Service User Experience Research Articles

An Innovative Workshop Embedding Pathology Service Users into the Undergraduate Biomedical Science Curriculum.

The integration of pathology service users into the biomedical science curriculum has been driven by the refinement of the Health and Care Professions Council (HCPC) Standards of Proficiency. This study aimed to design and implement a novel and innovative service user event with a reflective assessment to enhance students' knowledge and understanding of the impact of pathology laboratory results on the patient pathway. The 4-h workshop consisted of a series of service users. Patients discussed how pathology services had contributed to their diagnosis and treatment, while service providers-a Microbiology Consultant, a director of primary care, and the patient referral optimisation officer-discussed their roles and their interactions with pathology services. Post-event, students completed a 750-word reflective assessment, highlighting challenges experienced by service users and providing suggestions for improving the delivery of pathology services. In total, 57.5% of respondents (57/99) completed a post-reflection survey, which included open- and closed-ended questions. Quantitative analysis of the survey data revealed that over 87.7% of respondents had increased knowledge and understanding of the revised HCPC standards. Following the assessment, students reported a significant increase in their confidence with respect to reflective writing (p < 0.001), with over 90% of respondents agreeing that the reflective assessment had increased their knowledge and understanding of the limitations that may negatively impact service users and patient care. Moreover, respondents highlighted how advancements in point-of-care testing (POCT) and improvements in communication can improve patient experiences. Thematic analysis revealed that respondents agreed that embedding patients into the curriculum reinforced the importance of there being a patient behind every sample. Respondents reported that reflecting upon service user experiences enabled them to identify improvements to the delivery of pathology services while recognising the essential role that Biomedical Scientists play in the patient pathway. This successful workshop has created a platform encompassing a range of pathology service users in the undergraduate curriculum. We recommend that other accredited biomedical science programmes adopt and embed this innovative workshop and reflective assessment into their programmes to help them meet these standards relating to service users while fostering important transferable skills in their students.

A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care

Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps.

Recurrent miscarriage and infertility: a national service evaluation

The appropriate clinical care of women/couples with infertility experiencing recurrent miscarriage (RM) is overlooked in international guidelines. We sought to evaluate care provision for women/couples with RM and infertility across public (19 clinics providing RM care, five fertility clinics) and private sectors (nine fertility clinics) using adapted guideline-based key performance indicators (KPIs) for RM. An online survey comprised of multiple-choice/open questions was administered via Qualtrics from November 2021 to February 2022, encompassing: (i) structure of care, (ii) investigations, (iii) treatments, (iv)counselling/supportive care and (v) outcomes. Clinical leads for pregnancy loss and fertility and clinical nurse/midwife specialists within each unit/clinic were invited to participate. The response rate 73% (24/33), varied by provider: Public RM care (18/19; 95%), 2/5 public fertility (40%); private fertility (3/9; 33%). Access to fertility expertise was limited in public RM clinics (39%). While investigations and treatments provided mostly adhered to guidelines, there was uncertainty regarding immunotherapies. Educational needs identified included fertility counselling, informative and supportive care resources. Clinical outcomes were seldom audited (2/22; 9%). Greater engagement with the private sector is required to unify care across sectors and to ensure standardised evidence-based care. Audit and outcomes reporting should be mandated. Lived experience of current care structures should inform service improvements. Impact Statement What is already known on this subject? There is a paucity of research into the appropriate clinical care of women/couples with infertility experiencing recurrent miscarriage, with a resulting deficit within international RM guidelines. It is known that RM care is variable and often not in line with guidance. What do the results of this study add? This study demonstrates that while care is largely in line with clinical practice guidelines, there is variation in counselling, imaging and surgical treatments offered. Areas for education identified included fertility counselling and resources for information provision and supportive care. Clinical outcomes were seldom audited. What are the implications of these findings for clinical practice and/or further research? Fertility care must expand to ensure access for women with RM and infertility. Further research exploring barriers and facilitators to the delivery of evidence-based care for women/couples with infertility and RM is required. The lived experiences of service users must inform service improvements.

Evaluation of the home care service: a remote inpatient service for people requiring mental health care

Background/Aims In response to the COVID-19 pandemic, St Patrick's Mental Health Services introduced a home care package, offering all the elements of the inpatient programmes, but provided to the service user remotely in their own home. A survey was used to evaluate service user experiences of receiving remote inpatient mental health treatment via the home care service. Methods All participants who had a virtual admission were invited to complete a quantitative survey online. Data were inputted into the Statistical Package for Social Sciences software and a descriptive analysis was completed. Results A total of 88 participants completed the online survey, the majority of whom were women (62.5%) and between the ages of 61 and 70 years (28.4%). Diagnosis was most often depression (60.2%) or anxiety (29.4%) and almost 66% of participants had previous inpatient experience. Staff rated most highly by participants were the consultant psychiatrist (96.7%), ward-based nursing staff (95.2%) and their psychologist (92.3%). The highest rating statements, which participants rated as part of a questionnaire, were around technology options (87.1%), one-to-one work with a clinician (81.3%) and arranging collection of medicine (81%). Conclusions Preliminary scores on this survey demonstrate that remote care is an effective way to improve access, enhance quality and provide efficient care. Further research should consider clinical outcomes with this model compared to standard care.

Perspectives of service users and carers with lived experience of a diagnosis of personality disorder: A qualitative study.

INTRODUCTION: There is limited understanding of the experience of people with complex mental health (CMH) needs, including those with a diagnosis of personality disorder (PD) and carers of those individuals. Little is known about carers of those in inpatient forensic settings, yet it has been identified that they may have additional needs when compared to general carers. Research highlights that community carer support services were perceived as inadequate and out-of-area placements were described as putting an added strain on ability to support loved ones. Understanding PD within a population of people with CMH needs and how a diagnosis described as PD impacts on care and treatment experience is vital to providing high-quality care. To evaluate the care experience of service users and carers with lived experience of a diagnosis of PD and out-of-area placements. Semi-structured interviews were conducted with six service users and four carers to explore the experiences and perspectives of people with a diagnosis of PD. Interviews were audio recorded and thematically analysed. Four interrelated themes were developed; Influence of a diagnosis of PD on Staff, Early and Appropriate Intervention, Recognition of the Individual and Training and Knowledge of people with a diagnosis of PD. Anti-stigma interventions for staff, research on care provision and structural changes to services including more evidence-based therapy for individuals with a diagnosis of PD may help reduce disparate treatment and improve prognosis for recovery. This paper informs services of ways to improve care provision from the perspective of carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with diagnoses of PD should be adopted, and PD training for all healthcare practitioners to improve patient outcomes.

“The Service, I Could Not Do without It…”: A Qualitative Study Exploring the Significance of Meals on Wheels among Service Users and People Who Refer Them to the Service

Meals on Wheels (MoWs) is a social care service providing daily meals and social contact to adults who need support to live in the community. Considering the rising number of adults who need help with shopping for food and preparing meals in England, MoWs could be essential for these individuals; yet little is known about the experiences of MoWs service users and people who refer them to MoWs (“referrers”), with the service. The aim of this study was to explore different dimensions of the MoWs service from the perspectives of MoWs service users and referrers. Semistructured interviews were conducted in May–July 2022 with seven service users and 21 referrers, recruited from four MoWs providers across England, and analysed thematically. Participants indicated that benefits of the service encompassed the daily provision of a hot, nutritious meal, an informal welfare check, the service’s efficiency and reliability in promoting independent living and reducing pressures on families and carers, and the daily friendly interactions in reducing social isolation. The pandemic was not perceived to have affected participants’ experiences with MoWs but longer interactions between drivers who deliver the meals and service users would be welcomed to reduce isolation further. Despite the cost-of-living crisis and an increase in MoWs prices, participants perceived that MoWs are value-for-money due to the social care benefits derived from the service. The wide range of benefits exerted by MoWs suggests that the service should be recognised as a crucial preventative resource in maintaining the wellbeing and independence of adults with care and support needs and suggests that MoWs forms an essential part of the care package that people with care and support needs receive in England.

Mediating expectations and experiences that influence birth experiences in Canada's first Alongside Midwifery Unit.

Globally, midwifery-led birthing units are associated with excellent maternal and neonatal outcomes, and positive childbirth experiences. However, little is known about what aspects of midwife-led units contribute to favorable experiences and overall satisfaction. Our aim was to explore and describe midwifery service user experiences at Canada's first Alongside Midwifery Unit (AMU). We used a qualitative, grounded theory approach using semi-structured interviews with recipients of midwifery care at the AMU. Data were collected from twenty-eight participants between September 2018 and March 2020. Our generated theory explains how birth experiences and satisfaction were influenced by how well the AMU aligned with expectations or desired experiences related to the following four themes: (1) maintaining the midwifery model of care, (2) emphasizing control and choice, (3) facilitating interprofessional relationships, and (4) appreciating the unique AMU birthing environment. Canada's first AMU met or exceeded service-user expectations, resulting in high levels of satisfaction with their birth experience. Maintaining core elements of the midwifery model of care, promoting high levels of autonomy, and facilitating positive interprofessional interactions are crucial elements contributing to childbirth satisfaction in the AMU environment.

Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women’s experiences of healthcare on the island of Ireland

BackgroundLosing a baby during pregnancy can be a devastating experience for expectant parents. Many report dedicated, compassionate healthcare provision as a facilitator of positive mental health outcomes, however, healthcare services have been severely impacted during the COVID-19 pandemic.AimTo explore women’s experiences of healthcare service provision for miscarriage and termination of pregnancy for medical reasons (TFMR) on the island of Ireland during the COVID-19 pandemic.MethodsFindings combine data from elements of two separate studies. Study 1 used a mixed methods approach with women who experienced miscarriage and attended a hospital in Northern Ireland. Study 2 was qualitative and examined experiences of TFMR in Northern Ireland and Ireland. Data analysed for this paper includes open-ended responses from 145 women to one survey question from Study 1, and semi-structured interview data with 12 women from Study 2. Data were analysed separately using Thematic Analysis and combined for presentation in this paper.ResultsCombined analysis of results indicated three themes, (1) Lonely and anxiety-provoking experiences; (2) Waiting for inadequate healthcare; and (3) The comfort of compassionate healthcare professionals.ConclusionsWomen’s experiences of healthcare provision were negatively impacted by COVID-19, with the exclusion of their partner in hospital, and delayed services highlighted as particularly distressing. Limited in-person interactions with health professionals appeared to compound difficulties. The lived experience of service users will be helpful in developing policies, guidelines, and training that balance both the need to minimise the risk of infection spread, with the emotional, psychological, and physical needs and wishes of parents. Further research is needed to explore the long-term impact of pregnancy loss during a pandemic on both parents and health professionals delivering care.

Dementia care coordinator service in Kent and Medway: a realist evaluation protocol.

Dementia care is a key priority for both NHS England and the UK government. National guidelines highlight the importance of care coordination to address the challenges people living with dementia and their carers can encounter when trying to access the health and care system. To counter these challenges, Kent and Medway Integrated Care Board (ICB) have recently implemented a proactive dementia care coordinator (DCC) service to support people with dementia and their carers from pre-diagnosis to end-of-life care. To understand how the DCC service works (or does not work), for whom, and in what circumstances. The findings will inform service development and future investment decisions. This study will use a realist approach to evaluate the DCC service in Kent and Medway ICB, south-east England, which has a population of 1.9 million, comprising 42 primary care networks (PCNs; groups of general practices) each having a DCC. An initial programme theory will be developed from existing literature, and in collaboration with stakeholders. Mixed methods, including questionnaires to DCCs, service provider metrics, and qualitative interviews, will be used to collect data on service provider and service user experiences. Interpretive comparative analysis and narrative synthesis, including evaluation of service costs against outcomes, will produce a refined final programme theory. The results from this project will produce evidence-based recommendations to help improve service delivery and possible service expansion. This protocol describes a realist evaluation designed to investigate the recently implemented DCC service in Kent and Medway ICB.

Service user experiences of participating in a Recovery and Collaborative Care Planning Café framed with CHIME:

The Recovery and Collaborative Care Planning Café (RCCP) used World Café principles[i] to foster inquiry and learning about recovery by talking about important questions in a safe environment that allowed supportive relationships to form. Changing conversations towards recovery and living well with conditions by applying CHIME[ii] as a framework was an important part of the method. CHIME incorporates Connectedness, Hope, Identity, Meaning and Empowerment to help shape conversations. The monthly cafés began with a masterclass exploring each concept in turn and this was then followed by a World Café conversation. Through undertaking a reflective story process with four active service user participants, it became clear that these concepts resonated strongly; their feedback was that the cafe had led to growth and positive health changes and had helped them to develop supportive peer networks and increased stability. This article describes the methodology and explores the impact through service user voices.&#x0D;

Inter-Platform Consistency Inspection Method

Inter-platform consistency is a central inter-usability attribute in cross-platform service design. However, limited studies have investigated the importance of the different characteristics of inter-platform consistency for user experience (UX) of cross-platform services. A discounted, easy, fast inter-platform inspection method for cross-platform service design is still unavailable. In this paper, the authors present the results of a study on inter-platform service consistency using a new inspection method. Three UX experts evaluated three cross-platform services using predefined inter-platform consistency heuristics (perceptual, lexical, operational, and compositional). The evaluation yielded 287 inter-platform consistency findings (194 negative and 93 positive). The results indicated that all predefined consistency heuristics that represent inter-platform consistency characteristics are important and should be considered when designing the UX of cross-platform services. The evaluators assessed our inspection method and found it appropriate and effective.

A qualitative evaluation of an outdoor arts therapies group

ABSTRACT Aim To understand service user and therapist experiences of an outdoor arts therapies group, their views on its benefits and challenges. Background There is a lack of systematic research on the effectiveness of outdoor arts therapies. This article presents a systematic, qualitative evaluation of an outdoors arts therapies intervention for adults with mental health problems in the United Kingdom (UK). Methods Semi-structured interviews were held with service users and therapists providing the intervention. A thematic analysis was conducted on the interview transcripts. Results Key themes identified were: Benefits of Therapy Outdoors, Inclusive Understanding of Creativity and Engagement Challenges and Support. The outdoor setting was found to have a positive effect on group cohesion as well as on mood. Nature was experienced as an active participant in the therapy and this overlaps with an inclusive understanding of what it means to be creative. These findings broadly support the findings of the extant literature. Implications for practice/policy/future research Arts therapists should be aware of the distinct therapeutic potential of outdoors arts therapies interventions and need to be creative and flexible in adapting their practice to make it suitable to the outdoor space. Limitations This study employs only qualitative methods and lacks quantitative data. Conclusion Outdoor arts therapies can have a positive effect on participants’ mental health and wellbeing and that the natural environment plays a significant part in this. An inclusive understanding of creativity supports service users to engage creatively and therapeutically with the environment. Plain-language summary The arts therapies are generally provided in indoor settings but in recent years there has been a growth of outdoor provision. This is done in order to make use of the beneficial effects of natural environments, the experience of which becomes a source of sensory, aesthetic and psychological stimulation and thus an active element in the therapy. There is a growing literature on this type of provision but there is a lack of systematic investigation, including regarding provision for adults with mental health problems. This article reports on a qualitative evaluation of an outdoor arts therapies group for individuals with mental health problems in the UK National Health Service. The group met weekly in a carefully chosen, local green space in the outer zone of a large city. The location and the structure of sessions were designed to enable participants to safely explore personal thoughts and feelings in this public space. Interviews were conducted with service users and therapists from the group and these were then analysed to elicit themes. The theme Benefits of Therapy Outdoors included the sensory stimulation of the surroundings and how the surroundings prompted participants to look outside themselves as well as evoking positive associations. The theme Inclusive Understanding of Creativity included the use of natural materials and creative responses to the environment being about more than just art making. The theme Engagement Challenges and Support included challenges of ‘bad’ weather and anxieties about travel. The results of this evaluation broadly confirm the benefits of outdoor arts therapies as they appear in the literature. However, the data come only from people’s testimony, with no quantitative data. The authors recommend that future studies contain some quantitative data.

Pentingnya Pelayanan Informasi Berbasis Digital terhadap Pengguna Jasa Penerbangan di Bandar Udara Internasional Jenderal Ahmad Yani Semarang

This research aims to analyze the importance of digital-based information services for aviation service users at Jenderal Ahmad Yani International Airport in Semarang. The research method used is qualitative descriptive, collecting data through observations and interviews with passengers and airport staff. The results of the study indicate that passengers face difficulties in accessing information and there is a lack of personnel in the Customer Service department to serve passengers, thus requiring innovation in the form of a Virtual Customer Assistant (VICA) to facilitate passengers in obtaining desired information, as well as the addition of Customer Service personnel. Based on the findings of this research, it can be concluded that digital-based information services are crucial in enhancing the aviation service user experience at Jenderal Ahmad Yani International Airport in Semarang.

Exploring User Experience and User Interface of Indonesian e-Health PeduliLindungi Mobile-Apps with MeCUE 2.0 Framework

PeduliLindungi Mobile-Apps (PLMA) is a mobile-based e-Health application that was released by the Ministry of Communication and Information (KOMINFO) of the Republic of Indonesia in April 2020. Its goal is to help the government keep track of the Covid-19 Pandemic in Indonesia and stop it from spreading. PLMA is used to find Covid-19, keep track of it, warn people about it, and stop it from spreading. Reports say that more than 10,000,000 people have downloaded PLMA, and KOMINFO has told all citizens that they must use this app. But PLMA was criticized by people who used its apps because of problems like application errors, data leaks, and mistakes in user data. Also, as of September 29, 2021, 470,521 people had reviewed it on the Google Play Store, giving it an average score of 3.8. The score from the PLMA review shows that the application needs to be improved. PLMA also gets complaints about how hard it is to navigate, how features aren't clear, how there are problems with connection and performance, how personal data isn't safe, and how hard it is to get to. The purpose of the research is to investigate and evaluate PLMA which focuses on the user experience (UX) or user interface (UI) of application users. UI/UX in PLMA has been measured or evaluated in a few studies, but the numbers are still very small and limited. Minge (2020) came up with the meCUE 2.0 framework as a way to evaluate an application user experience service. It is a fairly new and comprehensive framework. The MeCUE 2.0 Framework has a questionnaire with 34 statement items. It is made up of 4 modules: Modules I and II (Perception of quality of instrumental and non-instrumental products), Module III (Emotions), Module IV (Consequences), and Module V (Overall Evaluation). In the first step of this study, the meCUE 2.0 questionnaire was translated and then given to 50 people. The results showed that the UI/UX ratings for PLMA were 3.17 for usefulness, 4 for usability, 3.33 for visual aesthetics, 3 for status, 3.67 for commitment, 3.67 for positive emotions, 2.67 for negative emotions, 3.67 for intention to use, 2.67 for product loyalty, and 3.67 for overall evaluation.(107.00). This research makes a contribution both in terms of ideas and in terms of how it can be used. For example, it tells UX designers and policymakers that they should pay attention to important factors while developing PLMAs.

Towards a better understanding of mental health care delivery systems: From stories to system components

ABSTRACT The growing demand for better quality of care, together with an increasing awareness of limited resources, is bringing attention to the need for design in healthcare. In mental health, considered the largest single cause of disability in the UK, the need is great. Existing services often fail to meet current levels of demand and do not consistently deliver good quality care for all service users. The design of better delivery systems has the potential to improve service user experience and care outcomes. This paper reports how through the interactive and participatory method of storytelling, the key components of a mental health delivery system were identified. We explain each of the ten components and discuss their implications for system understanding and service design. A model of a mental health delivery system has also been proposed.

Acceptance and commitment therapy for psychosis: Current status, lingering questions and future directions.

Acceptance and Commitment Therapy for psychosis (ACTp) is a contextual behavioural intervention that promotes psychological flexibility by fostering active acceptance, cognitive defusion, values construction and committed action to enhance well-being and recovery. Multiple studies have shown that ACTp is acceptable and efficacious, but questions remain as to its distinction from similar approaches and the conditions under which it would be implemented most effectively. We present the current evidence for processes and outcomes of ACTp and summarise the qualitative findings of experiences of service users in ACT programmes. We compare ACTp with other cognitive behavioural therapies and mindfulness-informed interventions for psychosis. Acceptance and commitment therapy for psychosis is promising as a pragmatic, process-driven intervention model. Further efforts are needed to investigate psychological flexibility in the context of psychosis with observational, experimental and intervention studies that will inform model scope and treatment refinement. Additionally, implementation research is the necessary next step, including how support persons can be trained in ACTp. Lower intensity and technology-assisted approaches have the potential to reduce barriers to accessing ACTp and extend impact. Over the last 20 years, ACTp has demonstrated meaningful effects in individual and group formats in a range of settings, targeting outcomes such as rehospitalisation, depression, psychotic symptom distress and impact. Future work should focus on how best to integrate ACTp with other current evidence-based interventions for psychosis.

Evaluating Outcomes and Experience of Eye Movement Desensitization Reprocessing Through a National Health Service Trust’s Staff Support Service

Aim: A National Health Service (NHS) mental health trust developed a pathway offering eye movement desensitization and reprocessing (EMDR) to healthcare professionals (HCPs). This research aimed to evaluate whether EMDR was linked to improvements in posttraumatic stress disorder (PTSD) and sought to understand the experiences of service users.Method: Pre- and post-outcome measures of the Impact of Events Scale—Revised (IES-r), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Work and Social Adjustment Scale (WASAS) were evaluated. Subsequently, a feedback survey was circulated to those who had accessed the service.Results: Analysis revealed statistically significant improvements in measures of PTSD, depression, anxiety, and functioning. The service was rated highly for accessibility and experience. Perceived treatment effectiveness was variable; however, reliving symptoms and sickness absence were reduced, and improvements made during therapy were reportedly maintained.Conclusion: This service evaluation offers preliminary support for the use of EMDR as a useful intervention for HCP. Recommendations that may be more broadly applicable for service development and considerations for future research are discussed.

Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework

BackgroundThe COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts.MethodsWe undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care.ResultsThe ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges.Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility.During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured.ConclusionsThe COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care.

Waiting for psychological therapy during the covid-19 pandemic: experiences of adults with an intellectual disability

PurposeMeasures introduced to mitigate the spread of coronavirus-19 (COVID-19) may have contributed to an increase in waiting times for face-to-face psychological treatments. As adults with intellectual disabilities (ID) are more likely to encounter barriers when accessing remote therapies, it is important they receive appropriate support while waiting. To understand what care is needed, this service evaluation [aimed to] explored the experiences of service users with ID who have waited for treatment during the pandemic.Design/methodology/approachSeven individuals who had been waiting for psychological therapy during the COVID-19 pandemic, which included those waiting longer than the national health service target of 18 weeks, were interviewed. Data were analysed using framework analysis.FindingsThe following four key themes were identified: waiting has been “painful”, related to how service users continued to experience difficulties whilst they waited; tolerating the wait, highlighted that individuals understood the reasons for waiting; use of coping strategies where service users identified both internal and external strategies they had used to cope; and support and contact from the learning disability team, related to how individuals experienced the support they received from the service.Originality/valueTo the best of the authors’ knowledge, this service evaluation is the first to explore the experiences of service users with ID waiting for psychological therapy during the Covid-19 pandemic. Results guide suggestions on improving support whilst they are waiting to help prevent further decline.

An Interpretative Phenomenological Analysis of the Experience of the Therapeutic Relationship between Service Users and Staff after Physical Restraint in a Secure Mental Health Service

Restrictive interventions, such as physical restraint, should be a last resort for managing imminent risk. There has been growing recognition of the harmful effects of them, for both staff and service users. Limited research has considered the impact of physical restraint on the therapeutic relationship between staff and service users. The aim of this research was to address this gap in the literature and explore both service user and staff perspectives of the therapeutic relationship after physical restraint, in a UK-based service that provides low and medium secure care for adults. Ten semi-structured interviews were conducted with five service users and five staff members. All participants had been involved in at least one incident of physical restraint. Interpretative Phenomenological Analysis was used to analyze the data. Three master themes emerged from the service user experiences: emotional impact; changes to the therapeutic relationship; and appraisal of the necessity of physical restraint. A further three master themes were produced from the staff member experiences: emotional response; balancing professional roles and responsibilities within the relationship; and moving forward with the therapeutic relationship after physical restraint. Findings support the need to continue to reduce restrictive interventions including physical restraint in secure mental health services and consider the impact upon those involved, both emotionally and relationally. Contemporary approaches to reducing power imbalances between staff and services users, as well as those that would reduce the likelihood of (re)traumatising service users, are also recommended.