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Three deaths at Cawston Park Hospital shed a bright light on Norfolk’s services for people with learning disabilities and autism, including those operated by the company that ran the hospital. The purpose of this paper is to review Norfolk County Council's current position from the unique aspect of a senior manager wihtin the system.

This paper reviews the unique perspective of a social worker from within the system.

The process of making change included engagement and action concerning such thorny challenges as the pressures on community services; the undervaluing of care-giving as a career; and the continuing admissions to specialist mental health services at a time when hospital discharges are being expedited.

Norfolk’s investment in improving its services involves the adoption of a human rights approach; a capital programme to facilitate new developments; nurturing care-giving as a career; and bringing a clearer evidence base to this work programme.

This case study, within the context of boundaryless and protean career development frameworks, investigates linguistic profiling and how code-switching is used to mitigate its impact on Black leaders during their careers. The experiences of Black women coaches and the coaching support they offered Black women clients in code-switching, leadership and career advancement are described. The value of leadership coaching when used to navigate these career progression challenges is emphasized.

The study employed a multiple-case study approach of two Black women leadership coaches.

The findings of this study illustrate the understanding of code-switching and the coaching techniques employed by two Black women leadership coaches. Sage focused on educational strategies, offering historical contexts and resources, while Khadijah leaned on empathy-driven methods, using storytelling to evoke reflection. Both coaches emphasized creating safe spaces for open dialog, encouraged clients to reconsider their actions and values regarding code-switching challenges and sought to prompt clients towards authenticity while navigating career spaces effectively.

Additional strategies for coach practitioners include cultivating trust and a safe environment; active listening; challenging biases and assumptions; contextual understanding; empowering authentic self-expression; fostering skill development; challenging stereotypes; promoting autonomy and flexibility and adopting cross-cultural sensitivity, humility and competence. These practical coaching strategies bridge the gap in career development research by demonstrating how race-conscious strategies can promote workplace inclusivity and promulgate career development.

The study underscores the problem of linguistic profiling, the complexity of code-switching and implications for Black women navigating their career journey within professional spaces. It highlights the significance and value of tailored leadership coaching strategies to promote career advancement. This study addresses the gap in career development research related to linguistic profiling avoidance strategies for workplace inclusivity.

Poverty is a powerful context that affects billions of consumers around the world. An appreciation of this context and the ways it shapes thoughts, feelings, and behaviors is essential to understanding the vulnerabilities of low socioeconomic status (SES) consumers. We synthesize research on consumption in poverty by reviewing some of the social vulnerabilities and frequent neglect, discrimination, and stigmatization encountered by low-SES consumers, as well as the cognitive challenges emerging from the experience of financial scarcity. These social, cognitive, and societal vulnerabilities highlight the importance of behaviorally informed programs and policies to address consumer vulnerability in contexts of poverty.

Diversifying the teaching profession has been of international concern for several decades. While most attention has been devoted to issues of ‘race’ and ethnicity, in comparison, social class has been relatively invisible. Research suggests that those from working class backgrounds experience challenges with regard to belonging in what has been regarded as a middle class teaching profession. An area unexplored has been the complexities of researching with student teachers from under-represented groups, including those from working class backgrounds. This chapter draws on research conducted as part of the Access to Post-primary Teaching (APT) project funded under the Higher Education Authority's Programme for Access to Higher Education (PATH): Strand 1 – Equity of Access to Initial Teacher Education. APT supports the participation of student teachers from lower socio-economic groups in initial teacher education. Following the introduction and literature review, we provide information about the methodology of the overall project, as well as the data upon which we draw in this chapter. Next, we present a critical reflective analysis of working with APT participants over the last six years, drawing on our own critical reflections as researchers, as well as the voices of our participants through the project's research strand. Here we highlight concerns pertaining to relative researcher-participant positionality, and issues of identity and disclosure. Finally, we interrogate our analysis using the methodological literature about researching with marginalised groups and end with recommendations for supporting researcher reflexivity.

This chapter examines the connections between race and class divisions and examines how they shape racial inequities in the distribution of resources, power and privilege. Throughout history, racial identity has been a key factor in determining a person's position in modern capitalist societies. As such, issues of race and class have preoccupied sociologists and other scholars with diverse ideological orientations. This is highlighted in debates around the nexus of race and class in the production of racial structures, laws and institutions that legitimate and perpetuate the normalisation and centrality of whiteness. This chapter summarises some of the historical and ongoing debates, providing a synthesis of how race and class divisions continue to shape contemporary intergroup relations and social policy. It delves into racial capitalism and how race intersects with other social identities to determine socio-economic hierarchy in many western countries.

This paper introduces a new approach to theorising and learning from Black, Asian and Minority Ethnic (BAME) women’s experiences of inequality in academia. It offers a versatile model with which the structure of a particular racist-sexist inequality regime can be theorised from empirical evidence.

The paper presents composite, fictionalised accounts of intersectional discrimination which are then analysed through critical realist frameworks, employing critical race feminist theory insights. This novel “whisper network” method centres the knowledge of BAME women in academia, and is translatable to other marginalised actors, offering a more protective means by which to access their knowledge as a foundation for organisational change.

Through theorising the ontological arrangement of key causal mechanisms responsible for the reproduction of inequality regimes, the paper illuminates links between micro-level intersectional discrimination and meso-level institutional inequality.

In order to preserve anonymity and reduce potential backlash, the vignettes in this paper are not intended to precisely capture specific empirical realities, but instead reflect wider patterns from the author's own whisper network knowledge. Nonetheless, the analytical method developed here could be applied to rigorously collected empirical data, with clear implications for improving organisational practice.

The paper offers a structured and systematic process by which qualitative data on institutional inequality can be analysed and stakeholders engaged to develop and propose solutions, even by individuals new to the field.

A methodical basis for strategic action addressing the issues revealed through such an analysis can be developed in order to galvanise and steer organisational change.

The novelty of the paper is twofold: in its original synthesis of critical realist depth ontology and ontological insights from critical race feminist theory about social structures of oppression, and in the development of the innovative “whisper network” method based upon a critical race theory counter-storytelling epistemology, in conversation with the emergent stream of literature within feminist organisation studies regarding the importance of “writing differently”.

There are multiple threats that cause consumers to be vulnerable in the marketplace, with poverty being a leading cause. Impoverishment often negatively impacts access to multiple categories of goods and services that consumers require to experience a reasonable quality of life. While there is research that explores the underlying factors that lead to resource deficits and marketplace restrictions, as well as their physical and emotional outcomes, an understanding of what is necessary to survive and thrive across societies is more elusive. To this end, our chapter carefully examines the concept of consumption adequacy (CA), which historically captures consumer needs for food and potable water, socially acceptable clothing adapted to weather conditions, safe housing that provides for privacy needs of occupants, preventative and remedial health care, and opportunities to grow and advance through education and training. After briefly summarizing the extant literature, each is described in turn, and ways of empirically investigating them across societies are advanced. This chapter closes with both marketer and public policy implications.

This study aims to investigate the prevalence and characteristics of dysphagia among adults with intellectual disabilities (ID) referred to speech and language therapy for swallow assessment, providing information on the demographic characteristics, referral trends, co-occurring health conditions and reasons for referrals highlighting the complex health-care needs of this population.

This study used a standardised patient data extraction method over a six-month period involving 74 adults with ID referred to speech and language therapy for swallow assessment.

This study revealed a high prevalence of dysphagia among adults with ID referred to speech and language therapy for swallow assessment. Increasing age and severity of ID were associated with an increased likelihood of swallowing difficulties. Co-occurring health conditions such as mobility difficulties, epilepsy and gastrointestinal conditions were prevalent, suggesting that adults with ID and swallowing difficulties are often living with complex health conditions. Choking incidents and hospital admissions were primary reasons for referral.

This study stresses the pressing need for strategies to mitigate risks associated with choking incidents and hospital admission among this vulnerable population. Possible limitations include a reliance on referral and the focus being on a single service over a short period which may limit generalisation to the wider ID population.

This study emphasises the need to understand each person’s unique profile of health needs and the value of a specialised speech and language therapy service.

The importance of increasing awareness among caregivers and medical experts is highlighted.

The findings underscore the importance of tailored assessment, caregiver involvement and heightened interdisciplinary awareness to effectively manage dysphagia in individuals with ID.

This study aims to evaluate the quality of a speech and language therapy (SLT) swallow service provided to adults with intellectual disability (ID) by exploring the process and outcome factors; to explore the process of what is done to and for the patient including identifying dysphagia, choking and pneumonia risk, typical interventions and management; examine clinical outcomes; and explore the relationship of outcomes with risk factors, satisfaction with the service and the impact of the service on the number of choking incidents and admissions to acute hospital with swallow concerns.

There were three specific work packages: (1) collecting and scrutinising patient data from the clinical record for adults with ID referred to the SLT swallow service over a six-month period. The researcher created aims, defined the limits to achieve the aims, designed a standardised data collection form, set out where data was in the clinical record, piloted, set limits for collection and trained reviewers; (2) gathering experience and satisfaction surveys from patients, caregivers and referrers over the six-month study period; and (3) monitoring choking adverse incident reports and hospital admission with swallow concerns for the whole ID population.

Choking and hospital admission were the main reasons for referral, and pneumonia risk significantly predicted dysphagia impairment. The research highlighted common dysphagia risk factors, interventions and recommendations for this population. The SLT swallow service is a quality service that is highly valued by patients, their caregivers and referrers. The service achieves significant clinical improvements, helps identify dysphagia and provides management to reduce associated risks.

This study found common dysphagia risk factors, interventions and recommendations; it also found that the therapy outcome measures/Royal College of Speech and Language Therapy online outcome tool was a meaningful outcome measure, and that pneumonia risk significantly predicted dysphagia impairment, all of which could inform the identified dysphagia research priorities for this population.

Naming usual care in treatment and recommendations could help ensure a fair service and could help form quality indicators. People with ID, their caregivers and staff generated valuable ideas for improvement, and further involvement work could create a logic model for the service. Other future work could explore the use of screening tools, increase multidisciplinary team working, improve access to instrumental assessments, raise awareness of swallowing and promote important oral health and medication reviews. By using this information to shape quality improvement work and policies, one can work toward addressing high health-related inequalities and preventable deaths associated with dysphagia in this vulnerable population.

It may be useful to raise awareness that adults with ID age earlier and that one should not exclude them from older people’s services because of an age threshold, often set higher than their life expectancy. This study highlighted a possible inequality of access issue for adults with ID who do not have direct care or day care staff. There is a need to increase access to awareness training so caregivers and general practitioners can recognise swallow difficulties and know how to make a referral for a swallow assessment.

Overall, the evaluation of the swallow service to adults with ID suggests that SLT have a quality service for adults with ID that is highly valued and provides significant clinical improvements. By building on these strengths, SLT could extend the reach, influence and impact of their services to help those adults with ID who have emerging swallow difficulties or who do not access the service.