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Purpose: This paper aims to outline the initial pilot use of the client complexity matrix (CCM), an outcome measure developed for an NHS Adult Intellectual Disabilities Intensive Support Team (IST) in the West Midlands of England. Design/methodology/approach: A mixed method approach was used to report the results and evaluate the use of the CCM within this IST. The CCM was trialled for six months between January 2022 and June 2022. CCM scores pre and post IST intervention were analysed via t-test, and qualitative feedback from clinicians is detailed. Findings: Analysis suggests the CCM captures service success showing a significant decrease in complexity and risk post-intervention. Qualitative comments from clinicians were generally positive; however, there were requested changes regarding specific presentations, use of labels/language and for a digital version. Research limitations/implications: The tool is not co-constructed with the client. Because of this IST's caseload, the sample size was small. Only one clinician was asked to complete the CCM pre and post intervention. Future use of the measure will encourage two clinicians to complete the measure to evidence its inter-rater reliability. Each client's specific presentation was not explicitly analysed here. Practical implications: The CCM will be updated using the feedback from clinicians and from the peer review process. Research that examines the generalisability of this measure to other IST services would be beneficial. Originality/value: The CCM appears to fill a gap in outcome measurements for this IST service which looks at breadth and depth of client complexity and risk. [ABSTRACT FROM AUTHOR]

Purpose: The article aims to argue that the concept of "distributed leadership" lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the "Strategic Action Field Framework" (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar.Design/methodology/approach: Using the SAF framework, the authors explored factors affecting whether and how local Vanguard initiatives were implemented in response to national policy, using a qualitative case study approach. The authors apply this to data from the focus groups and interviews with a variety of respondents in six case study sites, covering different Vanguard types between October 2018 and July 2019.Findings: While literature already acknowledges that leadership is not simply about individual leaders, but about leading together, this paper emphasises that a further interdependence exists between leaders and their organisational/system context. This requires actors to use their skills and knowledge within the fixed and changing attributes of their local context, to perform the roles (boundary spanning, interpretation and mobilisation) necessary to allow the practical implementation of complex change across a healthcare setting.Originality/value: The SAF framework was a useful framework within which to interrogate the data, but the authors found that the category of "social skills" required further elucidation. By recognising the importance of an intersection between position, personal characteristics/behaviours, fixed personal attributes and local context, the work is novel. [ABSTRACT FROM AUTHOR]

Purpose: This paper explores residents' perceptions and experiences of extra care housing as an integrated model of housing with care. Design/methodology/approach: Data were collected in a longitudinal qualitative study based on four extra care housing schemes. Data from interviews with residents, care workers, managers and local commissioners were analysed thematically. Findings: The integration of housing with care enabled many older people to manage their care proactively. However, the increasing number of residents with complex health and care needs, including chronic illness, led some residents to question the ability of the model to support residents to live independently. Research limitations/implications: The study struggled to recruit sufficient residents from the specialist dementia setting who were able to communicate their consent to take part in the research. In addition, the quality of qualitative data collected in interviews with participants at this setting reduced over successive rounds of interviews. Practical implications: The study suggests the need to ensure that residents are fully informed about levels of care and support is available when considering a move into extra care housing. Originality/value: This paper provides a timely opportunity to consider extra care housing as an example of an integrated housing service, particularly in light of the current challenges facing the sector. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate the extent, range and nature of literature concerning the mental health inpatient care of the young adult population (16-25 years) who have been admitted to adult mental health wards. This paper reports the findings and positions these in the context of the broader nature to adult inpatient care, evaluates the quality of the evidence and identify gaps in the literature.Design/methodology/approach This paper uses an adapted scoping review methodology, allowing for a broad search but utilised established steps that allowed for a structured, rigorous approach to be used. CINAHL, Cochrane Library, MEDLINE, PsycINFO, Google Scholar, plus a secondary hand search were conducted resulting in eight papers, of quantitative, qualitative and mixed methods papers.Findings Findings show admissions follow similar paths as to adults; admission reasons are largely unknown beyond simple descriptors; admission lengths are unknown whilst on adult wards; staff feel confident yet lack resources; young people feel the transition from CAMHS ward to adult ward can be beneficial if done sensitively; young people have positive experiences of adult wards, including factors that may not be present on CAMHS wards, e.g. role modelling by older patients; young people feel scared and vulnerable, including when excluded from decision making; however, involving young people can cause stress and be confusing if not done sensitively.Research limitations/implications The scoping review identified a limited amount of research evidence for the care of young people admitted to adult wards. The research methods used in these papers were varied and none was of a high-quality standard. All studies contained methodological gaps which detract significantly from their findings and conclusions. The studies go some way to fill the gaps in knowledge and evidence base for this group, although in doing this scoping review was to unearth more gaps in knowledge.Originality/value This scoping review collates findings from the literature regarding young people’s admissions to adult mental health wards. This sensitive and controversial area of mental health care is shown to be lacking in high-quality research. Young people are being admitted to adult wards in increasing numbers year on year in the UK, yet little research has been conducted to identify when and where treatment has been appropriate. This review provides a start to understanding what is known about admission and treatment for this group and what is not known so that these gaps may be investigated in future research. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate older people’s views and experiences of getting help from neighbours in order to consider whether such help is situated within neighbourliness and the implications for social care policy which seeks to harness help from neighbours.Design/methodology/approach A qualitative study in which 15 older people from the North of England were interviewed to explore relationships with neighbours, managing day to day life and experiences of getting help from neighbours.Findings Relationships with helper neighbours were reciprocal, dynamic and preceded the start of getting help. The help offered was not negotiated but evolved in response to changes in circumstances and was commensurate with normative views of neighbourliness, i.e. reciprocated sociability and helpfulness but also respect for privacy. Respondents were reluctant to ask for help. Underpinning such reluctance were perceptions of imposing on neighbours, suggestive of anticipated asymmetry in the give-and-take of neighbourliness.Social implications Policy makers who see the help from neighbours as an output of household production and available as a source of informal care for older people must appreciate that whether help is offered or taken up is dependent on the development of a reciprocal relationship which itself depends on observing and respecting normative boundaries, such as in relation to help giving or receiving and due respect for privacy.Originality/value There has been little research into older people’s perspectives on getting help from neighbours despite diminishing public services and neighbours viewed as a potential source of care. [ABSTRACT FROM AUTHOR]

Purpose - This qualitative study considers the roles of service user consultants (SUCs) in six of the original 11 Department of Health (DH) Community Personality Disorder (PD) pilot services; how these roles differ from the active participation traditionally encouraged in therapeutic communities (TCs) around responsibility for self and others; how a service user (SU) becomes a SUC; what responsibilities they hold; the views of both staff members and SUCs on the role and the benefits and difficulties it creates; and how the role could be developed in a service-specific and general way. It is of particular interest to consider the amount of time for which the SUC role is seen to be beneficial, and what support a SUC would need to leave the role.Design/methodology/approach - Two qualitative interview schedules were developed to investigate issues highlighted in previous literature, one designed to be answered by staff members, another developed with a SUC from Cumbria for SUCs and administered by telephone. The research questions were designed to look at four main themes: How SUs become SUCs; SUC responsibilities within the service; views on the benefits and difficulties of the SUC role; and developing the role and moving forward. The context of each service was explored to reflect the uniqueness of each SUC role and service philosophy.Findings - The SUC role continues to develop and is seen as having value, particularly as a "bridge" between SUs and staff members, and as a transitional stage in which the work of therapy can be consolidated. Problems remain in respect to: optimal levels of disclosure between other staff members and SUCs; the level and type of support needed to carry out the work and to remain well; acceptance of the role by professionals in other teams; and the extent to which SUCs are felt able to engage, or not, in direct clinical work.Research limitations/implications - This is a qualitative study in which only just over half of the pilot services agreed to take part and in which fewer SUCs were put forward to take part as compared to other staff members. There are therefore potential problems in generalising these findings to other services which employ SUCs.Practical implications - Within personality disorder services there is a perceived optimal level of disclosure and information sharing between other staff members and SUCs, and between SUCs and SUs, but this remains undefined. SUC responsibilities do not always include direct clinical work because of concerns to maintain their well being. There is evidence from a number of services that SUCs can safely and creatively engage in direct clinical work given suitable support and supervision. Staff members from other teams without experience of employing SUCs may not always understand the SUC role, may denigrate the experience of SUCs, or feel threatened by their incursion into training and clinical work. SUCs seem enthusiastic to work in other areas within their wider service to promote understanding of mental health and personality difficulties. In-service supervision/mentoring can help to monitor and alleviate SUC distress.Originality/value - The paper extends knowledge about the SUC role, as it has developed and diversified during the development of the DH Community PD Pilot Sites. Novel semi-structured interview schedules have been developed. [ABSTRACT FROM AUTHOR]

Purpose: In this viewpoint article, the authors consider the challenges in implementing restrictive policies, with a particular focus on how these policies are experienced, in practice, from alternative standpoints.Design/methodology/approach: The authors draw on social science studies of decommissioning work to highlight how patient and official versions of value often vary, creating difficulties and distrust as restrictive policies are implemented. Patients and the public are well aware that financial calculations are somehow embedded in concepts of "evidence" and "value" but are usually unfamiliar with the social infrastructures that produce and utilise such concepts. The authors discuss with reference to a contemporary restrictive programme in England.Findings: While policymakers and researchers frequently present restrictive policies as "win-win" scenarios (achieving both cost-savings for healthcare services and improved patient care), social science analyses highlight the potential for tensions and controversies between stakeholders. The authors recognise that cost containment is a necessary component of policymaking work but argue that policymakers and researchers should seek to map (and make visible) the socially organised reasoning, systems and processes that are involved in enacting restrictive policies. Although transparency may pose challenges, it is important for informed democratic engagement, allowing legitimate scrutiny of whose voices are being heard and interests served (the "winners" and "losers").Originality/value: The authors argue for social science analyses that explore overuse, value and restrictive practices from alternative (e.g. patient) standpoints. These can provide important insights to help identify priorities for intervention and support better communication. [ABSTRACT FROM AUTHOR]