Social Services Board Research Articles

VP190 A Review Of Best Practices In Five Mental Disorders In Youth

INTRODUCTION:In order to support service planning of the youth program of the East of Montreal Health and Social Services Board, and potentially of the other twenty-five programs across the Quebec province, our hospital-based Health Technology Assessment (HTA) unit was asked to bring evidence of the effective interventions for five most common mental disorders in children and young populations, namely anxio-depressive disorders, attention deficit and hyperactivity disorder, oppositional and conduct disorders, substance abuse disorders, and suicide attempts.METHODS:A review of reviews was conducted for the five disorders in young populations aged 6 to 25 years. This was based exclusively on systematic reviews and meta-analysis of a minimum two randomized-controlled trials. The review was completed with examples of Quebec's good practices in youth mental health gathered from personal research experience of clinical researchers involved in the project. The project involved collaboration with three other hospital units and provincial HTA agencies.RESULTS:No review supporting screening and early detection for the five disorders was identified. Prevention, however, was better covered in the literature, and a clear distinction was made between universal, targeted and indicated interventions. In general, targeted and indicated prevention interventions were effective in the case of anxio-depressive (1) and substance use disorders, while universal prevention strategies seemed to reduce suicide attempts and suicide ideation (2). Effective treatments also exist for these mental disorders. In general, psychotherapies dominated for anxio-depressive and substance use disorders; parental skills dominated in oppositional disorders, whilst pharmacological treatment dominated in attention deficit and hyperactivity disorder (3). Evidence was limited for suicide attempts. The overview of Quebec's good practices allowed identification of interventions or practices already in use in the province.CONCLUSIONS:The review summarized effective interventions for five most common mental disorders in young populations. It also permitted to identify several research gaps, and therefore research recommendations were formulated for the province's health research agency.

Editorial introductions

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Roderick James HayRoderick James HayProfessor Hay was born in Cobham, Surrey, he grew up in Devon and now lives in Shipton under Wychwood, Oxfordshire. He was educated at Oxford University, UK and Guys Hospital Medical School, London, UK and has been a Lecturer/Senior Registrar at the London School of Hygiene and Tropical Medicine, UK and at the St. Johns Hospital for Diseases of the Skin, London, UK. He has also been a Research Fellow at the Centers for Disease Control, Atlanta, USA. Professor Hay is currently Chairman of the International Foundation of Dermatology, London, Honorary Professor at the London School of Hygiene and Tropical Medicine and Consultant Dermatologist in Infectious Skin Disease at Kings College Hospital, London, UK. He is a former Head of the School of Medicine and Dentistry and Dean of the Faculty of Medicine and Health Sciences at Queens University, Belfast, Ireland and emeritus Professor of Dermatology. Professor Hay was President of the British Association of Dermatologists 2001–2002, the British Society for Medical Mycology 1997–2002, and the European Confederation of Medical Mycology 1998–2002. He serves on a number of boards including: the Eastern Health and Social Services Board and the International Committee of Dermatology; Professor Hay has authored over 500 scientific papers, books and reports on medical mycology and tropical dermatology, focusing on antifungal chemotherapy, cellular immunology and epidemiology. His present areas of research include studies of the virulence factors of pathogenic fungi and molecular diagnosis as well as health systems research in tropical skin disease. Michael S. NiedermanMichael S. NiedermanMichael Niederman is Professor and Vice-Chairman of the Department of Medicine at the State University of New York at Stony Brook, USA, and Chairman of the Department of Medicine at Winthrop-University Hospital in Mineola, New York, USA. He obtained his medical degree from Boston University School of Medicine, USA, and then completed his training in internal medicine at Northwestern University School of Medicine, USA, before undertaking a pulmonary and critical care fellowship at Yale University School of Medicine, USA. His interests lie in respiratory tract infections, and include mechanisms of airway colonization, the management of community- and hospital-acquired pneumonia, the role of guidelines for pneumonia, and the impact of antibiotic resistance on the management and outcomes of respiratory tract infections. He has published over 350 peer reviewed or review articles, and has lectured widely, both nationally and internationally. Dr Niederman served as co-chairman of the committees that created the American Thoracic Society 1993 and 2001 guidelines for the treatment of community-acquired pneumonia and the 1996 and 2005 committees that wrote guidelines for the treatment of nosocomial pneumonia. He was a member of the ATS/IDSA committee that published guidelines for community-acquried pneumonia in 2007. He is also Editor-in-Chief of Clinical Pulmonary Medicine, and has served on the editorial boards of The American Journal of Respiratory and Critical Care Medicine, Critical Care Medicine, and Chest.

Sources of Information that Influence Social Service Public Policy Decisions

To effectively advocate with local level policy makers it is important for social workers to understand how social services boards are structured as well as the factors that influence their decision-making process. This study explores these factors. Members of the 72 Wisconsin county human/social service boards were surveyed and 223 human/social service board members responded to the survey. Survey participants reported that they primarily use social service agency reports, social service agency staff consultation, and other board members' opinions when making decisions regarding service delivery and social service policy. Recommendations for social workers advocating for their clients are suggested.

Sixth Sense: The Disabled Children and Young People's Participation Project

The Disabled Children and Young Peoples Participation Project (DCYPPP) was established by Barnardos (Northern Ireland) in 2002 to explore ways of involving children and young people with disabilities in decision‐making processes within Children's Services Planning of the Health and Social Services Board. Over 200 young people have participated in its 10 years of existence. This article describes how the DCYPPP practice has evolved in support of the young people and the factors that contribute to its successes. Policy‐makers and professionals at all levels need to recognise the valuable contribution children and young people with disabilities can make and actively seek their engagement.

Pharmacy involvement in formulary development: community pharmacists' views

AbstractA postal survey was carried out in the Eastern health and social services board in Northern Ireland to evaluate the views of community pharmacists (n= 100) on pharmacy involvement in formulary development. There was one mailing, with a response rate of 66 per cent. Most respondents (78.7 per cent) agreed or strongly agreed that pharmacist involvement in formulary development was important. Almost two thirds of responding pharmacists said they would be prepared to approach a GP in relation to such collaborative work and 27 per cent had had previous contact with GPs on the subject. Respondents considered that their input would be particularly useful in improving prescribing, providing cost advice and developing a closer working relationship with GPs. Evaluation of current levels of interprofessional liaison in relation to prescribing issues showed that 33.3 per cent of the pharmacists were already contacted by a GP regularly and 45.4 per cent contacted a GP regularly. Most (80 per cent) rated their working relationship with the GP as useful or very useful. The results suggest that community pharmacists in the Eastern health and social services board are willing to become involved in formulary development, thereby extending the use of practice formularies in general practice and integrating community pharmacy more fully into the primary health care team.

Infant weaning and community pharmacy — the pharmacist's perspective

Abstract Community pharmacists' awareness of the COMA report on “Weaning and the weaning diet” and their knowledge of its recommendations was assessed in a questionnaire distributed to all (n=81) community pharmacists in the Western Health and Social Services Board in Northern Ireland. Sources of information and adequacy of training on childhood nutritional issues were determined. A knowledge score was computed for each pharmacist depending on their responses to questions based on key issues in the COMA report. Completed questionnaires were returned by 48 pharmacists (59 per cent). The COMA report had been read by 14.5 per cent of respondents while 12.5 per cent knew of its recommendations. Others had heard of it but not read it (52 per cent) or had never heard of it (21 per cent). The mean knowledge score was 66 per cent (±17.5). Scores ranged from 18 per cent to 90 per cent, indicating wide variability in pharmacists' knowledge of key recommendations for weaning. Only 29 per cent of pharmacists felt that they were adequately trained to give advice on weaning; 50 per cent felt that they did not have sufficient knowledge and 21 per cent were unsure. Pharmacists indicated that, on average, parents approached them weekly about a weaning topic, which emphasises the need for them to be well informed about current weaning recommendations.

Professor Thomas James Harrison (1919–2010)

Professor Thomas James Harrison (1919–2010)

Social Work with Children when Parents have Mental Health Difficulties: Acknowledging Vulnerability and Maintaining the “Rights of the Child”

The 40 substantive rights contained within the United Nations Convention on the Rights of the Child (UNCRC) 1989, have applied, without discrimination, to all children in the United Kingdom since 1992. However, recurrent tragedies starkly highlight the potential vulnerability of some children when their parents experience mental health difficulties; and many children affected by parental mental illness remain a hidden population, the unique challenges they face going unaddressed. Article 3 of the UNCRC states: “All organisations concerned with children should work towards what is best for each child”. Social workers occupy a critical position in safeguarding the UN Convention rights of children, particularly in situations where mental illness is having an adverse impact on parenting, and where children are “in need” or “at risk”. However, collaboration between Mental Health and Family & Child Care services can be problematic. Poorly-integrated service provision constrained by inadequate resources and training, and complicated by a latent dichotomy between the human rights of parents and the Convention rights of children, can contribute to regrettable outcomes for these most vulnerable families. This article highlights the potential psychological vulnerability of children living in a situation where one or both parents experience mental health difficulties. Evidence regarding the scale and impact of parental mental health difficulties is explored, and discussed in the context of the UNCRC, and the key findings of recent Child Protection Inspections and Health & Social Care inquiries in Northern Ireland. The article draws on relevant literature (specifically the Western and Eastern Health and Social Services Boards Inquiry into the tragic deaths of Madeleine and Lauren O'Neill in Northern Ireland, and the preliminary findings of research being carried out by the authors within the University of Ulster) to illustrate and consider the problems associated with effective social work practice with these families. The article concludes by making recommendations to enhance effective, responsive, collaborative social care provision for children in families experiencing parental mental health difficulties.

P01-106 New diagnostic approaches: To enable care home staff understand and work effectively with behaviours that challenge in dementia

Background:Behaviours that challenge in dementia exceed the capability of care home staff. Evidence shows medication, traditionally the first line treatment has limited benefit, may hasten cognitive decline and is associated with vascular and cardiac problems in older people. Alternatively, admission to hospital occurs despite 90% of behaviours occurring as a response to care practices or environmental factors. Instead, the reasons should be addressed focusing on when, where, why and with whom these behaviours manifest themselves.AIMS In 2006, a five-month pilot study within the Northern Health and Social Services Board (NHSSB) (Antrim and Ballymena, Northern Ireland), using the Newcastle Model, a bio-psycho-social intervention received 20 referrals involving 11 care homes.Method:This new diagnostic approach formulatesbehaviours in terms of peoples’ needs, which are assumed to drive behaviours. The model is a hybrid of well-established ideas from various psychological models,but its distinguishing feature lies in the unique integration of teaching, supervision and intense support provided to care home staff. The NeuroPsychiatric Inventory Caregiver Distress (NPI-D) measures frequency and severity of behaviours and level of distress this causes staff. This was administered pre and post intervention.Results:Four hospital admissions were averted which, based on the average length of stay, would have cost an estimated £81,500. NPI-D scores decreased following interventions.Conclusion:The potential of this pilot study was noted by the Institute of Healthcare Management Quality Awards prompting the NHSSB to fund a Behaviour Sciences Nursing Service. A clinical effectiveness and full cost effectiveness analysis is now planned.

Sexual health promotion in primary care – activities and views of general practitioners and practice nurses

Background Sexual health in Northern Ireland (NI) is poor compared with the rest of Europe with increasing incidences of sexually transmitted infections and one of the highest rates of teenage pregnancy. Traditionally, sexual health services have been provided in a fragmented way by a wide range of different providers but recent sexual health strategies have flagged sexual health as a key activity within the primary care setting.Aim The main aim of the study was to assess the sexual health promotion activities within the primary care setting across one Health and Social Services Board in NI.Methods A series of semi-structured interviews with both general practitioners (GPs) and practice nurses (PNs) was conducted to assess their views on the key issues in relation to sexual health in primary care. A questionnaire survey was also conducted with these health professionals to elicit information about sexual health promotion activities within the primary care setting.Findings The results have shown that promoting sexual health within the primary care setting is often ad hoc and often does not target the ‘at-risk’ population. As such, GPs and PNs tend not to discuss sexual health with non-heterosexual clients or those with learning disabilities due to lack of awareness and training. Health professionals feel inadequately trained to engage in effective sexual health promotion and to provide enhanced sexual health services. Personal embarrassment and lack of time were also identified as barriers for providing effective sexual health care.Conclusion Health professionals within the primary care setting require additional training to deal with the sensitive and complex issues inherent in the area of sexual health.

The pervalence of severe mental handicap in Northern Ireland

There are four administrative areas (Health and Social Services Boards) in Northern Ireland. Two prevalence surveys, carried out several years apart, show that there is a significant geographical gradient in the rates of severe mental handicap (IQ less than 50). The rates in the 20-29-year-old groups in the Eastern and Northern Boards range between 4.07 and 4.82 per thousand; comparable rates in the Southern and Western Boards range between 5.17 and 6.37. A similar gradient was discernible in the distribution of Down's syndrome.

The Male Workforce in Intellectual Disability Services

Abstract Staff shortages are predicted in community social care sector services for people with intellectual disabilities (ID). One option is to attract more men to the workforce, which would also counter the present sex‐ratio (gender) imbalance among workers. Potential strategies for recruitment could be identified by analyzing the characteristics and experiences of the male staff currently employed in such jobs. To do this, the authors undertook three studies: (1) a census of 653 staff in statutory services within one Health and Social Services Board district in Northern Ireland; (2) a survey of 463 staff from both statutory and nonstatutory services; and (3) small sample focus groups with designated male staff. Findings were that fewer than 1 in 5 of the workforce in ID sector services in Northern Ireland were men, with significant variance (0–40%) depending upon the type of services. Men were more likely than women to be in full‐time posts; to be the main wage‐earner in the household, and to have entered ID sector jobs from noncare settings. Male staff reported that their motivation for undertaking work in this sector was often questioned by peers and that they felt exposed to accusations of abuse. Authors conclude that male staff recruitment could be boosted by increased pay and more opportunities for full‐time work and career progression. Career advisers, teachers, and parents need to promote the value and opportunities of work available in ID sector services. The unique contributions of male staff also need to be identified and recognized as a means of retaining existing staff and recruiting others.

Northern Ireland Tier 4 Child and Adolescent Mental Health Services: A Survey of Admissions to the Child and Family Centre, January 2001–April 2004

In-patient care, provided at Tier 4 level, is a specialised field aimed at provision of high-quality care for young people with serious mental health problems. This survey investigates how the regional in-patient unit for children in Northern Ireland functioned. A retrospective investigation was performed of cases admitted under the care of the lead clinician in the unit during the three-year period from January 2001 until April 2004. There were 115 admissions to in-patient care during the period investigated, 14 of these being re-admissions. Sixty-one young people were from within the Eastern Health and Social Services Board area, 16 were from the Northern Health and Social Services Board area, another 16 were from the Western Health and Social Services Board area and the remaining eight were from the Southern Health and Social Services Board area. The mean length of stay was 10.5 weeks. Nineteen young people admitted were emergency referrals. Forty-five young people fulfilled diagnostic criteria for more than one ICD-10 diagnosis. Thirty-seven young people had experienced permanent parental separation. Ten young people were exposed to violence within the parental relationship. Five young people were on the Child Protection Register and 13 were looked-after children. Eighteen mothers had a history of depression. Eight fathers were noted to have a history of substance misuse and four received other psychiatric diagnoses. In 11 cases there was documented evidence of trauma other than abuse. In conclusion, the Child and Family Centre aims to provide a comprehensive and equitable Tier 4 service for young people and their families. Issues such as distance from the unit affect equity. Future service planning should bear this in mind. Tier 4 adolescent services should be developed to meet the needs of the older adolescent population. Family therapists, child psychotherapists, occupational therapists and dieticians should be recruited as a matter of urgency. There is a need for better liaison with adult mental health services. Northern Ireland requires appropriate therapeutic residential and or community service provision for severely disturbed children.

Developing a culture of evidence-based practice in social work agencies in Northern Ireland

Developing evidence-based practice has become a major policy objective in social work agencies throughout the United Kingdom. There has, however, been little empirical study of the perceptions of social work staff concerning the value of evidence-based practice in their work or about its practical development within organisations. This article contributes to the debate on evidence-based practice by reporting on an exploratory workshop for social work staff in the Southern Health and Social Services Board in Northern Ireland. The workshop aimed to identify the professional and organisational barriers to developing evidence-based practice. While highlighting the challenges staff in this social work organisation faced the findings also suggested ways in which these may be overcome. The paper explores the type of policies, structures and resources which may be required in the Southern Health and Social Services Board and by similar agencies in order to develop a culture in which evidence-based social work practice can flourish.

The introduction of innovative nursing and midwifery roles: the perspective of healthcare managers

This paper reports a study exploring issues arising from the introduction of innovative nursing and midwifery roles from the perspective of healthcare managers. In recent years, the number of innovative roles in nursing and midwifery has increased dramatically across all areas of health care. A comprehensive literature review has shown that there is a scarcity of empirical studies to inform policy or the organizational context of this rapidly changing situation. Semi-structured interviews were conducted with all Directors of Nursing, Chief Nurses and Directors of Primary Care in the Health and Social Services Trusts and Boards in Northern Ireland. This study formed the first phase of a larger exploration of innovative roles. Data were collected from July to October 2004. The findings confirm that in recent years there has been a considerable increase in the number and type of innovative nursing and midwifery roles. Themes that emerged from the data included professional identity and number of innovative roles; stimuli for role development; service commissioning; infrastructure support; and perceived value for money. Analysis of the impact of innovative nursing and midwifery roles on other members of staff, notably healthcare assistants, is needed. The internationally increasing number of innovative roles need to be evaluated further with regard to their effect on care outcomes for patients, their families and communities, their cost-effectiveness and to how best to secure the support and commitment of colleagues. Further study should also be undertaken to determine whether innovative role-holders are pioneers in the development of future nursing, or whether they are responding to the workforce needs of the medical profession or to the requirements of the health service to cut costs.

Improving access for patients – a practice manager questionnaire

BackgroundThe administrative and professional consequences of access targets for general practices, as detailed in the new GMS contract, are unknown. This study researched the effect of implementing the access targets of the new GP contract on general practice appointment systems, and practice manager satisfaction in a UK primary health care setting.MethodsA four-part postal questionnaire was administered. The questionnaire was modified from previously validated questionnaires and the findings compared with data obtained from the Western Health and Social Services Board (WHSSB) in N Ireland. Practice managers from the 59 general practices in the WHSSB responded to the questionnaire.ResultsThere was a 94.9% response rate. Practice managers were generally satisfied with the introduction of access targets for patients. Some 57.1% of responding practices, most in deprived areas (Odds ratio 3.13 -95% CI 1.01 – 9.80, p = 0.0256) had modified their appointment systems. Less booking flexibility was reported among group practices (p = 0.006), urban practices (p < 0.001) and those with above average patient list sizes (p < 0.001). Receptionists had not received training in patient appointment management in a quarter of practices. Practices with smaller list sizes were more likely than larger ones to utilise nurses in seeing extra patients (p = 0.007) or to undertake triage procedures (p = 0.062).ConclusionThe findings demonstrated the ability of general practices within the WHSSB to adjust to a demanding component of the new GP contract. Issues relating to the flexibility of patient appointment booking systems, receptionists' training and the development of the primary care nursing role were highlighted by the study.

Developing Everyone's Learning and Thinking Abilities: A Parenting Programme The Southern Area Experience—10 Years On!

The Developing Everyone's Learning and Thinking Abilities (DELTA) parenting programme aims to promote both the holistic development of children and their parent's self-esteem in order to enhance the parent/carer and child relationship. DELTA operates on a multidisciplinary basis using a “Parents as Partners” model. The programme was originally informed by reliable, rigorous research with sound data collection. The aim was to investigate the effects that mothers might have on their children's development by stimulating them through talking, listening and sharing books following the mother's attendance at a parenting programme. Broad positive gains were reported—maternal attitudes changed, as they felt they were sensitised to the natural learning opportunities in the home. Additionally, when fathers were involved significant higher gains were reported. The DELTA project in the Southern Area of Northern Ireland started in 1992 as a pilot project. Following the success of the pilot, the Southern Education and Library Board (SELB), the Southern Health and Social Services Board (SHSSB), the three Health and Social Services Trusts (Armagh/Dungannon, Craigavon/Banbridge, and Newry/Mourne) and the Voluntary sector agreed to work together to provide DELTA as a preventative support programme to parents and carers within their catchment area. It was the intention that DELTA would develop practice using the skills, opportunities and resources available within the area. The SELB/SHSSB employed a development officer in 1995 to facilitate the expansion of the project. Further growth took place in 1998 through the European Union Special Support Programme for Peace and Reconciliation's (Peace II) Measure 5.2, Preventing Exclusion (Childhood Fund). Primary and Post Primary Developments were implemented as a result of unpublished research entitled “Assessment of Parenting Educational Needs”. The SELB secured the funding through Department of Education Northern Ireland initiative. Further expansion took place after 2000 through the government's Sure Start scheme. Changes are taking place again when Newry and Mourne Trust become the lead agency for DELTA on behalf of the Boards in January 2006. Since 1995, over 18,000 parents and carers have taken part in DELTA programmes. This article seeks to provide a description of the project, its strategic and theoretical context, its aims and objectives. It will also look at DELTA's services and activities, how they have developed, and gives some feedback from parents.

The challenges associated with providing community care for people with complex needs in rural areas: a qualitative investigation

The aim of the present study was to explore the experiences of recipients and providers of community care in rural areas in Northern Ireland. Additionally, the authors sought to examine the impact of location, housing and environmental factors on the delivery of community care to older people with complex needs. Individual, semistructured interviews were held with service users (n = 17) and family carers (n = 14). Individual and focus group interviews were conducted with care assistants, health and social care professionals, and senior managers from a large health and social care trust and health and social services board in Northern Ireland. The importance of enabling older people to remain in their own homes and communities was emphasised by all participants. The main challenges associated with care provision in rural areas included: difficulties recruiting care assistants; lack of choice of care assistants; isolation; travel and distance between clients and their care assistants; and poor housing conditions. There was a general consensus among participants that the effectiveness of rural community care was perceived to be reliant upon the goodwill of the community. Additionally, changing demographic trends and the predicted shortfall in the number of formal and informal carers were considered key issues for service planners. A number of creative strategies could be used to address many of the limitations associated with rural isolation. These should involve capitalising on available community networks. However, planners should also acknowledge that additional resources are required to maintain older people in rural communities.

Patient-Active Prevention in Primary Dental Care: A Characterisation of General Practices in Northern Ireland

To investigate the preventive orientation of general dental practices by examining their patient-active prevention activities, practice policies for prevention and employment strategies. All general dental practices located within the region of the Eastern Health and Social Services Board (EHSSB) in Northern Ireland were contacted and invited to participate. A questionnaire assessed practice characteristics, patient-active prevention, practice policies and employment strategies. The principal general dental practitioner (GDP) was invited to complete the questionnaire. Seventy-seven per cent of practices participated. Nearly all the practices provided patient-active prevention; however, lower proportions of dentists provided advice on diet for dental caries (3%), oral hygiene instruction, fluoride toothpaste use and interdental cleaning (7%) with each new course of dental treatment. 'Patient-active' prevention practices were 5.8 times more likely to employ a hygienist and 5.3 times more likely to have a practice policy to screen for oral cancer. These findings suggest that the employment of a hygienist is central to the reorientation of primary dental care. The Government must be encouraged to provide the financial means to allow primary care to shift from being disease-centred to health-focused.

Fit For the Future? Future Development of the Emergency Duty Team

In July 2000 the first Emergency Duty Team was established within the Eastern Health & Social Services Board in Northern Ireland, fundamentally changing the way in which out of hours social work services are provided. The other three Boards are now also examining how they might provide for their statutory responsibilities out of hours and are looking to the model of the Emergency Duty Team. The concept of the Emergency Duty Team is now almost 30 years old. With services becoming more fragmented and specialist, has the generic out of hours role been redefined too generally or does it still remain a credible model for dealing with all social work emergencies out of hours? This paper is a personal reflection on the establishment and current position of the Emergency Duty Team and seeks to argue that Emergency Duty Social Work is a distinct and specialist form of practice and that its staff have developed a level of expertise in crisis resolution across the spectrum of emergency social work intervention providing a competent service at a modest cost.