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In this paper, we report findings from a qualitative, multidisciplinary analysis of 20 Child Practice Reviews (CPRs) (previously Serious Case Review) in Wales. The reviews were analysed from three different disciplinary perspectives: law, criminology and practice (social work). The following cross‐cutting themes were identified from our coding of the reviews: (i) hierarchy of knowledge, where certain sources of knowledge were privileged over others; (ii) information sharing/recording, where deficiencies of sharing or recording of information were evident; (iii) partial assessment, where certain assessments were not always holistic; and lastly, (iv) voice of the child, where the experience or perspective of the child was not always considered. In addition, our analysis revealed a range of challenges to the CPR process as implemented. This paper is the first to explore themes emerging from (Welsh) CPRs and is also the first to do so from a multidisciplinary perspective. We conclude by highlighting the recommendations for practice, such as the need for greater learning pan‐Wales, regular publication of the major themes emerging from CPRs and the need for deposit of CPRs in a central repository to facilitate learning from reviews. 'Report[s] findings from a qualitative, multidisciplinary analysis of 20 Child Practice Reviews... in Wales' Key Practitioner Messages: There is an urgent need for multidisciplinary training on contemporary data protection requirements as per the General Data Protection Regulation for all safeguarding boards.Creative methods are required to disseminate the messages from Child Practice Reviews more widely.Child Practice Reviews should be deposited and indexed in a central repository to facilitate learning across Wales.Guidance and training for Child Practice Reviews should be revisited, so that the child is repositioned at the centre of the process and the voice of the child is heard. [ABSTRACT FROM AUTHOR]

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

Professional identities are important in defining workers' roles, and are concerned with attributes relating to those roles and how they are performed. Evidence shows mental health nurses undertake many different roles as part of their work. Yet, the roles of mental health nurses are insufficiently understood by healthcare staff, service users, and nurses themselves. Mental health nursing work has been deemed invisible and lacking in role clarity. Poor understandings about professional identity of mental health nurses result in difficulties recruiting to the profession, nurses lacking confidence articulating the value of their work, with misunderstandings apparent with service users about the specific role of mental health nursing in their care. The primary focus of this study, conducted in Wales, United Kingdom, was to examine how talk about mental health nursing was handled by participants from multiple perspectives. Data consisted of 17 individual interview transcripts with mental health nurses and 13 interview transcripts from mental health service users, and three focus groups with nursing students. Participants' talk was analysed using thematic analysis. This paper reports how participants described mental health nursing work to have significant role overlap with other multidisciplinary team members. Participants highlighted that mental health nurses often have an 'in the middle' label because the complexity of their work can be hard to describe. The implications are pertinent for nurses because if they are considered to be in a liminal position, they risk being perceived as neither one role nor another, resulting in nurses struggling with professional identities and role confidence. [ABSTRACT FROM AUTHOR]

Rationale: Prudent Healthcare is a strategy adopted by the Welsh Government in response to the challenge of improving health care during times of austerity and when needs and demand are rising. Four principles underlie Prudent Healthcare: to achieve health and wellbeing through co production; care for those with the greatest health needs first; do only what is needed; and reduce inappropriate variation. For Prudent Healthcare to be implemented in Wales, it is necessary for health professionals to adopt these principles in practice. Objective: This paper reports a qualitative evaluation of clinicians' awareness, experiences, and views about Prudent Healthcare, identifying barriers and enablers to implementation from the clinician's perspective. Methods: Semi‐structured interviews (n = 28) and five focus groups (with 23 participants) were undertaken with a diverse range of health professionals working in primary and secondary care. Analysis was underpinned by the COM‐B model which provides a framework to understand behaviour change in context using three domains, Capability, Opportunity, and Motivation. Results: Clinicians reported the importance and challenges of accessing and sharing information and evidence to inform practice (Capability). Reduced staffing levels and service availability were highlighted as possible barriers to Prudent Healthcare implementation while multidisciplinary working and reorganization of staff roles and services were considered enablers (Opportunity). Finally, although the principles of Prudent Healthcare were broadly welcomed (Motivation), a lack of awareness of the initiative and the management of patient expectations presented barriers. Conclusion: While there was a positive response and widespread support for the principles of Prudent Healthcare by clinicians, increasing awareness of the initiative and improvement to systems to enable information sharing and the monitoring of patient outcomes could improve the consistency of implementation. [ABSTRACT FROM AUTHOR]

This paper assesses the nature of parental participation and legal representation in pre-proceedings meetings in England and Wales. These are called when a local authority is considering care proceedings on a child. The parent(s) are invited to a meeting to discuss the concerns, and are entitled to attend with a lawyer. The paper draws on findings from a study of the process which included a file survey of over 200 cases, observations of 36 meetings and interviews with more than 90 key informants, including parents. The aim of the process is (usually) to reach an agreement to prevent the case going to court, but the families are usually well known to children's services, and have been through many meetings and agreements before. What then are the possibilities for parental participation and legal representation in the meetings? The study shows that they may help bring a greater degree of clarity to the local authority's proposals, but are not expected to challenge them. Paradoxically, they serve to reinforce the authority's position. The meetings can help divert cases, but it is important to be realistic about the chances of change in these often long-standing 'edge of care' cases. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is an increasing priority in health‐related research and education. Attracting and supporting people from different demographic groups to give up their time and get involved is important to help ensure that all parts of society are empowered, represented and their voices heard in decisions that may affect their health and quality of life. Objectives: (1) To determine if a demographically diverse cross‐section of society would be interested in contributing to healthcare research and education. (2) To understand factors that can act as barriers and enablers to effective and diverse PPI. Method: PPI survey data was collected via engagement events, with the aim of scoping interest in PPI from a diverse public. A Focus Group study involving members of the public, academic and professional service staff, was then conducted to gain a deeper understanding around the barriers and enablers of diversity within PPI. Results: 71% of a diverse rich public indicated they would like to get involved in healthcare research and teaching. 76% of survey respondents indicated that they would be happy to share a personal or family experience of healthcare. The two biggest factors impacting on our cohort getting involved are' availability of time' and 'being aware of PPI opportunities'. These factors may disproportionally affect specific groups. Shared and individual PPI enablers and barriers were identified across all stakeholder groups within the Focus Group Study, as well as generic and novel factors that would impact on an institutions' ability to improve PPI diversity. Conclusion: These data points confirm a demographically diverse public's appetite to get involved in academic health research and teaching. This needs to be recognised and harnessed to ensure public contributor networks are representative of society. Equality Impact Assessments should be undertaken in relation to all PPI opportunities. There is a need to recognise the investment of time and resources required to build mutually beneficial relationships with diverse communities as well as the development of inclusive 'fit for purpose' PPI infrastructures to support the uptake of diverse PPI contributors. Public Contribution: This study involved members of the public responding to a short survey. Public contributors made up one of the three focus groups. The School of Medicine lead public contributor was also involved in the preparation of this manuscript. [ABSTRACT FROM AUTHOR]

Not only has research over the past decade documented the emotional and behavioural consequences for children who witness domestic violence, but a number of studies have used children as participants thus, giving them an opportunity to describe their experiences in their own words. In policy terms, there has been a growing emphasis on children's rights and the importance and understanding of children's perspectives on their own lives. Consequently, children can no longer be perceived as forgotten victims where domestic violence is concerned. This paper explores practitioners' awareness of the needs of children and young people living with, and fleeing from, domestic violence. The research, conducted in a rural area in Wales, reveals that although the views of practitioners reflect the concerns reported by young people in other studies, there can be barriers to meeting these needs. While policy prescribes engaging with children, at the institutional level, operational priorities and increasing administrative demands can actually reduce opportunities for working directly with children. These demands may hamper the development of multi-agency practice. [ABSTRACT FROM AUTHOR]

Abstract Background The common mental disorders of depression and anxiety often remain undetected in general practice. Psychiatric screening instruments have been recommended to assist detection. Aim To assess patients' attitudes towards the use of psychiatric screening questionnaires for common mental disorders within general practice. Design Twenty focus groups comprising 127 patients were conducted in Wales, UK. The groups were distinguished by age, sex and locality. Results The majority of respondents felt that the use of a screening questionnaire was acceptable and would be willing to complete one within a general practice setting. However, a number of individuals expressed concern about the validity of the kinds of questions asked and the usefulness of the instrument in practice. Respondents also discussed their concerns relating to issues of confidentiality and the doctor's response to the assessment. Conclusion The study indicates that lay beliefs towards mental illness, particularly relating to perceived stigma, will continue to pose problems for the routine use of psychiatric case-finding questionnaires within general practice. [ABSTRACT FROM AUTHOR]

Aim: To describe the development of the Optimising Health and Learning Program, guided by the only available published framework for the delivery of health services to newly arrived refugee children and report on the evaluation of the programme.Methods: We conducted process and impact evaluation using a mixed methods approach. The sample was 294 refugee young people enrolled in two Intensive English Centres in New South Wales. We collected quantitative data (demographic and clinical information) as well as qualitative data via focus groups, key informant interviews, surveys and programme documentation. Qualitative data were subjected to thematic analysis; programme documents underwent document review.Results: There were high levels of programme participation (90%), and the yield from routine health screening was high (80% of participants screened positive for two or more health conditions). All identified programme development strategies were implemented; programme partners and participants reported satisfaction with the programme. Sixteen programme partners were identified with a high level of intersectoral collaboration reported. Significant in-kind contributions and seed funding enabled the uptake of the programme to increase from one to five Intensive English Centres over a 4-year period.Conclusion: Process and impact evaluation identified that the programme was well implemented and met its stated objectives of increasing the detection of health conditions likely to impact on student health and learning; linkage of newly arrived students and their families with primary health care; and coordination of care across primary health and specialist services. [ABSTRACT FROM AUTHOR]

Background Despite the policy rhetoric, patient involvement in health service decisions remains limited. Highlighted barriers include a concern that most patients are unable to see beyond personal aspects of their care in order to contribute meaningfully to health service development, and a perception that professionals do not welcome patient involvement. Objectives We aimed to explore respiratory patients' awareness of changes in local health service provision and provide insight into health professionals' attitudes to engaging patients. Methods Nested within an ethnographic study of health service reconfiguration, we recruited 31 patients with a range of respiratory diseases from four case study areas in England and Wales. Data from telephone interviews, illness diaries and focus groups with patients, and interviews with health professionals and managers were transcribed and analysed using the Framework approach. Results Participants were not only aware of trends in health service provision (e.g. emergence of new professional roles, shift from secondary to primary care) but interpreted changes in the light of local and national events. Despite this awareness, none of the patients was formally involved in service development, though some contributed to local voluntary groups. Professionals generally welcomed the need for patients' views to be heard. Discussion and conclusions Our data give grounds for optimism. Patients are aware of and interested in a broad range of health-related issues. Professionals' motivation to involve patients in service development may be underestimated. Although practical obstacles remain, our findings should encourage the ongoing search for effective models of promoting patient engagement in health-care services. [ABSTRACT FROM AUTHOR]

Restorative justice has been an increasing feature in the discourses within adult and youth justice criminal justice systems in recent years. This article examines interpersonal conflicts arising from crime, bullying and antisocial behaviour in residential care, and the advantages and disadvantages of utilising such approaches in relation to these forms of conflict, based upon an evaluation of restorative principles and approaches from the perspectives of young people, residential workers and managers. The article sets out how the staff in the units studied modified restorative justice approaches to take into account the specific relationships within group care settings. [ABSTRACT FROM AUTHOR]

Improving the mental health of the people in Wales lies at the heart of the Welsh Assembly Government's public health agenda and the current reforms of the National Health Service in Wales. However, relative to its importance as a health problem, spending on mental health is disproportionately low. Statutory authorities in Wales highlight the importance of listening to, and learning from, service users and carers. This is seen as a way of improving services within the limited funding that is available. The aims of this study were to describe the ways in which mental health service users and carers are currently involved in mental health services across Wales; and to consider the need for an all-Wales mental health service user and carer ‘national mechanism’ to promote genuine partnership. Eight focus groups were held across Wales attended by mental health service users and carers. There is a clear picture of the level and nature of participation, evidence of good practice and user and carer based aspirations for future participation. There is an untapped source of energy and experience that could help transform mental health services for the good of all. To ignore this would be to miss an opportunity to improve the quality of care for all those dependent upon these services, both patients and carers. [ABSTRACT FROM AUTHOR]

Background: Widespread concerns are being voiced in the Western world about rising rates of childbirth intervention. In Wales, United Kingdom, a Clinical Pathway for Normal Labour (Normal Labour Pathway) was devised to support normal childbirth and reduce unnecessary interventions. This study investigated the implementation of the pathway, from the perspective of midwives, doctors, and midwifery managers. Methods: An ethnographic approach was used to observe use of the Normal Labour Pathway in real life settings and evaluate its implementation. Data were collected by means of semiparticipant observation, focus groups, and interviews. Participants ( n = 56) included senior practitioners involved in creating the pathway ( n = 4), midwives ( n = 41), managers ( n = 5), and doctors ( n = 6). Data were analyzed thematically. Results: Key themes related to the effect of the Normal Labour Pathway on Welsh maternity care, and midwives’ and doctors’ experiences. Midwives’ views focused on the pathway as a decision-making protocol and record of care. Recently qualified midwives were more likely to view the pathway positively than those with more experience. Doctors were critical of the pathway, experiencing it as exclusionary. Midwives and doctors considered that the Normal Labour Pathway had increased interprofessional tensions. There was no evidence that it had increased the normal birth rate. Conclusions: The Normal Labour Pathway is a complex intervention with complex outcomes. It has had intended and unintended consequences, for maternity care in general and for the roles and relationships of maternity care practitioners. The study raises questions about the appropriateness of clinical pathways and other standardized decision-making tools for the complexity of childbirth. (BIRTH 37:3 September 2010) [ABSTRACT FROM AUTHOR]