Social Care Staff Research Articles

A Case Study on Autism Spectrum Disorder with Low Level Attention

Autism spectrum disorder (ASD) is now more widely recognised in both the public and medical spheres. Developmental impairment known as autism spectrum disorder (ASD) is brought on by variations in the brain. Individuals with ASD may struggle with confined or repetitive activities or interests, as well as social communication and engagement. Moreover, people with ASD may learn, move, or pay attention in various ways. Due to the increased number of children and teenagers seeking earlier guidance, evaluation, and diagnosis, there is a strong need for services. All clinicians working with children, including primary care teams, allied healthcare professionals, educational and social care staff, must have a solid understanding of the presentation and assessment of autism spectrum disorders (ASD) and an understanding of the co-morbidities to maximise detection and minimise harm. There are standards in the identification, referral, and diagnosis of autism, even if entry points for referrals can change due to a variety of presentation and local service provision. In order to improve a child's potential, provide appropriate support, and implement focused interventions for ASD and co-occurring problems with the hope of improving outcomes, early identification is advantageous. This case study discusses autism spectrum disorder (ASD) diagnosis and offers professionals who come across a child with suspected ASD an assessment strategy.

Older women and domestic abuse: through a glass darkly

PurposeThis paper aims to offer a profile of domestic abuse of older women and its impact on their health and well-being; explore some of the conceptual tensions that exist in this field; and discuss current policy and practice responses to this group of victim-survivors.Design/methodology/approachIt is a review paper drawing on material from a range of sources; it has policy, practice and research implications.FindingsAlthough there is growing recognition that older women are victims of domestic abuse, it tends to be regarded as a “younger women’s issue” and to be subsumed under the umbrella of elder abuse. This not only removes the gendered element, but it also uncouples it from the lifecourse where, for many, its roots lie. It also tends to foreground “old age” as the primary dimension of risk. There is a tension between the justice-oriented approach of the domestic abuse system and the welfarist approach that imbues the safeguarding system. There is a need for integration between the two systems. Also, for the health and care system to be more alert to the needs of older women at risk, we need to achieve a more effective balance between protection and justice, accord a greater level of agency to older victim-survivors and ensure they have access to domestic abuse law, policy and appropriate support services.Research limitations/implicationsMore research is needed with older victim-survivors: listening to their lived experiences, coping strategies and pathways out of abuse. The issue also needs to be more visible.Practical implicationsDeveloping appropriate domestic abuse services for older women is critical. Practice lessons can be learnt too: especially greater integration of the safeguarding system with the domestic abuse system. Training is needed too for frontline health and social care staff about the distinctive nature of domestic abuse of older women.Social implicationsDomestic abuse of older women needs to be spoken about and made more visible in society and inside services, including older people’s third sector services.Originality/valueThis paper adopts a critical lens and makes a number of new arguments.

How can we define social care and what are the levels of true integration in integrated care? A narrative review

PurposeIntegrated health and social care initiatives are increasing and health and social care systems are aiming to improve health and social outcomes in disadvantaged groups. There is a global dialogue surrounding improving services by shifting to an integrated health and social care approach. There is consensus of what is “health care”; however, the “social care” definition remains less explored. The authors describe the state of “social care” within the current integrated care literature and identify the depth of integration in current health and social care initiatives.Design/methodology/approachA narrative literature review, searching Medline, PsychINFO, CINAHL, PubMed, Scopus and Cochrane databases and grey literature (from 2016 to 2021), employing a search strategy, was conducted.FindingsIn total. 276 studies were eligible for full-text review, and 33 studies were included and categorised in types: “social care as community outreach dialogues”, “social care as addressing an ageing population”, “social care as targeting multimorbidity and corresponding social risks factors” and “social care as initiatives addressing the fragmentation of services”. Most initiatives were implemented in the United Kingdom. In total, 21 studies reported expanding integrated governance and partnerships; 27 studies reported having health and social care staff with clear integrated governance; 17 had dedicated funding and 11 used data-sharing and the integration of systems’ records.Originality/valueThe authors' demonstrate that social care approaches are expanding beyond the elderly, and these models have been used to respond to multimorbidity [including coronavirus disease 2019 (COVID-19)], targeting priority groups and individuals with complex presentations.

Parental Perceptions of Family-Centred Supports for Children with Developmental Disabilities.

Family-centred interventions have long been advocated in paediatric practice and in public health, but their implementation is rarer with children experiencing developmental disabilities. Moreover, the uptake is lower in families from more socially deprived backgrounds. Yet there is robust evidence that such interventions bring benefits to the family caregivers as well as to the affected children. The present study emerged from a support service that had been located in a rural county in Ireland in which nearly 100 families of children with intellectual and developmental disabilities had participated. Using a qualitative research methodology, interviews were conducted with 16 parents who had taken part in the service with the aim of gaining insights into the ways a family-centred service had been of value to them. The themes identified in their responses were validated in two ways. All parents were given the opportunity to provide their perceptions using a self-completion questionnaire, and nearly 50% responded. In addition, seven health and social care staff who had referred families to the project were asked their views through personal interviews. The core theme to emerge was the focus placed on family engagement by the service, with four subthemes emerging: parental confidence boosted; children developed; community connections were made; and supportive staff. These insights should help existing health and social care services to become more family-centred and inform the development of new support services in response to the high levels of unmet needs among marginalized families in even the most affluent countries.

Social care professionals’ perceived barriers to implementing attachment and trauma-informed care training in their practice

Social care professionals support many children and their families with experiences of developmental trauma. There is a notable gap in research exploring the barriers these professionals face to working with an attachment and trauma-informed approach in the UK. The present study explores social care professionals’ reported barriers to using trauma and attachment principles in their practice. A thematic analysis was performed on responses drawn from a questionnaire completed by a sample of social care staff ( n = 98) who had received attachment and trauma-informed work training. These items explored barriers to working in an attachment and trauma-informed way on a personal and professional level, an organisational level, as well as what may overcome their identified barriers. Four main themes emerged from the analysis: (1) the widespread impact of trauma, (2) lack of funding, (3) inconsistent supportive culture, (4) inconsistent multiagency approach to trauma-informed care. Findings suggest that a whole systems approach to attachment and trauma is needed, in which there is an awareness of the impact of trauma, structures are in place to best support staff in their work, and everyone has a shared understanding and approach to working with these children and families. This study presents a promising start to identifying and making recommendations about what social care staff require to work in an attachment and trauma-informed way.

Dementia and delirium: recognising common factors

Delirium is a multifactorial syndrome that, when superimposed on dementia, can lead to twice the risk of being admitted to acute care than for a person who is cognitively intact. Early detection of delirium can be a challenge, especially when there is an existing diagnosis of dementia. Despite the wealth of literature, there continues to be a widespread lack of knowledge about delirium, and under-detection in all types of health and social care settings. This lack of recognition may lead to poor health outcomes and increased mortality. There is a need for effective training for staff working in community settings, and effective communication between health and social care staff and families who are affected by delirium. Furthermore, delirium superimposed on dementia is common, and may cause distress for patients, caregivers and staff. This article will explore some of the common factors when delirium is comorbid with dementia.

Dealing with the NHS staff recruitment and retention crisis: how are we doing?

Much more needs to be done to boost morale and reduce burnout for all grades of health and social care staff, to stem the haemorrhage of talent and recruit more desperately needed employees into the NHS. Otherwise the organisation may struggle to survive in its present form.

Experiences of digital exclusion and the impact on health in people living with severe mental illness.

The covid-19 pandemic has accelerated the use of digital tools within health and social care services. However, for a range of different reasons, across the UK there continue to be people who are digitally excluded. People living with a disability have been identified as being more likely to be digitally excluded and many of these people, including people with severe mental illness (SMI) already experience health inequalities. Therefore, understanding the perceived impact digital exclusion has on health and potential facilitators of increased inclusion is an important area for research. This study had two aims: 1. To understand experiences of digital exclusion and the impact on health in people with SMI. 2. To explore the influences and mechanisms which would increase engagement with digital health tools. This was an observational qualitative study, conducting focus groups (with the option of a 1:1 interview for those uncomfortable in groups) with nine people with severe mental illness. Participant's responses were themed in to four key areas in relation to digital exclusion and impact on health: 1. Reduced social connectedness, 2. The impact on wider determinants of health 3. Negative perception of self, 4. Disempowerment. Key facilitators for increased engagement with digital tools included, local digital skills support with mental health lived experience involvement in the delivery, digitally engaged social referents, access to digital tools and data, personalised and straightforward digital tools. In addition, increasing health and social care staff's awareness of digital exclusion was also viewed as important in promoting inclusion. The research findings suggest that digital inclusion should be viewed as a wider determinant of health. Many of the identified consequences of exclusion are particularly important in relation to mental health and mental health recovery. This research suggests that identifying and addressing digital exclusion should be viewed as a priority for mental health services.

No stability without health: time to give back to NHS and social care staff

No stability without health: time to give back to NHS and social care staff

Social care for disabled elderly women in urban China: The roles of the community

This article analyses the provision of community care for urban disabled elderly women. With the emergence of an aging society in China and the empty nest syndrome in Chinese families, the number of elderly people who cannot take care of themselves is increasing. With the reduction in family size and the weakening of the home care function, traditional family care in China is facing immense challenges. On the one hand, a growing number of disabled elderly women are in urgent need of care; they encounter many difficulties in daily life, including poor health status, the loss of their spouse and living alone, an inability to support themselves economically, the lack of a spiritual life, and a significant reliance on their children to take care of them. On the other hand, the family's function of providing for the elderly has been weakened, and the traditional way of care is affected by the changes in modern society. Based on a qualitative study in Beijing, this article examines the demand for care from disabled elderly women and the current supply of community care. It puts forward a community-centred and targeted assistance model and social work intervention. This study argues that the community care system for disabled elderly women in urban areas should focus on four aspects, namely living care, medical care, spiritual consolation, and emergency assistance; and the protection mechanism should be improved to support disabled elderly women from three aspects: a protection system, a fund guarantee and services from health and social care staff and social workers.

Digging deep – An opportunity to do something different (with our thanks to Dr Jo Billings & Dr Polly Kaiser)

The Care Home Wellbeing Service was commissioned in response to the Covid-19 pandemic. It works collaboratively with health and social care staff, local councils, and governing bodies in order to support carers, residents and care homes. The Covid-19 pandemic highlighted vulnerabilities, inequalities and challenges experienced by social care staff. The lens of intersectionality challenges and enables us to be able to provide person centred interventions to support recovery, to engage with the articulated disconnect between health and social care and, in so doing, to navigate the next phase of the service’s work.

The impact of COVID-19 on nurses (ICON) survey: Nurses' accounts of what would have helped to improve their working lives.

AimsTo use nurses' descriptions of what would have improved their working lives during the first peak of the COVID‐19 pandemic in the UK.DesignAnalysis of free‐text responses from a cross‐sectional survey of the UK nursing and midwifery workforce.MethodsBetween 2 and 14 April 2020, 3299 nurses and midwives completed an online survey, as part of the ‘Impact of COVID‐19 on Nurses’ (ICON) study. 2205 (67%) gave answers to a question asking for the top three things that the government or their employer could do to improve their working lives. Each participants' response was coded using thematic and content analysis. Multiple response analysis quantified the frequency of different issues and themes and examined variation by employer.ResultsMost (77%) were employed by the National Health Service (77%) and worked at staff or senior staff nurse levels (55%). 5938 codable responses were generated. Personal protective equipment/staff safety (60.0%), support to workforce (28.6%) and better communication (21.9%) were the most cited themes. Within ‘personal protective equipment’, responses focussed most on available supply. Only 2.8% stated that nothing further could be done. Patterns were similar in both NHS and non‐NHS settings.ConclusionsThe analysis provided valuable insight into key changes required to improve the work lives of nurses during a pandemic. Urgent improvements in provision and quality of personal protective equipment were needed for the safety of both workforce and patients.ImpactFailure to meet nurses needs to be safe at work appears to have damaged morale in this vital workforce. We identified key strategies that, if implemented by the Government and employers, could have improved the working lives of the nursing and midwifery workforce during the early stages of the COVID‐19 pandemic and could prevent the pandemic from having a longer‐term negative impact on the retention of this vital workforce.Patient or Public ContributionNo Patient or Public Contribution, due to the COVID‐19 Pandemic, urgency of the work and the target population being health and social care staff.

A case study of implementing interprofessional education in care home settings

Purpose The purpose of this paper is to report on an interprofessional (IPE) student training scheme recently conducted in three care homes across the Northwest of England. The intervention was designed as a feasibility study to explore the impacts such schemes have on residents, students and care home staff. Additional lessons emerged that contribute to the design and direction of future IPE initiatives in other care homes and care settings. Design/methodology/approach This case study outlines how the intervention was designed and implemented and the findings from its evaluation. This paper uses Biggs’ (1993) presage–process–product framework to evaluate the process of setting up care homes as a site of collaborative learning. Findings Collaborative working between stakeholders is necessary for the successful implementation of IPE in care home settings. The process is complex and requires communication and commitment across all levels of engagement. For this model to grow and have a beneficial impact on older people’s lives, there are layered factors to consider, such as the socio-political context, the characteristics of the individuals who participate and diverse approaches to learning. Research limitations/implications This case study reports the subjective views of the research collaborators. While this raises the potential for bias, it presents an “insider” perspective of the research process and offers learning that might be beneficial in efforts to run future IPE training schemes. Originality/value To the best of the authors’ knowledge, no other research studies or published interventions have been identified that explicitly address the experiences of implementing an IPE training scheme in UK care home settings. This paper will therefore be useful to academic researchers, individuals managing student placements and to health and social care staff who wish to learn about of the value of IPE learning schemes.

A qualitative exploration of the clinical presentation, trajectory, management and recovery of COVID-19 in older people: Learning from frontline staff experiences.

COVID‐19 had a devastating impact on older people living in care homes. This study explored the clinical trajectory and management of COVID‐19, as well as recovery of older people following infection during the early stages of the pandemic (May to August 2020). A two‐phase exploratory qualitative study was used. Frontline staff with experience of caring for older people with COVID‐19 were recruited to Phase 1, and senior care home operational and quality managers were recruited to Phase 2. During Phase 1 remote semi‐structured interviews (n = 35) were carried out with staff working in care homes, hospital and community settings in England. During Phase 2, a remote consultation event was carried out with senior care home operational and quality managers (n = 11) to share Phase 1 findings and check resonance, relevance and gaps. Data were analysed using Framework Analysis. Older people with COVID‐19 presented with wide ranging symptoms, and an unpredictable illness trajectory. The wide range of COVID‐19 symptoms required timely testing and supportive interventions. Staff used different interventions to manage symptoms and reported uncertainties of how individuals would respond. In care home settings, health and social care staff needed to work together when administering interventions such as subcutaneous fluids or oxygen therapy. Alongside symptom management, supportive care focused on nutrition and hydration, social interaction, and maintaining physical activity to meet both physical and emotional needs. The effects of prolonged periods of social isolation and inactivity on the health and well‐being of older people means rehabilitation is essential to enhance physical and emotional recovery, and to minimise impacts on cognition and function. The pandemic highlighted important areas for care of this population.

The vital role of healthcare assistants in pressure ulcer prevention: learning from research in practice

This article reports on the impact of an educational intervention to raise awareness of the prevention of pressure ulceration as an integral part of the PROACT project. This initiative took place in the north east of England in residential and non-residential care homes from May 2017 to March 2020, with a training programme on the need to raise awareness of the prevention of pressure ulceration delivered between January 2018 and September 2019. In total, 571 participants took part in the project. Of these, 493 (86%) were health and social care staff, including healthcare assistants, and the other 78 (14%) were informal carers. While many participants reported an increased level of confidence following the training programme, many could not bridge the theory–practice gap in terms of being able to articulate how they would prevent the development of pressure ulcers in practice. The study highlights the need for healthcare assistants to refer patients living with the earliest stages of pressure ulceration to other members of the healthcare team. Daily monitoring should include training about the key risk factors of ulceration, such as capacity for movement and being able to walk around, basic skin examinations and the continence status of patients. Training in the importance of monitoring and reporting weight loss, alongside adequate hydration, is also needed.

Predicting staff turnover in learning disability social care services

Background Staff working in learning disability social care services have high turnover rates resulting in disruption to care and financial costs to employers in relation to recruiting new staff.Aims To explore whether the theory of planned behaviour can be used as a framework to predict intention to leave their job and actual staff turnover, and to identify whether including measures of organisational ‘fulfilment’, work-related stress, perceived job equity and receiving positive behaviour support (PBS) training improved prediction of staff turnover.Method A quantitative design was used. Respondents were 285 social care staff working in learning disability services. Path analysis was used to explore the relationships between staff turnover and the theory of planned behaviour components, perceived equity score (the extent to which respondents believed they benefited from work compared with what they put into it), organisational fulfilment score (the extent to which respondents believed their organisation offered the elements they valued), stress score and group status (that is, whether respondents had undergone the PBS programme).Results Staff turnover was significantly predicted by perceived equity score at one and nine months after baseline, by stress score at six months and by whether respondents had undergone the PBS programme at six and nine months.Conclusion Reducing staff stress, increasing their perceived equity and offering PBS training may be ways of increasing staff retention.

Empathy Remotely

This article focuses on examining art-based research and empathy research related to health care. The article is based on two narratives produced in the project More Remotely – Work in Social and Health Care is Changing (2020–22): Carefree room project (2020–21) and Look at the Clouds webinar (2020). In this article, the former will be referred to as Narrative I and the latter as Narrative II. The narratives aim at enhancing the well-being of social and health care staff and university students, as well as their participation in changing work and study environments. Our research develops new kinds of methods for remote interaction, here called “compassion without in-person contact”. The research material and the related art-based processes define and develop a method for individual participation in remote interaction, and for understanding and articulating the subjectivity of the interaction. The research material was collected by using art-based research methods (ABR), and it is presented in this article using the abovementioned Narratives I and II as example cases with a special emphasis on visualizing emotions and empathy-based thinking. The method presented here enables ways to engage participants in building a shared understanding, aiming towards enhancing collective well-being and creating empathy-based methods in changing work environments. This article addresses the following questions: 1) How to encounter, process, and manage one’s own emotions? and 2) How to identify, share and understand the emotions of the others remotely?

How Did Levels of Psychological Distress and Perceptions of Workplace Support amongst Children’s Social Work Staff Change during the Covid-19 Pandemic?

Abstract Covid-19 brought about drastic changes in day-to-day life and working practices, and had a profound impact on the mental health and well-being of the general population. Certain professional groups have also been particularly affected. This study sought to explore how levels of psychological distress and perceptions of workplace support amongst social work staff changed during the pandemic. We present the results from a series of surveys conducted in four local authorities (LAs) in England, before and during the Covid-19 pandemic. Social workers and other social care staff (n = 62) were asked about their experiences of psychological distress, using the twelve-item General Health Questionnaire. Overall, we found the proportion of staff reporting elevated levels of psychological distress increased and, in line with previous studies involving social workers, was high relative to the general population. Yet, most staff also said they had high levels of support from managers and colleagues, whilst a small proportion reported an increased perception of workplace support during the pandemic, compared to before. We consider these findings in relation to Organisational Support Theory and reflect on the ability of LAs to provide effective support for social care staff.

A Three-Step System to Ensure Correct Attribution of Named Clinicians for Inpatients.

Background: The Francis report recommends that all patients admitted into a UK hospital must have a named identifiable and suitably trained consultant or clinician in charge of their care. This is regarded as a shared responsibility as highlighted by the recommendations made by the General Medical Council Best Practice guidance. However, this can become more error-prone, particularly in acute trauma and orthopaedic inpatients when the named consultant may change numerous times.Methods: We conducted an audit reviewing all the inpatients in the acute trauma and orthopaedic wards and then reaudited twice following the introduction of the three-step system. The results were then analysed and compared with previous cycle results.Results: Initially following the introduction of the three-step system, there were poorer outcomes. Inpatients with the correct named consultant declined from 47% to 37%. However, following further education and training of each respective member of the multidisciplinary roles, the results were much improved with 88.9% of the inpatients having the correct named consultant.Conclusions: Ensuring that all inpatients have the correct named consultant is a shared responsibility amongst all health and social care staff involved with the patient. This audit highlights that attributing specific roles to relevant members of the multidisciplinary team can improve communications and patient care.

Understanding the key components of effective dementia education and training.

Inadequate and poor care can lead to reduced quality of life for people living with dementia and a higher overall cost to healthcare. Dementia education and training for health and social care staff has been set as a priority by the Department of Health. It is vital to identify what specific factors are important when undertaking dementia care training. This commentary article critically appraises and evaluates a systematic review based on identifying key factors in delivering effective dementia care training.