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The purpose of this study is to explore the support needs surrounding intimate relationships and sexuality of autistic adults accessing funded social care in England.

Semi-structured interviews with 15 autistic adults who were accessing funded social care examined their support needs surrounding intimate relationships and sexuality, with subsequent data analysis using reflexive thematic analysis.

Four themes were generated: Help at hand, but not too close for comfort, No “cookie-cutter rules”: personalised, inclusive approaches, Playing it safe, not leaving it too late, and Autism-informed education and support.

The authors produced an online learning module for social care staff in England on best practice in supporting autistic adults without learning disabilities with relationships and sexuality.

To the best of the authors' knowledge, there has been no other UK-based research published to date on the social care support needs of autistic adults without learning disabilities surrounding relationships, gender and sexuality.

Institutional abuse is a worldwide phenomenon with the UK also subject to several high-profile abuse scandals perpetuated on people with learning disabilities and/or mental health conditions living within institutional settings. This study aims to provide a broad perspective of safeguarding practices within institutional care to inform practice and service development in this area.

A narrative overview was undertaken of a range of empirical evidence, discussion papers, enquiry reports, reports from regulatory bodies and professional guidance to explore safeguarding practices within institutional care for individuals with learning disabilities and/or mental health conditions.

A range of literature was identified that exposed and explored abuse in this context. Three key themes were identified: failings within institutional care; safeguarding issues and concerns; and good practice within institutional care. Whilst guidance is available, standards are explicit and protocols facilitate improvement potential in this area, a consistent message was that statutory recommendations for reform have not been effective.

This paper provides an important resource for practitioners and service providers involved in institutional care. An accessible overview of both the empirical evidence and grey literature on adult safeguarding within institutional settings is provided, along with a range of standards and resources that specify practice in these settings.

Recruitment to social care roles can be the weakest link in many integrated systems, with vacancy rates being very high compared to other sectors, especially in remote and rural places. Analysis of Employer Value Propositions (EVPs) in social care can capture and challenge perceptions of care work.

This study of EVP in four organisations in a rural setting in Scotland focussed on young people as a target demographic. This study interprets recruitment challenges in social care in three contexts, the technical-instrumental, the hermeneutic and the emancipatory.

EVP articulation is at present not effective. Refreshed and new messaging has potential to attract, employ and nurture young people to the social care sector in remote and rural places.

Recruiting to social care vacancies is crucial for sustainable social care. Improving the recruitment of young people is a key part of the longer-term solution. More studies on recruitment in a variety of remote and rural contexts, with a range of demographics, are needed.

The potential impact is attracting more young people to the social care workforce, enhancing capacity for integrated care improving lives for people who receive care and for paid care workers and unpaid carers.

Remote and rural areas often feature a generational imbalance, with more older people from in-migration and fewer young people from out-migration. Employment in social care has the capacity to redress that to some extent.

This study is original in outlining the messages and methods that can be adopted to boost recruitment to social care.

The purpose of this paper is to consider what safeguarding responses to discriminatory abuse and hate crime might learn from existing research on restorative justice and to drive practice development based on available evidence.

This paper is based on a scoping review of literature using four academic databases and reference harvesting. This comprised a critical appraisal of 30 articles, which were thematically analysed to appreciate the benefits and challenges of restorative justice responses to hate crime and how this might inform safeguarding responses to discriminatory abuse and hate crime.

The analysis identifies four domains where learning can be drawn. These relate to theory on restorative justice; restorative justice practices; perspectives from lived experience of restorative justice and hate crime; and an appraisal of critiques about restorative justice.

This paper connects the emerging evidence on restorative criminal justice responses to hate crime to the “turn” towards strengths-based practices in adult safeguarding. Although this provides a fertile environment for embedding restorative practices, the authors argue certain precautions are required based on evidence from existing research on hate crime and restorative justice.

Significant funding has been made available in the UK for social, behavioural and design research that aims to improve health and wellbeing for older adults. The growing importance and use of participatory and co-creative approaches in this field not only reflects a general turn in social research but also seeks to redress power imbalances between researchers and researched. This paper aims to use Miranda Fricker’s concept of “epistemic injustice” as a lens to describe the author’s experience with one such project, and highlight the cautions and considerations that must be made when navigating, handling and amalgamating “other people’s knowledge”.

Personal and theoretical reflection. Primary data for this paper consists of first-hand insider observations on how different forms of knowledge were treated in an interdisciplinary, intersectoral participatory research context.

Some participatory studies are hampered by insufficient consideration for a range of ways of thinking, including between researchers and participants, younger and older adults, different academic disciplines or academia and industry. This can harm project integrity and outcomes, potentially eroding trust in academic research.

By reflecting on a recent participatory study in healthy ageing, this paper outlines a theoretical basis to increase the benefits of working with different stakeholders across health and care, design, business and academia. It concludes by suggesting ways that researchers might address epistemic injustice, and so recognise and properly value the range of knowledge types encountered in participatory research.

This research was conducted as part of a PhD study. The purpose of this paper is to explore the factors taken into consideration when multi-agency practitioners were considering financial harm in the context of adult protection and how this influenced their decision-making processes.

An adapted q sort methodology initially established the areas of financial harm considered to have additional factors, which led to complexity in adult protection decision making. These factors were further explored in individual interviews or focus groups.

The data identified that the decision-making process varied between thorough analysis, rationality and heuristics with evidence of cue recognition, factor weighting and causal thinking. This highlighted the relevance of Kahneman’s (2011) dual processing model in social work practice. Errors that occurred through an over reliance on System 1 thinking can be identified and rectified through the use of System 2 thinking and strengthen social work decision-making.

This paper considers the practice of multi-agency adult protection work in relation to financial harm and identifies the influences on decisions.

This study aims to co-develop a Frailty, Health and Care Needs Assessment (FHCNA) questionnaire for people experiencing homelessness and explore the feasibility of its use by non-clinical staff in homeless hostels.

The FHCNA, aimed at identifying frailty and other health and care priorities for people experiencing homelessness, was co-designed in workshops (online and in person) with homelessness and inclusion health staff. Its feasibility was tested by staff and their clients in two hostels, with pre- and post-study focus groups held with hostel staff to gain input and feedback.

The FHCNA was co-developed and then used to collect 74 pairs of resident and key worker inputted data (62% of eligible hostel residents). The mean age of clients was 48 years (range 22–82 years). High levels of unmet need were identified. Over half (53%) were identified as frail. Common concerns included difficulty walking (46%), frequent falls (43%), chronic pain (36%), mental health issues (57%) and dental concerns (50%). In total, 59% of clients reported difficulty in performing at least one basic activity of daily living, while only 14% had undergone a Care Act Assessment. Hostel staff found using the FHCNA to be feasible, acceptable and potentially useful in facilitating explorations of met and unmet health and social care needs of hostel clients. By identifying unmet needs, the FHCNA has the potential to support staff to advocate for access to health and social care support.

To the best of the authors’ knowledge, this is the first study to co-develop and feasibility test a questionnaire for use by non-clinically trained staff to identify frailty and other health and care needs of people experiencing homelessness in a hostel setting.

The COVID-19 pandemic caused major disruption in community support for vulnerable older people and is thought to have exacerbated existing issues within UK adult social care. This study aims to examine the legacy of that disruption on how meeting centres for people affected by dementia have been impacted in continually evolving circumstances.

Semi-structured interviews and focus group discussions were conducted at three meeting centre case study sites. Ninety-eight participants, including people living with dementia, family carers, staff, volunteers, trustees and external partners, were asked about the impact and legacy of the pandemic upon meeting centres. A thematic analysis was carried out on the data.

Ten themes were identified: ability to re-open venues; increased health decline and loss of members due to isolation; closure or halting of linking services and dementia community support; disruption to diagnosis and referrals; increase in outreach, building communities and overall reach; digital access and use of technology (boom and decline); changes to carer involvement and engagement; continued uncertainty and changes to funding, resources and governance; staff and volunteer recruitment issues; and relief at/wish for return to pre-pandemic norms.

This paper offers new insight into a still-developing situation, namely, the legacy effects of the pandemic upon third-sector community support for people affected by dementia and the health and social care services that support it. The reduction in maintenance of pandemic-era technological innovations is a key finding.

In 2014, the Health Service Executive (HSE) in Ireland published its Safeguarding National Policy and Procedures (HSE, 2014). Under this policy, all agencies providing services through the social care directorate must ensure a robust culture of safeguarding is in place. Concurrent to this has been a move in social policy, practice and research to include the voice of the service user, both in terms of planning and reviewing services. (e.g. HIQA, 2012; Flanagan, 2020) This article examines whether service users with intellectual disabilities want to be involved in safeguarding plans and, if so, how that can be supported. Using focus groups service users demonstrated their knowledge of safeguarding as a concept, how they felt about the issues raised, and, crucially what they felt they would like to see happen next in addressing a safeguarding incident or concern. The focus groups took place in a large organisation providing residential services, day services, independent living supports and clinical supports. Engaging service users in planning and responding to safeguarding concerns is a fundamental principle of human rights legislation, both nationally and internationally. This study aims to highlight that it is both possible and desirable to engage fully with service users using a range of simple communication tools. For this to be implemented as routine practice in services providing support for people with intellectual disabilities, authentic leadership is required. Services will need to devote time, human resources and will need champions to get on board with the necessary culture shift.

Qualitative research examined peoples’ “lived experiences” and knowledge of safeguarding. Focus groups were used with thematic analysis highlighting common themes throughout, as guided by Braun and Clarke (2006). There were two objectives: Objective 1: measuring participant’s understanding of the safeguarding process. Objective 2: compare the potential differences between safeguarding plans devised by the participants in the focus groups, versus plans devised by trained designated officers responsible for safeguarding within the service.

Four principal themes emerged – 1. participants understanding of safeguarding; 2. restorative justice; 3. consent; and 4. high levels of emotional intelligence and compassion. Participants demonstrated that they could and did want to be involved in safeguarding planning and showed little variation in the plans compared to those completed by trained staff.

The study was completed with a small sample size in a single service in one area. It may not represent the lived experiences and knowledge of safeguarding in other services and indeed other countries. The video may have led to some priming; for instance, the Gardai in the footage being called may have resulted in the participants stating that contacting Gardai should be part of the plan. After the video was shown, there was a heightened awareness of safeguarding. This may indicate that participants are aware of safeguarding but unsure of the terminology or how to discuss it out of context.

For this to be implemented as routine practice in services providing support for people with intellectual disabilities, authentic leadership is required. Services will need to devote time and human resources and will need champions in the safeguarding arena to get on board with the shift in culture required.

While there did not appear to be many barriers to listening to participants, to progress this as a standard practice a very real shift in culture will be needed. It is important for practitioners to ask: Is the vulnerable person aware that this concern has been raised? What is known of the vulnerable person’s wishes in relation to the concern? To truly engage with service users in safeguarding plans these questions need to be more than a “tick box” exercise. This process needs to be fully embedded into a culture that promotes a person-centred, rights-based, inclusive approach as a standard rather than a one-off project. Some structural changes will be needed regarding the time given to designated officers, and what resources they can access (such as speech and language therapy). However, the real difference will be made by services operating authentic leadership that champions engagement on this scale, to fully answer the question posed by the researchers at the beginning of this report, “Whose safeguarding is it anyway?”

There appears to be little evidence of service user engagement in terms of planning and processing safeguarding responses, either in research or anecdotally.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.