Neighbourhood Teams Research Articles

From policy to practice: Insights from 15 Dutch integrated neighbourhood teams.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

More that unites us than divides us? A qualitative study of integration of community health and social care services

BackgroundThe integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation.MethodsTwenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis.ResultsWe describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building.ConclusionsGiven the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and inter-professional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.

The clinical and cost-effectiveness of a Victim Improvement Package (VIP) for the reduction of chronic symptoms of depression or anxiety in older victims of common crime (the VIP trial): study protocol for a randomised controlled trial

BackgroundOlder people are vulnerable to sustained high levels of psychosocial distress following a crime. A cognitive behavioural therapy (CBT)-informed psychological therapy, the Victim Improvement Package (VIP) may aid recovery. The VIP trial aims to test the clinical and cost-effectiveness of the VIP for alleviating depressive and anxiety symptoms in older victims of crime.Methods/designPeople aged 65 years or more who report being a victim of crime will be screened by Metropolitan Police Service Safer Neighbourhood Teams within a month of the crime for distress using the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2. Those who screen positive will be signposted to their GP for assistance, and re-screened at 3 months. Participants who screen positive for depression and/or anxiety at re-screening are randomised to a CBT informed VIP added to treatment as usual (TAU) compared to TAU alone. The intervention consists of 10 individual 1-h sessions, delivered weekly by therapists from the mental health charity Mind.The primary outcome measure is the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI), used as a composite measure, assessed at 6 months after the crime (post therapy) with a 9-month post-crime follow-up. Secondary outcome measures include the EQ-5D, and a modified Client Service Receipt Inventory. A total of 226 participants will be randomised VIP:TAU with a ratio 1:1, in order to detect a standardised difference of at least 0.5 between groups, using a mixed-effects linear-regression model with 90% power and a 5% significance level (adjusting for therapist clustering and potential drop-out).A cost-effectiveness analysis will incorporate intervention costs to compare overall health care costs and quality of life years between treatment arms. An embedded study will examine the impact of past trauma and engagement in safety behaviours and distress on the main outcomes.DiscussionThis trial should provide data on the clinical and cost-effectiveness of a CBT-informed psychological therapy for older victims of crime with anxiety and/or depressive symptoms and should demonstrate a model of integrated cross-agency working. Our findings should provide evidence for policy-makers, commissioners and clinicians responding to the needs of older victims of crime.Trial registrationInternational Standard Randomised Controlled Trials Number, ID: ISRCTN16929670. Registered on 3 August 2016.

Development and delivery of a clinical leadership programme for integrated community teams.

Neighbourhood teams were formed throughout Worcestershire in early 2018, which led to a change in staff roles and responsibilities, as these are multidisciplinary community teams. It became apparent during the transition that many of the staff in band 6 roles required additional support and education to enable them to develop their knowledge and skills. Therefore, a clinical leadership programme was developed specifically for these staff. The programme followed the principles of the NHS Leadership Framework and consisted of six full-day training sessions. During the programme, staff identified issues within their team and developed a plan to address these issues over the following 6-12 months. The next two cohorts of the programme included staff from out-of-hours community nursing teams. The feedback from all delegates and managers was overwhelmingly positive, and delegates continue to implement their plans.

Social Workers in a Modernising Welfare State: Professionals or Street-Level Bureaucrats?

AbstractSocial workers are often depicted as street-level bureaucrats (SLBs) or professionals interchangeably. However, to find out how social workers relate to new policy measures, a clear distinction between SLBs and professionals is helpful. Ideal–typical SLBs subscribe to new policies although they may diverge from them in practice, to accommodate clients. Ideal–typical professionals weigh new policies against their ethical code. If the new policy goes against their professional principles, they protest on behalf of their clients. In this article, we study Dutch social workers who have to implement a new policy that (i) obliges their clients to actively participate in society and (ii) obliges them to rely on family and friends when they need help. The data for this article are derived from two projects: interviews with twenty-nine experienced social workers and interviews with social workers in neighbourhood teams and observations of their interactions with clients in six municipalities. We found that Dutch social workers think as professionals: they weigh the new policy against their ethical code and have serious doubts about the second part of the new policy. Hence, they find ways to avoid implementation. However, they behave as SLBs, bending the rules in practice. They rarely confront policymakers or higher management.

Frailty: an in-depth qualitative study exploring the views of community care staff

BackgroundFrailty is seen across various health and social care settings. However, little is known about how healthcare professionals, particularly those who provide care for older adults living in the community view frailty. There is also a dearth of information about the extent to which a shared understanding of frailty exists across the various disciplines of care. Such an understanding is crucial across care professionals as it ensures consistent assessment of frailty and facilitates interdisciplinary working/collaboration which is a key component in the management of frailty. This study aimed to explore: (i) how community care staff from various specialties viewed frailty; (ii) whether they had a shared understanding; and (iii) how they assessed frailty in everyday practice.MethodsSemi-structured interviews were conducted with a purposive sample of 22 community care staff from seven specialties, namely: healthcare assistants, therapy assistants, psychiatric nurses, general nurses, occupational therapists, physiotherapists and social workers, recruited from four neighbourhood teams across Cambridgeshire, England. Interviews were analysed thematically.ResultsThere was a shared narrative among participants that frailty is an umbrella term that encompasses interacting physical, mental health and psychological, social, environmental, and economic factors. However, various specialities emphasised the role of specific facets of the frailty umbrella. The assessment and management of frailty was said to require a holistic approach facilitated by interdisciplinary working. Participants voiced a need for interdisciplinary training on frailty, and frailty tools that facilitate peer-learning, a shared understanding of frailty, and consistent assessment of frailty within and across specialities.ConclusionsThese findings underscore the need to: (i) move beyond biomedical descriptions of frailty; (ii) further explore the interacting nature of the various components of the frailty umbrella, particularly the role of modifiable factors such as psychological and socioeconomic resilience; (iii) care for frail older adults using holistic, interdisciplinary approaches; and (iv) promote interdisciplinary training around frailty and frailty tools to facilitate a shared understanding and consistent assessment of frailty within and across specialities.

Neighbourhood Care Development in Inverness, Highland, Scotland

Introduction: NHS Highland is responsible for the delivery of all adult health and social care services in this area with the Highland Council responsible for the delivery of children’s services under a Lead Agency model developed as part of health and social care integration in 2012. Whilst integration had brought together adult health and social care services into a single organisation the real benefit was not realised in Inverness due to the comparatively large size of the teams this created. There was an extended length of stay in hospital and waiting lists for assessment and commencement of care packages. Description of practice change: From 2 large district teams 7 community neighbourhood teams were formed with a single referral route to each team. The teams are responsible for all aspects of caseload management with decision making supported by multi-professional huddles. Work in progress to support the teams includes the introduction of an electronic record MORSE, the inclusion of independent care at home providers in huddles, community asset building with Inverness Community Planning Partnership, coaching development for managers and the development of team performance and governance information. Aim and Theory of change: The change is based on the principles of the Buurtzorg model of neighbourhood care in the following ways, Autonomous team decision making and caseload management Neighbourhood teams with a community asset approach to delivering and sustaining care. Coaching enabling team function and efficiency. The aim is to prevent unnecessary admission to hospital and care homes, prevent delay in hospital, provide palliative, preventative and rehabilitative treatment for the neighbourhood population through the effective use of combined team and community resources. We aim to improve staff and patient experience by increasing face to face time between staff and patients and reducing bureaucracy and duplication. Targeted populations and stakeholders: All adults requiring health or social care support in Inverness. Stakeholders are community team members, managers, GPs, independent sector care providers, acute and community hospitals in Inverness. Timeline: The model has been developing since 2016 with further supporting changes planned over the next year. Highlights: Builds on the foundations laid by the formation of the Lead Agency model which has not required cross organisational boundary work so restructure has been quick to effect. Comment on sustainability: The model requires organisational and community planning support to be sustainable. Comment on Transferability: Readily transferable to other integrated teams with effective cross-organisational working. Conclusion: These are early days but the smaller teams have embraced the change with a real sense of responsibility for supporting their local communities. Metrics are in place to measure the impact which will be reported on in due course. Discussions: What level of autonomy is desirable and possible in NHS organisations? Challenges for social care inspection and registration bodies. Lessons learned: Large teams lead to silo working. Clearer focus on meeting outcomes requires not just multidisciplinary but joint multi-agency and community engagement in its widest sense to be successful.

System wide self care

Introduction: Greater Manchester despite having a vibrant economy, has a higher than average prevalence of long term conditions, the impact being that people require support from health care services at a much younger age and for much greater periods of time1 . In 2016, a £6 billion health and social care budget was devolved to the region, with the ambition of radically improving the health outcomes, through the upscaling of prevention, early intervention, and self-care services. Devolution aims to facilitate happier, healthier and more prosperous communities. Supported by a sustainable health and social care economy1 Description of policy: To meet this ambition locally, the newly formed integrated care organisation developed a system wide self-care policy. The policy promotes working harmoniously with local communities to: tackle inequalities caused by the social determinants of health, change relationships between care providers and the wider population, and encourages the adoption of positive health behaviours. Ultimately, the policy facilitates a transformational shift from mainly treating ill health to proactively preventing and managing health and wellbeing3. This required fostering a ‘social model of health’ that combines a deep understanding of what matters to people, with excellent clinical care, timely data, and strong, sustained social support2. The policy was co-produced with a range of partners, including the voluntary/community sector. Asset based approaches to health care delivery are also key to the approach and the whole programme is under pinned by a workforce development programme across all sectors of the integrated organisation. Targeted population: System wide self-care is a population wide approach, with a focus on improving the health of the most vulnerable within our community, frail elderly, children and young people, mental health care and people with complex co-morbidity. Highlights (innovation, Impact and outcomes) Development of a collaborative approach across the health and social care economy Launch of social prescribing within first neighbourhood Commissioning of a third sector social prescribing team Commissioning of a comprehensive asset based community development programme Completion of workforce training pilot GP engagement Section as part of the GM transformation fund Comments on transferability: The policy provides a framework for a whole system. Providing guidance and vision alongside practical application of a wide range of interventions, which, can be tailored to local need. Early evaluation has demonstrated that local neighbourhood teams are able match the interventions to need of their population. Conclusions: The innovation within this policy is that it draws together several tried and tested self-care approaches within a framework that can be applied across whole health and social care economies. Acknowledging that current health and health social issues rarely require a single silo solutions.

Towards sustainable local welfare systems: The effects of functional heterogeneity and team autonomy on team processes in Dutch neighbourhood teams.

Nowadays, many European countries delegate health and social care responsibilities from the national level to local authorities. In January 2015, the Netherlands similarly introduced a policy programme authorising municipalities to set their own social welfare policy. A specific feature of this programme is that it stimulates municipalities to implement teams wherein professionals from different disciplines are collectively responsible for a team's decision‐making. This suggests that teams ideally have (a) high levels of functional heterogeneity (professionals from different disciplines) and (b) high levels of team autonomy (collective responsibility and decision‐making). Based on the policy programme, it can be further assumed that (a) information elaboration, (b) boundary management and (c) team cohesion in teams will improve. In practice, the majority (87%) of Dutch municipalities implemented neighbourhood teams in January 2015. A common feature of these neighbourhood teams is that the various professionals are collectively responsible for all the curative and preventive healthcare, social work and voluntary social support of the citizens in a specific neighbourhood. Nevertheless, the structure and organisation of neighbourhood teams (including the level of functional heterogeneity and team autonomy) vary within and between municipalities. Given this situation, our aim was to examine to what extent functional heterogeneity and team autonomy influence information elaboration, boundary management and team cohesion in neighbourhood teams. We developed six hypotheses based on literature that were then tested on data collected (between May 2016 and January 2017) through an online survey from 1335 professionals in 170 neighbourhood teams. An SEM analysis showed a positive effect of team autonomy on information elaboration, boundary management and team cohesion. Results further showed a negative effect of functional heterogeneity on information elaboration and boundary management. The implications of these findings for practitioners and academics are discussed.

How to… deliver integrated care to frail elderly? A SELFIE research on the barriers and facilitators in the Netherlands

Background : Frail elderly often have multiple health problems that span the physical, psychological, and cognitive domains. This makes frail elderly depend on care and support services. Simultaneously, frail elderly in the Netherlands are being stimulated to live at home independently as long as possible. Frail elderly are often supported by several care providers, like informal caregivers, GPs, practice nurses, district nurses, neighbourhood teams, social workers, physical therapists, elderly care physicians, home care nurses for domestic help, and medical specialists (e.g., geriatricians). It is important that the care provision of frail elderly is integrated and that providers collaborate, in order to tackle the risk of fragmentation. As a response, different care programmes have arisen that provide integrated care for frail elderly. Aim : In the EU Horizon2020-funded project SELFIE, promising integrated care programmes in Europe were selected to evaluate. One of these programmes is the Care Chain Frail Elderly (CCFE) – an integrated care approach for frail elderly. The qualitative thick description of the programme sheds light on what the CCFE approach is, how it is being implemented in daily practice, and how different stakeholders reflect on the approach, so that future interventions can benefit from the barriers and facilitators of this programme. Methods : The information necessary for a qualitative description of CCFE was gathered through document analyses as well as qualitative interviews with 11 stakeholders (e.g. professionals, frail elderly and informal caregiver, insurance employees) from July through September 2016. The results were structured according to the six elements of the SELFIE conceptual framework for integrated care for multi-morbidity: service delivery, leadership and governance, workforce, technologies and medical products, information and research/monitoring and financing). Results : The CCFE is a proactive nurse-led intervention providing case management, care coordination, and multidisciplinary care team meetings to the frailest elderly. They use case finding for identification of frail elderly persons, relying strongly on the professional’s ability and less-so on standardised screening algorithms or questionnaires, as some other programmes in the field do. Furthermore, this programme is unique in that it actively involves the frail elderly and informal caregiver in the multidisciplinary team meetings. To cover the costs of the programme, an innovative payment scheme was piloted, namely a bundled payment for frail elderly care that covers all primary care costs irrespective of diagnosis. Barriers in delivering the programme pertain to the sustainability of financing and the challenges in collaboration between health- and social care. These findings will be elaborated on during the presentation. Conclusion : The CCFE is an intensive care programme for the frailest elderly living at home. Convincing results on the (cost-) effectiveness of this programme are needed to ensure sustainable financing. Accordingly, the insights gained in this qualitative study form the basis for setting up an empirical evaluation of the CCFE in the context of further SELFIE research.

An Asset Based Approach to Health Care and Wider Public Sector Reform in the Wigan Borough

Introduction: The Wigan Borough’s system wide approach is based on the fastest and greatest improvement in the health of the population of the Borough. The way services are delivered to citizens are being reformed to include improved access, standardisation to best practice, technology deployment, integrated approaches to care, shifts to community and primary care orientated service delivery.Description: Wigan Borough has developed integrated care based on populations’ assets and is actively engaging communities to develop a place based model of care. Within this we have developed programmes on life cohorts of start well, live well and age well. These life cohorts are working across both formal and informal provider partnerships to implement new models of care.Core set of principles:- An asset based approach that recognises and builds on the strengths of individuals, families and our communities.- A new relationship between public services and citizens that enables shared decision making, genuine co-production and joint delivery of services. Do with, not to.- Integrated services that place families and communities at the heart.- An engaged workforce with core behaviours and values; be positive, be courageous and be accountable.- Confident communities where everyone does their bit.- Use of new technology to support residents to be independent and in control, enabling them to able to access services and support digitally.- An evidence based understanding of risk and impact to target services effectively and ensure that right intervention at the right time.- Building self-reliance and independence resulting in behaviour change and reduced demand for services.Key areas of service change to date are:- Across the Borough sixteen clusters of Integrated Neighbourhood Teams (INT) were put in place. These teams provide full population coverage for multi-disciplinary case management.- Complex dependence key workers for people of working age with chaotic lifestyles.- Identification of very early frail patients using risk stratification and electronic frailty scores.- Community link workers connecting patients much earlier in pathways into their local community and the assets within it.- Alongside and other public sector agencies such as Greater Manchester Police and North West Ambulance Service, we are ensuring all frequent attendees to all emergency services have an individual case management plan and a key worker assigned.The asset based approach has also been extensively tested in different settings using a Perfect Week methodology– in a GP practice (Boston House), in a primary school (St Georges), in a secondary school (Rosebridge), and in a whole place (Platt Bridge). Suspending local organisational rules, connecting professionals, generating greater understanding of local communities, and having new conversations focused in individual interest and capabilities and not needs, has had a profound impact on the way public services come together.Aim and theory change: The aim of this work was to find innovative ways to improve services for the whole population of Wigan Borough. Teams across the borough are using the asset based approach, placing emphasis on the wider determinants of health as much as traditional health and social care delivery.Targeted population and stakeholders: Targeted population is system wide and all partners’ whether statuary voluntary or private sector engaged to benefit the whole population.Timeline: This project commenced in April 2013 with the establishment of Integrated Neighbourhood Teams but is now becoming embedded practice across the Wigan Borough.Conclusions: The Clinical Commissioning Group and Council in Wigan, working with partners, believe this approach is genuinely transformational – it constitutes a paradigm shift in the way public services are delivered. We together believe this is true for older adults, for adults of working age, and for children.The Integrated Neighbourhood Teams are an essential anchor for our integrated place-based working and play a major role in the delivery of the Wigan Borough Locality plan linking local delivery into the Greater Manchester Devolution plan.The Clinical Commissioning Group and Council in Wigan are expanding their joint approach to investment and commissioning in the voluntary and third sector community to create the capacity to respond to the positive opportunities created for residentsCase Study evidence suggest the asset based approach is significantly improving outcomes and reducing demand for health and formal packages of social care.

URBAN FOOTBALL PERFORMANCES: PLAYING FOR THE NEIGHBOURHOOD IN SENEGAL, 1950s–2000s

ABSTRACTIn Senegal, neighbourhood football teams are more popular than teams in the national football league. The so-callednavétanesteams were first created in the 1950s. Since the early 1970s, they have competed in local, regional and national neighbourhood championships. This article considers the history of these clubs and their championships by focusing on the city of Dakar and its fast-growing suburbs, Pikine and Guédiawaye. Research on thenavétanesallows an exploration of the social and cultural history of the neighbourhoods from the actor-centred perspective of urban youth. The history of thenavétanesreflects the complex interrelations between young people, the city and the state. The performative act of football – on and beyond the pitch, by players, fans and organizers – constitutes the neighbourhood as a social space in a context where the state fails to provide sufficient infrastructure and is often contested. Thenavétanesclubs and championships demonstrate how young people have experienced and imagined their neighbourhoods in different local-level ways, while at the same time interconnecting them with other social spaces, such as the ‘city’, the ‘nation’ and ‘the world’.

Generating and Using Community Intelligence: The Case of Neighbourhood Policing

This paper examines the role that community-generated information plays in ‘neighbourhood policing’ — a key component of the UK police reform agenda. The neighbourhood policing agenda is concerned with the delivery of a consistent presence of dedicated neighbourhood teams which should be visible and accessible to the community. However, it also calls for the generation of community intelligence which should be used for local problem-solving and should be incorporated into National Intelligence Model (NIM) tasking. At the time of writing the principle of incorporating information generated from the public into policing intelligence and priority setting thus has strong resonance, at least at the level of rhetoric of policy and practice. It is contended that difficult questions are posed in thinking through what it means to consult with the ‘public’, the nature of community generated information and how it is translated into operational decisions and resource deployment. This paper explores the conceptual foundations of neighbourhood policing — which are found in reassurance policing, problem-oriented policing and the National Intelligence Model. It then examines the current mechanisms for generating community information, prioritising problems, and delivering responses as they are applied in neighbourhood policing. It finishes with a critical discussion of the concept and practice of generating and using community information for setting local policing priorities.

Community, continuity and commitment in a local Saturday football league in England

The local amateur grassroots level of English football is a neglected area of sociological research. This paper begins to address this lacuna by presenting aspects of a detailed case study of the Scunthorpe and District Football League from 1921 to 2007. Multiple data sources and multiple methods are employed. Access to the original minute books of the league is combined with material from league handbooks and local newspapers. Also, interviews were conducted with current leading officials of the league and a questionnaire was sent to longstanding current club secretaries. Throughout its existence, the league has reflected the local community in its catchment area. For most of its history, the league has been dominated by village teams, with workplace and neighbourhood teams from the town also prominent. A strong sense of continuity is evident in local football. Where a club left the league for financial or other reasons, in many cases a new club was formed within a year or two to represent the same community. League officials, referees and club secretaries all exhibit a high level of commitment, without which the league could not operate. Football in Scunthorpe reflects the national trend of decline in Saturday grassroots football, with a concomitant increase in Sunday football.

A social simulation-game to explore future co-ordination in knowledge networks at the Amsterdam Police Force

The 32 autonomous neighbourhood teams of the Amsterdam Police Force need to utilise each other's knowledge and expertise to deal with the variety and complexity of their daily work assignments. However, despite the creation of organisation wide knowledge networks, communication, co-ordination and knowledge sharing between the neighbourhood teams is disappointing. We conducted an action research to investigate how co-ordination in the knowledge networks could be improved with the help of information and communication technologies (ICTs). This article reflects on the choice of co-ordination perspectives and modelling techniques. The above problem is conceptualised and made operational in different ways in research on network co-ordination, knowledge co-ordination and co-ordination of distributed work. The article demonstrates how our initial focus on capturing quantitative measures of the co-ordination problem in a computer simulation was problematic in this case. Instead a social simulation-game that focused on the qualitative issues of this co-ordination problem was developed and played. We conclude that the choice of theoretical perspectives and modelling techniques strongly affected the results of both phases of our action research. Furthermore the article argues that more attention to qualitative issues in co-ordination is required to better understand the impact of ICT-support on co-ordination.

Involving the community in crime and disorder reduction

In what will be a regular column examining key issues facing community safety practitioners, Sarah Morton from Matrix Research and Consultancy discusses community involvement in crime and disorder reduction.Everyone appears to agree that increased community involvement is important because it can help to reassure members of the public as well as increase intelligence information gained from them. A variety of approaches for community engagement are discussed including the roll out of safer neighbourhood teams, which are felt to offer an opportunity to increase community empowerment further.

Progress in community policing

This article examines the development of community-based policing in the United States and the Netherlands. These two countries were selected because the United States has been the forerunner of research into the police and one of the first countries to attempt to introduce on a wide-scale, and conduct research into community policing. In the Netherlands, the Major Cities Policy, a governmental approach to addressing the cities' problems provided an interesting basis for comparison. Policy or operational changes in the police organization are generally influenced by the political climate and or scientific research. Both of these factors played a major role in the US. This section begins with a brief historical view of the factors which brought about changes within American policing, ultimately resulting in a new concept of community policing. This is followed by developments which led to community policing or the concept of the 'neighbourhood teams' (wijkbureaus) in the Netherlands.

A study of the attitudes of nurses to parental involvement in the initial child‐protection conference, and their preparation for it

Fifty-four nurses and 205 other professionals provided data on their attitudes to the involvement of parents in initial child-protection conferences in a northern English city, and on the preparation and training they had received for it. Data were collected before the local authority involved parents and again 1 year later, after parents had been invited to the conferences in four neighbourhood teams. This paper describes the attitudes and training of the nurse respondents at the two points in time, before the authority involved parents and after, and the degree and nature of the training they received in preparation. Overall, attitudes became more favourable over time. There were, however, some abiding concerns; for example, that discussion might be inhibited, and the interests of the child become less central. There were also differences in attitude by agency which reflected an agency orientation and its commitment to the child-protection task. Social workers were initially the most positive and their attitudes the least likely to change. Teachers and police began with the most negative attitudes, but their attitudes changed the most. The nurse professionals occupied the middle ground. There were also differences by agency and over time in the amount of training and preparation received. Nurses were the most likely to be offered training and teachers the least. Inter-agency training, including input from experienced practitioners, was valued.

The Other Italian Experiment: Neighbourhood Social Work in the Health and Social Services

Following recent legislation, most social workers in Italy are now responsible for giving a service to the population of a given geographical area rather than to any particular category of client. The findings suggest that there is some experimentation with regard to the organisation and composition of neighbourhood teams and that the trend, not without problems, is towards social workers becoming the ‘gatekeepers’ to financial and other resources in the Social Service Sector for the local population.