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The findings presented here derive from a wider study that sought to establish a baseline understanding of mental health and wellbeing among the agricultural community in England and Wales. This paper focuses on selected questions that investigated levels of anxiety and associated stress factors among farm women, a group which has been relatively neglected within previous research on farming mental health in the United Kingdom. A questionnaire survey was widely distributed to members of the agricultural community in England and Wales (n = 15,296) in both paper and online formats. The survey included a number of standardised instruments to assess mental health and wellbeing, including the Generalised Anxiety Disorder-7 scale (GAD-7). Focusing on a sub-sample of female respondents (n = 3487), this paper details the findings from the GAD-7, alongside those from a selection of other questions investigating sources of stress, loneliness and perceived business viability. A significant proportion of female respondents were experiencing anxiety at the time of survey completion, with 23.3% reaching the threshold for clinically relevant anxiety based on their GAD-7 scores (medium or severe anxiety, scores≥10). A further 34.6% were classified as experiencing mild anxiety (scores 5–9) whilst 42.1% were not suffering from anxiety (scores 0–4). Medium/severe anxiety was identified as being associated with a number of stress factors, feelings of loneliness and pessimistic perceptions of farm business viability. There were important age-based differences, with working-aged women identified as more likely to suffer from anxiety, loneliness and certain stressors than older women. The findings reported here indicate concerning levels of anxiety among farming women and this should be seen as a call to action. There are clear associations between anxiety and a range of stressors and, although we cannot ascertain causality, these point to issues that demand attention in efforts to improve mental health within this social group. The factors contributing to anxiety are, however, multiple and complex and farm women may be affected by particular gender-based challenges that have not yet been explicitly explored in relation to mental health. Further research is needed to investigate and understand these issues in greater depth. [ABSTRACT FROM AUTHOR]

This action research study aimed to ascertain the usefulness of a modified version of the reflective approach to teaching practicum debriefing (MVRATPD) strategy in ascertaining the degree to which students in a United Kingdom university faculty of education achieved module learning outcomes (LOCs). Using purposeful convenient sampling, twenty-seven(n = 27) students on the education studies pathway at the university, studying the module entitled international and comparative education, participated. The usefulness of the MVRATPD is revealed in several ways. It is primarily a reflective assessment instrument as purported by Minott. It revealed a direct fulfilment of several module objectives linked to several LOCs. However, for this study, it was not useful in capturing data about all 4 LOCs. Specifically, it captured no data related to LOC 2. The conclusion is that the MVRATPD, in its present form should not be the sole determinant of the degree to which LOCs are achieved. It is however, a complementary indirect reflective instrument for assessing LOCs and a user-friendly, practical and uncomplicated data collection tool i.e. using three reflective questions. [ABSTRACT FROM AUTHOR]

Developing a deep and contextualised understanding of risk is important for public health responses to young people's alcohol consumption, which is frequently positioned as an outcome of risky behaviour. This paper expands conceptualisations of risk to encompass its wider social and cultural context through a social practice exploration of young people's controlled and managed intoxicated alcohol consumption practice. We report data from a fourteen-month qualitative study of the alcohol consumption practices of 23 young people in England, drawing on group interviews and social media interactions. Our findings provide a nuanced understanding of risk-taking, demonstrating that risk is an important aspect of the ongoing participation and performance in alcohol consumption practice and that health information and advice can be and was frequently incorporated into drinking practice without contributing to fundamental change. This raises new questions about the effectiveness of health interventions that focus on the individual, discussed in the final section of the paper. [ABSTRACT FROM AUTHOR]

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

This paper is based on a research study which explores Social Workers' feelings about professionals touching children during statutory child protection visits to clients' homes in one part of a southern English county. The study focussed on Social Worker visits to children aged between two and ten years who were subject to child protection plans following Section 47 enquiries of the Children Act 1989. A convenience sample of ten completed questionnaires recorded the types of touch, which were reported during the last visit made by the social worker. Semi-structured interviews followed with a further ten Social Workers. Analysis of the data revealed that most of the Social Workers in the study did touch children in a range of ways and for a variety of reasons during visits. 'Touch' was a term which some found uncomfortable and this paper considers whether terminology obstructs open reflection on the topic. Practitioners were keen to discuss the subject more amongst their peers in order to share best practice. [ABSTRACT FROM AUTHOR]

This paper scrutinises the concepts of moral reasoning and personal reasoning, problematising the binary model by looking at young women’s pregnancy decision-making. Data from two UK empirical studies are subjected to theoretically driven qualitative secondary analysis, and illustrative cases show how complex decision-making is characterised by an intertwining of the personal and the moral, and is thus best understood by drawing on moral relativism. [ABSTRACT FROM AUTHOR]

Previous research with older gay men has overlooked their concerns about dating. This paper addresses the gap by analysing in-depth interviews conducted with 25 self-identified single gay men over the age of 50, who lived in England. The paper focuses on the research question: “What factors do older, single gay men consider when they contemplate dating?”. Five factors were identified which affected their decisions about whether to date. Because the same factors operated simultaneously to encourage and to discourage them to contemplate dating, feelings of tension and ambivalence were reported by participants. Although some of these issues are similar to the ones older straight people considered, some of the concerns identified in this study were distinctively different for older gay men. The findings can help to make therapists aware that being single among older gay men is not only a personal experience, but is heavily influenced by social ideals and historical development of gay rights. It also can inform therapists of the factors that encourage and discourage older gay men from contemplating dating. This awareness can help therapists with developing effective strategies for working with clients on the topic of relationships. [ABSTRACT FROM PUBLISHER]

This paper explores the impact for teachers’ identity of undertaking professional development designed to enhance provision for children identified as having dyslexia, in line with the recommendations made by the UK Government. In the paper the concept of ‘participation in communities of practice’ is taken as a departure point for investigating how reflective practice can inform professional identity. The data reported upon were gathered through focus groups and narrative life history interviews conducted with teachers on a Specialist Dyslexia Training for Teachers Programme. The paper identifies and investigates the ways in which teachers who work with dyslexic pupils view themselves as different from other teachers, as having distinct attributes and different motivations for pursuing their chosen career paths. These findings are reviewed, and it is argued that reflection can enable teachers to become better learners, develop their practice and feel integrated into a specific community of practice. However, tensions that arise from perceptions that these teachers have a distinct positioning in the school community are also explored. [ABSTRACT FROM PUBLISHER]

Background: Sleep problems are common amongst people who use alcohol and other drugs, but treatment options are limited. This paper explores how people in residential treatment for alcohol and other drug problems perceived and described 'non-problematic' sleep to provide insights that might inform sleep interventions for this population. Methods: Qualitative interviews were conducted with 28 residents (19 women, 9 men; ages 24–83 years) in two residential drug and alcohol treatment centres in England during 2014/15. Interviews were audio-recorded, transcribed, and coded. Accounts of non-problematic sleep were then analysed inductively. Results: Non-problematic sleep comprised three linked components: i. personal sleep patterns and routines; ii. sleep perceptions; and iii. sleep metacognitions. Some participants reported they slept well; others described their sleep as problematic but improving. Participants believed that sleep improved naturally with residential treatment and abstinence, but perceptions of 'good' sleep varied greatly. Participants used a range of metacognitive strategies (e.g. downgrading the importance of sleep; adapting their sleeping patterns; and focusing on sleep quality alongside sleep quantity) to manage sleep problems and render them non-problematic. Conclusions: Metacognitive strategies that focus on changing perceptions of sleep can potentially inform sleep interventions for people with a history of alcohol and other drug use. [ABSTRACT FROM AUTHOR]

An increasing number of migrant social workers are employed in the UK social work sector. This article explores the acculturative integration experiences of a small group of migrant social workers. We critically observe that research on migrant professionals' trajectories should adopt theories that emphasise people's empowerment and potential for agency. We use a framework drawing on liberation psychology for analysing the autobiographical narratives of a sample of migrant social workers employed in England. Findings indicate that the participants perceived prejudice on a number of occasions and circumstances. Even though in their narrative of survival they talked about activating several psychosocial resources, they were skeptical about their professional development and dissatisfied at work. The paper discusses the emerging findings while highlighting the framework's relevance for understanding these experiences from an empowering acculturation perspective and suggesting ways of improving migrant social workers' acculturative integration by addressing systemic barriers. [ABSTRACT FROM AUTHOR]

A number of current developments in the field potentially provide opportunities for preventative relationship and family interventions to be integrated into primary care. In this context, it is important to understand what family counselling is and how it might differ from family therapy. Thus, this paper investigates how the service of one low-intensity family counselling provider, Relate, is conceptualised and practised by counsellors on the ground. Questions about practice were posed to five focus groups of family counsellors and these were analysed using thematic analysis. The findings suggest that Relate family counselling is seen as ‘family therapy lite’, with a flexible, eclectic and integrative use of concepts and techniques within a systemic framework. Implications of this conceptualisation of family counselling for training, practice and research are discussed. [ABSTRACT FROM PUBLISHER]

It is now widely accepted that context matters in evaluations of the health inequalities impact of community-based social initiatives. Systems thinking offers a lens for uncovering the dynamic relationship between such initiatives and their social contexts. However, there are very few examples that show how a systems approach can be applied in practice and what kinds of evidence are produced when this happens. In this paper, we use data from ethnographic fieldwork embedded within a multi-site mixed method evaluation to demonstrate how a systems approach can be applied in practice to evaluate the early stages of an area-based empowerment initiative – Big Local (funded by the Big Lottery Fund and delivered by Local Trust). Taking place in 150 different local areas in England and underpinned by an ethos of resident-led collective action, Big Local offers an illustration of the applicability of a systems approach to better understand the change processes that emerge as social initiatives embed and co-evolve within a series of local contexts. Findings reveal which parts of the social system are likely to be changed, by what mechanisms, and with what implications. They also raise some salient considerations for knowledge generation and methods development in public health evaluation, particularly for the evaluation of social initiatives where change does not necessarily happen in linear or predictable ways. We suggest future evaluations of such initiatives require the use of more flexible designs, encompassing qualitative approaches capable of capturing the complexity of relational systems processes, alongside more traditional quantitative methods. [ABSTRACT FROM PUBLISHER]

Objectives:Subjective memory complaints (SMC) are common in older people and previous research has shown an association with mood problems, such as depression and anxiety. SMC form part of the criteria for many definitions of mild cognitive impairment (MCI), but there is controversy over whether they should be included as they may be related more strongly to mood than to objective cognitive impairment. This study aims to clarify the relationship between mood and SMC in people with MCI. Method:This paper reports an analysis of data from the Medical Research Council Cognitive Function and Ageing study. Structured interviews were conducted with community-dwelling older people to assess a range of aspects of cognitive functioning and mood. Data from two time points approximately 24 months apart were used in this analysis. At baseline, participants without dementia or severe cognitive impairment were categorised into three groups according to cognitive status. Mood was investigated by assessing symptoms of anxiety and depression which were defined using a diagnostic algorithm. Associations were tested using logistic regression and chi square analyses. Results:A clear association was shown between SMC and mood, both cross-sectionally and over time. The relationship between our two competing definitions of MCI suggested that mood problems were more strongly related to the presence of SMC than objective cognitive impairment. Conclusion:SMC may be a function of anxiety and depression rather than being related to objective cognitive function. This questions whether SMC should be included in definitions of MCI. [ABSTRACT FROM AUTHOR]

Background:Deaths associated with alcohol and/or drugs belong to a category of ‘special’ deaths due to three characteristics: traumatic circumstances of the death, stigma directed to both the bereaved and the deceased, and resulting disenfranchised grief experienced by the bereaved. These factors can impede those who are bereaved in this way from both grieving and accessing support. In response to a lack of research in this area this paper reports on an interview study that has aimed to better understand the experiences and needs of this neglected group of bereaved people. Method:Interviews with 106 adults (parents, children, spouses, siblings, nieces and friends) bereaved through substance use in Scotland and England. Results:Five themes describe interviewee experiences: possibility of death, official processes, stigma, grief and support. These findings suggest what is dominant or unique in this group of bereaved people; namely, that living with substance use (including anticipatory grief), experiencing the subsequent death (often traumatic and stigmatised) and the responses of professionals and others (more likely negative than positive) can disenfranchise grief and negatively impact bereavement and seeking support. Conclusions:This article describes a large and unique sample, the largest in the world to be recruited from this population. Our study raises awareness of a hitherto largely ignored and marginalised group of bereaved people, highlighting what might be particular to their bereavement experience and how this may differ from other bereavements, thereby providing an evidence base for improving the availability, level and quality of support. [ABSTRACT FROM AUTHOR]

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

Objectives:This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. Method:An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. Results:Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. Discussion and conclusions:The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation. [ABSTRACT FROM PUBLISHER]

This paper describes a preliminary investigation on the effectiveness of Dynamic Interpersonal Therapy (DIT). The research was undertaken in an inner London primary care psychological therapies service. Outcome data on the symptoms of depression [Patient Health Questionnaire-9 (PHQ-9)] and anxiety [Generalised Anxiety Disorder-7 (GAD-7)] were collected from service-users (n = 24) at the first and last episodes of treatment. There were statistically significant reductions in depression (PHQ-9) and anxiety (GAD-7) associated with DIT, with medium and large effect sizes, respectively. Overall, 75% of patients showed an improvement on the PHQ-9 and GAD-7 following DIT. When this was calculated as statistically reliable change, the improvements reduced to 42% for anxiety and 25% for depression. As this study was uncontrolled, the significance cannot be reliably attributed to DIT. Future research may aim to investigate DIT's effectiveness in different settings with a larger sample size, using appropriate comparison groups under controlled conditions. [ABSTRACT FROM PUBLISHER]

Across Europe and North America, few young people meet the recommended levels of physical activity (PA) of 1 hour of moderate to vigorous PA per day. However, the lives of young people cannot simply be polarised as either completely sedentary or active. Drawing on findings from the World Health Organization Health Behaviour in School-aged Children cross sectional international study, this paper examines the domains of adolescent life associated with young people's participation in overall PA, including health behaviours, social relationships and family activities. Consideration is also given to gender differences. Information in England was collected from 4404 students aged 11, 13 and 15 years, using anonymised self-completed questionnaires. Physical aspects of lifestyle were determined using internationally validated items for measuring PA that met international guidelines for activity and the frequency and duration of vigorous exercise undertaken during leisure activities. Separate analyses were conducted for boys and girls. Levels of PA and vigorous exercise were compared using the chi-squared test for trend. The findings draw attention to the value for the health and well-being of young people participating in some form of PA, even if they do not meet the recommended levels. Medium levels of PA appear to be associated with high levels of life satisfaction, self-rated health and an improved sense of body image. Significant health gains are likely to be made for adolescents in encouraging sedentary young people to undertake some form of PA. [ABSTRACT FROM PUBLISHER]

This study is the first empirical investigation that has explored levels of athletic identity in elite-level English professional football. The importance of understanding athletes’ psychological well-being within professional sport has been well documented. This is especially important within the professional football industry, given the high attrition rate (Anderson, G., & Miller, R. M. (2011).The academy system in English professional football: Business value or following the herd?University of Liverpool, Management School Research Paper Series. Retrieved fromhttp://www.liv.ac.uk/managementschool/research/working%20papers/wp201143.pdf) and distinct occupational practices (Roderick, M. (2006).The work of professional football. A labour of love?London: Routledge). A total of 168 elite youth footballers from the English professional football leagues completed the Athletic Identity Measurement Scale (AIMS). Multilevel modelling was used to examine the effect of playing level, living arrangements and year of apprentice on the total AIMS score and its subscales (i.e., social identity, exclusivity and negative affectivity). Football club explained 30% of the variance in exclusivity among players (P = .022). Mean social identity was significantly higher for those players in the first year of their apprenticeship compared to the second year (P = .025). All other effects were not statistically significant (P > .05). The novel and unique findings have practical implications in the design and implementation of career support strategies with respect to social identity. This may facilitate the maintenance of motivation over a 2-year apprenticeship and positively impact on performance levels within the professional football environment. [ABSTRACT FROM AUTHOR]

Social work education, social work practice and social work skills have been long-standing policy interests in England but the views of line managers of newly qualified social workers (NQSWs) have not always informed debate. This paper reports on interviews with 23 line managers which asked about their experiences of managing NQSWs. Interviews were held across a diverse range of English local authorities in 2009–2010 and covered participants’ general expectations of NQSWs and how far these have been met, or not; support and induction arrangements for the newly qualified; and how the managers responded to variability among their newly qualified staff. The study participants present their management style as being combinations of modelling, workload and staff management, being open, and exercising their judgment over NQSWs. This suggests that they already possess many of the skills needed to assess NQSWs in their Assessed and Supported Year in Employment and that these should be built upon. We locate our findings within the wider literature highlighting the lack of attention paid to the experiences of social work line managers and the diversity that can be found within them. [ABSTRACT FROM PUBLISHER]

There is a growing literature examining the way service users make choices in the context of complex and frequently changing forms of welfare provision and increasingly personalised services in England. Despite criticisms of the individualistic, consumerist assumptions underpinning these policies, little is known about the relational contexts of individuals’ lives and the role of professional support in choice-making. Drawing on interviews with ‘key professionals’, identified by service users as having played a crucial role in recent important choices, this paper explores how these choices are made with the support of those who are trusted to provide assistance. Placing ‘key professionals’ at the centre of the analysis, the distinct experiences of people with fluctuating and sudden-onset health conditions are examined. The analysis highlights the particular value of relationships that pay close attention to transitional health identities and the co-production of health-related decisions. [ABSTRACT FROM AUTHOR]

The paper examines assessment and outcomes of alcohol misuse and dual diagnosis from liaison psychiatry services for older people. The authors used a retrospective case note survey for referrals to four older adult liaison psychiatry services was carried out on consecutive anonymised in-patient records for admissions from 2006 to 2011. Notes were examined for all older people with alcohol-related problems seen by liaison psychiatry services, with documentation of reason for admission, accompanying mental disorder, referral to mental health services and 6 month follow-up. Four hundred and twenty unique case notes were identified, with 108 patients being eligible for inclusion. Sixty patients were admitted with alcohol withdrawal syndrome, 42 of whom were given a diagnosis of alcohol-related brain injury (ARBI). Fifty patients were taken on by community mental health teams (CMHTs); a further 14 were placed in continuing care facilities. Of the patients under CMHTs, 19 patients (38%) had achieved abstinence from alcohol or controlled drinking at 6 month follow-up. Patients with ARBI were less likely than those without it to have changed their drinking behaviour after 6 months. This is the first UK naturalistic study to show positive outcomes from community treatment of alcohol misuse and dual diagnosis. In spite of the high rate of referral to mental health services and positive outcomes, there was little indication of clear pathways being used in the assessment, treatment and referral of older people with alcohol misuse in medical wards. [ABSTRACT FROM PUBLISHER]

Background The majority of deaths in the UK occur in acute hospitals, and older people have the highest hospital death rates. Improved palliative care for older people has been identified as an international priority, yet little is known about the profile of older patients with palliative care needs in hospitals. Objective To describe the profile of older hospital inpatients (≥85 years), and to explore the prevalence and nature of palliative care needs among this group. Methods A cross-sectional survey of palliative care need in older people was undertaken in two UK acute hospitals. Hospital case notes were examined for evidence of palliative care need according to Gold Standards Framework (GSF) prognostic indicator criteria. Patients (or consultees) completed assessments of palliative care need. Subjects Data were collected for 654 consenting patients/consultees. This paper describes data from 110 patients aged ≥85 years. Results Forty per cent of the older patients were identified as having palliative care needs according to GSF criteria. Frailty was the most common indicator of palliative care need (16.7%). The most common reason for admission to hospital was general frailty (25.5%). Conclusions While this study is limited by its small sample size, the results suggest that older people with frailty conditions constitute a substantial proportion of hospital inpatients with palliative care needs. However, it is unclear whether a specialist palliative care framework is the most appropriate model for this group. The care provided to older people at the end of life may best be provided by generalists such as geriatricians, as part of a comprehensive generalist-led palliative care framework. [ABSTRACT FROM AUTHOR]

The aim of the current paper was to examine externalizing and internalizing behaviors in adolescents with gender dysphoria. One hundred forty-one young people (84 natal females and 57 natal males, M age = 15.13, SD = 1.70) attending the Gender Identity Development Service in London completed the Youth Self Report form at the end of the assessment period (4 to 6 sessions). The main findings indicated that, overall, the adolescents showed significantly more internalizing than externalizing behaviors. Using cutoff points provided by Achenbach and Rescorla (2001), the mean internalizing score fell within the clinical range and the mean externalizing score within the normal range. There was also a significant positive relationship between these two behaviors both in the natal females and the natal males. The natal males presented with significantly more internalizing behaviors than the natal females; however, no significant difference was observed between the genders in terms of the number of externalizing behaviors and total problems. We discuss the implications of these findings with regard to clinical work. [ABSTRACT FROM AUTHOR]

A small, self-selected convenience sample of male and female contraceptive users in the United Kingdom (n = 34) were interviewed between 2006 and 2008 concerning their feelings about the body and their contraceptive attitudes and experiences. The interviewees were a sub-sample of respondents (n = 188) who completed a paper-based questionnaire on similar topics, who were recruited through a poster placed in a family planning clinic, web-based advertisements on workplace and university websites, and through direct approaches to social groups. The bodily metaphors used when discussing contraception were analyzed using an interpretative phenomenological analytical approach facilitated by Atlas.ti software. The dominant bodily metaphor was mechanistic (i.e.,“body as machine”). A subordinate but influential bodily metaphor was the “natural” body, which had connotations of connection to nature and a quasi-sacred bodily order. Interviewees drew upon this “natural” metaphorical image in the context of discussing their anxieties about hormonal contraception. Drawing upon a “natural,” non-mechanistic body image in the context of contraceptive decision-making contributed to reluctance to use a hormonal form of contraception. This research suggests that clinicians could improve communication and advice about contraception by recognizing that some users may draw upon non-mechanistic body imagery. [ABSTRACT FROM PUBLISHER]

The Challenge Project is a community assessment and treatment programme in southeast London. The Project has been evaluated extensively in relation to community failure, with consideration of static risk prediction tools and the role of key developmental variables. This current paper is an extension of earlier evaluations, considering an extended range of outcomes with a longer-term follow-up period of more than nine years at risk in the community. The official sexual reconviction rate for this sample of sex offenders (of whom 275 were at risk in the community) was 12%. A wider definition of 'sexually risky behaviours' as an outcome variable, drawn from a range of police intelligence, suggested a 'truer' sexual re-offending rate of 20%. Although static tools were moderately predictive of community failure, the accuracy of risk prediction was enhanced if static tools were considered in conjunction with developmental variables. [ABSTRACT FROM AUTHOR]

The COVID-19 has had an impact on almost every aspect of life throughout the world. The quarantine, limited social life, and fear of contamination have triggered psychological symptoms in societies. The need for mental health services has increased, and online psychological counselling, which provides psychological help with no risk of infection, has become more popular. The purpose of this study was to examine the impact of the COVID-19 on psychological counselling services and compare the general situation of publications on online psychological counselling before and during the pandemic. For this purpose, 463 publications related to online psychological counselling in the Web of Science (WoS) database were examined. The results were discussed in the context of trends and differences before and during COVID-19. [ABSTRACT FROM AUTHOR]

To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic. People with dementia and their carers completed assessments before (July 2019–March 2020; 206 dyads) and after (July–October 2020) the first Covid-19 'lockdown' in England. At follow-up, the analytic sample comprised 67 people with dementia and 108 carers. We built a longitudinal path model with loneliness as an observed outcome. Carer type and social contacts at both measurements were considered. Other social resources (quality of relationship, formal day activities), wellbeing (anxiety, psychological wellbeing) and cognitive impairment were measured with initial level and change using latent growth curves. We adjusted for socio-demographic factors and health at baseline. In carers, higher levels of loneliness were directly associated with non-spouse coresident carer type, level and increase of anxiety in carer, more formal day activities, and higher cognitive impairment in the person with dementia. In people with dementia, non-spouse coresident carer type, and higher initial levels of social resources, wellbeing, and cognitive impairment predicted the changes in these factors; this produced indirect effects on social contacts and loneliness. Loneliness in the Covid-19 pandemic appears to be shaped by different mechanisms for people with dementia and their carers. The results suggest that carers of those with dementia may prioritize providing care that protects the person with dementia from loneliness at the cost of experiencing loneliness themselves. Directions for the promotion of adaptive social care during the Covid-19 pandemic and beyond are discussed. [ABSTRACT FROM AUTHOR]

Background: A lack of consensus exists concerning how to identify "heavy users" of inpatient mental health services. Aim: To identify a statistical approach that captures, in a clinically meaningful way, "heavy" users of inpatient services using number of admissions and total time spent in hospital. Methods: "Simple" statistical methods (e.g. top 2%) and data driven methods (e.g. the Poisson mixture distribution) were applied to admissions made to adult acute services of a London mental health trust. Results: The Poisson mixture distribution distinguished "frequent users" of inpatient services, defined as having 4 + admissions in the study period. It also distinguished "high users" of inpatient services, defined as having 52 + occupied bed days. Together "frequent" and "high" users were classified as "heavy users". Conclusions: Data driven criteria such as the Poisson mixture distribution can identify "heavy" users of inpatient services. The needs of this group require particular attention. [ABSTRACT FROM AUTHOR]

To establish whether ethnic inequalities exist in levels of self-reported hearing difficulty and hearing aid use among middle-aged adults. Cross-sectional data from the UK Biobank resource. 164,460 participants aged 40–69 who answered hearing questions at an assessment centre in England or Wales. After taking into account objectively assessed hearing performance and a corresponding correction for bias in non-native English speakers, as well as a range of correlates including demographic, socioeconomic, and health factors, there were lower levels of hearing aid use for people from Black African (OR 0.36, 95% CI 0.17–0.77), Black Caribbean (OR 0.38, 95% CI 0.22–0.65) and Indian (OR 0.60, 95% CI 0.41–0.86) ethnic groups, compared to the White British or Irish group. Men from most ethnic minority groups and women from Black African, Black Caribbean and Indian groups were less likely to report hearing difficulty than their White British or Irish counterparts. For equivalent levels of hearing loss, the use of hearing aids is lower among ethnic minority groups. Inequalities are partly due to lower levels of self-reported hearing difficulty among minority groups. However, even when self-reported hearing difficulty is considered, hearing aid use remains lower among many ethnic minority groups. [ABSTRACT FROM AUTHOR]

This exploratory study examines how social work practitioners in England integrate service users' religion, belief and spiritual identities. The study involved 34 semi-structured interviews with Qualified Social Workers and took a qualitative investigational perspective. By means of thematic analysis, the study suggests that practitioners employ either avoidant or utilitarian approaches, which may indeed be a coping strategy before the vast religious plurality in practice. The study also highlights when professionals perceive religion, belief and spirituality important. Those times are a) initial assessments, b) conditional intervention, c) referrals and d) response to this subject when safeguarding and child protection issues arise. [ABSTRACT FROM AUTHOR]

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

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

The aim of this study is to examine the relationship between impairment, disabling barriers and risk factors relating to hate crime incidents. The study analyses quantitative data collected in 2011–2012 where there were 81 incidents of disability hate crime reported in the Tyne and Wear area of England. The research discovered that in the Tyne and Wear region people with learning difficulties have a greater likelihood of experiencing hate crime than do people with other impairments. Although there was no significant difference between impairment and types of hate crime incidents recorded (i.e. verbal abuse/harassment, violence and criminal damage), there were distinct differences between police and victim support responses to victims which correlated to impairment categories (p ≤ 0.05). The study concludes by suggesting that owing to specific disabling barriers experienced by people with learning difficulties, this group is at increased risk of being victimised and is less likely to receive support from criminal justice agencies. [ABSTRACT FROM PUBLISHER]

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

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

University students routinely participate in research, including research on trauma and adversity, but the unique implications of trauma and adversity for educational and developmental outcomes for this group have received less attention. This study surveyed first year undergraduate students at an urban university located in the most ethnically diverse district in England, with the second highest poverty rate. Of 7,110 students, 858 responded; a response rate of 12%. The survey included thirteen questions about adverse events and circumstances before age 18. Four in five students (79%) reported at least one adversity, 51% reported three or more, and 20% reported at least six. Female students reported a higher mean number of adversities than men, but men were significantly more likely to report having been "attacked, stabbed, shot or robbed by threat." Where comparisons were possible, rates were higher than for the general population or for the only other UK university survey. A Latent Class Analysis produced four groupings. Besides the 'No adversity' (36%) and "Intermediate" (46%) classes, there were two "High adversity" groups, differentiated by high (12%) or moderate (6%) adversities related to cohabitation (parental separation, lived with depressed person, lived with alcohol/drug user, and lived with incarcerated person). Higher rates of adversities, and latent class membership, were related to predictions that one would not complete one's degree. Implications and next steps are discussed. [ABSTRACT FROM AUTHOR]

Psychological difficulties among young people are common. Various initiatives are being proposed in schools, yet no evidence-based data is available on how to address family difficulties (the most prevalent issues in school-based counselling). The current study examined the use of a two-component intervention based on the principles of Perceptual Control Theory (PCT). One is Method of Levels therapy (MOL) and the other is a parent–child activity (Shared Goals). Young people were invited to choose how often to engage in both MOL and the Shared Goals activity as well as the topics discussed during sessions for four months. Seven dyads were recruited and six were retained. At the end of the intervention, five young people were considered recovered. [ABSTRACT FROM AUTHOR]

To examine how patients spend their time in stroke rehabilitation units in England. We recruited 144 patients within a month after stroke from four stroke rehabilitation units and observed their activity type, interactions and location. Each participant was observed for 1 min every 10-minutes, for a total of 20 h, over three consecutive days. Multilevel modelling was performed to assess differences across sites. Across the four sites a total of 12,248 observations were performed. Patients spent on average 37% of the observed time inactive and 60% alone. A health care professional was present for 18% of the observations and patients' most frequent contact was with family members (19%). Patients were mainly physically active in the presence of therapists, but they practiced self-care activities of daily living most frequently in the presence of nursing staff. There were limited opportunities for activity away from the bedside. Significant differences were found between the units, including patients' level of contact with rehabilitation assistants and nursing staff, but not in their time with occupational therapists and physiotherapists. Stroke patients in England spend a large proportion of their day inactive and alone. Opportunities to promote a rehabilitation focused environment may include: a) enhancing the role of rehabilitation assistants, b) supporting nursing staff in maximising opportunities for the practice of activities of daily living and c) involving family members in the rehabilitation process. Clinicians need to consider stroke patients' activity levels and rehabilitation experience outside formal therapy. The role of rehabilitation assistants and nursing staff can be key in promoting patient activity and practice of self-care ADL tasks. Pragmatic strategies to encourage family involvement in the rehabilitation process need to be developed. [ABSTRACT FROM AUTHOR]

Overuse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance. Most antibiotics in the United Kingdom (71.4%) are prescribed in primary care by general practitioners, with about half prescribed for viral rather than bacterial illnesses. To explore antibiotic prescribing and factors which may influence maternal decision making to seek antibiotics for their young children. Data for children under five years were gathered using a mixed-methods case study approach. Quantitative general practice antibiotic prescribing data (n = 697 children) was statistically analysed and these results were further explored in six focus groups with mothers (n = 19) of children under five. The qualitative data was thematically analysed. Quantitative data identified nearly half of children received antibiotics. Children under one were prescribed the fewest antibiotics. Qualitative focus group data showed mothers trusted their general practitioner to provide expert care for their child and often wanted convenient and timely access to advice and reassurance rather than treatment. Antibiotics are frequently prescribed for young children in primary care. Healthcare professionals need to understand the maternal influences contributing to antibiotic use in children and consider strategies and interventions to reduce unnecessary antibiotic prescriptions. Nurses and health visitors should have a greater role in supporting maternal decision making for managing their children's illnesses. [ABSTRACT FROM AUTHOR]

This research examined the educational inclusion of children who are deaf or hard of hearing (DHH) and from Roma families who have migrated to England. The study was co-developed with practitioners in the field and involved: a demographic survey of deaf education services; five institutional case studies of local authority services and four individual case studies of children who are DHH and from Roma families. An intersectional approach to the analysis of the data revealed the different vulnerabilities associated with being a child who is DHH and being from a migrant Roma family in England. The study provides the first estimate of the numbers of children who are DHH and from Roma families in England. It also documents an overview of the support offered to Roma children by local authority services and offers insights into the experiences of families and children. In conclusion, it considers the implications for multi-professional practice. [ABSTRACT FROM AUTHOR]

Parent-to-parent support for the families of deaf children has been provided in an East London district as an adjunct to the existing Early Support programme. Two parents of deaf children were employed as Parent Support Workers. They were members of a multi-disciplinary team of audiologists, teachers of the deaf and a specialist speech therapist. A questionnaire was used to obtain the views of the parents of a 10-year cohort of 35 deaf children who had received the peer support. There were high levels of satisfaction. Twenty-two respondents (63%) judged that a parent who had a shared experience was the person best placed to offer help and advice immediately following the diagnosis of childhood deafness with 27 (77%) considering the counselling and guidance of the teacher or therapist as most useful in the pre-school period after this initial period. An overwhelming 34 (97%) would recommend peer support as being useful. Twelve professionals, including five teachers, submitted free text on their views of the support. This was evaluated using thematic analysis. There were concerns about training and governance of the Parent Support Workers, with one teacher considering that the role may conflict with that of the teacher. However, ten professionals considered it to be a beneficial addition to existing programmes and none wanted it withdrawn. Most recognised that the "shared experience" of caring for a deaf child enabled the support workers to get close to families and provide a link with the home, which helped the parents engage with the intervention of the multi-disciplinary team. [ABSTRACT FROM AUTHOR]

This article draws from a 15-month participant observation study of social work and child protection practices in England to illustrate how social workers used Facebook to gain another view of service-users' lives. Social media use was not an intended focus for the study, its presence emerged during our data analysis. While some research has shown that such practices occur, our long-term ethnographic approach provides new insights into how Facebook was actually used in ongoing casework with families and why it was used. Our findings show that Facebook use took multiple forms. Some social workers actively searched service users' Facebook pages and some opposed any such usage. We further advance the literature by introducing a third group who were unwillingly "drawn into" acting on Facebook information presented to them by others such as their managers. Our research insights suggest that social work must pause to consider the implications of these complex emerging practices. [ABSTRACT FROM AUTHOR]

Increasing numbers of women living with HIV are reaching their midlife. We explore the association of HIV status with sexual function (SF) in women aged 45–60 using two national cross-sectional surveys: the third British National Survey of Sexual Attitudes and Lifestyles ("Natsal-3") and "PRIME", a survey of women living with HIV attending HIV clinics across England. Both studies asked the same questions about SF that take account not only sexual difficulties but also the relationship context and overall level of satisfaction, which collectively allowed an overall SF score to be derived. We undertook analyses of sexually-active women aged 45–60 from Natsal-3 (N = 1228, presumed HIV-negative given the low estimated prevalence of HIV in Britain) and PRIME (N = 386 women living with HIV). Women living with HIV were compared to Natsal-3 participants using multivariable logistic regression (adjusting for key confounders identified a priori: ethnicity, ongoing relationship status, depression and number of chronic conditions) and propensity scoring. Relative to Natsal-3 participants, women living with HIV were more likely to: have low overall SF (adjusted odds ratio (AOR) 3.75 [2.15–6.56]), report ≥1 sexual problem(s) lasting ≥3 months (AOR 2.44 [1.49–4.00]), and report almost all 8 sexual problems asked about (AORs all ≥2.30). The association between HIV status and low SF remained statistically significant when using propensity scoring (AOR 2.43 [1.68–3.51]). Among women living with HIV (only), low SF was more common in those who were postmenopausal vs. Premenopausal (55.6% vs. 40.4%). This study suggests a negative association between HIV status and sexual function in women aged 45–60. We recommend routine assessment of SF in women living with HIV. [ABSTRACT FROM AUTHOR]

Copyright of Australian Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To explore the validity of change scores of the Children's Handuse Experience Questionnaire (CHEQ). Methods: Analysis of the CHEQ included 44 children (15 girls) between 6-16 years (median 9.0; IQR 8-11) with unilateral cerebral palsy, with baseline and post- (two-week intensive) intervention assessments using the Goal Attainment Scale (GAS) as external anchor for change. Hypotheses on the magnitude of expected changewere formulated and correlation coefficients and effect sizes calculated. Receiver operating curve analysis was performed and the area under the curve (AUC) calculated to investigate the ability of CHEQ to discriminate between improvement and non-improvement according to GAS. Results: All hypotheses about the magnitude of change were confirmed supporting longitudinal validity of CHEQ scales to measure change in the perception of bimanual performance. AUCs for the Grasp efficacy and the Time utilization were slightly below, and for the Feeling bothered slightly above the threshold. The latter one accurately discriminating between children that improved and did not improve according to the GAS. Conclusions: Evidence was found that CHEQ scales capture change in bimanual performance but with limited accuracy for two out of three scales. The validity of CHEQ change scores needs to be further explored in a wider population. [ABSTRACT FROM AUTHOR]

Purpose: This first psychometric evaluation of the Patient Categorisation Tool examined its properties as an instrument to measure complexity of needs in a mixed population of patients presenting for specialist neurorehabilitation. Materials/methods: Analysis of a large multicentre cohort of patients (n = 5396) from the national clinical dataset representing 63 specialist rehabilitation services across England. Structural validity was examined using exploratory and confirmatory factor analysis. Concurrent and criterion-validity were tested through a priori hypothesized relationships with other validated measures of resource requirements and dependency. Results: All but two items loaded strongly onto a single principal component with Cronbach's alpha 0.88. A total score of ≥30 identified patients with complex (category A) needs with sensitivity 76% and specificity 75%. However, confirmatory factor analysis provided a better fit when the scale was split into two subscales – a 'Cognitive/psychosocial' and a 'Physical' sub-scale (alpha 0.83 and 0.84, respectively). Moderate convergent and discriminant correlations were consistent with hypothesized relationships. Conclusions: The findings provide some overall support for the Patient Categorisation Tool as a unidimensional tool for measuring complexity of needs for neurorehabilitation, but the subscales may be more suitable for certain groups of patients. Further analysis is now required to evaluate its performance in different conditions. A psychometrically robust tool for measuring the complexity of rehabilitation needs has potential value, both at an individual level for treatment planning, and at a population level for planning and commissioning rehabilitation services. The Patient Categorisation Tool now forms part of the United Kingdom national clinical dataset mandated by the National Health Service in England This psychometric analysis from a large national multicentre cohort representing a diverse range of conditions, provides evidence for its validity as a means to identity patients with complex rehabilitation needs requiring specialist rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: Hip osteoarthritis (OA) is a chronic musculoskeletal condition affecting 2.5 million people in England. There is limited evidence on practice in the United Kingdom (UK) by physiotherapists in the public sector. A snapshot survey was conducted in a limited time period to inform standard care in a trial funding application. Methods: An online survey was circulated using Twitter. Thirteen Tweets linking to the survey were posted over 6 days to gain a snapshot view of physiotherapy practice within the public sector in the UK. Results: Sixty-two physiotherapists from 25 counties in the UK and Wales responded. The median waiting time from referral to physiotherapy treatment was 5 weeks and patients were seen a median of 3 times. The median total number of hours treated was 2 hours, and the median duration time for treatment was 8 weeks. All respondents used strengthening exercises, 73% stretches, 50% cardiovascular exercise, 73% balance exercises and 26% proprioceptive exercises. Thirty-nine percent of respondents use both strengthening and cardiovascular exercises, and provide an education leaflet, as contained within National Institute for Health and Clinical Excellence (NICE) guidance. Conclusions: This snapshot suggests that physiotherapeutic management varies widely across the UK. [ABSTRACT FROM AUTHOR]

Two cluster-randomised trials were carried out in 2013-2014, investigating the impact of In:tuition (a school-based life skills and alcohol education intervention). One involved 10-11 year olds in primary schools and the other 12-13 year olds in secondary schools. In primary schools, the outcomes measured were: resistance skills; knowledge of alcohol; decision-making skills; and understanding of social norms relating to alcohol. The secondary school trial also measured age of first alcoholic drink and frequency of drinking (among drinkers). Schools were randomly allocated to receive In:tuition or to a 'business-as-usual' control. A self-report student survey was administered before and after the intervention. In total, 79 primary schools and 55 secondary schools were included. 'Intention-to-treat' analysis was undertaken, including all students regardless of the extent of In:tuition delivery. 'On-treatment' analysis was also carried out, to account for differences in programme delivery. A process evaluation, involving interviews with staff and pupils in nine schools and a teacher survey, was carried out to investigate programme implementation. The primary intervention group had slightly better knowledge of alcohol than those in the control, although the results were not significant at p = 0.07. There was no evidence of impact on resistance skills, decisionmaking or understanding of social norms. There was no evidence of any significant impact in secondary schools. Although teachers saw some value in the individual elements of the programme, they did not always deliver it in its entirety. It was recommended that for the programme to have a positive impact in its entirety it needed fundamental revision. [ABSTRACT FROM AUTHOR]