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A quantitative observational study was conducted. The purpose of this study is to examine the continuing adherence to the stopping over-medication of people with intellectual disability and/or autism guidelines for a cohort of outpatients seen in the outpatients’ clinics in the two teams who participated in this study to review the trend of psychotropic prescribing with a prescription indication along with the utilisation of non-pharmacological interventions.

Data was retrospectively collected over a period of one year for patients sampled conveniently in the outpatient’s clinic. The data was collected from two sites from psychiatric letters to the general practitioners (GPs), with the focus being psychotropic prescription indication and their adherence to British National Formulary limits, inclusion of a wider multi-disciplinary team or MDT (including nurses, psychologists and health support workers), use of Clinical Global Impression (CGI) scale for assessing medication side effects and response to treatment.

Most of the patients had at least one review in the previous six months. Antipsychotics were the highest prescribed medications without an indication for their use (13.3%) followed by anxiolytics and other medications. CGI recording was suboptimal, with 26% of the patient population did not have medication side effects and effectiveness monitored through this method. In total, 41% of patients were open to community nurses followed by other disciplines.

To the best of the authors’ knowledge, this is an original article following the pilot study completed by the authors.

Promoting mental health and meeting the needs of the large numbers of the general public with problems of anxiety and depression is a big challenge. Particular difficulties are the low capacity of the therapy services and the reluctance of the general public to seek help. The aim of this study was to compare the attendance, effectiveness and characteristics of participants self‐referring to six different psycho‐educational workshops, each using non‐diagnostic titles: self‐confidence; stress; sleep; relationships; happiness; and anger. The series of day‐long workshops ran for one year and were offered to members of the general public in south east London. Over a quarter had not previously sought help from their GP. The take‐up rates for the self‐confidence, sleep and anger workshops were highest and one month after attending these workshops, participants reported significantly lower depression and distress. It was concluded that a self‐referral route to some day‐long workshops can attract quite large numbers of the general public and provide access to effective psychological treatment. These workshops can be used as an effective way of promoting mental health and improving the provision of evidence‐based mental health treatment in the community, possibly within the Improving Access to Psychological Treatments (IAPT) programme in the UK.

This chapter investigates the current trend toward both creative and experiential tourism in cities in terms of the development and marketing of local attractions.

Creative tourism in cities is profiled through a literature review and further investigated by means of a case study at a local attraction in Toronto, Canada. The choice of a site was one of a creative city and the re-purposing of a formerly industrial site for visitation.

The study of Evergreens Brickworks demonstrated the use of marketing techniques to identify markets and match visitors with experiences. The visitor segmentation method determined that pre-scheduled and bookable activities offered for locals need to be offered on a different basis for tourists, who may be one time visitors to the site. The product-market match process suggested areas in which products could be modified or indeed created.

This practical study offers lessons for other local visitor attractions and their managers desiring to identify market segments and match them with appropriate activities creating experiential tourism at the site level within the creative city context.

While many studies of the creative tourism concept and cities have been undertaken within the context of destinations this research offers a site-specific perspective as well as marketing perspective that will be of practical value to attraction managers.

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

We show the geographic distribution, funding patterns, and utilization trends for outreach clinics over a 20-year period. Interviews with program planners and outreach clinic staff show how external and internal constraints limited the program’s capacity. We compare clinic operations to the conceptual models guiding program design.

Our findings show that state health officials had to scale back financial support for outreach clinic activities while healthcare providers faced increasing pressure from administrators to reduce investments in charity care. These external and internal constraints led to a decline in the overall number of patients served. We also find that redistribution of clinics to the Milwaukee area increased utilization among Hispanics but not among African-Americans. Our interviews suggest that these patterns may be a function of shortcomings embedded in the planning models.

Planning models have three shortcomings. First, they do not identify the mitigation of health disparities as a specific goal. Second, they fail to acknowledge that partners face escalating profit-seeking mandates that may limit their capacity to provide charity services. Finally, they underemphasize the importance of seeking trusted partners, especially in working with communities that have been historically marginalized.

There has been little discussion about equitably leveraging genetic advances that improve healthcare quality and efficacy. The role of State Health Agencies in mitigating disparities in access to genetic services has been largely ignored in the sociological literature.

This paper explores how ethnicity is implicated in an etic–emic understanding through day-to-day practices and how such practices meet external accountability demands. Addressing the broader question of how ethnicity presents in an accounting situation, it examines the mundane level responses to those accountability demands manifesting an operationalisation of the ethnicity of the people who make those responses.

The study followed ethnomethodology principles whereby one of the researchers acted both as an active member and as a researcher within a Salvation Army congregation in Manchester (UK), while the others acted as post-fieldwork reflectors.

The conceivers and guardians of an accountability system relating to the Zimbabwean-Mancunian Salvationist congregation see account giving practices as they appear (etic), not as they are thought and interiorised (emic). An etic–emic misunderstanding on both sides occurs in the situation of a practice variation in a formal accountability system. This is due to the collision of one ethnic group's emics with the emics of conceivers. Such day-to-day practices are thus shaped by ethnic orientations of the participants who operationalise the meeting of accountability demands. Hence, while ethnicity is operationalised in emic terms, accounting is seen as an etic construct. Possible variations between etic requirements and emic practices can realise this operationalisation.

The authors’ findings were based on one ethnic group's emic construction of accountability. Further research may extend this to multi-ethnic settings with multiple etic/emic combinations.

This study contributed to the debate on both epistemological and methodological issues in accountability. As it is ill-defined or neglected in the literature, the authors offer a working conceptualisation of ethnicity – an operating cultural unit being implicated in both accounting and accountability.

The COVID-19 pandemic is unprecedented for young people within the UK. The pandemic has presented particular challenges for vulnerable children and young people. For example, a recent study in the UK indicated that 83% of young people with existing mental health conditions said the pandemic had made their condition worse (Young Minds, 2020). To date, the impact upon populations such as young people in Secure Children’s Homes (SCHs) is unknown. This study aims to elucidate this area.

SCHs provide a safe, supportive environment for vulnerable young people who frequently present with multiple and complex needs. Young people residing within a SCH may be residing at the setting because of a Secure Accommodation Order under a Section 25 Order of the Children’s Act (1989) or for criminal justice reasons, i.e. serving a Remand period or custodial sentence. Preliminary research compared a baseline period to a follow-up period after the commencement of COVID-19 national lockdown measures within a SCH in the North of England to develop understanding of the impact for young people.

A significant decrease in overall incidents (t (5) = −6.88, p < 0.001), restraints (t (5) = −9.07, p < 0.001) and other incidents including assaults occurred during follow-up. The SECURE STAIRS framework supports trauma-informed care and enhances support within the setting. Consistent with the framework, provision of formulation meetings was significantly increased within the follow-up period (Welsh’s t (74) = −2.74, p < 0.001). Reflections and future recommendations are outlined.

The unanticipated results highlight the value of examining incident data within secure environments and could lead to effective practice changes for practitioners working within this domain. This research also demonstrates how frameworks such as SECURE STAIRS can be beneficial for vulnerable young people during periods of change and stress in mitigating some of the potential negative effects. The implementation of such frameworks within SCHs is still novel and thus evaluative research is valuable.

Integrated health care occurs when specialty and general care providers work together to address both the physical and mental health needs of their patients. The Substance Abuse and Mental Health Services Administration model of integration is broken into six levels of coordinated, co-located and integrated care. Our institution offers both co-located and integrated care among eight clinic sites. The care team is typically composed of the primary care provider, nurse and medical assistant, but other professionals may be introduced based on the patient’s medical and psychiatric conditions. The purpose of this prospective, quality improvement study was to compare the rates of adherence to long-acting injectable antipsychotics (LAIAs) between both types of integrated primary care settings at our institution. The comparison of the two settings sought to determine which environment provides improved outcomes for patients with serious psychiatric illnesses. Additionally, we aimed to assess the quality of medication-related monitoring and care team composition between care settings, and the ability of pharmacists to deliver interprofessional care team training and education on LAI use in clinical practice.

Subjects were identified and included in the study if they had received primary care services from our institution within the previous 12 months. Patient demographic and laboratory variables were collected at baseline and when clinically indicated. The rates of adherence between care settings were assessed at intervals that align with the medication’s administration schedule (e.g. every four weeks). Medication-related monitoring parameters were collected at baseline and when clinically indicated. The interprofessional care team completed Likert scale surveys to evaluate the pharmacist’s LAIA education and training.

There was not a statistically significant difference detected between integrated primary care settings on the rates of adherence to LAIAs. Additionally, there was not a statistically significant difference between rates of adherence to medication-related monitoring parameters or the effect of the patient treatment team composition. There was a statistically significant difference between pre- and post-session survey scores following interprofessional education and training provided by a pharmacist.

Because overall rates of adherence were low, both primary care settings were found to be equivalent. Our study may have been underpowered to detect a difference in the primary endpoint because of the small sample size. However, our study demonstrates that interprofessional education and training may lend itself to changes in practice, which is evident by the clinically significant relative increase in adherence. The Henry J. Austin Health Center network will be implementing a standard operating procedure regarding LAIA management within the primary care setting. Further studies are needed to assess a larger number of patients between both types of primary care settings, as well as the impact of the clinical psychiatric pharmacist as a member of the treatment team.