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Technology and social care in a digital world: challenges and opportunities in the UK
- Author:
- HAMBLIN Kate
- Journal article citation:
- Journal of Enabling Technologies, 14(2), 2020, pp.115-125.
- Publisher:
- Emerald
Purpose: Technology enabled care (TEC) equipment has been a part of adult social care (ASC) in most areas of the UK for decades. More recently, commissioners have been exploring mainstream technologies’ potential to support older people living in the community. The purpose of this paper is to examine the challenges and opportunities presented by the growing application of mainstream technologies in ASC against the backdrop of the planned UK-wide switchover from analogue to digital telecommunications by 2025. Design/methodology/approach: This general review uses research evidence, literature, industry standards and policy documents to address the challenges presented by the UK’s digital switchover and the potential role of mainstream technologies such as “smart speakers” in ASC. Findings: The use of digital TEC and mainstream devices in ASC brings challenges related to access to reliable internet connections in parts of the UK; the need to update TEC safety standards; the ethics, privacy and data security measures that ensure digital products and services safeguard the interests of users; and evidence and commissioning practice. Originality/value: This general review explores emerging areas of policy and research related to the planned UK digital switchover and the use of mainstream technologies in ASC. It offers a conceptual approach and suggests ways forward for research, regulatory and commissioning agendas. (Edited publisher abstract)
Evaluation of a diagnostic ADHD pathway in a community child mental health service in South London
- Authors:
- BARNES Georgina L., et al
- Journal article citation:
- Mental Health Review Journal, 25(1), 2020, pp.1-19.
- Publisher:
- Emerald
Purpose: Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people. Design/methodology/approach: Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline. Findings: Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis. Research limitations/implications: Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence. Practical implications: The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families. (Edited publisher abstract)
Virtual Dementia Tour: limitations and ethics
- Author:
- MERIZZI Alessandra
- Journal article citation:
- Quality in Ageing and Older Adults, 19(2), 2018, pp.146-155.
- Publisher:
- Emerald
Purpose: Dementia care is an important aspect affecting the quality of life of people living with dementia. There are many studies that test the efficacy of methods of care in order to support and even increase the quality of life of dementia patients (e.g. Gridley et al., 2016; Thyrian et al., 2017). A novel approach developed by Beville (2002) called Virtual Dementia Tour® (VDT®) also aims to improve the care of people living with dementia in their middle and late stages of deterioration. VDT® is now becoming popular internationally (see www.provdt.co.uk/) and it is sold to the general public as an evidence-based method through which people can experience what it is like to live with dementia, aiming to increase empathy and improve the delivery of care. The purpose of this paper is to explore the validity of the VDT® intervention. Design/methodology/approach: The author explores the original research article upon which the VDT® was developed, highlighting critical points and reviewing these through a rigorous selection of references. Findings: The supporting evidence base is consistently weak on closer scrutiny, and in combination with anecdotal evidence of distress related to the VDT® experience, this analysis suggests a need for caution in implementation. Originality/value: Although high-quality standards of care from the national guidelines (National Institute for Health and Clinical Excellence, 2010) ensure that health services implement evidence-based interventions, it may be important to discern that which is empirically based from that which is not. (Edited publisher abstract)
Outcomes in Children’s Social Care
- Author:
- FORRESTER Donald
- Journal article citation:
- Journal of Children's Services, 12(2/3), 2017, pp.144-157.
- Publisher:
- Emerald
Purpose: There are often calls for more focus on outcomes in Children’s Social Care yet there is little consensus on what these outcomes should be. Key challenges include who should decide what outcomes should be measured and the sheer range of issues that social workers deal with. This paper provides a reflective account of approaches to measuring outcomes that the author has used in recent studies in order to illustrate the complexity involved in understanding what the purpose of Children’s Social Care is and therefore how outcomes might be measured. Design/methodology/approach: A review of and reflection on lessons from recent research studies carried out by the author and colleagues. Findings: The results are used to illustrate and support an argument that Children’s Social Care performs multiple functions and that this has implications for thinking about outcomes. Helping children and parents is one element of the work, but assessing risk across large numbers of referrals and identifying those that require involvement is equally important. Furthermore, the social work role requires complex considerations around liberty and the rights of parents and children. One consequence of this is that the quality of the service provided is important in its own right. Research limitations/implications: It is suggested that the evaluation of Children’s Social Care involves four types of outcomes: measures of the quality of the service provided; assessment of whether the “right” families are being worked with; client-defined measures of change; and the development of appropriate standardised instruments. Examples of approaches in each area are discussed. Practical implications: The theoretical considerations suggest that we need to have a multi-dimensional approach to evaluating, inspecting and leading Children’s Social Care services. In particular, the importance of the quality of delivery and appropriate targeting of the service are emphasised, as well as considering various approaches to measuring outcomes. Originality/value: The paper proposes a combination of qualitative and quantitative measures of process, assessment and outcomes for evaluating outcomes in Children’s Social Care. (Edited publisher abstract)
Elder abuse screening tools: a systematic review
- Authors:
- McCARTHY Louise, CAMPBELL Susan, PENHALE Bridget
- Journal article citation:
- Journal of Adult Protection, 19(6), 2017, pp.368-379.
- Publisher:
- Emerald
Purpose: Elder abuse results in high rates of morbidity and mortality. It has longstanding physical and psychological effects and is difficult to detect. Due to fear or embarrassment, victims may make attempts to hide it rather than to disclose and professionals are often reluctant to report it as they may worry about worsening a situation. If detected early enough, serious harm can be prevented and lives saved. Screening and screening tools can assist health and social care practitioners to detect abuse. This review of screening tools was undertaken as part of an MSc in clinical research, funded by the National Institute for Health Research; the purpose of this paper is to report on the review and its findings. Design/methodology/approach: This was a systematic review with eligibility inclusion and exclusion criteria decided in advance. Keywords and their synonyms were combined and then used to search health and social care databases. Data items were collected from the included studies. The preferred reporting item for systematic reviews and meta-analysis was followed for the reporting of the results. A narrative synthesis approach was applied to the analysis. Findings: A total of 34 full text studies were downloaded, read and analysed. In all, 11 met the inclusion criteria and were included in the final analysis. Of these, three studies reported sensitivity and specificity, with the remainder reporting validity and reliability testing. In total, 12 tools of varying length and quality were found. The length and characteristics of tools affects the efficacy of their use. The clinical environment will determine choice of screening tool to be used. Screening tools should be used within an overall system of detection and management of abuse. Research limitations/implications: The synthesis of results was challenging due to the lack of homogeneity between the included studies. The variations in tool characteristics and qualities added to this challenge. A further limitation was the lack of a gold standard tool in elder abuse. Originality/value: This systematic review highlights a lack of robust evidence in the development and validation of screening tools to detect elder abuse. Though there is an increasing awareness and knowledge about elder abuse, its detection remains problematic and the lack of research in this area is worth emphasising. Specific tools, centred on the clinical setting in which they are used, are recommended (Publisher abstract)
CQC inspection reports for acute NHS trusts: are there relationships between the comments in inspection reports regarding people with learning disabilities and CQC hospital/trust ratings?
- Journal article citation:
- Tizard Learning Disability Review, 23(1), 2018, pp.56-62.
- Publisher:
- Emerald
Purpose: People with learning disabilities are at risk of poor health and premature death. Due to these inequalities, NHS trusts are required to make reasonable adjustments to their care, such as longer appointment times, with the legal duty on them being “anticipatory”. The paper aims to discuss these issues. Design/methodology/approach: Secondary analysis of CQC acute hospital inspection reports asking the following research questions: Do CQC inspection reports mention people with learning disabilities? Where issues concerning people with learning disabilities are reported in CQC hospital inspection reports, what issues and reasonable adjustments are reported? Are there any relationships between comments made in the inspection reports and CQC ratings of the trusts? Findings: In total, 29 of the 30 trust-wide inspection reports (97 per cent) and 58 of the 61 specific site reports (95 per cent) included at least one mention of people with learning disability/ies. Most comments about practices for people with learning disabilities were positive across all CQC inspection output types and across all CQC overall ratings, although the proportion of positive comments decreased and the proportion of negative comments increased as CQC ratings became less positive. Research limitations/implications: Overall the authors found that CQC inspection reports routinely contained some information regarding how well the hospitals were working for people with learning disabilities. The depth of information in reports varied across trusts, with the potential for CQC reports to more consistently report information collected during inspections. Originality/value: The report updates and extends a report published by the Public Health England Learning Disabilities Observatory in 2015. (Publisher abstract)
The journey from first inspection to quality standards (1857-2016): are we there yet?
- Author:
- CAMPBELL Martin
- Journal article citation:
- Journal of Adult Protection, 19(3), 2017, pp.117-129.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to qualitatively analyse the inspection and regulation of care for people with learning disabilities and mental health problems in Scotland, in two time periods. Design/methodology/approach: The paper uses comparative historical research drawing on primary sources from 1857 to 1862 in the form of Annual Reports of the General Board of Commissioners in Lunacy for Scotland and associated papers, to compare inspection methods, quality standards and to identify persistent challenges to effective inspection. Findings: Political, clinical and public awareness led initially to criticisms of existing care and eventually to the development of the “The Lunacy Act” of 1857. This Act resulted in the first attempts to set minimum standards of care for individuals at risk, with enforceable regulation. Some factors recur as challenges to effective practice in the inspection and regulation of care today. Practical implications: There are problems of definition, reliable monitoring of quality standards and adequate, independent inspection of services that respond to unacceptable standards of care. There is a growing evidence base about best methods of inspection of services for people in care who are most at risk. These methods attempt to strike a balance between evidence- and value-based judgments. Perspectives from history may help focus resources. Originality/value: This paper compares common and common challenges in two time periods to investigate what can be learned about the development of policy and practice in inspection and regulation of care. (Publisher abstract)
Examining ethnic disparities in provider and parent in-session participation engagement
- Authors:
- DICKSON Kelsey S., et al
- Journal article citation:
- Journal of Children's Services, 12(1), 2017, pp.47-58.
- Publisher:
- Emerald
Purpose: Well-documented ethnic disparities exist in the identification and provision of quality services among children receiving community-based mental health services. These disparities extend to parent treatment engagement, an important component of effective mental health services. Currently, little is known about differences in how providers support parents’ participation in treatment and the degree to which parents actively participate in it. The purpose of this pilot study was to examine potential differences in both provider and parent in-session participation behaviours. Design/methodology/approach: Participants included 17 providers providing standard community-based mental health treatment for 18 parent-child dyads, with 44% of the dyads self-identifying as Hispanic/Latino. In-session participation was measured with the Parent Participation Engagement in Child Psychotherapy and Therapist Alliance, Collaboration, and Empowerment Strategies observational coding systems. Findings: Overall, results indicate significantly lower levels of parent participation behaviours among Hispanic/Latino families compared to their Non-Hispanic/Non-Latino counterparts. No significant differences were seen in providers’ in-session behaviours to support parent participation across Hispanic/Latino and Non-Hispanic/Non-Latino families. Research limitations/implications: These findings contribute to the literature on ethnic differences in parent treatment engagement by utilising measures of in-session provider and parent behaviours and suggest that further investigation is warranted into documenting and understanding ethnic disparities in parents’ participation in community-based child mental health treatment. Originality/value: This article contributes to the evaluation of differences in parent treatment engagement through demonstrating the utility of an in-session observational coding system as a measure of treatment engagement. (Publisher abstract)
How does accreditation influence staff perceptions of quality in residential aged care?
- Authors:
- HOGDEN Anne, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 18(2), 2017, pp.131-144.
- Publisher:
- Emerald
Purpose: Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme. Design/methodology/approach: Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views. Findings: Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life. Research limitations/implications: For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question. Originality/value: This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting. (Publisher abstract)
On self-neglect and safeguarding adult reviews: diminishing returns or adding value?
- Author:
- PRESTON-SHOOT Michael
- Journal article citation:
- Journal of Adult Protection, 19(2), 2017, pp.53-66.
- Publisher:
- Emerald
Purpose: The purpose of this paper is twofold: first, to update the core data set of self-neglect serious case reviews (SCRs) and safeguarding adult reviews (SARs), and accompanying thematic analysis; second, to respond to the critique in the Wood Report of SCRs commissioned by Local Safeguarding Children Boards (LSCBs) by exploring the degree to which the reviews scrutinised here can transform and improve the quality of adult safeguarding practice. Design/methodology/approach: Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs) and from contacts with SAB independent chairs and business managers. Thematic analysis is updated using the four domains employed previously. The findings are then further used to respond to the critique in the Wood Report of SCRs commissioned by LSCBs, with implications discussed for Safeguarding Adult Boards. Findings: Thematic analysis within and recommendations from reviews have tended to focus on the micro context, namely, what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis enables an understanding of local geography. However, there are other wider systems that impact on and influence this work. If review findings and recommendations are to fully answer the question “why”, systemic analysis should appreciate the influence of national geography. Review findings and recommendations may also be used to contest the critique of reviews, namely, that they fail to engage practitioners, are insufficiently systemic and of variable quality, and generate repetitive findings from which lessons are not learned. Research limitations/implications: There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here against the strands in the critique of SCRs enables conclusions to be reached about their potential to transform adult safeguarding policy and practice. Practical implications: Answering the question “why” is a significant challenge for SARs. Different approaches have been recommended, some rooted in systems theory. The critique of SCRs challenges those now engaged in SARs to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice. Originality/value: The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of conducting SARs by using the analysis of themes and recommendations within this data set to evaluate the critique that reviews are insufficiently systemic, fail to engage those involved in reviewed cases and in their repetitive conclusions demonstrate that lessons are not being learned. (Publisher abstract)