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This paper briefly describes a small research study, and presents its findings on the factors that have had an impact on the implementation of single shared assessment (SSA) in co‐located primary care and social work teams. Findings highlight continuing difficulties of policy implementation and the need for ongoing support, guidance and training.

In Ireland, the Assisted Decision Making (Capacity) Act 2015 provides a statutory framework to adults who are experiencing difficulties with decision-making. This legislation has significant implications for all who work in health and social care. Increasing age and life expectancy, alongside the rising incidence of chronic health conditions and dementia-related diseases, indicates that more individuals are likely to experience challenges regarding decision-making capacity. Therefore, the need for more consistent, best-practice processes to assess decision-making capacity is likely to increase. To ensure occupational therapists are responsible in their contributions, and to ensure those with disabilities are supported, clinicians must be well-informed of the principles underscoring the Act. The purpose of this paper is to provide an overview of this multidisciplinary issue, including recent legislation, and consider how occupational therapy can contribute.

The authors reviewed current literature and considered occupational therapy’s role in decision-making capacity assessment.

Occupational therapists have potential to play a key role in multi-disciplinary assessments of decision-making capacity for clients. Further research is required to explore professional issues, identify clinical best practices and determine training and resource needs.

This paper seeks to provoke consideration of how occupational therapists can contribute to capacity assessment from a client-centred, occupation-based perspective that is mindful of ethical and legislative considerations.

This paper describes a multistrategy knowledge‐based framework for supporting human experts in assessing applications for the house renovation grant system (HRGS). This framework integrates different problem solving strategies as set up by the task analysis. The task analysis carried out in the context of the HRGS domain decomposed the overall task into a number of subtasks and problem solving methods for performing each subtask. The framework modularises the knowledge required to solve each subtask into historical cases, objects, procedures and domain models. The framework was implemented as a computer system using Kappa‐PC which is a shell designed for implementing knowledge‐based systems. The implementation followed the client centred approach (CCA) method. This computer application has been successful in demonstrating that a multistrategy knowledge base can be used to support human experts in assessing applications for the HRGS. Therefore, the application has proved to perform as accurately as human experts do for all of the subtasks set up by the task analysis.

In considering the alternative strategies for change in Part I of this article, and the strategy of OD in particular, the definitions of OD suggested that the consultant played an essential role in facilitating change. Despite this, there is no widely accepted definition of the role of consultant. Indeed, it may be argued that several roles are currently subsumed under the title, for example the role of “change generator” and “change implementor” as defined by Ottaway and Cooper. There is also some evidence that internal and external consultants, apart from working from different bases, are capable or equipped to perform different tasks. External consultants are able to create and sustain a belief that change is possible, whilst internal consultants are the disseminators and implementors of change.

Defining quality of healthcare and determining how to improve organisational performance in developed countries is still an unresolved issue among healthcare professionals. However, given that it is an important area of responsibility and accountability it is no longer acceptable to view the issue as discretionary. An increasingly acceptable operative option for achieving continuous improvement and excellence seems to be the self‐assessment of an organisation, based on the principles of knowledge management and total quality management (TQM). This article provides an explanation of a two‐level self‐assessment approach for implementing TQM within the Spanish healthcare system. The first level integrates a client‐centred approach using classical healthcare accreditation criteria along with ISO 9000 standards, the aim being to establish quality assurance systems in the whole organisation. The second level uses the European Foundation for Quality Management Excellence Model as a road map for self‐assessment and continuous improvement towards excellence.

Microfinance impact evaluation studies help in discovering client needs which are diverse, special and different from the needs of the conventional bankable clients. Thus, such area of market research is becoming essential for microfinance institutions for designing better client-centred products. In this research, the authors discuss the specific model of household economic portfolio (HEP) for qualitative impact evaluation in microfinance. The paper aims to discuss the complexity limitations of the HEP. Solutions are provided for overcoming these limitations. The modified household economic portfolio (M-HEP) model is simplified and detailed, and two types of diaries are suggested for implementing it.

First, the authors briefly review the literature on impact assessment methods in microfinance and on the HEP model. In the second part of the paper, the M-HEP is suggested and discussed in detail. In the third part, the authors present a case study to illustrate the additional information that can be generated by using our suggested research tool and model. Finally, the authors wrap up with a summary of the findings.

Solutions are provided for overcoming the limitations of the HEP model. The suggested model (M-HEP) is simplified and detailed, and two types of diaries are suggested for implementing it. The case study shows that, certainly, time and money are related. While time may mean money for a rich person, for a poor person, if money is not forthcoming, she may spend time on non-income generating work that adds to her social esteem. She may also consume inexpensive assets because spending time at low cost is important. Finally, she spends time in conducting activities for which she cannot afford to pay.

The paper offers two novelties. First, it details the interactions between the elements of the HEP model of Chen and Dunn. This improvement to the original model is highly important for defining the measures that are required for redrawing the economic portfolio of an individual. The second novelty is in suggesting the collection of time-use and financial daily data. To the best of our knowledge, this is the first time a combined diary is used in microfinance research. These two novelties allow the application of a modified version of the highly interesting HEP model in spite of its complexity.

There has been a recent initiative in England to establish a wider provision of psychotherapy. Studying the models of psychological treatment and experiences in other countries may enable policy makers in England to learn lessons and avoid pitfalls. This paper assesses and compares the provision of psychotherapy for adults in a selected number of European and non‐European countries. A structured list of psychotherapy features was used to collect information from each country on the number of psychotherapists, professional qualifications, the settings and models of psychotherapy, the referral procedures, funding arrangements, quality management and outcome assessments. These data were then compared in a non‐systematic way. Comparison of levels of provision was the most difficult to establish, but the findings suggest that psychotherapy that is broadly free at the point of entry is more widely available in other EU countries than in England. They also show that the plans currently being discussed for a psychotherapy service in England differ from those provided in most of the other countries in this study. The differences include the lack of statutory accreditation rules and lower qualification thresholds for psychotherapists, the concept of treatment centres, the low number of sessions, and the regular assessment of outcome data. Therefore, based on this comparison, the necessity of these features, their priority and possible alternatives may need to be considered.

The results of a pilot project between the Discipline of Occupational Therapy, Trinity College, Dublin, and the National Behaviour Support Service (NBSS) demonstrate that collaboration between professionals, students and parents can enable those of social disadvantage with significant behavioural problems participate better in school. This chapter describes the development of this service for students in two disadvantaged second-level schools, the processes of identifying need, interventions delivered and the collaborative workings of the partnership. The broad view of the Person–Environment–Occupation (Law et al., 1996) and a client-centred approach (Law & Mills, 1998) guided the intervention. An understanding of the social and situational influences in the school and classroom as experienced by each student was sought, as was the impact of possible sensory processing and attention difficulties on satisfactory participation in school. Students were perceived as having individual social and self-management learning needs and each class group and school was acknowledged as a unique culture. Engagement in fun-focused group processes supported the experience of inter-subjectivity and peer group learning was actively fostered. Thus, social action and co-construction of shared learning brought students to better connect with themselves and each other resulting in better engagement in school. However, each school staff and management team had its own culture and metaphor for explaining their students’ behaviours. This influenced their response to the occupational therapy perspective applied in this project. Following on from the success of this project, it is recommended that the collaborative approach between student, parents, teachers and therapist should be further developed in schools to benefit those with complex challenging behaviours. A national agency such as the NBSS is central to delivering this collaboration and partnership.

Occupational therapists are concerned with how people perform across the various daily activities that are important to them. It is recognised within occupational therapy that the presence of illness or disability might affect this performance.In order to assess how a person complete a task and identify what is making it unsatisfying, the occupational therapist will observe the person engaged in familiar activities. The Assessment of Motor and Process Skills (AMPS) provides a standardised framework within which to make these observations. We have found the AMPS to be useful in assessing the performance of people with learning disabilities generally, as well as in assessing those with additional mental illness.We recognise that occupational therapy assessment plays a useful part in a wider multi‐professional, multi‐agency approach to identifying and managing the needs of people with learning disabilities.

This study aims to improve accessibility to frontline psychological services for youths in difficulty. In the province of Quebec, Canada, the first significant intervention must take place within 30 days for at least 75% of the clients. Achieving this target is challenging. This was observed in the Youth Programme of a health-care network in Montreal (Centre Intégré (Universitaire) de la Santé et des Services Sociaux Centre-Sud-de-l’île-de-Montréal).

Lean Six Sigma (LSS) approach within the Action Research methodology was used. Define, Measure, Analyse, Innovate, Implement and Control structure combined with Lean techniques and a Kaizen event were implemented.

In total 69% of the clients have now had their first intervention within 30 days and 91% within 60 days. Improving accessibility to frontline services led to improving accessibility to second-line services. Communicating performance objectives to employees led to increasing their awareness about the importance of performance assessment and their willingness to contribute to improvement. The Kaizen event was a driving force that enabled more collaboration and trust. The participation of a partner-client in the Kaizen helped finding client-centred solutions. The large number of participants in the Kaizen added complexity.

It was difficult to sort and rank a large number of solutions during the Kaizen. The impact of hiring additional employees has not been investigated. Despite the significant improvements, the targets were not achieved. More research is required to identify more accurately critical factors that have a major impact on the success of LSS projects involving complex processes.

This study contributes to the body of knowledge in Lean health care. It describes Lean tools/techniques used, solution implementation and improvements achieved in a real context. 10 success factors and 4 challenges were identified. The study provides a model for other organizations for developing their own roadmap to improve accessibility to their services, notably in large and complex processes.