Can a case lead approach deliver the "craft and graft" of integration?

Purpose: The aim of this study was to explore the experiences and outcomes for adults with complex needs over time, within and between two teams that delivered integrated care across different Councils' services. The teams' approach to integration included two key features: a “case lead” way of working and the team itself operating as a single point of access (SPA) for residents in given neighbourhoods with high deprivation. Design/methodology/approach: The study was designed as evaluation research located in the realist tradition. Two teams acted as a case study to provide an in-depth understanding of how the case lead approach and SPA delivered the craft and graft of integrated working in the teams. Mixed methods of data collection included residents' ratings of their quality of life on five domains in an outcome measure over a six-month period. Residents and staff working in the teams also participated in semi-structured interviews to explore their respective experiences and receiving and delivering integrated care. The costs of care delivery incurred by residents were calculated based on their demands on public services in the year leading up to the teams' intervention and the projected costs for one year following this. Findings: The relationship between team context, case leads' inputs and residents' outcomes was mediated through the managerial style in the integrated teams which enabled case leads to be creative and do things differently with residents. Case leads worked holistically to prevent residents being in crisis as well as giving practical help such as sorting debts and finances and supporting access to volunteering or further education. Residents rated their quality of life as significantly improved over a six-month period and significant savings in costs as result of the teams' support were projected. Originality/value: The study used a multi-evaluation realistic evaluation methodology to explore the relationship between team context, case leads' inputs and residents' outcomes in terms that integrated services across different District and County Council Departments

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

The care programme approach in England and care and treatment planning in Wales are systems designed to provide mental health service users with a named care co-ordinator who meets regularly with the service user, oversees their care and develops a written plan to guide the care that they receive. These approaches are meant to help people towards recovery. In this study, we investigated whether care is organised to help people’s recovery and whether this is done in a personalised way. We identified six NHS trust/health board sites in England and Wales, and surveyed staff and service users to measure views on recovery, empowerment and therapeutic relationships. At each site we also interviewed managers, clinical staff care co-ordinators, service users and carers about their experiences of care planning. We found that good relationships are important for service users, carers and care co-ordinators in care planning and supporting recovery. Experiences of care planning and co-ordination varied within all sites. People do not always feel involved in their own care. The understanding of recovery and personalisation varied among the service users and staff interviewed. Workers say that there is too much paperwork and, like service users, they rarely look at care plans once written. Staff focus on risk but this does not often appear to be discussed with people using services, which may be problematic. We recommend research to investigate new ways of working and training to increase staff contact time with service users and carers and to improve a focus on recovery

Why Have We Made Neglect So Complicated? Taking A Fresh Look At Noticing And Helping The Neglected Child

The experience of chronic neglect is extremely harmful to children’s physical, emotional, cognitive and behavioural development. As an area of resaerch it has been traditionally described as neglected and as an arena of practice it is viewed as complex and intractable. Over the last few decades, however, there has been a body of evidence building up to help with the understanding of the impact of neglect upon children and to guide intervention. This paper argues that this evidence is not being used to best effect and that curernt protective systems, like those in the UK, are still struggling to provide an effective response to neglected children. The language of neglect has become over-complicated and the systems and processes for assessment, planning and intervention are mired in bureacracy. Some of these complexities are explored in more detail and a model is proposed that would support a more direct and straightforward response to children whose needs are not being met

Cross-national mixed methods comparative case study of recovery-focused mental health care planning and coordination in acute inpatient mental health settings (COCAPP-A)

Background: Serious concerns have been identified in relation to care planning, patient involvement and consent to treatment in mental health wards, including for those patients detained under the Mental Health Act. Further evidence is needed to develop care planning interventions that embed dignity, recovery and participation for all people using inpatient mental health care. Design: We propose to undertake a cross-national comparative study of recovery-focused mental health care planning in inpatient settings. This two-phase exploratory mixed methods study will produce theory and empirical evidence to complement that developed in our current study of community mental health services to inform a future whole systems intervention study. The study is guided by a theoretical framework emphasising the connections between different 'levels' of organisation (macro/meso/micro). In phase 1 we study the macro-level through the comparative analysis of English and Welsh policy contexts. In phase 2 concurrent quantitative and qualitative data will be collected at 6 NHS Trust/Health Board case study sites (meso-level) and within each site, a single micro-level mental health ward will be selected to provide in-depth qualitative data related to care planning processes. Phase 1: We will extend our current meta-narrative mapping review (Wong et al 2013) of English and Welsh policies and the international literature on personalised recovery-oriented care planning and coordination in community settings to include inpatient settings. We will provide a review of evidence that is useful, rigorous and relevant for service providers and decision-makers and to inform Phase 2. Phase 2: We are employing a concurrent transformative mixed methods approach with embedded case studies (Creswell 2009: 215). We will conduct six in-depth meso-level case study investigations across contrasting NHS Trusts in England (n=4) and Local Health Boards in Wales (n=2), selected to reflect variety in geography and population and include a mix of rural, urban and inner city settings providing routine inpatient care. A large sample of service users (total n=300), inpatient staff (n=300) and informal carers (n=150) will be surveyed about perceptions of acute mental health care and care planning, recovery oriented practices, therapeutic relationships and empowerment using validated questionnaires. Documents and interviews with managers, consultant psychiatrists, ward staff and informal carers (n=60) will also be generated relating to local contexts, policies and practices. In each site we will also select a single inpatient ward and conduct a series of case studies embedded within each organisational case study, to explore care planning in detail. We will invite a sample of service users (total n=36) to participate in in-depth interviews about care planning and structured narrative reviews of their care plans; undertake a structured review of anonymised care plans for a further sample (n=60) of consecutively discharged patients; and conduct observation of care planning processes (n= 18). Framework method will be employed to integrate and compare textual and statistical summaries of qualitative and quantitative analyses within each case study site, informed by the theoretical framework focused on recovery and personalisation. Armed with our set of six within-case analyses we will then conduct a cross-case analysis to draw out key findings from across all sites

Work to be done? A survey of educational psychologists exploring their contribution to special schools for profound and multiple learning difficulties

This article explores the perspectives of educational psychologists across England with regard to their professional involvement, role and contribution to special schools for children and young people with profound and multiple learning difficulties (PMLD). An online survey was distributed to all educational psychology services in England and to private educational psychology practices. Data collected from 207 respondents were analysed using descriptive statistics and quantitative and qualitative content analysis. The findings suggest a complex national picture, including great variation in the frequency of educational psychology visits and indirect contact with the special schools. While the work carried out by educational psychologists in these special schools is primarily individual, statutory-led casework, systemic work is considered to be the ‘ideal’ contribution. Educational psychologists’ views on their role in PMLD settings seem to feature limited ideas. The authors suggest that improving educational psychologists’ skills and knowledge of PMLD, building relationships with special schools and finding a niche in supporting, among other things, the emotional well-being of the school’s community, might be ways forward for working in PMLD schools. The article concludes by emphasising the continued need for the profession to understand and market the specific role it can play in PMLD settings

Costs, effects and implementation of routine data emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions: a systematic review protocol

INTRODUCTION: Emergency admission risk prediction models are increasingly used to identify patients, typically with one or more chronic conditions, for proactive management in primary care to avoid admissions, save costs and improve patient experience. AIM: To identify and review the published evidence on the costs, effects and implementation of emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions. METHODS: We shall search for studies of healthcare interventions using routine data-generated emergency admission risk models. We shall report: the effects on emergency admissions and health costs; clinician and patient views; and implementation findings. We shall search ASSIA, CINAHL, the Cochrane Library, HMIC, ISI Web of Science, MEDLINE and Scopus from 2005, review references in and citations of included articles, search key journals and contact experts. Study selection, data extraction and quality assessment will be performed by two independent reviewers. ETHICS AND DISSEMINATION: No ethical permissions are required for this study using published data. Findings will be disseminated widely, including publication in a peer-reviewed journal and through conferences in primary and emergency care and chronic conditions. We judge our results will help a wide audience including primary care practitioners and commissioners, and policymakers. TRIAL REGISTRATION NUMBER: CRD42015016874; Pre-results

Factors associated with high and low levels of school exclusions:Comparing the English and wider UK experience

This article draws on findings from the first cross-national study of school exclusions in the four jurisdictions of the UK. It sketches factors associated with the past research with reductions in exclusions. It then reports interview data gathered in England in 2018 from five specialist officers working in two Local Authorities and a senior officer working for a national voluntary organisation. The officers describe good practice but also national, local and school level developments contributing to a deteriorating situation. These developments include unhelpful government guidance and regulations; school accountability frameworks affecting curriculum and leading to the neglect of Special Educational Needs; loss of Local Authority powers and funding resulting in reductions in support services. Data gathered for this study in other UK jurisdictions suggests that in Scotland and Northern Ireland, and to a lesser extent in Wales, a practice that avoids school exclusions has persisted more than in England