International Developments in Self-Directed Care

Highlights innovative self-directed care programs in Europe and the United States that allow patients to choose home and community-based services, within a budget, in managing mental illness and chronic conditions. Examines outcomes and lessons learned

The environmental and social impacts of ebanking : a case study with Barclays PLC ; final report ; Digital Europe

This report presents the calculations and findings as well as the resulting recommendations from the Barclays Plc case study within the Digital Europe project. Chapter 2 gives the background to the case study; chapter 3 investigates the environmental aspects; and chapter 4 highlights social aspects of different banking scenarios. Chapter 5 outlines future scenarios in the sector and chapter 6 finally makes recommendations for business and government

‘It's a whole cultural shift’: Understanding Learning in Cultural Commissioning from a Qualitative Process Evaluation

This qualitative process evaluation investigated learning from stakeholders (patient representatives, art managers/artists, clinicians and commissioners) involved in a co-produced cultural commissioning grant scheme. The scheme was devised as a mechanism to foster learning between, and within, stakeholder groups and to embed co-production in decision-making in clinical commissioning. The evaluation included respondents (n=36) from four stakeholder groups in three sequential stages. Findings identified themes centred on outcomes, learning, co-production, and cultural and political change, specifically that stakeholder roles need to be clearly defined and understood and that co-production takes a significant time commitment. Co-production in innovative projects is both complex and challenging. However, despite this, involving stakeholders has benefits for service design and the clinical commissioning process

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Background The mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health. Objectives To identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision. Design Two inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study. Setting Global (systematic reviews); England and Wales (mapping exercise and case study). Participants (case study) Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites. Main outcome measures (meta-analysis) A measure of CYP’s mental health symptomatology. Data sources (literature reviews) MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC). Review methods Titles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review. Results Sixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support. Conclusions Mental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes. Future work Future work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness

Unpacking the relationship between parenting and poverty: Theory, evidence and policy

Policy discourses around child poverty and its causes and effects on families emerged in the 1990s, culminating in the Coalition government's emphasis on the quality of couple relations in improving child outcomes and in reducing child poverty. This article reviews and updates the current evidence base around the relationship between parenting and poverty. Evidence suggests an intricate relationship between complex and mediating processes of, for instance, income, parental stress, disrupted parenting practices and neighbourhoods and environments, as opposed to a simplistic causal relationship between poverty, parenting and child outcomes. The article then proceeds to suggest responses to enhance the evidence and research. Lastly, it considers the implications for child poverty policy, arguing that current responses are too simplistic and do not sufficiently reflect the evidence base