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The purpose of this paper is to review the role of social networks in the translation of research into practice, propose a broader model of communities of practice (CoPs) involving practitioners, researchers and service users, and describe a case report which adopts this broader model.

Using the evidence on both knowledge transfer and the use of CoPs to share practice, this work presents an approach to supporting and developing CoPs around the specific context of an applied research programme in health and social care.

The development of CoPs across the professional and organisational boundaries of researchers, practitioners, and service users has the potential to enhance the translation of evidence into practice. It requires bringing together the right people and providing a supportive infrastructure to facilitate exchanges. Methods of engaging and involving the different stakeholder groups vary according to the specific context and pre‐existing networks, but developing closer working relationships and sharing common values is an important step in this process. Within the applied health research partnership of the Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire (CLAHRC‐NDL), the role of Diffusion Fellows, Engagement Fellows and CLAHRC Associates provides a way of engaging with its diverse stakeholders.

This paper builds on existing evidence about CoPs and the role of social networks in knowledge transfer.

Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are a new UK initiative to promote collaboration between universities and healthcare organisations in carrying out and applying the findings of applied health research. But they face significant, institutionalised barriers to their success. This paper seeks to analyse these challenges and discuss prospects for overcoming them.

The paper draws on in‐depth qualitative interview data from the first round of an ongoing evaluation of one CLAHRC to understand the views of different stakeholders on its progress so far, challenges faced, and emergent solutions.

The breadth of CLAHRCs' missions seems crucial to mobilise the diverse stakeholders needed to succeed, but also produces disagreement about what the prime goal of the Collaborations should be. A process of consensus building is necessary to instil a common vision among CLAHRC members, but deep‐seated institutional divisions continue to orient them in divergent directions, which may need to be overcome through other means.

This analysis suggests some of the key means by which those involved in joint enterprises such as CLAHRCs can achieve consensus and action towards a current goal, and offers recommendations for those involved in their design, commissioning and performance management.

The purpose of this paper is to examine how knowledge exchange between academics and clinicians in Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) is influenced by their social position based on their symbolic and social capitals, that is, their personal professional status and connections to high-status professional peers, knowledge brokers, and unfamiliar professional peers.

Using an online survey, the author triangulates the cross-sectional measurement of the effects of academic and clinicians’ social position in the initial and later phases of CLAHRCs with the longitudinal measurement of these effects over a two-year period.

First, academics and clinicians with a higher personal professional status are more likely to develop joint networks and decision making both in the early and later phases of a CLAHRC. Second, academics and clinicians who are more connected to higher status occupational peers are more likely to develop joint networks in the early phase of a knowledge exchange partnership but are less likely to become engaged in joint networks over time. Third, involvement of knowledge brokers in the networks of academics and clinicians is likely to facilitate their inter-professional networking only in the later partnership phase.

Academics and clinicians’ capitals have a distinctive influence on knowledge exchange in the early and later phases of CLAHRCs and on a change in knowledge exchange over a two-year period.

Prior research on CLAHRCs has examined how knowledge exchange between academics and clinicians can be encouraged by the creation of shared governance mechanisms. The author advances this research by highlighting the role of their social position in facilitating knowledge exchange.

The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.

Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.

While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.

There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.

While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.

Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs.

While “generic” community teams for adults with learning disabilities (CTs) are well-established in the UK, very little recent evidence is available about any aspect of their work. As part of a larger project about the role, structure and functioning of CTs, the purpose of this paper is to provide data about referrals.

Over three months, the authors obtained data about 270 consecutive new referrals to five CTs in a countywide integrated health (NHS) and care management (local authority) service.

The 270 referrals related to 255 individuals, mainly already service users, with almost a third (30 per cent, n=204) described as people with severe or profound disabilities. Consistent with the reported living arrangements (residential accommodation or with one or more family members (87 per cent, n=270)), referrals were most often made by social care staff, General Practitioners or carers. The referrals related to a wide range of issues including mental health and/or behavioural needs, physical health and skills, and independence. The major group, however, were requests about a person’s entitlement to specialist learning disability services and/or reviews of an existing social care package.

The focus on new referrals and the exclusion of intra-team referrals mean that the data are not representative of a CT’s caseload and cannot be used as a basis for resourcing. Nevertheless, the findings emphasise the heterogeneity of the population, and the long-term and varied nature of their needs, meaning that CTs require access to a range of expertise and, often, an inter-agency approach. The implications for service design are considered.

This is the first empirical study of referrals to specialist integrated (health and care management) community learning disabilities teams in England.

National and local policy supports the involvement of patients at all levels in the design, delivery and improvement of health services. Whilst existing approaches to support involvement have been described and disseminated, including the 4Pi National Involvement Standards, their application in quality improvement is rarely reported. The paper aims to discuss this issue.

A quality improvement initiative within a mental health trust was developed with a multi-disciplinary team, including those with professional experience of delivering or improving care and those with lived experience. The aim of the initiative was to improve the physical health of inpatients within an acute mental health unit. This case study aims to describe how the integration of concepts from the 4Pi National Involvement Standards (Principles, Purpose, Presence, Process and Impact) provided a framework for engaging and involving service users. The case study also aims to describe how co-design was included within the 4Pi approach and supported the development of a tool to aid improving physical healthcare.

The 4Pi National Involvement Standards provided a guiding framework for the involvement of service users within a quality improvement initiative. Value of the approach was realised through the co-design of a tool developed by service users, along with healthcare professionals, to facilitate discussion and support shared-decision making about inpatients’ physical health.

Identifying “ways that work” for service user involvement is crucial to move beyond the policy rhetoric or tokenistic involvement. Involvement in quality improvement initiatives can bring benefits both to services and the service users themselves.

Whilst the 4PI approach is recognised as a useful framework for involvement, few examples exist of its practical applications within a quality improvement setting.

This paper aims to report on the approach to change used in the development of a tool to assess patient status six months after stroke (the Greater Manchester Stroke Assessment Tool: GM-SAT).

The overall approach to change is based on the Promoting Action on Research Implementation in Health Services (PARiHS) Framework, which involves extensive stakeholder engagement before implementation. A key feature was the use of a facilitator without previous clinical experience.

The active process of change involved a range of stakeholders – commissioners, patients and professionals – as well as review of published research evidence. The result of this process was the creation of the GM-SAT.

The details of the decision processes within the tool included a range of perspectives; the process of localisation led commissioners to identify gaps in care provision as well as learning from others in terms of how services might be provided and organised. The facilitator role was key at all stages in bringing together the wide range of perspectives; the relatively neutral perceived status of the facilitator enabled resistance to change to be minimised.

The output of this project, the GM-SAT, has the potential to significantly improve patients' physical, psychological and social outcomes and optimise their quality of life. This will be explored further in future phases of work.

A structured process of change which included multiple stakeholder involvement throughout, localisation of approaches and a dedicated independent facilitator role was effective in achieving the development of a useful tool (GM-SAT).

Public sectors have responded to grand societal challenges by establishing collaboratives – new inter-organizational partnerships to secure better quality health services. In the UK, a proliferation of collaboration-based healthcare networks exists that could help to enhance the value of investments in quality improvement programs. The nature and organizational form of such improvements is still a subject of debate within the public-sector literature. Place-based collaboration has been proposed as a possible solution. In response, the purpose of this study is to present the results and findings of a place-based collaborative network, highlighting challenges and insights.

This study adopted a social constructionist epistemological approach, using a qualitative methodology. A single case study was used and data collected in three different stages over a two-year period.

The study finds that leadership, data-enabled learning through system-wide training and development, and the provision of an enabling environment that is facilitated by an academic partner, can go a long way in the managing of healthcare networks for improving quality.

Regardless of the tensions and challenges with place-based networks, they could still be a solution in maximizing the public value required by government investments in the healthcare sector, as they offer a more innovative structure that can help to address complex issues beyond the remit of hierarchical structures. This study is limited by the use of a single case study.

Across countries health systems are moving away from markets to collaborative models for healthcare delivery and from individual services to population-based approaches. This study provides insights to inform leaders of collaborative health models in the design and delivery of these new collaborations.

As demand rises (as a result of increasing complexity and demographics) in the western world, health systems are seeking to redefine the boundaries between health service provision and community self-reliance and resilience. This study provides insights into the new partnership between health institutions and communities, providing opportunities for more social- and solidarity-based healthcare models which place patients and the public at the heart of change.

The city place-based network is the first of such organizational form in healthcare collaboration in the UK.

The purpose of this paper is to describe mental health-related contact with educational professionals amongst children in the British Child and Adolescent Mental Health Survey (BCAMHS) 2004.

BCAMHS 2004 was a community-based survey of 5,325 children aged 5-16, with follow-up in 2007. This paper reports the percentage of children with a psychiatric disorder that had mental health-related contact with education professionals (categorised as teachers or specialist education services) and the percentage with specific types of psychiatric disorders amongst those contacting services.

Two-thirds (66.1 per cent, 95 per cent CI: 62.4-69.8 per cent) of children with a psychiatric disorder had contact with a teacher regarding their mental health and 31.1 per cent (95 per cent CI: 27.5-34.7 per cent) had contact with special education either in 2004 or 2007, or both. Over half of children reporting special education contact (55.1 per cent, 95 per cent CI: 50.0-60.2 per cent) and almost a third reporting teacher contact in relation to mental health (32.1 per cent, 95 per cent CI: 29.7-34.6 per cent) met criteria for a psychiatric disorder.

Many children in contact with education professionals regarding mental health experienced clinical levels of difficulty. Training is needed to ensure that contact leads to prompt intervention and referral if necessary.

This is the first paper to report on mental health-related service contact with education professionals in the 2004 BCAMHS survey along with its 2007 follow-up. It identifies high levels of teacher contact which represent challenges in supporting staff with training, resources and access to mental health services.

This paper seeks to highlight the findings from a research project on improving treatment engagement for clients with personality difficulties.

The authors provide an overview of the studies conducted to date. These are a systematic review of the literature examining non‐completion of psychosocial treatment by people with personality disorder, a systematic review of assessments to measure treatment engagement, and a Delphi survey of both staff and patients' views on factors that impact on engagement in psychosocial treatment for this client group.

Poor engagement with psychosocial treatment is an issue for clients with personality disorder and rates of non‐completion are high. Discontinuation of treatment is associated with adverse clinical outcomes. Although a number of assessments exist for measuring engagement, none can be described as comprehensive and few are adequately validated. Engagement factors identified from the survey were broadly in keeping with previous work, but additional factors specific to this client group were identified. A treatment readiness model for people with personality difficulties is described.

Research outputs from the project are a set of specifications for good practice in facilitating engagement, and a web‐based training package aimed at helping staff improve their understanding of their clients' engagement issues.

The findings will be useful to service managers as well as clinicians working directly with people with personality difficulties. Improving client engagement will improve clinical outcomes and service cost‐efficiency.