Final Evaluation Report: Pilot for New Model of Midwifery Supervision

The focus of the evaluation was a bridging programme to prepare existing supervisors of midwives (SOMs) to become professional midwifery advocates (PMAs) in order to deliver a new model of supervision (A-EQUIP). It set out to assess the bridging programme and the A-EQUIP model. This report documents the following stages of the evaluation: 1. Establish baseline data, prior to the adoption of the A-EQUIP pilot a. Development and completion of a site pro-forma to provide contextual organisational data 2. Evaluation of the preparation of the A-EQUIP practitioner and assessment of the A-EQUIP model through the following mechanisms: a. Documentary analysis b. Supervisor/PMA survey c. Supervisee survey d. Supervisor/PMA interview

Young People’s, Parents’, and Professionals’ Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study

Background: There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people’s self-management of Juvenile Arthritis. Objective: The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people’s self-management of chronic Juvenile Arthritis. Methods: A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants’ views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results: Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications

Are we there yet?:An update on transitional care in rheumatology

Abstract Significant progress has been made in the understanding of transitional care in rheumatology over the last few decades, yet universal implementation has not been realised and unmet needs continue to be reported. Possible explanations for this include lack of evidence as to which model is most effective; lack of attention to the multiple dimensions, stakeholders and systems involved in health transitions; and lack of consideration of the developmental appropriateness of transition interventions and the services/organisations/systems where such interventions are delivered. Successful transition has major implications to both the young people with juvenile-onset rheumatic disease and their families. Future research in this area will need to reflect both the multidimensional (biopsychosocial) and the multisystemic (multiple systems and stakeholders across personal/social/family support networks and health/social care/education systems). Only then will we be able to determine which aspects of transition readiness and service components influence which dimension. It is therefore imperative we continue to research and develop this area, involving both paediatric and adult rheumatology clinicians and researchers, remembering to look beyond both the condition and our discipline. Neither should we forget to tap into the exciting potential associated with digital technology to ensure further advances in transitional care are brought about in and beyond rheumatology

The justice system is failing victims and survivors of sexual violence

Tammi Walker, Alison Foster, Rabiya Majeed-Ariss and Miranda Horvath on a role for psychologists in improving processes and protection around rape cases. The justice system in England and Wales continues to fail survivors of sexual violence. Official figures from the Crown Prosecution Service and Police highlight the ongoing problem of attrition of rape cases from the criminal justice system. Here, we outline the limitations of the endless cycle of reviews in response to the poor treatment of survivors. We argue that solutions which could lead to significant improvements for survivors of sexual violence are possible

Improving understanding of the scale and nature of child sexual abuse Characteristics and experiences of children and young people attending Saint Mary's Sexual Assault Referral Centre, Greater Manchester A review of 986 case files

This report brings together evidence collected from the case files of children and young people aged 0–17 attending Saint Mary’s Sexual Assault Referral Centre (SARC) in Greater Manchester for a forensic medical examination following disclosure or suspicion of sexual abuse. The data relates to all 986 forensic medical examinations of under-18s living in the Greater Manchester area who accessed the service between April 2012 and March 2015. Data was retrospectively extracted from the paper case file of each ‘service user’, including background and demographic data about them, the route by which they were referred to the SARC, the nature of the child sexual abuse (CSA) reported to have taken place, and the people suspected of committing it. The choice of data extracted was based on the ‘data collection template’, a core dataset developed by the Centre of expertise on child sexual abuse (CSA Centre) to standardise and improve agencies’ recording of data about CSA. Established in 1986, Saint Mary’s SARC is the UK’s largest single-centre SARC. It was the first of its kind, developed to provide high quality medical examinations in a designated and specialised space for men, women and children who had experienced sexual assault. The findings generated through the study have wider relevance because they represent the experiences of a large number of children for whom there were concerns about sexual abuse. It is important to emphasise, however, that they are not representative of CSA in other settings or locations. The vast majority of victims of CSA do not disclose their abuse and are not identified by professionals, and many of those who are identified do not attend a SARC. Furthermore, medical examinations of children at a SARC are provided following disclosure or suspicion of contact sexual abuse; experiences of non-contact CSA are, therefore, not represented in the study

Evaluation of the Macmillan Cancer Care Co-ordinator and Community Cancer Care Sisters work-stream for the South Tees Integrated Cancer Care programme (Macmillan South Tees Evaluation)

Background to the programme: The Macmillan Integration of Cancer Care programme (MacICC) was established in February 2014 as a partnership programme between Macmillan Cancer Support and South Tees NHS Foundation Trust and is scheduled to finish in December 2018. This evaluation is focused on the two new roles that were developed and implemented as a result of the programme; the Cancer Care Coordinator (CCC) and the Community Cancer Care Sisters (Community Sisters). Evaluation Approach: The evaluation was formed from two main approaches. Firstly, we used interviews and group discussions and read available literature to describe the experiences and opinions of staff and patients and to understand what sort of benefits the roles might bring about and why. Secondly, we gathered data about areas of the services that we expected to change as a result of the roles being introduced. For instance, the amount of Accident and Emergency services being used by people with cancer diagnoses, the amount of time that might be saved for other members of staff and reductions in missed appointments. Findings: One of the key findings was that the roles were highly valued by the people in the roles, their colleagues and patients. They clearly filled gaps in services. There was very good evidence about how the CCC roles had improved patient experiences; for instance, by reducing waiting times, providing somebody to talk to that had time to deal with their concerns and increasing the extent to which all patients’ needs were assessed. Service-users valued the Community Sisters' family-focused approach and focus on the whole person rather than immediate clinical needs. Outcomes included being able to cope better with the illness and to return to a more normal life of activities. Some specific activities, such as making treatment recommendations, helping to make difficult decisions and intervening to solve problems with other services were reported to be particularly important. Before the roles were introduced there were more than 30 people every month waiting longer than 62 days. We observed a reduction, so that the number of long waits was consistently below the average from 3 months after the roles were introduced, and at one point dropping below 10 people per month. At 21-months after the new roles, there had been a reduction of about 245 attendances to A&E per month, which could be equal to a saving of about £381,850 over the course of the 21 month observation period. Conservative estimates for the return on investment indicated a break-even point at 13-months and a £1.05 return for each £1.00 invested over 21 months. This includes the considerable costs for initial development of the roles. Conclusions and recommendations: The new roles are widely regarded as valuable both in terms of health service efficiency and patient experience. We found good quality evidence to support the claim that the new roles helped to provide the right care, at the right time, with the right person. The evidence that we gathered from talking to people and understanding how the programme might work was supported by the examination of the other available data. The findings support the further adoption and spread of the CCC roles to other cancer specialties and the expansion of the Community Sister roles so that more people, particularly those in more remote areas can benefit. The economic evaluation indicates that this should result in further savings across the health care system to offset any additional costs in providing the service. There is also potential for the roles to take on additional responsibilities to further improve pathways for cancer care and support. It should be recognised that this was a rapid evaluation, and there were limitations in both the quality and type of information available, and therefore the conclusions that can be drawn also have limitations and rely on certain assumptions that needed to be made. Whilst we believe that the evaluation presents a strong case for the benefits of these roles for a wide range of people and services, they would benefit from more in-depth investigation, particularly if there are plans to scale up the programme workstream

Impact of social prescribing to address loneliness: a mixed methods evaluation of a national social prescribing programme

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service‐users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service‐users’ loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service‐users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre‐post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi‐structured interviews with service‐users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service‐users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was −1.84 (95% CI −1.91 to −1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service‐users’ needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service‐users experiencing loneliness

The effectiveness of sexual assault referral centres with regard to mental health and substance use: a national mixed-methods study – the MiMoS Study

Background Sexual assault referral centres have been established to provide an integrated service that includes forensic examination, health interventions and emotional support. However, it is unclear how the mental health and substance use needs are being addressed. Aim To identify what works for whom under what circumstances for people with mental health or substance use issues who attend sexual assault referral centres. Setting and sample Staff and adult survivors in English sexual assault referral centres and partner agency staff. Design A mixed-method multistage study using realist methodology comprising five work packages. This consisted of a systematic review and realist synthesis (work package 1); a national audit of sexual assault referral centres (work package 2); a cross-sectional prevalence study of mental health and drug and alcohol needs (work package 3); case studies in six sexual assault referral centre settings (work package 4), partner agencies and survivors; and secondary data analysis of outcomes of therapy for sexual assault survivors (work package 5). Findings There is a paucity of evidence identified in the review to support specific ways of addressing mental health and substance use. There is limited mental health expertise in sexual assault referral centres and limited use of screening tools based on the audit. In the prevalence study, participants (n = 78) reported high levels of psychological distress one to six weeks after sexual assault referral centre attendance (94% of people had symptoms of post-traumatic stress disorder). From work package 4 qualitative analysis, survivors identified how trauma-informed care potentially reduced risk of re-traumatisation. Sexual assault referral centre staff found having someone with mental health expertise in the team helpful not only in helping plan onward referrals but also in supporting staff. Both sexual assault referral centre staff and survivors highlighted challenges in onward referral, particularly to NHS mental health care, including gaps in provision and long waiting times. Work package 5 analysis demonstrated that people with recorded sexual assault had higher levels of baseline psychological distress and received more therapy but their average change scores at end point were similar to those without sexual trauma. Limitations The study was adversely affected by the pandemic. The data were collected during successive lockdowns when services were not operating as usual, as well as the overlay of anxiety and isolation due to the pandemic. Conclusions People who attend sexual assault centres have significant mental health and substance use needs. However, sexual assault referral centres vary in how they address these issues. Access to follow-up support from mental health services needs to be improved (especially for those deemed to have ‘complex’ needs) and there is some indication that co-located psychological therapies provision improves the survivor experience. Routine data analysis demonstrated that those with sexual assault can benefit from therapy but require more intensity than those without sexual assault. Future work Further research is needed to evaluate the effectiveness and cost-effectiveness of providing co-located psychological therapy in the sexual assault referral centres, as well as evaluating the long-term needs and outcomes of people who attend these centres. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (16/117/03) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 21. Trial registration This trial is registered as PROSPERO 2018 CRD42018119706 and ISRCTN 18208347

On-going collaborative priority-setting for research activity: a method of capacity building to reduce the research-practice translational gap

Background: International policy suggests that collaborative priority setting (CPS) between researchers and end users of research should shape the research agenda, and can increase capacity to address the research-practice translational gap. There is limited research evidence to guide how this should be done to meet the needs of dynamic healthcare systems. One-off priority setting events and time-lag between decision and action prove problematic. This study illustrates the use of CPS in a UK research collaboration called Collaboration and Leadership in Applied Health Research and Care (CLAHRC). Methods: Data were collected from a north of England CLAHRC through semi-structured interviews with 28 interviewees and a workshop of key stakeholders (n = 21) including academics, NHS clinicians, and managers. Documentary analysis of internal reports and CLAHRC annual reports for the first two and half years was also undertaken. These data were thematically coded. Results: Methods of CPS linked to the developmental phase of the CLAHRC. Early methods included pre-existing historical partnerships with on-going dialogue. Later, new platforms for on-going discussions were formed. Consensus techniques with staged project development were also used. All methods demonstrated actual or potential change in practice and services. Impact was enabled through the flexibility of research and implementation work streams; ‘matched’ funding arrangements to support alignment of priorities in partner organisations; the size of the collaboration offering a resource to meet project needs; and the length of the programme providing stability and long term relationships. Difficulties included tensions between being responsive to priorities and the possibility of ‘drift’ within project work, between academics and practice, and between service providers and commissioners in the health services. Providing protected ‘matched’ time proved difficult for some NHS managers, which put increasing work pressure on them. CPS is more time consuming than traditional approaches to project development. Conclusions: CPS can produce needs-led projects that are bedded in services using a variety of methods. Contributing factors for effective CPS include flexibility in use and type of available resources, flexible work plans, and responsive leadership. The CLAHRC model provides a translational infrastructure that enables CPS that can impact on healthcare systems