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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.

Local Safeguarding Adults Board (SAB) policies, procedures, guidance and related documents on self-neglect were gathered and analysed, to map what approaches are being taken across England. This paper aims to identify areas of divergence to highlight innovations or challenges faced by SABs.

Self-neglect documents were identified by searching SAB websites. Data were extracted into a framework enabling synthesis and comparison between documents.

This paper reports on how English SAB documentation defines self-neglect, treats executive capacity, lays out pathways for self-neglect cases, advises on refusal of service input and multi-agency coordination and draws on theories or tools. Greater coherence in understanding self-neglect has developed since it was brought within safeguarding in 2014; however, variation remains regarding scope, referral pathways and threshold criteria.

This review was limited to published SAB documentation at one point in time and could not consider either the wider context of safeguarding guidance and training or implementation in practice.

This review provides an overview of how SABs are interpreting national guidance and guiding practitioners. The trends and areas of uncertainty identified offer a resource for informed research and policy-making.

To the best of the author’s knowledge, this is the first systematic survey of SAB self-neglect policies, procedures and guidance since self-neglect was included under safeguarding.

The purpose of this paper is to report on the aspects of an exploratory investigation into the scale and nature of the financial abuse of adults lacking mental capacity.

It uses mixed-methods study which comprises of: a review of safeguarding adults’ statistics; analysis of court case findings; classification of types of financial abuse, victims and perpetrators; qualitative exploration of professional views of the nature of financial abuse of those lacking mental capacity; and a consideration of policy implications.

It demonstrates the significance of financial abuse within the spectrum of abuse experienced by adults at risk; the wide range of both victims lacking capacity being abused and type of financial abuse; its often hidden nature embedded within the family; and the limitations of processes designed to protect.

The investigation reveals the paucity of statistical data available on the nature of financial abuse and the outcomes of official investigations into reported cases, both of which limit analysis and understanding of the phenomenon.

It demonstrates the need for greater transparency and consistency in the reporting of safeguarding and legal processes to enable practitioners and policymakers to fully understand the nature and significance of this abuse for both victims and society.

It questions the extent to which existing protective processes are sufficient in terms of safeguarding victims and deterring perpetrators.

It involves original research that brings together data from a range of sources involved in the protection of a particular hard-to-reach group of individuals (those lacking capacity) from a particular type of risk (financial abuse) of increasing social significance.

The purpose of this paper is to present findings from a mixed-methods study on the impact that COVID-19 has had on adult safeguarding. The research sought to explore the challenges and opportunities presented by COVID-19 to both frontline and non-frontline professionals working in adult safeguarding.

A mixed-methods project was undertaken comprising a literature review, survey, semi-structured interviews and a small number of freedom of information requests. This paper presents the findings predominantly from the survey and interviews.

Unsurprisingly, COVID-19 has presented a variety of challenges for professionals working in adult safeguarding. The themes that occurred most often were the day-to-day changes and challenges, relationships across sectors, information and navigating the ethical questions in safeguarding.

To the best of the authors’ knowledge, the findings represent the first focused qualitative mixed-method study aimed at understanding more about the impact the pandemic has had on adult safeguarding through the eyes of those professionals working in that field.

Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care.

The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London.

Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub.

Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub.

Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams.

Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems.

The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

This study aims to determine the factors and dynamic systems behaviour of essential medicine stockout in public health-care supply chains. The authors examine the constraints and effects of mental models on medicine stockout to develop a dynamic theory of medicine availability towards saving patients’ lives.

This study uses a mixed-method approach. Starting with a survey method, followed by in-depth interviews with stakeholders within five health-care supply chains to determine the dynamic feedback leading to stockout and conclude by developing a network mental model for medicines availability.

The authors identified five constraints and developed five case mental models. The authors develop a dynamic theory of medicine availability across cases and identify feedback loops and variables leading to medicine availability.

The need to include mental models of stakeholders like manufacturers and distributors of medicines to understand the system completely. Group surveys are prone to power dynamics and bias from group thinking. This survey’s quantitative output could minimize the bias.

This study uniquely uses a mixed-method of survey method and in-depth interviews of experts to assess the essential medicine stockout in Nigeria. To improve medicine availability, the authors develop a dynamic network mental model to understand the system structure, feedback and behaviour driving stockouts. This research will benefit public policymakers and hospital managers in designing policies that reduce medicine stockout.

Stereotypes are simplified and widely shared visions held by a social group regarding a place, object, event or recognizable set of people united by certain characteristics or qualities. They are “dangerous” mental models because they are widely disseminated, devious and capable of acting even unconsciously in individuals, social groups and organizations altering the rationality of assessments and choices and producing discrimination and prejudice. Stereotypes acritically extend from a characteristic of a significant percentage of a category to the totality of individuals. The process of generalization triggered by a stereotype produces the error of discrimination and prejudice. There are numerous forms of stereotypes, but this study takes into account gender stereotypes because they act pervasively, often subtly, to reduce “productivity”. People who are aware of being discriminated perceive an unsatisfactory fulfillment of their motivations, which reduces their incentive to improve their performance. Since productivity measures the efficient use of energy from working in production processes, the author believes that wherever gender stereotypes are at play, there is a productive “waste of energy”, an inefficiency in work activity with harmful effects for organizations of all kinds, including families.

The work aims to demonstrate that wherever gender stereotypes are at play, a “waste of energy” manifests itself in terms of productivity, representing an inefficiency in work activity with harmful effects for organizations of all kinds, including families. To describe the negative effects stereotypes produce in organizations, some models are presented based on the methods and language of systems thinking. These models, although typically qualitative, are capable of exploring the most accepted theories in the literature: tournament theory, the Pygmalion effect, the Galatea effect, self-fulfilling prophecies, the Queen bee syndrome, the role congruency theory, the glass ceiling theory (“think manager, think male” and “family responsibilities wall”). The paper follows a predominantly organizational and corporate approach, although the copious literature on stereotypes belongs largely to the area of social psychology and organization studies.

The paper does not consider the psychological origin of stereotypes but highlights their use as routines-shortcuts for evaluations and decisions demonstrating that, when adopted in social systems and within organisations, stereotypes produce different forms of discrimination: in social rights, in work, in careers and in access to levels of education and public services, reducing performance and limit potential. The paper also examines some ways gender and culture stereotypes can be opposed, presenting a change management strategy and some concrete solutions proposed by the process–structure–culture model for social change (PSC model).

The main limitation of the work is that it focuses on gender stereotypes, choosing not to consider the “intersection effect” of these with other stereotypes: racial stereotypes, religious stereotypes, color stereotypes, age stereotypes, sex and sexual orientation stereotypes, and many others, whose joint action can cause serious inefficiencies in organizational work.

As stereotypes are a component of social culture and are handed down, by use and example, from generation to generation, the maintenance over time of stereotypes used by individuals to evaluate, judge and act can be seen as an effect of the typical action of a combinatory system of diffusion, which can operate for a long time if not effectively opposed. Il PSC model indicates the strategy for carrying out this opposition.

With regard to gender stereotypes, it should be emphasized that in organizations and social systems, “gender diversity” should be considered an opportunity and not as a discriminating factor and thus encouraged by avoiding harmful discrimination. In fact, this diversity, precisely because of the distinctive characteristics individuals possess regardless of gender, can benefit the organization and lead to an increase in organizational and social performance. The United Nations 2030 Agenda for Sustainable Development (2020) Goal 5: Achieving gender equality and empowering all women and girls is examined in this context.

This study views the action of gender stereotypes as especially harmful “mental models”, highlighting the distortions they cause in the allocation of productive energy in society, groups and organizations. The paper follows a predominantly organizational and corporate approach, although the copious literature on stereotypes belongs largely to the area of social psychology. Using the “logic” and “language” of systems thinking, theories and models that describe and interpret the distorting effects of organizational choices based on stereotypes rather than rational analysis are highlighted. The action of stereotypes and their persistence over time can also be described using combinatory systems theory. With this paper, the author hopes that by acting on the three wheels of change highlighted by the PSC model, through legal provisions, control tools and actions on the culture operated by educational and social aggregative institutions, it should not be impossible to change the prevailing culture so that it becomes aware of the harmful influence of gender stereotypes and other discriminatory mental models and come to reject them. The author hopes this paper will help to understand the need to make this change.

We sought to evaluate the capacity of the Edinburgh Postnatal Depression Scale (EPDS) in discriminating mental disorders other than depression in pregnant women in northern Mexico. Three hundred pregnant women attending prenatal consultations in a public hospital in Durango City, Mexico submitted a validated EPDS and were examined for mental disorders other than depression using the Diagnostic and Statistical Manual of Mental Disorders - 4th Ed. (DSM-IV) criteria. Sensitivity and specificity of cut-off points of the EPDS, and positive and negative predictive values were calculated. Of the 300 pregnant women studied, 21 had mental disorders other than depression by the DSM-IV criteria. The best EPDS score for screening mental disorders other than depression was 8/9. This threshold showed a sensitivity of 52.4%, a specificity of 67.0%, a positive predictive value of 11.5%, a negative predictive value of 95.4%, and an area under the curve of 0.643 (95% confidence interval: 0.52-0.76). The EPDS can be considered for screening mental disorders other than depression in Mexican pregnant women whenever a cut-off score of 8/9 is used. However, the tool showed small power to separate pregnant women with and without mental disorders other than depression.

The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.

Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.

Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.

This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.

Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.

This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.

This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

Post-COVID-19, public K–12 schools are still facing the consequences of the years of interrupted learning. Schools serving minoritized students are particularly at risk for facing challenges with academics, behavior and student social emotional health. The university counseling programs are in positions to build capacity in urban schools while also supporting counselors-in-training through service-learning opportunities.

The following conceptual manuscript demonstrates how counselor education counseling programs and public schools can harness the capacity-building benefits of university–school partnerships. While prevalent in fields like special education, counselor educators have yet to heed the hall to participate in mutually beneficial partnership programs.

Using the multi-tiered systems of support (MTSS) and the components of the university–school partnerships, counselor educators and school stakeholders can work together to support student mental health, school staff well-being and counselor-in-training competence.

The benefits and opportunities within the university–school partnerships are well documented. However, few researchers have described a model to support partnerships between the university counseling programs and urban elementary schools. We provide a best practice model using the principles of university–school partnerships and a school’s existing MTSS framework.