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Background: Festivals play an important role in improving death and grief literacy, enabling members of the public to engage with these often-sensitive topics. Good Grief Weston festival was co-designed and delivered with the community in Weston-super-Mare, a coastal town in South-West England with high levels of socioeconomic disadvantage but rich community assets. It was held in person over 8 days in May 2023. Objectives: To evaluate the reach and impact of Good Grief Weston festival and gather data to inform future festivals. Design: Mixed methods evaluation (survey and focus groups). Methods: Online and paper surveys assessing participants' characteristics and experiences were administrated during and after the festival. Survey participants who indicated their willingness to participate were invited to attend a focus group. Focus groups were recorded, transcribed and analysed using thematic analysis. Data were collected by trained community co-researchers. Results: Approximately 3000 people attended the festival. Of 204 completed surveys, 64.5% were from women, age range ⩽15 to ⩾75 years; 88.2% identified as White; 14.9% deaf, disabled/with a chronic condition; 18.9% neurodivergent; 9.0% gay, bisexual or queer. Festival participants were entertained (70.9%), inspired (68.5%), felt part of a like-minded community (54.3%), talked to someone new (49.2%), learnt about grief/bereavement (34.3%), shared or expressed experiences (30.3%) and found out about local support (19.7%). 71.3% reported that they felt more confident talking about grief after attending. Median experience rating was 5 (IQR 0; possible range 1 = poor to 5 = excellent). In free-text comments, participants expressed appreciation for the festival and described benefits in attending. Two focus groups were conducted (n = 8 participants, all women), lasting c.1.5 h. Focus groups added rich descriptions of the festival's value, and data to inform the next festival. Conclusion: Findings suggest festivals of this nature can play a central role in a public health approach. Plain language summary: What was the impact of Good Grief Weston festival? Why was the study done? Previous studies have shown that many people feel unsupported by their community after the death of a loved one. We designed a festival to improve knowledge and support for bereaved people. We did this study to assess how the festival affected the people who attended. What did the researchers do? The team included researchers and people and organisations from the local community. Together, we designed and ran a festival on the topic of death, grief and bereavement in Weston-super-Mare, a coastal town with areas of high deprivation. The festival took place over an eight-day period in May 2023 and included creative, interactive and educational events. The team collected feedback on attendees' experiences of the festival. We did this using online and paper feedback forms, postcards, and focus groups to collect as many opinions as possible. What did the researchers find? We found that a wide range of people attended the festival. Most people who took part in the research rated the festival as 'excellent'. They told us they learnt about grief and bereavement and found out about local support services. Attendees met new people, shared their experiences, and felt that the festival built community spirit. They also made suggestions to improve any future festivals. What do the findings mean? The findings show that in-person festivals can effectively engage the public on the topic of death, grief and bereavement. They can also help develop connections between people and organisations in communities. These connections and learning opportunities may help communities to support their members through bereavement. [ABSTRACT FROM AUTHOR]

Background: Palliative care is insufficiently integrated in the continuum of care for older people. It is unclear to what extent healthcare policy for older people includes elements of palliative care and thus supports its integration. Aim: (1) To develop a reference framework for identifying palliative care contents in policy documents; (2) to determine inclusion of palliative care in public policy documents on healthcare for older people in 13 rapidly ageing countries. Design: Directed documentary analysis of public policy documents (legislation, policies/strategies, guidelines, white papers) on healthcare for older people. Using existing literature, we developed a reference framework and data extraction form assessing 10 criteria of palliative care inclusion. Country experts identified documents and extracted data. Setting: Austria, Belgium, Canada, Czech Republic, England, Japan, Mexico, Netherlands, New Zealand, Singapore, Slovenia, South Korea, Spain. Results: Of 139 identified documents, 50 met inclusion criteria. The most frequently addressed palliative care elements were coordination and continuity of care (12 countries), communication and care planning, care for family, and ethical and legal aspects (11 countries). Documents in 10 countries explicitly mentioned palliative care, nine addressed symptom management, eight mentioned end-of-life care, and five referred to existing palliative care strategies (out of nine that had them). Conclusions: Health care policies for older people need revising to include reference to end-of-life care and dying and ensure linkage to existing national or regional palliative care strategies. The strong policy focus on care coordination and continuity in policies for older people is an opportunity window for palliative care advocacy. [ABSTRACT FROM AUTHOR]

Background: Hospice-at-home aims to enable patients approaching end-of-life to die at home and support their carers. A wide range of different service models exists but synthesised evidence on how best to support family carers to provide sustainable end-of-life care at home is limited. Aim: To explore what works best to promote family carers' experiences of hospice-at-home. Design: Realist evaluation with mixed methods. This paper focuses on qualitative interviews with carers (to gain their perspective and as proxy for patients) and service providers from 12 case study sites in England. Interviews were coded and programme theories were refined by the research team including two public members. Setting/participants: Interviews with carers (involved daily) of patients admitted to hospice-at-home services (n = 58) and hospice-at-home staff (n = 78). Results: Post bereavement, 76.4% of carers thought that they had received as much help and support as they needed and most carers (75.8%) rated the help and support as excellent or outstanding. Of six final programme theories capturing key factors relevant to providing optimum services, those directly relevant to carer experiences were: integration and co-ordination of services; knowledge, skills and ethos of hospice staff; volunteer roles; support directed at the patient–carer dyad. Conclusions: Carers in hospice-at-home services identified care to be of a higher quality than generic community services. Hospice staff were perceived as having 'time to care', communicated well and were comfortable with dying and death. Hands-on care was particularly valued in the period close to death. [ABSTRACT FROM AUTHOR]

This paper presents findings from a study of family literacy provision in England and focuses on the effects of family literacy programmes on the home literacy environment. The fieldwork took place between September 2013 and December 2014 and involved 27 school-based programmes for pupils aged between 5 and 7, and their parents. The study used mixed methods, which involved observations of family literary sessions, a quantitative pre- and post-survey of 118 parents, and pre- and post-telephone qualitative interviews with a sub-sample of 24 parents. Building on previous theoretical work, the study conceptualises the home literacy environment into four areas (family resources; parental literacy behaviours and attitudes; parental beliefs and understandings; and family literacy activities and practices). The paper develops understandings of how parents translate and implement messages from family literacy into the home setting, and it shows how participation in these programmes leads to changes in family literacies across all four areas identified. [ABSTRACT FROM AUTHOR]

This paper presents one aspect of a sociocultural micro-ethnographic study examining how 11- and 12-year-old children formulate meanings when working with an artist in a contemporary art gallery. My primary focus is an examination of methodological contributions emerging from an imaginative coding and analysis of children's art. Ninety-nine artworks were created in collaboration with the artist and were organised and interpreted using a constructionist interviewing coding scheme. This unorthodox approach to visual analysis unearthed information that oral accounts cannot provide alone revealing meanings which would otherwise remain dormant. By intuitively applying the coding framework I expose how participants' meanings are negotiated by appropriating and re-organising cultural concepts into personalised narratives. As such, artworks reveal participants' desires, interpretations and intentions, operating as agentic cultural producers as well as unconsciously reproducing visual epistemologies ubiquitous in Western cultures. [ABSTRACT FROM AUTHOR]

Summary: The social care assessment is a 'key interaction' between a person and the local authority with 'critical' importance for determining a person's needs for care and support. In order to achieve this, the guidance requires that assessments must be 'person-centred throughout'. The concept of person-centred practice is now routinely invoked, but there remains little empirical evidence on how it gets put into practice. Findings: This paper draws on interview data from 30 practitioners about their experiences of conducting social care assessments in England. While there was widespread support for the principles of a person-centred approach, tensions emerged for practitioners in three ways: the way in which 'chat' was used to build a relationship or conduct the assessment, whether to conduct the assessment via a conversation or by following the sections on the agency form and the extent to which the assessor should involve and negotiate the contributions of family members. Applications: We argue that each of these dilemmas represents an occasion when a commitment to person-centred practice is negotiated between professionals and service users and sometimes compromised as a result. We consider the possibilities for and constraints on achieving person-centred assessments in a post-Care Act environment and discuss the implications for social work practice and research. [ABSTRACT FROM AUTHOR]

Social care assessments in England are envisaged as conversations, implying an informal and congenial encounter, in which both parties have equal roles. However, a fundamental task during an assessment is to gauge eligibility for resources. This article uses conversation analysis to consider audio recorded data of seven social care assessments in England. The article focuses on topic shifts, where the assessor introduces an 'assessment relevant' topic, and we examine how these shifts are managed. Sometimes assessors used what was said by the client or by the carer as a 'pivot', which could produce a feeling of friendly conversation, but simultaneously lead to an intrusion into the client's personal knowledge domain. Assessors also had other strategies for framing a 'next question', such as noticing something in the environment, referring to previous notes or to previous conversations. The conversation might feel 'friendly', but these tactics could lead to the personal life domain of the client being inadvertently revealed and used as relevant for their assessment. [ABSTRACT FROM AUTHOR]

Increased emphasis on the child's voice and point of view in care and treatment has led to an expansion in the development of methods to access and identify their perspectives. Drawing on our experiences in a study of children with leukemia in hospital, this article explains the challenges and opportunities that arise in the use of five commonly used methods in a study of hospitalized children's experiences with health care professionals, including the "Draw and Write" technique, a sticker activity, a paper–person exercise, informal interviews, and participant observation. Each of these methods was examined with regard to ease of use, data generation, and utility of data for accessing children's perspectives and development of initial clinical guidance. [ABSTRACT FROM AUTHOR]

This paper discusses the UK’s National Programme for IT (NPfIT), which was an ambitious programme launched in 2002 with an initial budget of some £6.2 billion. It attempted to implement a top-down digitization of healthcare in England’s National Health Service (NHS). The core aim of the NPfIT was to bring the NHS’ use of information technology into the 21st century, through the introduction of an integrated electronic patient record systems, and reforming the way that the NHS uses information, and hence to improve services and the quality of patient care. The initiative was not trusted by doctors and appeared to have no impact on patient safety. The project was marred by resistance due to the inappropriateness of a centralized authority making top-down decisions on behalf of local organizations. The NPfIT was officially dismantled in September 2011. Deemed the world’s largest civil IT programme, its failure and ultimate demise sparked a lot of interest as to the reasons why. This paper summarises the underlying causes that lead to dismantling the NPfIT. At the forefront of those circumstances were the lack of adequate end user engagement, the absence of a phased change management approach, and underestimating the scale of the project. [ABSTRACT FROM AUTHOR]

There is an increasing emphasis on supporting the oral language needs of children in the classroom. A variety of different measures have been developed to assist this process but few have been derived systematically from the available research evidence. A Communication Supporting Classrooms Observation Tool (CsC Observation Tool) for children aged 4–7 years (that is, in Reception and Key Stage 1 classrooms) was devised following a review of the research literature. The evidence derived from 62 research papers was rated based on the studies’ research design following specific rating criteria. Based on the review of the literature and rating of the evidence, three main areas were identified and included as dimensions in the CsC Observation Tool: Language Learning Environment, Language Learning Opportunities and Language Learning Interactions. A feasibility study was carried out in 101 classrooms in 39 schools across 10 local authorities in England. The results suggested that the CsC Observation Tool discriminated well between different age groups within the sample and between different schools. In addition, significant differences were found across the three dimensions of the CsC Observation Tool. For all year groups, scores for the Language Learning Environment dimension were significantly higher than scores for Language Learning Interactions, and scores for the Language Learning Interactions dimension were significantly higher than those for the dimension of Language Learning Opportunities. The study provided evidence for using the CsC Observation Tool in schools to support training and development. The tool has the potential to be used as a key feature in universal intervention studies to promote oral language in the classroom. [ABSTRACT FROM AUTHOR]

Background: Although home non-invasive ventilation for patients with chronic obstructive pulmonary disease and persisting hypercapnia prolongs time to hospital readmission and prognosis, they retain a poor long-term prognosis. Requiring non-invasive ventilation in this population should trigger advance care planning, yet only 50% of patients are engaged in such discussions. Aim: This study aimed to explore the barriers and facilitators to advance care planning for patients with chronic obstructive pulmonary disease on home non-invasive ventilation and generate recommendations for improving practice. Study design: A cross-sectional interview study took place with 10 patients with chronic obstructive pulmonary disease on home non-invasive ventilation and 12 North East Assisted Ventilation Service healthcare professionals from the North East of England. Results: Three themes ('overlooked', 'disjointed care' and 'awareness and expertise') were identified. Patients with chronic obstructive pulmonary disease are a 'forgotten about' population, exacerbated by prejudice and unpredictable disease trajectories. Recognition as a distinct and underserved population may improve care and advance care planning. All participants recognised a lack of care continuity, including limited collaboration and communication between services, as a significant barrier to advanced care planning. Additionally, lacking understanding of the rationale and positive impacts of advance care planning, exacerbated by a lack of expertise in difficult conversations, was a barrier to advance care planning. Conclusions: Patients and healthcare professionals highlighted the need for individualised and ongoing advance care planning, particularly around prognosis and care preferences. Discussions should be initiated by familiar clinicians. Effective communication between services, clear agreements and protocols and upskilling healthcare professionals may ensure continuity of care. [ABSTRACT FROM AUTHOR]

Introduction: Medicines Management Technicians have been shown to be an underused resource in medicines optimisation and medicines waste. In the United Kingdom, there are national recommendations for the clinical pharmacy service in cancer services ambulatory units, despite these recommendations, there was no clinical pharmacy service on the day case unit at a specialist tertiary centre in England. A lot of the patient pathways had been in place for many years and had not progressed with the changes in the clinical pathways. The main objectives of this study were to analyse how a medicines management technician could reduce medicines waste, improve the current pathway, increase medicines optimisation and ultimately improve the patient experience in an oncology day case unit at a specialist tertiary centre in England. Methods: A prospective mixed methods study was carried out at Weston Park Hospital. Descriptive statistical analysis was conducted on the quantitative data collected, and thematic analysis was carried out on the qualitative data collected by questionnaire to staff members and patients. Results: This study has shown that a medicines management technician can complete some of the tasks more traditionally done by the chemotherapy nurses on the day case unit, increasing their capacity for more clinically appropriate tasks. A medicines management technician can work as part of the wider multidisciplinary team on a day case unit contributing to medicines optimisation and cost savings for the oncology directorate. Conclusions: This study has shown that a medicines management technician can act as a valued member of the wider multidisciplinary team, improving communication and patient pathways, improving medicines optimisation and contributing to cost saving initiatives. Further studies are required to assess whether a medicines management technician role can be of the same value on a haematology day case unit. [ABSTRACT FROM AUTHOR]

This study builds on recent research into young children’s pretend play. Social literacy practices and events in which children engaged were investigated to reveal features of their meaning making. Drawing on Vygotsky’s view of the social nature of symbol use and writing, it stresses the significance of cultural and social features of meanings and literacies within children’s play narratives. Data were collected from case studies of seven children aged three to four years in an inner-city maintained nursery school in southwest England, as part of a larger longitudinal ethnographic study. Data comprise written documentation of the children’s play and their visual representations, and the analysis follows an interpretive, social semiotic multimodal paradigm. The findings make a compelling case for greater appreciation of pretence as a potentially valuable context for the enculturation of literacies, highlighting the diversity and richness of children’s spontaneous meaning making and self-chosen literacy events. Informed by cultural and literacy practices of home and nursery, the children’s communications show how meanings and signs are carried across time, space and contexts. Rich and sustained play supported the children’s self-initiated literacies in which they explored a heterogeneous range of textual genres, revealing their developing semiotic understandings and expanding repertoire. [ABSTRACT FROM AUTHOR]

The project aims to develop a safer and more efficient method of general surgery firms handing over their patients to the on-call team, for the planning of weekend ward round reviews and checking blood results. [ABSTRACT FROM AUTHOR]

This article presents an evidence-based analysis of the communicative influences on children's engagement in the Youth Justice System of England and Wales. The multidisciplinary criminologist–linguist 'YOT Talk' project utilized Svalberg's (2009) dimensions of engagement (cognitive, affective, social; augmented by behavioural) to explore the enablers of, and barriers to, children's engagement with youth justice assessment processes. A tripartite mixed methodology of observation of assessment interviews, questionnaires with children in the Youth Justice System and youth justice practitioners, and focus groups with practitioners was implemented across three Youth Offending Teams in England and Wales. Analyses synergized methods from conversation analysis and corpus linguistics. Findings inform recommendations for refocusing youth justice assessment and staff training on facilitating children's communicative engagement (that is, enhancing enablers and removing/minimizing barriers). These findings and recommendations challenge asymmetrical (adult-centric) power dynamics during assessment interviews and challenge perceptions of children's communicative deficits as irreconcilable barriers to effective assessment. [ABSTRACT FROM AUTHOR]

Background: Families and professionals caring for children with life-limiting conditions face difficult healthcare decisions. Shared decision-making is promoted in many countries, however little is known about factors influencing these processes. Aim: To explore the communication strategies used in shared decision-making for children with life-limiting conditions. Design: A longitudinal, qualitative, multiple-case study. Cases were centred around the child and parent/carer(s). Most cases also included professionals or extended family members. Data from interviews, observations and medical notes were re-storied for each case into a narrative case summary. These were subject to comparative thematic analysis using NVivo11. Setting/participants: Eleven cases recruited from three tertiary hospitals in England. 23 participants were interviewed (46 interviews). Cases were followed for up to 12 months between December 2015 and January 2017. 72 observations were conducted and the medical notes of nine children reviewed. Findings: Strategies present during shared decision-making were underpinned by moral work. Professionals presented options they believed were in the child's best interests, emphasising their preference. Options were often presented in advance of being necessary to prevent harm, therefore professionals permitted delay to treatment. Persuasion was utilised over time when professionals felt the treatment was becoming more urgent and when families felt it would not promote the child's psychosocial wellbeing. Conclusions: Communication strategies in shared decision-making are underpinned by moral work. Professionals should be aware of the models of shared decision-making which include such communication strategies. Open discussions regarding individuals' moral reasoning may assist the process of shared decision-making. [ABSTRACT FROM AUTHOR]

While matter clearly matters to organization theory, its absence from the study of organizational ethics is striking. Despite the obdurate materiality of the workplace, critical scholarship on organizations and morality sees ethics as interpersonal, subjective and embodied. Organizations, meanwhile, are characterized by moral anomie and dysfunction. This article advances our understanding of the material entanglements of organizational morality, drawing on the science and technology studies inflected study of markets to show how moral orders arise in dialectic between the social and the material. It argues that moral orders are entangled in the material infrastructures of organizations. Its empirical case is the founding and development of a small-company focused stock exchange, OFEX, launched in London in 1995, accessed through elite interviews and documentary work. The article seeks to develop our understanding of morality in critical organization studies, to further defend the Weberian notion of 'ethics of office' by emphasizing the sociomaterial dimension of organizational morality, and to contribute to an ongoing renaissance of the study of morality as a sociological phenomenon. There are implications for managers and engaged scholars alike. [ABSTRACT FROM AUTHOR]

This paper was originally read to an Open Meeting of the Department of Psychotherapy in Cambridge in 1991. It draws on experiences in working with groups and organizations to reflect on and illustrate aspects of mental process, which relate to the realization and communication of thoughts. [ABSTRACT FROM AUTHOR]

Touch and silence are neglected across most disciplines, including within child-specific academic literature, and their interconnections have not been studied before. This article focuses on touch/silence convergences in residential childcare in England, drawing from two qualitative studies. We reveal the fluidity, multidimensionality and intersectionality of touch and silence, illuminating the labyrinthine ways they frequently coalesce in children's homes, often assuming ambiguous forms and meanings. We therefore offer new understandings of these concepts, as multifaceted, entwined, temporal and malleable. [ABSTRACT FROM AUTHOR]

Agile working (flexibility about where and when practitioners do their work) is increasingly common across public sector social work, but there has been little research about how practitioners engage with it or its impacts on communication between social workers, their colleagues and the families with whom they work. This article presents findings from an ethnographic study of a children's safeguarding social work team in an English local authority who were engaged in agile working. It draws on data from observations, local authority documents, semi-structured interviews, participant research diaries, participants' photographs and the researcher's photographs taken during fieldwork. An analytical frame drawing on Henri Lefebvre's concept of spatial dialectics and Wanda Orlikowski's concept of sociomateriality is used to identify how agile working involves entanglements of practitioners and families with restructured office spaces, digital information systems and mobile devices such as convertible laptop–tablet computers and mobile phones. Innovations such as these are commonly understood as promoting more effective and transparent social work practice, but the study's data show that entanglements between workspaces, digital devices and people in practice are having multiple effects, producing new hierarchies of belonging in space, shaping what can be communicated, and the ways it can be presented and received. The article argues for critical attention to the role of material space in digital and place-based innovations in social work practice. [ABSTRACT FROM AUTHOR]

This article acts as a reflexive account of my experience of doing qualitative research with d/Deaf people in a prison setting. This research was the first in England and Wales (excluding small-scale unpublished undergraduate dissertations) to include semi-structured interviews with multiple d/Deaf prisoners, and thus the journey documented is both innovative and unique. Because I was entering unmarked territory methodologically, my experience was laden with obstacles, as is discussed throughout. Key issues explored relate first to the process of gaining access to d/Deaf prisoners, second to researcher–participant language barriers, and third to issues of ethics and authenticity generated by the Deaf participants' preference for a visual language (British Sign Language) in a setting like prison. Guidance is given throughout about how to overcome complex methodological issues, and concluding remarks include a set of recommendations for prospective researchers. [ABSTRACT FROM AUTHOR]

Background: At a medium-sized district general hospital in the heart of England, it was identified that compliance to the administration of topical prophylaxis on three general surgery wards had reduced to 23%, following implementation of an electronic medication prescription record. Therefore, a quality improvement project was commenced to improve this compliance to protect patients from meticillin-resistant Staphylococcus aureus (MRSA) colonisation and associated bacteraemia. Aim: To improve compliance of topical prophylaxis administration on three surgical wards to protect patients from infection. Method: Quality improvement plan – do – study – act (PDSA) cycles evaluated the effectiveness of four different strategies from baseline data which was 23% compliant in December 2016. These included teaching and communication strategies, prompts in medical notes, discontinuation of Mupirocin 2% nasal ointment as part of the topical prophylaxis regime and discontinuation of the topical wash lotion from requiring a prescription. Results: The compliance of prophylaxis administration increased consistently throughout from 23% in December 2016 to 92% in March 2018. Consequently, the number of patients that developed a MRSA colonisation on the three wards reduced by 54%, from 13 in the 12 months before the study to six in the 12 months after the study. Discussion: This study led to a change in the Trust MRSA Policy to better protect patients from infection, particularly surgical site infection and MRSA bacteraemia. It suggests that quality improvement methodology has a place in infection prevention practice. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced chronic obstructive pulmonary disease have difficulty reporting their holistic support needs to health care professionals, undermining delivery of person-centred care. We lack tools that directly support patients with this. Aim: To develop an evidence-based, designed-for-purpose, tool to enable patients to directly identify and express support needs to health care professionals. Design: Two-stage qualitative study. Stage 1: domains of support need were identified through a systematic review, analysis of an established qualitative dataset and patient/carer focus groups. Stage 2: draft tool developed using the identified domains of need and then refined through feedback from patients, carers and health care professionals, ensuring acceptability and suitability. Setting/participants: Stage 1 patients/carers recruited via four primary care practices and two patient support groups (East of England). Stage 2 health care professionals recruited via the Clinical Research Network and local community trust and patients/carers through two further practices and two additional support groups (East of England). In total, 57 patients, carers and health care professionals participated. Results: A comprehensive set of evidence-based support domains (for example: overcoming boredom or loneliness, knowing what to expect in the future) was identified and formulated into questions. The resulting tool asks patients to consider whether they need more support in 15 broad areas. Patients, carers and clinical stakeholders broadly endorsed the tool's content and wording. Conclusion: The Support Needs Approach for Patients (SNAP) tool is a concise evidence-based tool designed to help patients with advanced chronic obstructive pulmonary disease identify and express their support needs to enable delivery of person-centred care. [ABSTRACT FROM AUTHOR]

In this article we describe and critique a methodological exercise that brings together multimodality, ethnography and walking in order to investigate the city. Drawing on the experience of enacting our methodology in central London, we describe how an openness to the full range of meaning-making phenomena encountered during an unscripted excursion through the city provided ways of thinking critically about our relationship with the city. This research is undertaken against a backdrop of a growing critical interest in the complex and shifting nature of the urban environment, reflected in the range of approaches that investigate how we understand and experience our surroundings. Central to this methodological approach is the intersection of ethnography and multimodality which, when brought together within the device of an unscripted walk, provides valuable opportunities for thinking critically about our surroundings. [ABSTRACT FROM AUTHOR]

This article explores a 'hybridized approach' to multimodal research drawing on video data of classroom communication involving children diagnosed with Autism Spectrum Disorder. The focus is a short video of 'Luke', aged six, who at snack time declines to request an available food item (carrot, tomato or apple) with the available Picture Exchange Communication System (PECS); instead deploying embodied, idiosyncratic communication including gaze, vocalisation and object manipulation to request raisins. The article explores the potential of a hybridized approach for understanding Luke's communicative competencies which draws upon the theoretical perspectives of Ethnography of Communication, Conversation Analysis and Multimodal (Inter)Action Analysis; and uses two forms of multimodal transcription (the multimodal matrix and annotated video stills). It is argued that each tradition brings distinct affordances to our understanding of this short interaction and that together they can permit inferences which would not have been possible working with one approach alone. [ABSTRACT FROM AUTHOR]

This article presents an innovative project to develop and trial a prototype product called ‘trove’ to start to address challenges identified regarding current practice of life story work with children who are looked after and adopted. trove is a digitally enhanced memory box that utilises raspberry pi (a small single board computer) and radio-frequency identification (RFID) technologies to enable children to record their memories and to attach these to their precious objects using an electronic tag: providing a safe ‘container’ for their mementoes and memories. Located in theories of narrative identity and object attachment and drawing on Brodinsky’s concept of communicative openness, we describe the children’s engagements in the design and report the results of a small trial of 10 troves with adopted children in England. [ABSTRACT FROM AUTHOR]

The article discusses the CoramBAAF Health Group conference that was held in Birmingham, Great Britain in 2018. Topics discussed include recognition of individuality among looked after children (LAC); paediatric services for post permanence, health and development of children entering care, supporting positive sexual health and views of Ellie Johnson of CoramBAAF on health needs of LAC.

Felt or enacted criticism was identified as a significant influence on White British parents' decision making during acute childhood illness in a substantive grounded theory "Containing acute childhood illness within family life." These parents sought to avoid further criticism, sometimes leading to delayed consultation. Using Glaserian grounded theory principles, we conducted a secondary analysis of data from three studies, to establish the transferability and modifiability of the original theory to other settings and communities in Ireland and England. Felt or enacted criticism was found to operate across the childhood age range, social groups, and settings. Parent's strategies to avoid criticism reduced contacts with health professionals, access to support and, more worryingly, communication about their child's health. These findings demonstrate the wider applicability, or "work" in Glaser's terms, of the concept in the English speaking Western world. Findings indicate the need for nurses to identify and mitigate sources of criticism. [ABSTRACT FROM AUTHOR]

Objective: To identify why the National Clinical Guideline recommendation of 45 minutes of each appropriate therapy daily is not met in many English stroke units. Design: Mixed-methods case-study evaluation, including modified process mapping, non-participant observations of service organisation and therapy delivery, documentary analysis and semi-structured interviews. Setting: Eight stroke units in four English regions. Subjects: Seventy-seven patients with stroke, 53 carers and 197 stroke unit staff were observed; 49 patients, 50 carers and 131 staff participants were interviewed. Results: Over 1000 hours of non-participant observations and 433 patient-specific therapy observations were undertaken. The most significant factor influencing amount and frequency of therapy provided was the time therapists routinely spent, individually and collectively, in information exchange. Patient factors, including fatigue and tolerance influenced therapists' decisions about frequency and intensity, typically resulting in adaptation of therapy rather than no provision. Limited use of individual patient therapy timetables was evident. Therapist staffing levels were associated with differences in therapy provision but were not the main determinant of intensity and frequency. Few therapists demonstrated understanding of the evidence underpinning recommendations for increased therapy frequency and intensity. Units delivering more therapy had undertaken patient-focused reorganisation of therapists' working practices, enabling them to provide therapy consistent with guideline recommendations. Conclusion: Time spent in information exchange impacted on therapy provision in stroke units. Reorganisation of therapists' work improved alignment with guidelines. [ABSTRACT FROM AUTHOR]

This article considers the implications of children's out-of-school musical experiences and activities for conceptualisations of child agency. In particular, it engages with differing approaches to relational agency and considers their value for understanding music-related practice during middle childhood. Accounts from children (n = 111) living in three parts of England are explored, and the subsequent analysis provides the basis for proposing the potential of an interactional-relational approach for approaching questions about children's agency within such domains of practice and beyond. [ABSTRACT FROM AUTHOR]

This small-scale qualitative study explores how children participate in their own child protection/child in need planning within a statutory setting in England. Their experience of participation and the impact that voicing their wishes and feelings had on outcomes are highlighted and discussed against a background of conflicting discourses of statutory safeguarding and empowering participation, barriers to engagement and hearing the child’s voice. [ABSTRACT FROM AUTHOR]

Outcomes for individuals with psychosis remain far from acceptable. Recently, prominent psychiatrists have called for an improved understanding of the impact of social contexts, and how social contexts might influence the development and maintenance of mental health problems. A key social context for individuals with psychosis is the therapeutic relationship. As part of a trial of joint crisis planning in England, this qualitative study aimed to determine the mechanism through which joint crisis planning might affect the therapeutic relationship. Results suggest that routine processes in mental health care are affected by policy and organizational requirements for risk mitigation—aspects that undermine person-centered approaches. In contrast, strong therapeutic relationships are characterized by individualized care and reliable and respectful treatment. The Joint Crisis Plan intervention partially succeeded in reducing contextual influences on routine role enactments, facilitating the demonstration of respect and improving the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Background: Clinical uncertainty is emotionally challenging for patients and carers and creates additional pressures for those clinicians in acute hospitals. The AMBER care bundle was designed to improve care for patients identified as clinically unstable, deteriorating, with limited reversibility and at risk of dying in the next 1–2 months. Aim: To examine the experience of care supported by the AMBER care bundle compared to standard care in the context of clinical uncertainty, deterioration and limited reversibility. Design: A comparative observational mixed-methods study using semi-structured qualitative interviews and a followback survey. Setting/participants: Three large London acute tertiary National Health Service hospitals. Nineteen interviews with 23 patients and carers (10 supported by AMBER care bundle and 9 standard care). Surveys completed by next of kin of 95 deceased patients (59 AMBER care bundle and 36 standard care). Results: The AMBER care bundle was associated with increased frequency of discussions about prognosis between clinicians and patients (χ2 = 4.09, p = 0.04), higher awareness of their prognosis by patients (χ2 = 4.29, p = 0.04) and lower clarity in the information received about their condition (χ2 = 6.26, p = 0.04). Although the consistency and quality of communication were not different between the two groups, those supported by the AMBER care bundle described more unresolved concerns about caring for someone at home. Conclusion: Awareness of prognosis appears to be higher among patients supported by the AMBER care bundle, but in this small study this was not translated into higher quality communication, and information was judged less easy to understand. Adequately powered comparative evaluation is urgently needed. [ABSTRACT FROM AUTHOR]

Little is known about separated asylum seeking young people in foster care. This article addresses this gap by drawing together findings from qualitative research conducted with separated refugee and asylum seeking young people in two studies – one in England and one in Ireland. Focusing on the role of culture, the authors examine similar findings from the two studies on the significance of culture in young people’s experiences of foster care. Culturally ‘matched’ placements are often assumed to provide continuity in relation to cultural identity. This article draws on young people’s accounts of ‘matched’ and ‘non-matched’ placements to examine the extent to which this may be the case for separated young people. It was found that young people regarded it as important to maintain continuity in relation to their cultures of origin, but that cultural ‘matching’ with foster carers according to country of origin and/or religion was not the only means for achieving this. The authors suggest that practitioners need to adopt an individualised approach in determining whether a ‘matched’ or a cross-cultural placement best meets the various needs of separated young people, including their identity development needs. [ABSTRACT FROM PUBLISHER]

Not enough is known about parents' experiences of receiving the news that their child warrants a diagnosis of Autism Spectrum Disorder (ASD). Sharing this information with parents is an important and difficult part of Child and Adolescent Mental Health (CAMH) practice. Qualitative methodology was used to explore the experiences of the 'feedback session' with nine sets of parents in a community Child and Adolescent Mental Health Service (CAMHS) in North East England. Parents gave vivid accounts of their experiences and described issues relating to the structure, style and content of the session. The experiences of CAMHS users should inform the development of good practice in this important area. [ABSTRACT FROM AUTHOR]

The article discusses development of a model for breaking bad news to people with intellectual disabilities(IDs). The findings based on survey feedback for preliminary model was collected from 60 out of 109 participants including people with IDs, family carers, ID professionals, general health professionals and other stakeholders recommends to consider aspects of capacity, people and support to derive robust outcome measures for developing new model for breaking bad news to people with ID.

The Achievement for All (AfA) pilot initiative, delivered in partnership by the Department for Education (DfE), (formerly the Department for Children, Schools and Families [DCSF]), National Strategies and the National College (NCSL), aims to increase the attainment and progress of children in schools with special educational needs and disabilities (SEND); improve the engagement of their parents with the school and improve wider outcomes for this group of children. Introduced in September 2009 as a two year pilot in 454 primary, secondary and special schools and Pupil Referral Units across 10 Local Authorities in England, AfA, with a particular focus on inclusive leadership practice, takes a whole school approach to school improvement. The population included pupils in Years 1, 2, 5, 6, 7, 8, 10 and 11 identified with SEND on School Action, School Action Plus or holding Statements; 85 per cent of the participating schools are primary. Guided by government documentation (DCSF, 2009a) and local authority advisers, schools have implemented the initiative around three distinct but integrated strands: assessment, tracking and interventions; structured conversations with parents and provision for developing wider outcomes. By considering focus group data evidence from headteachers/school project leaders across the participating local authorities, this article will explore the impact of AfA on inclusive leadership practices in schools. Findings suggest that although vision, commitment, collaboration and communication remain self evident for the majority of leaders, within the context of AfA, these characteristics of effective inclusive leadership along with pupil learning have been enhanced. [ABSTRACT FROM PUBLISHER]

English government policy advocates providing greater choice-making opportunities for service users and their families. However, there is a gap in our knowledge about the role family, especially parents, and also friends play in the choice-making processes of disabled young people. Drawing on data from an English longitudinal study, this article begins to address this gap by exploring disabled young people's shared choice-making with parents and peers. Using qualitative data from 27 interviews with disabled young people with degenerative conditions, it demonstrates that young people want to participate in making choices about their own lives but choices are often made with other people, especially parents and peers. Processes of choice-making are diverse. Parents and/or peers are involved at different stages and in varying degrees with young people depending on personal circumstances. For example, circumstances such as young people's age and experience and the type of choice and its perceived seriousness. Recognizing this complexity and the importance of a holistic approach to choice-making, the article concludes with some practice suggestions. [ABSTRACT FROM AUTHOR]

Objectives: A number of evidence-based interventions are now available for stroke patients. Good-quality stroke care involves a range of health professionals located across ambulance, hospital, community and primary care services. This study examined the perspectives of health-care workers involved in stroke care in Sweden and England on the integration challenges stroke care presents. Methods: Four qualitative case studies were carried out in Sweden and England, including 95 semistructured interviews with clinicians and managers associated with four different hospitals providing specialized stroke services. Findings: High levels of organizational, functional, service and clinical integration among clinicians that deliver emergency and acute stroke care were identified. This is frequently lacking among professionals delivering postacute care. These findings are linked to the prevalence or lack of normative and systemic integration in each respective stage of care. Conclusions: Emphasis on the need to treat stroke as an emergency condition in both countries has created a context in which normative and systemic integration often occurs among clinicians that deliver emergency and acute stroke care, aiding the development of organizational, functional, service and clinical integration across the case study sites. In contrast, integration between hospital and community (rehabilitation and general practice) care is frequently less successful. [ABSTRACT FROM AUTHOR]

Increasing emphasis is being placed on the need for advanced care planning (ACP) at the end of life. The Preferred Priorities for Care (PPC) document is a patient-held record promoted by the End of Life Care Strategy as an ACP tool to promote discussion and communication amongst patients, family and health care providers. However, little research exists into evaluating its effectiveness or exploring patient and carer views, particularly in non-malignant disease. Because the majority of patients with Motor Neurone Disease (MND) lose verbal communication, early discussion of patients’ wishes and preferences, a central aspect of ACP, is vital. This study examined MND patients’ bereaved relatives’ experiences of using the PPC document and their perceptions about its impact on end-of-life care using qualitative methods. Key findings adding to existing literature were that the PPC document was felt to have little impact on end-of-life care amongst this patient group and that there was a perceived lack of awareness of the document amongst health care professionals (HCPs), in particular hospital staff. This was felt to limit the effectiveness of the document. This has obvious implications for practice, looking at awareness amongst HCPs and ways to improve this situation, particularly in light of the current pressures to meet patient preferences at the end of life. [ABSTRACT FROM PUBLISHER]

The aim of the current study was to document the peer interaction patterns of students with autistic spectrum disorders in mainstream settings. Structured observations of a group of 38 adolescents with ASD drawn from 12 mainstream secondary schools were conducted over a two-day period and data compared with those of school, age, and gender matched comparison groups of 35 adolescents with dyslexia and 38 with no identified special educational needs (the ASD and dyslexia groups were also matched on SEN provision). Frequency and duration of peer interaction behaviours were coded. In terms of duration, multivariate analyses of variance (MANOVAs) indicated that participants with ASD spent more time engaged in solitary behaviours, less time engaged in co-operative interaction with peers, and more time engaging in reactive aggression towards peers than either comparison group. In terms of frequency, similar patterns emerged, but additionally participants with ASD engaged in fewer instances of rough/vigorous play, and were subject to more instances of social initiation and instrumental verbal aggression by peers than either comparison group. The findings of the current study support the authors’ theoretical model of peer group interaction processes for individuals with ASD, and have implications for both social skills training and the development of peer awareness and sensitivity. Limitations are noted. [ABSTRACT FROM PUBLISHER]

The aims of this qualitative study were to identify patients' and family members' experiences of acute stroke and their preferences for end-of-life care. Twenty-eight purposely sampled patients with an acute stroke who had high (n=13) and low (n=15) disability were selected from 191 sequential cases admitted to two general hospitals in north-east England. In addition, 25 family members of other stroke patients were recruited. Views about current stroke services and preferences for end-of-life care were elicited in semi-structured interviews. Communication between patients and family members and healthcare professionals was consistently highlighted as central to a positive experience of stroke care. Honesty and clarity of information was required, even where prognoses were bleak or uncertain. Patients and family members appeared to attach as much importance to the style of communication as to the substance of the transfer of information. Where decisions had been made to shift the focus of care from active to more passive support, families, and where possible patients, still wished to be included in ongoing dialogue with professionals. Where patients were thought to be dying, family members were keen to ensure that the death was peaceful and dignified. Families reported few opportunities for engagement in any form of choice over place or style of end-of-life care. No family member reported being offered the possibility of the patient dying at home. Uncertainty about prognosis is inevitable in clinical practice, and this can be difficult for patients and families. Our findings demonstrate the importance of improving communication between patient, family and health professionals for seriously ill patients with stroke in UK hospitals. [ABSTRACT FROM AUTHOR]

This article explores a series of 27 jury deliberations, undertaken by volunteer members of the public, following their observation of a mini-rape trial reconstruction. While research with 'real' jurors is prohibited in England and Wales, previous social attitude and experimental studies have suggested that jurors in sexual assault trials may well be influenced by dubious stereotypes about rape, rapists and rape victims. In this article, the authors explore the relationship between these (mis)conceptions about rape and public expectations regarding socio-sexual conduct more broadly. The authors examine the scripts that were invoked, defended and relied upon by mock jurors in order to distinguish 'normal' (hetero)sexual seduction from rape. More specifically, this article explores participants' expectations (both descriptive and normative) in relation to the communication of consent, the role of male initiative, and the location, timing of and parties to sexual intercourse, as well as the relevance of the use of physical force, the fact of the parties' drunkenness or the nature of their respective post-coital conduct. [ABSTRACT FROM AUTHOR]