was also valuable. The rebuilding of relationships based on trust was an active mechanism of change and recovery from CPTSD. Participants felt that sufficient time, at least one year of psychotherapy with weekly sessions, was needed. [ABSTRACT FROM AUTHOR]

To develop a career is considered a central task for adolescents. The aim in the present study was to explore the content and process of career development and meaning making processes using a narrative approach. As a convenience sample, participants were 20 Italian students attending their last two years of high school and 23 English students attending sixth form education. Students in both groups produced written narratives using the same prompt. Analysis indicated that most of the students are still at a development stage of "exploration", although there appear to be cultural differences. However, those who explored personal values, interests and passions, and had early work experiences, showed clearer career development. [ABSTRACT FROM AUTHOR]

On completion of a medical degree, junior doctors in the UK undergo a 2 year Foundation Programme. Since 2016, 45% of Foundation Programme doctors are required to undertake a psychiatry placement during foundation training. During this time, recruitment to Core Psychiatry Training has fluctuated, dropping to a 69% fill rate in 2017. With the support of the Royal College of Psychiatrists, Health Education England and the UK Foundation Programme Office, a large-scale study was formulated utilising semi-structured focus groups. These exploring participant experiences help to understand how and if the psychiatry foundation placements are valuable, and their potential influence on a trainee choosing psychiatry as a career. A framework analysis was used to analyse data. Seventy-four participants across 10 foundation schools in England participated. Experiences and perceptions were split into three broad themes; pre-placement, during placement, and post-placement. Within these, 12 sub-themes emerged. Doctors valued independence and responsibility especially if accompanied by a level of support from seniors. They also enjoyed working as part of a multi-disciplinary team. However, there were clear issues around staffing levels, stigma attached to psychiatry, and out of hours working. The pre-placement perceptions of psychiatry as a specialty as well as the trainees' personal priorities for career selection were influenced by psychiatry placement experiences. The results have important implications for the recruitment to the specialty and need to be considered when designing and constructing placement aims. [ABSTRACT FROM AUTHOR]

A new form of narrative counselling for adolescents at risk of exclusion was piloted in 3 schools with 11 students between the ages of 13–14 years over a 6–7-week period. The intervention took into consideration that compared to adults, adolescents are more susceptible to being influenced by their immediate surroundings of home and school. A measure of progress on a student engagement scale showed an improvement in educational engagement, particularly in students' behavioural engagement in class. The process of narrative counselling adolescents at school is described and the issues addressed in the narrative counselling sessions are discussed. Finally, the inclusive ethos of the secondary schools that the counsellors worked in are considered, as they facilitated or hindered the counselling intervention. [ABSTRACT FROM AUTHOR]