Shades of communitas: a study of soft skills programs

In societies where neoliberal individualism prevails, communal experiences nevertheless remain crucial to human life. Drawing on data from a series of soft skills programs (SSPs) for Higher Education (HE) staff, we investigated SSP social worlds, their role in navigating staff in uncertain times and points of resistance within them. We found SSPs to be distinctly performative platforms, engaging actors in various self-care and entrepreneurial activities. A complex network of relationships was established via SSPs, and group effects akin to communitas, in “lighter” and “darker” forms. Incongruities of SSPs included gender imbalances and emotional management issues, while a mismatch between managerial attempts to create positive communitas and the reality of mounting workloads and job-cuts facing HE staff were noted in this study. SSPs may help counter organizational siloism, but reflect the ambiguities within neoliberal culture and can deter staff from pursuing political modes of collective expression in the workplace

Atlas Men’s Well-being Programme: Evaluation Report

EXECUTIVE SUMMARY Background to the evaluation Men’s mental health and well-being is increasingly of concern. In England and Wales, the suicide rate is now almost four times higher for men (78%) than women (22%). Rates of diagnosis of men’s mental health problems do not capture distress among men well, as men may express distress in atypical ways (eg acting out, blunting emotions), suggesting that we need a deeper understanding of male experiences of distress and ‘men-friendly’ services to better help men. One such service, Atlas, was designed as a potential way of improving access to mental health services for men. Atlas was originated by Professor Damien Ridge, co-designed by Prof Ridge and Professor David Peters, and managed and governed by adapting University of Westminster Polyclinic guidelines, developed over 15 years. The Atlas Men’s Well-being Programme was designed to be ‘male sensitive’, to provide counselling and/or acupuncture for men suffering from stress or distress. Based at the Victoria Medical Centre (VMC), a busy NHS GP practice in central London, the pilot Programme ran from March 2013 until July 2014 for practice patients only. Our evaluation collected quantitative patient outcomes and qualitative data, to examine clinical changes in patients and their experiences of the Programme. In addition, interviews were conducted with a wide range of key stakeholders involved in the Programme. The aims of the interviews were to (a) understand the Programme from the perspectives of key stakeholders, and (b) improve the Programme early on by identifying any problems and feeding them back to the people who needed to know. Methods Questionnaires: All patients using the Atlas service were invited to take part in the evaluation. Questionnaires were used to collect predominantly quantitative data and were completed by patients prior to using the Programme as well as on finishing the Programme. Measures collected included anxiety, depression, perceived stress, positive well-being, physical health and outcomes for problems identified as most important by each individual patient. Open-ended questions collected written data regarding patient experience of the Atlas Programme. Interview data: Semi-structured interviews with 14 key stakeholders (including Atlas practitioners, VMC GPs, VMC administration staff and other VMC practice staff) were conducted five to six months into the Programme. In addition, narrative interviews were conducted with six men who used Atlas to provide deeper insights behind the numerical results. The narrative interviews provided an understanding of men’s distress and Atlas. All qualitative data were analysed using thematic analysis. Cost implications: Additional questions regarding patients’ employment and service use were collected on patient questionnaires (before and after engaging in Atlas services) and formed the basis for the cost implications analysis. Key findings • GPs played a key role in referring and encouraging men to attend Atlas. • Patients took a variety of routes through the service, using counselling and acupuncture in different combinations, according to their needs, in consultation with their GPs and practitioners. • Of the 107 patients using the Programme, 102 (95%) completed a pre-treatment questionnaire, and 82 (80%) of those went on to complete their post-treatment questionnaire. • Men said that they were attending the Programme to help reduce psychological and physical symptoms, promote positive mental states and relaxation, improve daily functioning, understand and manage their problems, talk things through, and deal with a range of specific issues affecting their lives such as work and relationships. • Comparisons between pre- and post-treatment revealed statistically significant improvements in anxiety, perceived stressed, positive well-being, physical health and patient-centred outcomes (ie problems rated as most important to each patient at the time of first attendance). • Overall there was no change in depression, but this is likely to be because a significant proportion of the men using the Programme were not initially identified as depressed. However, the sub-sample (n=50) of men who were at risk of depression (as identified using recommended cut-off scores on our depression scale) before using the Programme did experience a statistically significant improvement in depression post-treatment. • 78% of patients said that they felt better after their Atlas sessions, 13% reported no change and 4% felt a little worse. • Patients reported an improvement in their understanding and awareness of themselves and/or the situation that they found stressful, and found ways of coping with and managing their issues as a result of using the Programme. • Some patients described being able to talk to an objective professional as helpful, although challenging at times. Some patients wanted a more structured or directive approach to working with their problems than counselling could provide. • The unanimous opinion among stakeholders was that the Atlas Men’s Well-being Programme functioned well. Some minor challenges for professionals included pressures on scarce room space, a lack of clarity regarding which health professionals were able to refer to Atlas, and occasional difficulties for receptionists with appointment bookings. Some patients wanted to have more than their allocated six or 12 sessions. When the demand for the Programme allowed, practitioners were able to provide up to six additional sessions. • Professional stakeholders felt that having a male-only service sent an implicit message to men that validated their emotional needs and normalised the idea of getting help for stress/distress, and attuned practitioners and GPs to the emotional needs of men. Other stakeholders felt the Programme should also be available to women. In interviews, men said that it being a male-only service had not occurred to them (GP referral was the most likely route rather than the flyer) and was not of particular significance. However, many agreed there was an unmet need for male mental health services, and that having a male-only service may improve access for other men. • Often counselling was more acceptable to patients than acupuncture as a way of helping them with their mental health problems. However, the acupuncture service was well used and was reported to reduce stress, and patients evaluated it well. • Qualitative data suggested a synergy between counselling and acupuncture: Atlas practitioners considered that acupuncture might help patients to be more emotionally ‘open’ in counselling sessions, or that acupuncture could help relax patients after a challenging counselling session. Further research will be needed to explore this interaction. • Atlas reduces costs, when taking costs related to health and social care usage and lost employment into account; reductions in these costs exceeded the cost of the Atlas counselling and acupuncture sessions, with an average saving of nearly £700 per patient. Quotes from Atlas participants “It was great to have someone independent from the situation to talk to and get objective feedback from. The action of talking about issues is itself a therapeutic process and helps one understand.” P2 “A good blend of professional and approachable. I guess these things can be a little strange at the beginning (especially if you are not pre-disposed to talking about your issues such as I), but she made me feel comfortable early and established credibility and trust early too. This helped develop the relationship quickly, which in turn helped get maximum benefits from the conversations.” P2 “The realisation that I was suffering from serious stress, which I wasn’t addressing and how to stop that happening in the future. I got a much-needed sense of perspective and was able to see that things had become almost unbearable in terms of not communicating how I was feeling.” P109 “It helped understand the reasons behind thoughts and emotions I had been experiencing. This led to a better acceptance of my moods/worries.” P13 “Helped me to understand myself better – ideally what’s important to me, what makes me special, who I am. Helped to identify my strengths and what makes a brilliant person. It was the first step on the road to recovery.” P22 “[Acupuncture practitioner] found ways of exploring my depression which were helpful, even though I sought only treatment via acupuncture.” P79 Conclusions The evaluation demonstrates a hitherto under-investigated pathway by which men experiencing mental health problems can be identified in primary care and helped to talk about the problems that are concerning them, and/or receive physical therapy aimed at reducing stressed-related symptoms. Findings from this evaluation suggest that the Atlas Men’s Well-being Programme was helpful for stressed and distressed men, particularly in terms of reducing anxiety and stress and improving physical health, positive well-being and individual problems important to each patient. The Programme also promoted relaxation as well as better understanding and coping with problems. Consistent with previous research in this area, the study found that a ‘one size fits all’ approach is unlikely to be useful for men, and indeed men using Atlas had varying preferences and expressed diverse needs in relation to the Programme. We found that it is possible to effectively develop and deliver a primary care-based programme offering help to men for their mental and physical symptoms of stress and distress. Flexibility (timing and treatment options), the close involvement and encouragement of GPs, and high-quality branding appear to be important considerations when providing men’s mental health services. This evaluation highlighted the value of engaging GPs in encouraging stressed/distressed men to identify – and seek help for – mental health problems

A Qualitative Study Exploring Patient Shadowing as a Method to Improve Patient-Centred Care: Ten Principles for a New Gold Standard

Background In recent years there has been an increased emphasis on patient experience as a dimension of quality in healthcare, and subsequently a drive to understand care from the patient’s perspective. Patient shadowing is an approach which has been used in service improvement projects, but its potential as a Quality Improvement (QI) method has not been studied in practical and replicable detail. This research aimed to do this, and to produce clear guidance for future teams. Methods Qualitative interviews were conducted with 20 clinical and non-clinical participants of a national quality improvement programme in England, which focused on improving the experience of patients at the end of life. All participants had shadowed patients. Data were analysed using thematic analysis. Results There were two broad themes: 1) The process of shadowing: how participants went about shadowing, adopting different approaches and making judgements about the care they observed, and any challenges they had encountered. 2) The impact of shadowing: on the engagement and motivation of those who shadowed, and in terms of service changes to benefit patients and their families. Conclusion The findings led to a new set of ‘gold standard’ principles to benefit both staff and patients where shadowing is used as QI method. These, together with new guidance, will ensure that shadowing is conducted as a team exercise, and that all those involved are more robustly prepared and supported, and that its purpose as a method to improve patient experience will be better understood

‘As soon as you've been there, it makes it personal’: The experience of health-care staff shadowing patients at the end of life

Background Patient shadowing is an experiential technique intended to enable those who shadow to understand care experience from the patient's point of view. It is used in quality improvement to bring about change that focuses on what is important for patients. Aim To explore the acceptability of patient shadowing for health-care staff, the impact of the experience and subsequent motivations to make improvements. Method A qualitative study with a diverse sample of 20 clinical and non-clinical health-care staff in different end-of-life settings. Data were analysed thematically. Results Anticipated anxieties about shadowing did not materialize in participant accounts, although for some it was a deeply emotional experience, intensified by being with patients who were at the end of life. Shadowing not only impacted on participants personally, but also promoted better insights into the experience of patients, thus focusing their improvement efforts. Participants reported that patients and families who were shadowed welcomed additional caring attention. Conclusion With the right preparation and support, patient shadowing is a technique that engages and motivates health-care staff to improve patient-centred care

What criteria do police officers use to measure the success of an interview with a child?

This study used a mixed-methods approach to explore the perceptions of a heterogeneous sample of 75 police interviewers regarding their performance in a mock interview with a 5-7-year-old child. Each officer recruited for this study was authorised to conduct investigative interviews with children. Specifically, we explored how the officers\u27 perception of what makes a good interview differs depending on their background experience and their (perceived and actual) ability to adhere to best-practice interview guidelines. Overall, the officers\u27 perceptions of what constitutes an effective interview were not entirely consistent with those held by experts in forensic interviewing. The majority of the interviewers perceived that the locus of control in the interview rested primarily with the child and/or the environmental setting. In contrast, experts tend to place the central onus of responsibility for the outcome of an interview on the skill of the interviewer in using open-ended questions. Several possible explanations for, and the implications of, these findings are discussed.<br /

The Changing Narratives of Death, Dying, and HIV in the United Kingdom

Death and infection were closely linked from the start of the HIV epidemic, until successful treatments became available. The initial impact of mostly young, gay men dying from HIV was powerful in shaping UK responses. Neoliberal discourses developed at the same time, particularly focusing on how citizens (rather than the state) should take responsibility to improve health. Subsequently “successful ageing” became an allied discourse, further marginalising death discussions. Our study reflected on a broad range of meanings around death within the historical UK epidemic, to examine how dying narratives shape contemporary HIV experiences. Fifty-one participants including people living with HIV, professionals, and activists were recruited for semistructured interviews. Assuming a symbolic interactionist framework, analysis highlighted how HIV deaths were initially experienced as not only traumatic but also energizing, leading to creativity. With effective antiretrovirals, dying changed shape (e.g., loss of death literacy), and better integration of palliative care was recommended

Ageing with HIV

Applying Fraser’s inequalities framework to our UK-based HIV and Later Life (HALL) study, we show that, for the growing population of older people living with HIV (PLWH), HIV intersects with ethnicity, sex, sexuality, stigma, and ageism to produce bivalent identities. These shape their experience of ageing with HIV and intersect with economic factors, the social status order, and statutory policy to subject them to socioeconomic and cultural injustices only roughly captured by Fraser’s three domains of inequality. Under recognition, the stigmatization of HIV and its exacerbation by normative ageist expectations threaten social relationships. Under resources, older PLWH’s disproportionate financial disadvantage, linked to interrupted work histories, uncertain migration status, and recent changes to benefits on which PLWH are disproportionately reliant and whose new criteria disadvantage them, make access to support from others living with HIV and from HIV organizations even more essential for mental health and wellbeing. Finally, under representation, stigma and homophobia in care settings may undermine the quality of long-term care, and defunding of HIV organizations and welfare benefit changes via neo-liberal policies and austerity measures create political disenfranchisement and barriers to social participation. Thus, Fraser’s clear-cut domains imperfectly capture factors undermining underlying causes of older PLWH’s disadvantage: HIV-specific supports (resources) established to compensate for difficulties emanating from Fraser’s recognition and resources domains are increasingly threatened by agents operating within Fraser’s representation domain. Our conclusion considers other sources of older PLWH’s underrepresentation: their waning participation in activism and advocacy on their own behalf, and inadequate attention by non-HIV organizations

Users` experiences of heroin and methadone treatment

The present study, conducted in 2003, Melbourne, Australia, examined and compared how different personal and social resources related to participants\u27 use of both heroin and methadone, as well as their experiences of stigma and program regulation, and their evaluation of methadone treatment. In-depth interviews were conducted with 10 participants (five men, five women) aged between 25 and 42. Participants who had diverse personal and social circumstances were purposefully sought. Findings showed that users with &ldquo;non-addict&rdquo; or &ldquo;functional&rdquo; self-concepts had more resources and supportive social relationships that assisted them to develop realistic treatment expectations, avoid the stigma associated with methadone, and focus on the benefits of the treatment. Conversely, &ldquo;conflicted&rdquo; users with limited resources, few social connections, and negative self-concept saw methadone as an addiction, and as a highly stigmatizing and disempowering intervention. Social policies that differentiate users and address ways of improving users\u27 personal and social resources are now needed.<br /

Child abuse investigation: an in depth analysis of how police officers perceive and cope with daily work challenges

Purpose: The purpose of the current study was two-fold: to explore police officers\u27 perceptions of the daily challenges involved in child abuse investigation and how those challenges affect their ability to undertake child abuse investigations, and to explore how these challenges are managed on a daily basis. Design/methodology/approach: This study employed a qualitative research design. In-depth interviews were conducted with a diverse sample of 25 police officers working in child abuse units across three Australian states. Findings: Inductive thematic analysis revealed that heavy caseload and collaboration with other professional groups are two key sources of negative work stress frequently associated with child abuse investigation. Further, despite the provision of organisational strategies aimed at reducing work stress, the officers tended to rely predominantly on informal coping mechanisms.&nbsp; Research limitations/implications: This study has raised many questions for further research aimed at developing interventions to assist police organisations in managing work stress. Originality/value: This paper provides an in-depth analysis of the key challenges associated with child abuse investigation and the coping mechanisms employed for overcoming these challenges from the unique perspective of police officers authorised to investigate child abuse.<br /

Self-care and entrepreneurism: An ethnography of soft skills development for higher education staff

Despite the ubiquity of staff soft skills programmes, few studies have examined why and how academic and corporate services staff utilise these programmes for self-care/governance. This study reports on findings from an ethnography of soft-skills learning and development programmes (LDPs) in a UK university, focusing on interviews with programme participants and facilitators. Results suggest that, as social worlds with neoliberal directives, LDPs promote various self-governance activities in the form of entrepreneurism and novel, corporate versions of self-care. Time on LDPs was seen as a chance to, ‘put oneself first,’ examine career options and cultivate sought-after attributes, including self-confidence and assertiveness. Social networking and performance management also emerged as significant issues. Career development was important for all participants; however, perceptions of how to realise this differed. Based on our findings, we propose three types of work-related performance – ‘career nomad,’ ‘reluctant entrepreneur,’ and ‘course hopper’ – constituting a typology for understanding social worlds inhabited by contemporary university professionals. Our study suggests that self-care ‘technologies’ have multiple, competing functions in continuing professional education. While LDPs can help professionals navigate paths through increasingly turbulent organisations, their entrepreneurial ethos and content reflect the market interests they serve