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This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

The purpose of this paper – the second of three – is to report the findings from a service user needs assessment in those who have contact with a local homelessness service in the North-West of England.

Data were collected using a semi-structured questionnaire that included a section exploring Adverse Childhood Experiences. Aggregated data from a total of 100 completed questionnaires were analysed to understand the nature and scope of those accessing the Homelessness and Vulnerable Adults Service (HVAS).

Homeless people accessing HVAS face a number of challenges, which reflect their upbringing and chaotic and complex lifestyles. Reports of multiple disadvantage, social isolation, physical and mental health problems were common among the cohort.

This was a small cohort study, and the authors accept that this may potentially limit the scope of the findings. Themes identified are, however, reflected in wider research and official data collection sources. Future research may seek to widen the data collection methods to offer a more representative cohort.

The provision of co-ordinated multi-agency support is essential to tackle health inequalities experienced by those who are homeless.

The complex issues often experienced by those who are homeless can further compound the impact of social exclusion on health and well-being. The reduction of statutory support and increased emphasis on self-reliance can further impact those people on the margins of society.

This study identifies how multiple deprivations and social isolation impacts upon health and well-being, further compounding a person’s ability and willingness to engage with services. It raises the question of the systems failure to respond effectively.

This paper – the first of three – aims to explore some of the complex physical and mental health needs of those experiencing homelessness. It will act as a leader to the other articles by establishing the nature of the problem and offer a rationale for carrying out a service user needs assessment as part of a review of local service provision in the North West of England against the backdrop of the current COVID-19 epidemic.

There are a number of complex social and health inequalities often experienced by those who are homeless. Effectively tackling these requires a co-ordinated multi-agency response to both prevent and tackle the harms associated with being and becoming homeless.

Partnership working offers the best opportunity to meet the complex needs of those experiencing homelessness. The current delivery model being actioned in the North West of England highlights the importance of the links between statutory and non-statutory services. An ongoing service user needs assessment will further help to highlight contemporary issues faced by those experiencing homelessness and those providing services in the context of the COVID-19 epidemic.

Future papers as part of this series of three will consider the implications of social exclusion and barriers to accessing services faced on a day-to-day basis by those experiencing homelessness.

The opportunity to reflect on established views in relation to the nature and scope of homelessness. It will consider the implications exclusion from society and service provision that this group face on a day-to-day basis. The paper will describe a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 epidemic.

When the first edition of Poems by Emily Dickinson was published in 1890, Samuel G. Ward, a writer for the Dial, commented, “I am with all the world intensely interested in Emily Dickinson. She may become world famous or she may never get out of New England” (Sewall 1974, 26). A century after Emily Dickinson's death, all the world is intensely interested in the full nature of her poetic genius and her commanding presence in American literature. Indeed, if fame belonged to her she could not escape it (JL 265). She was concerned about becoming “great.” Fame intrigued her, but it did not consume her. She preferred “To earn it by disdaining it—”(JP 1427). Critics say that she sensed her genius but could never have envisioned the extent to which others would recognize it. She wrote, “Fame is a bee./It has a song—/It has a sting—/Ah, too, it has a wing” (JP 1763). On 7 May 1984 the names of Emily Dickinson and Walt Whitman were inscribed on stone tablets and set into the floor of the newly founded United States Poets' Corner of the Cathedral of St. John the Divine in New York City, “the first poets elected to this pantheon of American writers” (New York Times 1985). Celebrations in her honor draw a distinguished assemblage of international scholars, renowned authors and poets, biographers, critics, literary historians, and admirers‐at‐large. In May 1986 devoted followers came from places as distant as Germany, Poland, Scandinavia, and Japan to Washington, DC, to participate in the Folger Shakespeare Library's conference, “Emily Dickinson, Letter to the World.”

Inter-organisational collaboration (IOC) across healthcare settings has been put forward as a solution to mounting financial and sustainability challenges. Whilst ingredients for successful IOC have been explored, there remains limited understanding of the development of IOCs over time.

The authors systematically reviewed the literature to identify models applied to IOCs in healthcare across databases such as Healthcare Management Information Consortium (HMIC) and MEDLINE, identifying 2,763 titles and abstracts with 26 final papers included. The authors then used a “best fit” framework synthesis methodology to synthesise fourteen models of IOC in healthcare and the wider public sector to formulate an applied composite model describing the process through which collaborations change over time. This synthesis comprised extracting stages and behaviours from included models, selecting an a priori framework upon which to code these stages and behaviours and then re-coding them to construct a new composite model.

Existing models often did not consider that organisations may undergo many IOCs in the organisations' lifetime nor included “contemplation” stages or those analogous to “dissolution”, which might negatively impact papers using such models. The formulated' composite model utilises a life-cycle design comprising five non-linear phases, namely Contemplating, Connecting, Planning, Implementation and Maintenance or Dissolution and incorporates dynamic elements from Complex Adaptive Systems thinking to reflect the dynamic nature of collaborations.

This is the first purpose-built model of the lifecycles of IOCs in healthcare. The model is intended to inform implementers, evaluators and researchers of IOCs alike.

The National Health Service (NHS) is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and safety of the NHS provider sector. To make the necessary improvements to performance, policy interest has turned to encouraging greater collaboration and partnership working across providers.

Using a purposive search of academic and grey literature, this narrative review aimed (1) to establish a working typology of partnering arrangements for improvement across NHS providers and (2) inform the development of a plausible initial rough theory (IRF) of partnering to inform an ongoing realist synthesis.

Different types of partnership were characterised by degree of integration and/or organisational change. A review of existing theories of partnering also identified a suitable framework which incorporated key elements to partnerships, such as governance, workforce, leadership and culture. This informed the creation of an IRF of partnerships, which proposes that partnership “interventions” are proposed to primarily cause changes in governance, leadership, IT systems and care model design, which will then go on to affect culture, user engagement and workforce.

Further realist evaluation, informed by this review, will aim to uncover configurations of mechanisms, contexts and outcomes in various partnering arrangements and limitations. As this is the starting point for building a programme theory, it draws on limited evidence.

This paper presents a novel theory of partnering and collaborating in healthcare with practical implications for policy makers and practitioners.

A Promoting Mental Health and Well-Being Working Model (subsequently “the model”) was developed in response to recognition through teaching undergraduate nursing students that interventions aimed at enhancing mental health and well-being are often hidden or cloaked in traditional professional specific working interventions. The model was developed with the purpose of making the elements of mental health and well-being promotion visible and structuring them into a framework to aid working practice and personal development. The purpose of this paper is to evaluate the effectiveness from the participant perspective of using the model to enhance clients’ mental health and well-being in community settings (Keeling and McQuarrie, 2014).

A total of 14 participants were interviewed within two focus groups. Five questions were posed to the participants structured around their experiences of using the model when working with clients in the community. The responses were recorded and transcribed and then categorised using a thematic analysis approach.

Three key themes were derived from the analysis in equal measure: “Reconciling a Non-traditional approach”, “Promoting a holistic approach” and “Developing creativity and sense of empowerment to promote mental health and well-being”. The findings suggest that using the model enabled participants to engage with clients in meaningful ways that in turn developed their self-confidence in helping clients develop creative strategies to promote their own mental health and well-being.

This paper shows that using a structured model to promote well-being and mental health has benefits in enhancing creativity, therapeutic relationships and knowledge base. Further research is needed in terms of the utility of the model from the client’s perspective.

The aim of this study is to investigate perceptions of cycle commuting barriers in relation to stage of change, gender and occupational role. Stage of change is a key construct of the transtheoretical model of behaviour change that defines behavioural readiness (intentions and actions) into five distinct categories.

A cross‐sectional online questionnaire was completed by staff and PhD students (n=831) based in cycle‐friendly buildings in a large UK university. The questionnaire included questions relating to demographics, stages of behaviour change and 18 potential barriers. Data were analysed using t‐tests, one‐way ANOVAs and two‐way ANOVAs.

Overall, environmental factors were perceived as the biggest barriers to cycle commuting. However, perceptions of cycle commuting barriers significantly differed between stages of change, genders and occupational roles. Precontemplators, females and support staff commonly perceived greater barriers to cycle commuting compared to maintainers, males and academic staff.

The results indicate that tailored individual‐level behaviour change interventions focusing on reducing perceptions of barriers that take into account stage of change, gender and occupational differences may play a role in encouraging people to cycle to work.

The study reveals evidence of a significant subjective element involved in perception formation of some potential barriers associated with cycle commuting. Women not only hold stronger perceptions compared to males of risk‐orientated barriers but also of more general barriers associated with cycle commuting. The findings also suggest that occupational roles may influence an individual's perceptions of cycle commuting barriers.