Transitioning to a safeguarding children clinical network during a time of major NHS reform: an exploratory study about the experiences of Designated professionals

Background: Safeguarding children is a priority area, yet the experiences of those statutorily charged with offering strategic direction and clinical leadership in health organisations has received little research attention. This study focuses on the experiences of Designated nurses and doctors as they transition from working as an organisation’s sole expert to sharing tasks and responsibilities across many organisations as part of a countywide clinically-led Network. Method: This qualitative study used a participatory action research methodology that allowed the author – a participant Designated nurse – together with colleagues to address concerns and ensure improvements during the course of the study. Data was collected at two points: during the consultation on the Network’s form; and 12-18 months after its implementation. Results: The first data, gathered when Designates were working as sole practitioners, illustrated their isolation, difficulties in accessing knowledge and anxieties about their capacity to respond to changing demands. Further analysis demonstrated that participants’ experiences were shaped by local circumstances and the concerns raised by the newly announced NHS reforms. The second data set, gathered a year after the Network’s launch and contemporaneous with the implementation of the NHS reforms, showed that team working had addressed most of their earlier concerns. The Network had legitimised sharing tasks, combatted isolation, improved access to new knowledge, and benefitted the professionals’ authority through the reputation the Network had achieved for innovation in safeguarding. However, professionals raised concerns regarding collective responsibilities and individuals’ accountability to the team. Conclusion: The study’s inability to completely separate the effects of this change in working practice from the NHS reforms limits its generalisability. The research offers insights into whether small groups of practitioners endeavouring to deliver scarce expertise to multiple organisations would benefit from a team approach, and whether voluntary participation and shared objectives are enough to sustain such teams

Gesture production and comprehension in children with specific language impairment

Children with specific language impairment (SLI) have difficulties with spoken language. However, some recent research suggests that these impairments reflect underlying cognitive limitations. Studying gesture may inform us clinically and theoretically about the nature of the association between language and cognition. A total of 20 children with SLI and 19 typically developing (TD) peers were assessed on a novel measure of gesture production. Children were also assessed for sentence comprehension errors in a speech-gesture integration task. Children with SLI performed equally to peers on gesture production but performed less well when comprehending integrated speech and gesture. Error patterns revealed a significant group interaction: children with SLI made more gesture-based errors, whilst TD children made semantically based ones. Children with SLI accessed and produced lexically encoded gestures despite having impaired spoken vocabulary and this group also showed stronger associations between gesture and language than TD children. When SLI comprehension breaks down, gesture may be relied on over speech, whilst TD children have a preference for spoken cues. The findings suggest that for children with SLI, gesture scaffolds are still more related to language development than for TD peers who have out-grown earlier reliance on gestures. Future clinical implications may include standardized assessment of symbolic gesture and classroom based gesture support for clinical groups

Very Late–Onset Schizophrenia-Like Psychosis: A Clinical Update

Psychosis symptoms (delusions and hallucinations) are multifactorial in origin and, in later life, occur in the context of schizophrenia, delirium, dementia, delusional and schizophrenia-like disorders, mood disorders, and alcohol or substance abuse. The current article provides a clinical overview of very late–onset (after age 60) schizophrenia-like psychosis (VLOSLP), summarizing the literature on treatment options and reflecting on the role of psychiatric–mental health nurses (PMHNs). Increased awareness of the clinical presentation, key features, and evidence-based treatment options will assist PMHNs to confidently recognize this often under-diagnosed disorder and adopt a more assertive role in terms of engagement and follow up. Pragmatic research involving individuals with VLOSLP is required to increase the evidence base for treatment and improve outcomes of care. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 37–47.] It has long been acknowledged that psychotic illness can lead to alienation, discrimination, and isolation (Burke & Shome, 1998), and older adults with psychosis represent one of the most disenfranchised groups in relation to health care (Mitford, Reay, McCabe, Paxton, & Turkington, 2010). In the older adult mental health setting, nurses encounter two main groups with a schizophrenia diagnosis: (a) individuals with early-onset schizophrenia (EOS) who have grown old, and (b) those who experience the onset of psychosis in later life, either as late-onset (after age 40) schizophrenia (LOS) or very late–onset (after age 60) schizophrenia-like psychosis (VLOSLP). Older adults with schizophrenia have been somewhat neglected historically by the scientific research community (Cohen et al., 2008; Folsom et al., 2006), and there is a significant gap between the high prevalence of psychotic disorders in older adults and the availability of evidence-based treatments (Reinhardt & Cohen, 2015). This gap leaves health care systems ill-prepared to manage the predicted substantial growth in the older adult population (Cohen, Meesters, & Zhao, 2015). Drawing on the published literature and the current authors' clinical and research experience, the current article reflects on VLOSLP from a person-centered, biopsychopharmacosocial mental nursing perspective (Clarke & Clarke, 2014), describing clinical presentation and treatment interventions. A search of PubMed and CINAHL using “very late-onset schizophrenia-like psychosis” and a range of related terms combined with (mental health/psychiatric) nursing revealed very little attention specifically relating to mental health nursing care of this patient group, although information is available in relation to generically supporting older adults experiencing psychosis, schizophrenia, or both

The acquisition of Sign Language: The impact of phonetic complexity on phonology

Research into the effect of phonetic complexity on phonological acquisition has a long history in spoken languages. This paper considers the effect of phonetics on phonological development in a signed language. We report on an experiment in which nonword-repetition methodology was adapted so as to examine in a systematic way how phonetic complexity in two phonological parameters of signed languages — handshape and movement — affects the perception and articulation of signs. Ninety-one Deaf children aged 3–11 acquiring British Sign Language (BSL) and 46 hearing nonsigners aged 6–11 repeated a set of 40 nonsense signs. For Deaf children, repetition accuracy improved with age, correlated with wider BSL abilities, and was lowest for signs that were phonetically complex. Repetition accuracy was correlated with fine motor skills for the youngest children. Despite their lower repetition accuracy, the hearing group were similarly affected by phonetic complexity, suggesting that common visual and motoric factors are at play when processing linguistic information in the visuo-gestural modality

Explaining context, mechanism and outcome in adult community mental health crisis care: a realist evidence synthesis

Mental health crises cause significant distress and disruption to the lives of individuals and their families. Community crisis care systems are complex, often hard to navigate and poorly understood. This realist evidence synthesis aimed to explain how, for whom and in what circumstances community mental health crisis services for adults work to resolve crises and is reported according to RAMESES guidelines. Using realist methodology, initial programme theories were identified and then tested through iterative evidence searching across 10 electronic databases, four expert stakeholder consultations and n = 20 individual interviews. 45 relevant records informed the three initial programme theories, and 77 documents, were included in programme theory testing. 39 context, mechanism, outcome configurations were meta-synthesized into three themes: (1) The gateway to urgent support; (2) Values based crisis interventions and (3) Leadership and organizational values. Fragmented cross-agency responses exacerbated staff stress and created barriers to access. Services should focus on evaluating interagency working to improve staff role clarity and ensure boundaries between services are planned for. Organizations experienced as compassionate contributed positively to perceived accessibility but relied on compassionate leadership. Attending to the support needs of staff and the proximity of leaders to the front line of crisis care are key. Designing interventions that are easy to navigate, prioritize shared decision-making and reduce the risk of re-traumatizing people is a priority

Building an Assessment Use Argument for sign language: the BSL Nonsense Sign Repetition Test

In this article, we adapt a concept designed to structure language testing more effectively, the Assessment Use Argument (AUA), as a framework for the development and/or use of sign language assessments for deaf children who are taught in a sign bilingual education setting. By drawing on data from a recent investigation of deaf children's nonsense sign repetition skills in British Sign Language, we demonstrate the steps of implementing the AUA in practical test design, development and use. This approach provides us with a framework which clearly states the competing values and which stakeholders hold these values. As such, it offers a useful foundation for test-designers, as well as for practitioners in sign bilingual education, for the interpretation of test scores and the consequences of their use

An audit of Supplementary Prescribing within South West Yorkshire Mental Health Trust

Results are presented from an audit of mental health nurses (MHNs) who have undertaken training in order to practise as supplementary prescribers as part of an evaluation of the development of non-medical prescribing (NMP) across South West Yorkshire Mental Health Trust (SWYMHT). Quantitative (demographics) and qualitative (open-ended statements) results derived from a questionnaire survey are analysed and compared to the national picture. Implications for the governance arrangements which need to be in place for the further development of non-medical prescribing in mental health care, both for the Trust and nationally, are suggested

Capturing the experiences of younger people with dementia and those close to them: co-constructing the ‘Sharing Model’

This thesis presents a constructivist grounded theory study of the experiences of younger people with dementia (YPWD) and those close to them. Semi-structured interviews were conducted over a two and a half year period. Younger people with dementia of age < 65 (n = 16), partners of YPWD (n = 11), adult children of YPWD (n = 3), a professional carer (n = 1) and a specialist nurse (n = 1), were recruited through their contact with a specialist NHS service in the north of England. Draft study proposals were initially reviewed by a group of YPWD and their partners and also a health and social care YPWD team. The literature relating to the experience of YPWD that existed at the outset of the study was considered and informed the initial foreshadowed questions that provided direction for the study. Following a purposive sampling strategy, theoretical sampling was later employed throughout the process of data collection. Transcribed interview data were qualitatively analysed for codes and themes to produce a grounded theory. The methodological underpinnings of this constructivist study, including the processes employed for ‘co-construction’ of the findings are presented. A four stage temporal model was identified: 1) Noticing something unusual, 2) What’s happening? Seeking a diagnosis, 3) Receiving & sharing a diagnosis, & 4) Where do we go from here? Getting on with it. Sharing is presented as a core social process that was present across all four of these temporal stages and was central to how participants engaged in either; Maintaining, Modifying or Abandoning aspects of their lives across the temporal journey of being (or being close to) a YPWD. The usefulness and applicability of the Sharing theory and of how this may contribute to the broader literature related to the experience of dementia is discussed. The study findings and the Sharing theory are then considered in light of recent UK literature on the prevalence and experience of dementia at a younger age and current related health and social care policy in England