Social Care Teams Research Articles

Crossing the tracks: continuing inter-professional development in social and primary care

Introduction: The need to positively engage professionals in the development and practice of integrated care is well researched. Constructive professional difference is an enabler of holistic care and support, but inter-professional rivalries, misconceptions and mistrust can undermine integration. Inter-professional learning and development is seen as one option to facilitate better joint working between professions. This case study presents the development of a resource to support such development across the crucial boundary between adult social care teams and general practice in the UK. Change in practice: Following theories and insights from previous research regarding inter-professional learning, the resource was created followed the stages below: Review of evidence: A literature review of evidence regarding general practice – social work interaction was completed to identify previous research regarding inter-professional experience and practice in this area and attempts to address any issues through learning and development. Gaining perspectives: Focus groups were carried out separately with general practices and with adult social work teams. These sought to gain the views of the range of professions and practitioners within the two services regarding their knowledge of those working in the other services and their experience of collaborating. Groups were then asked to reflect on the strength of their own profession and their ability to work collaboratively. Finally different options regarding inter-professional development were presented for their comment. From these discussions it became clear that services would typically only be able to allocate up to 4 hours for such sessions and that the professionals would prefer interactive face-to-face sessions. Developing resources: The resources were developed by a multi-professional team which included those from a nursing and social work background. Involving professionals and practitioners from both services, the sessions would be facilitated by someone external to the services and be structured around the following themes: Sharing impressions: Participants are asked to identify which services made a quote regarding professions in one of the services and their ability to collaborate. This is carried out within mixed groups and was used to generate discussion of the thinking that lay behind the quotes and their selection of the stakeholder concerned. Sharing knowledge: Participants are separated into single service groups and asked to respond to a series of questions regarding key aspects of the professions within the other service – how are they trained, governed, incentivised etc. They then match with a group from the other service and share their answers, with the service in question clarifying and correcting their knowledge. Sharing roles, values & conflict: Participants return to mixed groups and follow a three stage case study. The case study and related questions provide a focus for exploration of respective contributions to supporting someone with complex health and social care needs, the values that underpin their work, and how they would (or would not) deal with conflict Sharing plans: personal and collective action planning is facilitated in response to what they have learnt and reflected upon during the session. Delivering the sessions: the initial sessions were facilitated by the team which developed the resources. Feedback was provided at the end of the session by participants and this was then followed up with a short on-line survey to explore further their learning and potential behavioural change. The facilitators met to discuss feedback and iteratively develop and refine the materials. Key findings: Despite considerable contact with professionals from the other service over several years (if not decades) knowledge of, and confidence in, working with others was often weak. The principles of inter-professional learning can be applied successfully to short continuing education sessions. A multi-professional development and facilitation team provides the knowledge and insights to engage successfully with an inter-professional group Highlights of learning: The process of reviewing evidence, gaining perspectives of a sample of the key professionals, and developing sessions on these experiences worked well. The current and ‘real’ experiences and views provided validity to the content. Considerable difficulties were encountered in the recruitment of services to participate due to other priorities, changing structures and a lack of recognition of the cultural aspects of joint working alongside those of systems and processes Conclusion: Despite the importance of inter-professional issues many professionals and their organisations struggle to prioritise it as an area for improvement alongside more technical and process challenges. However with careful planning and thoughtful facilitation even a short inter-professional session can help to break down barriers and provide a foundation for better joint working in future.

Exploring the Coordination of Care for People with Multimorbidities and their Support Networks using Social Network Analysis: A Research Protocol

Introduction: Multimorbidity is the presence of two or more chronic conditions within one individual. Continuity of care and appropriate treatment decisions are essential for these individuals in order to avoid adverse outcomes and preventable healthcare costs. People with multimorbidity (_PMM_) can have multiple treatment options and/or require multiple services concurrently, which often is exasperated by fragmented health systems organised to deliver episodic care for single conditions (“disease silos”). Thus, achieving effective integrated care is a particularly complex task for this population. Yet research to date on how care is coordinated for PMMs has been limited, and extant research tend to focus on formal care delivery and seldom accounts for the “hidden” informal care provided by families and communities. There is a need for research that examines how access to care for this population is shaped by clinician-to-clinician and peer-to-peer interactions and how formal and informal care can be integrated. Aims: We aim to gain a better understanding of how care is coordinated for PMMs both formally and informally, and how this influences their access to health services. Study objectives include: 1. Illuminate the clinical and social support networks that PMMs have with their healthcare providers and with their families and communities; and identify key individuals that broker care for PMMs within these networks; 2. Identify barriers and facilitators that influence PMMs’ access to formal healthcare services 3. Evaluate the extent to which PPMs’ clinical and social support networks influence their health service utilisation patterns and health outcomes. An hypothesis is that good PMM care coordination results in better access to services, which may manifest as increased healthcare use compared to those with poor care coordination. Methods: Social network analysis (SNA) is chosen as it facilitates the exploration of social interactions on care coordination: 1. Ego-centric SNA. will be performed on a sample of PMMs receiving formal care from a collaborating hospital. Profiles of PMM are being developed based on analysing combinations of chronic illnesses that are most prevalent in Ireland that were captured within “The Irish Longitudinal Study on Ageing” (_TILDA_) datasets. Social support data on PMMs will be collected via a researcher-administered network survey, and respondent-driven sampling will be used to recruit members of PMMs’ informal support networks for data on interactions with formal healthcare providers in accessing care for PMMs. 2. Socio-centric SNA. will be performed on a sample of clinicians responsible for the formal care of the PPMs recruited in the study. The survey will ascertain the type and frequency of interactions they have with other clinical and social care team members also involved in caring for the PMM cohort. Key individuals involved in coordinating formal care for the PMMs will be identified, along with any gaps that exist in the spectrum of formal care for PMMs, and any barriers / facilitators that impinge on integrated care delivery for PMMs. The survey for these clinical support networks will be based on adapting an instrument already trialled in a number of social network studies conducted in Irish health and social care settings. The SNA measures on the existence and structures of PPMs’ support networks will then be correlated with the level and type of health service utilisation by these individuals to determine whether better care coordination may lead to better access and more service use. Results: Visual displays (sociograms) will summarise the structure of the PMMs’ support networks. A number of relevant SNA metrics for both ego- and network-level analysis will also be reported, along with measures capturing the respondents’ self-reported barriers and facilitators to accessing care across clinical domains. Results from testing hypotheses relating PMMs’ clinical and social support networks with their health service utilisation patterns and health outcomes will be reported. Discussion: Behaviours in and outside healthcare settings have been shown to play a key role on health outcomes and on financing healthcare. This research protocol outlines a study employing network research methodologies that will contribute to the evidence base on chronic disease management not only for people with multi-morbidities, but also on the general literature on integrated care and on formal and informal health organisation. Conclusions: This study is one of the first studies of its kind to utilise network research methodologies to explore the coordination and integration of care for people with multi-morbidities. Data from this study will add to our knowledge and understanding about how care is currently organised for and by PMMs, and will inform strategies for developing integrative care models for this population.

Developing a framework for gathering and using service user experiences to improve integrated health and social care: the SUFFICE framework.

BackgroundMore people than ever receive care and support from health and social care services. Initiatives to integrate the work of health and social care staff have increased rapidly across the UK but relatively little has been done to chart and improve their impact on service users. Our aim was to develop a framework for gathering and using service user feedback to improve integrated health and social care in one locality in the North of England.MethodsWe used published literature and interviews with health and social care managers to determine the expected service user experiences of local community-based integrated teams and the ways in which team members were expected to work together. We used the results to devise qualitative data collection and analysis tools for gathering and analyzing service user feedback. We used developmental evaluation and service improvement methodologies to devise a procedure for developing service improvement plans.FindingsWe identified six expected service user experiences of integrated care and 15 activities that health and social care teams were expected to undertake. We used these to develop logic models and tools for collecting and analysing service user experiences. These include a narrative interview schedule, a plan for analyzing data, and a method for synthesizing the results into a composite ‘story’. We devised a structured service improvement procedure which involves teams of health and social care staff listening to a composite service user story, identifying how their actions as a team may have contributed to the story and developing a service improvement plan.ConclusionsThis framework aims to put service user experiences at the heart of efforts to improve integration. It has been developed in collaboration with National Health Service (NHS) and Social Care managers. We expect it to be useful for evaluating and improving integrated care initiatives elsewhere.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2230-0) contains supplementary material, which is available to authorized users.

Building resilience in health and social care teams

Purpose Maintaining user-focused integrated team working in complex care is one of the demands made of UK health and social care (H&SC) organisations who need employees that are resilient, resilience being the ability to persevere and thrive in the face of exposure to adverse situations (Rogerson and Ermes, 2008, p. 1). Grant and Kinman (2012) write that resilience is a complex and multi-dimensional construct that is underexplored in social care team work. The purpose of this paper is to capture the views of managers in H&SC to explore the making of resilient teams, identify factors that influence team performance and inform organisational workforce development strategy. Design/methodology/approach A general inductive approach (Silverman, 2011) was applied. Five focus groups were facilitated (n=40) each with eight participants all of whom were leaders and managers of teams in H&SC, working in the integrated care context in the UK. Findings Findings indicate that further investment in strategies and resources to sustain and educate employees who work in teams and further research into how organisational systems can facilitate this learning positively may contribute to resilient teams and performance improvement. The authors note specifically that H&SC organisations make a distinction between the two most prevalent team types and structures of multi-disciplinary and inter-professional and plan more targeted workforce development for individual and team learning for resiliency within these team structures. In doing so organisations may gain further advantages such as improved team performance in problematic care situations. Research limitations/implications Data captured are self-reported perceptions of H&SC managers. Participant responses in the focus group situation may have been those expected rather than those actually modelled in the realities of team work practice (Tanggaard, 2008). Further, in the sample all participants were engaged in a higher education programme and it is possible participants may have been more engaged with their practice and thinking more critically about the research questions than those not currently undertaking postgraduate study (Ng et al., 2014). Nor were the researchers able to observe the participants in team work practice over time or during critical care delivery incidents. Practical implications The preliminary link made here between multi-disciplinary and inter-professional team type, and their different stress points and subsequent workforce intervention, contributes to the theory of resilient teams. This provides organisations with a foundation for the focus of workplace learning and training around resilience. H&SC practitioner views presented offer a greater understanding of team work processes, together with a target for planning workforce development strategy to sustain resilience in team working. Originality/value This preliminary research found that participants in H&SC valued the team as a very important vehicle for building and sustaining resilience when dealing with complex H&SC situations. The capitalisation on the distinction in team type and individual working practices between those of interprofessional and multidisciplinary teams and the model of team learning, may have important consequences for building resilience in H&SC teams. These findings may be significant for workforce educators seeking to develop and build effective practice tools to sustain team working.

Putting people at the centre: facilitating Making Safeguarding Personal approaches in the context of the Care Act 2014

Purpose – The purpose of this paper is to describe and discuss the pilot Making Safeguarding Personal (MSP) project that ran in three London boroughs in England in 2014-2015. The project aimed to help local authority social work practitioners better engage with adults at risk at the beginning, middle and end of safeguarding work and to develop a more outcomes focused approach to safeguarding. Design/methodology/approach – Three adult social care teams volunteered to take part in the MSP pilot for four months, November 2014-February 2015. They were closely supported through telephone conferencing, bespoke training and individual mentoring. Evaluative data were collected from the participating teams about their work and the MSP change processes to assist in further implementation. Findings – The findings suggested that staff felt that the open discussions with adults at risk that were encouraged by the MSP initiative enabled safeguarding to be more effective and provided a better basis of support for adults at risk. The support from the project team was appreciated. Staff reported their own increased confidence as a result of involving adults at risk in decisions about their situations and risks of harm. They also reported their increased awareness of cross-cutting subjects related to adult safeguarding, such as domestic abuse and working with coercive and controlling behaviours. Permission to exercise greater professional discretion to make responses more considered, rather than the need to adhere to time-limited imperatives, was received positively. Staff felt that this enhanced discussions about resolution and recovery with adults at risk although it required greater expertise, more extensive managerial support, and more time. These were available in the pilot. Research limitations/implications – The MSP pilot was confined to three teams and took place over four months. The numerical data reported in this paper are provided for illustrative purposes and are not statistically significant. As with other evaluations of implementation, the data provided need to be set in the local contexts of population profiles, care settings and the reporting source. The pilot also took place during the early implementation of the Care Act 2014 which affected the context of practice and training. The views of adults at risk were not collected. There is a risk of bias in that participants may have wished to convey positive views of MSP to their colleagues. Practical implications – The paper indicates a need for the roll out of MSP philosophy and MSP approaches to be communicated with other agencies supporting adults at risk and for project support of some form to continue. It will be important to see if the overall enthusiasm, support and motivation reported by the pilot teams when taking a MSP approach in practice extend beyond a pilot period during which the staff received substantial support from a dedicated Professional Standards Safeguarding Team. Many of those staff participating in the pilot perceived the MSP approach as a return to core social work principles and welcomed putting these into practice. Originality/value – The paper provides details of one pilot in which the feasibility of the MSP approach was tested by supporting three frontline teams working in different contexts. The pilot suggests that the level and type of support offered to the pilot teams were effective in a variety of practice settings. It draws attention to the need for the MSP concept and approach to be shared with other agencies and for implementation support to continue beyond initial pilot period.

Transitioning care-leavers with mental health needs: 'they set you up to fail!'

Children in the UK care system often face multiple disadvantages in terms of health, education and future employment. This is especially true of mental health where they present with greater mental health needs than other children. Although transition from care - the process of leaving the local authority as a child-in-care to independence - is a key juncture for young people, it is often experienced negatively with inconsistency in care and exacerbation of existing mental illness. Those receiving support from child and adolescent mental health services (CAMHS), often experience an additional, concurrent transfer to adult services (AMHS), which are guided by different service models which can create a care gap between services. This qualitative study explored care-leavers' experiences of mental illness, and transition in social care and mental health services. Twelve care-leavers with mental health needs were interviewed and data analysed using framework analysis. Sixteen individual themes were grouped into four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. Existing social care and mental health teams can improve the care of care-leavers navigating multiple personal, practical and service transitions. Recommendations include effective Pathway Planning, multiagency coordination, and stating who is responsible for mental health care and its coordination. Participants asked that youth mental health services span the social care transition; and provide continuity of mental health provision when care-leavers are at risk of feeling abandoned and isolated, suffering deteriorating mental health and struggling to establish new relationships with professionals. Young people say that the key to successful transition and achieving independence is maintaining trust and support from services.

The effects on team emotions and team effectiveness of coaching in interprofessional health and social care teams

ABSTRACTThe purpose of this study was to examine the effects of coaching behaviours provided by peers and by the leader on the emotions experienced by interprofessional health and social care teams and on members’ satisfaction with the team, as well as on team performance. Data were obtained from a survey among 344 employees working in 52 interprofessional health and social care teams from nine Portuguese organizations. The results show that leader coaching and peer coaching have a positive effect on the level of team members’ satisfaction with the team and on positive emotions, and a negative effect on negative emotions. Furthermore, coaching provided by peers presents a positive effect on team performance as assessed by the leader of the team. Our findings put forward the importance of engaging in coaching behaviours to promote quality of the team experience, as well as the achievement of team performance objectives. Further studies should explore how coaching behaviours impact the patient, whose well-being is the ultimate objective of a team in the health and social care system, namely in terms of the patient’s perception of quality care or patient outcomes.

Person-Centredness and Fundamentals of Care - Dancing with Beauty Rather than Fighting Ugliness.

The fundamentals of care have re-emerged as an important consideration in nursing following a period when these role elements were predominantly "delegated tasks" delivered by other (usually unregistered/unregulated) members of the health and social care team. Contemporary critiques of nursing highlight the technical focus of nursing at the expense of its caring function. Person-centred nursing theory offers a way of reinstating the value of fundamental care as a core part of providing holistic nursing to persons as well as highlighting the importance of the nursing role in coordinating healthcare services in ways that are consistent with a person's beliefs and values. This paper argues that a focus on person-centredness enables the core function of nurses as providers and coordinators of holistic person-centred fundamental care to be revalued. It highlights the importance of nurses being clear about "what matters" in caring practices and suggests that nurses adopting a person-centred approach can achieve effective care coordination through the lens of the fundamentals of care. In reading this paper, a greater understanding of person-centredness in the context of the fundamentals of care can be achieved.

Factors enabling implementation of integrated health and social care: a systematic review.

In spite of ongoing UK Government recommendations for integrated health and social care, the implementation has been slow. While there are pockets of integration happening across England, many services remain isolated and fragmented. This review aims to critically review existing evidence to identify if there are any factors enabling successful implementation of integrated health and social care for people with long-term conditions in the community. A review was conducted following the principles of a systematic review. Relevant data was extracted from the identified papers and the papers were quality appraised. A total of seven studies were included in the review. Data analysis and synthesis identified a number of themes in relation to enablers of integrated care, including co-location of teams, communication, integrated organisations, management and leadership, capacity and resources, and information technology. There is a limited amount of evidence regarding integrated health and social care teams. Although there are some consistencies within the findings, further research is needed to enhance the validity of the body of evidence available.

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England.

ObjectivesTo evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission.MethodsAn observational study of service use and admissions to institutional care was undertaken for a prospectively‐sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent ‘high’ or ‘low’ levels of integrated working practice and patients were followed‐up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission.ResultsPatients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types.ConclusionsIntegrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient‐reported measures. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

Literature review of best health and social care practices for individuals with intellectual disabilities encountering the end of life

This Literature Review (LR) aimed to identity what were care best practices for individuals with intellectual disabilities (ID) encountering the end of life. Five EBSCOhost academic databases were used to choose thirty primary research articles, from which four emergent themes were identi ed: (1) end-of-life care approaches, policies and guidelines; (2) challenges experienced by members of the health and social care team; (3) the importance, challenges and bene ts of communication; and (4) examples of good practice including rounded end-of-life care that emphasises working collaboratively and inclusively with family and friends. Further, overall ndings revealed that there was an absence of policies, procedures and guidelines governing these critical end-of-life care practices, including decision making processes. is means that committed members of the health and social care team working to engage with and support individuals with intellectual disabilities at the end of life are habitually underprepared as they lack appropriate communication skills, experience of dealing with death, relevant training and formal support. On top of this, the LR indicated that there was inadequate collaborative, interagency and multi-professional working. is requires also the integration of the views of the individual with disabilities into models of care, using plain language when communicating with them, especially when breaking bad news that extents to their families and friends. Similarly, the provision of integrated services that respects and fosters autonomy of the dying person with intellectual disabilities. Finally, the LR noted an absence of theory and universal good practice guidance/frameworks on dying, death and intellectual disabilities, and calls for future research framed within the human rights approach.

Assessing Decision-making Capacity: The Interpretation and Implementation of the Mental Capacity Act 2005 Amongst Social Care Professionals

The Mental Capacity Act, 2005 (MCA) provides a statutory framework for assessing an individual’s decision-making capacity and for making best interests decisions on behalf of those who lack capacity. This study explores how the MCA is understood and interpreted by social care practitioners, with specific reference to assessing decision-making capacity. It was complete across four adult health and social care teams in the south-west of England, semi-structured interviews were completed with six social work practitioners. The findings suggest that the interpretation of the principles and criteria for assessing capacity varies and that assessing decision-making capacity can often be a complex process; assessments are often part and parcel of numerous interdependent processes and competing demands. It is necessary to ensure that the different processes are carried out separately and sequentially in order to promote objective capacity assessments. The study outlines the key responsibilities that the local authority has with regards to the implementation of the MCA.

The importance of small steps: making safeguarding personal in North Somerset

Purpose – The purpose of this paper was to establish the extent to which safeguarding procedures in North Somerset identified and reviewed outcomes for the alleged adult at risk. The project aimed to address whether outcomes could be achieved and what steps need to be taken to make the experience of safeguarding personal. Design/methodology/approach – Three social care teams with a responsibility for following up safeguarding referrals were asked to participate in the work and provide feedback on cases completed within the project timeframe. Data were gathered centrally on specific forms and through focus group discussions with social workers. Findings – The findings confirmed the need for a change in practice to ensure safeguarding procedures are personal. Research limitations/implications – The number of completed cases in the timeframe of the project was small and this limits the conclusions. Practical implications – The paper identifies change needed to training and recording systems and recognises th...

The role of unregistered healthcare workers in preventing readmission to hospital: a systematic review protocol

The role of unregistered healthcare workers in preventing readmission to hospital: a systematic review protocol

Knowing me, knowing you

Purpose – The purpose of this paper is to report on the findings of the first stage of a project seeking to improve interprofessional working between general practice and adult social care teams. It develops the current evidence base through findings from focus groups and reflects on the implications of the findings for interprofessional collaboration. Design/methodology/approach – The project involved running seven focus groups with general practice staff and adult social work teams to explore their perceptions and understanding of each other. Findings – The focus groups highlighted that the negative aspects of interprofessional working outweighed the positives. Negatives included perceptions of different value bases, a lack of knowledge about each others’ roles and responsibilities which resulted in resorting to stereotypes, poor interprofessional communication and a sense of an unspoken professional hierarchy with general practitioners (GPs) at the top leading preventing a culture of appropriate challenge. Research limitations/implications – The research has only been conducted with four GP practices and three social work teams that had expressed an interest in improving their interprofessional working. Therefore the findings may not be generalisable. Practical implications – The case study suggests that there is a lack of effective interprofessional working between social care teams and general practice. With the current health and social care agenda focused on integration, this suggests there should be a greater focus on this area. Originality/value – This paper illustrates that despite many years of policy makers promoting better integration, the quality of the interprofessional collaboration between social care teams and general practice remains poor.

Embedding an Integrative Systemic Style of Working Within a Social Care Context

This paper offers an experiential account of how the social workers and family therapists can collaborate within the context of a local authority social care team. The paper presents a joint conceptualisation of the way of working together of those two disciplines with the aim to effect specific change according to the team’s remit. The intention is to share with the social work community a model of practice, which has evolved in this local context. The paper demonstrates the process of an isomorphic congruency between practices offered to work directly with the social work clients and those used by social workers and family therapists in the team’s daily operations. The paper also debates the usefulness of using the linear outcome measure tools demanded by the local authority to evidence practice which itself is non-linear, often messy, complex and unpredictable. The system of work described is proposed as one of the ways of enhancing and eliciting practice wisdom.

G58(P) Multi-agency review of child protection medical reports

The RCPCH Child Protection Companion provides guidance on medical report writing. We wanted to audit local medical reports against this guidance. Reports are shared with social care and police child abuse investigation team (CAIT), contributing to decision making for children. We therefore wished to determine whether our local social care and CAIT teams felt the opinions in the reports were helpful to their decision making. A retrospective audit of reports of 24 children seen in the first half of 2014 was undertaken, using section 16 of the RCPCH companion as standards. 3 reports from each of the 8 consultants were chosen at random. CAIT and social care reviewed the same 24 reports and completed a proforma regarding key aspects of the medical opinion. Patients’ details, consultation time/place, specific concerns, appearance of the child, past medical, family and developmental history were completed in all reports. 75% gave the child’s own words where applicable, 89% gave information regarding school/nursery and 64% commented on parent/carer interaction. Most reports commented on the need for section 47 investigation but made no direct statement on whether it was safe for the child to return home. Social care and CAIT thought 19 and 16 reports respectively were helpful in decision making. Reported unhelpful factors were non-committal wording on the likelihood of NAI, ambiguity around sibling cases and lack of documentation regarding evidence for neglect concerns. Clear documentation of patients’ and consultation details reflects local strong administrative support. Key areas for child protection, notably the words of the child and child parent interaction were lacking and should be highlighted in training. Paediatricians may have made verbal recommendations during the medical but documentation of this is imperative. The satisfaction of CAIT/social care with reports depends upon their expectations as well as the doctor’s clarity. In some cases the doctor could not have given a ‘clear’ opinion based on what was in front of them. It is valuable for local audits of child protection reports to involve local CAIT and social care to optimise the usefulness of reports in safeguarding of children.

An Evidence-Based, Pre-Birth Assessment Pathway for Vulnerable Pregnant Women.

The developmental needs of infants during the first year of life have been emphasised by recent research from a variety of sources highlighting the crucial role that early parent–infant interaction plays. Infants identified as being at significant risk of maltreatment need adequate protection within a time frame consistent with their developmental needs. This briefing paper describes a new care pathway established within a UK-based social care team, which aims to provide early identification, intensive support, timely assessment and decision making for a group of highly vulnerable, pregnant women, their partners and their infants. The pathway of care is described and a case study is presented to illustrate this care pathway. A mother is referred at eighteen weeks of pregnancy and supported post birth for six months. The combination of supporting structured professional judgement by the inclusion of standardised tools and training in a programme specifically developed for high-risk families suggests that this pre-birth risk-assessment process warrants further evaluation.

The Road Ahead To Cure And Prevent Alzheimer's Disease: Implementing Prevention into Primary Care.

Most old adults receive their health care from their primary care practitioner; as a consequence, as the population ages, the manifestations and complications of cognitive impairment and dementia impose a growing burden on providers of primary care. Current guidelines do not recommend routine cognitive screening for older persons by primary care physicians, although the vast majority recommend a cognitive status assessment and neurological examination for subjects with a cognitive complaint. Also, no clinical practice guidelines recommend interventions in older adults with cognitive impairment in primary care settings. However, primary care physicians need to conduct a review of risks and protective factors associated with cognitive decline and organize interventions to improve or maintain cognitive function. Recent epidemiological studies have indicated numerous associations between lifestyle-related risk factors and incidental cognitive impairment. The development of biomarkers could also help in diagnosis, prognosis, selection for clinical trials, and objective assessment of therapeutic responses. Interventions aimed at cognitive impairment prevention should be pragmatic and easy to implement on a large scale in different health care systems, without generating high additional costs or burden on participants, medical and social care teams.

Practice Development Workbook for Nursing, Health and Social Care Teams Dewing Jan , McCormack Brendan , Titchen Angie Practice Development Workbook for Nursing, Health and Social Care Teams 248pp £29.99 Wiley Blackwell 9781118676707 111867670X [Formula: see text

WITH THE growth of practice development over the past 20 years there has been an increased understanding and focus on the importance of systematic, collaborative approaches, that lead to better outcomes for patients and their supporters. The pathways that individuals have followed as practice developers look and feel different, however, what is key is how they/we have applied learning to improve effectiveness, understanding and knowledge of approaches to challenge, support and develop practice.