Implementing an Integrated Acute Response Service: Professional Perceptions of Intermediate Care

Purpose: The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of the service are to enhance the level of health and social care integration across a range of organisations, to ensure a timelier and appropriate service for people in the community at risk of admission to hospital. Design/methodology/approach: A qualitative methodology was employed in order to gain a deep understanding of the experiences of staff members within the ART service and external stakeholders. Twenty-one professionals took part in a focus group or one-to-one interviews. Data were analysed thematically. Findings: The key to successful implementation was that the service was co-created from the “ground-up” with support from local provider organisations. The inclusion of general practitioners (GPs) as part of the team was instrumental in setting up and maintaining the service and seems to be unique in intermediate care settings. Referrals into the ART service were dependent on awareness of the service at the interface with mainstream services. Transitions out were sometimes delayed due lack of availability of social care packages. To ensure sustainability of the ART and other integrated intermediate care services, continued resources, especially skilled staff members, are necessary. Originality/value: This study adds to the intermediate care and acute response service literature by offering insights into “what works” from a professional perspective in terms of service implementation, care processes and sustainability, in an integrated care system

An exploration of the factors influencing career choice in mental health

Aims and objectives: To identify the factors that are associated with considering a career in mental health. Background: The mental health specialty is facing a recruitment crisis in the United Kingdom but there is limited evidence about which factors encourage and discourage people from considering a career in mental health. Design: Quantitative, observational, online survey using a multiple ordinal logistic regression model to identify if there were any significant predictors of the extent to which participants would consider a career in mental health. The design and write up of the study were guided by the STROBE checklist. Method: We gathered the views of 231 participants (female = 188, 81.7%) aged between 16–65 (mean = 22.7, SD = 8.9), using an online survey, the majority of whom were studying on, or graduates of, psychology/social studies degrees. Information was gathered about the extent to which a range of factors influenced consideration of a career in mental health. Results: The majority (71.2%) of participants reported that they would definitely or probably consider undertaking a career in mental health, and over half (51.4%) would consider a career as a mental health nurse. The ability to help others and receiving appropriate training required for the role were important career choice factors. Being female, having a mental health condition and greater knowledge of mental health were associated with a significantly greater likelihood of considering a career in mental health, while having had experience of working with people with mental health difficulties was significantly negatively associated. Conclusions: Students and graduates of psychology and social studies degrees appear to be a large, untapped recruitment pool for mental health services. Relevance to clinical practice: The results can inform more targeted recruitment strategies and development of suitable career pathways for those interested in a career in mental health

Perinatal mental health : preparing the future nursing workforce

Perinatal mental health (PMH) problems occur during pregnancy and up to a year after giving birth. They can have a significant effect on the mother and family, and can affect the social, emotional and cognitive development of the child. PMH nursing is gaining increasing recognition in national policy; additional funding has been announced to align national perinatal services with agreed standards and the perinatal workforce has been identified as an area of growth. The PMH competency framework published by Health Education England and the Tavistock and Portman NHS Foundation Trust, London, is aimed at training staff to deliver high-quality care to women who experience mental health problems during the perinatal period. However, the framework does not address the competencies required from the emerging workforce: nursing students. The pre-registration nursing curriculum must align with PMH competencies to ensure that nursing students become competent practitioners who are adequately prepared to care for the PMH needs of the mother and family

General practitioners’ perceptions on their role in light of the NHS five year forward view: a qualitative study

Background: The NHS is undergoing unprecedented change, central to which is policy aimed at integrating health and social care services, resulting in the implementation of new care models. GPs are at the forefront of this change. However, there is lack of academic literature on General Practitioners’ perceptions on their role in light of the new models of care proposed by the NHS Five Year Forward View which this small-scale study begins to address. Objectives: This study aims to produce a description of how GP’s construct their current and future general practice, professional status and identify within the context of the current NHS transformation agenda. Methods: Qualitative study using semi-structured interviews and one focus group to gather the perspective of GPs (n = 10) working across three clinical commissioning groups in South East England. Results: While the GPs embraced the principles underpinning the new care models, they were both willing and reluctant to adopt their new roles, struggled with inter-organisational and cultural barriers and their changing professional identity. Conclusion: Multi-professional education in primary and community care could be an effective model to offer support and resources to the development of the clinical and leadership skills GPs will require to respond effectively to the transformation agenda. The emergence of community education provider networks, innovative network organisations designed to support workforce transformation through education and training, can provide the vehicle through which clinical and leadership skills training are sourced and coordinated

Who is a credible source of preventive advice? An experimental vignette study of general public attitudes towards role expansion in health and social care

© 2020 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society Objectives: To investigate the general public’s source credibility attitudes towards health and social care professionals when giving advice associated with their ‘traditional role’ versus an ‘expanded health behaviour change’ role, to facilitate the implementation of the health behaviour change agenda. Design: A 3x3 experimental between-subjects vignette questionnaire study with nine scenarios in which a general practitioner (GP), health visitor, or firefighter offered advice on either stopping smoking, preventing cot death, or fire safety. Combinations were either congruent with a traditional role (e.g., health visitor and cot death) or an expanded role (e.g., firefighter and stopping smoking). Methods: Adults were recruited from metropolitan locations in northern England. Participants were randomized to one scenario and complete a validated 18-item source credibility questionnaire. Factor analysis explored source credibility components; ratings for traditional and expanded role scenarios were compared using Mann–Whitney tests. Results: 369 participants completed the questionnaire (49.3% women, 64% White British, age range: 16–83). Factor analysis confirmed three source credibility dimensions: competence, caring, and trustworthiness. Ratings were generally high across professions and scenarios; participants rated professionals as significantly more ‘competent’ where scenarios related to their traditional roles than expanded roles (U 9778.5, p <.001) but equally as caring (U = 14467.5, p<.485) and trustworthy (U 14250.5, p.348). Conclusions: GPs, health visitors, and firefighters were all perceived as credible sources of health behaviour change advice, but may be viewed as ‘less competent’ sources of messages associated with an expanded job role. Effective professional training and public engagement regarding the role expansion agenda are needed to support policy implementation. Statement of Contribution What is already known on this subject? Source credibility surrounds people’s perceptions of the source of advice and includes competence, caring, and trustworthiness dimensions. This may have an important influence on people’s attitudes and behaviour, especially when messages are complex or emotive. A wide range of public sector workers is now expected to routinely offer preventive health and safety advice, as part of role expansion. What does this study add? This experimental survey study compared source credibility perceptions of GPs, health visitors, and firefighters giving advice on topics associated with a traditional or expanded role. Professionals were perceived as less ‘competent’ when giving advice on ‘expanded role’ topics, such as a firefighter discussing smoking, with a small reduction in source credibility. This highlights that source credibility may be specific to professional identities. Policymakers may need to explore this further as part of implementing role expansion for prevention and self-management in health and social care

Integrated care to address the physical health needs of people with severe mental illness : a rapid review

Background People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests that this discrepancy is driven by a combination of clinical risk factors, socioeconomic factors and health system factors. Objective(s) To explore current service provision and map the recent evidence on models of integrated care addressing the physical health needs of people with severe mental illness (SMI) primarily within the mental health service setting. The research was designed as a rapid review of published evidence from 2013–15, including an update of a comprehensive 2013 review, together with further grey literature and insights from an expert advisory group. Synthesis We conducted a narrative synthesis, using a guiding framework based on nine previously identified factors considered to be facilitators of good integrated care for people with mental health problems, supplemented by additional issues emerging from the evidence. Descriptive data were used to identify existing models, perceived facilitators and barriers to their implementation, and any areas for further research. Findings and discussion The synthesis incorporated 45 publications describing 36 separate approaches to integrated care, along with further information from the advisory group. Most service models were multicomponent programmes incorporating two or more of the nine factors: (1) information sharing systems; (2) shared protocols; (3) joint funding/commissioning; (4) colocated services; (5) multidisciplinary teams; (6) liaison services; (7) navigators; (8) research; and (9) reduction of stigma. Few of the identified examples were described in detail and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge from the evidence. Efforts to improve the physical health care of people with SMI should empower people (staff and service users) and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication between professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered. Limitations and future work The literature identified in the rapid review was limited in volume and often lacked the depth of description necessary to acquire new insights. All members of our advisory group were based in England, so this report has limited information on the NHS contexts specific to Scotland, Wales and Northern Ireland. A conventional systematic review of this topic would not appear to be appropriate in the immediate future, although a more interpretivist approach to exploring this literature might be feasible. Wherever possible, future evaluations should involve service users and be clear about which outcomes, facilitators and barriers are likely to be context-specific and which might be generalisable

Work‐related post‐traumatic stress symptoms in obstetricians and gynaecologists: findings from INDIGO a mixed methods study with a cross‐sectional survey and in‐depth interviews

Objectives: To explore obstetricians’ and gynaecologists’ experiences of work‐related traumatic events, to measure the prevalence and predictors of post‐traumatic stress disorder (PTSD), any impacts on personal and professional lives, and any support needs. Design: Mixed methods: cross‐sectional survey and in‐depth interviews. Sample and setting: Fellows, members and trainees of the Royal College of Obstetricians and Gynaecologists (RCOG). Methods: A survey was sent to 6300 fellows, members and trainees of RCOG. 1095 people responded. Then 43 in‐depth interviews with trauma‐exposed participants were completed and analysed by template analysis. Main outcome measures: Exposure to traumatic work‐related events and PTSD, personal and professional impacts, and whether there was any need for support. Interviews explored the impact of trauma, what helped or hindered psychological recovery, and any assistance wanted. Results: Two‐thirds reported exposure to traumatic work‐related events. Of these, 18% of both consultants and trainees reported clinically significant PTSD symptoms. Staff of black or minority ethnicity were at increased risk of PTSD. Clinically significant PTSD symptoms were associated with lower job satisfaction, emotional exhaustion and depersonalisation. Organisational impacts included sick leave, and ‘seriously considering leaving the profession’. 91% wanted a system of care. The culture in obstetrics and gynaecology was identified as a barrier to trauma support. A strategy to manage the impact of work‐place trauma is proposed. Conclusions: Exposure to work‐related trauma is a feature of the experience of obstetricians and gynaecologists. Some will suffer PTSD with high personal, professional and organisational impacts. A system of care is needed

Physiotherapy and Physical Activity: A cross-sectional survey exploring physical activity promotion, knowledge of physical activity guidelines and the physical activity habits of UK physiotherapists.

Objective: Physical inactivity is a public health priority and embedding promotion of physical activity (PA) within healthcare systems is an important lever for change. Many factors influence PA promotion in routine healthcare practice, these include the PA habits of healthcare professionals and also their knowledge of the PA guidelines. Little is known about the extent to which PA is currently promoted in physiotherapy practice or the factors that influence it. Methods: Following ethical approval a cross-sectional survey of UK physiotherapists was conducted. Findings were analysed and reported in accordance with STROBE guidelines. Results: There were 522 respondents, 514 of whom were physiotherapists. Seventy seven percent of respondents routinely discussed PA with patients and 68% routinely delivered Brief Interventions. Assessment of PA status was not routine practice neither was signposting to further sources of PA support. Only 16% of respondents correctly answered questions about the content of the PA guidelines. Only 38% of respondents met current PA recommendations. Clinicians' PA levels were not associated with PA promotion activity. Conclusion: Despite the promising finding that some form of PA promotion is integrated into most respondents' practice, we report a poor understanding of Brief Interventions and poor knowledge of the PA guidelines. Additionally, the majority of respondents were not sufficiently active to meet current PA recommendations

The use of an implementation science theoretical framework to inform the development of a region wide Positive Behavioural Support Workforce Development approach

Background: Concern about the poor care of some people with an intellectual disability has highlighted the need for systemic, large scale interventions to develop a skilled workforce. Method: We outline how an implementation science theoretical model informed the development of a region wide Positive Behavioural Support (PBS) Workforce Development (WFD) approach. Results: We provide an example of the application of the model in practice and demonstrate how this enabled us to: understand the competencies and development needs of the workforce; engage effectively with stakeholders; and develop, deliver, and evaluate a PBS WFD model. Conclusion: The application of the model helped us to identify, prioritise, and address the multiple and complex factors that were relevant to the implementation of the PBS WFD approach

Plans that work: improving employment outcomes for young people with learning disabilities

This article offers a critical reflection on the function of education, health and care plans (EHCPs) in pathways to employment for disabled young people. We consider ‘the education plan’ as an artefact of special educational needs systems. We problematise the often taken‐for‐granted assumption that such plans are always and only a ‘good’ thing in the lives of disabled young people seeking pathways to employment. At the same time, we consider the rise in demand for plans that are understood by many as a crucial mechanism for achieving support. Following the recent policy reforms in England, we describe a context in which the funding of education is shrinking and in which the promise of employment for disabled young people has yet to be delivered. We conclude by proposing some changes to policy and practice to enhance employment opportunities for disabled young people