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The psycho-oncology and social work services recognised that a cancer diagnosis and treatment can result in considerable emotional consequences for patients, yet the referral rate to both services was extremely low. Only very visibly distressed patients were being referred to the service. The “Distress Thermometer” (DT), a distress screening tool, was introduced as a pilot project with day care and inpatient oncology patients of St Vincent ' s University Hospital, Dublin, in an effort to improve the identification, management and treatment of psychological distress in oncology patients. The purpose of this paper is to evaluate the effectiveness of this new intervention.

The Psycho-oncology service in conjunction with the Medical Social Work Department and Nursing Management at St Vincent ' s University Hospital, Dublin, initiated a Distress Education Management and Training Programme (DEMP). The initiative involved providing a training programme for oncology nursing staff and the introduction of a distress-screening tool for patients. In 1998, the DT was developed and validated for evaluation of distress (and depression) in cancer. It was adopted into recommendations made by the US National Comprehensive Cancer Network. The DT is a simple, self-report, pencil and paper measure consisting of a line with a 0-10 scale anchored at the zero point with “No distress” and at scale point ten with “Extreme distress”. Patients are given the instruction, “How distressed have you been during the past week on a scale of 0-10”? Patients indicated their level of distress with a mark on the scale. Patients scoring 4 or above were regarded as requiring intervention. The DT includes a problem checklist. The patient is asked to identify those problems from the checklist which are contributing to their score. The use of the DT was evaluated through interviews with patients and professionals.

Patients who scored four or above (38 per cent of patients), were seen by the Oncology Social Worker for psychosocial assessment and mental health triage. Patients who scored above a certain level (usually above 12/20) in the clinical range on the Hospital Anxiety and Depression scale (3 per cent) were referred to Psycho-oncology. That 38 per cent of oncology patients required intervention from a specialist service accurately reflects international findings on the rate of distress among cancer patients.

Assessment of cancer patients ' distress levels in a structured and planned manner with a Distress Thermometer, as recommended by best international practice, works very effectively and should be considered for all cancer out-patients This will have implications in terms of staff that will be required to manage such a service.

This was the first time that this internationally recognised tool was used to such an extent and to positive effect in an Irish context.

In the early to mid-twentieth century, psychiatrist-led occupational therapy departments emerged in Irish psychiatric hospitals. This marked a transition towards establishing rehabilitative services in institutional settings. This paper aims to examine the development of occupational therapy in Grangegorman Mental Hospital and its auxiliary hospital, Portrane Mental Hospital from 1934-1954.

Historical documentary research methods were used to analyse primary source data from Grangegorman Committee Minutes, Inspector of Mental Hospital Reports, Boroughs of Mental Hospitals, Department of Foreign Affairs documents and newspaper archives. The archival data was analysed using both a chronological and thematic approach.

The main key event emerged in 1935 when four Grangegorman nursing staff were sent to Cardiff Mental Hospital to undergo a six month training course in occupational therapy. The following themes emerged – “establishing occupational therapy in Grangegorman and Portrane”; “the role of short-course trained nursing staff in providing occupational therapy services” and “therapeutic rationales vs hospital management rationales”.

This study throws light on the early practitioners of occupational therapy in Grangegorman and highlights the complexities of occupational therapy’s role origins in mid-twentieth century Ireland. In line with contemporaneous psychiatric hospitals, the occupational therapy activities promoted in Grangegorman were mainly handicraft or productivity based. The absence of patients’ voices means there are limitations to determining the therapeutic nature of this early occupational therapy service.

Leeds autism diagnostic service is an adult autism diagnostic service for people of any intellectual ability which also offers consultancy to service users/carers or professionals, as well as a wide range of autism training. The service was set up as a pilot in 2011 and a paper describing the service development was published in this journal in November 2015. The purpose of this paper is to describe the approach taken to measure the quality of the service the authors provide and accurately assess risk in adults with autism.

The process of evaluating appropriate outcome measures is described, along with considering appropriate risk assessment tools for use in the community. Over 200 people each year complete the autism diagnostic pathway, and 164 patients were invited to respond to service evaluation questionnaires in 2014.

To date, the most useful outcome measures for this group include a prospective service user questionnaire which enables service user opinion to influence service development. In the absence of any appropriate autism-specific risk assessment tools, the service has developed one which it is currently piloting. This has proved particularly useful in the consultancy setting

This paper is a follow-up paper looking at the day-to-day issues that the team have had to grapple with – how do you assess whether what you are doing is providing the best possible service for the people that you serve and how do you accurately assess risk in this population?