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There is growing interest in factors which can contribute to the wellbeing of older adults. Participation in learning could have beneficial effects, but to date research on the benefits of learning has tended to focus on young people or those in mid-life and there is currently little evidence on the impact of learning on the wellbeing of older adults. In this paper we provide new, quantitative evidence on the relationship between participation in learning and the wellbeing of older adults. Our study used data from the English Longitudinal Study of Ageing (ELSA), a continuing, longitudinal survey of older adults. To measure wellbeing we used the CASP-19 instrument, a subjective wellbeing measure which is available at all waves of the ELSA survey. Respondents were asked about four types of learning activity: obtaining qualifications; attendance at formal education/training courses; membership of education, music or arts groups or evening classes; membership of sports clubs, gym and exercise classes. To take account of unobservable factors which might influence wellbeing, we applied fixed effects panel regressions to four waves of ELSA data. Learning was associated with higher wellbeing after controlling for a range of other factors. We found evidence that more informal types of learning were associated with higher wellbeing. There was no evidence that formal education/training courses were associated with higher wellbeing. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials (RCTs) of social interventions are often criticised as failing to open the 'black box' whereby they only address questions about 'what works' without explaining the underlying processes of implementation and mechanisms of action, and how these vary by contextual characteristics of person and place. Realist RCTs are proposed as an approach to evaluation science that addresses these gaps while preserving the strengths of RCTs in providing evidence with strong internal validity in estimating effects.Methods: In the context of growing interest in designing and conducting realist trials, there is an urgent need to offer a worked example to provide guidance on how such an approach might be practically taken forward. The aim of this paper is to outline a three-staged theoretical and methodological process of undertaking a realist RCT using the example of the evaluation of a whole-school restorative intervention aiming to reduce aggression and bullying in English secondary schools.Discussion: First, informed by the findings of our initial pilot trial and sociological theory, we elaborate our theory of change and specific a priori hypotheses about how intervention mechanisms interact with context to produce outcomes. Second, we describe how we will use emerging findings from the integral process evaluation within the RCT to refine, and add to, these a priori hypotheses before the collection of quantitative, follow-up data. Third, we will test our hypotheses using a combination of process and outcome data via quantitative analyses of effect mediation (examining mechanisms) and moderation (examining contextual contingencies). The results are then used to refine and further develop the theory of change.Conclusion: The aim of the realist RCT approach is thus not merely to assess whether the intervention is effective or not, but to develop empirically informed mid-range theory through a three-stage process. There are important implications for those involved with reporting and reviewing RCTs, including the use of new, iterative protocols.Trial Registration: Current Controlled Trials ISRCTN10751359 (Registered 11 March 2014). [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Educational workshops are a commonly used quality improvement intervention. Often delivered by credible local health professionals who do not necessarily have skills in pedagogy, it can be challenging to achieve high intervention fidelity. This paper summarizes the fidelity assessment of a workshop designed to increase the uptake of a primary care alcohol screening recommendation. Method Delivered in a single health region, the workshop comprised separate sessions delivered by three local health professionals, plus two role plays delivered by a commercial company. Sessions were tailored to local barriers. Meetings were held with presenters and an outline of the barriers was provided. Two researchers attended the workshop, rating the number of specified barriers targeted by presenters and their quality of delivery. Participant responsiveness was measured through attendees' feedback and intervention dose was calculated as the proportion of health professionals who attended and proportion of general practices represented. Results Exposure was low, with 62 of 545 health professionals from 30 of a possible 80 practices attending. Sixty-five per cent of the specified barriers were targeted. There was variability in quality of delivery and participant responsiveness; challenges included potential mixed messages, overreliance on didactic methods and certain barriers appearing easier to target than others. Conclusions The framework provided a rounded assessment of intervention fidelity: intervention coverage was low, adherence was moderate and there was variability in the quality of delivery across presenters. Future studies testing the effectiveness of interventions delivered by local experts with and without brief training in pedagogy/behaviour change would be beneficial. [ABSTRACT FROM AUTHOR]

Background: The rise in electronic cigarette use by smokers may be responsible for the decreased use of licensed nicotine products and/or increased overall use of non-tobacco nicotine-containing products. This paper reports findings from the Smoking Toolkit Study (STS) tracking use of electronic cigarettes and licensed nicotine products to address this issue.Methods: Data were obtained from monthly surveys involving 14 502 cigarette smokers in England between March 2011 and November 2014. Smokers were asked about their use of electronic cigarettes and licensed nicotine products.Results: Prevalence of electronic cigarette use increased rapidly from 2.2% (95% CI 1.4% to 3.2%) in quarter 2 of 2011 to 20.8% (95% CI 18.3% to 23.4%) in quarter 3 of 2013, after which there was no change. Prevalence of licensed nicotine product use in smokers remained stable from quarter 2 of 2011 (17.4%, 95% CI 15.3% to 19.8%) to quarter 3 of 2013 (17.9%, 95% CI 15.62% to 20.5%), and thereafter declined steadily to 7.9% (95% CI 6.0% to 10.4%). Prevalence of use of any product was stable to quarter 1 of 2012, after which it increased from 18.5% (95% CI 16.3% to 21.0%) to 33.3% (95% CI 30.4% to 36.3%) in quarter 3 of 2013, and then decreased to 22.7% (95% CI 19.3% to 26.3%).Conclusions: The shapes of trajectories since 2011 suggest that electronic cigarettes are probably not responsible for the decline in use of licensed nicotine products. Electronic cigarettes appear to have increased the total market for use of non-tobacco nicotine-containing products. [ABSTRACT FROM AUTHOR]

There is considerable interest in determining the impact that increased uptake of treatment for hepatitis C virus (HCV) infection will have on the burden of HCV among people who inject drugs (PWID). An understanding of the size of the population of PWID, rates of injecting cessation and HCV prevalence and incidence within the PWID population is essential for such exercises. However, these parameters are often uncertain. In this paper we review methods for estimating the size of the population of PWID and related parameters, taking into account the uncertainty that exists around data on the natural history of injecting drug use; consider issues in the estimation of HCV prevalence among PWID; and consider the importance of opioid substitution therapy and prisons as settings for the prevention and treatment of HCV infection among PWID. These latter two points are illustrated through examples of ongoing work in England, Scotland and Australia. We conclude that an improved understanding of the size of PWID populations, including current and former PWID and parameters related to injecting drug use and settings where PWID may be reached, is necessary to inform HCV prevention and treatment strategies. [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]

The paper explores the issues raised by social work students failing in practice learning settings from the perspective of university tutors, by drawing on existing literature in this area from social work and nursing, as well as findings from a small-scale empirical qualitative study. The qualitative study was influenced by practitioner-researcher and practice-near paradigms, and is based on interviews with twelve social work tutors in England. The findings reveal that tutors are able to articulate the important tasks and functions of their roles when issues of failing students in practice learning settings arise, although the process can be challenging. The challenges include: supporting practice educator and student, concerns about other tutors' practices, the difficulties in promoting appropriate professional standards and values within higher education contexts, and frustrations with practice educators and placements. Only a third of the respondents (four), however, articulated their gate-keeping roles and responsibilities, although this was not without its difficulties. Given the current reforms in social work education in England at this present time, with greater emphasis on threshold standards at entry level and at key stages throughout the programme of study, the research is timely in terms of the critical consideration of the tutor role and challenges inherent in promoting appropriate standards. [ABSTRACT FROM AUTHOR]

Health visitors working in Tower Hamlets, a deprived inner London borough, face a large and growing under-5 population, and caseloads with disproportionate numbers of vulnerable families and child protection concerns. This paper reports an evaluation of a project to empower health visitors. Baseline data about their activity (primarily derived from observation and interviews) showed that health visitors would benefit from improved resources (e.g. leaflets, books, training packs); enhanced knowledge of local borough and third sector services; and support for their own wellbeing and morale. After the programme that was implemented to provide these, seven health visitors were interviewed for evaluation purposes. They reported feeling empowered by the project: the training had been invaluable in providing affirmation, reassurance, and the opportunity to reflect; the new sleep information packs were very helpful for families, as was the new leaflet explaining their role; and restorative supervision had been useful in helping individuals think through how to deal with particular challenges in life or work. The project was thus successful in helping the health visitors interviewed to feel more supported and thus empowered in their work with families. [ABSTRACT FROM AUTHOR]

Background: The Public Health Responsibility Deal (RD) in England is a public-private partnership involving voluntary pledges between government, industry, and other organisations to improve public health by addressing alcohol, food, health at work, and physical activity. This paper analyses the RD physical activity (PA) pledges in terms of the evidence of their potential effectiveness, and the likelihood that they have motivated actions among organisations that would not otherwise have taken place. Methods: We systematically reviewed evidence of the effectiveness of interventions proposed in four PA pledges of the RD, namely, those on physical activity in the community; physical activity guidelines; active travel; and physical activity in the workplace. We then analysed publically available data on RD signatory organisations' plans and progress towards achieving the physical activity pledges, and assessed the extent to which activities among organisations could be attributed to the RD. Results: Where combined with environmental approaches, interventions such as mass media campaigns to communicate the benefits of physical activity, active travel in children and adults, and workplace-related interventions could in principle be effective, if fully implemented. However, most activities proposed by each PA pledge involved providing information or enabling choice, which has limited effectiveness. Moreover, it was difficult to establish the extent of implementation of pledges within organisations, given that progress reports were mostly unavailable, and, where provided, it was difficult to ascertain their relevance to the RD pledges. Finally, 15 % of interventions listed in organisations' delivery plans were judged to be the result of participation in the RD, meaning that most actions taken by organisations were likely already under way, regardless of the RD. Conclusions: Irrespective of the nature of a public health policy to encourage physical activity, targets need to be evidence-based, well-defined, measurable and encourage organisations to go beyond business as usual. RD physical activity targets do not adequately fulfill these criteria. [ABSTRACT FROM AUTHOR]

Background: Cognitive behaviour therapy (CBT) is recommended for the treatment of psychosis; however, only a small proportion of service users have access to this intervention. Smartphone technology using software applications (apps) could increase access to psychological approaches for psychosis. This paper reports the protocol development for a clinical trial of smartphone-based CBT.Methods/design: We present a study protocol that describes a single-blind randomised controlled trial comparing a cognitive behaviour therapy-informed software application (Actissist) plus Treatment As Usual (TAU) with a symptom monitoring software application (ClinTouch) plus TAU in early psychosis. The study consists of a 12-week intervention period. We aim to recruit and randomly assign 36 participants registered with early intervention services (EIS) across the North West of England, UK in a 2:1 ratio to each arm of the trial. Our primary objective is to determine whether in people with early psychosis the Actissist app is feasible to deliver and acceptable to use. Secondary aims are to determine whether Actissist impacts on predictors of first episode psychosis (FEP) relapse and enhances user empowerment, functioning and quality of life. Assessments will take place at baseline, 12 weeks (post-treatment) and 22-weeks (10 weeks post-treatment) by assessors blind to treatment condition. The trial will report on the feasibility and acceptability of Actissist and compare outcomes between the randomised arms. The study also incorporates semi-structured interviews about the experience of participating in the Actissist trial that will be qualitatively analysed to inform future developments of the Actissist protocol and app.Discussion: To our knowledge, this is the first controlled trial to test the feasibility, acceptability, uptake, attrition and potential efficacy of a CBT-informed smartphone app for early psychosis. Mobile applications designed to deliver a psychologically-informed intervention offer new possibilities to extend the reach of traditional mental health service delivery across a range of serious mental health problems and provide choice about available care.Trial Registration: ISRCTN34966555. Date of first registration: 12 June 2014. [ABSTRACT FROM AUTHOR]

Background Amid concern about the reach and inclusivity of parenting interventions, attempts have been made to culturally adapt programmes for specific ethnic or linguistic groups. This paper describes a novel approach of the religious adaptation of a parenting programme, namely the Family Links Islamic Values course. Methods A small-scale qualitative process evaluation was conducted on one Family Links Islamic Values course for Muslim fathers in the South of England in order to describe the intervention as implemented and its theory of change, as well as the acceptability of the programme to the participants. The data consisted of 13 semi-structured interviews (10 with parents and three with staff), 25 h of observation and reading of programme manuals. Results A logic model is presented to describe the theoretical basis of the intervention. The programme was highly acceptable to fathers who valued the integration of religious teachings and were generally very positive about their experience of attending the course. Post-course interviews with both fathers and mothers mentioned some positive changes in fathers as a result of their attendance. Conclusions It is important to be responsive to the needs of some British Muslims for religiously credible interventions. This small-scale process evaluation needs to be followed by a robust evaluation of programme outcomes for parents and children. [ABSTRACT FROM AUTHOR]

Online health behaviour interventions have great potential but their effectiveness may be hindered by a lack of formative and theoretical work. This paper describes the process of formative research to develop theoretically and empirically based health messages that are culturally relevant and can be used in an online intervention to promote healthy lifestyle behaviours among new university students. Drawing on the Theory of Planned Behaviour, a three-phase programme of formative research was conducted with prospective and current undergraduate students to identify (i) modal salient beliefs (the most commonly held beliefs) about fruit and vegetable intake, physical activity, binge drinking and smoking, (ii) which beliefs predicted intentions/behaviour and (iii) reasons underlying each of the beliefs that could be targeted in health messages. Phase 1, conducted with 96 pre-university college students, elicited 56 beliefs about the behaviours. Phase 2, conducted with 3026 incoming university students, identified 32 of these beliefs that predicted intentions/behaviour. Phase 3, conducted with 627 current university students, elicited 102 reasons underlying the 32 beliefs to be used to construct health messages to bolster or challenge these beliefs. The three-phase programme of formative research provides researchers with an example of how to develop health messages with a strong theoretical- and empirical base for use in health behaviour change interventions. [ABSTRACT FROM AUTHOR]

Football can bring people together in acts of solidarity and togetherness. This spirit is most evocatively illustrated in the world renowned football anthem 'You'll Never Walk Alone' (YNWA). In this paper, we argue that this spirit can be effectively harnessed in nursing and mental health care. We draw on data from qualitative interviews undertaken as part of evaluating a football and mental health project to explore the nature of supportive social relations therein. We use some of the lyrics from YNWA as a metaphor to frame our thematic analysis. We are especially interested in the interactions between the group facilitators and group members, but also address aspects of peer support within the groups. A contrast is drawn between the flexible interpersonal boundaries and self-disclosure evident in the football initiative, and the reported, more-distant relations with practitioners in mainstream mental health services. The findings suggest scope for utilizing more collective, solidarity-enhancing initiatives and attention to alliances and boundaries to maximize engagement and therapeutic benefits within routine practice. [ABSTRACT FROM AUTHOR]

This paper argues that the increasing international salience of homelessness can be partially explained by reference to the revanchist thesis (involving processes of coerced exclusion and abjection), but the situation on the ground is more complex. It reports on interviews with 18 representatives of 11 homelessness service providers in one city in England. As Cloke et al. found, these providers tended to be either larger, more 'professional', 'insider' services or smaller, more 'amateur', 'outsider' services. However, this does not mean that the former were necessarily more revanchist and the latter less so. Rather, the actions of both types of organisation could, in some cases, be construed as both advancing and counteracting a revanchist project. [ABSTRACT FROM AUTHOR]

Research studies and serious case reviews following child deaths often criticise social work practitioners for failing to maintain a focus on the child. This paper draws on findings from a qualitative study of child protection planning in cases of chronic child neglect to increase understanding as to why this is the case. Four key themes that appear to affect social work practice are explored. These are: generalised assessments prior to conference; a narrow interpretation of the identity of a child; superficial engagement by professionals with the wishes and feelings of the child throughout the planning process; a lack of awareness of the different needs of siblings in large families; and parenting interventions considered in a vacuum. The authors argue that part of the reason social workers have found child-centred practice in these cases difficult is a consequence of the way in which the neglected child appears to be constructed. They conclude by considering how the latest English government guidance Working Together at one level exacerbates the issue whilst also providing opportun ities for innovative practice designed to focus on the daily lived experience of the child. [ABSTRACT FROM AUTHOR]

Background Establishing what constitutes clinically significant change is important both for reviewing the function of services and for reflecting on individual clinical practice. A range of methods for assessing change exist, but it remains unclear which are best to use and under which circumstances. Method This paper reviews four indices of change [difference scores ( DS), crossing clinical threshold ( CCT), reliable change index ( RCI) and added value scores ( AVS)] drawing on outcome data for 9764 young people from child and adolescent mental health services across England. Results Looking at DS, the t-test for time one to time two scores indicated a significant difference between baseline and follow up scores, with a standardised effect size of d = 0.40. AVS analysis resulted in a smaller effect size of 0.12. Analysis of those crossing the clinical threshold showed 21.2% of cases were classified as recovered, while 5.5% were classified as deteriorated. RCI identified 16.5% of cases as showing reliable improvement and 2.3% of cases as showing reliable deterioration. Across RCI and CCT 80.5% of the pairings were exact (i.e., identified in the same category using each method). Conclusions Findings indicate that the level of agreement across approaches is at least moderate; however, the estimated extent of change varied to some extent based on the index used. Each index may be appropriate for different contexts: CCT and RCI may be best suited to use for individual case review; whereas DS and AVS may be more appropriate for case-mix adjusted national reporting. [ABSTRACT FROM AUTHOR]

Background: Peer support is reported to be a key method to help build social capital in communities. To date there are no studies that describe how this can be achieved through a breastfeeding peer support service. In this paper we present findings from an evaluation of a voluntary model of breastfeeding peer support in North-West England to describe how the service was operationalized and embedded into the community. This study was undertaken from May, 2012 to May, 2013. Methods: Interviews (group or individual) were held with 87 participants: 24 breastfeeding women, 13 peer supporters and 50 health and community professionals. The data contained within 23 monthly monitoring reports (January, 2011 to February 2013) compiled by the voluntary peer support service were also extracted and analysed. Results: Thematic analysis was undertaken using social capital concepts as a theoretical lens. Key findings were identified to resonate with 'bonding', 'bridging' and 'linking' forms of social capital. These insights illuminate how the peer support service facilitates 'bonds' with its members, and within and between women who access the service; how the service 'bridges' with individuals from different interests and backgrounds, and how 'links' were forged with those in authority to gain access and reach to women and to promote a breastfeeding culture. Some of the tensions highlighted within the social capital literature were also identified. Conclusions: Horizontal and vertical relationships forged between the peer support service and community members enabled peer support to be embedded into care pathways, helped to promote positive attitudes to breastfeeding and to disseminate knowledge and maximise reach for breastfeeding support across the community. Further effort to engage with those of different ethnic backgrounds and to resolve tensions between peer supporters and health professionals is warranted. [ABSTRACT FROM AUTHOR]

Background: The level of frailty in the older population across age cohorts and how this changes is a factor in determining future care costs and may also influence the extent of socioeconomic and gender inequalities in frailty. Methods: We model cohort-specific trajectories in frailty among the community dwelling population older than 50 years, using five waves (2002–2010) of the English Longitudinal Study of Ageing. We stratify our analysis by wealth and gender and use a frailty index, based on accumulation of ‘deficits’. Results: For males and females between the ages of 50 and 70 in 2002, frailty trajectories for adjacent age cohorts converge. However, levels of frailty are higher in recent compared with earlier cohorts at the older ages (for cohorts aged over 70 in 2002). These cohort differences are largest in the poorest wealth group, while for the most affluent, frailty trajectories overlap across all adjacent cohorts suggesting no change across cohorts. Conclusions: A key driver of the cohort differences in frailty that we observe is likely to be increased survival of frail individuals. Importantly, this paper illustrates that the social conditions experienced across the wealth distribution impacts on the rate of deficit accumulation in older populations. Our results on trajectories of frailty between 2002 and 2010 are pessimistic and, in the context of rising life expectancies, suggest that poorer older people in particular spend additional years of life in a frail state. [ABSTRACT FROM AUTHOR]

This paper examines a sample of ninety-three child welfare workers' perceptions of emotional relations in risk assessment situations.Workers from England, Norway and California (USA) are interviewed about risk factors in a vignette. Seventy-three per cent of the total workers identify the emotional issues described in the vignette as a risk factor, but a lower percentage of the American workers do so. Nearly all of these workers identify the mother's lack of meeting her daughter's emotional needs as a risk factor; however, the analysis shows that only approximately one-third of these workers elaborate on the possibleconsequencesandreasons for this lack of attachment. Evenfewersuggest services that can improvethe situation.Thefindings suggest thatemotional issues havea relatively low importance in a risk assessment situation but that there are differences by country. Although the sample is small, it is likely that systemic factors in the child welfare system and the risk assessment approach explain some of these differences. [ABSTRACT FROM AUTHOR]

Background This paper examines knowledge exchange dynamics in a specialist integrated intellectual (learning) disability service, comprising specialist healthcare provision with social care commissioning and management, and considers their significance in terms of integrated service delivery. Methods A qualitative study focusing on knowledge exchange and integrated services. Semi-structured interviews ( n = 25) were conducted with members of an integrated intellectual disability service in England regarding their perceptions of knowledge exchange within the service and the way in which knowledge exchange impinges on the operation of the integrated service. Results Exchange of 'explicit' (codifiable) knowledge between health and care management components of the service is problematic because of a lack of integrated clinical governance and related factors such as IT and care record systems and office arrangements. Team meetings and workplace interactions allowed for informal exchange of explicit and 'tacit' (non-codifiable) knowledge, but presented challenges in terms of knowledge exchange completeness and sustainability. Conclusions Knowledge exchange processes play an important role in the functioning of integrated services incorporating health and care management components. Managers need to ensure that knowledge exchange processes facilitate both explicit and tacit knowledge exchange and do not rely excessively on informal, ' ad hoc' interactions. Research on integrated services should take account of micro-scale knowledge exchange dynamics and relationships between social dynamics and physical factors. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to evaluate the impact on recovery and personal goal attainment of a transition intervention service for return to the community following exit from an alternative to psychiatric inpatient admission -- a residential recovery house. The services seek to facilitate community reintegration, promote recovery and prevent future mental health crisis. The service was funded by the Stone Family Foundation. Design/methodology/approach -- This evaluation employed a within groups design: a single case evaluation follow-up. Analysis of Recovery Star and personal goal achievement data collected at service entry and exit points during routine practice (n=181), at four sites in England. The adults had mental illness diagnoses including depression, schizophrenia, bipolar disorder, personality disorder, and anxiety disorder. Findings -- There was a significant increase in overall Recovery Star scores with a large effect size, and significant increases in eight of the ten Recovery Star life domains. There were significant increases in the goal scores linked to "Managing mental health", "Self-care" and "Living skills". Practical implications -- A transitional intervention service provided by the third sector for return to community following mental health crisis may contribute to recovery and personal goal achievement. A randomised control trial of this transition intervention service is recommended. Originality/value -- This is first outcome evaluation of an alternative to psychiatric inpatient admission transition intervention service and findings indicate the potential positive effect of having this service incorporated into the design of alternative to admission provision. [ABSTRACT FROM AUTHOR]

There is increasing evidence that many homeless people have multiple and complex needs but are excluded from social work support. The data on which this pa per draws a re part of a study investigating service interfaces and interprofessional working that took place in three areas of England in 2009-11. This paper reports and discusses the ways in which some social workers employed in statutory and voluntary agencies work with people with risks of and experiences of homelessness. The findings reveal that social workers recognise and make efforts to minimise the risks of homelessness by seeking to enhance people's ability to survive adverse circumstances. Other social work practice involves responding to the needs of people who are homeless and who have possible entitlements for social care. Social work practice with people with multiple exclusions may be more visible in the voluntary sector than the statutory sector, meaning that social work skills may therefore seem less available to people with homelessness experiences or at risk of homelessness than is the case. There may be scope for the profession to articulate more clearly the potential for social work support to improve outcomes for people at risk of homelessness or with experiences of it. [ABSTRACT FROM AUTHOR]

Background Previous research suggests that the health effects of recessions are mixed and vary spatially between countries. Using the North-South English health divide as an example, this paper examines whether there are also spatial variations within countries. Methods Cross-sectional data on self-reported ‘not good health’ was obtained from the British Household Panel Survey and the Health Survey for England from 1991 to 2010. Age-adjusted generalized linear models were used to examine the effects of recessions (1990/91 and 2008/09) on self-reported health in the four English NHS Commissioning Regions (North, South, Midlands and London) with stratification by gender. Results Over the 20-year study period, the North had consistently higher rates of ‘not good health’ than the South [OR 1.50 (1.46–1.55) outside recessions and OR 1.29 (1.19–1.39) during recessions]. However, during periods of recession, this health divide narrowed slightly with a 2% decrease in the prevalence of ‘not good health’ in the North [OR 0.91 (0.86, 0.96)]. Conclusion This study is evidence of spatial variations in the health effects of recessions within England and the North-South divide appears to slightly reduce during recessions. Health in the North remains worse than the South. [ABSTRACT FROM PUBLISHER]

Purpose -- The purpose of this paper is to report on a part of a study examining the interrelationships between personalisation and safeguarding practice. Specifically the authors aimed to examine how safeguarding practice is affected by the roll out of personalisation in adult social care, particularly when the adult at risk has a personal budget or is considering this. Design/methodology/approach -- A sample of annual reports from Adult Safeguarding Boards in England was accessed for content analysis covering the period 2009-2011. One part of this sample of local authorities was selected at random; the other authorities selected had been early adopters of personalisation. The reports were analysed using a pro forma to collect salient information on personalisation that was cross-referenced to identify common themes and differences. Findings -- The authors found variable mentions of personalisation as part of the macro policy context reported in the annual reviews, some examples of system or process changes at mezzo level where opportunities to discuss the interface were emerging, and some small reports of training and case accounts relevant to personalisation. Overall these two policy priorities seemed to be more closely related than had been found in earlier research on the interface between adult safeguarding and personalisation. Research limitations/implications -- There was wide variation in the annual reports in terms of detail, size and content, and reports for only one year were collected. Developments may have taken place but might not have been recorded in the annual reports so these should not be relied upon as complete accounts of organisational or practice developments. Practical implications -- Authors of Safeguarding Adults Board reports may benefit from learning that their reports may be read both immediately and potentially in the future. They may wish to ensure their comments on current matters will be intelligible to possible future readers and researchers. Originality/value -- There does not appear to have been any other previous study of Safeguarding Adult Boards' annual reports. Documentary analysis at local level is under-developed in safeguarding studies. [ABSTRACT FROM AUTHOR]

Since 1977 homelessness legislation in England has offered limited statutory accommodation rights to unintentionally homeless people who are judged to be in priority need and able to demonstrate a local connection. Using data generated in interviews with homeless people and staff working to support them, this paper considers the impact of current homelessness policy and practice and explores how decisions about intentionality, priority need and local connection serve to exacerbate the social exclusion experienced by single homeless people with multiple support needs. It is concluded that a more genuinely inclusive welfare state will only emerge when, and if, policymakers and wider society are able to abandon their current fixation with using welfare policy to punish ‘irresponsible’ behaviour and refocus instead on providing services to adequately meet the basic needs of marginalised people. [ABSTRACT FROM PUBLISHER]

The context of this article is the use of employer sanctions, in the form of raids and fines on businesses found to be employing people who do not have permission to work in the UK, as a method of in-border immigration control. Drawing on qualitative interviews with undocumented migrants and ethnic enclave employers in London, this article examines the impact of sanctions from the perspectives of those who have been or are most likely to be affected. More specifically the article sheds light on individual experiences of and strategies against immigration enforcement raids, and the effect of raids on the labour market, conditions of work and more widely, on local community relations. The paper concludes that there is a disjuncture between the real impact of sanctions and at least some of the stated policy aims. [ABSTRACT FROM PUBLISHER]

Despite media and political rhetoric to the contrary, there is persuasive evidence to suggest an association between deprivation and those involved in the English riots of 2011, which continues to be downplayed when developing responses to crime and crime prevention policy. This study explores empirical evidence from two major cities in the North West of England, which highlights an association between deprivation and rioting in both criminal charge and sentencing data allowing further exploration of some of these issues. The paper argues that to mask the rioting as ‘mindless criminality’ is to ignore wider social-structural inequalities and to silence important messages contained in the rioting behaviour from disenfranchised youth and communities about the inequalities they suffer. [ABSTRACT FROM PUBLISHER]

Objective: The current paper describes Diet In Nutrients Out (DINO), an integrated dietary assessment system incorporating dietary data entry and nutritional analysis within one platform for use in dietary assessment in small-scale intervention studies to national surveys. Design: DINO contains >6000 food items, mostly aggregated composites of branded foods, across thirty-one main food groups divided into 151 subsidiary groups for detailed reporting requirements, with fifty-three core nutrient fields. Setting: MRC Human Nutrition Research (HNR), Cambridge, UK and MRC Keneba, Gambia. Subjects: DINO is used across dietary assessment projects at HNR and MRC Keneba. Results: DINO contains macro- and micronutrients as well as additional variables of current research and policy interest, such as caffeine, whole grains, vitamin K and added sugars. Disaggregated data are available for fruit, vegetables, meat, fish and cheese in composite foods, enabling greater accuracy when reporting food consumption or assessing adherence to dietary recommendations. Portion sizes are categorised in metric and imperial weights, with standardised portion sizes for each age group. Regular reviews are undertaken for portion sizes and food composition to ensure contemporary relevance. A training programme and a checking schedule are adhered to for quality assurance purposes, covering users and data. Eating context questions are integrated to record where and with whom the respondent is eating, allowing examination between these factors and the foods consumed. Conclusions: An up-to-date quality-assured system for dietary assessment is crucial for nutritional surveillance and research, but needs to have the flexibility to be tailored to address specific research questions. [ABSTRACT FROM AUTHOR]

Objectives: To examine variability across England in certification rates for age related macular degeneration (AMD) between 1st April 2011 and 31st March 2012. Study design: Cross-sectional survey. Methods: An electronic version of the CVI, the ECVI, was used at the Certifications Office, London, to transfer information from paper based certificates into a database. The electronic certifications data set was queried for all certificates completed in England between April 1st 2011 and March 31st 2012 with the main cause of certifiable visual loss being AMD or with the main cause of certifiable visual loss being multiple pathology but a contributory cause being AMD. Data were explored by type of AMD, visual status, age and sex and then directly standardized rates were computed by English region. Results: The Certifications Office received 23,616 CVIs for England between April 2011 and March 2012, of which 10,481 (44%) were people certified severely sight-impaired (blind) (SSI) and 12,689 (54%) were certified as sight-impaired (partial sight) (SI). The remainder did not have visual status classified. AMD contributed to 11546 causes of certification on the CVI forms during this period, 53% of forms being for geographic atrophy (GA)/dry AMD which is currently mostly untreatable. The median (interquartile) age at certification for AMD was 86 (81, 90) years and women were more commonly certified than men (66%). Considerable variability was seen across English regions, although there was consistency in that GA was the more common form in all areas. Conclusions: There is considerable regional variability in CVI rates in England, which are not attributable to differences in age or sex. Reasons for such variability need examination yet this should not undermine the value of these data in terms of describing those newly registered with sight impairment due to AMD who are predominantly female and over 85 years of age. [ABSTRACT FROM AUTHOR]

This paper examines body mass index (BMI) trajectories among children from different race/ethnic and maternal nativity backgrounds in the United States and England from early- to middle-childhood. This study is the first to examine race/ethnic and maternal nativity differences in BMI trajectories in both countries. We use two longitudinal birth cohort studies-The Fragile Families and Child Wellbeing Study (n = 3,285) for the United States and the Millennium Cohort Study (n = 6,700) for England to estimate trajectories in child BMI by race/ethnicity and maternal nativity status using multilevel growth models. In the United States our sample includes white, black, and Hispanic children; in England the sample includes white, black, and Asian children. We find significant race/ethnic differences in the initial BMI and BMI trajectories of children in both countries, with all non-white groups having significantly steeper BMI growth trajectories than whites. Nativity differences in BMI trajectories vary by race/ethnic group and are only statistically significantly higher for children of foreign-born blacks in England. Disparities in BMI trajectories are pervasive in the United States and England, despite lower overall BMI among English children. Future studies should consider both race/ethnicity and maternal nativity status subgroups when examining disparities in BMI in the United States and England. Differences in BMI are apparent in early childhood, which suggests that interventions targeting pre-school age children may be most effective at stemming childhood disparities in BMI. [ABSTRACT FROM AUTHOR]

Background Alcohol-related blackouts ( ARBs) are reported by ~50% of drinkers. While much is known about the prevalence of ARBs in young adults and their cross-sectional correlates, there are few prospective studies regarding their trajectories over time during mid-adolescence. This paper reports latent trajectory classes of ARBs between age 15 and 19, along with predictors of those patterns. Methods Latent class growth analysis ( LCGA) was used to evaluate the pattern of occurrence of ARBs across 4 time points for 1,402 drinking adolescents from the Avon Longitudinal Study of Parents and Children ( ALSPAC). Multinomial regression analyses evaluated age-15 demography, substance-related items, externalizing characteristics, and estimated peer substance use as predictors of latent class membership. Results ARBs were reported at age 15 in 30% and at age 19 in 74% of these subjects. Four latent trajectory classes were identified: Class 1 (5.1%) reported no blackouts; for Class 2 (29.5%), ARBs rapidly increased with age; for Class 3 (44.9%), blackouts slowly increased; and for Class 4 (20.5%), ARBs were consistently reported. Using Class 2 (rapid increasers) as the reference, predictors of class membership included female sex, higher drinking quantities, smoking, externalizing characteristics, and estimated peer substance involvement (pseudo R2 = 0.22). Conclusions ARBs were common and repetitive in these young subjects, and predictors of their trajectories over time involved multiple domains representing diverse characteristics. [ABSTRACT FROM AUTHOR]

This paper reports children's, young people's and parents' perspectives on birth family contact from interviews conducted across eleven local authorities in England between 2009 and 2012 as part of the national evaluation of Social Work Practice (SWP) pilots: independent organisations providing social work support for looked after children and care leavers. The matched control evaluation, reported fully elsewhere ( Stanley et al., 2013), showed most children and young people interviewed in both SWP and comparison sites felt they had the 'right' amount of contact with the 'right' members of their birth families. Factors found to be key to child and parental satisfaction with contact include: involvement in decision making; speed of social work response; resolution of practical problems; provision of information and emotional support; and investment in building relationships. Evaluation of the SWPs demonstrated progress over time in increasing satisfaction with contact for some young people and some parents also reported improvements, but progress was not uniform and good practice was also evident in comparison sites. Regardless of the organisational model adopted, social work which increases children's, young people's and families' satisfaction with contact arrangements requires an ethic of care, a rights-based approach and access to resources, such as worker time and transport. [ABSTRACT FROM AUTHOR]

Social work supervision is receiving renewed attention internationally with calls for it to be remodelled and given greater priority, this paper uses data from a longitudinal study in England, which involved: three online surveys of Newly Qualified Social Workers (NQSWs); an online survey of Directors and face-to-face interviews with 23 social work managers which enabled us to investigate the receipt of supervision and its provision. Data on the frequency of supervision were analysed in relation to other job-related factors reported by NQSWs alongside information on NQSWs' views of the content of supervision. Findings suggest a tapering of supervision for social workers as they become more experienced but the overall level of supervision appears to be both limited and variable. NQSWs appreciated supervision from managers, and this affects their engagement with their work. Managers reported pressures of time in providing sufficient supervision. Directors conveyed their perception of the importance of supervision but indicated that there may be blurring of supervision as more structured support for NQSWs becomes part of the requirements for those in their first year in the profession. Greater attention should be given to investigating the effectiveness of supervision and to the support of those managers who are expected to provide it. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the methodology being used in a study exploring the organisation of adult safeguarding. Design/methodology/approach -- A mixed-methods study is presented which describes how the research team is seeking to identify models of adult safeguarding and then compare them using a quasi-experimental study design. Findings -- Close examination of this study's methodology highlights the potential value of mixed-method research approaches. Research limitations/implications -- Anticipated study challenges include difficulties with gaining agreement from study sites and recruitment of people who have been the subject of a safeguarding referral. Originality/value -- This will be the first study in England to identify and compare different models of adult safeguarding in depth. Outlining and discussing current methodology is likely to be of interest to practitioners, managers and other researchers and policy makers. [ABSTRACT FROM AUTHOR]

Aims To report on a survey of sexual health service needs among substance-misusing women attending a substance misuse service. Background Substance-misusing women carry a disproportionate burden of sexual ill health, yet the range and frequency of their sexual health risks, morbidities and service engagement are poorly understood. Design A cross-sectional survey of a convenience sample of substance-misusing women attending a substance misuse service. Methods From 4 April 2010-17 September 2010, substance-misusing women in Hastings & Ore, UK, were invited to complete a paper questionnaire addressing: drug use; cervical cytology, sexually transmitted infection and HIV screening history; pregnancy history, perceived pregnancy risk and contraceptive advice and supply; sexual activity and assault. Of 91 respondents, 77 attended local drug treatment services - results comprise analysis of this sub-sample. Results The study sample was characterized by long-term opioid and crack cocaine use. Of 53% sexually active in the previous 4 weeks, 66% perceived they had experienced sexual intercourse that could lead to pregnancy during that time. Fifty-five per cent had been forced to have sex against their will during their lifetime. High rates of sexually transmitted infections, pregnancy termination, miscarriage and abnormal cervical cytology were reported. Conclusions Findings indicate the need to recognize the breadth of elevated sexual health risks and morbidities experienced by substance-misusing women with long-term opioid/crack use, including those not identifying as intravenous drug users. Poor recall of drop-in and appointment times, reluctance to disclose substance misuse and likelihood of previous sexual assault present significant challenges to nurses, who must take a sensitive, opportunistic approach to referral and provision of sexual health interventions to substance-misusing women. [ABSTRACT FROM AUTHOR]

Context In 2004, the English Public Health White Paper Choosing Health introduced 'health trainers' as new members of the National Health Service (NHS) workforce. Health trainers would offer one-to-one peer-support to anyone who wished to adopt and maintain a healthier lifestyle. Choosing Health implicitly envisaged health trainers working in community settings in order to engage 'hard-to-reach' individuals and other groups who often have the poorest health but who engage the least with traditional health promotion and other NHS services. Methods During longitudinal case studies of 6 local health trainer services, we conducted in-depth interviews with key stakeholders and analyzed service activity data. Findings Rather than an unproblematic and stable implementation of community-focused services according to the vision in Choosing Health, we observed substantial shifts in the case studies' configuration and delivery as the services embedded themselves in the local NHS systems. To explain these observations, we drew on a recently proposed conceptual framework to examine and understand the adoption and diffusion of innovations in health care systems. Conclusions The health trainer services have become more 'medicalized' over time, and in doing so, the original theory underpinning the program has been threatened. The paradox is that policymakers and practitioners recognize the need to have a different service model for traditional NHS services if they want hard-to-reach populations to engage in preventive actions as a first step to redress health inequalities. The long-term sustainability of any new service model, however, depends on its aligning with the established medical system's (ie, the NHS's) characteristics. [ABSTRACT FROM AUTHOR]

Multi-touch surfaces have the potential to change the nature of computer-supported collaborative learning, allowing more equitable access to shared digital content. In this paper, we explore how large multi-touch tables can be used by groups of students as an external representation of their group interaction processes. Video data from 24 groups of students working on a logic reasoning problem was examined to identify their levels of reasoning about the task, and how they used the table to support their reasoning. Results indicate that of the 13 groups who solved or nearly solved the problem, 12 used the table to represent their reasoning process, while only four groups who used the table to support their reasoning process did not solve the problem. Examples from three groups are used to explore the different ways the table was used as an external representation of the groups' processes. The findings indicate that the group problem-solving process can be enhanced with the use of multi-touch tables, although students may need support in using the technology effectively to support their collaborative reasoning. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to identify features of community mental health teams (CMHTs) for older people valued by their managers, and those they would most like to change. Design/methodology/approach: Content analysis was used to analyse "free text" responses to open questions from a national survey about CMHTs' organisational structures and processes. Responses were sorted into statements which were categorised into content areas and higher level dimensions. Findings: Free text information was provided by 376 teams (an 88 per cent response rate). Eight higher level dimensions were identified. One related specifically to integration with social care services, whilst several more included material about other aspects of intra-team integration (e.g. documentation and location). The largest proportion of statements related to staffing and teamwork. Statements about inter-personal and inter-professional issues were largely positive, whilst statements about resources, bureaucracy and integration with social care services typically detailed desired changes. Practical implications: Four key issues emerged comprising a high level of support from managers to develop integrated practices; a need to define the focus of CMHTs for older people and to be fully resourced; and the importance of a nurturing and supportive team environment. Originality/value: The methodology provides a bridge between qualitative and quantitative research, exploring the volume of statements on particular topics and their meaning. [ABSTRACT FROM AUTHOR]

Background: Traditional measures of social status are predicated on position in the labour market. There has been less attention directed to the meanings of social position for people with a long-term condition whose relationship to employment is precarious. Previous research has demonstrated that the MacArthur scale is capable of capturing contextualised aspects of social status, which makes it a useful tool for exploring changes in meaning. Aims: The paper explores the meanings and experiences of social status of people living with a long-term condition with particular reference to employment status. Methods: A sample of 300 participants was drawn from diabetes and chronic heart disease registers of General Practices in North West England. A cross-sectional survey with nested qualitative interviews was used in collecting and analysing the data. Findings: Having financial independence and participating in valued activities are more important for people with chronic illness than power and status mediated through the labour market. Income and the lack and loss of employment were given a central role in respondents’ narratives reflecting the absence of acceptable alternative routes through which social status for those with a long-term condition can realistically be rebuilt outside of participation in the labour market. [ABSTRACT FROM AUTHOR]

Aims and objectives. To determine the feasibility and acceptability of using trained volunteers as mealtime assistants for older hospital inpatients. Background. Poor nutrition among hospitalised older patients is common in many countries and associated with poor outcomes. Competing time pressures on nursing staff may make it difficult to prioritise mealtime assistance especially on wards where many patients need help. Design. Mixed methods evaluation of the introduction of trained volunteer mealtime assistants on an acute female medicine for older people ward in a teaching hospital in England. Methods. A training programme was developed for volunteers who assisted female inpatients aged 70 years and over on weekday lunchtimes. The feasibility of using volunteers was determined by the proportion recruited, trained, and their activity and retention over one year. The acceptability of the training and of the volunteers' role was obtained through interviews and focus groups with 12 volunteers, nine patients and 17 nursing staff. Results. Fifty-nine potential volunteers were identified: 38 attended a training session, of whom 29 delivered mealtime assistance, including feeding, to 3911 (76%) ward patients during the year (mean duration of assistance 5-5 months). The volunteers were positive about the practical aspects of training and ongoing support provided. They were highly valued by patients and ward staff and have continued to volunteer. Conclusions. Volunteers can be recruited and trained to help acutely unwell older female inpatients at mealtimes, including feeding. This assistance is sustainable and is valued. Relevance to clinical practice. This paper describes a successful method for recruitment, training and retention of volunteer mealtime assistants. It includes a profile of those volunteers who provided the most assistance, details of the training programme and role of the volunteers and could be replicated by nursing staff in other healthcare units. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in 2011. Design/methodology/approach -- Jenny Weinstein is a Hon Senior Lecturer at Kingston University, Professor Ray Jones and Rick Hood are based at the Joint Faculty of Health and Social Care, St George's, University of London and Kingston University, London, UK.A qualitative study is described in which structured interviews were carried out with participants belonging to each service user group. The study aimed to explore the following issues: first, service users' experiences of the assessment process, second, whether service users wanted full control of their budgets and third, if personal budgets make a difference to quality of life. Findings -- xService users (n = 7 older people and carers; n = 7 people with mental health problems) found the personal budgets system and assessment process difficult to understand and its administration complex. Older people in particular were reluctant to assume full control and responsibility for managing their own personal budget in the form of a Direct Payment. Participants in both groups reported their continued reliance on traditional home care or day care services. These findings were reported back to the LA to help staff review the implementation of personal budgets for these two user groups. Research limitations/implications -- Study participant numbers are low due to difficulties recruiting. Several potential participants were not interviewed due to their frailty. Practical implications -- Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care. Originality/value -- Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care. [ABSTRACT FROM AUTHOR]

Across Europe and North America, few young people meet the recommended levels of physical activity (PA) of 1 hour of moderate to vigorous PA per day. However, the lives of young people cannot simply be polarised as either completely sedentary or active. Drawing on findings from the World Health Organization Health Behaviour in School-aged Children cross sectional international study, this paper examines the domains of adolescent life associated with young people's participation in overall PA, including health behaviours, social relationships and family activities. Consideration is also given to gender differences. Information in England was collected from 4404 students aged 11, 13 and 15 years, using anonymised self-completed questionnaires. Physical aspects of lifestyle were determined using internationally validated items for measuring PA that met international guidelines for activity and the frequency and duration of vigorous exercise undertaken during leisure activities. Separate analyses were conducted for boys and girls. Levels of PA and vigorous exercise were compared using the chi-squared test for trend. The findings draw attention to the value for the health and well-being of young people participating in some form of PA, even if they do not meet the recommended levels. Medium levels of PA appear to be associated with high levels of life satisfaction, self-rated health and an improved sense of body image. Significant health gains are likely to be made for adolescents in encouraging sedentary young people to undertake some form of PA. [ABSTRACT FROM PUBLISHER]

People with dementia have been assumed to possess weak or even no agency, so this paper provides a novel contribution to academic debate by examining their actual potential for agency. The author draws on findings from a qualitative study of everyday decision-making by people with dementia that aimed to identify the role of social factors (such as gender) in influencing their involvement in decisions. Whilst decision-making constitutes a form of deliberative agency, the research also identified when agency was alternatively habituated, embodied or emotional. The Economic and Social Research Council-funded research was undertaken in the North of England. Existing theoretical perspectives on agency are critiqued, particularly in relation to rationality, language and individualised agency. The study highlighted that people with dementia who lack deliberative capacity can nonetheless demonstrate creative capacity for agency. A more expansive concept of agency is needed in social science theory that is informed by the experiences of cognitively disabled people. [ABSTRACT FROM AUTHOR]

Background: An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support - education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). Objectives: To evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. Design: Qualitative semi-structured interviews with primary care professionals. Settings: 12 General Practices in the Northwest of England located within a deprived inner city area. Participants: Practices were approached 3-6 months after undergoing training in a selfmanagement support approach. A pragmatic sample of 37 members of staff - General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years' experience of working in general practice. Methods: A qualitative design involving face-to-face, semi-structured interviews audio- recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. Findings: The guidebooks were embedded in daily practice but the shared decision- making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; [ABSTRACT FROM AUTHOR]

This paper reports on a funded project that explored the perceptions and experiences of mentors regarding student nurse support in practice. The study employed a mixed-method approach, using questionnaires and focus groups with mentors from one acute Trust and one community Trust. The findings highlighted the multifaceted nature of student learning in practice, with mentors reporting that clinical skills, adjustment to the placement and integrating into the team were the aspects students needed most support with. Mentors were aware of their roles and responsibilities in supporting students and recognized the importance of their own personal attributes. The participants reported a number of challenges, particularly time, competing demands and paperwork, and suggested that a team approach and support groups could help to overcome these. The support for students provided by peers and health-care assistants was recognized, as was the need to ensure that students are prepared to take responsibility for their learning. [ABSTRACT FROM AUTHOR]

Schools have been identified as playing a key role in supporting the children of prisoners. This paper reports on a study, which explored the support provision offered in schools to children who experience parental imprisonment. By interviewing school representatives, stakeholders, parents and children, we illustrate the support available in schools, the issues that arise and ways in which support provision can be strengthened. Our findings indicate that children of prisoners often constitute a 'forgotten' group in schools, and we suggest that an awareness of these children and the challenges they face needs to be raised amongst education practitioners and policy-makers. [ABSTRACT FROM AUTHOR]

Background: We evaluated end of life care services in two English counties including: coordination centres, telephone advice line, ‘Discharge in Reach’ nurses, a specialist community personal care team and community nurse educators. Elsewhere, we published findings detailing high family carer satisfaction and fewer hospital admissions, Accident and Emergency attendances and hospital deaths for service users compared to controls. The aim of this paper is to discuss what contributed to those outcomes. Methods: Using realist evaluation, data collection included documentation (e.g. referral databases), 15 observations of services and interviews with 43 family carers and 105 professionals. Data were analysed using framework analysis, applying realist evaluation concepts. Findings were discussed at successive team meetings and further data was collected until team consensus was reached. Results: Services ‘worked’ primarily for those with cancer with ‘fast track’ funding who were close to death. Factors contributing to success included services staffed with experienced palliative care professionals with dedicated (and sufficient) time for difficult conversations with family carers, patients and/or clinical colleagues about death and the practicalities of caring for the dying. Using their formal and informal knowledge of the local healthcare system, they accessed community resources to support homecare and delivered excellent services. This engendered confidence and reassurance for staff, family carers and patients, possibly contributing to less hospital admissions and A&E attendances and more home deaths. Conclusions: With demand for 24-hour end of life care growing and care provision fragmented across health and social care boundaries, services like these that cut across organisational sectors may become more important. They offer an overview to help navigate those desiring a home death through the system. [ABSTRACT FROM AUTHOR]

Background A 'blended' (e-learning and facilitated workshops) training course for Group C staff (i.e. staff with relatively infrequent contact with end of life care) has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes. This paper evaluates the impact of the course on participants' understandings of and confidence in delivering end of life care in one nursing home, while also considering barriers to change in practice. Methods A mixed-methods case study approach, incorporating pre- and post-course questionnaires (SHA East of England End of Life Care Education Programme 'ABC' Project Work Force C or Non Nurse Workforce B Pre and Post Course Questionnaire; E-Learning in End of Life Care Study Pre and Post Course Questionnaire), documentary analysis, semi-structured interviews, and observation of course workshops. Participants were 20 members of staff at a nursing home in a city in the East of England, including 14 Health Care Assistants (carers) and 6 others (administrative, activities, hosting, and catering staff). The questionnaires and interviews assessed understandings of and confidence towards end of life care delivery. Results Improvements in participants' confidence in delivering end of life care were observed, particularly in the core competency areas of symptom management, communication, and advance care planning. A shift towards more detailed and more holistic understandings of end of life care was in evidence; some participants also championed end of life care in the home as a result of the course. Several barriers to changes in practice were encountered, including uneven participation, the absence of mechanisms for disseminating new insights and knowledge within the home, and a widespread perception that nurses' professional dominance in the home made sustainable change difficult to enact. Conclusions While blended e-learning courses have the potential to generate positive change in participants' understandings of and confidence about End of Life Care, organizational and inter-professional obstacles must be overcome in order to translate these changes into improved end of life care delivery in nursing (and residential) homes. [ABSTRACT FROM AUTHOR]

Purpose – Positive behaviour support has been positioned by current government policy as an important intervention for people with intellectual disabilities who display behaviours that challenge services. However, little is known about service user or carer opinions towards the use of this kind of model. The paper aims to discuss this issue. Design/methodology/approach – Opinions and experiences of 25 carers and six service users were collected through semi-structured interview as part of the evaluation of an enhanced service, Complex Behaviour Service, based on positive behaviour support principles. Findings – Content analysis indicated that the service was seen as acceptable and useful and that positive experiences of the service linked to: frequency and availability of the service; talking about behaviour and being listened to; understanding, and change in, the service user, carer and behaviour. Originality/value – This adds to the small but growing literature on service user and carer opinions towards specific interventions and highlights themes that future services could consider in delivering evidence-based care. [ABSTRACT FROM AUTHOR]

Based on qualitative research with eighty participants, this paper examines the notion of support planning, as it was experienced by people using personal budgets. The research took place during 2009–10, in three demonstration sites in England where support planning was commissioned out from local authorities into user-led organisations. In general, satisfaction with user-led support planning revolved around respectful styles of facilitation, good listening skills and the expertise brought by the experience of disabled people themselves. However, it was found that different styles of support planning were effective for different people, depending on several factors relating to their life experience, the length of time they had been disabled, the availability of family support and their connection with other disabled people. Whether social services or voluntary-sector staff are facilitating support plans, we conclude that some people need more help initially with support planning than others, and that a good model should differentiate and be flexible, to allow people to move towards independent planning at their own pace. [ABSTRACT FROM AUTHOR]