Implications For Service Development Research Articles

Friends, peers and safeguarding

Friends, peers and safeguarding

A Review and Analysis of the Experiences of Adverse Childhood Experiences and Trauma of Service Users in a Substance Use Service in South Wales

Background and aims: There is an established link between experiences of adverse childhood experiences (ACEs) and substance use difficulties. This paper aims to further explore the complex relationship between childhood adversity, trauma and substance use. Method: This paper audited the number and nature of adverse childhood experiences and experiences of trauma reported by a sample of 25 individuals under a specialist substance use service in South Wales, in order to build on the current research on ACEs and substance use. The incidence of the ACEs and trauma in relation to the commencement of the substance use is also audited. Results: The findings show high levels of reported ACEs and severely traumatic experiences within the sample, consistent with existing research. Nineteen service users had reported experiencing childhood trauma and the sample had a mean number of 2.76 reported ACEs. The majority of service users had experienced trauma and ACEs prior to the commencement of their substance use, supporting the self-medication explanation of the cooccurrence between substance use with trauma and adversity. Conclusions: The findings have implications for service development in relation to promoting trauma informed services and meeting the psychological needs of those who have experienced trauma and use substances.

Exploring Family Planning Perspectives Among Men Receiving Medications for Opioid Use Disorder: Implications for Service Development.

Studies have consistently found high rates of unintended pregnancy among women with substance use disorder. While research efforts have begun to focus on understanding needs and providing family planning services for women in treatment, few studies have included men. This has resulted in a gap in the literature regarding men's reproductive health experiences and family planning desires. Between December 2019 and February 2020, we conducted semistructured qualitative interviews with adult men receiving medications for opioid use disorder at a safety-net healthcare system in Denver, Colorado. Interviews were recorded and analyzed using the Rapid Assessment Process. Fifteen men participated in an interview. Overall, men described feeling excluded from family planning education and services as well as from decision making with their partners. Participants desired knowledge and resources related to contraceptive methods, partner communication, and parenting. Additional themes included loss of autonomy around pregnancy decisions, the importance of fatherhood, and the importance of addressing family planning during recovery. Participants expressed interest in a family planning intervention but indicated that engaging men on this topic may be challenging. Our findings suggest that men in treatment desire education and involvement in family planning. Participants endorsed access to a subject expert within the treatment environment, but engagement strategies that underscore topic relevance to men will be critical. Initiating a conversation involving education and service navigation in the treatment setting may be a promising strategy for engaging men in recovery in family planning and improving men's access to needed services and resources.

Understanding context: A qualitative analysis of the roles of family caregivers of people living with cancer in Vietnam and the implications for service development in low-income settings.

Research on the needs of family caregivers of people living with cancer remains disproportionately focused in high income contexts. This research gap adds to the critical challenge on global equitable delivery of cancer care. This study describes the roles of family caregivers of people living with cancer in Vietnam and possible implications for intervention development. Semi-structured interviews and focus groups with family caregivers (n=20) and health care providers (n=22) were conducted in two national oncology hospitals. Findings were verified via workshops with carers (n=11) and health care professionals (n=28) in five oncology hospitals representing different regions of Vietnam. Data was analyzed collaboratively by an international team of researchers according to thematic analysis. Family caregivers in Vietnam provide an integral role in the delivery of inpatient cancer care. In the hospital environment families are responsible for multiple roles including feeding, hydration, changing, washing, moving, wound care and security of personal belongings. Central to this role is primary decision making in terms of treatment and end-of-life care; relaying information, providing nutritional, emotional and financial support. Families are forced to manage severe complications and health care needs with minimal health literacy and limited health care professional input. Understanding context and the unique roles of family caregivers of people living with cancer is critical in the development of supportive services. As psycho-oncology develops in low and middle income contexts, it is essential that family caregiver roles are of significant importance.

The characteristics of homicide perpetrators in a medium secure forensic hospital: A study from dundrum hospital

IntroductionThe majority of homicides in society are not associated with mental illness, however there is an established association between homicide and schizophrenia. Homicide perpetrated by mentally disordered offenders is a leading reason for admission to secure forensic psychiatric hospitals.ObjectivesTo investigate the clinical characteristics of those with a history of completed homicide in the CMH Dundrum.MethodsThis study was a cross sectional study of a cohort of patients in the Central Mental Hospital who had completed homicide (n=63).ResultsA total of 136 patients were included, 46.3% (n=63) of whom had committed homicide. Mean age of homicide perpetrators at admission was 34.6 years old (median 33.4, s.d. = 9.72). The most common diagnosis was schizophrenia (n=40, 63.5%). 73.0% (n=46) had a history of substance misuse. 36.5% (n=23) had a diagnosis of a personality disorder, including traits only. The most common victim type was a family member (n=32, 50.8%). Patients with a history of homicide had better scores on dynamic risk of violence (F=8.553, p=0.004), programme completion (F=8.258, p=0.005) and recovery (F=3.666, p=0.058) compared to non-homicide offenders, however they also had significantly longer mean length of stay, 12.7 years v 7.5 years (F=9.634,p=0.002).ConclusionsHomicide perpetrators with a mental illness constitute a significant portion of the forensic mental health population and a high number of these offences were against family members. A history of homicide among forensic in-patients is associated with a longer length of stay which has implications for service development into the future.

The Offender Personality Disorder Pathway: An exploration of the differences between offenders accessing a prison pathway service and a non-accessing population

ABSTRACT As the Offender Personality Disorder (OPD) pathway continues to expand in Her Majesty’s Prison and Probation Service, the diversity and characteristics of offender populations accessing the pathway becomes an important area of study. This was the first controlled study to investigate the risk, personality, readiness to change and reflective functioning abilities of offenders accessing a range of OPD prison services and make comparisons with offenders from the wider non-OPD-accessing prison population. A total of 105 males participated. OPD-accessing groups included; a Progression Psychologically Informed Planned Environment (PIPE), a Provision PIPE and an OPD Outreach Service (OPD-OS). The study found significant differences between risk, personality pathology, difficulties maintaining change and reflective functioning abilities of offenders accessing the OPD services when compared to the wider prison population. The OPD-OS service caseload emerged as a particularly high risk and needs group. Further implications for service development and future directions are considered.

Patterns of psychiatric morbidity among children and adolescents presenting to an outpatient child and adolescent mental health service (CAMHS) in a Teaching Hospital in Colombo, Sri Lanka-Challenges and implications for service development.

Patterns of psychiatric morbidity among children and adolescents presenting to an outpatient child and adolescent mental health service (CAMHS) in a Teaching Hospital in Colombo, Sri Lanka-Challenges and implications for service development.

Forty years of referrals and outcomes to a UK Child Development Centre (CDC): Has demand plateaued?

To explore 40years of Child Development Centre (CDC) activity and outcomes at Northampton General Hospital 1974-2014. The study comprises 3 data sets: a published report from 1974 to 1999, an internal audit from 2001 to 2004, and more recent data collected from 2005 to 2014. The medical notes of all children who were assessed by the CDC in 2014 were reviewed, along with referral data collected by the CDC manager from this year and the preceding 10years. From January 1, 1974 to December 31, 2014, 3,786 children were assessed. The male to female ratio is 2.8:1 from 2005 to 2014. Referrals for behavioural difficulties increased from 10% (10/100 referrals) in 1999-2004 to 17.8% (18/101 referrals) in 2014. Similarly, referrals for social and communication problems, "interaction" increased two and a half fold from 10% (10/100 referrals) in 1999-2004 to 26.7% (27/101 referrals) in 2014. Between 2004 and 2014, numbers of referrals for "developmental delay" halved (22.2% to 12%). We are aware of no other comparable extant UK CDC database. Services should plan for a referral rate of 6.5 per 1,000 preschool children. Between 1974 and 2014, there has clearly been a change in recorded assessment outcomes. From the mid-1980s, this reflects the change to a preschool assessment role and a shift away from purely educational outcome to include medical conditions. Covering 1974-2014, we demonstrate a clear increase in the number of referrals together with an increasing demand for assessments for social interaction and behavioural difficulties. This reflects the increased awareness of these neurodevelopmental difficulties and the changing diagnostic criteria which will now more likely result in an Autistic Spectrum Disorder diagnosis than previously. Together, these two features are most likely to have considerable implications for service development within Child Development Centres (CDCs) and Child Development Teams (CDTs).

"They just said inappropriate contact." What do service users hear when staff talk about sex and relationships?

Research into how people with intellectual disabilities (ID) pursue intimate relationships in care settings presents some contradictory findings; despite increasingly liberal staff views, service users experience significant restrictions. This study attempts to explore this gap within a secure hospital, examining service user's representations of staff discourses about sexuality and intimate relationships. Semi-structured interviews with eight service users with intellectual disability were analysed using critical discourse analysis. Analysis enabled construction of 11 themes falling into three categories. Dominant discourses appeared to maintain the integrity of the institution, enable staff to occupy a position of power and demonstrate service users' responses to perceived control. Discourses around sex appear to serve the interests of staff and the hospital, while being restrictive and often incomprehensible to service users. Implications for service development, and future research directions, are considered in the context of "Transforming Care."

A qualitative study of patient and professional perspectives of healthcare services for multiple sclerosis: implications for service development and policy.

Multiple sclerosis (MS) is a chronic degenerative condition, with heterogeneous symptoms, and an unpredictable prognosis. Previous literature suggests patients' experiences of healthcare are unsatisfactory. Primary care may play a key role in the management of people with MS (PwMS); however, provision of services for PwMS has received little focus in the primary care literature. This study aimed to explore perspectives and experiences of PwMS and healthcare professionals of UK healthcare services for MS. Semi-structured interviews were conducted with 24 PwMS, 13 Practice Nurses, 12 General Practitioners and 9 MS Specialist Nurses in northern England, between October 2012 and April 2014. Participants were purposively selected. Data were analysed thematically using constant comparative analysis. The theoretical framework of candidacy was used to interrogate data, with themes mapping onto the National Institute for Health and Care Excellence (NICE) guideline for MS. How PwMS interpreted symptoms as leading to candidacy for care dictated help-seeking. PwMS required additional support in identifying symptoms due to MS. Participants reported poor experiences of care including poor access to services, poor continuity of care and poor interpersonal interactions with perceptions of limited person-centredness. PwMS and professionals identified that MS-related disability and progression of symptoms required responsive care. Relational continuity enabled PwMS to feel understood, and professionals to holistically appraise symptoms and progression. In conclusion, continuity and patient-centredness of care are central to positive healthcare experiences for PwMS and professionals. Services need to be more accessible to ensure responsive and effective MS management. This study provides unique findings on the role of primary care for PwMS, and the relationship between findings and MS NICE guideline recommendations with implications for service delivery in the community.

P139 Screening for child exploitation in online sexual health services: An exploratory study of expert views

<h3>Background/introduction</h3> Sexual health services routinely screen for child sexual exploitation. Although, sexual health services are increasingly provided online there has been no research on translation of the safeguarding function to online services. We studied expert views on safeguarding in this context. <h3>Aim(s)/objectives</h3> To explore expert views on safeguarding within online sexual health services and their implications for service development. <h3>Methods</h3> We conducted semi-structured interviews with local, regional and national experts purposively sampled to represent a wide range of organisations that have direct influence over CSE protocols, child protection policies and sexual health services. Interviews were analysed by three researchers using a matrix based analytic method. <h3>Results</h3> Our respondents described two different approaches to safeguarding. The ‘information providing’ approach considers that young people, at risk of CSE, will ask for help, when they are ready from someone they trust. The primary function of the service is to provide information, generate trust and respond reliably to disclosure. The approach values online services as an anonymous space to test out disclosure without commitment. The ‘information gathering’ approach considers that young people may withhold information about exploitation. Services should therefore seek out information to assess risk and initiate disclosure. This approach values face-to-face opportunities for individualised questioning and immediate referral. <h3>Discussion/conclusion</h3> The ‘information providing’ approach is associated with confidential telephone support lines and the ‘information gathering’ approach with clinical services. The approach adopted online will depend on ethos and the range of services provided. Effective transition from online to clinic services after disclosure is an essential element of this process and further research is needed to understand and support this transition.

Hospital volume status is related to technical failure and all-cause mortality following ERCP for benign disease.

Population-based data on hospital procedure volume and outcome of endoscopic retrograde cholangiopancreatography (ERCP) are limited. To investigate procedural failure, early re-admission, and all-cause mortality following ERCP performed due to benign disease and to examine their relation to hospital procedure volume. All patients with a first ERCP in 2005-2008 in Sweden were identified from the Swedish Hospital Discharge Registry. Data on indication, admission method, length of stay (LOS), and comorbid illness were extracted. Patients were linked to the Swedish Death and Cancer Registries. Factors associated with failed index ERCP, early re-admission, and all-cause mortality were identified by multiple logistic analyses. Overall, 12,695 first ERCPs for benign disease were analyzed. The 30-day re-admission rate was 13 % and all-cause 30-day mortality 2.2 %. Failed index ERCP was more common in low-volume than high-volume institutions (p = 0.007). In logistic regression analysis, low hospital procedure volume was an independent predictor of failed index ERCP (odds ratio (OR) 2.72 vs. high), but not 30-day re-admission (p > 0.05). LOS was longer in cases of procedural failure (p < 0.001). All-cause 30-day mortality was independently related to low hospital ERCP volume (OR 1.41 vs. high) and failed ERCP (OR 5.65 vs. successful). In this population-based cohort of first ERCPs due to benign disease, lower hospital ERCP volume was related to failed ERCP, which, in turn, was associated with longer LOS. Failed ERCP and lower hospital procedure volume were associated with poor survival, but not with early re-admission following index ERCP. These findings may have implications for service development.

'It's made all of us bond since that course…' - a qualitative study of service users' experiences of a CBT anger management group intervention.

People with intellectual disabilities (ID) are rarely asked about their experiences as users of psychological services and little is known about the views of clients with ID who have undergone cognitive behavioural therapy (CBT). This study aimed to gather the views of adults with ID who had recently taken part in a cluster randomised control trial (RCT) of a staff-delivered manualised CBT anger management group intervention. A qualitative method, Interpretative Phenomenological Analysis (IPA), was employed and eleven participants were interviewed. The interviews took place after the intervention, within two weeks of the end of the group, to gain an understanding of service users' experiences of participating in a CBT group. IPA of the interview transcripts indicated that the intervention was experienced as effective and enjoyable and a number of themes were identified including: 'the importance of relationships', 'a new me', 'new and improved relationships', 'presenting myself in a positive light' and 'what the group didn't change'. The results will be discussed in the context of applying group CBT for adults with ID and implications for service development.

Service user views of acceptability of different therapy locations

Service users were surveyed on satisfaction with different therapy sites, expectations about sites and suggestions for possible alternative locations. The findings indicate actions that services can take to promote satisfaction with therapy locations, and implications for service development.

Plural provision of primary medical care in England, 2002–2012

Health care reforms often include provider diversification, including privatization, to increase competition and thereby health care quality and efficiency. Donabedian's organizational theory implies that the consequences will vary according to the providers' ownership. The aim was to examine how far that theory applies to changes in English NHS primary medical care (general practice) since 1998, and the consequences for patterns of service provision. Framework analysis whose categories and structure reflected Donabedian's theory and its implications, populated with data from a systematic review, administrative sources and press rapportage. Two patterns of provider diversification occurred: 'native' diversification among existing providers and plural provision as providers with different types of ownership were introduced. Native diversification occurred through: extensive recruitment of salaried GPs; extending the range of services provided by general practices; introducing limited liability partnerships; establishing GPs with special clinical interests; and introducing a wider range of services for GPs to refer to. All of these had little apparent effect on competition between general practices. Plural provision involved: increased primary care provision by corporations; introducing GP-owned firms; establishing social enterprises (initially mostly out-of-hours cooperatives); and Primary Care Trusts taking over general practices. Plural provision was on a smaller scale than native diversification and appeared to go into reverse in 2011. Although the available data confirm the implications of Donabedian's theory, there are exceptions. Native diversification and plural provision policies differ in their implications for service development.

Nursing and health‐care assistant experience of supervision in a medium secure psychiatric service for women: implications for service development

In secure psychiatric services where the potential for 'burnout' by nurses is high, clinical supervision is viewed as a key to reflective practice to support staff in stressful working environments. Barriers to the uptake of clinical supervision in such service settings are personal and organizational. The study was prompted by the need to evaluate the effectiveness of supervision for registered nurses and health-care assistants (HCAs) and a desire to use survey findings to improve the quality and uptake of supervision. The study examined the perceived benefits, the best practice elements and the practical aspects of clinical supervision including how to improve practice. An approximate uptake of clinical supervision by 50% of staff confirmed previous findings; that HCAs were significantly less likely to engage in supervision and less likely to perceive benefit from it. Initiatives to address the training and managerial obstacles to the provision of formal supervision are described.

Cocaine-Related Health Emergencies in Europe: A Review of Sources of Information, Trends and Implications for Service Development

Background: Cocaine-related health consequences are difficult to observe. Data on drug users in health-emergency settings may be a useful source of information on consequences that are not visible via other information sources. Methods: Thirty European countries submit an annual national report on the drug situation to the EMCDDA. All reports for the period 2007–2010 were analyzed, with particular attention given to auditing cocaine-related mentions. Analysis was also performed in order to identify sources and case definitions, assess coverage, audit cases and, where possible, to identify long-term trends. Results: Considerable heterogeneity existed between countries in their approach to recording drug-related emergencies, with only Spain and the Netherlands having established formal indicators. The highest annual numbers of cocaine-related episodes were reported by the UK (3,502), Spain (2,845) and the Netherlands (1,211). A considerable (2- to 3-fold) increase in the numbers of cocaine-related episodes has been reported since the end of the 1990s in these countries; these increases peaked in Spain and England around 2007/08. Conclusions: The analysis reported here suggests the need to develop more standardized approaches to monitoring drug-related emergencies. It points to the potential value of developing effective referral links between the emergency and specialized drug services working with cocaine users.

Promoting Personalization in Social Care Services for Older People

This article presents findings on 4 themes associated with the personalization of social care for older people: integration of health and social care services; initiatives that prevent the need for more costly interventions; services to maintain people at home; and systems that promote choice, control, and flexibility. The quantitative study utilized data from a national postal survey conducted in England. Findings suggest variable progress regarding the range and style of support available to older people. These are discussed in the context of service integration, community-based services, and consumer-directed care. Implications for service development and future research are highlighted.

Making use of historical case material: the problems of looking back and the implications for service development in relation to research and evaluation activities

This methodological paper details the process of embarking on a follow-up study of young people with sexual behaviour problems who were known to services in the 1990s and who are now young adults in their 20s or early 30s. In the context of the importance of such follow-up work, the overall aim and objectives of the funded research project are specified and the challenges presented in setting up research partnerships with service sites, including the negotiation of access and ethical approval, are the subject of overview and reflection. The practicalities of beginning the fieldwork which comprised an initial analysis of historical case material held in the research sites are then detailed and the solutions to the problems encountered are explained. The paper concludes by identifying the kinds of questions services and researchers need to consider when wanting to engender or enhance a research culture which is facilitative of this kind of outcome research. These relate to the resources necessary to support a research culture, the requirements of data protection and ethical approval processes, obtaining service user consent to participate in future research, secure but accessible storage of records, staff development and researchers’ obligations to minimise disruption to already hard-pressed services.

Ethnic variations in the caregiver role: A qualitative study

The present study aimed to establish an in-depth qualitative analysis of the convergence and divergence of the experiences of caregivers from four ethnic groups. Eight Bangladeshi, nine Indian, four Pakistani and nine White-British caregivers participated in five focus groups. Differences and similarities between motivations for role adoption, willingness to care, experience of role, adaptation to role, coping, use of and satisfaction with support were discussed. Key differences were found in adaptation to care role and use of social support. The article highlights the need for further study of the ethnic minority caregiver experience and has implications for service development.