Getting involved in the community—What stops us? Findings from an inclusive research project

© 2019 John Wiley & Sons Ltd Feeling alone and not connected to other people where you live affects many people and especially people with a learning disability. The government and the newspapers are talking a lot about this, they want to understand who is affected and what can be done. Our group did a research project to find out some of the things that stop us getting involved in local places with local people where we can make and keep friends. The people in the research project mainly lived independently and did not use learning disability services, so needed to use local community organisations. Pictorial cards, made by one of the group members, using photographs were used to sort out all the things we talked about into groups. These included transport, fear and anxiety, limits on our choice and control, risks and personal safety. We then talked about what could be done, this included more easy read information, so people know what is available locally, more support to go to places and advocacy to get involved. There also needs to be better community safety including more Safe Places in the community. Abstract: Background Social isolation is an issue that affects many people and especially people with a learning disability. There is an association between social exclusion and feeling lonely, an issue currently highlighted as a growing concern which needs to be addressed both in the media and by the government. Methods The Building Bridges Research Group do inclusive research projects about the issues that are important to them. Over the summer of 2018, the research group undertook an inclusive research project to identify some of the specific barriers that prevent community inclusion and the opportunity to develop friends. The people involved mainly lived independently and did not use learning disability services, with the exception of evening clubs, so needed to use universal services. Results Pictorial cards, made by one of the group, using photographs were used to organise the data into themes. These included transport, fear and anxiety, limits on choice and control, risks and personal safety. Conclusion The inclusive research design enabled people with a learning disability to contribute to all stages of the research project, from identifying the issue, gathering data, the analysis and writing up. They also made suggestions of ways to increase social networks, friendships and well-being and so decrease loneliness. These include more access to easy read information, more support and advocacy and measures to address community safety including a wider roll-out of the Safe Places scheme. There also needs to be further research undertaken with other people with a learning disability in different areas to widen the understanding of the impact of these barriers on people's lives.Published versio

Treating Adults With Complex Posttraumatic Stress Disorder Using a Modular Approach to Treatment: Rationale, Evidence, and Directions for Future Research

ICD-11 complex PTSD (CPTSD) is a new condition and therefore there are as yet no clinical trials evaluating interventions for its treatment. In this paper, we provide the rationale for a flexible multi-modular approach to the treatment of CPTSD, its feasibility and some evidence suggesting its potential benefits. The approach highlights flexibility in the selection of empirically-supported interventions (or set of interventions) and the order of delivery based on symptoms that are impairing, severe and of relevance to the patient. The approach has many potential benefits. It can incorporate the use of interventions for which there is already evidence of efficacy allowing the leveraging of past scientific efforts. It is also consistent with patient-centered care which highlights the importance of patient choice in identification of the problems to target, interventions to select and outcomes to monitor. Research on modular treatments with other disorders has found that compared to disorder-specific manualized protocols, flexible multi-modular treatment programs are superior in resolving identified problems and are associated with greater therapist and reduced patient burden. We briefly identify types of interventions that have been successful in treating trauma-exposed populations along with emerging interventions that are relevant to the particular problems associated with exposure to complex trauma and conclude with examples of how such treatments can be organized and tested. Research is now urgently needed on the effectiveness of existing and new intervention approaches to ICD-11 CPTSD treatment

Shared decision making for psychiatric medication management: beyond the micro-social

Background: Mental health care has lagged behind other health-care domains in developing and applying shared decision making (SDM) for treatment decisions. This is despite compatibilities with ideals of modern mental health care such as self-management and recovery-oriented practice, and growing policy-level interest. Psychiatric medication is a mainstay of mental health treatment, but there are known problems with prescribing practices, and service users report feeling uninvolved in medication decisions and concerned about adverse effects. SDM has potential to produce better tailoring of psychiatric medication to individuals' needs. Objectives: This conceptual review argues that several aspects of mental health care that differ from other health-care contexts (e.g. forms of coercion, questions about service users' insight and disempowerment) may impact on processes and possibilities for SDM. It is therefore problematic to uncritically import models of SDM developed in other health-care contexts. We argue that decision making for psychiatric medication is better understood in a broader way that moves beyond the micro-social focus of a medical consultation. Contextualizing specific medication-related consultations within longer term relationships, and broader service systems enables recognition of the multiple processes, actors and agendas that shape how psychiatric medication is prescribed, managed and used, and which may facilitate or impede SDM. Conclusion: A broad conceptualization of decision making for psychiatric medication that moves beyond the micro-social can account for why SDM in this domain remains a rarity. It has both conceptual and practical utility for evaluating research evidence, identifying future research priorities and highlighting fruitful ways of developing and implementing SDM in mental health care

Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study

BACKGROUND: Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. METHODS: Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent), recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. RESULTS: A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors") and attractive aspects of complementary therapies ("pull factors"). While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. CONCLUSION: Complementary therapy use reflects patients' and parents' underlying desire for greater self-care and need of opportunities to address some of their concerns regarding NHS asthma care. Self-management of chronic conditions is increasingly promoted within the NHS but with little attention to complementary therapy use as one strategy being used by patients and parents. With their desire for self-help, complementary therapy users are in many ways adopting the healthcare personas that current policies aim to encourage

Improving Quality of Life Outcomes in Supported Accommodation for People with Intellectual Disability: What Makes a Difference?

Background: The quality of life (QOL) of people with intellectual disability living in supported accommodation services is variable, influenced by many possible factors. Various frameworks have attempted to identify these factors without assigning value, direction of influence or relative impact on outcomes. Methods: A realist review of the literature aimed to expose different propositions about variables influencing QOL outcomes and review the strength of supporting evidence for these, to identify their relative influence. Evidence was reviewed for and against each of five clusters. Results: Evidence was strongest for the presence of staff practices (use of Active Support), front-line management practice (use of practice leadership), culture (enabling and motivating), human resources policies and practice (that support front-line leaders and recruitment of staff with the right values), adequate resources, and small, dispersed and homelike settings. Conclusions: The evidence informs policy and practice but in some clusters remains limited, warranting further research which measures outcomes on all QOL domains

Long term and community care 1981 report

SIGLELD:5096.254(KFC--81/59). / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Long term and community care 1980 report

LD:5096.254(KFC--81/85). / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Treatment of primary breast cancer The second King's Fund Forum; consensus statement

First published in the British Medical Journal 1986 vol. 293 p. 956-7Available from British Library Document Supply Centre- DSC:88/22656(Treatment) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo