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

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

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 examination of the preventive process: Comparison of behaviour and education support team work with children's services

Behaviour and Education Support Teams (BESTs) were developed as a significant element of the Every Child Matters programme. Although varying in composition, they were generally designed to provide support for groups of schools in relation to behavioural, emotional and educational issues. They have not been subject, however, to a great deal of published research and their development, furthermore, raised significant issues about prevention and the preventive process, in particular the capacity to reach vulnerable children and families where thresholds for mainstream services were high. This paper, comparing a BEST with a children's services team, examines the nature of work undertaken. It shows the 'service on offer' from the two agencies differed markedly, with BESTs undertaking a more child-focused approach. The implications of the development of additional services for prevention and the preventive process are discussed © 2012 John Wiley & Sons, Ltd

Caregivers’ experiences of service transitions in adult mental health: An integrative qualitative synthesis

Approximately 5% of the UK population live with serious mental health problems. Data show that informal caregivers of people with mental illness provide care for the highest number of hours compared to other illness and the economic cost of this care is highest in the UK when compared internationally. People living with serious mental health problems make transitions between different intensities of service as their needs fluctuate, including referral, admission, transfer or discharge. Although caregiving is associated with both stress and positive reward, service transitions are particularly associated with increased stress. This review aimed to investigate what is known about the experiences of informal caregivers during mental health service transitions. An integrative qualitative synthesis was conducted following searches in six bibliographic databases and of the grey literature. Studies published in English between 2001 and 2017 were included if the study focus was on serious mental health problems, the experiences of caregivers and service transitions. Eleven studies were included, appraised using the Mixed Methods Appraisal Tool (MMAT) and synthesised, resulting in four themes: 1) Caregiver information 2) Caregiver involvement in decisions about care and treatment 3) Accessing services 4) Being a caregiver. Caregivers’ experiences were similar during transitions to their usual caregiving role but they faced more challenges and their experiences were amplified. Concerns about confidentiality created barriers to information sharing. Continuity of professionals across transitions was helpful. Caregivers struggled to deal with their own conflicting emotions and with the behaviours of the person yet rarely received help. The review findings point to a need for continuity of professionals across service transitions, co-designed and delivered training for professionals and caregivers about information sharing, greater understanding of barriers to implementation of family interventions and interventions that address emotional needs of caregivers

Visual memory for shapes in deaf signers and non-signers and in hearing signers and non-signers: Atypical lateralization and enhancement

Deaf and hearing individuals who either used sign language (signers) or not (nonsigners) were tested on visual memory for objects and shapes that were difficult to describe verbally with a same/different matching paradigm. The use of 4 groups was designed to permit a separation of effects related to sign language use (signers vs. nonsigners) and effects related to auditory deprivation (deaf vs. hearing). Forty deaf native signers and nonsigners and 51 hearing signers and nonsigners participated in the study. Signing individuals (both deaf and hearing) were more accurate than nonsigning individuals (deaf and hearing) at memorizing shapes. For the shape memory task but not the object task, deaf signers and nonsigners displayed right hemisphere (RH) advantage over the left hemisphere (LH). Conversely, both hearing groups displayed a memory advantage for shapes in the LH over the RH. Results indicate that enhanced memory performance for shapes in signers (deaf and hearing) stems from the visual skills acquired through sign language use and that deafness, irrespective of language background, leads to the use of a visually based strategy for memory of difficult-to-describe items