Reclaiming social work? an evaluation of systemic units as an approach to delivering children’s services

This report presents the findings of an evaluation of the systemic unit model as an approach to the delivery of Children‘s Social Services. The systemic unit model has sometimes been referred to as the ―Hackney Model‖ or ―Reclaiming Social Work‖ (Cross et al, 2010; Munro, 2011a; Trowler and Goodman, 2012). The evaluation is an in-depth comparative description of practice and the factors shaping it in three local authorities. One of the authorities used the systemic unit model; the other two authorities differed but both had a more conventional model for the structure of services. This involved individual allocation to social workers who received supervision from a line manager

'Keeping your body and mind active': an ethnographic study of aspirations for healthy ageing.

OBJECTIVE: To describe and explore perceptions, practices and motivations for active living in later life. DESIGN: Qualitative study with semistructured interviews and 'semistructured' participant observations of participant-selected activities, such as exercise classes, private or organised walks, shopping and gardening. PARTICIPANTS: 27 participants (65-80 years) from the European Prospective Investigation into Cancer Norfolk study, purposefully selected by gender, age, occupational class, living status and residential location; 19 of the participants agreed to be accompanied for observed activities. SETTING: Participants' homes, neighbourhoods, places of leisure activities and workplaces in Norfolk, England. RESULTS: All participants regarded a positive attitude as important for healthy ageing; this included staying active, both physically and mentally through sedentary activities such as reading and crosswords. 'Getting out of the house', being busy, or following a variety of interests were regarded as both important motivators and descriptions of their 'activeness'. Purposeful activities formed an important part of this, for example, still being engaged in paid or voluntary work, having caring responsibilities, or smaller incidental activities such as helping neighbours or walking for transport. Many also reported adapting previous, often lifelong, activity preferences and habits to their ageing body, or replacing them altogether with lower impact activities such as walking. This included adapting to the physical limitations of partners and friends which dictated the intensity and frequency of shared activities. The social context of activities could thus form a barrier to active living, but could also encourage it through companionship, social responsibilities and social pressures. CONCLUSIONS: Promoting and maintaining physical activity among older people may require more attention to activeness as an attitude and way of life as well as to its social context, and initiatives encouraging broader activity habits rather than discrete activities.This work was supported by the UK Research Councils’ Lifelong Health and Wellbeing (LLHW) Initiative in partnership with the Department of Health [grant number MR/K025147/1]; LLHW is led by the Medical Research Council. The work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust. SG and DO are also supported by the Medical Research Council [Unit programme numbers MC_UU_12015/4 and MC_UU_12015/6].This is the final version of the article. It was first available from BMJ via http://dx.doi.org/10.1136/bmjopen-2015-00997

The response to receiving phenotypic and genetic coronary heart disease risk scores and lifestyle advice – a qualitative study

Abstract Background Individuals routinely receive information about their risk of coronary heart disease (CHD) based on traditional risk factors as part of their primary care. We are also able to calculate individual’s risk of CHD based on their genetic information and at present genetic testing for common diseases is available to the public. Due to the limitations in previous studies further understanding is needed about the impact of the risk information on individual’s well-being and health-behaviour. We aimed to explore the short term response to receiving different forms of CHD risk information and lifestyle advice for risk reduction. Methods We conducted fourty-one face-to-face interviews and two focus groups across England with participants from the INFORM trial who received a combination of individualised phenotypic and genotypic CHD risk scores and web-based lifestyle advice. Risk scores were presented in different formats, e.g. absolute 10 year risk was presented as a thermometer and expressed as a percentage, natural frequency and ‘heart age’. Interviews and focus groups explored participants’ understanding and reaction to the risk scores and attempts to change lifestyle during the intervention. We tape-recorded and transcribed the interviews and focus groups and analysed them using thematic analysis. Results Three main themes were identified: limitations of risk scores to generate concern about CHD risk; the advantages of the ‘heart age’ format of risk score presentation in communicating a message of sub-optimal lifestyle; and intentions and attempts to make moderate lifestyle changes which were prompted by the web-based lifestyle advice. Conclusions There are a number of limitations to the use of risk scores to communicate a message about the need for a lifestyle change. Of the formats used, the ‘heart age’, if noticed, appears to convey the most powerful message about how far from optimal risk an individual person is. An interactive, user friendly, goal setting based lifestyle website can act as a trigger to initiate moderate lifestyle changes, regardless of concerns about risk scores. Trial registration Current Controlled Trials ISRCTN17721237 . Registered 12 January 2015

Lean implementation within healthcare: imaging as fertile ground

Purpose - The purpose of this paper is to understand the barriers and enablers to Lean implementation as part of an imaging quality improvement programme, from a socio-cultural perspective. Design/methodology/approach – An in-depth 33 month ethnographic study, using observation and qualitative interviews, examined the process of Lean implementation as part of an improvement programme. Findings - Implementation of Lean was more successful compared with other reports of Lean in healthcare settings. Key enablers of Lean were high levels of multidisciplinary staff involvement and engagement; the professional credibility of facilitators; clinicians as early adopters; all within a wider culture of relatively strong inter-professional relationships in the imaging department. These enablers combined with the more routinised and standardised nature of imaging pathways compared to some other acute specialties, suggest that imaging is fertile ground for Lean, linked to the manufacturing origins of Lean. Practical implications - When introducing Lean within healthcare settings special attention needs to be paid to the specific healthcare context and the existing cultures of inter-professional relationships. Fostering an improvement culture and engagement with training, together with adequate financial resource, are key to contributing to the level of acceptability of an improvement tool such as Lean. Originality/value- This ethnographic study, bringing together rich multi-source data, has provided a detailed insight into the cultural workings of the process of Lean implementation within a complex healthcare system

Information and Risk Modification Trial (INFORM): design of a randomised controlled trial of communicating different types of information about coronary heart disease risk, alongside lifestyle advice, to achieve change in health-related behaviour

Abstract Background Cardiovascular disease (CVD) remains the leading cause of death globally. Primary prevention of CVD requires cost-effective strategies to identify individuals at high risk in order to help target preventive interventions. An integral part of this approach is the use of CVD risk scores. Limitations in previous studies have prevented reliable inference about the potential advantages and the potential harms of using CVD risk scores as part of preventive strategies. We aim to evaluate short-term effects of providing different types of information about coronary heart disease (CHD) risk, alongside lifestyle advice, on health-related behaviours. Methods/Design In a parallel-group, open randomised trial, we are allocating 932 male and female blood donors with no previous history of CVD aged 40–84 years in England to either no intervention (control group) or to one of three active intervention groups: i) lifestyle advice only; ii) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic characteristics; and iii) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic and genetic characteristics. The primary outcome is change in objectively measured physical activity. Secondary outcomes include: objectively measured dietary behaviours; cardiovascular risk factors; current medication and healthcare usage; perceived risk; cognitive evaluation of provision of CHD risk scores; and psychological outcomes. The follow-up assessment takes place 12 weeks after randomisation. The experiences, attitudes and concerns of a subset of participants will be also studied using individual interviews and focus groups. Discussion The INFORM study has been designed to provide robust findings about the short-term effects of providing different types of information on estimated 10-year CHD risk and lifestyle advice on health-related behaviours. Trial registration Current Controlled Trials ISRCTN17721237 . Registered 12 January 2015

Effect of communicating phenotypic and genetic risk of coronary heart disease alongside web-based lifestyle advice:the INFORM Randomised Controlled Trial

Objective To determine whether provision of web-based lifestyle advice and coronary heart disease risk information either based on phenotypic characteristics or phenotypic plus genetic characteristics affects changes in objectively measured health behaviours. Methods A parallel-group, open randomised trial including 956 male and female blood donors with no history of cardiovascular disease (mean SD age=56.7 8.8 years) randomised to four study groups: control group (no information provided); web-based lifestyle advice only (lifestyle group); lifestyle advice plus information on estimated 10-year coronary heart disease risk based on phenotypic characteristics (phenotypic risk estimate) (phenotypic group) and lifestyle advice plus information on estimated 10-year coronary heart disease risk based on phenotypic (phenotypic risk estimate) and genetic characteristics (genetic risk estimate) (genetic group). The primary outcome was change in physical activity from baseline to 12 weeks assessed by wrist-worn accelerometer. Results 928 (97.1%) participants completed the trial. There was no evidence of intervention effects on physical activity (difference in adjusted mean change from baseline): lifestyle group vs control group 0.09 milligravity (mg) (95% CI-1.15 to 1.33); genetic group vs phenotypic group-0.33 mg (95% CI-1.55 to 0.90); phenotypic group and genetic group vs control group-0.52 mg (95% CI-1.59 to 0.55) and vs lifestyle group-0.61 mg (95% CI-1.67 to 0.46). There was no evidence of intervention effects on secondary biological, emotional and health-related behavioural outcomes except self-reported fruit and vegetable intake. Conclusions Provision of risk information, whether based on phenotypic or genotypic characteristics, alongside web-based lifestyle advice did not importantly affect objectively measured levels of physical activity, other health-related behaviours, biological risk factors or emotional well-being. Trial registration number ISRCTN17721237; Pre-results. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ

Doing rehabilitation in the contemporary prison : the case of one-wing therapeutic communities

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Only Making Things Worse:A Qualitative Study of the Impact of Wrongly Removing Disability Benefits from People with Mental Illness

Many countries belonging to the Organisation for Economic Co-operation and Development (OECD) have seen a considerable increase in the number of disability benefits recipients (DBRs), in addition to an increase in the proportion of people with mental illness. As in other countries, changes to the welfare benefits system in England were made in order to reduce the number of DBRs. Many people lost their benefit payments, although a considerable number had them reinstated after appeal. Our aim was to investigate the impact of the process on DBRs whose disability was related to mental health and who won their appeal. Seventeen DBRs were interviewed. The participants reported three main types of impact. Beyond the practical reduction of income and the related anxiety, interviewees reported considerable stress when coping with the ‘never-ending’ cycle of bureaucracy. They also expressed anger, frustration and demoralisation at mistrust on the part of the authorities partly due to the ‘invisibility’ of their disability