Search

This chapter addresses the (pragmatic) language and communication difficulties of adults who are in prison. While there are no systematic studies of speech, language and communication difficulties in adult prisoners, conditions which are strongly associated with communication difficulties such as dementia, learning difficulties and psychiatric conditions are shown to be prevalent in this population. In addition, low levels of education and literacy difficulties are frequently revealed in studies of adult prison populations. By contrast, there is far better recognition of the communication needs of foreign national prisoners. Many of the communication difficulties that are specific to the prison environment for foreign national prisoners apply equally to a home language speaker who has speech, language or communication difficulties. These difficulties are detrimental to the individual and may also reduce the effectiveness of the prison regime given that most assessment and treatment to prevent re-offending is verbally mediated. Risk assessment relies particularly on effective communication with the prisoner. If communication difficulties prevent full disclosure of risk factors, risk assessment will be of limited value and may affect not only the person but also staff and other inmates. The chapter highlights many areas where further research into adult offenders is needed and presents a policy agenda to improve health care provision for older prisoners.

Young offenders disproportionately present with Developmental Language Disorder and are likely to struggle with the communication demands of the justice system. Professional guidance outlines strategies for facilitating successful communication, but it is unknown to what extent recommendations are substantiated by evidence. This review mapped academic and grey literature regarding the communication requirements, barriers and recommendations for routine youth justice interactions, such as forensic interview and courtroom testimony. Academic papers were identified through searches of five online databases, and OpenGrey, Google Scholar and organizational websites were searched to identify grey literature. 75 of 505 retrieved papers met inclusion criteria. Extracted data were presented regarding a) requirements and barriers a young person would encounter in the youth justice system, b) communication recommendations made for each stage of this journey, and c) type of evidence underlying the outlined findings. Communication barriers included exposure to unfamiliar vocabulary, repairing misunderstandings, constructing narratives and displaying the appropriate attitude. Recommendations were wide-ranging and broadly consistent, though very few had been evaluated for effectiveness. Some papers queried the practicality and effectiveness of recommendations such as rephrasing difficult terminology. A relatively small number of papers considered the views of young offenders or observed real youth justice interactions. Future research should include observational studies of real youth justice interactions to evaluate the effectiveness of widely recommended strategies. Policymakers may wish to consider concerns raised that rephrasing the language used in the youth justice system is not practical or sufficiently effective, and that broader changes to the communication environment are required.

Background\ud \ud While the prevalence of language and communication difficulties among young people in custody is well established, holistic understanding of the complexity and co-occurrence of additional vulnerabilities among this population are rare.\ud \ud \ud Methods\ud \ud Ninety-three young people in a young offenders institution in England were assessed using the Comprehensive Health Assessment Tool, the Test of Word Knowledge, and a range of additional assessments of communication, cognition, and neurodevelopmental difficulties.\ud \ud \ud Results\ud \ud Forty-seven percent of the young people demonstrated an aspect of language skills significantly below the population average, with more than one in four identified as having impairment. Only one in four of those with an impairment had previously accessed speech and language services. Language needs were associated with difficulties with social communication and nonverbal cognition, as well as higher risk of self-harm and substance misuse.\ud \ud \ud Conclusions\ud \ud Earlier identification of language difficulties requires routine assessment of young people at risk of engagement in offending behavior. Where language difficulties are identified, holistic assessments of needs should be undertaken. There is a need for speech and language therapy provision within youth justice services, as well as in other services accessed by young people at risk of engagement in offending.

Background:\ud The number of complaints from patients and/or carers concerning aspects of care has increased over time. Yet, in spite of a growing body of national and international literature on healthcare complaints, there is a lack of knowledge around how nurses and midwives manage informal complaints at ward level, or staff needs in relation to this.\ud \ud Aim:\ud Using an action research approach with mixed methods, four phases and four cycles, the aim was to explore informal complaints management by nurses and midwives at ward level. We discuss the action research process primarily in connection with learning and service change, drawing from the qualitative data in this paper.\ud \ud Findings:\ud The analysis of the collected qualitative data resulted in three main themes, related to the complexities of complaints and complaints management, staff support needs and the existing ambiguous complaints systems, which are hard for staff and service users to negotiate. The action research approach facilitated learning and change in participants in relation to complaints management, in the collaborating trust.\ud \ud Conclusions:\ud The extant body of research on complaints does not sufficiently recognise the complexity of complaints and informal complaints management, or the complaints systems that are in place. Needs-based staff training can help support staff to manage informal complaints more effectively.\ud Implications for practice:\ud •There needs to be recognition of the complexities involved in complaints management\ud •Complaints systems need to be clearer for the benefit of service users and staff\ud •Staff need training and support that is tailored to their needs to improve their response to complaints, leading to a better patient experience\ud •Limited interventions, informed by staff needs, can lead to change and act as a catalyst for a wider change in informal complaints management

Aim and objective To understand how nurses and midwives manage informal complaints at ward level. Background The provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service in the UK to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives. Design Collaborative action research. Methods Four phases of data collection and analysis relating to primarily one National Health Service trust during 2011–2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust. Results Three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems. Conclusions Current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints. Relevance to clinical practice Robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience.

BackgroundMultidisciplinary rehabilitation is recommended for Parkinson’s disease, but evidence suggests that benefit is not sustained.Objectives(1) Implement a specialist domiciliary rehabilitation service for people with Parkinson’s and carers. (2) Provide continuing support from trained care assistants to half receiving the rehabilitation. (3) Evaluate the clinical effectiveness of the service, and the value added by the care assistants, compared with usual care. (4) Assess the costs of the interventions. (5) Investigate the acceptability of the service. (6) Deliver guidance for commissioners.DesignPragmatic three-parallel group randomised controlled trial.SettingCommunity, county of Surrey, England, 2010–11.ParticipantsPeople with Parkinson’s, at all stages of the disease, and live-in carers.InterventionsGroups A and B received specialist rehabilitation from a multidisciplinary team (MDT) – comprising Parkinson’s nurse specialists, physiotherapists, occupational therapists, and speech and language therapists – delivered at home, tailored to individual needs, over 6 weeks (about 9 hours’ individual therapy per patient). In addition to the MDT, participants in group B received ongoing support for a further 4 months from a care assistant trained in Parkinson’s (PCA), embedded in the MDT (1 hour per week per patient). Participants in control group (C) received care as usual (no co-ordinated MDT or ongoing support).Main outcome measuresFollow-up assessments were conducted in participants’ homes at 6, 24 and 36 weeks after baseline. Primary outcomes: Self-Assessment Parkinson’s Disease Disability Scale (patients); the Modified Caregiver Strain Index (carers). Secondary outcomes included: for patients, disease-specific and generic health-related quality of life, psychological well-being, self-efficacy, mobility, falls and speech; for carers, strain, stress, health-related quality of life, psychological well-being and functioning.ResultsA total of 306 people with Parkinson’s (and 182 live-in carers) were randomised [group A,n = 102 (n = 61); group B,n = 101 (n = 60); group C,n = 103 (n = 61)], of whom 269 (155) were analysed at baseline, pilot cohort excluded. Attrition occurred at all stages. A per-protocol analysis [people with Parkinson’s,n = 227 (live-in carers,n = 125)] [group A,n = 75 (n = 45); group B,n = 69 (n = 37); group C,n = 83 (n = 43)] showed that, at the end of the MDT intervention, people with Parkinson’s in groups A and B, compared with group C, had reduced anxiety (p = 0.02); their carers had improved psychological well-being (p = 0.02). People with Parkinson’s in groups A and B also had marginally reduced disability (primary outcome,p = 0.09), and improved non-motor symptoms (p = 0.06) and health-related quality of life (p = 0.07), compared with C. There were significant differences in change scores between week 6 (end of MDT) and week 24 (end of PCA for group B) in favour of group B, owing to worsening in group A (no PCA support) in posture (p = 0.001); non-motor symptoms (p = 0.05); health-related quality of life (p = 0.07); and self-efficacy (p = 0.09). Carers in group B (vs. group A) reported a tendency for reduced strain (p = 0.06). At 36 weeks post recruitment, 3 months after the end of PCA support for group B, there were few differences between the groups. Participants reported learning about Parkinson’s, and valued individual attention. The MDT cost £833; PCA support was £600 extra, per patient (2011 Great British pounds).ConclusionsFurther research is needed into ways of sustaining benefits from rehabilitation including the use of care assistants.Study registrationCurrent Controlled Trials: ISRCTN44577970.FundingThis project was funded by the National Institute for Health Research Health Services and Delivery Research programme and the South East Coast Dementias and Neurodegenerative Disease Research Network (DeNDRoN), and the NHS South East Coast. The report will be published in full inHealth Services and Delivery Research; Vol. 2, No. 51. See the NIHR Journals Library website for further project information.

Objective: To compare two approaches to providing training to care assistants in Parkinson’s disease. Design: Pragmatic parallel arm controlled trial. Setting: Training either by an interactive training day at a local medical education establishment or self study. Subjects: Care assistants recruited from local health and social care providers. Interventions: The content of both interventions was similar, covering causes, symptoms, diagnosis of Parkinson’s disease, multidisciplinary management, mobility, communication, swallowing, and involving 5 hours of study time. Main measures: Knowledge about Parkinson’s (assessed by true/false quizzes and identifying ‘four facts’ about Parkinson’s) immediately post training and six weeks later; views on training methods of care assistants and employers/managers. Results: Thirty-seven employers nominated 100 care staff who were allocated to interactive training (49) and self study (51). Training completion rates (retained to six-week follow-up) were lower for self study (42.1% vs. 83.7% training day). There were no significant differences between groups on quiz or ‘four facts’ scores at baseline or six-week follow-up. Immediately post training, the self-study group (with access to written materials) had significantly higher quiz scores than the training day group (no access to materials at test). Within-group comparisons showed improvements post training. Although interactive training may be preferred, obtaining release from duties can be problematic. Conclusions: Both approaches have similar effects on knowledge of care assistants without prior specific training. Providing a variety of approaches will cater for all preferences. The findings may be generalizable to training the care workforce for other specific roles.

Background: Increasing numbers of children with behaviour and school problems (related to both academic achievement and social participation) are recognized as having undiagnosed speech, language and communication difficulties. Both speech, language and communication difficulties and school failure are risk factors for offending. Aims: To investigate the prevalence of speech, language and communication difficulties in a group of persistent and prolific young offenders sentenced to the Intensive Supervision and Surveillance Programme (ISSP), and to provide a preliminary evaluation of the impact of speech and language therapy (SLT) intervention. Methods & Procedures: Seventy-two entrants to ISSP over 12 months were screened by the speech and language therapist. Those showing difficulties then had a detailed language assessment followed by intervention delivered jointly by the speech and language therapist and the youth offending team staff. Reassessment occurred at programme completion. Outcomes & Results: A total of 65% of those screened had profiles indicating that they had language difficulties and might benefit from speech and language therapy intervention. As a cohort, their language skills were lower than those of the general population, and 20% scored at the ‘severely delayed’ level on standardized assessment. This is the first study of speech and language therapy within community services for young offenders, and is the first to demonstrate language improvement detectable on standardized language tests. However, further research is needed to determine the precise role of speech and language therapy within the intervention programme. Conclusions & Implications: Children and young people with behavioural or school difficulties coming into contact with criminal justice, mental health, psychiatric, and social care services need to be systematically assessed for undiagnosed speech, language and communication difficulties. Appropriate interventions can then enable the young person to engage with verbally mediated interventions.

This paper describes the processes involved in evaluating a Sure Start programme in one inner city area. The evaluation was set up in the spirit of participatory action research in which the researchers aimed to work in partnership with key stakeholders to both enable and sustain supportive evaluative processes. The evaluation supported the aspirations espoused by the national Sure Start agenda to improve the lives of children under four, their parents and communities through an expressed commitment to partnership working. The paper draws on ethnographic reflections to describe and analyse the processes involved in setting up the evaluation over two years. Issues of trust, ambiguity and conflict associated with partnership working are explored. In particular the emotional components of relationships required to work in partnership are described as a means of managing ambiguity and conflict and promoting trust. Emotional labour is taken as a conceptual starting point to analyse the relationships and the organisational conditions required to sustain partnerships. Further psychoanalytic and sociological studies are drawn upon to aid the analysis and in particular to understand the emotional components of partnerships in the relatively uncharted waters of inner city regeneration work.

This article addresses the theoretical integration of macro and micro dimensions of global workforce migration, detailing overseas nurses’motivations for working in the UK. The discussion is based on focus group interviews with overseas nurses in three areas in the UK. Their motivations for migrating are contrasted with their experiences of frequently being stereotyped as economic migrants who come from poor countries to gain financial benefits. These conflicting perspectives on overseas nurses’ motivations are explored through a discussion of Bauman’s notion of global and local values, which conceptually combines issues of globalization with the migrants’ perspectives. Giddens’ concept ‘life politics’ is introduced to take further account of individuals’experiences and perspectives. Our data suggest that overseas nurses take a global, transnational perspective on life. Likewise, the simplistic understanding of overseas nurses as economic migrants appears to reflect a local perspective where the lives of individuals are seen to be confined within the borders of nation states. The analysis suggests how perspectives on migration are shaped by individuals’ values and life orientations interfacing with conditions of globalization.

Aims : This research investigates the relationship between dyslexia traits and nurse performance on a laboratory task designed to assess one of the key cognitive skills involved in drug administration. The potential moderating role of perceived performance control was also assessed, based on previous work demonstrating the importance of self-belief as a facilitator of vocational success. Background : Dyslexia within the health care professions has been the subject of wide and emotionally charged debate but has not yet been scientifically examined. Those who fear clinicians with dyslexia do so because of a presumed or potential risk to patient health and safety posed by dyslexia-induced performance error (e.g. problems with drug administration). Design, sample and methods : 46 nurses (40 student nurses and 6 qualified nurses) volunteered to complete a battery of computerised tasks assessing for dyslexia traits (using four accuracy tasks measuring different types of literacy skill), a paired association task designed to measure one of the key cognitive skills involved in drug administration) and a self-report questionnaire (Learning Styles Questionnaire, self-reported reading difficulty and a history of educational support, perceived control over performance). The performance criterion measure was constructed after detailed job analysis (involving analysis of official documentation, in-depth interviews and field observation across a variety of clinical settings) and involved matching drug names to patient names and vice versa. Results : The results showed that the dyslexia indicators (objective and self-report) were significantly correlated with performance on the paired association task. Contrary to expectation however, the perceived control variable was not associated with performance. Conclusion : The findings provide tentative support for the idea that some tasks might be problematic for the clinician with dyslexia. Taken in isolation however, it would be inappropriate to conclude that this will necessarily translate into true performance errors without taking into consideration the entire performance context. Suggestions are made for replicating and extending the study to provide a more solid and constructive basis for intervention (e.g. support measures, a built-in checking process).

Clinical neurolinguistics still lacks consolidated and standardised tools for the assessment of impairments of pragmatics of verbal communication. In the present paper we present norms of the Italian version of the Right Hemisphere Language Battery (Batteria del Linguaggio dell’Emisfero Destro, BaLED) [1] originally devised by Bryan [2]. The normative study has been conducted with the recruitment of 440 healthy subjects. The battery of tests was not intended to be cognitively oriented, by providing evidence of the cognitive impairments underpinning verbal pragmatic deficits; on the contrary, it permits the detection of the presence/absence of impairments in processing the main pragmatic features of verbal communication traditionally associated with right hemisphere lesions. Thus, apart from being a clinical tool for diagnosing pragmatic impairments of verbal communication, the BaLED represents a useful initial battery of tests for clinical assessment and for selecting specific populations of neurological patients suitable for investigation in further experimental studies.

Background Parkinson's Disease is a degenerative neurological condition that causes movement problems and other distressing symptoms. People with Parkinson's disease gradually lose their independence and strain is placed on family members. A multidisciplinary approach to rehabilitation for people with Parkinson's is recommended but has not been widely researched. Studies are needed that investigate cost-effective community-based service delivery models to reduce disability and dependency and admission to long term care, and improve quality of life. Methods A pragmatic three parallel group randomised controlled trial involving people with Parkinson's Disease and live-in carers (family friends or paid carers), and comparing: management by a specialist multidisciplinary team for six weeks, according to a care plan agreed between the professionals and the patient and carer (Group A); multidisciplinary team management and additional support for four months from a trained care assistant (Group B); usual care, no coordinated team care planning or ongoing support (Group C). Follow up will be for six months to determine the impact and relative cost-effectiveness of the two interventions, compared to usual care. The primary outcomes are disability (patients) and strain (carers). Secondary outcomes include patient mobility, falls, speech, pain, self efficacy, health and social care use; carer general health; patient and carer social functioning, psychological wellbeing, health related quality of life. Semi structured interviews will be undertaken with providers (team members, care assistants), service commissioners, and patients and carers in groups A and B, to gain feedback about the acceptability of the interventions. A cost - effectiveness evaluation is embedded in the trial. Discussion The trial investigates components of recent national policy recommendations for people with long term conditions, and Parkinson's Disease in particular, and will provide guidance to inform local service planning and commissioning. Trial registration ISRCTN: ISRCTN44577970