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The Adult Support and Protection (Scotland) Act 2007 places a duty on Councils to investigate the circumstances of adults who, because of a disability, health condition or illness are unable to safeguard themselves from harm. Public partner agencies, including the NHS have a statutory obligation to bring to the attention of the Council those individuals who may be at risk of harm. Health professionals cooperate with adult protection investigations and participate in the development of adult support and protection plans, yet do not appear to be initiating adult protection referrals with the Council. Low reporting by health has also been recognised as a national issue. The purpose of this paper is to explore what promotes and what prohibits the identification and reporting of situations of abuse within the Scottish Legislative Framework. Understanding the decision-making processes of prospective reporters would potentially allow the barriers to be reduced and the supports to be strengthened.

The research strategy is based on a literature review, a web-based survey and semi-structured interviews with health professionals within community learning and community mental health teams.

The findings point to a number of inter-related factors which impinge upon the professional’s confidence to initiate adult protection referrals. Workers must first recognise harm as conduct which needs to be reported and addressed. They need to be familiar with referral procedures and be assured that their concerns will be dealt with appropriately. Health professionals are more likely to report if they are based in an environment which supports honest and open discussion regarding harm, without over-concern about agency reputation or resources. Access to multi-disciplinary consultation and support, particularly in relation to more ambiguous protection situations, was viewed as fundamental to reporting.

This small scale study adds to a developing bank of literature providing a Scottish perspective on protecting adults. It offers some insight into reporting decisions from the viewpoint of community health professionals.

Frequent attendance at emergency departments (ED) has been identified in adult protection reviews as a potential warning sign of the escalation of someone’s vulnerability. Concern has been expressed about the engagement of the National Health Service (NHS) in adult protection and the small number of NHS adult protection referrals. More specifically ED departments have been identified as an area of high patient through put where there has been little evidence around how well adult support and protection (ASP) was being delivered. The paper aims to discuss these issues.

A series of audits were undertaken in three different hospitals across a large Scottish Health Board accessing ED at different times of day on different days of the week to test out whether NHS staff working in EDs are identifying adults who meet the criteria of “an adult at risk”.

The audits identified a total of 11 patients from a total sample of 552 records examined who may have met the criteria to be considered an adult at risk, although further information would have been required to make a fully informed decision.

The main study limitation is that the hospitals are all within a single Health Board. The EDs have a large number of admissions and it is possible that a less pressurised area, might have a lower threshold of “risk” than the practitioners involved in the audits. The decision as to whether an adult was considered to meet the three-point test by the three people undertaking the audit was dependent on the quality of information recorded on the patients’ electronic hospital record.

It is essential that NHS Boards proactively support practice in ED settings so staff are able to identify adults at risk of harm under the ASP legislation so that ED staff are responsive to ASP needs.

The research evidence around adult protection in the UK is still emerging. The development of good practice based on the Scottish Government’s ASP legislation is still being shaped. In England and Wales, the principles of identification and multi-agency working underpinning the safeguarding of vulnerable individuals are broadly similar to Scotland. These audits add to the literature by challenging the assumption that patients who would benefit from local authority investigation and possible support are not being identified within EDs.

Low self-esteem is common in people with learning disabilities. There is limited research examining the effectiveness of cognitive behavioural therapy (CBT) focused on low self-esteem within this client group. The purpose of this paper is to add to the limited evidence by describing the use of CBT focused on low self-esteem for a person with a learning disability in the context of emotion regulation difficulties.

An individual case study design was used, with repeated quantitative measures to monitor progress during weekly individual psychology sessions.

There was a reduction in the client’s feelings of anger and an increase in their self-esteem.

Further studies and follow-up would determine longevity of benefits. The inclusion of distress tolerance techniques may have impacted on the findings and limits the conclusions that can be drawn about the impact of CBT focused on low self-esteem.

This case study could make a small contribution to the evidence base for the effectiveness of CBT-based treatments for low self-esteem in people with learning disabilities, which is an under-researched area.

This paper aims to shed light on the demand side of sustainability, that is, on its perceived meaning. The goal is to understand how people think of sustainability, the concepts they evoke when they talk of sustainability and the images and symbols they use to explain these concepts.

This study uses a mixed method. First, ten individuals are interviewed using the Zaltman metaphor elicitation technique (ZMET), a protocol developed by Gerald Zaltman in the early 1990s. The concepts and categories emerging from the ZMET have been analyzed, integrated and classified to identify key dimensions.

Ten concepts related to sustainability are the most recurring in the ZMET: problems and solutions, individual behavior, environment and ecosystem, technologies and innovations, social fairness, food and nutrition, mobility, education and mindfulness, sustainable development and utopia/ideal world.

Ten interviews is a small number to provide a comprehensive analysis of all the meanings of sustainability. To obtain a more complete picture, the number of interviews may need to be increased to 15–20.

The fact that the two concepts appearing with the highest frequency in the ZMETs are “problems and solutions” and “individual behavior” signals that though people understand that there are many problems to be solved in the world as it is now, even the single individual can contribute with his/her behavior.

Sustainability is an issue that involves society as a whole; hence, its improvement requires concerted political action coordinated at the national and local levels. The key point of this action is education of people, to make them aware of what sustainability really is.

Although the literature on sustainability is rather abundant, extant literature has mainly focused on the supply/managerial side such as sustainable and responsible companies, corporate social responsibility and also sustainable tourism. This paper sheds some light on the more neglected side of the demand perspective.

I suppose that most noticeable of all the changes in our profession since I came into it has been the multiplicity of the methods by which one can become a librarian. A. E. Standley says in a recent article in the L.A.R., in 1970: “The term librarian includes the Library Association chartered librarian, the graduate with a degree in librarianship, the scholar librarian, the information and intelligence officer, the translator, the abstracter, the non‐library‐qualified subject expert”.

This article is drawn from doctoral research exploring the identity struggles faced by professionals who take on management and leadership roles. The research focused on the experience of medical directors – the most senior doctor‐manager with board responsibility for medical affairs. Based on the fact that a medical director is a hybrid manager this research has implications for any professional who takes on a managerial or leadership role while continuing to practice their profession. Some challenges of working as a hybrid are associated with the difference in orientations between professionals and managers. While the notion of who and what a professional is has changed and new forms of accommodation have been forged the hybrid identity remains a site of potential conflict for the individual and those they work with. The purpose of this paper is to explore the experience of the hybrid identity.

The experience of the hybrid identity is explored through social identity theory (Tajfel and Turner).

The analysis reveals that the medical director role is ambiguous, that medical identity is robust and that medical management is difficult compared to clinical work. Managerial identity in general is constructed negatively and from the perspective of doctors. The importance of maintaining clinical credibility is both embraced as a resource which bolsters and maintains medical identity and so distinguishes medical directors from the taint associated with the pejorative managerial identity that doctors construct of managers.

The implications for the selection, training and development of doctors and medical directors are raised as are those for the relationship between doctors and patients, and doctors and the organisation. Some implications identified, specifically for leadership in practice are as follows: leadership/management is challenging and difficult compared to professional work; language use is significant for how leaders are perceived; language use has implications for leader effectiveness; early exposure to leadership for professionals is important; and leadership role definition is important for consistency and role credibility.