Models Of Good Practice Research Articles

LGBTQ PROGRAMMING AT SENIOR CENTERS IN MASSACHUSETTS

LGBTQ seniors have some different needs for programs and services, are at a higher risk of social isolation, and are often underserved in the community. Senior centers serve as a hub of resources in a community and are purposefully situated to address the needs and interests of all seniors in a community; they are a natural outlet for targeted programming for LGBTQ seniors. The purpose of this project is to demonstrate what municipal senior centers across Massachusetts are doing to meet the needs of their LGBTQ seniors. A total of 24 senior centers were identified by the Massachusetts Association of Councils on Aging (MCOA) as providing LGBTQ programming. Semi-structured interviews were conducted with 14 senior center directors or programming staff from different communities across Massachusetts to learn more about their specific programming. For almost all senior centers in this study, the main LGBTQ-specific programming was a congregate meal with an activity. Activities included both recreational activities like a film-screening and educational engagements such as guest speakers or specialists on housing, legal services, and health promotion. Distinguishing characteristics included whether or not programming had an intergenerational component, type of recruitment methods, and geographic clustering of programs. For example, two regions emerged as having shared activities for LGBTQ seniors. Results from this study will be used to illustrate models of best practice when it comes to LGBTQ programming for older people.

Deliberative Law-Making: A Case Study of the Process of Enacting of a \u2018Constitution of the Third Sector\u2019 in the Polish Sejm

The main objective of the paper is to present a model of the good practices of deliberative cooperation in a parliamentary setting. This goal is achieved through applying the three functions of the deliberative system—epistemic, ethical and democratic (Mansbridge et al. 2012)—to an analysis of cooperation between different stakeholders during the work of a Polish Parliamentary Subcommittee. They are used as an evaluative tool for analysing the cooperation of MPs, members of the public and representatives of the government (promoters of the bill). The paper analyses a concrete example of the work of the Permanent Subcommittee on the government bill amending the Act on Public Benefit Activity and Voluntary Work in the Polish Parliament. This concrete example is presented as a model of good practices when it comes to deliberative cooperation between representatives of the authorities and citizens aiming at the development of shared practical judgement. The paper consists of three parts. In the first, a systemic approach to deliberative democracy is briefly introduced, and the history of the work on the bill is outlined. The main part consists of an analysis of the three speeches of three main stakeholders in the legislative process, from the perspective of their view of legislative deliberations, and in terms of the three functions of deliberative system. In the conclusions, four main issues are analysed with reference to the presented legislative deliberations: 1. Legislative committees as mixed deliberative spheres; 2. Internal/external deliberation; 3. The distinction between stakeholders/ordinary citizens; and 4. Deliberative stance/deliberative mindset.

Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology.

Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a model of good practice for CRTs, via one-day fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate fidelity and the rest as low fidelity, with no team achieving high fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess model fidelity in CRTs. There is a need for development and testing of interventions to enhance model fidelity and facilitate improvements to these services.

196 A Structured Literature Review of Diagnostic Processes and Pathways for People Living with Younger Onset Dementia

Abstract Background Currently, 1 in 10 people diagnosed with dementia in Ireland are aged under 65, this is termed “Younger Onset Dementia” (YOD). Though small in numbers these figures (4000 people) are increasing, and important differences exist between people diagnosed with (PwYOD) and those diagnosed with later onset dementia (LOD). As dementia is normally associated with advancing age, clinicians are not always on the alert for its diagnosis in younger people. Diagnosing YOD can be especially challenging since presentation may be atypical and there is a lack of clinical ownership in this area. Methods A structured literature review was conducted to identify optimum models of diagnostic processes and pathways for PwYOD. Two research questions were addressed: (i) what models for the diagnosis of PwYOD exist nationally and internationally, and what evidence supports these and (ii) what are the differences between diagnostic processes and pathways for PwYOD compared with PwLOD. A systematic search strategy was devised to identify all relevant scientific papers. Key databases were used, supplemented by grey literature searches. A narrative synthesis approach was undertaken to assess the literature identified. Results Pathways and processes to the diagnosis of YOD are unclear and complex and compared with LOD, diagnosis takes more time. PwYOD are more likely to have multiple referrals to different specialists, have their memory and cognitive complaints misattributed to other factors such as depression and experience longer delays in obtaining a diagnosis. Conclusion Few evidence-based best-practice models or guidelines for the diagnosis of YOD exist internationally. Increased awareness of the signs and symptoms of YOD among all healthcare professionals is necessary. There is a need for improved linkages to be developed between Geriatric Medicine, Neurology, Psychiatry, and Primary Care services and in certain instances for suspected cases of YOD to be referred to neurology-led memory clinics.

Self-neglect and safeguarding adult reviews: towards a model of understanding facilitators and barriers to best practice

PurposeThe purpose of this paper is twofold: first, to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis; second, to draw together the learning available from this data set of reviews to propose a model of good practice that can be used as the basis for subsequent SARs.Design/methodology/approachFurther published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains employed previously. A sufficient number of reviews have been performed from which to construct an evidence-based model of good practice. A framework is presented with the proposition that this can be used as a proportional methodology for further SARs where self-neglect is in focus.FindingsFamiliar findings emerge from the thematic analysis. This level of analysis, constructed over time and across reviews, enables a framework to be developed that pulls together the findings into a model of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners involved in such cases. This framework can then be used as an evidence-based model with which to review new cases where SARs are commissioned.Research limitations/implicationsThe national database of reviews commissioned by SABs is incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless enables conclusions to be proposed about the components of effective practice, and effective policy and organisational arrangements for practice. Future reviews can then explore what enables such effective to be achieved and what barriers obstruct the realisation of effective practice.Practical implicationsAnswering the question “why” is a significant challenge for SARs. A framework is presented here, drawn from research on SARs featuring self-neglect, that enables those involved in reviews to explore the enablers and barriers with respect to an evidence-based model of effective practice. The framework introduces explicitly research and review evidence into the review process.Originality/valueThe paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also proposes a new approach to SARs by using the findings and recommendations systematically within a framework designed to answer “why” questions – what promotes and what obstructs effective practice.

Working with Deafblind people to develop a good practice approach

Summary There is growing recognition of the importance in social research and social policy development of engaging with people with lived experience and using intervention approaches characterised by co-design and co-production. However, the inclusion of some minority groups such as those who are Deafblind has proven challenging. Working from the perspective of Appreciative Inquiry, a qualitative research methodology called The World Café was used to generate patterns of insight and collective discoveries from Deafblind participants. Data from The Deafblind World Café were analysed using inductive thematic analysis. Findings Four themes were produced that could inform the development of a good practice model for engaging with people who are Deafblind: Being Deafblind – it’s who we are, not what we are; we welcome co-production with outsiders who are prepared to make the effort to become insiders; being culturally inclusive is about both what you say and what you do; and listen to our story – don’t try to count it. Applications Group-based and interactive approaches, such as World Café, though challenging, can be successfully adapted for those who are Deafblind. How this might be up-scaled is yet to be explored.

End of life care for people with alcohol and drug problems: Findings from a Rapid Evidence Assessment.

People who use alcohol and other drugs(hereafter "substances") and who are over the age of 40 are now more likely to die of a non-drug related cause than people who use substances under the age of 40. This population will therefore potentially need greater access to palliative and end of life care services. Initially, the purpose of this rapid evidence assessment (REA), conducted August 2016-August 2017, was to explore the peer-reviewed evidence base in relation to end of life care for people with problematic substance use. The following databases were searched using date parameters of 1 January 2004-1 August 2016: Amed, Psycharticles, Ovid, Ageinfo, Medline, Ebscohost, ASSIA, Social Care Online, Web of Knowledge, Web of Science, SSCI, Samsha, NIAAA. Data were extracted using a predefined protocol incorporating inclusion and exclusion criteria. Given the dearth of evidence emerging on interventions and practice responses to problematic substance use, the inclusion criteria were broadened to include any peer-reviewed literature focussing on substance use specifically and end of life care. There were 60 papers that met the inclusion criteria. These were quality assessed. Using a textual thematic approach to categorise findings, papers fell into three broad groups (a) pain management, (b) homeless and marginalised groups, and (c) alcohol-related papers. In general, this small and diverse literature lacked depth and quality. The papers suggest there are challenges for health and social care professionals in meeting the end of life needs of people who use substances. Addressing issues like safe prescribing for pain management becomes more challenging in the presence of substance use and requires flexible service provision from both alcohol/drug services and end of life care providers. Work is needed to develop models of good practice in working with co-existing substance use and end of life conditions as well as prevalence studies to provide a wider context for policy development.

All aboard or still at check-in? Teacher educators’ use of digital technologies: Lessons from a small island

Teachers are increasingly integrating ICT into formal education (McKnight et al. Journal of Research on Technology in Education, 48(3), 194–211, 2016), helping to incorporate technologies in learning and teaching. However, an important expectation relating to ICT integration is that Initial Teacher Educators model their own practice as well as developing digital skills and competencies in pre-service teachers (Haydn 2010; Gudmundsdottir and Hatlevik European Journal of Teacher Education, 41(2), 214–231, 2018). To test these expectations, this paper reports on a convergent mixed methods study that consisted of twelve interviews with Initial Teacher Educators as well as a series of questionnaires that were distributed to four teacher education providers in Ireland and four in Northern Ireland. Findings suggest that, while there are certainly pockets of excellence and some individual models of good practice, it is evident that there is a limited coherent integration of ICT within and across Initial Teacher Education providers, despite efforts to achieve this.

Getting Addiction Into the Nursing Education "Water Supply": A U.K. Case Study.

Evidence remains fundamentally unchanged over the last 30 years that nurses are not sufficiently prepared during their undergraduate education to work with alcohol and other drug (AOD) use. Employing a mixed-methods longitudinal panel design, our study objectives were to (a) explore perceptions among entry level nursing students regarding AOD work and (b) explore whether current alcohol and drug education efforts impact on the perception of AOD by nursing students over time. Two hundred forty-two students were recruited (94% response rate). Most (86%) of the study participants identified AOD training as relevant/extremely relevant to their future practice. After exposure to AOD sessions in the nursing curriculum, there was no significant change to participants' score on either alcohol or drug role security between T1 and T2/T3. However, there was a statistically significant improvement in alcohol therapeutic commitment between T1 and T2/T3 (F(2, 136) = 5.87, p < .01), but not between T2 and T3; conversely, drug therapeutic commitment was significantly higher at T2 but signficantly lower at T3 (F(2, 149) = 254.19, p < .0001). There was no significant difference in alcohol or drug role security between the three nurse training pathways. However, alcohol and drug therapeutic commitment scores at T1 were significantly higher in students taking the mental health field/track (F(2, 160) = 9.45, p < .001, and F(2, 236) = 15.23, p < .0001). Although the positive message is that students recognize the importance of the topic to their future practice, concerns remain regarding the impact and efforts of readiness for practice. Over a 3-year training period, no significant gains were made in increasing students' knowledge and skills, and their training experiences in clinical practice appear to have a negative effect on "therapeutic commitment" influenced by exposure/contact to patients with drug use disorders specifically and less than positive mentoring experiences with qualified nursing staff. How to address these issues is explored including the need to perhaps shift the focus of attention from "negative attitudes" held by students to exploring the barriers and obstacles in upskilling nursing faculty and clinical mentors so that they feel able and willing to teach and be a role model of good practice in this area.

Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review.

The number of people presenting to EDs with mental health problems is increasing. To enhance and promote the delivery of safe and efficient healthcare to this group, there is a need to identify evidence-based, best-practice models of care. This scoping review aims to identify and evaluate current research on interventions commenced or delivered in the ED for people presenting with a mental health problem. A systematic search of eight databases using search terms including emergency department, mental health, psyc* and interventions, with additional reference chaining, was undertaken. For included studies, level of evidence was assessed using the NHMRC research guidelines and existing knowledge was synthesised to map key concepts and identify current research gaps. A total of 277 papers met the inclusion criteria. These were grouped thematically into seven domains based on primary intervention type: pharmacological (n = 43), psychological/behavioural (n = 25), triage/assessment/screening (n = 28), educational/informational (n = 12), case management (n = 28), referral/follow up (n = 36) and mixed interventions (n = 105). There was large heterogeneity observed as to the level of evidence within each intervention group. The interventions varied widely from pharmacological to behavioural. Interventions were focused on either staff, patient or institutional process domains. Few interventions focused on multiple domains (n = 64) and/or included the patient's family (n = 1). The effectiveness of interventions varied. There is considerable, yet disconnected, evidence around ED interventions to support people with mental health problems. A lack of integrated, multifaceted, person-centred interventions is an important barrier to providing effective care for this vulnerable population who present to the ED.

Virtual Laboratories for Biodiversity Modelling: An Australian perspective

Recent technologies have enabled consistent and continuous collection of ecological data at high resolutions across large spatial scales. The challenge remains, however, to bring these data together and expose them to methods and tools to analyse the interaction between biodiversity and the environment. These challenges are mostly associated with the accessibility, visibility and interoperability of data, and the technical computation needed to interpret the data. Australia has invested in digital research infrastructures through the National Collaborative Research Infrastructure Strategy (NCRIS). Here we present two platforms that provide easy access to global biodiversity, climate and environmental datasets integrated with a suite of analytical tools and linked to high-performance cloud computing infrastructure. The Biodiversity and Climate Change Virtual Laboratory (BCCVL) is a point-and-click online platform for modelling species responses to environmental conditions, which provides an easy introduction into the scientific concepts of models without the need for the user to understand the underlying code. For ecologists who write their own modelling scripts, we have developed ecocloud: a new online environment that provides access to data connected with command-line analysis tools like RStudio and Jupyter Notebooks as well as a virtual desktop environment using Australia’s national cloud computing infrastructure. ecocloud is built through collaborations among key facilities within the ecosciences domain, establishing a collective long-term vision of creating an ecosystem of infrastructure that provides the capability to enable reliable prediction of future environmental outcomes. Underpinning these tools is an innovative training program, ecoEd, which provides cohesive training and skill development to enhance the translation of Australia’s digital research infrastructures to the ecoscience community by educating and upskilling the next generation of environmental scientists and managers. Both of these platforms are built using a best-practice microservice model that allows for complete flexibility, scalability and stability in a cloud environment. Both the BCCVL and ecocloud are open-source developments and provide opportunities for interoperability with other platforms (e.g. Atlas of Living Austalia). In Australia, the same technical infrastructure is also used for a platform for the humanities and social science domain, indicating that the underlying technologies are not domain specific. We therefore welcome collaborations with other organisations to further develop these platforms for the wider bio- and ecoinformatics community. This presentation will showcase the tools, services, and underpinning infrastructure alongside our training and engagement framework as an exemplar in building platforms for next generation biodiversity science.

Corporate sustainability accounting information systems: a contingency-based approach

Purpose This paper aims to explore the development of sustainability accounting information systems through lens of contingency theory. In this digital age when companies are confronted with massive sets of data, integration of financial and non-financial data, little empirical evidence exists on how sustainability issues are integrated or linked within internal corporate information systems. Design/methodology/approach A questionnaire-based survey, hypothesis testing, principal component methods and hierarchical clustering are used to provide original empirical evidence from major Lithuanian companies. Findings The main findings reveal that most companies surveyed include a sustainability strategy in their core strategy, but there is a lack of linkage with measuring and integrating sustainability outcomes within the entirety of corporate financial results. Unexpectedly, the association between stakeholders' involvement and sustainability accounting information system design was not as strong as hypothesized theoretically. Therefore, it deserves further investigation, constituting an important implication for future research. Specifically, three profiles of sustainability accounting information systems were explained, namely, integrated, fragmented and compliance systems. Research limitations/implications The limitations of this study relate to the small sample size, as sustainability-related information is still regarded quite confidential. Practical implications This result could serve as a specific reference for companies to apply integrated sustainability accounting information systems that might serve as a good practice model for companies, however, fragmented and compliance profiles are the prevailing ones. Social implications The findings are important for fostering corporate social responsibility by developing sustainability accounting information systems. Originality/value This paper contributes to the sustainability accounting and information systems literature by providing empirical evidence linking contingent factors with the development of sustainability accounting information systems.

Development of a Fetal Surgery Program to Improve Neonatal Outcomes

In 2017, our pediatric hospital developed a fetal surgery program offering in utero procedures to repair complex congenital anomalies. The service provides comprehensive care for the maternal-fetal dyad, in one location. Fetal surgery allows for treatment of specific fetal conditions that were once considered life threatening or only treatable after birth. Emerging evidence demonstrates that treatment of certain fetal conditions increases a baby’s chances of survival and improved health. Leadership and frontline staff collaborated with specialists and surgeons to develop guidelines and protocols in the implementation of this program. Our hospital was one of the first pediatric facilities in the United States to offer inpatient obstetric care for women who experience complex fetal diagnoses. An interprofessional response to fetal complications was well established within the center. The provision of fetal surgery options was a continuance of the center’s approach of comprehensive care for the maternal-fetal dyad. Extensive program development included the following: addition of a fetal surgeon; creation of nurse coordinator roles to provide support, education, and comprehensive follow-up care for patients; exhaustive literature reviews; development of process flow diagrams to delineate roles and responsibilities; and didactic and operative skills training for staff, including simulations, mandatory preprocedure huddles, and formalized procedure debriefing. Our team has now successfully performed more than 90 fetal surgeries, such as open fetal myelomeningocele (fMMC) repair, open fetal teratoma resection, fetoscopic laser treatment for twin-to-twin complications, and complex ex utero intrapartum treatment procedures. The center has completed 14 open fMMC repairs, with early outcomes data demonstrating a 15% postbirth shunt placement rate. These are encouraging data compared with the MOMS trial, which indicated a 40% shunt placement rate in those with prenatal repair and an 82% shunt placement rate with postnatal repair. For our center, the average gestational age at the time of repair was 25.4 weeks and the average gestational age at birth was 35.2 weeks. Program development challenges included logistics planning, resource allocation, and staff trepidation. Challenges were overcome through teamwork, research, and an unflagging focus on evidence-based, best-practice models. Inclusion of frontline nursing staff was critical to the success of this innovative program.

Best practices in implementing inpatient pediatric asthma pathways: a qualitative study

Objective: Clinical pathways (operational versions of practice guidelines) can improve guideline adherence and quality of care for children hospitalized with asthma. However, there is limited guidance on how to implement pathways successfully. Our objective was to identify potential best practices in pathway implementation.Methods: In a previous observational study, we identified higher and lower performing children’s hospitals based on hospital-level changes in asthma patient length of stay after implementation of a pathway. In this qualitative study, we conducted semi-structured interviews with a purposive sample of healthcare providers involved in pathway implementation at these hospitals. We used constant comparative methods to develop a conceptual model of potential best practices in implementation.Results: Healthcare providers (n = 24) from 6 higher performing and 2 lower performing hospitals were interviewed about pathway implementation. We identified several practices that addressed barriers and promoted successful pathway implementation: (1) utilizing quality improvement (QI) methodology and a data-driven approach helped overcome inertia of current practice; (2) getting teams to commit to shared goals around asthma care helped overcome disagreements in the implementation process; (3) integrating pathways into the electronic medical record decreased some burdens of implementation; (4) leveraging multidisciplinary teams by developing protocols for nurses and/or respiratory therapists to titrate medications reduced variability in provider practice; and (5) engaging hospital leaders with pathway implementation teams helped secure crucial resources.Conclusions: We identified several potential best practices to support pathway implementation. Hospitals implementing pathways should consider applying these strategies to better ensure success in improving quality of asthma care for children.

CHARACTERISTICS OF HUMAN RESOURCES MANAGEMENT MODEL IN PUBLIC ADMINISTRATION OF REPUBLIC OF SERBIA: CONTEMPORARY TRENDS AND CHALLENGES

Human resources management in the public administration of the Republic of Serbia is a combined model of good practices from the European administrative area and the remaining stereotypes from pre-transition period. Introduction of the public servant system with all features of contemporary public servant related legislation was a necessity that accompanied overall reform of the public administration in Serbia. The process of introducing human resources management function in the Serbian public administration has been encumbered with application of two different legal models that define the status of public servants: public servant related legislation is applied to employees in executive branches of the central government (ministries, government departments and offices), and the status of employees in city and municipal administrations is stipulated in obsolete laws, adopted over 20 years ago. It should be noted that employees in public sector are still prone to old habits in their work, which altogether reduces successful reforms in this area. This paper provides a description of the current state of affairs and opens certain questions: whether the modern human resources (HR) management in Serbia’s public sector is understood and accepted in the right way; and whether it is possible, by means of applying specific methods, to strengthen awareness of public employees concerning their actual position and responsibility to establish a new public administration, adjusted to the citizens’ needs, requirements and expectations. Relying on a decade-long personal engagement in this field, the author analyzes the current circumstances and provides critical remarks and recommendations.

Improving performance of a pharmacy in a Romanian hospital through implementation of an internal management control system

According to general principles of good practice, adopted at the international level, quality control is a key function in management and not just a simple means of verification. In a clinic or hospital pharmacy, the chief pharmacist has the training and authority to take the control measures necessary to develop and implement an Internal Managerial Control System (IMCS). The present article analyzes and describes the case of the County Hospital of Oradea, Romania, and presents how the IMCS was adopted and integrated. Quality assessment in the health services takes place via an accreditation process and quality certification, as well as through an internal audit of the hospital pharmacy. The authors report a retrospective and descriptive study carried out from 2012 to 2017, analyzing how current legislative standards are applied. The IMCS in the hospital pharmacy is a dynamic process of continuous transformation, permanently adapted to hospital requirements, achieved under the direction of the chief pharmacist and involving all pharmacy employees, as well as through good coordination practices applied by hospital management. In this specific case, the IMCS features 11 annually updated compliance standards, classed under the headings of work procedures, risk register, job descriptions and staff training. The pharmacy's good practice model for IMCS development, was adopted by all of the hospital's sectors, services and departments.

Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs

Background Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high. Aims The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a model of best practice for CRTs, develop a measure to assess adherence to this model and evaluate service improvement resources to help CRTs implement the model with high fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support. Methods Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT model fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up. Results Workstream 1 – a 39-item CRT fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in model fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes. Limitations Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements. Conclusions The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT model fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care. Study registration The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048. Funding The National Institute for Health Research Programme Grants for Applied Research programme.

Policy-making for the diffusion of social innovations: the case of the Barnahus model in the Nordic region and the broader European context

The Barnahus model was launched in Iceland in 1998, and it subsequently spread to all the Nordic countries. It is an interagency, co-located model for working with cases of violence and abuse against children that addresses two vital concerns of welfare societies: to process cases through the legal system and to offer support and treatment to victims. The model is currently recommended as a best-practice model on the European level – and understood as representing a radical change in the organisational setup related to such cases. This paper analyses the diffusion and implementation of the model in two different contexts: the Nordic region and the wider European arena, where the model is currently promoted as an important innovation. Drawing on the concept of social innovation, we explore the structural and contextual conditions for the diffusion of the model and discuss its role in the ongoing transformation of welfare societies’ response to children exposed to violence and abuse. We identify the policy-making means by which the model is promoted today and conclude that it can lead to manifold institutional changes, both radical and incremental, and both desired and undesired, depending on how the original idea is translated and adapted in different contexts.

The Ealing Intensive Therapeutic and Short Breaks Service: an update five years on

PurposeThe purpose of this paper is to present an update on the Ealing Intensive Therapeutic and Short Breaks Service (ITSBS).Design/methodology/approachThe challenges the service has faced are reviewed, including the service’s response to those challenges. Also provided is a more detailed analysis of the outcomes of the service.FindingsThe ITSBS continues to succeed in supporting young people with intellectual disabilities and challenging behaviour to stay at home with their families.Originality/valueDespite considerable challenges and adaptations to the model, the ITSBS is still achieving successful outcomes for vulnerable young people and is considered nationally to be a best-practice model. Few prior articles have provided an account of how innovative service models are maintained and evolve over time.

Tackling Irregularities in Sport through Education on Whistleblowing

Recent years have brought to the attention of sport specialists new challenges in education, aiming to defend ethics and integrity in sport. Doping, match fixing and corrupted sport governance represent ongoing threats to the integrity, good reputation, and societal welfare dimension of sport. At the same time, from the athletes’ perspective, abuse, sexual harassment, bullying, violence and psychological pressure are other types of threats to the ethics in all sport domains. Different educational approaches that aim to achieve a culture of ethics and integrity in sport have been designed and implemented. Recently, whistleblowing has been promoted as a useful means in the fight against corruption in sport. This trend called for more educational efforts designed to encourage the participation of those involved in the sport phenomenon (i.e. athletes, coaches, managers, spectators) in whistleblowing in order to prevent the violation of ethics.The paper is an analysis of the usefulness of an educational material on whistleblowing implemented in Romania. In order to promote models of good practice, information is directly related to the educational rationale through an explanation of not only what knowledge and skills can be expected to be gained, but also what professional capabilities will be achieved. The conclusions of the paper emphasize the need to develop and test new education and training methodologies, promoting whistleblowing in sport, which will be adapted to the needs of the target sport population aiming to induce positive beliefs and behaviours about whistleblowing.