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In Scotland, individuals referred for NHS psychological therapies are expected to commence “treatment” within 18 weeks of receipt of referral. With high demand, high non-attendance rates and limited capacity, this can be a challenging goal. The service discussed here was keen to develop a way of seeing individuals referred sooner and improving the efficiency of the assessment process. The purpose of this paper is to look at the impact of introducing assessment (“Signpost”) appointments on waiting times, attendance, and treatment planning.

Signpost appointments were offered to all existing, and any new referrals, to an adult psychological therapies team (PTT) in NHS Lanarkshire. Clinicians kept a record of the outcomes of these appointments over a six month period. Waiting times and attendance figures were compared before and after the introduction of the Signpost system.

Following the introduction of Signpost appointments, individuals were seen sooner for both assessment and therapy. Attendance at first appointments improved and Signpost appointments helped inform treatment planning. Although alternatives were discussed, the majority of clients were still offered individual therapy. Service user and staff satisfaction was high.

The results from this study led to assessment (“Signpost”) appointments being rolled out across other adult PTTs in NHS Lanarkshire.

There is little research looking at the impact of assessment/signpost appointments on adult mental health services in the UK. In the current climate of public service cuts, this study provides an innovative way of reducing waiting times and maintaining service user satisfaction, without requiring more resources.

Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. To date, these pathways have not been formally evaluated. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people.

Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline.

Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis.

Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence.

The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families.

This article is unique in that it is, to the best of the authors’ knowledge, the first to describe and report clinician-adherence to a structured pathway for diagnosing ADHD in young people within a community CAMHS service in South London.

This paper aims to examine effective diagnostic and treatment pathways for attention deficit hyperactivity disorder (ADHD) in prison settings given the high prevalence of ADHD and comorbidities in the prison population.

Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.

Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.

Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.

China’s healthcare system is being burdened by the increasing prevalence of chronic diseases. Therefore, this study investigated the health service requirements of mobile health applications (mHealth apps) users in Hangzhou, China. This study aimed to propose suggestions and theoretical references to improve mHealth apps and promote their development, thereby meeting public medical and health needs and creating an efficient medical service system.

We constructed a model of health service demands using a literature review, network survey, and semi-structured interviews. We analyzed the demand attributes using the Kano model and Better-Worse index and obtained the priority ranking of demands.

The results revealed 25 demand elements in four dimensions: must-be (M), one-dimensional (O), attractive (A), and indifferent (I) requirements. The findings suggest that mHealth app developers can optimize health services by categorizing and managing health services, focusing on middle-aged users, enhancing the professionalism of health service providers, and improving the feedback mechanism.

Studies on mHealth apps user demands, particularly on health service needs, remain scarce. This study employed a mixed-methods approach, integrating both qualitative and quantitative research techniques, to establish a priority ranking of user health service needs for mHealth apps. The study offers recommendations and theoretical references to optimize and improve mHealth app services.

1. Construct a better health service requirements model for mHealth app users.

2. Obtain the prioritization of demand elements in the model.

3. Propose some management suggestions to improve mHealth apps.

Construct a better health service requirements model for mHealth app users.

Obtain the prioritization of demand elements in the model.

Propose some management suggestions to improve mHealth apps.

The critical potential of hospital discharge policies and practices to ameliorate the health and social care needs of homeless people has become the focus of considerable interest in England. Central to this rise in policy formation and practice development is an acute understanding of the multiple exclusions homeless people face in navigating public health and social care systems. In ways small and large this nascent landscape is serving to redefine and reshape hospital arrangements for homeless people, and opening-up new ways to deliver care across clinical, social and therapeutic boundaries. The purpose of this paper is to seek to add empirical vigour and theoretical rigour to this unfolding policy and practice terrain.

This paper draws on findings from a case study concerned with exploring and explaining how statutory and voluntary sector organisations use specialist hospital discharge policies and practices to coordinate pathways of care for homeless people.

This paper illustrates how people affected by homelessness and ill-health are routinely denied access to statutory housing support, social work assessments and district nursing provision through acts of institutional gatekeeping and professional abrogation.

This paper makes an important contribution to understandings of the connections between hospital discharge arrangements for homeless people and statutory housing, social work and district nursing provision.

The purpose of this paper is to review the evidence on providing services to people with neurodevelopmental disorders in prisons, with a focus on those prisoners with autism spectrum disorder (ASD).

Electronic databases were used to search for literature specifically on ASD in prisons. The literature was supplemented with the authors’ experiences of carrying out research on ASD in prison.

The searches only identified four articles and therefore the broader literature on people with ASD and other developmental disorders was reviewed in relation to the prison context.

The paper highlights the current limited evidence base on prisoners with autism spectrum disorders.

This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients.

Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires.

All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency.

With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

Non‐attendance for first appointments in primary care mental health services represents a major service delivery challenge. Previous research identified how invitation type can influence attendance rates and a localised study was therefore carried out to examine the most effective invitation method and to inform local service guidelines. This exploratory study aims to consider the rate of non‐attendance to assessment for clients referred for psychological therapy in relation to invitation type.

In total, 521 invitations to initial assessment were sent over a three month period with clients being drawn from a rolling waiting list of referrals and invited to attend initial assessment by letter, telephone, or telephone with a telephone reminder. Non‐attendance rates were examined and findings compared across invitation type.

The study concluded that telephone invitations followed by a telephone prompting reminder significantly reduced non‐attendance to initial assessment appointments.

The findings highlight how using phone based invitation to assessment with a phone reminder can increase attendance rates and improve service efficiencies locally and more widely. There were several limitations to the research project including key variables not included or controlled for which it is felt may have biased the findings and the small effect size.

The findings of the present study extend and build on previous research in the area of attendance, particularly in relation to the provision of localised evidence from which to develop and improve local, national and international service delivery.

This paper aims to examine empirical evidence of the criterion, construct, and face validity of two processes commonly used in selection – selection interviews and assessment centres (ACs) – in the selection of chairs of primary care trusts.

A critical review of the literature and an empirical investigation are undertaken.

Evidence is presented of the reliability and the predictive, construct, and face validity of using a combination of selection interviews and AC methodology in appointments to public office. In the light of the evidence of the potential benefits of using more than one approach, it is suggested that a combination of AC methodology and panel interviews be used in making public sector appointments.

The evidence presented supports the decision of the Appointment Commission to use AC methodology in the selection for positions in public office, and points to ways in which the process could be improved.

The paper provides empirical evidence of the reliability and validity of two methodologies used in selection to posts.

Women have conquered the universities but their way into top positions is still stopped by a class ceiling. Focusing appointment procedures for full professors the chapter examines why policies aiming at gendered practices have only shown moderate success.

The analysis follows a praxeological approach and draws on material derived from case studies covering all 22 universities in Austria. The aim of these case studies was to analyze the implementation of a new legal framework for appointment procedures at Austrian universities.

In this chapter, the effects of specific measures to tackle gender bias in appointment procedures for full professors in the Austrian context are analyzed. It is evident that despite gender awareness and a comprehensive set of regulations, regularly traditional practices remain stable and unreflected with regard to an inherent gender bias. The analysis presented thus reveals the limitations of existing equality policies. We can assume that reflexivity is a precondition for a change of unreflected practices, but does not form a part of existing policies.

We conclude that policies aimed at changing gendered practices have to (1) built up gender awareness as well as gender competence and (2) encourage reflexivity as well as agency among all stakeholders involved in a practice. Although there are cases where reflexivity arises from an individual conviction with regard to equality, most stakeholders have to be convinced – or even forced – by a superior authority to change their practices. Such a change can be forced by legal obligation or set down as a clear requirement by university management. It becomes evident that any guideline or regulation addressing gendered practices have to be accompanied by features that create room for reflection and reflexivity.