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This paper outlines the approach taken by East Renfrewshire Council to regenerate Barrhead, a typical post-industrial town in the west of Scotland. A major long-term regeneration programme began in 2006 with a view to bringing in new inward investment, creating jobs, improving health outcomes, raising educational achievement, improving house values and creating much enhanced public realm, green space and amenity within the town itself. Key issues include: deindustrialisation and the need to reinvent the purpose and function of the town in the wider Clyde Valley/Glasgow City context, how to develop a long-term approach, the stages involved and the requirement to secure political commitment, Urban Design Framework - high-quality approach, combining all the opportunities, keeping on track, when major elements are delayed or lost, measuring impacts - some unforeseen success, what would be done differently next time? [ABSTRACT FROM AUTHOR]

Purpose – The ongoing integration of health and social care in Scotland presents both challenges and opportunities. The purpose of this paper is to consider emerging enablers and barriers to integration by focusing on the views of senior stakeholders. Design/methodology/approach – This paper presented an opportunity to gain an insight into the integration movement by considering the views of key stakeholders within Scottish Local Authorities, NHS Boards and other relevant stakeholders. These insights, were collected through a combination of interviews and questionnaires. Findings – This paper highlights a number of factors key to the success of the integration agenda. These include: governing terms and conditions of existing staff; engagement of clinical and professional leads; and synthesising joint outcomes in locality planning. Acts of transformational change such as integration place particular demands upon those in leadership positions. This paper identifies key leadership strengths pivotal to driving forward change, such as effective performance management and influencing skills. Originality/value – This is one of a small number of papers addressing the scale and scope of efforts to integrate health and social care within Scotland. Integration between health services and social care continues to be a priority of the Scottish Government. [ABSTRACT FROM AUTHOR]

Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A future for pathways in mental health care in Norway - a discussion paper based on El-Ghorr et al.," by E. Biringer and M. Hartveit in an issue in 2010.

This paper evaluates the use of self-curated photo elicitation as a new method for exploring self-identity by reflecting on its design and use in a study of Scottish identity. The approach builds on the work of others in the fields of visual analysis and interpretative phenomenological analysis (IPA). Participants were style influencers who were asked to select and discuss a sample of their own Instagram posts that they felt represented their Scottish identity. The approach enabled deep and meaningful engagement with research participants and encouraged further revelations through asking them to reflect on how they went about choosing their posts. Participants spoke passionately and at length about the story behind these and began to understand more about themselves in doing so. Recommendations are made as to how self-curated photo elicitation could be used in future. It is proposed that this method is particularly adaptable to IPA research and studies of self-identity. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals.Design/methodology/approach A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced.Findings The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge.Practical implications The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working.Originality/value The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy. [ABSTRACT FROM AUTHOR]

Purpose: The Public Bodies (Joint Working) (Scotland) Act 2014 set the framework for the integration of adult health and social care services. Teams, organisations and sectors are now required to work in partnership and interdependently to deliver shared outcomes for the people they serve. The purpose of this paper is to explore any features, practices and behaviours that could influence effective partnership working across sectors. Design/methodology/approach: A questionnaire was designed and distributed to a range of stakeholders working in health, social care and the third sector. With reference to the changing health and social care reform agenda, the aims of the survey were to gather views, experiences and perceptions of working across sectors, and any workforce development needs. Findings: The majority of respondents were from the NHS (80.3 per cent, 118/147), and experiences were largely drawn from those working with the third sector. The utility of working with the third sector was positively highlighted; however, there were limited opportunities to fully engage. Whilst formal education and training was welcomed, workforce development needs were mostly related to fostering relationships and building mutual trust. Originality/value: This paper highlights views, perceptions, enablers and barriers to integrated care in Scotland. Whilst the Scottish integration landscape is currently not fully fledged, insights into prevailing attitudes towards integrated care, by a cohort of the Scottish health and care workforce, are offered. In particular, reflections by the NHS workforce to working with third sector services are discussed. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. Background Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. Design Naturalistic prospective repeated-measures mixed-methods approach. Methods Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. Results Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. Conclusions It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations. Relevance to clinical practice It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to identify barriers for people with psychotic spectrum disorders accessing CBTp in NHS Lothian. Despite national guidelines recommending CBT for the treatment of schizophrenia (National Institute for Health and Care Excellence Guidelines 2014) and (Scottish Intercollegiate Guidelines Network Guidelines 2013), levels of access to CBTp remain low. The overall goal of the study is to uncover emergent themes regarding barriers to access to CBT for patients with psychosis. In addition, the influence of psychosocial skills intervention (PSI) training for psychosis (Brooker and Brabban, 2006) will be explored and if completion of this training effects referral behaviours and attitudes to CBTp.Design/methodology/approach This study is a quantitative service evaluation project which uses a questionnaire design to explore the factors that influence a clinician's decision to refer a patient for CBTp. Three qualitative questions are included for thematic analysis to allow the respondents to elaborate on their views on potential barriers. All appropriate Community Mental Health Team (CMHT) staff in adult mental health in NHS Lothian were invited to participate in the study.Findings CMHT staff in NHS Lothian hold favourable views of CBTp and would support an increase in access for patients with psychosis. Key barriers to access for CBTp identified in this study comprise of, little or no access to CBTp, lack of integration of services and unclear referral pathways. Further themes emerging from the study also included, improving multi-disciplinary communication and increasing CMHT staff knowledge and confidence in CBTp. PSI training was shown to have a significant effect on referral rates. Further research would be warranted to explore the influence of PSI training on CMHT staff confidence and knowledge in CBTp.Originality/value This is the first paper of its kind to investigate the potential barriers to access to CBTp in Scotland. The paper has highlighted some key barriers and potential strategies to overcome the barriers identified will be discussed. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Nurses in mental health inpatient settings use a range of methods to try and help service users who self‐harmHarm‐reduction approaches are intended to help service users reduce the impact of their self‐harm rather than simply to prevent them self‐harmingHarm‐reduction techniques might be helpful for people who cut themselves because there are some clear ways harm can be minimized such as providing advice about cuttingNo one has previously tried to measure whether harm‐reduction techniques are more or less acceptable to mental health practitioners and service users than traditional methods. What the paper adds to existing knowledge?: The paper describes the development of the Attitudes to Self‐cutting Management scale. It met the criteria required of a good measurement tool.Each method of managing self‐cutting has a unique acceptability profileHarm‐reduction methods like advising on wound care and providing a first aid kit are endorsed by nurses and former service usersNurses providing sterile razors or remaining present during self‐cutting attract more divergent opinions but are preferred to seclusion and restraint. What are the implications for practice?: Nurses should talk through the approaches to management with service users and agree which techniques are preferred. Introduction: Harm‐reduction approaches for self‐harm in mental health settings have been under‐researched. Aim: To develop a measure of the acceptability of management approaches for self‐cutting in mental health inpatient settings. Methods: Stage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross‐sectional survey and statistical methods from classical test theory informed scale development. Results/Findings: At stage one, N = 27 staff and service users participated. At stage two, N = 215 people (n = 175 current mental health practitioners and n = 40 people with experience of self‐cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity and internal consistency were acceptable. The harm‐reduction approaches "advising on wound care" and "providing a first aid kit" were broadly endorsed; "providing sterile razors" and "maintaining a supportive nursing presence during cutting" were less acceptable but more so than seclusion and restraint. Discussion: The Attitudes to Self‐cutting Management scale is a reliable and valid measure that could inform service design and development. Implications for practice: Nurses should discuss different options for management of self‐cutting with service users. Harm‐reduction approaches may be more acceptable than coercive measures. [ABSTRACT FROM AUTHOR]

The Mellow Futures programme is a specially adapted parenting programme for mothers with learning difficulties that combines group work with home‐based support. This paper reports on the findings of prospective and retrospective interviews with professionals who had referred mothers to the programme in England or Scotland between 2013 and 2015. The aim was to explore their perceptions of the programme as a whole, and its impact on the mothers they had referred to it. Mothers attending the Mellow Futures programme were invited to consent for a key professional to be contacted as part of the evaluation, generally those social workers who had referred the mothers to the programme. The 'referrers' were interviewed at the start and end of the programme. Thirty referrers contributed their views on the impact of the programme. Twenty‐six were very positive about the impact of the Mellow Futures programme on the mothers: the programme was thought to have increased the mothers' confidence and self‐esteem; supported them to work through issues; and helped them strengthen their relationship‐building skills. Four referrers felt that the programme had not had any impact on the mothers they were supporting. The Mellow Futures programme focused on relationships, rather than parenting techniques, and three fundamentally important relationships in the mothers and babies' lives were targeted: the relationship/attachment between mother and baby; the supportive, ongoing relationships between the mothers in the group; and the mothers' more positive engagement with the professionals concerned with the welfare of their baby. The research confirms that, from the perspectives of referrers, linking group and home‐based support can successfully help mothers with learning difficulties to care for their children. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to reflect on five reasons why personalisation is so contested. It aims to highlight the shared themes that point to common ground between advocates and critics of personalisation. Design/methodology/approach – The paper draws on different academic and practitioner perspectives on personalisation, covering both advocates for and critics of the personalisation reforms. Findings – The paper concludes by suggesting that the development of self-directed support in Scotland has the potential to develop social care change in ways which may be palatable to both sides of the English policy debate. Originality/value – People who support and critique personalisation often write in ways which do not directly engage with the perspectives of the other side. Here the authors engage directly with the points of difference to explicate why such a diversity of perspectives exists, and how there is more common ground than might be assumed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the implementation of a physical activity (PA) scheme - Let's Motivate (LM) - within private care homes (CHs) in Dumfries and Galloway (D&G), Scotland; aiming to provide an insight into the different factors which might contribute to its success and further sustainability. Design/methodology/approach: A qualitative study is described in which one-to-one semi-structured interviews were carried out with eight key staff involved in implementing the project within two purposively sampled CHs; in order to explore their views and experiences of implementation. Findings: The paper provides an insight into the different factors which stand to both promote and impede the successful implementation of LM, within the two CHs involved. Originality/value: This paper explores a new and innovative PA initiative in CHs in D&G, Scotland. Studies exploring the factors which can both promote and impede implementation are important as they can help to usefully inform the implementation and sustainability of initiatives. [ABSTRACT FROM AUTHOR]

This paper uses analysis of interview transcripts and notes from participant observation to explore white reactions to the introduction of diversity management in a large public sector workplace in Glasgow. The paper analyses white talk about racial equality in a social context where the shaming, exclusion and demonization of disadvantaged groups including migrants, asylum seekers and the poor have ensured that issues of entitlement and race are highly charged. It is suggested that in such contexts diversity management is being wielded as a new kind of civility by middle-class people invested in the objectification of poor whites. This represents a form of class conflict over belonging within the body of whiteness that risks reinforcing rather than redressing racial resentments. [ABSTRACT FROM AUTHOR]

The global aging demographic is putting pressure on state-delivered health and social care services. As the austerity agenda in the UK cuts state-funded service provision for older people despite increasing demand, social enterprise has become a politically and economically attractive model for the sustainable delivery of some public services. Yet little is known about the impact of social enterprise on the health and wellbeing of older people. In this paper we address this gap in understanding and consider social enterprise activities as complex public health-promoting interventions. Our study aimed to understand what impact social enterprise activities had on the health and wellbeing of participants aged over 50, and also how that impact was created. To achieve this, we conducted qualitative semi-structured interviews with a sample (n = 43) of staff, volunteers, clients and carers aged over 50 who were involved in activities delivered by three social enterprises. Using a thematic analysis to explore manifest and latent themes, two antecedents of subjective younger age emerged explaining how benefit was created, namely downward social comparison and identity. The social enterprise activities we studied benefited participants' health and wellbeing, impacting positively on participants' sense of purpose, social support, connectedness and inclusion. These health and wellbeing benefits can be considered as outcomes of complex public health interventions for older people, and we relate these outcomes to beneficial conditions within the intermediary social determinants of health. We conclude by discussing the future impact of social enterprise activities and current UK policy on the structural determinants of health. [ABSTRACT FROM AUTHOR]

There is renewed interest in the place of direct work and relationship-based practice in social work. This paper explores the day-to-day direct work that happens where children and young people are 'looked after' at home, from the perspectives of children, social workers and those supervising practice. It is based on interviews with eight children and 25 professionals about their experiences. In this paper, I highlight that despite barriers, direct work, which is characterized as meaningful by children and professionals, happens and that the relationships formed between children and social workers are an important precursor to and an outcome of direct work. The research was undertaken in Scotland, and although the legislation, policy and guidance differ from other jurisdictions, the messages about direct work are relevant for practice in other countries. [ABSTRACT FROM AUTHOR]

Background: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice.Methods: Data generation was by in-depth interview with key staff exploring participant's perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory.Results: All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness.Conclusions: This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.Trial Registration: ClinicalTrials.gov, NCT01425502 . [ABSTRACT FROM AUTHOR]

The authors of this paper discuss the use of participatory and visual research methods with older adults with daily care needs in the United Kingdom. The comments made by older adults and their caregivers in focus groups provided the narrative for this paper. The authors also discuss how to engage older adults in participatory research. Nursing research and practice both involve evaluating processes to gain a holistic understanding of patients through multiple means of data collection. In other words, how do nurses give voice to otherwise silent older adults, even in cases when their strength and recall is failing? [ABSTRACT FROM AUTHOR]

A growing ageing population and an increasing reliance on information and communication technologies (ICT) to conduct activities associated with daily living means that addressing how older people learn to use ICT is timely and important. By drawing on a four-year ethnographical study with 420 older people in two different environments, this paper shows that they adopt three strategies to become successful ICT learners, while at the same time dealing with the effects of age-related changes in fluid memory: (a) linking learning to real-life needs, (b) learning collaboratively and informally, and (c) adopting appropriate memory aids. This paper also addresses the question of how valid these results will be when today's ICT-literate adult people grow older. The longitudinal aspect of the data gathered shows that older people become confident ICT learners over time, that the learning strategies and cognitive-related difficulties are mostly time-persistent, and that their life experience is always important in learning transfer. Implications for providing older people with a more integrated approach to ICT learning are discussed. [ABSTRACT FROM PUBLISHER]

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The professional status of UK healthcare chaplains remains partial, with voluntary accreditation effective in achieving around 50% registration. This study set out to elicit reasons for this by surveying healthcare chaplains working in Scotland. An online survey was created to gather demographic details and chaplains' opinions on the importance of five key elements of professional status: A body of knowledge that underpins practice; A code of professional ethics; An occupational organization controlling the profession; Substantial intellectual and practical training; and Provision of a specialized skill or service. Most respondents (38/43) agreed that chaplains should belong to a professional body in order to maintain standards, ensure accountability and formalize professional development. They said that registration reinforced their professional status, added credibility and a clear governance structure to protect the public. However, a minority felt disconnected from the professionalization agenda. This paper discusses the reasons for this. Further UK and international studies into the professional status of chaplains are planned. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore implementation and development of step-down intermediate care (IC) in Glasgow City from the perspective of staff. Design/methodology/approach: The study used qualitative methods. Nine key members of staff were interviewed and three focus groups were run for social work, rehabilitation and care home staff. Framework analysis was used to identify common themes. Findings: The proposed benefits of IC were supported anecdotally by staff. Perceived enablers included: having a range of engaged stakeholders, strong leadership and a risk management system in place, good relationships, trust and communication between agencies, a discharge target, training of staff, changing perception of risk and risk aversion, the right infrastructure and staffing, an accommodation-based strategy for patients discharged from IC, the right context of political priorities, funding and ongoing adaptation of the model in discussion with frontline staff. Potential improvements included a common recording system shared across all agencies, improving transition of patients from hospital to IC, development of a tool for identifying suitable candidates for IC, overcoming placement issues on discharge from IC, ensuring appropriate rehabilitation facilities within IC units, attachment of social work staff to IC units and finding solutions to issues related to variation in health and social care systems between sectors and hospitals. Originality/value: The findings of this study help the ongoing refinement of the IC service. Some of the recommendations have already been implemented and will be of value to similar services being developed elsewhere. [ABSTRACT FROM AUTHOR]

Background: Preschool language and behavioural difficulties impact on multiple domains of the child's early life and can endure into adulthood, predicting poor educational, social, and health outcomes. Highlighting risk factors associated with poor outcomes following language and behavioural difficulties raised in early childhood may facilitate early identification and intervention. Methods: Data from the Growing Up in Scotland national birth cohort study were used. Language and behavioural difficulties were assessed at age 4 years using parent‐reported language concerns and the Strengths and Difficulties Questionnaire. Measures of adjustment were collated into four key outcome domains: attitude to school life, language and general development, behaviour, and general health at age 6 years. Both univariate and multivariate logistic regression models were fitted in order to explore independent associations between language and behavioural difficulties at age 4 years and adjustment to life circumstances at age 6 years, whilst controlling for other risk factors. Results: Language difficulties at age 4 years increased the odds of the child experiencing difficulty with language and general development, poorer health outcomes, and behavioural difficulties at age 6 years. Behavioural difficulties alone at age 4 years were associated with increased odds of the child experiencing all of the aforementioned outcomes and difficulties in early school life. Lone parent family, low income, and male gender were identified as risk factors for poorer outcomes in the domains measured. At age 4 years, there was no additive effect found with the presence of behaviour difficulties on the relationship between language difficulties and language and developmental outcomes at 6 years. Conclusions: This paper demonstrates language and behavioural difficulties are associated with poor social, educational, health, and behavioural outcomes. Taking seriously parent‐reported concerns and identifying risk factors could limit negative outcomes for the child, their family, and society. [ABSTRACT FROM AUTHOR]

This paper analyses how middle managers perform and experience their role in enacting policy in Scottish higher education institutions. The policy focus is the quality enhancement framework (QEF) for learning and teaching in higher education, which was launched in 2003. The data-set was collected between 2008 and 2010, during the evaluation of the QEF by means of focus groups with middle managers at nine Scottish institutions. The metaphor of a policy implementation staircase helps to situate middle managers’ position in enactment, and analyse their experience of the role. Despite the values of collegiality and ownership upheld by the QEF, middle managers’ accounts of their practices reveal that their position at the interface between university management and core academic activities continues to be a delicate one, marked by contradictory allegiances to institutional strategies and the concerns of academic colleagues. While emphasising middle managers’ pivotal role in the implementation of the QEF policy, the data paradoxically suggest that the systemic positioning of middle managers is more influential in shaping their role of mediation than the values of collegiality and ownership promoted by this enhancement approach to quality specific to Scotland. [ABSTRACT FROM PUBLISHER]

This paper presents findings from a qualitative study of a group of 12 teachers in primary special schools in Scotland for children with moderate learning difficulties. It sets out an analysis of classroom observations and interviews that explored teachers' knowledge and beliefs about teaching and learning in mathematics with children with moderate learning difficulties. The teachers were interviewed pre- and post-intervention; this was a research-based professional development programme in children's mathematical thinking ( Cognitively Guided Instruction) which teachers then developed in their classrooms. The findings showed that prior to the professional development, the teachers had a limited knowledge of children's mathematical development with teaching frequently informed by intuitive beliefs and dated and sometimes discredited practices. Most teachers had low expectations of children with learning difficulties. Post-intervention, the teachers reviewed this stance and affirmed that a deeper understanding of children's mathematical thinking provided a more secure knowledge base for instruction. They also recognised the extent to which learners were constrained by existing classroom practices. The paper argues for the commonality of this knowledge base and considers the problematic nature of viewing such knowledge as sector specific. [ABSTRACT FROM AUTHOR]

Purpose - To consider the power of psychological well-being, empathy and coping style in predicting staff attitudes towards young people in looked after accommodation, involved in or at risk of offending behaviour. The purpose of this paper is to understand more about staff attitudes which have a significant role in the care and rehabilitation of this client group. Design/methodology/approach - Psychological well-being, empathy and coping style are discussed in terms of their impact on attitudes towards young people. The predictive power of each factor is considered using multiple regression analysis of participants' responses on an adapted version of the Attitudes to Prisoners (ATP) scale, the General Health Questionnaire (GHQ), the Interpersonal Reactivity Index (IRI) and the Coping Styles Questionnaire (CSQ). Findings - Multiple regression analyses showed that empathic concern (affective empathy) was the only factor predictive of attitudes towards young people. The paper discusses the applied implications for employers, including the possibility of empathy training for staff members and highlights the need for further consideration of the factors impacting on staff attitudes. Practical implications - The outcome suggests that empathy may serve as a protective factor against the development of negative attitudes. This highlights the importance of fostering staff empathy and the possible use of empathy training. Originality/value - The research findings question the robustness of the relationships between staff psychological well-being, empathy, coping styles and attitudes towards their client group. The outcome suggests that empathy may serve as a protective factor against the development of negative attitudes. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to highlight the importance of Make Every Moment Count (MEMC) and explain the development of it. Design/methodology/approach -- A working group of representatives from key organisations in Scotland developed the resource MEMC. It was tested out in a variety of care settings and issued to all care homes for older people and care at home services in Scotland. Findings -- The paper highlights the importance of participating in day-to-day life on health and well-being and provides feedback from care staff on using the resource. Practical implications -- The resource is for all those supporting someone to engage in day-to-day life. A lot of good care is given however sometimes the small, everyday interactions are taken for granted and people need reminded about the big difference this can make to someone's life. Social implications -- MEMC has the potential to begin to change culture -- to rethink "activity" which is often thought of as planned organised events to everyday activities and interactions. Originality/value -- This paper describes an initiative which sets out to remind us all of the importance of basic human rights -- dignity, respect and choice. [ABSTRACT FROM AUTHOR]

Abstract: Health and social care integration has been a long‐term goal for successive governments in Scotland, culminating in the implementation of the recent Public Bodies (Joint Working) Scotland Act 2014. This laid down the foundations for the delegation of health and social care functions and resources to newly formed Integrated Joint Boards. It put in place demands for new ways of working and partnership planning. In this article, we explore the early implementation of this Act and how health and social care professionals and the third sector have begun to renegotiate their roles. The paper draws on new empirical data collated through focus groups and interviews with over 70 professionals from across Scotland. The data are explored through the following key themes: changing cultures, structural imbalance, governance and partnership and the role of individuals or “boundary spanners” in implementing change. We also draw on evidence from other international systems of care, which have implemented integration policies, documenting what works and what does not. We argue that under the current framework much of the potential for integration is not being fulfilled and that the evidence suggests that at this early stage of roll‐out, the structural and cultural policy changes that are required to enable this policy shift have not yet emerged. Rather, integration has been left to individual innovators or “boundary spanners” and these are acting as key drivers of change. Where change is occurring, this is happening despite the system. As it is currently structured, we argue that too much power is in the hands of health and despite the rhetoric of partnership working, there are real structural imbalances that need to be reconciled. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to assess unit manager perspectives on the introduction of a group-based trauma-specific programme delivered across Scotland’s secure estate. As this was the first time such an estate-wide initiative had occurred, it was important to identify the benefits/challenges at a strategic level.Design/methodology/approach An exploratory qualitative case study was utilised involving semi-structured interviews with five senior unit managers in three secure units to discover their perceptions of the benefits and challenges of implementing Teaching Recovery Techniques (TRT). A quasi-qualitative analysis was used to quantify and give meaning to manager responses. Inter-rater reliability of analysis was assessed.Findings Unit managers perceived gains in trauma-informed knowledge for themselves, and knowledge and skills gains for programme workers, care staff and adolescents. Challenges involved: managing a shift in paradigm to include a trauma-specific programme; the limiting context of competitive tendering; short duration placements; and the need for psychoeducation for staff, parents and agencies.Research limitations/implications Large sample sizes are likely to identify further issues for unit managers. Manager perceptions need directly compared with staff and adolescent perceptions and included in randomised control trials of trauma-specific programmes.Practical implications Managers perceived that TRT needed to be delivered within trauma-informed organisations and identified the need for manager training in traumatisation, trauma recovery and organisational implications to guide strategic planning. Managers emphasised the need for psychoeducation for families, staff and agencies.Originality/value The current study is the first in Scotland to explore unit manager experience of introducing a trauma-specific programme across the secure estate. [ABSTRACT FROM AUTHOR]

This paper explores the use of critical reflection in reviewing my professional development in a West of Scotland university. The paper explores my development against the changing socio-political, cultural and educational landscapes in the Scottish HE sector. The first part addresses my development as a professional educator, citing seminal experiences that have been influential in my thinking and practice. It examines how social interaction, engagement with peers, the HEA subject centre and students helped form and reform my professional identity, allowing me to develop a robust sense of professional autonomy. The second part explains how the process of critical reflection has led to a deeper understanding of how I reconnect with the moral dimension of professional academic practice. [ABSTRACT FROM PUBLISHER]

This paper reports findings from an exploratory qualitative study concerning end-of-life support for family carers in an acute ward setting. The participants included bereaved carers of patients who had died in an acute ward or hospice, as well as health professionals. Interviews and focus groups were used to collect data. The study provides insights into the perceptions and needs of carers at the end of life and the challenges these present for nursing staff in an acute ward. This paper focuses on one key theme incorporating issues around communication between family and nursing staff and the availability of practical facilities. It provides information that may be beneficial to hospital staff who work in acute areas where there is an expectation they will support carers around the time of death. [ABSTRACT FROM AUTHOR]

Objectives This paper outlines a model developed by NHS Education for Scotland to pilot consultant appraiser training. The training was aimed at both new/inexperienced appraisers and experienced appraisers. A Course for New/Inexperienced Appraisers was held over 2 days and the Experienced Course over 1 day. Both are described, as is an initial tutor induction day designed to recruit consultant tutors who could contribute to delivering the courses. A thorough qualitative evaluation of the courses was undertaken and this is reported. The paper also discusses the desirability and implications of rolling out the pilot on a wider scale. Method A qualitative evaluation design using interviews to collect feedback from participants who had attended all three courses - the Induction event, the Inexperienced Appraiser Course and the Experienced Appraiser Course - was employed. Telephone interviews were transcribed and analysed using framework analysis and aided by NVivo 7. Results The response of those interviewed for this evaluation of the three courses was very positive. The content, organization, skills of the tutors and usefulness of the courses were commended. Suggested improvements were relatively minor and included: introducing more material on the requirements of revalidation, more small group discussions and making the course more secondary care-orientated. However, it was recognized that with the requirements for 'enhanced' appraisal and revalidation still uncertain, this created difficulties and the course would evolve to take account of further developments. Conclusions The training piloted represents an effective way to train consultants in appraisal skills. Interviewees were supportive of the pilot being continued: either nationally or cascaded down locally. Exactly what model is achievable and desirable will depend on the number of appraisers to be trained and the availability of resources to support 'enhanced' appraisal in secondary care. [ABSTRACT FROM AUTHOR]

This paper describes the relationship that exists between Scotland and its diaspora and the ways in which this has changed since the advent of devolution. Based on interviews carried out primarily in the United States, it explores how members of the diaspora have adopted a less historical and sentimental approach to their ‘homeland’ and are increasingly knowledgeable about Scottish constitutional change. In part this has resulted from the growth of the internet and the ease of finding out about developments in Scotland itself, as well as the greater ease and affordability of travel back to Scotland. But, most importantly, the existence of a government in Edinburgh has allowed Scottish politicians and organizations to engage with the diaspora in events such as Tartan Day, in a way in which London-based politicians were never likely to do. Tourist developments promoted by the Scottish government, such as the Year of Homecoming in 2009, have also been highly significant. Thus links between Scotland and its diaspora have been changed and strengthened in various ways. [ABSTRACT FROM PUBLISHER]

Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness. Following an oral health and psychosocial needs assessment of 853 homeless people across Scotland, the Smile4life Intervention was developed and rolled out across all NHS boards. Dental health and health and social care practitioners were invited to attend a training event at the launch of the Smile4life: Guide for Trainers -- a training guide for practitioners working with homeless people. This paper presents results from HoPSCOTCH, a pilot study that took place in four NHS boards to examine the benefits of training for practitioners regarding their awareness of homelessness and the oral health needs of homeless people. Dental health (baseline: 10; follow-up: 8) and health and social care practitioners (baseline: 13; follow-up: 12) completed questionnaires about their knowledge, attitudes and behaviours. The results showed that there were increases in practitioner knowledge, confidence and motivation to help service users access dental care, to provide oral health education and to use motivational interviewing. The authors recommend that future training for practitioners who work with homeless people should include communication skills and advice on how to deliver tailored interventions, with the aim of strengthening practitioners' confidence and motivation to deliver the Smile4life intervention. [ABSTRACT FROM AUTHOR]

Background: The consequences of the move towards a primary-care-led NHS are shifts in activity from secondary care to primary care and more involvement of GPs in purchasing decisions. Although there are many anecdotal reports of an increasing primary care workload, there is little empirical evidence on the extent of such shifts. This paper reports the results of a survey of GPs in Grampian, in the north-east of Scotland, in which we attempted to gather information on the effects of shifts in the balance of care on general practice.Objective: We aimed to examine GPs perceptions of the extent to which general practice workload has changed due to planned and unplanned shifts in the balance of care.Methods: The design of the study was a self-reported questionnaire, which was administered in general practices in the Grampian Health Board, Scotland. The subjects were senior partners of all general practices and the main outcome measures were the types of changes which have taken place in general practice, their source, their effect on practice workload and how practices have reacted.Results: A 60% response rate was achieved (52/86); 85% (44/52) of GPs claimed that their workload had increased due to shifts in the balance of care and that 72% of the shifts were initiated outside the practice. Geriatric care, early discharge and psychiatric and psychology services, as well as nursing home care, were reported to have had the greatest impact on workload. The main aspects of practice workload which had increased included the number of GP consultations, general stress at work and number of home visits, whereas the net income of the practice and health outcome of patients were reported to have decreased. Practices have dealt with the increase in workload by shifting tasks from GPs to nurses and absorbing the workload into existing practices/patterns. Responders reported that ideally more nursing and GP staffing would be required. Overall, GPs welcomed the shifts in the balance of care, were more concerned about poor communication rather than actual increases in workload and claimed that morale had fallen.Conclusion: GPs perceive that the move towards a primary-care-led NHS is increasing the workload in general practice. If the shift in the balance of care away from secondary care is to be successful, then more information is required about such shifts to support practices as change continues. [ABSTRACT FROM AUTHOR]

In the United Kingdom, undertaking continuing professional development (CPD) is required for revalidation with regulatory authorities for general practitioners, general practice nurses and registered pharmacy staff – pharmacists and pharmacy technicians. A survey of CPD preferences and activities of these four professions has been published and this paper focuses on one qualitative question in the survey: 'Please describe any changes that you anticipate in the way in which you will undertake CPD over the next 12 months.' Responses were analysed using content analysis, then codes and themes were developed into a coding framework. 1,159 respondents provided comments to the question and five themes were identified: options for learning, time, appraisal and revalidation, people in transition and use of technology. There was a desire for face-to-face courses, for interactive learning and for variety of learning methods. Respondents valued learning with others and Practice-Based Small Group Learning was considered to be flexible and promoted inter-professional learning and socialisation. Lack of time for learning was seen as a barrier for respondents. Respondents considered that CPD was needed to support them as their roles developed in primary healthcare. [ABSTRACT FROM AUTHOR]

The medicalisation of the behaviour of children is a phenomenon that is attracting growing attention, with particular concern about the increased likelihood of children living in disadvantaged contexts receiving a medical diagnosis, such as attention-deficit hyperactivity disorder, and treatment. This paper reports on a study of professionals involved with children experiencing behavioural problems. The professionals interviewed in this study articulated their own reservations about the medicalisation of children’s behaviour and revealed a number of strategies for interrupting the process towards diagnosis. These interruptions, analysed using Deleuze and Guattari’s concept of deterriorialisation, took place along linguistic, visual and affective planes and were successful in encouraging teachers and head teachers to see alternatives to the medical route. The findings have implications for existing practice in the response to, and support for, behavioural problems and for teacher education. [ABSTRACT FROM PUBLISHER]

Purpose - The purpose of this paper is to evaluate the organisational impact of the New to Forensic Mental Health education programme, developed for use across all forensic services in Scotland. To date, 267 have been trained as a trainer or mentor; 502 have completed the programme and 375 are yet to complete. The programme is designed to promote self-directed learning and is multi-disciplinary and multi-agency in approach. It includes case studies and problem-based learning relating to patients in a variety of settings, from the community to high secure care. Design/methodology/approach - As part of a larger longitudinal study to assess the value of this New to Forensic Mental Health education programme, organisational impact was assessed using semi-structured interviews with (n = 13) senior staff working in forensic services. Participants were purposively selected for interview. Findings - Transcripts were analysed using thematic analysis, which revealed three themes: "Acquiring knowledge: what you learn and how you learn", "Developing skills" and "Shift in attitudes and behaviour. The results demonstrate the positive impact the programme has had at an organisational level and what changes can occur when staff become more knowledgeable, skilful and confident. The implications for practice, along with the limitations of the study, are discussed. One of the weaknesses of this type of analysis is that it is always dependent on the analyst's interpretation, and is thus the product of that person's bias, filters or prejudices. Originality/value - This evaluation is one of the limited few that explore organisational impact of an education programme. [ABSTRACT FROM AUTHOR]

Over the last 25 years, shortfalls in health care funding and a growing shortage of nurses entering the operating theatre (OT) has driven the development of roles for qualified, non-nursing personnel. Yet, historical differences in training and scope of practice of nurses and non-nursing personnel have influenced the convergence of these roles in providing competent patient care in the OT. This paper compares operating department practitioners (ODPs) and OT nurses' levels of perceived perioperative self-competence. A consecutive sample of 428 perioperative practitioners (ODPs and nurses) across three NHS trusts in Scotland was surveyed in 2011. Perioperative competence was assessed using a 40-item instrument comprising six subscales: foundational knowledge and skills, leadership, collaboration, proficiency, empathy, and professional development. The survey response rate was 50%. Internal consistency for the scale and its six competence domains was high, with Cronbach's alpha ranging from .73 to .95. Both groups reported their competence as high across all subscales. There were significant differences between the two groups in foundational knowledge and skills (p=.002), and empathy (p<.0001). These results suggest that there are more similarities than differences between ODPs and nurses. However, a defining difference lies in nurses' capacity to demonstrate "caring" skills that extend beyond those with a technical orientation. [ABSTRACT FROM AUTHOR]

Drawing on data from a Scottish research study, this paper explores the relationship of professionals’ perceptions about specific perpetrators and victims to their constructions of ‘adult protection’ issues in practice. It finds that professionals’ perceptions of victim distress did not consistently coincide with the construction of adult protection issues, whilst the connection to any assessment of victims’ heightened vulnerability in specific cases was not clear. With respect to perpetrators, implicit practice rules were evidenced which differed from explicit policy criteria. In particular, there were different rules for relatives, staff and service user perpetrators, whilst harms attributed to institutions were de-emphasized. Explanations of the findings are advanced based on the complex power relations underpinning practice but unacknowledged in policies. More research is recommended to deepen this analysis in a changing policy context, to foreground service user perspectives, and to contextualize harms potentially resolvable through adult support and protection/safeguarding routes with respect to harms better addressed in other ways. [ABSTRACT FROM PUBLISHER]

T olson D and S chofield I. Nursing Inquiry 2012; 19: 63-70 Football reminiscence for men with dementia: lessons from a realistic evaluation A major challenge of studies of non pharmacological dementia interventions is the likely modest intervention effect size and difficulties collecting data from individuals with behavioural, psychological and communicative symptoms. The reported Realist Evaluation is built around sets of contextually comparable case studies of Football Focussed Reminiscence for men with dementia. The study aim was to evaluate benefits of football related reminiscence for individuals and family carers. Four case studies were constructed; two community groups, one nursing home groups and individual sessions within their family home. Data was collected as field notes from non-participation observation of reminiscence sessions, notes of conversations with people with dementia, audio recorded interviews with family members, facilitators and dementia link workers. The analysis was framed around identification and extraction of data pertaining to Context-Mechanism-Outcome configurations within each data set, and patterns and threads were compared across the cases. An important finding was that anticipation of pleasure in tandem with a sense of continuity appeared to be important mechanisms triggering optimal benefit. The paper explores design considerations, project delivery experiences and the contribution that innovative theory driven research adds to the study of complex interventions including those with behavioural and communicative symptoms of dementia. [ABSTRACT FROM AUTHOR]

Context: This paper reports on a qualitative study looking at the perceptions of clients who use drugs and are on low income. Research suggests that counselling services can experience difficulties in reaching and retaining such clients, and outcomes of counselling can be disappointing. Aim: To learn from clients who had engaged in counselling for over six months what difference it had made to their lives. Method: Grounded theory methodology was used to analyse semi-structured interviews with six participants. Findings: Findings included changes in the clients' internal world, their connectedness with society, their familiarity with counselling, and their perception of the relationship with the counsellor. Factors within the counselling process which helped and hindered change were identified. The study documents how participants were able to use counselling to improve their lives. [ABSTRACT FROM AUTHOR]

Aim. The paper is a report of one aspect of a hermeneutic study of lesbian women's experiences of maternity care, specifically interpretations of negative experiences. Background. There is a growing body of literature in relation to lesbian women's experiences of maternity care. Although most commentators discuss the negative experiences encountered by lesbian mothers, there has been no contextual analysis of these expressions of negativity in an increasingly positive environment. Methods. The study was undertaken using a qualitative approach using an adapted Gadamerian hermeneutic phenomenology using unstructured interviews with eight women. The interviews took place between November 2007 and March 2008. All of the participants had disclosed their sexual orientation in pregnancy. Snowball sampling was used. The data were then analysed using an iterative hermeneutic framework. Findings. The participants not only described their experiences of maternity care as being positive but also offered examples of negative experiences. These were analysed separately to explore the ways in which the women made sense of them in the context of an otherwise positive experience. These experiences were expressed in ways that distanced the negative and that seemed to rationalize behaviour or ascribe it to the health professional. Conclusions. Negative encounters with health professionals are processed by women in a way that protects their overall experience. Health professionals in maternity care should consider the impact of negative responses to lesbian mothers and the effect that it has in reducing the overall quality of this significant life event. [ABSTRACT FROM AUTHOR]

Abstract: Teenage parenthood is problematised in the UK. Attention is increasingly falling on the potential or actual father yet we still know relatively little about young men’s experiences and attitudes in this area. This paper focuses on the experiences of, and attitudes towards, pregnancy and fatherhood amongst a sample of men incarcerated in a Scottish Young Offender Institute. In-depth interviews were conducted with 40 inmates, aged 16–20, purposively sampled using answers from a questionnaire administered to 67 inmates. Twelve men reported eighteen pregnancies for which they were, definitely or possibly, responsible. All but one of the pregnancies were unplanned. Five of the men were fathers: two were still in a relationship with the mother of their child and were in close contact with her and the child while incarcerated, three, all of whom had separated from their partner before the birth, had had patchy contact with mother and child before and/or during their sentence. All five of the men expressed a strong desire to be ‘a good father’. Amongst the interview sample as a whole, most said they did not feel ready to become fathers. The main reason given was being unable to fulfil what they regarded as the key role of financial provider. Most of the men had given little or no thought to the possibility of a sexual partner becoming pregnant. Contraceptive use was high, however, amongst the minority who reported thinking about this possibility. The paper concludes by considering the cultural context of the men’s attitudes and the potential for intervention development for incarcerated male young offenders in the areas of Sex and Relationships Education and parenting. [Copyright &y& Elsevier]

This paper examines the extent to which student teachers' attitudes towards inclusion change over the course of a four-year Bachelor of Education programme in Scotland. Using a mixed methods design, the study employed a quantitative survey, a qualitative interview and survey to obtain data from two cohorts of student teachers. Results indicate significant changes in student teachers' attitude towards educational inclusion. The student teachers' conceptualised inclusion as an interrelated component of support, belongingness, sensitivity and fairness. Their evaluation shows that programme inputs on inclusion contributed to an enhancement of their attitudes and understanding. However, there is a need for further practical knowledge in the area of inclusion. [ABSTRACT FROM AUTHOR]

Background: It is widely accepted that service users should be actively involved in new service developments, but there remain issues about how best to consult with them and how to reconcile their views with those of service providers. Aims: This paper uses data from The Aphasia in Scotland study, set up by NHS Quality Improvement Scotland to identify the direction of the development of services for people with aphasia in Scotland. It examines the views both of those who provide and of those who receive those services. Methods & Procedures: The study integrated findings from a questionnaire to all speech and language therapists treating people with aphasia across Scotland with findings from focus groups with service users and aphasia practitioners. Outcomes & Results: Three themes were identified: (1) public and professional awareness of the impact of aphasia on the individual and their family; (2) current service provision and gaps in services; and (3) directions for the future development of services and barriers to change. Although the impact of aphasia is well recognized amongst most professionals (that is, not just speech and language therapists), considerable concern was expressed about the level of knowledge amongst professionals who do not specialize in stroke care and about public awareness of aphasia. Service providers indicated a shift in the model of service delivery of which the service users were largely unaware. Although the majority of speech and language therapists spend most of their time providing one-to-one therapy, and this is valued by service users, there is undoubtedly an emerging shift towards a focus on broader social function and the inclusion of the person with aphasia in supportive social networks. This creates tensions because of the existing pressure for individualized models of delivery. Concern was expressed by practitioners, although not echoed by patients, about the transition from the acute sector to primary care. Practitioners also expressed concern about the introduction of more recent services like NHS 24 and e-health initiatives, which rely on means of communication that may be particularly challenging for people with aphasia. Conclusions & Implications: The findings from this study indicate that although there are clearly common perspectives, the views of people with aphasia about services do not necessarily coincide with those of service providers. This is an important consideration when initiating consultation and highlights the need for clarity on the part of practitioners in identifying the aims and objectives of their ervices as far as people with aphasia are concerned. [ABSTRACT FROM AUTHOR]

This paper is based on a mainly qualitative study of 22 recently married or cohabiting Scottish couples who have set up home together. The research focuses on their food shopping habits in this period of transition as they adjust to living together. Despite the increased involvement of men the findings suggest that much of the responsibility for food shopping still fell on the women in the study. Control over what was bought raised some interesting questions about the concept of the woman as 'gatekeeper' and primary target for food marketers. [ABSTRACT FROM AUTHOR]

The comprehensive analysis of social identity cannot simply focus on individuals' cognitive self‐definition. Rather it should also theorize the social conditions that affect individuals' opportunities to act in terms of those self‐definitions. We argue that the social distancing interventions associated with Covid‐19 provide an opportunity to explore the significance of otherwise taken‐for‐granted social factors which routinely support and sustain individuals' identity enactments. Using qualitative data gathered with 20 members of the Scottish Muslim community (19 diary entries and 20 post‐diary interviews), we explore their experiences of restricted access to community‐relevant social spaces (e.g., mosques and prayer rooms). Our analysis shows that while these regulations could result in new opportunities for Muslims' religious identity enactments, they also impeded their abilities to act in terms of their religious identification. Addressing such impediments, we develop our understanding of the contextual factors that shape individuals' abilities to enact identity‐defining norms and values. [ABSTRACT FROM AUTHOR]

This article explores children's understanding of the role that neighbourhood plays in their health and well-being. Whilst evidence exists on the relationship between the environment and children's health, we have little knowledge of this from the perspective of children themselves. Children's experiences are all too frequently researched through the eyes of adults. Following a Rights of the Child framework, respecting children's views and giving them due weight, this paper reports from a project that worked with children from two relatively deprived urban neighbourhoods in Scotland. Using this framework, the children themselves were the researchers who designed the themes, decided upon the methods, conducted the research and analysed the resulting data. Using focus groups, visual mapping and community walks the children explored their local neighbourhoods and the findings reveal features of the environment that the children perceive as important for their health and well-being. The children selected three themes to explore in the research: safety, littering, and family and friends, through which they elicit their experiences, feelings and attitudes towards the environment and their well-being. The paper reveals that not only do the children have a deep understanding of the link between environment and health, but that they also understand how aspects of disadvantage, including place-based stigma, can limit their social participation and inclusion in society. We conclude with recommendations made by the children themselves, ranging from access to affordable activities, improved open spaces, 'support not stigma' and the need to be heard in local decision making. • Children understand the relationship between neighbourhoods and health. • Three key themes were highlighted: safety, littering and family and friends. • Place-based stigma and exclusion may limit children's social participation. • The 'in place' experiences of children are important for health research. • Children can play a role in creating places to improve their health and well-being. [ABSTRACT FROM AUTHOR]