Health Inequalities at the Heart of the Social Work Curriculum.

yesEfforts to reduce the widening gap between the health and social well-being of people within and between countries have become an urgent priority for politicians and policymakers. The Rio Declaration called on governments worldwide to promote and strengthen universal access to social services and to work in partnership to promote health equity and foster more inclusive societies. This paper contributes to international debates about the role of social work in promoting social justice by reducing social and health inequalities. Despite clear commitments to promote good health, there is a notable absence of a social determinants of health perspective in international social work curricula standards. The current review of social work education in England presents a timely opportunity to integrate such a perspective in teaching and learning and to disseminate this more widely. Employing the concepts of downstream and upstream interventions, the first part of the paper examines the distinctiveness of the social work contribution to this global agenda. In the second part of the paper, we consider how the content of learning activities about health inequalities can be incorporated in international social work curricula, namely, human rights, using Gypsy and Traveller families as an exemplar, inter-professional education and international perspectives

LGBT asylum seekers and health inequalities in the UK

YesThe experiences of LGBT asylum seekers in the UK are the focus of this chapter. The relative invisibility of LGBT asylum seekers in social work literature and research is acknowledged. Data from interviews undertaken as part of a small scale research study is used to highlight issues of psychological stress, safety, social isolation and resilience and survival. This material is discussed in relation to models of minority stress, discrimination, social determinants of health, and human rights. A holistic approach to practice in response to an opening vignette, is presented with reference to the importance of advocacy and cross-sector partnership working.This is a post-peer-review, pre-copy edited version of a chapter published in: Fish J and Karban K (Eds.) Lesbian, Gay, Bisexual and Trans Health Inequalities. Details of the definitive published version and how to purchase it are available online at https://policypress.co.uk/lesbian-gay-bisexual-and-trans-health-inequalities

Who calls the tune? Participation and partnership in research

yesThis paper explores issues of partnership and participation in research and evaluation, drawing on the experiences of evaluating a move from hostel accommodation to independent supported living for people with mental health difficulties or learning disabilities. The service change project involved a partnership between a local authority and a housing association with over 300 people moving into their own tenancies in newly-built flats and bungalows. The accompanying evaluation was designed on a model of service user participation and action research and was specifically concerned to explore the impact of the changes on people’s actual or perceived social inclusion into local communities. Ten service user and carer researchers, some of whom were directly involved in the move from hostel to independent living, were recruited and worked with ‘professional’ researchers to examine both the process and the outcomes of the move. The work will be viewed through the insights offered by feminist, transformative and participatory approaches to research. The ‘positioning’ of the researcher in relation to boundaries and the construction of the ‘other’ will be considered, emphasising an approach grounded in reflexivity and an acknowledgement of the complex ethical issues involved. A key feature of this study has been the negotiation involved between a complex change project and a participatory evaluation design. Learning points from the work so far will also be considered in terms of their wider application in future evaluations of complex change projects that involve multiple stakeholders.Published online Nov 2012

Service User and Carer Involvement in Mental Health Education, Training and Research – A Literature Review

As part of an evaluation of service users’ and carers’ experience of involvement in mental health education, training and research, an extended literature review was undertaken. The purpose of this was to review policy underpinning service user and carer involvement in those areas, identify the extent and range of involvement, the processes involved, and the extent to which the effectiveness and impact of involvement had been evaluated. The review found that there was a range of different ways in which people were involved. It identified different types and levels of involvement and different motivations for taking part in involvement activities. Government policy and guidance on public and patient involvement (PPI) in health services has clearly been a driver and has resulted in widespread involvement activity but this has developed on an ad hoc and inconsistent basis. There are benefits for service users and carers, the NHS, and educational establishments arising out of involvement activity. These include improvements in the health and well-being of service users, enhancing the student experience, and improvements to service delivery. However, there are still barriers to involvement including organisational factors and unintentional discrimination. Payment for involvement activity remains an under researched area. Service users value payments but welfare benefits rules, and inconsistent interpretation of good practice guidance, mean this can be a further barrier to involvement. Currently, the evidence base evaluating the effectiveness of service user involvement in a range of activities including service planning, delivery, education and research is limited

On the Edge: Power and Partnership in Social Work

This submission for the award of PhD by Published Work includes a range of single, joint and multiple-authored publications that were published between 2005 and 2016. The publications cover a range of issues relevant to social work with a particular emphasis on mental health and health inequalities. The statement provides an underpinning conceptual framework that demonstrates interwoven themes of power, partnership and marginality. These are explored in relation to the published work, demonstrating an original and coherent contribution to the social work knowledge and practice base. The discussion draws on a reflexive journey through social work practice, education and research. The conclusion proposes that considerations of power and partnership are crucial elements of the potential for creative work ‘on the margins’

Developing a health inequalities approach for mental health social work

YesDespite increasing evidence of the impact of health inequalities on mental health (Pickett and Wilkinson, 2015) there is only limited recognition of the potential role for mental health social work in addressing ‘upstream’ as well as ‘downstream’ challenges of poverty, disadvantage and oppression affecting many people experiencing mental health difficulties. This paper presents some of the current evidence concerning mental health inequalities and the opportunities for mental health social workers to promote wellbeing. A theme throughout the paper is the need to avoid the many examples of dichotomous thinking that frequently characterise thinking about mental health and mental health practice. Additionally the limitations of an individualised recovery discourse are acknowledged. Drawing on Krieger’s (2011) ecosocial model, the social determinants of mental health are considered and the concept of embodiment is examined for its contribution to a more nuanced understanding of the relationship between inequality and health. Finally, the paper offers a version of mental health social work that ‘faces both ways’, involving issues at both the individual and the wider societal level. This includes developing and extending partnerships with service users and carers and with other professional and agencies

Building Capacity in the Zambian Mental Health Workforce through Engaging College Educators: Evaluation of a Development Partnership in Higher Education (DelPHe) project

yesBetween 2008 and 2011 academic teaching staff from Leeds Beckett University (UK) and Chainama Hills College of Health Sciences (Zambia) worked together on a Development Partnership in Higher Education (DelPHe) project funded by the Department for International Development (DFID) via the British Council. The partnership focused on “up-scaling” the provision of mental health education which was intended to build capacity through the delivery of a range of workshops for health educators at Chainama College, Lusaka. The project was evaluated on completion using small focus group discussions (FGDs), so educators could feedback on their experience of the workshops and discuss the impact of learning into their teaching practice. This chapter discusses the challenges of scaling up the mental health workforce in Zambia; the rationale for the content and delivery style of workshops with the health educators and finally presents and critically discusses the evaluation findings.Department for International Development (DFID) via the British Counci

Towards a middle-range theory of mental health and well-being effects of employment transitions: Findings from a qualitative study on unemployment during the 2009-2010 economic recession.

This article builds upon previous theoretical work on job loss as a status passage to help explain how people's experiences of involuntary unemployment affected their mental well-being during the 2009-2010 economic recession. It proposes a middle-range theory that interprets employment transitions as status passages and suggests that their health and well-being effects depend on the personal and social meanings that people give to them, which are called properties of the transitions. The analyses, which used a thematic approach, are based on the findings of a qualitative study undertaken in Bradford (North England) consisting of 73 people interviewed in 16 focus groups. The study found that the participants experienced their job losses as divestment passages characterised by three main properties: experiences of reduced agency, disruption of role-based identities, for example, personal identity crises, and experiences of 'spoiled identities', for example, experiences of stigma. The proposed middle-range theory allows us to federate these findings together in a coherent framework which makes a contribution to illuminating not just the intra-personal consequences of unemployment, that is, its impact on subjective well-being and common mental health problems, but also its inter-personal consequences, that is, the hidden and often overlooked social processes that affect unemployed people's social well-being. This article discusses how the study findings and the proposed middle-range theory can help to address the theoretical weaknesses and often contradictory empirical findings from studies that use alternative frameworks, for example, deprivation models and 'incentive theory' of unemployment

Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity

YesBackground: medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods: a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results: twenty-four studies (total participants=17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone followup (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion: our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant PB-PG-0317-20010)

A Grounded Theory approach to understanding the role of medication safety within a hospital early discharge team

YesConference abstract from the British Geriatrics Society Autumn Meeting, 14-16 Nov 2018, London, UK