Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study

Background In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care. Methods We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method. Results Significant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery. Conclusions Administrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common understandings of recovery which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated

"Including us, talking to us and creating a safe environment" - Youth Patient & Public Involvement and the Walking In ScHools (WISH) Study: Lessons learned

© 2023 The authors. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/hex.13885Background: Young people have the right to be informed and consulted about decisions affecting their lives. Patient and public involvement (PPI) ensures that research is carried out ‘with’ or ‘by’ young people rather than ‘to’, ‘about’ or ‘for’ them. The aim of this paper is to outline how youth PPI can be embedded within a physical activity intervention, reflect on the impact of PPI and provide recommendations for future PPI in a similar context. Methods: A Youth Advisory Group (YAG) was set up within the Walking In ScHools (WISH) Study to involve adolescent girls in the delivery, implementation and dissemination of a physical activity intervention targeted at adolescents. Schools invited pupils aged 12–14 years and 15–18 years to YAG meetings (n3, from 2019 to 2023). Participative methods were used to inform recruitment strategies and data collection methods for the WISH Study. Results: Across the three YAG meetings, n51 pupils from n8 schools were involved. Pupils enjoyed the YAG meetings, felt that their feedback was valued and considered the meetings a good way to get young people involved in research. The YAG advised on specific issues and although measuring impact was not the primary aim of the YAG meetings, over the course of the study there were many examples of the impact of PPI. Recruitment targets for the WISH Study were exceeded, the attrition rate was low and pupils were engaged in data collection. Conclusion: Youth PPI is a developing field and there are few physical activity studies that report the PPI work undertaken. Within the WISH Study, three YAG meetings were held successfully, and the views of adolescent girls were central to the development of the study. Considering the specific issues that the YAG advised on (study recruitment, attrition and data collection), there was evidence of a positive impact of PPI. Patient or Public Contribution: Pupils from post-primary schools interested/participating in the WISH Study were invited to attend YAG meetings. YAG meetings were set up to consult adolescent girls on the delivery, implementation and dissemination of the WISH intervention.The WISH Study was funded from INTERREG VA funding of €8.84m (including a 15% contribution from the Department of Health in NI and Republic of Ireland), which had been awarded to the HSC Research & Development Division of the Public Health Agency Northern Ireland and to the Health Research Board in Ireland for the Cross-border Healthcare Intervention Trials in Ireland Network project.Published versio

Key findings from The Walking In ScHools (WISH) Study, a peer-led walking intervention for adolescent girls

Project Description: The effects of walking interventions on adult health are known, however the potential of walking to promote physical activity (PA) in adolescents is less known. This study evaluated the effectiveness of a novel, school-based walking intervention at increasing PA levels of adolescent girls. Female pupils aged 12-14 years, were recruited from eighteen (mixed or single-sex) schools across the Border Region of Ireland/Northern Ireland. Schools were randomised to control (usual physical activity; n9) or intervention (n9). In intervention schools, female pupils (15-18 years) were trained as walk leaders and led the younger pupils in 10-15min walks before school, at break and lunchtime. Walks were in school grounds and pupils were encouraged to join as many walks as possible. Excluding holidays, the intervention was delivered for a full school year (18-21 weeks). Accelerometers measured PA and the primary outcome was total PA (cpm). Impact: In total, 589 pupils were recruited (intervention: n286; control n303). Baseline moderate-vigorous PA (MVPA) for the intervention group was (median [IQR]) 36.1 (23.0) mins per day and 35.3 (19.8) mins per day in the control group. At baseline, only 15% (n37) of intervention and 10% (n29) of control participants met PA guidelines (60 mins MVPA per day). Post-intervention total PA (cpm) did not statistically differ between groups when adjusted for age, body mass index z-scores and baseline PA (mean difference, -33.5, 95% CI= -21.2 to 88.1; p=0.213). Learning: ‘Scaling-up’ PA interventions is challenging. Despite a promising feasibility study, the results of this fully powered trial indicate that in this context, the walking programme did not increase PA. Since the COVID-19 pandemic, school environments have changed and although pupils enjoyed the programme, attendance at walks was low. There is a need to better understand the implementation of interventions such as WISH within schools

S06-1 Putting young people at the heart of physical activity research design: The Walking In ScHools (WISH) Study

BACKGROUND: Young people have the right to be informed and consulted about decisions affecting their lives. Youth Patient and Public Involvement (PPI) should be encouraged to ensure research is carried out ‘with' or ‘by' young people rather than ‘to', ‘about' or ‘for' them. PPI can ensure research is relevant, results are accessible and recruitment rates are improved. Young people have had limited involvement in the design, implementation and dissemination of public health research and there have been calls for a greater focus on youth PPI in research. METHODS: Following the WISH feasibility study that consulted young people pre and post-intervention, a Youth Advisory Group (YAG) was set up within the main trial. The WISH study is a clustered randomised controlled trial in which a peer-led, school-based, brisk walking intervention is compared to usual physical activity in adolescent females. The YAG was introduced to inform intervention delivery and provide researchers with an understanding of what would encourage/discourage participation. Schools were asked to invite pupils aged 12-14 years (participants) and 15-18 years (walk leaders). Participative methods were used to develop and review study documentation. The YAG completed a short questionnaire and recruitment rates were monitored. RESULTS: Fourteen pupils from 3 schools attended the 2019 YAG meeting. The YAG agreed the meeting was a good way of getting young people involved in research (93%) and attendees enjoyed the meeting (100%). As a result, changes were made to study documentation, incentives were purchased and recruitment materials developed. Participant recruitment was higher in schools who participated in the YAG (54%) compared to those who did not (47%). In 2021 the second YAG occurred and 1 teacher, 12 participants and 10 walk leaders from 2 schools provided feedback on the trials COVID-19 contingency plan. The girls felt their feedback was valued (100%) and it was important young people had the chance to contribute to research studies (100%). CONCLUSIONS: The views of young people have been central to the development of the WISH Study and although youth PPI is not without challenges, there are many benefits for researchers, the study and the young people involved

Late Pleistocene to early-Holocene rainforest foraging in Sri Lanka:Multidisciplinary analysis at Kitulgala Beli-lena

Sri Lanka has produced the earliest clear evidence for Homo sapiens fossils in South Asia and research in the region has provided important insights into modern human adaptations and cultural practices during the last ca. 45,000 years. However, in-depth multidisciplinary analyses of Late Pleistocene and Holocene sequences remain limited to just two sites, Fa Hien-lena and Batadomba-lena. Here, we present our findings from the reinvestigation of a third site, Kitulgala Beli-lena. New chronometric dating from the site confirms the presence of humans as early as ca. 45,000 cal. BP. in the island's Wet Zone rainforest region. Our analyses of macrobotanical, molluscan, and vertebrate remains from the rockshelter show that this early human presence is associated with rainforest foraging. The Late Pleistocene deposits yielded evidence of wild breadfruit and kekuna nut extraction while the Holocene layers reveal a heavy reliance on semi-arboreal and arboreal small mammals as well as freshwater snails as a protein source. The lithic and osseous artefacts demonstrate that populations developed a sophisticated tool kit for the exploitation of their immediate landscapes. We place the rich Kitulgala Beli-lena dataset in its wider Sri Lankan context of Late Pleistocene foraging, as well as in wider discussions of our species’ adaptation to ‘extreme’ environments as it moved throughout Asia