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Background: Spoken discourse impairments post‐traumatic brain injury (TBI) are well‐documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech–language pathologist (SLP) is recommended for adults with discourse impairments post‐TBI, with an emphasis on context‐sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice. Aims: To explore the under‐researched area of clinical practice for spoken discourse interventions with adults post‐TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base. Methods & Procedures: Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi‐structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach. Outcomes & Results: :Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight‐building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client‐specific factors and rationales prioritized tailored, context‐sensitive and goal‐directed treatment. Conclusions & Implications: This study provided insight into a previously under‐researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post‐TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post‐TBI, from initial assessment to outcome measurement, may help inform clinical decision‐making and the transfer of research to practice. WHAT THIS PAPER ADDS: What is already known on the subject: Spoken discourse impairments occur in dialogic and monologic productions post‐TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision‐making for discourse interventions post‐TBI are limited. What this paper adds to existing knowledge: This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post‐TBI. It details the factors that influence clinical decision‐making for this caseload and identifies an emphasis on client priorities and the value of clinician experience. What are the potential or actual clinical implications of this work?: This study identifies the broad and complex considerations required to deliver context‐sensitive discourse intervention post‐TBI. It indicates the need for an in‐depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing clinical knowledge and resources within and across the profession to support all levels of clinician experience. [ABSTRACT FROM AUTHOR]

Women with intellectual disability (ID) are surviving to the age group at greatest risk of developing breast cancer (50-69 years). These women are more likely to experience a greater number of risk factors placing them at an advanced threat of developing breast cancer. However, as a result of cognitive deficits and communication difficulties these women are dependent upon staff to support them to attend the breast screening clinics. The aim of this paper was to examine how community nurses and residential staff support women with ID to access breast screening services. Six focus groups were held with community nurses and residential staff who work in the field of ID in one region of the UK. The focus groups were tape recorded and the transcriptions were subjected to a thematic content analysis. Although many of the participants recognised the risk factors and signs/symptoms of breast cancer, there was still a deficit of knowledge. Both positive and negative experiences of women with ID attending for breast screening were reported; however, greater discussion focused on the latter. The participants identified 'a lack of health educational material' and also negative 'emotions, attitudes and physical barriers' as inhibiting factors for attendance. This paper highlights the need for developing a health promotion programme for women with ID focusing on breast awareness and information on screening, and also healthier lifestyles. Breast awareness via visual checks was identified for women with ID who refused to attend the breast clinics; however, issues of informed 'consent' and 'vulnerability' were raised for staff and also family carers having to undertake these checks. Development of user-friendly health educational literature using 'pictures, symbols, signs' and simplified words should be accessible to all ID staff, healthcare staff, and also women with ID. [ABSTRACT FROM AUTHOR]

Most perinatal research relating to COVID‐19 focuses on its negative impact on maternal and parental mental health. Currently, there are limited data on how to optimise positive health during the pandemic. We aimed to bridge this knowledge gap by exploring how women have adapted to becoming a new parent during the pandemic and to identify elements of resilience and growth within their narratives. Mothers of infants under the age of 4 months were recruited as part of a wider UK mixed‐methods study. Semi‐structured interviews with 20 mothers elicited data about how COVID‐19 had influenced their transition to parent a new infant, and if and how they adapted during the pandemic, what strategies they used, and if and how these had been effective. Directed qualitative content analysis was undertaken, and pre‐existing theoretical frameworks of resilience and post‐traumatic growth (PTG) were used to analyse and interpret the data set. The findings show evidence of a range of resilience and PTG concepts experienced during the pandemic in this cohort. Salient resilience themes included personal (active coping, reflective functioning, and meaning‐making), relational (social support, partner relationships, and family relationships), and contextual (health and social connectedness) factors. There was also evidence of PTG in terms of the potential for new work‐related and leisure opportunities, and women developing wider and more meaningful connections with others. Although further research is needed, and with individuals from diverse socioeconomic backgrounds, these findings emphasise the significance of social support and connectivity as vital to positive mental health. Opportunities to increase digital innovations to connect and support new parents should be maximised to buffer the negative impacts of further social distancing and crisis situations. [ABSTRACT FROM AUTHOR]

Background: Young women's attendance at cervical screening in the UK is continuing to fall, and the incidence of invasive cervical cancer is rising. Objectives: We assessed the preferences of non‐attending young women for alternative ways of delivering cervical screening. Design: Postal discrete choice experiment (DCE) conducted during the STRATEGIC study of interventions for increasing cervical screening uptake. Attributes included action required to arrange a test, location of the test, availability of a nurse navigator and cost to the National Health Service. Setting and participants: Non‐attending young women in two UK regions. Main outcome measures: Responses were analysed using a mixed multinomial logit model. A predictive analysis identified the most preferable strategy compared to current screening. Preferences from the DCE were compared with observed behaviours during the STRATEGIC trial. Results: The DCE response rate was 5.5% (222/4000), and 94% of respondents agreed screening is important. Preference heterogeneity existed around attributes with strong evidence for test location. Relative to current screening, unsolicited self‐sampling kits for home use appeared most preferable. The STRATEGIC trial showed this same intervention to be most effective although many women who received it and were screened, attended for conventional cytology instead. Conclusions: The DCE and trial identified the unsolicited self‐sampling kit as the most preferred/effective intervention. The DCE suggested that the decision of some women receiving the kit in the trial to attend for conventional cytology may be due to anxieties around home testing coupled with a knowledge that ignoring the kit could potentially have life‐changing consequences. [ABSTRACT FROM AUTHOR]

Survivors of clerical institutional childhood abuse (ICA) experience poor mental health outcomes in adulthood. Resilience research with this group has focused on psychological adjustment and we know less about the factors across the social ecology that support positive adaptation, including the impact of migration. This study explores the influence of resilience‐enhancing factors across the social ecology on the mental wellbeing (MWB) of Irish emigrant survivors of ICA and how this compares with non‐migrant survivors. Fifty‐six survivors based in the UK and 46 based in Ireland completed a quantitative survey that assessed resilience‐potentiating resources and associations with MWB. A further nine participants, resident in the UK, engaged in a structured interview which aimed to further explain these quantitative data. Results indicate more resilience‐enhancing resources across the ecology of emigrant survivors of ICA. Personal skills and competencies, such as problem‐focused coping, altruism and defiance, and social inclusion were associated with MWB regardless of country of residence. For the migrant group, social identity not defined by institutional care facilitated social inclusion. Migration to the UK and informal instrumental support in the aftermath of institutional care were identified as key turning points towards resilience. Key Practitioner Messages: Multiple factors across the ecology influence the resilience of survivors of institutional childhood abuse (ICA).Resilience strategies for survivors of ICA are contextual and may appear maladaptive to practitioners unfamiliar with the cultural context of this abuse.For Irish emigrant survivors of ICA, problem‐focused coping, defiance, altruism, social inclusion, instrumental support and a social identity not defined by childhood abuse enhanced resilience.Resilience is dynamic and emerges over time for adult survivors of chronic childhood abuse. 'Explores the influence of resilience‐enhancing factors across the social ecology on the mental wellbeing... of Irish emigrant survivors of institutional childhood abuse' [ABSTRACT FROM AUTHOR]

Background Patients with tracheostomy tubes are at risk of aspiration and swallowing problems (dysphagia), and because of their medical acuity, complications in this patient population can be severe. It is well recognized that swallow screening in stroke significantly reduces potential complications by allowing early identification and appropriate management of patients at risk (by health professionals), thereby reducing delays in commencing oral intake and preventing unnecessary, costly interventions by speech and language therapists (SLTs). However, there is no standardized swallow screen for the tracheostomised population and there is a paucity of literature regarding either current or best practice in this area. Aims To investigate current UK practice for dysphagia screening in adult patients with tracheostomy tubes and to explore and describe health professionals' perceptions of their current practice or current systems used. Methods & Procedures A mixed-methods approach was adopted comprising a semi-structured online questionnaire and recorded follow-up telephone interviews. Participants were SLTs, nurses and physiotherapists working with patients with tracheostomies. Responses were analysed to determine current practice with regard to swallow screening. Thematic analysis of interviews allowed further exploration and clarification of the questionnaire findings. Outcomes & Results A total of 221 questionnaires were completed. Approximately half (45%) the participants worked in trusts with formal swallow screens, whilst the remainder used a variety of other approaches to identify patients at risk, often relying on informal links with multidisciplinary teams (MDT). In line with current evidence, patients with neurological diagnoses and a tracheostomy were consistently referred directly to speech and language therapy (SLT). Only one-quarter of questionnaire participants thought their current system was effective at identifying patients at risk of swallowing problems. Eleven questionnaire participants were interviewed. They highlighted the important role of MDT team working here, emphasizing both its strengths and weaknesses when working with these patients. Conclusions & Implications Current practice in the UK for screening patients with a tracheostomy for swallow problems is varied and often suboptimal. Despite the evidence for enhancing outcomes, MDT working is still perceived as problematic. A swallow screening tool for use with this population, to enhance MDT working whilst also ensuring that practice fits in line with current evidence, may improve patient safety and care. [ABSTRACT FROM AUTHOR]

Background Reflective practice groups have been recommended for improving staff wellbeing and team functioning in inpatient psychiatric services, and clinical psychologists have been identified as potential leaders in this type of work. Research is limited with little information about reflective practice group guidelines, prevalence and effectiveness. Aims The aims of this study were to describe clinical psychologists' practice in reflective groups for staff in inpatient psychiatric services and to explore how such groups are conceptualized and implemented. Methods Online questionnaires and follow-up interviews were used to gain broad descriptions of practice and in-depth information about participants' experiences. The sample consisted of 73 clinical psychologists working in the UK, six of whom were interviewed. Data were analysed using descriptive statistics, content analysis and thematic analysis. Results Clinical psychologists regularly facilitate reflective staff groups in inpatient psychiatric settings in the UK. Common outcomes related to staff wellbeing, service culture and teamwork. Engagement, group dynamics and lack of management support were common challenges. Group experiences were influenced by the organizational context. Conclusions Clinical psychologists' practices regarding reflective staff groups were in line with recent professional developments. Several difficulties were described, which may be indicative of both a difficulty inherent to the task and a training gap in reflective staff group process. The study had methodological limitations but offers a useful contribution to the literature, and enables practice and training implications to be drawn. The need for further research exploring facilitator characteristics, views of group participants and the impact of reflective staff groups on patients is indicated. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The term 'reflective practice group' encompasses a range of practices, but a typical group structure was found with common aims, outcomes and challenges., Reflective staff groups are regularly facilitated by clinical psychologists in inpatient psychiatric settings in the UK and are influenced by practitioner experience as well as psychodynamic, systemic and group process theories., The safety required for reflective groups to function is influenced by the organizational context, and groups can contribute to shifts in culture toward including psychosocial perspectives., Reflective staff groups represent one type of contribution to an inpatient psychiatric service and team relationships; other processes to encourage alternative professional perspectives and values might also support change., More research is recommended to explore facilitator characteristics, the views of staff teams on reflective staff groups and the impact of these groups on patients. [ABSTRACT FROM AUTHOR]

Current UK Department of Health guidelines recommend that infants are introduced to complementary foods at around 6 months of age. Intake of complementary foods should be gradual, should incorporate a range of tastes and should be based around family foods. The infant should be 'developmentally ready', able to sit up, grasp objects and chew. Introduction to complementary foods in the UK is typically via purée and spoon-feeding although an alternative approach is growing in popularity. The baby-led weaning approach advocates bypassing purées and allowing infants to self-feed foods in their solid form from the start of weaning. Research surrounding this method is sparse, and it is not advocated in Department of Health literature but understanding, if not advocacy of the method, is needed for health professionals faced with questions from parents. Here, 36 mothers of an infant aged 12-18 months who followed baby-led weaning completed a semi-structured interview examining their attitudes, beliefs and behaviours towards the approach. Key themes included following infant cues of readiness, hunger and satiety, exposure to textures and tastes and experiences, both positive and negative of following the method. The findings are considered in relation to Department of Health weaning guidelines and literature pertaining to the development of eating styles and weight gain in young children. Overall, the study offers an insight into this emerging method for child health practitioners raising questions as to the use or potential adaptation of key principles of the methods. [ABSTRACT FROM AUTHOR]

Background: Representatives of counselling and person‐centred organisations indicate many of their members feel their profession and orientation is under threat, with counselling services being decommissioned in NHS settings. Aims: To understand the views of key figures in the psychological therapies field (policy makers, researchers and representatives of the counselling community) towards randomised controlled trials (RCTs), and their present and future role in developing the evidence‐base for counselling and psychotherapy. Method: Interviews (phone, Skype or face‐to‐face) were conducted with 24 authorities in the field. Relevant practitioner and academic networks were also contacted and key documents in the field were reviewed. Results: Key figures believe that RCTs will continue to play a decisive role in determining which psychological interventions are recommended and commissioned within the NHS for the foreseeable future. Other methods are seen as having some validity, but are generally considered supplementary to RCTs and not a replacement for them. Discussion: Although many members of the counselling community are critical of RCTs, they are likely to remain the mainstay of commissioning policy for some years to come. This means, in the coming years, members of the counselling community may face difficult choices in how to promote their work, while maintaining their core principles and values. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 381-393 Risks with older adults in acute care settings: UK occupational therapists' and physiotherapists' perceptions of risks associated with discharge and professional practice Internationally, there is evidence that hospital discharge to home for older adults is a complex and challenging process that is dependent upon multidisciplinary team working. At the centre of the discharge process is the management of risk, which involves occupational therapists and other healthcare professionals managing perceived dangers and determining why some dangers are seen as presenting risks while others are not. This study did not aim to explore interprofessional differences but to ascertain a greater understanding of professionals' perceptions of risk in acute care settings. This qualitative study utilised 12 semi-structured interviews with seven occupational therapists and five physiotherapists in the United Kingdom (UK). During the interview, therapists were asked to read and answer questions on a validated vignette. The interview data were subjected to thematic content analysis and the vignettes to template analysis. Our research is one of the first studies to explore therapists' perceptions of risk with older adults in acute care settings. Our study has highlighted that perception of risk does have an impact on discharge decision-making and location. Therapists used negative terminology to refer to patients who wanted to take risks, which could be a reflection of the therapists' anxiety. Mental capacity, and patients' functioning and safety were key factors in risk decision-making with older adults. Our research has highlighted the potential value of multidisciplinary working to manage risk situations and the need for reflection and discussion regarding how persons who do not have capacity wishes are managed within acute care settings. There is a need to develop an interprofessional care pathway to guide clinicians through the risk decision-making process which needs to ensure that the client's opinions and wishes are taken into account throughout. [ABSTRACT FROM AUTHOR]

Purpose The study examined the experience of carers of people with eating disorders after having participated in a skills-based training programme that incorporated five psycho-educational DVDs and book. Supplemental telephone coaching was also offered. Method Nineteen interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Results (1) The transfer of specialist skills was highly valued in lessening carer stress and care-giving difficulties and, in some instances, appeared to have a positive effect on both carer and sufferer, (2) caregivers provided useful suggestions for building upon the current intervention, (3) future programmes would benefit from stronger fidelity to the principles of motivational interviewing, stricter monitoring of coaches and increased participation in male carers. Conclusion This study has confirmed that skills-training can be beneficial in increasing carer self-efficacy and reducing psychological distress, anxiety and burden. They can be a cost-effective method of supporting carers who might otherwise struggle to find therapeutic family support. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Aim: This study explores dilemmas facing psychodynamic therapists who provide personal therapy to therapists in training. Method: Eight experienced psychodynamic psychotherapists were interviewed using a semi-structured interview format during which they were asked about the importance of personal therapy, if they encountered any dilemmas and, if so, how they resolved those dilemmas. Their responses were analysed using a qualitative form of content analysis. Findings: Two categories of dilemma emerged: clinical and personal. Clinical dilemmas arose out of the mandatory requirement for therapy, boundaries, fitness to practice and the suitability of trainees. Personal dilemmas included pressure to model, sense of responsibility, therapeutic narcissism, countertransference reactions, over-use of self and stressful involvement. The therapists' strategies for resolving the dilemmas are described. Conclusion: The results show participants considered personal therapy to be essential for trainees and thought it should be mandatory even though it led to difficulties in the therapy. Questions arose about the suitability of some trainees, the person of the therapist and stressful involvement. Further research into these important areas is recommended. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 467-475 Engaging and supporting fathers to promote breastfeeding: a new role for Health Visitors? Background: Health visitors have a central role in delivering and leading on the new UK government targets on breastfeeding as part of the strategy to reduce health inequalities. This article explores fathers' views and proposes that health visitors are best placed to engage with fathers in supporting the initiation and continuance of breastfeeding. Aim: To conduct initial pilot scoping of fathers' views on breastfeeding in order to provide insights into possible interventions which could contribute to increasing rates of exclusive breastfeeding. Methods: Eight individual in-depth interviews were conducted with fathers (aged 28-47) from different socio-economic groupings living in Brighton and Hove (UK). Data were collected as part of a larger social marketing project focussing on increasing rates of exclusive breastfeeding in Brighton and Hove. Fathers were recruited through their partners whom had been interviewed previously about breastfeeding. Interviews were digitally recorded, transcribed, and analysed using a 'framework' approach. Findings: Data reveal that fathers are interested in breastfeeding and want to be involved more broadly in preparation for, and supporting of, breastfeeding. Fathers reported requiring more relevant and accessible information about the benefits of breastfeeding as well as details concerning some of the practical issues involved in supporting their partner's breastfeeding. Discussion and conclusion: Although in our study fathers reported wanting to be involved in supporting breastfeeding, it is likely that current discourses about men and fathers as well as more practical worries and concerns may prevent some health visitors and other health professionals from involving them in meaningful ways. Whilst our study is limited in its scope and more research is needed, our data indicates that fathers are potentially a missing part of the jigsaw in terms of breastfeeding support. [ABSTRACT FROM AUTHOR]

Objectives. Despite national guidelines recommending cognitive-behavioural therapy (CBT) and family intervention (FI) in the treatment of schizophrenia, levels of implementation in routine care remain low. The present study investigates attitudinal factors amongst community mental health team (CMHT) staff affecting guideline implementation. Design. CMHTs were audited to measure the capacity and delivery of CBT and FI, and semi-structured interviews were conducted with staff from the teams. Methods. Four CMHTs were audited, and five care coordinators from each team were interviewed. A purposive approach to sampling was used to represent the range of professional training of care coordinating staff. Data were analysed using thematic content analysis. Results. Positive views towards guidelines were evident, although tempered by specific implementation issues. Employing simple psychological interventions and approaches as part of the care coordinating role also emerged as highly valued by staff. Severe workload, time pressure and the need for specialist staff were crucial barriers to implementation. Pessimistic views of recovery for clients with psychosis were also apparent and may affect implementation. Conclusions. Staff attitudes and knowledge are an important area of research when examining guideline implementation and require further study. Key themes that have emerged could inform future training agendas and should be considered when developing guideline implementation strategies for the updated 2009 guidelines. Copyright © 2010 John Wiley & Sons, Ltd. • There continues to be limited access to psychological therapies for those with a diagnosis of schizophrenia-barriers relate to staff attitudes and knowledge as well as training, resources and organization of services. • A rolling programme of training is required to ensure all clinical staff have a broad understanding of recommended psychological therapies and are competent to discuss these interventions with patients and carers. • Services require access to staff with both the appropriate competencies and dedicated time to deliver CBT for psychosis and FI and ongoing supervision of this work. • Services should regularly and objectively audit eligibility for interventions and offers, uptake and outcome of therapy. [ABSTRACT FROM AUTHOR]