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Alcohol-related brain injury (ARBI) is part of a group of conditions that do not fit easily into existing systems of care. People living with ARBI require flexible health and social services to ensure they receive person-centred, therapeutic care and treatment. Effective service provision promotes recovery for people who continue to experience significant levels of morbidity and mortality due to symptoms that are potentially reversible or at least amendable to appropriate care and treatment options. There exist significant gaps in the provision of this care for these vulnerable populations.

A literature review was undertaken of various scholarly databases (e.g. CINAHL, MEDLINE and Web of Science), as well as government and non-government publications and reference materials. Publications were included for analysis if they reported participant cohorts who had a diagnosis of ARBI or were carers or service staff involved with individuals who lived with ARBI.

In total, 31 publications on the needs of people living with ARBI were reviewed. Of the 67 sources identified a total of 31 were accessed and retrieved. Four main themes were identified: under-recognition and lack of a timely diagnosis, inadequate service provision and limited care pathways, stigma, and homelessness. Sources came from Australian, British, North American and Canadian literature.

Significant gaps were found in both the literature and in current clinical practices when it comes to the identification, care and treatment of people with ARBI. Globally, ARBI policy, treatments and service provision is often not available and when it does exist, it lacks consistency. Variations in models of care are significant given the fact that the predicted increase in per capita alcohol consumption will see a disproportionate increase in ARBI in future generations. This review was generated by the lack of contemporaneous evidence and may be considered a starting point for future research looking into the needs of individuals living with ARBI.

This international literature review contributes to a broader understanding of the issues and problems faced by people with ARBI. Of the 67 resources identified through a rigorous search method only 31 were relevant to people who live with ARBI in relation to care and support services. This indicates a lack of research in this area but that which needs to be undertaken. The review also highlighted service disconnection and the need for specific, tailored treatment approaches for people with ARBI. It was also found that the identification of ARBI in clinical practice has been protracted by the lack of systemised and standardised screening tools to use in the assessment of those who display signs and symptoms of these conditions.

Governments mediate, through their architecture of machinery and policy, access to rights and, by extension, to services. There is limited but growing recognition in both the UK and other European governments that individuals' power to negotiate this access is limited by the structural inequality of groups in certain named categories of disadvantage (inter alia, people with disabilities), and they are adapting their machinery to provide the support they require to ‘level the playing field’. However, intersectionality (identities which cut across these recognised categories of disadvantage) prevents those affected from using such mechanisms effectively. Those whose disability impairs their mental awareness and understanding face an additional barrier. The paper explores how this limits the rights of those with both learning disabilities and mental illness, and looks at some of the ways in which this problem is being addressed.

The experiences of clinical facilitators working within non-conventional mental health settings have not yet been explored. The purpose of this paper is to explore the experiences of clinical facilitators when facilitating nursing student learning within a non-conventional mental health clinical placement.

This study adopted a qualitative phenomenological approach. The participants in this study were five registered nurses who had facilitated students at a non-conventional mental health clinical placement called Recovery Camp. Individual in-depth interviews were conducted.

The facilitators experiences could be understood through two main themes: facilitator skills and opportunities for student learning. Recovery Camp allowed the facilitators to build on their own nursing and facilitation skills, while examining themselves as a mental health nurse. “Being with” students (immersive engagement) enabled opportunistic and rare learning moments.

To the best of the authors’ knowledge, this is the first known study to explore the experiences of clinical facilitators working in a non-conventional mental health placement.

Aarhus Kommunes Biblioteker (Teknisk Bibliotek), Ingerslevs Plads 7, Aarhus, Denmark. Representative: V. NEDERGAARD PEDERSEN (Librarian).

Robin Johnson continues his excellent series on housing issues, this time exploring the important role that support workers can have in reaching out to and engaging with individuals who would ordinarily be reluctant to put themseves in the hands of conventional care or therapy services.

The purpose of this research is to evaluate the longitudinal effect of innovation programmes on improving the process of innovation in manufacturing SMEs. The process of innovation in organisations covers people, process and technology. Therefore interventions in the form of innovation improvement programmes often require high levels of complexity. This complexity is compounded in SMEs, where issues such as scarce resources and skill shortages must be recognised.

A multiple case research methodology combined with an innovation evaluation model is used to evaluate the longitudinal effect of an innovation intervention programme, which combined taught modules and Critical Action Learning networks over an eighteen month period. Within‐group comparisons are made.

The findings reveal that SMEs, which have high levels of innovation improvement, adopted a broad process based approach to innovation rather than using a narrow technical definition of innovation. These SMEs also developed a process of critically reflective action learning to ground the innovation in organisational practice.

There is a paucity of longitudinal research studies on innovation interventions in SMEs.

Innovation efforts of small- or medium-sized enterprises (SMEs) in peripheral regions are limited both by innate resource limitations and by location factors such as excessive distance from key markets and higher cost bases for new technology. However, the emergence of the knowledge economy may enable leveraging of knowledge to address such innate limitations. The aim of this study is to twofold. First, the study explores how SMEs in peripheral areas, i.e. challenging regions, seek to implement innovation from a path perspective by examining the contributions from antecedent and mediator variables or constructs, including knowledge-based factors identified in the literature, using a cross-sectional survey of SMEs at firm level. Second, to further examine how these path model constructs and relationships contribute in a causal manner to innovation implementation at an activity level of analysis based on knowledge-based view and dynamic capability theory, using a case study analysis.

A sequential mixed method approach is used. In relation to the first aim a hypothetical path model is tested using structured equation modelling techniques based on a cross-sectional survey of SMEs in peripheral regions (n=604). For the second aim, to further examine how the path model constructs and relationships contribute to innovation implementation in a causal manner at an activity level of analysis, an explanatory case-based approach is used based on dynamic capability theory.

The findings show that at a firm level knowledge factors influence innovation implementation as mediating factors through knowledge acquisition and assimilation which is consistent with potential absorptive capacity, and knowledge sharing linkages. Antecedent factors of lifecycle, leadership, culture and historical propensity to innovation were found to interact with the mediating variables of knowledge acquisition and assimilation, TQM/business improvement and knowledge sharing linkages (external), to produce a range of innovation outputs, including knowledge transformation and sales of new products and services from innovation activities. Based on the case study findings the underlying knowledge-based dynamic capabilities which contribute to the relationships within the path model were identified and further research agendas established.

There is a relative paucity of studies on innovation implementation within SMEs in peripheral regions using a knowledge-based perspective at firm level, as opposed to regional level (e.g. regional innovation studies). In this context unique resource limitations and the contribution of knowledge-based factors need to be addressed. This study seeks to compliment regional level studies by making a contribution at both a cross-sectional SME or firm level and at an activity level of analysis in this area and to identify areas for further research.

Relational autonomy proposes that persons are socially embedded, with decisions being made within social relationships. Through this theoretical lens, this article explores how the healthcare professional–patient relationship can affect pregnant women’s decisions to accept pertussis and influenza vaccines.

Hackney was chosen as the study site as it has very low vaccine uptake rates. In-depth interviews were conducted with 40 pregnant and recently pregnant women, as well as 10 healthcare professionals. Interviews explored experiences of the UK's National Health Service (NHS) health care and views towards vaccination in pregnancy. An observation of a consultation between a pregnant patient and her General Practitioners (GPs) was also conducted in order to understand how the vaccination discussion takes place.

The findings of this study indicate that advice from friends and family can greatly influence a pregnant woman’s vaccination decisions. The patient’s social context, including influences on her decisions, must be understood by healthcare professionals, so that discussions about concerns can take place. If close relationships with patients are formed, healthcare professional advice is more likely to be trusted. With support from healthcare professionals, patients feel competent, empowered to make the right decision for them, and are more likely to vaccinate.

This research will help to inform contextualised policies aimed at increasing vaccination acceptance and reducing inequality in access to vaccination during pregnancy in Hackney.

To the author’s knowledge, this chapter is the first to apply the theory of relational autonomy to views towards maternal vaccination and decision making. It provides valuable insights into how healthcare professionals’ interactions with their pregnant patients can influence vaccination acceptance. The chapter contains advice on how both healthcare professionals and policy-makers can include mothers in vaccine decision-making processes in more personalised ways, by adopting a dialogue that appreciates and understands the social processes around vaccination concerns.