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Background: The MODEM project (A comprehensive approach to MODelling outcome and costs impacts of interventions for DEMentia) explores how changes in arrangements for the future treatment and care of people living with dementia, and support for family and other unpaid carers, could result in better outcomes and more efficient use of resources.Methods: MODEM starts with a systematic mapping of the literature on effective and (potentially) cost-effective interventions in dementia care. Those findings, as well as data from a cohort, will then be used to model the quality of life and cost impacts of making these evidence-based interventions more widely available in England over the period from now to 2040. Modelling will use a suite of models, combining microsimulation and macrosimulation methods, modelling the costs and outcomes of care, both for an individual over the life-course from the point of dementia diagnosis, and for individuals and England as a whole in a particular year. Project outputs will include an online Dementia Evidence Toolkit, making evidence summaries and a literature database available free to anyone, papers in academic journals and other written outputs, and a MODEM Legacy Model, which will enable local commissioners of services to apply the model to their own populations.Discussion: Modelling the effects of evidence-based cost-effective interventions and making this information widely available has the potential to improve the health and quality of life both of people with dementia and their carers, while ensuring that resources are used efficiently. [ABSTRACT FROM AUTHOR]

Background Valuable learning derived from public health practice can be captured through practice-based case studies, also known as practice examples. Practice examples of participatory interventions supplement the evidence base by providing information on the complexities of implementation in communities. This paper reports on a Public Health England project to build a bank of community-centered practice examples based on robust processes of collection and curation. Methods The multidisciplinary project had three phases: (i) development and piloting a process to collect practice examples, (ii) refining review processes and gathering further examples via national and regional teams (iii) maintenance of an accessible collection on the library platform. Results The project resulted in a searchable collection of 55 practice examples illustrating participatory approaches in public health practice. The collection shows diversity in terms of settings, population, focus and type of approach used to work with communities. A secondary outcome was the development of generic guidance and templates for further collections on public health topics. Conclusions This project illustrates how information on the implementation of community-centered approaches in real-life contexts can be gathered and disseminated through a transferable process. Having collections of practice examples supports knowledge exchange in public health as learning is shared. [ABSTRACT FROM AUTHOR]

Starting in 2002, the UK Labour Government of 1997–2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase patients’ choices of the place of elective hospital care and encourage competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. In June 2008, the White Paper, High quality care for all, was published. It represented the government’s desire to focus the next phase of health care system reform in England as much on the quality of care as on improving its responsiveness and efficiency.The 2008 White Paper led to the commissioning of a further wave of evaluative research under the auspices of HREP, as follows:an evaluation of the implementation and outcomes of care planning for people with long-term conditions;an evaluation of the personal health budget pilots;an evaluation of the implementation and outcomes of the Commissioning for Quality and Innovation (CQUIN) framework; andan evaluation of cultural and behavioural change in the NHS focused on ensuring high quality care for all.This Supplement includes papers from each project.The evaluations present a mixed picture of the impact and success of the 2008 reforms. All the studies identify some limitations of the policies in the White Paper. The introduction of personal health budgets appears to have been the least problematic and, depending on assumptions, likely to be cost-effective for the sorts of patients involved in the pilot. For the rest of the changes, impacts ranged from little or none (CQUIN and care planning for people with chronic conditions) to patchy and highly variable (instilling a culture of quality in acute hospitals) in the three years following the publication of the White Paper. On the other hand, each of the studies identifies important insights relevant to modifying and improving the policies. These findings have continuing relevance since both the 2008 White Paper’s policies, and the issues they were focused on remedying, remain central to the current Coalition Government’s reform agenda. [ABSTRACT FROM PUBLISHER]

Aim: To develop and explore the validity of a Patient Reported Experience Measure (PREM) for adult inpatient diabetes care. Method: 27 in‐depth interviews were conducted to inform the development of the 42‐item PREM which was cognitively tested with 10 people. A refined 38‐item PREM was piloted with 228 respondents completing a paper (n = 198) or online (n = 30) version. The performance of the PREM was evaluated by exploring (i) uptake/number of responses and (ii) survey validity by investigating whether the PREM data were of adequate quality and delivered useful information. Results: The PREM had low drop‐out or missing data rates suggesting it was appropriately constructed. Analysis of item frequencies and variances, and problem score calculations concluded that questions provided sufficient score differentiation. Conclusions: This new PREM allows for experiences of inpatient diabetes care to be measured, understood and reported on to help identify priority areas for improving care quality. [ABSTRACT FROM AUTHOR]

Introduction: Peer-reviewed research helps to advance many aspects of medical and surgical practice. This paper determines the main contributors tos joint arthroplasty research in terms of quantity and quality. Methods: A search of the Web of Science™ platform was conducted to identify arthroplasty articles published between 2001 and 2016. The number of articles and citations per article were analysed to assess the quantity and quality of research from individual countries. Results were standardised according to the country's populations and Gross Domestic Product (GDP). Results: In total, 43,470 arthroplasty articles were published worldwide from January 2001 through December 2016. There was a 4.5-fold increase in global output during this time period. Twenty-two countries contributed at least 1% to the total number of publications. The United States of America published the most articles (35.40%), followed by England (10.31%) and Germany (10.03%). The USA had the highest absolute number of citations (50,777). Denmark had the highest average citation per item (8.76). When number of articles was normalized to population, Switzerland ranked the highest. When adjusted by GDP, Scotland ranked highest. When standardised according to GDP per capita, the People's Republic of China rated highest. The Journal of Arthroplasty produced the highest number of publications related to arthroplasty with 10.9% of total volume. Conclusion: There has been a substantial increase in worldwide publications relating to arthroplasty. The USA has produced the largest volume whilst Denmark has produced the highest quality publications. When output was normalized according to population and GDP, Switzerland and Scotland ranked highest. [ABSTRACT FROM AUTHOR]

Purpose: In care homes concerns about abuse have established a culture where all information pertaining to a person must be shared, and little attention is paid to privacy in its broader sense. The purpose of this paper is to take a human rights perspective and consider how information governance may impact on the health, well-being and quality of life of residents. It proposes a proactive approach and presents a template for a privacy impact assessment which services could use to improve their approach to privacy, protecting the human rights of those in their care, contributing to their independence and improving outcomes. Design/methodology/approach: A review of historical and current thinking about the value of privacy in human services and wider society leads to a series of challenges to the way in which privacy is upheld in residential care services. Findings: Recent preoccupations with data privacy have led to a myopic neglect of broader considerations of privacy. Whilst it continues to be important to protect the confidentiality of personal data and to ensure that residents are protected from abuse, human services that provide 24 hour care in congregated settings must not neglect broader components of privacy. Research limitations/implications: Privacy impact assessments have been widely used to check whether data privacy is being upheld. The broader concept that might be termed "Big Privacy" is introduced within which data privacy is but one section. It is suggested that big privacy is severely compromised in residential care settings, thus denying residents their human right to privacy. The extent of such violation of rights should be investigated. Practical implications: Having set out the potential reach of the human right to privacy, important work needs to be done to find out how privacy might be upheld in the real world of congregate residential care. Some service providers may have solutions to the organisational challenges, have addressed staff training needs and revised risk assessment strategies so that privacy is upheld alongside other rights. Social implications: Nearly half a million people live in congregate residential care settings in England, and deprivation of privacy is argued to be a significant deprivation of human rights. Occasional tragedies and scandals in congregate settings create pressure for increasing the level of surveillance, and the right to privacy is sacrificed. This paper offers a challenge to this process, arguing that competing rights need to be balanced and privacy is an essential component of a decent quality of life. Originality/value: Personal growth and development depends to some extent on choice and control over access to privacy. Recent changes in the law regarding data protection have narrowed our thinking about privacy until it is a small concept, largely concerned with data handling. This paper invites consideration of big privacy, and invites congregate residential care settings to consider how a deep and broad definition of privacy could transform these services. [ABSTRACT FROM AUTHOR]

The professed aim of any social welfare or legal intervention in family life is often to bring about "better outcomes for the children." But there is considerable ambiguity about "outcomes," and the term is far too often used in far too simplistic a way. This paper draws on empirical research into the outcomes of care proceedings for a randomly selected sample of 616 children in England and Wales, about half starting proceedings in 2009–2010 and the others in 2014–2015. The paper considers the challenges of achieving and assessing "good outcomes" for the children. Outcomes are complex and fluid for all children, whatever the court order. One has to assess the progress of the children in the light of their individual needs and in the context of "normal" child development, and in terms of the legal provisions and policy expectations. A core paradox is that some of the most uncertain outcomes are for children who remain with or return to their parents; yet law and policy require that first consideration is given to this option. Greater transparency about the uncertainty of outcomes is a necessary step towards better understanding the risks and potential benefits of care proceedings. [ABSTRACT FROM AUTHOR]

Purpose - Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however, there is little guidance available to help those working with detained patients with ID and offending histories to consider how to affect safe and effective discharges. The paper aims to discuss these issues. Design/methodology/approach - In this paper, the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought. Findings - Initial outcome data provide support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support. Practical implications - People with ID are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission. Originality/value - This is the first attempt to describe and evaluate a discharge planning intervention for detained offenders with ID. The intervention described appears to be a promising approach but further evaluation across a range of service settings is required. [ABSTRACT FROM AUTHOR]

While many evidence-based tools and measures exist to support child protection practice, in the United Kingdom, there is little evidence of their routine use in casework. This paper reports on a qualitative study exploring the use of such tools with children and families receiving statutory social care services. Fifteen social workers working in child safeguarding teams in two local authorities in Southeast England agreed to incorporate the use of outcome measures into their casework over a 6-month period. Qualitative data were collected through monthly action learning workshops held separately in each local authority. The results showed how the impact of using the measures was shaped by a combination of institutional factors, practice context and the dynamics of casework. Outcome measures were found to have benefits as well as limitations with respect to partnership working, assessment and decision-making and overall social work practice. Implications are discussed for the prospects of enhancing the use of evidence-based tools in statutory social work with children and families. [ABSTRACT FROM AUTHOR]

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

The NHS England Radiotherapy Service Specification calls for routine use of patient-reported outcome measures (PROMs). However, barriers exist at patient, healthcare professional and service levels. The aim of the present study was to determine the current use of PROMs within radiotherapy services in England. The current attitudes, barriers and enablers to the implementation of PROMs in radiotherapy practice were evaluated and practical recommendations to inform future implementation were developed. A mixed-methods approach was adopted to obtain quantitative and qualitative data. An online questionnaire was developed and disseminated to all radiotherapy operational delivery network managers across England. The questionnaire consisted of 12 open and closed questions relating to PROMs use, with the option to provide free-text responses. Inductive thematic analysis was conducted on free-text comments, whereas descriptive statistics were used to analyse quantitative data. In total, 182 responses were received from 40 of the 50 radiotherapy providers, resulting in a response rate of 84%. The current use of PROMs was analysed, including rationale for use, tools used, format of PROMs collection and timing within the radiotherapy pathway. Most respondents indicated that PROMs were used in the context of clinical trials only. Through thematic analysis, four identical key themes were identified relating to both barriers and enablers to PROMs use; these included IT infrastructure, time, human/financial resources and training/education. A fifth theme, standardisation, was identified as a key enabler to PROMs use. Our findings show that outside of clinical trials, PROMs are not routinely used in radiotherapy services due to barriers identified at professional and service levels. Here we provide recommendations to mitigate the barriers identified and implement PROMs in radiotherapy, including training for healthcare professionals and standardisation of PROMs tools and storage. This study provides a key first step in driving PROMs implementation within radiotherapy services across England. • Outside of clinical trials, PROMs were not widely used within radiotherapy services. • Common PROMs used included QOL, anxiety/depression and urinary/bowel function tools. • PROMs are completed using either paper or electronic forms, by staff or patients. • Barriers include IT infrastructure, time, resources (staff/finances) and training. • Enablers included IT, time, resources, training and standardisation. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to discuss whether the use of outcome-focused homecare improves the subjective well-being of the familial carers of older people with dementia. It also discusses familial carers’ perception of whether this intervention has improved the well-being of their relative. Design/methodology/approach – This qualitative study followed the familial carers of 20 service users suffering from dementia over a six-month period. Semi-structured interviews were undertaken at three intervals during the six months. The carers were asked to assess their subjective well-being at the start, middle and end of the study. Findings – The key findings were that all 20 familial carers expressed an improvement in their subjective well-being and that of their older family member, who appeared more settled as a result of this model of care. Practical implications – The need to consider the use of outcome-focused care as an intervention strategy for older people living alone in the community. The need to provide supportive environments for the carers of older people with dementia to limit their sense of isolation. The prioritising of outcome-focused care in the most complex and chaotic cases. Originality/value – This study provides an insight into the effectiveness of outcome-focused homecare with older people experiencing dementia as perceived by their familial carers. Previously, research has established that outcome-focused care increased the subjective well-being of non-dementia sufferers. This study dovetails neatly with this in demonstrating the same effect on dementia sufferers as perceived by their familial carers. Additionally, this study also demonstrated that this model of outcome-focused care also improved the subjective well-being of the familial carers themselves. These finding will help practitioners consider the use of this model of homecare as a potential alternative or a delaying strategy to residential care. [ABSTRACT FROM AUTHOR]

Introducing continental European approaches to UK child welfare practice raises a problem of comparison: to what extent are the problems and issues similar to or different from one country compared to another. Social pedagogues trained in continental Europe and working in English residential care services often encountered the phrase ‘our young people are worse’ from their English colleagues, with the implication that the social pedagogic approach was not suitable for the client group. This paper examines two propositions: (1) that in the context of introducing the continental European approach of social pedagogy into children's residential care services in England, young people are ‘different’ in England compared to other European countries and (2) that the placement options and practices for young people living away from their birth parents in continental European countries differ from those in England. Using data from a five nation study of young people from public care backgrounds, the paper argues that while family backgrounds are remarkably similar there are marked differences in the child welfare systems that might account for the perception that young people in care are ‘worse’ in England. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to share the challenges of, and learning gained by a voluntary sector organisation, Coventry Rape and Sexual Abuse Centre (CRASAC) in providing integrated care to victims of sexual violence. Design/methodology/approach – The paper first considers the big picture, focusing on the current UK public sector commissioning environment, the policy commitment to integrated care, and challenges a current focus on definitions of integration that do not consider wider determinants of health and well-being. As an example of client groups who may not meet narrow criteria, but require person centred coordinated care, the needs of victims of sexual violence are explored, illustrated by a case study within CRASAC. Findings – Challenges faced by CRASAC include identifying responsibility for specialist commissioning, maintaining strategic partnerships and a lack of cross-sector understanding of the needs of victims of sexual violence. Key learning points are the need to form strategic alliances and partnerships, to lobby and influence decision makers, to develop monitoring tools that demonstrate impact on long-term client outcomes and to constantly raise awareness of the needs of victims of sexual violence. Final reflections focus on the questions these issues raise for the future of specialised integrated care in the voluntary sector. Originality/value – The paper is of value to commissioners in health, social care and the criminal justice system, in addition to providers of services that are in contact with victims of sexual abuse. These include health, criminal justice, education, police and social care, alongside other voluntary and community sector organisations. [ABSTRACT FROM AUTHOR]

Objectives There are few papers concerning ethnic differences in disease expression in PsA, which may be influenced by a number of genetic, lifestyle and cultural factors. This article aims to compare clinical and radiographic phenotypes in people of South Asian (SA) and North European (NE) origin with a diagnosis of PsA. Methods This was a cross-sectional observational study recruiting patients of SA and NE origin from two hospitals in a well-defined area in the North of England. Results A total of 58 SA and 48 NE patients were recruited. SA patients had a more severe clinical phenotype with more tender (median 5 vs 2) and swollen (median 1 vs 0) joints, more severe enthesitis (median 3 vs 1.5), more patients with dactylitis (24% vs 8%), more severe skin disease (median PASI 2.2 vs 1) and worse disease activity as measured by the composite Psoriatic Arthritis Disease Activity Score (mean 4.5 vs 3.6). With regards to patient-completed measures, SA patients had worse impact with poorer quality of life and function (mean HAQ 0.9 vs 0.6; mean PsAQoL 10.8 vs 6.2; mean 36-item short form physical component score 33.5 vs 38.9). No significant differences in current MTX and biologics use were found. Conclusions SA patients had a worse clinical phenotype and worse impact of disease than NE patients. Further studies are needed to confirm and explore the reasons behind these differences. [ABSTRACT FROM AUTHOR]

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

Background: In recent years joint commissioning has assumed an important place in the policy and practice of English health and social care. Yet, despite much being claimed for this way of working there is a lack of evidence to demonstrate the outcomes of joint commissioning. This paper examines the types of impacts that have been claimed for joint commissioning within the literature. Method: The paper reviews the extant literature concerning joint commissioning employing an interpretive schema to examine the different meanings afforded to this concept. The paper reviews over 100 documents that discuss joint commissioning, adopting an interpretive approach which sought to identify a series of discourses, each of which view the processes and outcomes of joint commissioning differently. Results: This paper finds that although much has been written about joint commissioning there is little evidence to link it to changes in outcomes. Much of the evidence base focuses on the processes of joint commissioning and few studies have systematically studied the outcomes of this way of working. Further, there does not appear to be one single definition of joint commissioning and it is used in a variety of different ways across health and social care. The paper identifies three dominant discourses of joint commissioning - prevention, empowerment and efficiency. Each of these offers a different way of seeing joint commissioning and suggests that it should achieve different aims. Conclusions: There is a lack of clarity not only in terms of what joint commissioning has been demonstrated to achieve but even in terms of what it should achieve. Joint commissioning is far from a clear concept with a number of different potential meanings. Although this ambiguity can be helpful in some ways in the sense that it can bring together disparate groups, for example, if joint commissioning is to be delivered at a local level then more specificity may be required in terms of what they are being asked to deliver. [ABSTRACT FROM AUTHOR]

Purpose This paper reports research undertaken into the practices, processes and outcomes of joint commissioning at five English localities. This paper reflects on the implications of this study for the practice of joint commissioning. Design/methodology/approach A case study approach to the research was adopted where the assumptions about what joint commissioning should deliver in five "best practice" sites. These hypothesised relationships about organisational processes, services and outcomes were then tested through the collection of primary and secondary data. Methods of data collection included an online tool based on Q methodology, documentary analysis, interviews and focus groups. Findings - Very little of what we found seemed to relate directly to issues of joint commissioning. Respondents often spoke of joint commissioning conflating it with issues of commissioning or joint working more generally. We found a variety of different definitions and meanings of joint commissioning in practice suggesting that this is not a coherent model but varies across localities. Little evidence of improved outcomes was found, due to practical and technical difficulties. Research limitations/implications -Joint commissioning is not a coherent model and is applied in different ways across different contexts. As such we may need to ask very different questions of joint commissioning to those typically asked. Practical implications - It is important that local sites are clear about what they are trying to deliver through joint commissioning or else risk that it becomes an end in itself. Some of the current reforms taking place in health and social care risk pulling apart existing relationships that have taken significant time and resource to develop. Originality/value - This is one of the first large-scale studies of joint commissioning conducted in England. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care coordination. The paper illustrates the potential for integration through the experience of the personal health budgets pilot programme. Design/methodology/approach - This paper is based on a review of the experience of personal health budget pilot sites, drawing on the national evaluation of the pilot programme and the author's experience of working with pilot sites between 2010 and 2013. It also draws on the experience of similar programmes in the USA. Findings Personal health budgets support integration in two distinct ways. First, they can support the delivery of more holistic, whole-person care in line with the principles of shared decision making. Second, by bringing personal budgets in social care and personal health budgets together, they can provide a vehicle for integration across health and social care systems. If integration starts from, and responds to, what matters most to individuals rather than with the development of joint structures and processes, the result is more likely to be integrated care. Originality/value - This is one of only a small number of papers that discusses the scope for personal health budgets to improve the integration of care. Integration between the NHS and social care, in particular, has been identified as a central priority for the NHS. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to report on a study of outcome-focused care for older people in one English local authority. The aim of the research is to examine whether altering the delivery of care to an outcome-focused model would improve the individual participant's subjective well-being and save money for the local authority. Design/methodology/approach – In order for the aim of the research to be established, a pilot study was devised. This was a longitudinal study over 18 months, using a quantitative design. The sample was of 40 service users aged 65 and over whom all had critical and substantial care needs. Half of the sample of service users was receiving the new form of outcome-focused care and the other half were a comparison group who were receiving care packages according to the traditional form of delivery that could be characterised as a "task-focused" model. The service users were administered the Measure Yourself Concerns and Wellbeing Questionnaire (MYCAW). This questionnaire involves respondents identifying quality of life issues; where they are seeking improvement; and measures change over time in relation to these. Findings – The research established that there was a greater improvement in subjective well-being in the group receiving outcome-focused care, when compared with the comparison group receiving the traditional task-focused model. Practical implications – This paper will assist managers in their decision making to implement a more outcome-focused model of home care with older people. Originality/value – To use MYCAW in a social care context is an innovative aspect of this study as it has previously been used only in mainstream and complementary medicine. The focus of this paper is to examine the impact of two models of home care delivery for older people, and how these two models impact on the older persons' self-reported well-being. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to share the key findings of the Wandering in the Woods action research project conducted by Dementia Adventure. Practical implications for changing practices in the dementia care and health and well-being sectors are highlighted. Design/methodology/approach – Qualitative and quantitative data were gathered using the participatory appraisal method in small groups both before and after "woodland adventure" days out. Findings – There was a 41 per cent increase in participants rating "exercise" as a factor which is "very important" to them. A number of potential physical, emotional, and social benefits of activity out in woodlands, for people with dementia, were identified. Research limitations/implications – The research is conducted with three relatively small groups, which vary in composition across the study, for practical reasons associated with care and capability of participants. Practical implications – Suggestions are shared and questions posed for individuals wanting to practically embed the learning from this project. Originality/value – Research looking at the benefits of green exercise and experiences of people living with dementia in care taking activity out in nature is very limited, this paper significantly contributes to this growing body of knowledge. [ABSTRACT FROM AUTHOR]

Purpose - This paper identifies ways in which community action can enhance the quality of life of older residents and reports specifically on four community gardening initiatives developed with older people living in disadvantaged communities in Manchester.Design/methodology/approach - The Community Action in Later Life - Manchester Engagement (CALL_ME) project used an action research approach to engage older people. Older people and other stakeholders were actively involved in designing, planning and implementing the projects.Findings - Drawing on a range of qualitative data, the paper provides evidence of how older people can be actively engaged in community projects, and explores the benefits of involvement including: enhanced well-being, and increased socialisation, learning and empowerment. The challenges faced by the older people are also reported which include maintaining interest, recruiting new members and needing external support.Research limitations/implications - The paper also reports the implications for practice, discussing how gardening initiatives can involve and benefit older people and the wider community and the value of an action oriented approach in disadvantaged communities. Recommendations are made regarding ensuring sustainability of such projects by providing education and training to enhance participants' skills and build their confidence.Originality/value - Whilst recognising the problems associated with living in disadvantaged communities, the CALL-ME project takes a new approach and moves the focus to ways in which older people can become engaged in and benefit from community action, and empowered to sustain the projects they develop. [ABSTRACT FROM AUTHOR]

Purpose - This is the second of two papers which aims to describe the development of a sex offender assessment and treatment service for men with intellectual disability (ID) within a community ID service. The first paper by McBrien et al. in 2010 described the mapping of need, the assessment methods and results.Design/methodology/approach - This paper describes how decisions were made about whether or not to enrol 20 assessed men on group treatment and outlines the treatment group and outcomes.Findings - None of the seven men who completed treatment had committed a further sexual offence at 12-24 months follow-up. Other outcomes are discussed including the outcomes for the men who did not start or complete treatment. The available measures are not sufficiently sophisticated to detect change in individuals.Originality/value - This paper contributes to the literature that describes the assessment and treatment of men with an ID who have committed sexually harmful behaviours. It describes one community service's response to the complex needs of this client group. [ABSTRACT FROM AUTHOR]

Purpose - The search for alternatives to inpatient mental health care in the UK and further a field has been going on over the last few decades of the previous century. Amongst the range of alternatives that have been developed are community-based mental health crisis houses that seek to work with people, who may otherwise have been admitted to hospital. Amethyst House is a four-bed mental health crisis house based in inner city Liverpool and works solely with the local Crisis Resolution Home Treatment Team (CRHTT) to work with people who require support that could not be delivered at home. The purpose of this paper is to report the findings of one element of a service evaluation: the effectiveness of the service in relation to the mental health needs of people admitted.Design/methodology/approach - The paper describes the service model, which integrates the crisis house and the CRHTT, with the latter acting as gatekeepers to the service.Findings - Findings showed improvements in mental health symptomatology and disabilities associated with the crisis between admission and discharge from the service.Originality/value - The paper describes the profile of the people who used the service over a six-month period in 2009, their care pathways through the service and their clinical outcomes between admission and discharge. [ABSTRACT FROM AUTHOR]

Purpose: Applications for clinical psychology training far outstrip places and relevant work experience is key. Paid opportunities are limited and therefore many choose volunteering, with well-connected graduates faring best. To promote equal opportunities a coordinated psychology graduate voluntary internship programme was established in a National Health Service Trust in the South of England. The purpose of this paper is to evaluate intern and supervisor outcomes, equality of access and adherence to governance standards. Design/methodology/approach: Three cohorts of interns, unappointed applicants and supervisors were surveyed. Between 2013 and 2016, 270 psychology graduates applied, 119 were recruited and 151 either refused a place or were unsuccessful. In total, 91 supervisors provided service-level feedback. Findings: Interns and applicants were predominantly young, able-bodied white British heterosexual females. Demographic profiles were similar and broadly representative of psychology graduates nationally. While fewer were from Black and Ethnic Minority backgrounds, proportions were greater than the local population. Participants were more socioeconomically privileged than undergraduates nationally. The scheme was popular and well governed according to interns and supervisors. Post-internship employment prospects were improved, with most interns gaining paid mental health roles like assistant psychologist. Most supervisors commented on the positive contribution made by interns to service outcomes. Originality/value: This study makes a significant contribution to the literature on voluntary psychology graduate posts, an area under-researched until now. Our results suggest that a coordinated, transparent approach can benefit both interns and services by minimising exploitation and maximising developmental opportunities for the new graduate. The programme makes an important contribution to addressing inequalities experienced by psychology graduates attempting to enter mental health careers. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the association between multi-agency working and psychosocial characteristics of work, practitioner time-use and job satisfaction. Design/methodology/approach – A comparison of practitioners working in multi-agency (health and social care) and single-agency (social care-only) teams, using data from the 2008 evaluation of individual budgets pilots in England. Participants worked in care manager roles supporting adult social care service users, and comprised social workers and a smaller number of health professionals. Data were collected using a self-completed questionnaire. Findings – Data were returned from 249 respondents (a 29 per cent response rate), with two-thirds working in single-agency teams. No significant differences were found between team type and job satisfaction. Respondents in multi-agency teams reported greater decision authority but poorer supervisory support than those in single-agency teams. The latter finding was robust to further exploration using regression to control for confounding factors. Research limitations/implications – These data were not specifically collected for the study and response rates were relatively low due to organisational upheaval at the time of data collection, which may affect interpretation. Practical implications – Government policy is dedicated to extending integrated forms of working, including multi-agency teamwork. This research suggests that such structures need careful planning for them to work effectively, with particular attention to supervision arrangements. Originality/value – This research gives a systematic and objective exploration of the relationship between job characteristics, time-use and satisfaction of practitioners in single as compared to multi-agency teams. [ABSTRACT FROM AUTHOR]

This paper discusses key challenges and opportunities that arise when using linked electronic health records (EHR) in health economics and outcomes research (HEOR), with a particular focus on estimating healthcare costs. These challenges and opportunities are framed in the context of a case study modelling the costs of stable coronary artery disease in England. The challenges and opportunities discussed fall broadly into the categories of (1) handling and organising data of this size and sensitivity; (2) extracting clinical endpoints from datasets that have not been designed and collected with such endpoints in mind; and (3) the principles and practice of costing resource use from routinely collected data. We find that there are a number of new challenges and opportunities that arise when working with EHR compared with more traditional sources of data for HEOR. These call for greater clinician involvement and intelligent use of sensitivity analysis. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present the findings of a small-scale evaluation of the Department of Health “Homeless Hospital Discharge Fund” (HHDF) in England. Design/methodology/approach – The paper is based on a mixed-method approach comprising 52 telephone interviews with project staff, 48 responses from an online survey with staff, outcomes data collected by projects, 30 semi-structured interviews with patients and nine in-depth telephone interviews with staff and commissioners. Findings – Overall the 52 pilots funded under the “HHDF” provided positive health and accommodation outcomes for homeless people admitted and discharged from hospital. In contrast to previous studies patients described not feeling judged during their stay, however the admission process was a more mixed experience due to communication breakdown by hospital staff. Integrating housing and clinical staff in the hospital discharge projects produced better outcomes for patients and the availability of accommodation as part of the model allowed improved and more stable housing outcomes. We recommend integrated commissioning takes place for future funding of any hospital discharge projects. Research limitations/implications – The study was small in scale and carried out before some of the projects had become fully established. The data were self-reported and the quality and completeness varied between projects. Originality/value – This is one of the few examples of hospital discharge outcomes for homeless people across a number of different localities and project models which examine the role of both health and housing professionals in the process. [ABSTRACT FROM AUTHOR]

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

Perinatal mental health problems vary in impact and severity, and can have long-lasting effects on maternal health and child psychological health and development. The evidence to support the effectiveness of postnatal peer and volunteer support schemes to improve the long term health of women is mixed, with some studies highlighting positive effects in terms of reducing symptoms of depression. Using data from a peer support scheme designed to support women with low mood following childbirth, this paper provides insight into the initial support needs of women, alongside the challenges of using volunteer and peer support services. This paper provides health visitors and others working in community settings with an understanding of how volunteer befriending services may, or may not work in community settings. The data suggests that Home-Start does have a positive impact on the lives of some women, however more work is required in order to understand which aspects of the Home-Start intervention women find effective and why. [ABSTRACT FROM AUTHOR]

Background: Standard methods for eliciting the preference data upon which 'value sets' are based generally have in common an aim to 'uncover' people's preferences by asking them to evaluate a subset of health states, then using their responses to infer their preferences over all dimensions and levels. An alternative approach is to ask people directly about the relative importance to them of the dimensions, levels and interactions between them. This paper describes a new stated preference approach for directly eliciting personal utility functions (PUFs), and reports a pilot study to test its feasibility for valuing the EQ-5D.Methods: A questionnaire was developed, designed to directly elicit PUFs from general public respondents via computer-assisted personal interviews, with a focus on helping respondents to reflect and deliberate on their preferences. The questionnaire was piloted in England.Results: Seventy-six interviews were conducted in December 2015. Overall, pain/discomfort and mobility were found to be the most important of the EQ-5D dimensions. The ratings for intermediate improvements in each dimension show heterogeneity, both within and between respondents. Almost a quarter of respondents indicated that no EQ-5D health states are worse than dead.Discussion: The PUF approach appears to be feasible, and has the potential to yield meaningful, well-informed preference data from respondents that can be aggregated to yield a value set for the EQ-5D. A deliberative approach to health state valuation also has the potential to complement and develop existing valuation methods. Further refinement of some elements of the approach is required. [ABSTRACT FROM AUTHOR]

Background Establishing what constitutes clinically significant change is important both for reviewing the function of services and for reflecting on individual clinical practice. A range of methods for assessing change exist, but it remains unclear which are best to use and under which circumstances. Method This paper reviews four indices of change [difference scores ( DS), crossing clinical threshold ( CCT), reliable change index ( RCI) and added value scores ( AVS)] drawing on outcome data for 9764 young people from child and adolescent mental health services across England. Results Looking at DS, the t-test for time one to time two scores indicated a significant difference between baseline and follow up scores, with a standardised effect size of d = 0.40. AVS analysis resulted in a smaller effect size of 0.12. Analysis of those crossing the clinical threshold showed 21.2% of cases were classified as recovered, while 5.5% were classified as deteriorated. RCI identified 16.5% of cases as showing reliable improvement and 2.3% of cases as showing reliable deterioration. Across RCI and CCT 80.5% of the pairings were exact (i.e., identified in the same category using each method). Conclusions Findings indicate that the level of agreement across approaches is at least moderate; however, the estimated extent of change varied to some extent based on the index used. Each index may be appropriate for different contexts: CCT and RCI may be best suited to use for individual case review; whereas DS and AVS may be more appropriate for case-mix adjusted national reporting. [ABSTRACT FROM AUTHOR]

Purpose – Positive Behaviour Support (PBS) is thought to be an important model for working with people with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour Service (CBS). Design/methodology/approach – Clinical outcomes of 24 service users treated by the CBS team were assessed at baseline, six and 12 months and compared with those of 22 peers who received usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and social care supports. Findings – At six months improvements were seen across all ABC domains in both groups, with greater improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group differences were maintained only for stereotypy at 12 months. No other differences were found. Originality/value – This paper suggests that PBS delivered by trained and dedicated staff may provide clinical benefits to individuals with challenging behaviours. However, there are issues around integration into existing services that need to be addressed in order to maximise efficiency. [ABSTRACT FROM AUTHOR]

This paper is an account of a small scale exploratory study about the use and value of football metaphor as a device for facilitating therapeutic work. It is based on an evaluation which used a range of qualitative and quantitative approaches. In this paper, we selectively draw on the qualitative data to provide examples to inform our discussion. We illustrate various ways in which football metaphor can support therapeutic change: by aiding initial engagement, facilitating mutual support, enabling self-understanding and motivating change. We relate our analysis to the literature about the therapeutic value of metaphor and highlight the salience of using football metaphor in a group-based setting for men who are often seen as ‘hard to engage’ in therapeutic support. With some caveats, we argue that football metaphor offers a potentially rich and flexible therapeutic resource. [ABSTRACT FROM AUTHOR]

Purpose National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. The purpose of this paper is to describe the outcomes of a patient group discharged from a specialist forensic ID service in London, England.Design/methodology/approach This is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history and readmissions to hospital and reoffending following discharge.Findings The study identified 40 male patients, 29 of which were admitted to the medium secure ward. In all, 27 patients (67.5 per cent) were discharged into the community with 14 patients having sole support from the community ID services and 4 from the community forensic services. In total, 20 per cent of patients were readmitted within the study period and 22.2 per cent of patients received further convictions via the Criminal Justice System following discharge.Originality/value This was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission and of reoffending. Community-based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist inpatient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services. [ABSTRACT FROM AUTHOR]

A small-scale consultation of care leavers in South London was undertaken in 2013–2014, in order to inform a pilot mentoring scheme to reduce depression in young women through supporting their transition from care to independence. Research on the social factors implicated in the onset and course of depression indicates that social support during stressful events can be protective. Youth mentoring is now widely offered to disadvantaged young people. This paper examines what some young people told us about if and how our proposed mentoring intervention might help in maintaining their well-being through the stress of leaving care. Eleven participants of focus group discussions told us they could see clear benefits in receiving mentoring at this time, and discussed the kind of mentor and activities they might like. However, most did not want a mentor now. Thematic analysis of the discussions arising identified unpaid, open-ended ‘natural mentoring’ relationships as particularly important to them in maintaining their well-being. We consider the fit with related research, and emerging new policy, and the implications for our proposed study, and conclude that supporting the establishment and continuation of natural mentoring is a particularly promising way forward. [ABSTRACT FROM PUBLISHER]

Background: The National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5-11 years. As these are not effective in 25-33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial.Methods and Design: TIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child's behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5-11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3) therapeutic delivery, treatment retention and attendance, intervention adherence rates, (4) follow-up data collection, and (5) statistical, health economics, process evaluation, and qualitative outcomes.Discussion: TIGA-CUB will provide important information on the feasibility and potential challenges of undertaking a confirmatory RCT to evaluate the effectiveness and cost-effectiveness of mPCP.Trial Registration: Current Controlled Trials, ID: ISRCTN86725795 . Registered on 31 May 2016. [ABSTRACT FROM AUTHOR]

The 11th annual National Lymphoedema Conference, organised by the British Journal of Community Nursing in association with the British Lymphology Society and Lipoedema UK, was hosted at the America Square Conference Centre, London, on 22 February 2024. The conference, which aims to provide new insights into the latests developments in lymphoedema care and management through talks by leading experts in the field, was attended by an impressive number of delegates and exhibitors. The sessions were Chaired by BLS Trustee Rebecca Elwell, and are summarised below. [ABSTRACT FROM AUTHOR]

This paper gives a history of Hampshire and Thames Valley (HTV) Circles, an organisation which recruits, trains and supports volunteer members of the public who are formed into small groups meeting weekly to provide support and monitoring of post-conviction sex offenders (Core Members) in the community. It describes the origins of Circles of Support and Accountability in Canada and gives an account of its implementation in the UK and a summary of the findings of the previous study of the first 16 HTV Circles Core Members in 2006 and some discussion about the challenges inherent in evaluating this kind of community-based and volunteer-led intervention. It describes demographic data on 60 Core Members followed-up for an average period of 36.2 months, including offence and sentence category, treatment history and statistically assessed risk of reconviction. It provides evidence of progress by these Core Members across a range of dynamic risk factors, as well as information on sexual reconviction, recall to prison and dropout from Circles. Three case studies provide details of Circles practice in community risk management of sex offenders. The paper discusses proposed areas of further research into Circles work, as well as the development of new techniques for measuring and managing dynamic risk factors displayed by Core Members in the community. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper pertains to the implementation of an occupational therapy service within a newly-established medium secure service for 16 men with intellectual disabilities and additional diagnosis of personality disorder located in the North West of England. Design/methodology/approach – This is a general review, providing a descriptive account of the development and implementation of an occupational therapeutic provision for men residing in a medium secure unit with a dual diagnosis of intellectual disability and personality disorder and a service user account of its efficacy. Findings – The paper seeks to illustrate the efficacy of occupational therapy implemented by a specifically recruited and trained staff team, describing engagement in meaningful, bespoke programmes of occupation used to assist service users to address deficit areas via mutual engagement in activities, serving to facilitate the formation and development of positive and trusting relationships between service users and staff. The impact of the service is described from a service user's perspective. Originality/value – There is very little literature relating to those with intellectual disability also diagnosed with personality disorder. There appears to be no specific study of occupational therapy amongst those with dual diagnosis of intellectual disability and personality disorder. This paper is therefore unique in its approach and provides an overview of both the process and method used to implement occupational therapy, as well as a service user perspective and an illustration of its efficacy in a medium secure setting. [ABSTRACT FROM AUTHOR]

This paper describes the conceptual underpinnings, structure and operations of a novel service, the City and Hackney Primary Care Psychotherapy Consultation Service – a service set up partly with the aim of addressing the needs of patients who present with ‘medically unexplained symptoms’. As part of the Tavistock and Portman NHS Trust, this service moves its clinical base, staff members and daily work, as well as the foundations of psychoanalytic thinking that define the Trust's work, into the heart of a community, and provides psychoanalytically informed clinical practice and consultation to patients and general practitioners in the City and Hackney, one of London's (and the UK's) most deprived and ethnically diverse boroughs. The authors describe the psychoanalytical underpinnings of the model, the design and structure of the service, patient demographics and preliminary outcome data, as well as an example of consultation work with general practitioners. The authors propose that psychoanalytic applications have a place in primary care and that psychoanalytic thinking can help general practitioners and patients alike, even when the clinical interventions offered are not solely based on psychoanalytic technique or therapeutic approaches. The paper concludes with thoughts about the model, its origins and its future. [ABSTRACT FROM PUBLISHER]

ABSTRACT This paper describes a project undertaken by family centre staff, drawing on the ideas of the Marlborough Family Service in using multi-family groups as part of their parenting assessments. Child protection assessments are complex and have a far reaching effect on the lives of vulnerable children; practitioners can carry the burden of assessing parents' capacities to meet their children's needs without adequate supervision or support. Our project was developed following the implementation of a new policy, the Public Law Outline, requiring parenting assessments to be completed within a 40-week time frame. We were concerned that this would not afford the opportunity to develop a sufficient relationship with families to provide a thorough assessment. The paper describes the incorporation of multi-family days into the parenting assessments and the effect of this work on clients and practitioners. This paper is a practice paper, rather than a formal evaluation, and describes a project in which family centre workers sought to provide a model of assessment based on working as part of a team, managing uncertainty and valuing the opportunity to develop a relationship with clients in order to make an assessment. [ABSTRACT FROM AUTHOR]

Objective:Anterior tongue reduction is indicated when macroglossia causes problems with oral hygiene, airway compromise, deglutition, articulation or orthognathic complications. Causes of macroglossia include hypothyroidism, mucopolysaccharide and lipid storage disease, lymphangioma, haemangioma, neurofibroma, and muscular macroglossia. This paper presents an 11-year experience of anterior tongue reduction at Great Ormond Street Hospital.Method:Retrospective study of patient medical records identified from the hospital ENT database. Anterior wedge resection was the preferred technique.Results:Anterior tongue reduction was performed on 18 patients, due to cystic hygroma with tongue involvement (nine patients), Beckwith–Wiedemann syndrome (eight) and Down's syndrome (one). Anterior wedge resection was preferred, using electrocautery in the majority, except for four cases involving CO2 laser. All but one patient had a good surgical outcome (i.e. tongue in mouth at rest). One patient subsequently required multiple laser procedures for recurrent macroglossia.Conclusion:Anterior tongue reduction can be a safe procedure, with limited post-operative morbidity, consistently resulting in good surgical outcomes and improvement in macroglossia symptoms. Speech development does not appear to be adversely affected. [ABSTRACT FROM PUBLISHER]

This paper describes an innovative systems methodology for evaluating child protection social work practice and improving organisational learning. It draws on learning in other high-risk areas where the importance of understanding performance in context has been recognised. Using a case study for illustration, the methodology is presented. This evaluative approach engages management, staff, service users and other stakeholders in assessing the factors that influence practice and outcomes. The data collection tools developed included surveys to reach staff, multi-agency professionals and service users, together with in-depth interviews to get a deep understanding of causal factors and their interactions. Data included organisational cultural factors that influence the effectiveness of decision making, improve patterns of interaction with families and other professionals, remove constraints on practice, help prioritisation and improve consistency of care. The paper discusses some of the practical implications of applying the instruments, such as avoiding bias and dealing with unresponsiveness. It also supports the gathering of feedback from vulnerable service users. [ABSTRACT FROM PUBLISHER]

This paper reports some of the findings from a study (Farmer et al., 2007), commissioned by an independent foster-care agency (IFA), to examine the support services offered to foster-carers and the young people in their care. In particular, this paper documents the use of a ‘team parenting’ approach within a ‘therapeutic’ fostering environment. Whilst there were some issues regarding the comprehensive assessments and the provision of therapy, foster-carers were positive about the support provided both to themselves and directly to the young people within the team parenting approach. On the other hand, communication and inter-agency working between the IFA and the local authority could be problematic, particularly in relation to funding decisions, which could limit the effectiveness of the team parenting approach. [ABSTRACT FROM PUBLISHER]

Background: There is a need for further development and evaluation of group-based parent- training interventions for parents of children with disabilities. This paper describes interventions delivered in two areas of Greater Manchester. Method: The process and content of an approach designed for parents of children with learning disabilities and autistic spectrum disorders is described. Results: Clinical outcome data for 22 parents/carers are presented. Client feedback about the course is also reported. Conclusions: The data suggest that this intervention is effective in reducing the frequency and impact of children’s challenging behaviours, and improving parental psychological well-being. More rigorous and extensive evaluation is required. [ABSTRACT FROM AUTHOR]

Background: This paper presents the quality of life (QOL) outcome results from the UK700 randomised controlled trial of case management.Method: A total of 708 patients with severe mental illness were randomly assigned to intensive and standard forms of case management in four sites in the UK. QOL was assessed using the Lancashire Quality of Life Profile, which provides a self-reported objective and subjective appraisal of eight life domains (finances, work, leisure, family, social relations, living situation, safety and health). The outcome after 2 years was examined using univariate and multivariate analyses.Results: Significant improvements in QOL over the 2 years were observed. The QOL outcome did not differ significantly by case management treatment conditions or by diagnosis. A better outcome was associated with improvements in depression and with the location (site) of treatment. In one site there were significant improvements in all eight domains and overall QOL, with moderate or better effect sizes (> 0.4) in three domains and overall QOL.Conclusions: Depression should be assessed when subjective QOL measures are used. Better means for describing service organisations and the context/place in which they operate should be developed in order to explain more of the variance in QOL outcomes. [ABSTRACT FROM AUTHOR]

Background: Acute epistaxis can be a life-threatening airway emergency, requiring in-patient admission. The coronavirus disease 2019 pandemic placed significant strain on hospital resources, and management has shifted towards an out-patient-centred approach. Methods: A five-month single-centre retrospective study was undertaken of all epistaxis patients managed by the ENT department. A pre-coronavirus disease 2019 pandemic group was managed with pre-existing guidelines, compared to new guidelines for the coronavirus disease 2019 pandemic group. A telephone survey was performed on out-patients with non-dissolvable packs to assess patient comfort and satisfaction. Results: A total of 142 patients were seen. The coronavirus disease 2019 pandemic group had significantly more patients aged over 65 years (p = 0.004), an increased use of absorbable dressings and local haemostatic agents (Nasopore and Surgiflo), and fewer admissions (all p < 0.0005). Rates of re-presentation and morbidity, and length of hospital stay were similar. The telephone survey revealed out-patient management to be efficacious and feasible. Conclusion: The coronavirus disease 2019 pandemic has shifted epistaxis management towards local haemostatic agents and out-patient management; this approach is as safe and effective as previously well-established regimens. [ABSTRACT FROM AUTHOR]

This paper describes the solution adopted by a research team to the problem of evaluating rehabilitation outcomes across 12 differing traumatic brain injury services in England. A total of 507 subjects and their families received first and follow-up interviews. A wide range of data were collected, including medical and demographic data, hours and nature of rehabilitation, and details of pre-injury lifestyle. Subjects were monitored for up to 3 years from entry into the study. The process of change was charted in a series of interviews in which subjects and carers were asked to describe current problems and strengths. Responses were classified and quantified. The resulting information was used in a number of different ways: To examine whether problems resolved; to examine the range of impairments, disabilities and more general problems, and changes over time, and to examine reported problems in the context of individual experience in order to measure the response of communities. Although existing objective measures are of use in measuring outcome prior to discharge from hospital, evaluation following community re-entry must take account of the priorities and preferences of subjects and their families. By following the method described in this paper, the team was able both to summarise and quantify the reporting of problems by subjects and their families, and to assess the response of communities to difficulties experienced by head-injured people and their families. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report on the use of an innovative peer review approach to identifying and addressing the causes of inappropriate admissions from hospital to nursing homes in South Gloucestershire (SG). It explains the methodology that was developed, the findings of the peer review process and reflects on the effectiveness of the process. Design/methodology/approach – The peer review consisted of two stages. The first stage involved a panel of local stakeholders carrying out an audit of a random selection of cases where people had been assessed as needing permanent nursing or residential care. From this four cases of inappropriate admissions were identified. Stage two involved an externally facilitated process with two peer challenge panels; one of local stakeholders and the other external experts. The two panels analysed the cases of inappropriate admissions, identified the system causes and suggested actions to tackle the issues which were fed back to an audience of local stakeholders. Findings – The combination of case audit and peer review was successful in providing robust challenge to the processes in SG by identifying shortcomings in the system and suggesting actions to improve outcomes. Research limitations/implications – The approach was taken in one Council area and therefore may not be replicable in another area. Practical implications – The case study suggests that a peer review approach using both local and external peers, including providers, is an effective way to identify weaknesses in the health and social care processes. The insights offered by external peers and providers is helpful for councils in identifying where to focus resources and suggests that other areas should consider proactive adaptations to the peer review methodology that is offered as part of the LGA’s programme of sector-led improvement. Social implications – The case study suggests that a peer review approach could have a positive impact on the quality of care and quality of life for older people who are admitted to hospital. Originality/value – The case study offers an innovative and original use of the peer review approach in social care that can be shared with other councils and partners. The Southwest Improvement Board have identified it as of particular interest to other areas seeking to work with partners to identify and implement positive change. [ABSTRACT FROM AUTHOR]