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Journal article

A new health and social care context in Wales: promoting resilience through a shift in perspective and different relationships

Authors:
GREENWELL Stewart, ANTEBI Daniel
Journal article citation:
Journal of Integrated Care, 25(4), 2017, pp.265-270.
Publisher:
Emerald

Purpose: The Social Services and Wellbeing (Wales) Act 2014 and the Well-being of Future Generations (Wales) Act 2015 provide a direction of travel for all public services in Wales and a framework for delivering the aspirations in the legislation. Although specifically referring to social care, both pieces of legislation are as relevant to the NHS as they are to other public bodies, providing an opportunity for NHS Wales and local government, in particular, to be equal partners in making a difference to the people and communities they serve. The paper aims to discuss these issues. Design/methodology/approach: A viewpoint paper. Findings: In Wales the time is right to do things differently in health and social care, so the authors will reflect on why current services are struggling and propose an approach that is rooted in communities rather than in specialities. The authors suggest developing a centre of gravity in the community through a multi-agency collaboration to achieve the greatest health, social care and economic impact. Originality/value: Attention needs to be directed to supporting people, communities and frontline workers to become more resilient, rather than our current focus on specialist services. (Publisher abstract)

Journal article

Variation in rates of inpatient admission and lengths of stay experienced by adults with learning disabilities in England

Author:
MACDONALD Anne
Journal article citation:
Tizard Learning Disability Review, 22(4), 2017, pp.218-221.
Publisher:
Emerald

Purpose: The purpose of this paper is to provide a commentary from a Scottish perspective on some of the issues raised in the paper “Variation in rates of inpatient admission and lengths of stay experienced by adults with learning disabilities in England”. Design/methodology/approach: The policy context in relation to people with learning disabilities in Scotland is reviewed, alongside an update about a current Scottish Government project focussed on understanding and addressing the issue of people with learning disabilities whose discharge from hospital is delayed. Findings: As regards to people with learning disabilities who are inpatients in hospitals in Scotland, there are similar themes in common with those in the paper by Elaine James and colleagues; however Scottish policy has developed differently from that in England in this area. Originality/value: This commentary adds to the discussion by contributing a Scottish perspective on issues and outlines work being done to address the need for people with learning disabilities and complex needs in Scotland to live within their local communities. (Publisher abstract)

Journal article

Learning disability market position statements, are they fit for purpose?

Author:
GIRAUD-SAUNDERS Alison
Journal article citation:
Tizard Learning Disability Review, 22(4), 2017, pp.206-210.
Publisher:
Emerald

Purpose: The purpose of this paper is to provide a commentary on the issues raised in the article 'Learning disability market position statements (MPS), are they fit for purpose?' Design/methodology/approach: The commentary draws on the literature and the author’s experience in developing commissioning. Findings: Published documents such as MPS and joint strategic needs assessments do not give an encouraging picture of progress in commissioning with and for people with learning disabilities. Actual commissioning practice may or may not be stronger than the documents suggest; however, more robust planning may help to sustain progress through times of organisational and social change. Originality/value: The commentary sets MPS in the context of other guidance on commissioning and development of services. It addresses questions about the need for published statements and the factors that help or hinder development of commissioning. (Edited publisher abstract)

Journal article

Variation in rates of inpatient admissions and lengths of stay experienced by adults with learning disabilities in England

Authors:
JAMES Elaine, HATTON Chris, BROWN Mark
Journal article citation:
Tizard Learning Disability Review, 22(4), 2017, pp.211-217.
Publisher:
Emerald

Purpose: The purpose of this paper is to analyse rates of inpatient admissions for people with learning disabilities in England and to identify factors associated with higher rates of inpatient admission. Design/methodology/approach: Secondary analysis of data submitted as part of the Transforming Care programme in England. Findings: 2,510 people with learning disabilities in England were inpatients on 31st March 2016. Findings indicate that people with learning disabilities are at risk of higher rate of inpatient admission than can be explained by prevalence within the general population; this risk may be associated with areas where there are higher numbers of inpatient settings which provide assessment and treatment for people with learning disabilities. Research limitations/implications: Variability in the quality of the data submitted by commissioners across the 48 Transforming Care Plan areas mean that greater attention needs to be paid to determining the validity of the common reporting method. This would improve the quality of data and insight from any future analysis. Practical implications: The study’s findings are consistent with the hypothesis that geographical variations in the risk of people with learning disabilities being admitted to inpatient services are not consistent with variations in prevalence rates for learning disability. The findings support the hypothesis that building alternatives to inpatient units should impact positively on the numbers of learning disabled people who are able to live independent lives. Originality/value: This is the first study which examines the data which commissioners in England have reported to NHS England on the experience of people with learning disabilities who are admitted as inpatients and to report on the possible factors which result in higher rates of inpatient admission. (Publisher abstract)

Journal article

Learning disability market position statements, are they fit for purpose?

Authors:
BROADHURST Sarah, LANDAU Keri
Journal article citation:
Tizard Learning Disability Review, 22(4), 2017, pp.198-205.
Publisher:
Emerald

Purpose: The purpose of this paper is to review whether current learning disability market position statements (MPS) are actually helping to shape the market and explore their implications for people with learning disabilities and their families. Design/methodology/approach: Published learning disability MPS were identified via the Institute of Public Care’s MPS database. The quality of the MPS was analysed using a good practice checklist developed by a range of stakeholders. Findings: Learning disability MPS are not currently fit for purpose. They demonstrate that local authorities are not fully engaging in their market-shaping duties, as required under The Care Act 2014. It is suggested that this is in part due to the lack of recognition that market shaping is a council-wide responsibility and can only be successful if senior officers across the council (and their partners) acknowledge this and are held accountable. Unless this happens, people with learning disabilities will continue to lack the enablers that support them to lead the lives they choose in their communities. Originality/value: This is the first review of the quality and potential impact of learning disability MPS. (Edited publisher abstract)

Journal article

Adult autism advocacy in the UK: a policy review

Author:
WATTS Georgina
Journal article citation:
Tizard Learning Disability Review, 22(4), 2017, pp.185-192.
Publisher:
Emerald

Purpose: The need for advocacy for autistic adults is emphasised in many government policy and good practice guidelines. The purpose of this paper is to investigate legislation and policy relevant to advocacy for autistic adults in England and explore whether this translates into practice. It also seeks to clarify which policies can be enforced under current legislation and highlight the gaps in legislative power to ensure implementation of good practice. Design/methodology/approach: This paper aims to define what is meant by autism advocacy. Relevant legislation, including human rights, disability and autism-specific guidelines, are discussed in respect to autistic adults in England. Findings: Implementation of autism advocacy policy appears to vary greatly according to local and individual resources. Originality/value: Autistic adults, and services that support them, may be unaware of the policies and guidelines relevant to advocacy, they may also be confused by the plethora of different guidelines or unsure how to implement these. Further research is needed to review obstacles to the practical application of autism advocacy policy. (Edited publisher abstract)

Journal article

Overview of challenges to implementation of good practice in perinatal mental health promotion and management, in universal primary care and community services

Author:
MARKS Lucy
Journal article citation:
Journal of Public Mental Health, 16(3), 2017, pp.100-103.
Publisher:
Emerald

Purpose: The purpose of this paper is to describe some of the barriers and solutions to implementing good practice in perinatal mental health promotion in universal services, and propose some ways forward. Design/methodology/approach: This paper describes the rationale and evidence base for proactive management of perinatal mental health in primary care and community services and good practice recommendations. There is considerable evidence that these recommendations have not been implemented nationally in the UK. A range of solutions and proposed ways forward to manage barriers to implementation are set out. Findings: It is proposed that a number of factors need to be in place in order to deliver best practice in perinatal mental health. Originality/value: The value of this paper is to set out what needs to be in place in order for services to promote good perinatal mental health and secure attachment and change the life chances of children and their parents, by intervening early. This will also ultimately save financial resources for public services, because the quality of early relationships is linked to health and mental health. (Publisher abstract)

Journal article

Child and adolescent mental health services: longitudinal data sheds light on current policy for psychological interventions in the community

Authors:
NEUFELD Sharon A.S., JONES Peter B., GOODYER Ian M.
Journal article citation:
Journal of Public Mental Health, 16(3), 2017, pp.96-99.
Publisher:
Emerald

Purpose: The purpose of this paper is to expand upon policy implications of a recent study assessing adolescent mental health service contact and subsequent depression. Design/methodology/approach: Review of related evidence from academic and grey literature. Findings: Studies assessing the role of mental health services in reducing mental disorder during adolescence are sparse, and even prevalence figures for adolescent mental disorders are out-of-date. Adolescent mental health service contact rates are shown to fall concurrent with budgetary decreases. School-based counselling is highlighted as an important source of help that may be at risk of being cut. Increased training of General Practitioners and school counsellors is needed to improve efficiency in specialist Child and Adolescent Mental Health Services (CAMHS). Practical implications: Longitudinal studies of young people’s mental health should include mental health service usage and its relationship with subsequent mental health outcomes. Social implications: Funding cuts to CAMHS must be avoided, school-based counselling must be protected, and service referrers should be better trained. Originality/value: This paper highlights the need for increased CAMHS data, sustained funding, and improved training for this vital service. (Publisher abstract)

Journal article

Perception of risk of adverse outcomes of older people: comparison between nursing homes, day centers and home care services

Authors:
TEIXEIRA Laetitia, et al
Journal article citation:
Quality in Ageing and Older Adults, 18(3), 2017, pp.212-220.
Publisher:
Emerald

Purpose: In Portugal, the three main kinds of care services available for older people are nursing homes, day centers and home care services. The use of these care services is mostly based on complex socioeconomic and functional criteria; however it is not clear if this placement corresponds to a higher/lower risk of adverse outcomes. The purposes of this paper are: to characterize clients of each type of service; to estimate the proportion of individuals at perceived risk of each adverse outcome according to type of service; to assess the ability of the Risk Instrument for Screening in the Community (RISC) to identify the risk profiles according to type of service. Design/methodology/approach: The sample comprised individuals aged 65+ (n=224), receiving care at home, in day centers or in nursing homes. The identification of individuals at risk for three adverse outcomes (institutionalization, hospitalization and death) was performed using a short pre-screen instrument (RISC). Findings: The RISC identified mental state issues as the unique factor that differentiated clients according the type of care services (χ2 (6, N=224)=20.96, p=0.002), with day center presenting the lowest percentage of mental health concerns and nursing home presenting the highest percentage (44.44 and 71.91 percent, respectively). Additionally, a gradient was found between perceived risk of adverse outcomes (institutionalization and hospitalization) and care of levels required. Originality/value: The RISC can be used to discriminate people in different settings of care and can be helpful in the selection of groups at risk that will benefit more from available services. (Publisher abstract)

Journal article

Notes from the hospital bedside: reflections on researcher roles and responsibilities at the end of life in dementia

Authors:
SWARBRICK Caroline Margaret, SAMPSON Elizabeth, KEADY John
Journal article citation:
Quality in Ageing and Older Adults, 18(3), 2017, pp.201-211.
Publisher:
Emerald

Purpose: The purpose of this paper is to explore some of the ethical and practical dilemmas faced by an experienced researcher in undertaking research with a person with dementia (whom we have called Amy). Amy died shortly after a period of observation had ended and the family subsequently consented to the data being shared. Design/methodology/approach: This individual case study presentation was nested within a larger study conducted in England and Scotland between 2013 and 2014. The overall aim of the main study was to investigate how healthcare professionals and informal carers recognised, assessed and managed pain in patients living with dementia in a range of acute settings. Findings: The presented case study of Amy raises three critical reflection points: (i) Researcher providing care, i.e. the place and positioning of compassion in research observation; (ii) What do the stories mean? i.e. the reframing of Amy's words, gestures and behaviours as (end of) life review, potentially highlights unresolved personal conflicts and reflections on loss; and (iii) Communication is embodied, i.e. the need to move beyond the recording of words to represent lived experience and into more multi-sensory methods of data capture. Originality/value: Researcher guidance and training about end of life observations in dementia is presently absent in the literature and this case study stimulates debate in a much overlooked area, including the role of ethics committees. (Publisher abstract)

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