Community-based Professionals Research Articles

Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components

BackgroundTechnology-enabled inpatient-level care at home services, such as virtual wards and hospital at home, are being rapidly implemented. This is the first systematic review to link the components of these service delivery innovations to evidence of effectiveness to explore implications for practice and research.MethodsFor this review (registered here https://osf.io/je39y), we searched Cochrane-recommended multiple databases up to 30 November 2022 and additional resources for randomised and non-randomised studies that compared technology-enabled inpatient-level care at home with hospital-based inpatient care. We classified interventions into care model groups using three key components: clinical activities, workforce, and technology. We synthesised evidence by these groups quantitatively or narratively for mortality, hospital readmissions, cost-effectiveness and length of stay.ResultsWe include 69 studies: 38 randomised studies (6413 participants; largely judged as low or unclear risk of bias) and 31 non-randomised studies (31,950 participants; largely judged at serious or critical risk of bias). The 69 studies described 63 interventions which formed eight model groups. Most models, regardless of using low- or high-intensity technology, may have similar or reduced hospital readmission risk compared with hospital-based inpatient care (low-certainty evidence from randomised trials). For mortality, most models had uncertain or unavailable evidence. Two exceptions were low technology-enabled models that involve hospital- and community-based professionals, they may have similar mortality risk compared with hospital-based inpatient care (low- or moderate-certainty evidence from randomised trials). Cost-effectiveness evidence is unavailable for high technology-enabled models, but sparse evidence suggests the low technology-enabled multidisciplinary care delivered by hospital-based teams appears more cost-effective than hospital-based care for those with chronic obstructive pulmonary disease (COPD) exacerbations.ConclusionsLow-certainty evidence suggests that none of technology-enabled care at home models we explored put people at higher risk of readmission compared with hospital-based care. Where limited evidence on mortality is available, there appears to be no additional risk of mortality due to use of technology-enabled at home models. It is unclear whether inpatient-level care at home using higher levels of technology confers additional benefits. Further research should focus on clearly defined interventions in high-priority populations and include comparative cost-effectiveness evaluation.Trial registrationhttps://osf.io/je39y.

Beyond constraints: interpreting voices to reframe preparation of teachers for inclusive kindergarten classrooms

ABSTRACT Despite increased governmental support and attention, improved collaboration with community-based professionals, and enhanced teacher knowledge and training in Hong Kong, studies continue to reveal the unreadiness or even resistance of kindergarten teachers to include children with special educational needs (SENs) in their classrooms. This study aimed to unveil the possible reasons behind such unreadiness and resistance among trained early childhood teachers. The research team interviewed four early childhood educators from Hong Kong with various positions, experiences, and standpoints to explore their perspectives on pre-service teacher education and practicums in preparing teachers to support children with SENs. The results indicated that, while trainee teachers had the necessary knowledge to work with children with SENs, they lacked opportunities and support to apply and connect theory to practice during their practicums. This could be due to constraints such as being assigned passive roles by mentors and trainees’ own complacency. Implications and recommendations for improving future pre-service programmes are discussed to better prepare teachers for inclusion. The analysis contributes an ecological perspective by investigating experiential learning as negotiated within dynamic sociocultural and structural forces, furthering understanding of influences shaping competence development.

Community Collaboration for Suicide and Overdose Prevention: Attitudes, Perceptions, and Practices of Community-Based Professionals and County Leadership in New York State.

Deaths by overdose and suicide have been steadily rising, yet efforts to jointly address them have been limited despite shared risk and protective factors. The purpose of this study was to explore ways of jointly addressing these two significant public health issues at the community level. To accomplish this goal, we distributed an electronic survey via email to all 58 Local Mental Hygiene Directors (LMHDs) and 184 substance use and 57 suicide prevention coalition leads in New York State in March 2019 to better understand attitudes, perceptions, and practice of community-based overdose and suicide prevention. A total of 140 unique individuals completed the survey for a 47% usable response rate. Participants overwhelmingly reported that suicide and overdose are preventable and that individuals with risky substance use would benefit most from suicide prevention services compared to other populations. In addition, substance use prevention coalition leads reported less awareness of key suicide prevention programs than suicide prevention coalition leads and LMHDs; LMHDs were generally most familiar with suicide prevention programs. Finally, substance use and suicide prevention coalition leads were interested in collaborating to raise awareness, provide training, and implement community-based activities. These findings demonstrate a consensus among county leadership and substance use and suicide prevention coalition leads that suicide and overdose are prevalent in their communities and that increased collaboration to address these two public health issues is warranted. Results suggest a need for education, training, and technical assistance to support collaboration.

Empowercare: Development and evaluation of a competency-framework and educational course to teach community-based professionals how to empower vulnerable community residents.

Background: Communities are increasingly seen as the preferred context to organize care and interprofessional collaboration. The primary goal of community-based care is to enable people to live at home longer, delaying or preventing hospitalization of (vulnerable) people by focusing on organizing care in a familiar environment which benefits both physical and mental wellbeing. Community-based care demands that people with a need for care and support are included as equal partners in deciding what works best, during which their needs, preferences, and strengths are seen as the building blocks of delivered care. This shift from a system based on specialized and supply-driven care to community-based care brings new challenges, and a new role and set of competencies for all professionals involved. ‘Empowerment’ seems to be a key concept when it comes to shaping these new care perspectives and practices. More specifically, professionals need to take on an empowering attitude, supporting the active participation and the acquisition of skills of the (vulnerable) person, whilst focusing on needs and strengths. However, the competencies needed to change perspectives and take on an empowering attitude have not yet sufficiently found their way to day-to-day care practices. In the context of the Interreg2Seas Empowercare project, we have tackled this issue by designing and evaluating an online module and neighbourhood workshops to teach professionals what community-based empowerment entails and how to implement it in daily practice.
 Method: A literature review and one-on-one interviews with community-based professionals who have acquired an expertise in community-based empowerment were conducted to build a competency framework and to inform the development of an educational course on ‘community-based empowerment’, consisting of an e-learning, face-to-face workshops with case intervisions, in-field exercises, and podcasts. The course was piloted and evaluated in four communities in Flanders, Belgium.
 Target group: The course is intended for professionals from health and social care who are active in primary care and/or community care, that work with (vulnerable) community residents, and who work in the same neighbourhood.
 
 Evaluation: Feedback and input on the structure and content of the course was obtained from participants throughout and after the course. Participants were asked to fill out questionnaires on self-efficacy and implementation of community-based empowerment competencies. The qualitative data revealed that participants were overall very satisfied with the course. Participants specifically liked the blended nature of the course, and the opportunity to connect with community-based professionals from the same neighbourhood during the face-to-face workshops. Response on the questionnaires was too low to draw conclusions based on quantitative data.
 Next steps: The course is currently being optimized based on feedback and will be tested in four new communities based in the province of Antwerp, Belgium. More specifically, the course mainly delt with competencies needed to obtain an empowering attitude but lacked in-depth content on how to implement the competencies in community-based care and how to establish sustainable collaboration between community-based professionals.

Caregiver education programme on intellectual and developmental disabilities: An acceptability and feasibility study in an academic medical setting.

Children and adolescents with intellectual and developmental disabilities (I/DD), including autism spectrum disorder, benefit from a variety of specialized interventions. However, there are barriers that impact families' ability to access such services for their children. While not intended as a replacement for individualized or group-based interventions, educational classes may be an option in providing supplemental resources and support to families of individuals with I/DD. This study was a programme evaluation that examined the feasibility and acceptability of a Caregiver Education Program that was created in an outpatient specialty clinic of an academic medical centre, designed to provide educational information on a variety of topics relevant to children and adolescents with I/DD (e.g., toilet training, understanding behaviour and managing anxiety). The review included 1027 participants from 40 classes led by licensed clinicians, trainees, and/or experienced caregivers. Classes occurred approximately one time per month over the course of three-and-a-half years and targeted caregivers of children and adolescents with I/DD and community-based professionals in the field of I/DD. Participants were able to attend one or multiple classes, based on their interest in the given topic. Participants were asked to complete post-training surveys at the end of each session as part of ongoing programme evaluation. Participants reported a high level of satisfaction and increased knowledge as a result of participating in classes, and higher knowledge gained and higher satisfaction for in-person classes compared to virtual classes. This programme is one model of education delivery with high acceptability and feasibility, designed to support families and increase access to information beyond specialized interventions. Future directions include improving the model of programme data collection, examination of the programme's generalization to practice and to other communities, and an emphasis on culturally responsive curricula.

Barriers to Effective Communication about Advance Care Planning and Palliative Care: A Qualitative Study.

The purpose of this study was to identify barriers to effective conversations about advance care planning (ACP) and palliative care reported by health care and community-based service providers in Massachusetts, USA. This qualitative research analyzed open-ended responses to two survey questions, inquiring about perceived barriers to having conversations about ACP and palliative care with patients and consumers. Data were collected between November 2017 and June 2019 from nine organizations in Massachusetts, including health care provider organizations, health insurers, community-based organizations, and a nursing education institution. Two researchers reviewed and coded the responses and identified common themes inductively. Across 142 responses, primary barriers to ACP included hesitation and lack of understanding and knowledge, discomfort and resistance among service providers, lack of staff knowledge, difficulties with follow-up, and differences in ACP policies across regions. Common barriers to palliative care were misconceptions about palliative care and lack of knowledge, service providers' lack of preparedness, and limited policy support and availability. Challenges relevant to both ACP and palliative care were fear and discomfort around serious illness discussions, lack of knowledge and awareness, discussions that occur too late, and cultural and language barriers. Health care practitioners and community-based professionals reported consumer-, service provider-, and system-level barriers to facilitating conversations about ACP and palliative care with patients experiencing serious illness. There is a need for more tools and support to strengthen service providers' ACP and palliative care competencies and to promote a structured approach to health care planning conversations.

Professional support and re-entry preparedness among prisoners

Multiagency support is considered crucial in the successful resettlement of prisoners. Various prison-based and community-based professionals should each play a part in supporting prisoners through the gate regarding employment, housing, financial problems, healthcare or valid identification issues. Yet, little is known about the actual contribution of this support to a better perceived re-entry preparedness among prisoners. To examine the association between professional support and re-entry preparedness, the current study uses self-reported data from 1442 soon-to-be-released prisoners across 26 Dutch institutions. We include general satisfaction with support, and satisfaction with the specific instrumental support received, and compare prisoners who did and did not have reintegration needs prior to imprisonment. Support was positively related to re-entry preparedness for prisoners who had needs prior to imprisonment, and instrumental support from community-based professionals showed the most robust results. The implications and future recommendations are discussed.

Development and evaluation of the Food Bank Health and Nutrition Assessment.

Efforts to improve the nutritional quality and health promotion in the charitable food system have been undertaken. Though methods exist to track these efforts in terms of food banks' inventory, there are not research-tested tools to assess, monitor and influence policy, systems and environmental (PSE) changes. The study objective was to develop and evaluate a novel assessment tool that could be used to evaluate a food bank's efforts to improve the promotion of health and nutritious foods. The study had five phases: (1) initial development; (2) iterative review and revisions; (3) pilot testing; (4) content validity assessment and (5) inter-rater and test-retest assessment. The Food Bank Health and Nutrition Assessment (FB-HANA) was drafted after reviewing existing policies, nutrition-focused charitable food systems guidance and similar tools for food pantries. Midwestern United States. Eleven food banks. Stakeholders and pilot testers provided initial feedback to refine the FB-HANA's flow, ease of completion and collection of contextual information. External experts rated the FB-HANA and each of the eight objectives as content valid. A set of two assessments completed by twenty-six community-based professionals, employed by Extension and fourteen food bank staff across eleven food banks, supported moderate to excellent inter-rater and test-retest reliability for the FB-HANA overall and each of its objectives. Evidence suggests that the FB-HANA can be used by either food bank or community-based professionals, such as Extension staff, to provide a perspective on ways food banks promote health and nutrition through PSE approaches.

A Community-Based Approach to Supporting the Mental Health of Rural Youth

This publication highlights the role the established presence of UF/IFAS Extension in rural regions can play in the dissemination of community-based professionals into these areas. The integration of these professionals and the various programs and services they offer will serve as a buffer to the many stressors faced by rural residents, the complexities of which often lead to overall poor mental health. Written by Ashlyn Michael, LaToya O’Neal, Erin Kersey, Angela Nielsen, Karen Coker, and Larry Forthun, and published by the UF/IFAS Department of Family, Youth and Community Sciences, November 2022.

Intersectoral collaboration in home-based end-of-life pediatric cancer care: A qualitative multiple-case study integrating families’ and professionals’ experiences

Background: Many children and adolescents with incurable cancer and their families prefer to receive end-of-life care and to die at home. This implies a transition of care from hospital to home and presupposes the establishment of a well-functioning collaboration between the family and professionals across health care sectors. Aim: To identify and explore key elements of home-based end-of-life care collaboration for children with cancer, as experienced by their parents and grandparents and the hospital- and community-based professionals involved. Design: Descriptive qualitative multiple-case study. Data were collected by semi-structured interviews and written responses to open-ended questions, and analyzed inductively across cases using qualitative content analysis. Setting/participants: Cases comprised a criterion sample of five children (aged <18 years), who died of cancer at home. Cases were represented by the children’s bereaved parents (n = 8) and grandparents (n = 7), and community-based professionals (n = 16). Also, hospital-based professionals (n = 10) were interviewed about the children’s end-of-life care through group interviews. Results: We identified five main themes, describing key elements of the end-of-life collaboration: Establishing the collaboration, Bolstering family life, Elucidating organization and integration, Managing challenges, and Closing the collaboration. These themes all came under the overarching theme: A mutual trust-based collaboration. On this basis, we developed the “Home-Based Pediatric End-of-Life Care Model for Children with Cancer.” Conclusions: By highlighting key elements in the family-centered, intersectoral and interprofessional end-of-life care collaboration, our “Home-Based Pediatric End-of-Life Care Model for Children with Cancer” offers a framework for further optimization of home-based end-of-life care services for children with cancer and their families.

"I Don't Think It's on Anyone's Radar": The Workforce and System Barriers to Healthcare for Indigenous Women Following a Traumatic Brain Injury Acquired through Violence in Remote Australia.

Aboriginal and Torres Strait Islander women experience high rates of traumatic brain injury (TBI) as a result of violence. While healthcare access is critical for women who have experienced a TBI as it can support pre-screening, comprehensive diagnostic assessment, and referral pathways, little is known about the barriers for Aboriginal and Torres Strait Islander women in remote areas to access healthcare. To address this gap, this study focuses on the workforce barriers in one remote region in Australia. Semi-structured interviews and focus groups were conducted with 38 professionals from various sectors including health, crisis accommodation and support, disability, family violence, and legal services. Interviews and focus groups were audiotaped and transcribed verbatim and were analysed using thematic analysis. The results highlighted various workforce barriers that affected pre-screening and diagnostic assessment including limited access to specialist neuropsychology services and stable remote primary healthcare professionals with remote expertise. There were also low levels of TBI training and knowledge among community-based professionals. The addition of pre-screening questions together with professional training on TBI may improve how remote service systems respond to women with potential TBI. Further research to understand the perspectives of Aboriginal and Torres Strait Islander women living with TBI is needed.

How do Visit Facilitation and Accessibility of Prisons Relate to Visits from Professionals and Volunteers?

Reintegration support by community-based professionals and volunteers (CBPs) is needed to prepare prisoners for release. Yet, the way in which CBPs are received, informed and accommodated, may hamper in-prison involvement. Therefore, the current study explores the visit facilitation and accessibility of prisons in the Netherlands as experienced by CBPs. A new instrument to measure facilitation and accessibility across institutions is introduced. The findings among 4,309 prisoners and 1,077 professionals across 24 Dutch prisons revealed that although institutions differ in facilitation and accessibility, this is unrelated to prison visits received from most CBPs, apart from the likelihood of receiving visits from parole officers. The study confirms the importance of considering facilitation and accessibility in relation to in-prison involvement of external agencies.

Do Prisoners With Reintegration Needs Receive Relevant Professional Assistance?

Ex-prisoners often experience barriers to successful transition regarding employment, finances, housing, healthcare, and valid identification. Based on the Offender Management framework, assistance during imprisonment by prison- and community-based professionals is considered key in preparing prisoners for release regarding these reintegration needs. Therefore, the current study examines the degree to which prisoners with reintegration needs are assisted by relevant professionals. We used self-reported data from 4,309 prisoners of the Dutch Prison Visitation Study, part of the Life in Custody Study. The results showed that prisoners have more contact with prison-based than with community-based professionals, but that the latter relatively often have contact with prisoners with related reintegration needs. Yet, a specific group of prisoners with reintegration needs remains invisible. Prisoners with complex, health, or valid identification needs, and prisoners in the start or pre-release phase require further attention. It is discussed what can be learned from these findings on Dutch Offender Management practices.

Towards implementing exercise into the prostate cancer care pathway: development of a theory and evidence-based intervention to train community-based exercise professionals to support change in patient exercise behaviour (The STAMINA trial)

BackgroundThe National Institute for Health and Care Excellence (NICE) recommend that men on androgen deprivation therapy (ADT) for prostate cancer should receive supervised exercise to manage the side-effects of treatment. However, these recommendations are rarely implemented into practice. Community-based exercise professionals (CBEPs) represent an important target group to deliver the recommendations nationally, yet their standard training does not address the core competencies required to work with clinical populations, highlighting a need for further professional training. This paper describes the development of a training package to support CBEPs to deliver NICE recommendations.MethodsDevelopment of the intervention was guided by the Medical Research Council guidance for complex interventions and the Behaviour Change Wheel. In step one, target behaviours, together with their barriers and facilitators were identified from a literature review and focus groups with CBEPs (n = 22) and men on androgen deprivation therapy (n = 26). Focus group outputs were mapped onto the Theoretical Domains Framework (TDF) to identify theoretical constructs for change. In step two, behaviour change techniques and their mode of delivery were selected based on psychological theories and evidence to inform intervention content. In step three, the intervention was refined following delivery and subsequent feedback from intervention recipients and stakeholders.ResultsSix modifiable CBEPs target behaviours were identified to support the delivery of the NICE recommendations. Nine domains of the TDF were identified as key determinants of change, including: improving knowledge and skills and changing beliefs about consequences. To target the domains, we included 20 BCTs across 8 training modules and took a blended learning approach to accommodate different learning styles and preferences. Following test delivery to 11 CBEPs and feedback from 28 stakeholders, the training package was refined.ConclusionEstablished intervention development approaches provided a structured and transparent guide to intervention development. A training package for CBEPs was developed and should increase trust amongst patients and health care professionals when implementing exercise into prostate cancer care. Furthermore, if proven effective, the development and approach taken may provide a blueprint for replication in other clinical populations where exercise has proven efficacy but is insufficiently implemented.

Building Community Capacity to Care for Military and Veteran Families: The Star Behavioral Health Providers Program

Service members, veterans, and their families frequently have difficulties finding trained behavioral health providers who have knowledge of military culture and issues specific to the military population. This paper documents the design, implementation, effectiveness, and proximal outcomes of the Star Behavioral Health Providers training program (SBHP). We created SBHP as a dissemination effort in response to elevated levels of mental health problems among community-dwelling military and veteran families (CDMVF), limitations in provider capacity in the Departments of Defense (DoD) and Veterans Affairs (VA), and uneven preparation of civilian providers to serve military and veteran families. The goals of the initiative were to: Improve the preparation of community-based professionals to work with CDMVF. Increase providers’ use of evidence-informed information and practices. Strengthen the behavioral health infrastructure for treating CDMVF. The program provides military-specific training to community-based behavioral health providers and provides a mechanism for those seeking such services to find trained providers. Evaluation data, though limited by the lack of comparison or control groups, provided correlational evidence consistent with each program goal.

"They were just waiting for me to mess up": A critical discourse analysis of immigrant Latinx teens' perceptions of power dynamics.

This paper explores Latinx adolescents' perceptions of power dynamics with authority around them. We seek to inform how community-based professionals engage with and seek to understand members of this population. We conducted a critical discourse analysis of data collected during a community action photovoice project with 13 Latinx adolescents living in a metropolitan region of the southeastern United States. Participants felt they were under greater surveillance scrutiny by authority figures in social and academic spaces than their non-Latino peers. They discussed ways their movements were at times constrained because others presumed they were deviant, and how that affected their identity development. Judgments and assumptions held by both powerful adults and oppressed groups alike serve to reinscribe social stratification that places Latinx adolescents at a power disadvantage relative to their white peers. These experiences and understandings of power relations shape the circuitous racial dispossession of youth.

BARRIERS AND OPPORTUNITIES TO HEALTHY AGING IN ANCHORAGE, ALASKA, USING CONCEPT MAPPING

Alaska currently has the fastest growing proportion of older adults than any state in the country, and seniors are choosing to age-in-place in Anchorage in record numbers. Research shows that including older adults with community-based professionals (aging advocates, researchers, service providers) in focus group activities can provide a rich and holistic model of aging that demonstrates a robust foundation for supporting aging and addressing health disparities. This paper presents the results of a project conducted with older adults (50+ years), advocates, and other stakeholders in Anchorage using Concept Mapping (CM) methodology, a technique not often used in the gerontology literature. CM is a mixed-method, participatory approach that uses brainstorming and unstructured card-sorting combined with multivariate statistics (multi-dimensional scaling, hierarchical cluster analysis) to create a data-driven visual representation of thoughts or ideas of a community. CM is well suited to integrating perspectives from multiple points of view. Participants were prompted to address the research question: how do we think about aging in Anchorage & what are the barriers and facilitators to aging well? Results indicate services for seniors should include culturally responsive health programming, low-cost opportunities for social engagement, inclusion of older adults with intellectual/developmental disabilities, transportation considerations, navigators to locate services in Anchorage, and more. CM allowed the researchers to identify how residents view healthy aging in this urban subarctic location and brainstorm practical solutions with stakeholders and local policy-makers. This presentation will also share lessons-learned regarding the use of this participatory approach with older adults.

Industry-based issues in the provision of hearing aids in Italy

Despite the availability of free hearing tests and aids provided by qualified community-based professionals specialising in audiology services, hearing aid adoption remains low in Italy. This article investigates the reasons why hearing aids have a low acceptance level in Italy. Interviews with different hearing health professionals were conducted along with an analysis of the regulations and documentation governing the provision of publicly funded hearing aids. A combined service management and hearing-health literature review was then carried out and analysis performed. Interviews were then conducted with other hearing health professionals to confirm our analysis and findings. We contend that industry operational issues related to the structure, culture and public financing of the Italian audiology industry adversely impact on consumer service experiences. Based on this finding we propose a conceptual framework and offer four theory building propositions that we have identified as related to this highly regulated service industry.

Home pressures: failures of care and pressure ulcer problems in the community – the findings of serious case reviews

Purpose Local serious case reviews (SCRs) (now Safeguarding Adults Reviews (SARs)) may be held in England when a vulnerable adult dies or is harmed or at risk of being so, and local agencies may not have responded to the abuse or neglect. The purpose of this paper is to present findings from a documentary analysis of these reviews to ascertain what recommendations are made about pressure ulcer prevention and treatment at home, setting these in the context of safeguarding, and assessing what lessons may be learned by considering them as a group. This analysis is presented at a time of increased interest of the risks of pressure ulcers among frail and very ill populations; and debates about the interface of neglect and safeguarding systems. Design/methodology/approach Identification of SCRs from England where the person who died or who was harmed had been suffering from pressure ulcers or their synonyms in their home; termed home acquired pressure ulcers. Narrative and textual analysis of documents summarising the reports was undertaken to explore the reviews’ observations and recommendations. The main circumstances, recommendations and common themes were identified. Findings The authors located 18 relevant SCRs, one of which was a case summary and two SARs covering pressure ulcers that had been acquired or worsened when the individual was living at home. Most of these inquired into the individual’s circumstances, their acceptance of care and support, the actions of others in their family or professionals, and the events leading up to the death or harm. Failures to have followed guidance were noted among professionals, and problems within wider health and care systems were identified. Recommendations include calls for greater training on pressure ulcers for home care workers, but also greater risk communication and better adherence to clinical guidelines. A small number focus on neglect by family members, others on self-neglect, including some vulnerable adults’ lack of capacity to care for themselves or to access help. In some SCRs the presence of a pressure ulcer is only mentioned circumstantially. Research limitations/implications The value of this documentary analysis is that it draws on case examples and scrutiny at local level. Future research could consider the related findings of SARs as they emerge, similar documents from the rest of the UK, and international perspectives Practical implications This analysis highlights the multitude of complex social and health situations that gives rise to pressure ulcers among people living at home. Several SCRs observe problems in the wider communications with and between health and care providers. Nonetheless poor care quality and negligence are reported in some SCRs. Cases of self-neglect give rise to challenging practice situations. While practices and policies about poor quality care and safeguarding in the form of prevention of wilful neglect are emerging, they often relate to hospital and care home settings. Preventing and treating pressure ulcers may be part of safeguarding in its broadest sense but raises the question of whether training, expertise and support on this subject or wider self-neglect and neglect by others are sufficiently robust for home care workers and community-based professionals. Originality/value The value of having a set of SCRs is that they lend themselves to analysis and comparison. This analysis is the first to focus on home acquired pressure ulcers and to address wider considerations related to safeguarding policy and practice. Pressure ulcers feature in several SCRs either as contextual information about the vulnerable adults’ health-status or as indications of poor care. The potential value of examining home acquired pressure ulcers as a key line of enquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what is optimal care and treatment. In the new Care Act 2014 context, they may still feature in safeguarding inquiries as symptoms of failings in systems or of personal culpability for poor care. Learning from them may be of interest to other parts of the UK.

Alcohol screening and brief interventions for adults and young people in health and community-based settings: a qualitative systematic literature review

BackgroundSystematic reviews of alcohol screening and brief interventions (ASBI) highlight the challenges of implementation in healthcare and community-based settings. Fewer reviews have explored this through examination of qualitative literature and fewer still focus on interventions with younger people.MethodsThis review aims to examine qualitative literature on the facilitators and barriers to implementation of ASBI both for adults and young people in healthcare and community-based settings. Searches using electronic data bases (Medline on Ovid SP, PsychInfo, CINAHL, Web of Science, and EMBASE), Google Scholar and citation searching were conducted, before analysis.ResultsFrom a total of 239 papers searched and screened, 15 were included in the final review; these were selected based on richness of content and relevance to the review question. Implementation of ASBI is facilitated by increasing knowledge and skills with ongoing follow-up support, and clarity of the intervention. Barriers to implementation include attitudes towards alcohol use, lack of structural and organisational support, unclear role definition as to responsibility in addressing alcohol use, fears of damaging professional/ patient relationships, and competition with other pressing healthcare needs.ConclusionsThere remain significant barriers to implementation of ASBI among health and community-based professionals. Improving the way health service institutions respond to and co-ordinate alcohol services, including who is most appropriate to address alcohol use, would assist in better implementation of ASBI. Finally, a dearth of qualitative studies looking at alcohol intervention and implementation among young people was noted and suggests a need for further qualitative research.