On (not) learning from self-neglect safeguarding adult reviews

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Michael Preston-Shoot
Keyword(s):  
Thematic Analysis ◽  
Good Practice ◽  
Evidence Base ◽  
National Database ◽  
Effective Practice ◽  
Data Set ◽  
Content Type ◽  
Core Data ◽  
The Core ◽  
National Analysis

Purpose The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. It also explores whether lessons are being learned from the findings and recommendations of an increasing number of reviews on self-neglect cases. Design/methodology/approach Further published reviews are added to the core data set, mainly drawn from the websites of safeguarding adults boards (SABs). Thematic analysis is updated using the domains used previously. The domains and the thematic analysis are grounded in the evidence-based model of good practice, reported in this journal previously. Findings Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. Multiple exclusion homelessness and alcohol misuse are prominent. Some SABs are having to return to further cases of self-neglect to review, inviting scrutiny of what is (not) being learned from earlier findings and recommendations. Research limitations/implications The national database of reviews commissioned by SABs remains incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. National Health Service Digital annual data sets do not enable the identification of reviews by types of abuse and neglect. However, the first national analysis of SARs has found self-neglect to be the most prominent type of abuse and/or neglect reviewed. Drawing together the findings builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Practical implications Answering the question “why” remains a significant challenge for SARs. The findings confirm the relevance of the evidence-base for effective practice but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of research and other published SARs might assist with answering the “why” question. Greater scrutiny is needed of the impact of the national legal, policy and financial context within which adult safeguarding is situated. Originality/value The paper extends the thematic analysis of available reviews that focus on study with adults who self-neglect, further reinforcing the evidence base for practice. Propositions are explored, concerned with whether learning is being maximised from the process of case review.

scholarly journals Safeguarding adult reviews: informing and enriching policy and practice on self-neglect

2020 ◽  
Vol 22 (4) ◽  
pp. 199-215 ◽  
Author(s):  
Michael Preston-Shoot
Keyword(s):  
Thematic Analysis ◽  
Good Practice ◽  
Evidence Base ◽  
National Database ◽  
Annual Data ◽  
Effective Practice ◽  
Data Set ◽  
Content Type ◽  
Core Data ◽  
The Core

Purpose The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis and explore the degree to which SARs draw upon available research and learning from other completed reviews. Design/methodology/approach Further published reviews are added to the core data set, mainly drawn from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains used previously. The four domains and the thematic analysis are rounded in the evidence-based model of good practice, reported in this journal previously. Multiple exclusion homelessness and alcohol misuse are prominent in this sample of reviews. Findings Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. Multiple exclusion homelessness emerges as a subset within this sample, demonstrating that SABs are engaging in reviews of people who die on the streets or in temporary accommodation. Research limitations/implications The national database of reviews commissioned by SABs remains incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. NHS Digital annual data sets do not enable identification of reviews by types of abuse and neglect. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Practical implications Answering the question “why” remains a significant challenge for safeguarding adult reviews. The findings confirm the relevance of the evidence-base for effective practice but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of research and other published SARs might assist with answering the “why” question, drawing attention where appropriate to policies being pursued by the central government that undermine any initiative to end rough sleeping. Originality/value This paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence-base for practice. The evidence-base also supports practice with individuals who experience multiple exclusion homelessness. Policymakers and practitioners have an approach to follow in this complex, challenging and demanding area of practice.

scholarly journals Self-neglect and safeguarding adult reviews: towards a model of understanding facilitators and barriers to best practice

2019 ◽  
Vol 21 (4) ◽  
pp. 219-234 ◽  
Author(s):  
Michael Preston-Shoot
Keyword(s):  
Thematic Analysis ◽  
Good Practice ◽  
National Database ◽  
Evidence Based ◽  
Effective Practice ◽  
Data Set ◽  
Content Type ◽  
Core Data ◽  
The Core ◽  
Evidence Based Model

Purpose The purpose of this paper is twofold: first, to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis; second, to draw together the learning available from this data set of reviews to propose a model of good practice that can be used as the basis for subsequent SARs. Design/methodology/approach Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains employed previously. A sufficient number of reviews have been performed from which to construct an evidence-based model of good practice. A framework is presented with the proposition that this can be used as a proportional methodology for further SARs where self-neglect is in focus. Findings Familiar findings emerge from the thematic analysis. This level of analysis, constructed over time and across reviews, enables a framework to be developed that pulls together the findings into a model of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners involved in such cases. This framework can then be used as an evidence-based model with which to review new cases where SARs are commissioned. Research limitations/implications The national database of reviews commissioned by SABs is incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless enables conclusions to be proposed about the components of effective practice, and effective policy and organisational arrangements for practice. Future reviews can then explore what enables such effective to be achieved and what barriers obstruct the realisation of effective practice. Practical implications Answering the question “why” is a significant challenge for SARs. A framework is presented here, drawn from research on SARs featuring self-neglect, that enables those involved in reviews to explore the enablers and barriers with respect to an evidence-based model of effective practice. The framework introduces explicitly research and review evidence into the review process. Originality/value The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also proposes a new approach to SARs by using the findings and recommendations systematically within a framework designed to answer “why” questions – what promotes and what obstructs effective practice.

scholarly journals Learning from safeguarding adult reviews on self-neglect: addressing the challenge of change

2018 ◽  
Vol 20 (2) ◽  
pp. 78-92 ◽  
Author(s):  
Michael Preston-Shoot
Keyword(s):  
Thematic Analysis ◽  
Action Plan ◽  
Evidence Base ◽  
Practice Change ◽  
National Database ◽  
Policy And Practice ◽  
Data Set ◽  
Content Type ◽  
Core Data ◽  
The Core

Purpose The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis, and to address the challenge of change, exploring the necessary components beyond an action plan to ensure that findings and recommendations are embedded in policy and practice. Design/methodology/approach Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains employed previously. The repetitive nature of the findings prompts questions about how to embed policy and practice change, to ensure impactful use of learning from SARs. A framework for taking forward an action plan derived from an SAR findings and recommendations is presented. Findings Familiar, even repetitive findings emerge once again from the thematic analysis. This level of analysis enables an understanding of both local geography and the national legal, policy and financial climate within which it sits. Such learning is valuable in itself, contributing to the evidence base of what good practice with adults who self-neglect looks like. However, to avoid the accusation that lessons are not learned, something more than a straightforward action plan to implement the recommendations is necessary. A framework is conceptualised for a strategic and longer-term approach to embedding policy and practice change. Research limitations/implications There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here enables conclusions to be reached about issues to address locally and nationally to transform adult safeguarding policy and practice. Practical implications Answering the question “how to create sustainable change” is a significant challenge for SARs. A framework is presented here, drawn from research on change management and learning from the review process itself. The critique of serious case reviews challenges those now engaged in SARs to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice. Originality/value The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of following up SARs by using the findings and recommendations systematically within a framework designed to embed change in policy and practice.

scholarly journals On self-neglect and safeguarding adult reviews: diminishing returns or adding value?

2017 ◽  
Vol 19 (2) ◽  
pp. 53-66 ◽  
Author(s):  
Michael Preston-Shoot
Keyword(s):  
Thematic Analysis ◽  
Annual Reports ◽  
National Database ◽  
Service Improvement ◽  
Policy And Practice ◽  
Data Set ◽  
Content Type ◽  
Core Data ◽  
The Core

Purpose The purpose of this paper is twofold: first, to update the core data set of self-neglect serious case reviews (SCRs) and safeguarding adult reviews (SARs), and accompanying thematic analysis; second, to respond to the critique in the Wood Report of SCRs commissioned by Local Safeguarding Children Boards (LSCBs) by exploring the degree to which the reviews scrutinised here can transform and improve the quality of adult safeguarding practice. Design/methodology/approach Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs) and from contacts with SAB independent chairs and business managers. Thematic analysis is updated using the four domains employed previously. The findings are then further used to respond to the critique in the Wood Report of SCRs commissioned by LSCBs, with implications discussed for Safeguarding Adult Boards. Findings Thematic analysis within and recommendations from reviews have tended to focus on the micro context, namely, what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis enables an understanding of local geography. However, there are other wider systems that impact on and influence this work. If review findings and recommendations are to fully answer the question “why”, systemic analysis should appreciate the influence of national geography. Review findings and recommendations may also be used to contest the critique of reviews, namely, that they fail to engage practitioners, are insufficiently systemic and of variable quality, and generate repetitive findings from which lessons are not learned. Research limitations/implications There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here against the strands in the critique of SCRs enables conclusions to be reached about their potential to transform adult safeguarding policy and practice. Practical implications Answering the question “why” is a significant challenge for SARs. Different approaches have been recommended, some rooted in systems theory. The critique of SCRs challenges those now engaged in SARs to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice. Originality/value The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of conducting SARs by using the analysis of themes and recommendations within this data set to evaluate the critique that reviews are insufficiently systemic, fail to engage those involved in reviewed cases and in their repetitive conclusions demonstrate that lessons are not being learned.

scholarly journals Towards explanations for the findings of serious case reviews: understanding what happens in self-neglect work

2016 ◽  
Vol 18 (3) ◽  
pp. 131-148 ◽  
Author(s):  
Michael Preston-Shoot
Keyword(s):  
Thematic Analysis ◽  
Evidence Base ◽  
Annual Reports ◽  
National Database ◽  
Service Improvement ◽  
Content Type ◽  
Personal Impact ◽  
Systemic Analysis ◽  
Systemic Theory ◽  
Level Of Analysis

Purpose – The purpose of this paper is to draw on systemic and psychodynamic theories to subject published serious case reviews (SCRs) involving self-neglect to a deeper level of scrutiny, in order to understand how complex contexts impact on self-neglect work. It also updates the dataset of self-neglect SCRs and accompanying thematic analysis. Design/methodology/approach – Psychodynamic and systemic ideas are applied to the content of published SCRs in order to understand how different contexts – societal, legal, organisational, professional and personal – impact on and are influenced by work with adults who self-neglect. Further published reviews are added to the core dataset, with thematic analysis updated using four domains. Findings – Thematic analysis within and recommendations from SCRs have focused on the micro context, what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis also commonly extends to how organisations have worked together and how Local Safeguarding Adults Board (LSABs) have supported and scrutinised their collaboration. This level of analysis enables an understanding of local geography. However, there are wider systems that impact on and influence this work, especially law and the societal context. If review findings and recommendations are to fully answer the question why, systemic analysis should be extended to appreciate the influence of national geography. Research limitations/implications – There is still no national database of reviews commissioned by LSABs so the dataset reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in LSAB annual reports. This makes learning for service improvement challenging. Practical implications – Answering the question why is a significant challenge for safeguarding adults reviews (SARs). Different approaches have been recommended, some rooted in systems theory. The theoretical formulations here extend the lens of systemic analysis on the different contexts that influence how practitioners work with adults who self-neglect and simultaneously are shaped by that work. This adds to the practice, management and organisational evidence base for working with adults who self-neglect but also shines the analytic lens on legal and policy mandates. Originality/value – The paper extends the use of systemic theory for understanding and learning from practice with adults who self-neglect and additionally offers psychodynamic formulations to appreciate what happens within and between practitioners and their organisations. The paper therefore contributes new perspectives to the methodology for conducting SARs. It also extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice.

Supporting early learning for children under three: research and practice

2014 ◽  
Vol 9 (2) ◽  
pp. 177-187 ◽  
Author(s):  
Sandra Mathers ◽  
Kathy Sylva ◽  
Naomi Eisenstadt ◽  
Elena Soukakou ◽  
Katharina Ereky-Stevens
Keyword(s):  
Early Childhood ◽  
Evidence Base ◽  
Current Evidence ◽  
Effective Practice ◽  
Policy And Practice ◽  
Content Type ◽  
Expert Review ◽  
Starting Point ◽  
The Usa ◽  
Early Childhood Settings

Purpose – The purpose of this paper is to review the literature on young children's learning at home and in early childhood settings, in order to identify key caregiving practices which support the learning and development of children under three. Design/methodology/approach – Starting with well-known reviews carried out in England, the USA, Australia and New Zealand, the authors searched the literature for evidence of the developmental needs of babies and toddlers. They then drew on the psychological and educational literatures to identify key practices supporting physical development, learning and communication, using expert review to build on the scientific research in areas where evidence was sparse. Findings – The review explores three key areas of practice: play-based activities and routines; support for communication and language; and opportunities to move and be physically active. Research limitations/implications – This review is not systematic or exhaustive, but aims to integrate current evidence within these three key areas in a succinct and accessible manner. The authors recognise that there are many other dimensions of effective practice, many of which are addressed elsewhere in this special edition, as well as myriad other influences on children's development, including social, family and environmental factors. Originality/value – Worldwide, growing numbers of children under three are experiencing non-parental care in early childhood settings. In comparison to evidence for preschool children, the literature on effective practice for under-threes is sparse. Given the urgent need for information to guide policy and practice, this paper provides a starting point and calls for a multi-source approach to strengthening the evidence base.

Facilitators and barriers to developing firefighter resilience

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rebecca Rose Conway ◽  
Sara Waring
Keyword(s):  
Thematic Analysis ◽  
Design Methodology ◽  
Evidence Base ◽  
Structured Interviews ◽  
Content Type ◽  
Formal Support ◽  
The United Kingdom ◽  
Support Mechanisms ◽  
Facilitators And Barriers ◽  
Potential Improvement

PurposeDeveloping resilience is vital for firefighters and other practitioners exposed to trauma as part of their day-to-day work in maintaining physical and mental resilience. However, further understanding of what factors facilitate and hinder the development of firefighter resilience and why is needed. The current study evaluates efficacy of support mechanisms currently in place and develops an evidence base for interventions to support development of firefighter resilience.Design/methodology/approachSemi-structured interviews were conducted with 12 firefighters from across two regions in the United Kingdom, the Northwest and Southeast of England. Thematic analysis was used to analyse transcripts, highlighting themes within, and across, services to identify what factors affect development of firefighter resilience and why.FindingsThematic analysis highlighted four key themes shared by firefighters across regions: “informal support”, “formal support”, “basic welfare measures” and “trust”. Importantly, how effective formal measures are perceived to be and the willingness for firefighters to access these resources was dependent upon the level of trust held in senior management. Firefighters across locations highlighted levels of trust were affected by industrial actions which created divides. Accordingly, one way firefighter resilience may be further promoted is by altering how formal support mechanisms are accessed.Originality/valueAlthough existing research has found factors which promote resilience of firefighters, evaluation of specific services is lacking. The current research highlights areas among two UK services where resilience is effectively being promoted and areas for potential improvement.

scholarly journals Walking side-by-side: Recovery Colleges revolutionising mental health care

2018 ◽  
Vol 22 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Joanne Sommer ◽  
Katherine Gill ◽  
Jane Stein-Parbury
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Thematic Analysis ◽  
Evidence Base ◽  
Fundamental Aspect ◽  
Health Staff ◽  
Personal Recovery ◽  
Mental Health Staff ◽  
Content Type ◽  
Group Interviews

Purpose The Recovery College model is an innovative approach to providing education to consumers, carers and mental health staff, with the potential to facilitate both personal recovery gains and organisational transformation towards recovery-focused service provision. The purpose of this paper is to explore the experiences of students who attended the South Eastern Sydney Recovery College (SESRC). Design/methodology/approach An exploratory, descriptive qualitative design was employed with data collected through seven focus group interviews with consumers and mental health staff who had participated in courses run by the SESRC. Thematic analysis of the data was conducted using both deductive and inductive processes in order to interpret the data. Findings All participants were positive about their involvement in the RC. Four themes emerged from the thematic analysis: connection with others, hope for the future, the importance of the lived experience, and changing attitudes and systems. Originality/value The outcomes of this study indicate that the SESRC is achieving its aims in relation to both personal recovery gains, and the potential to impact on service transformation. It highlights the centrality of co-production as a fundamental aspect of the Recovery College model. This paper contributes to the emerging evidence base for this model and provides evidence that this model is applicable to the Australian context.

scholarly journals Evolutionary Dynamics Based on Comparative Genomics of Pathogenic Escherichia coli Lineages Harboring Polyketide Synthase (pks) Island

mBio ◽  
2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Arya Suresh ◽  
Sabiha Shaik ◽  
Ramani Baddam ◽  
Amit Ranjan ◽  
Shamsul Qumar ◽  
...  
Keyword(s):  
Comparative Genomics ◽  
Maximum Likelihood ◽  
High Throughput ◽  
Core Genome ◽  
Polyketide Synthase ◽  
Clinical Implications ◽  
Data Set ◽  
Content Type ◽  
E Coli ◽  
The Core

ABSTRACT The genotoxin colibactin is a secondary metabolite produced by the polyketide synthase (pks) island harbored by extraintestinal pathogenic E. coli (ExPEC) and other members of the Enterobacteriaceae that has been increasingly reported to have critical implications in human health. The present study entails a high-throughput whole-genome comparison and phylogenetic analysis of such pathogenic E. coli isolates to gain insights into the patterns of distribution, horizontal transmission, and evolution of the island. For the current study, 23 pks-positive ExPEC genomes were newly sequenced, and their virulome and resistome profiles indicated a preponderance of virulence encoding genes and a reduced number of genes for antimicrobial resistance. In addition, 4,090 E. coli genomes from the public domain were also analyzed for large-scale screening for pks-positive genomes, out of which a total of 530 pks-positive genomes were studied to understand the subtype-based distribution pattern(s). The pks island showed a significant association with the B2 phylogroup (82.2%) and a high prevalence in sequence type 73 (ST73; n = 179) and ST95 (n = 110) and the O6:H1 (n = 110) serotype. Maximum-likelihood (ML) phylogeny of the core genome and intergenic regions (IGRs) of the ST95 model data set, which was selected because it had both pks-positive and pks-negative genomes, displayed clustering in relation to their carriage of the pks island. Prevalence patterns of genes encoding RM systems in the pks-positive and pks-negative genomes were also analyzed to determine their potential role in pks island acquisition and the maintenance capability of the genomes. Further, the maximum-likelihood phylogeny based on the core genome and pks island sequences from 247 genomes with an intact pks island demonstrated horizontal gene transfer of the island across sequence types and serotypes, with few exceptions. This study vitally contributes to understanding of the lineages and subtypes that have a higher propensity to harbor the pks island-encoded genotoxin with possible clinical implications. IMPORTANCE Extraintestinal pathologies caused by highly virulent strains of E. coli amount to clinical implications with high morbidity and mortality rates. Pathogenic E. coli strains are evolving with the horizontal acquisition of mobile genetic elements, including pathogenicity islands such as the pks island, which produces the genotoxin colibactin, resulting in severe clinical outcomes, including colorectal cancer progression. The current study encompasses high-throughput comparative genomics and phylogenetic analyses to address the questions pertaining to the acquisition and evolution pattern of the genomic island in different E. coli subtypes. It is crucial to gain insights into the distribution, transfer, and maintenance of pathogenic islands, as they harbor multiple virulence genes involved in pathogenesis and clinical implications of the infection.

Making peer-focused self-management programmes work in public mental health

2018 ◽  
Vol 13 (5) ◽  
pp. 257-263 ◽  
Author(s):  
Emily Satinsky ◽  
David Crepaz-Keay ◽  
Antonis Kousoulis
Keyword(s):  
Mental Health ◽  
Good Practice ◽  
Public Mental Health ◽  
Evidence Base ◽  
Self Management ◽  
Management Skills ◽  
Content Type ◽  
At Risk Populations ◽  
Mental Health Foundation ◽  
Service Paradigm

Purpose The purpose of this paper is to review the Mental Health Foundation’s experiences designing, implementing and evaluating peer-focused self-management programmes. Through a discussion of barriers and good practice, it outlines ways to be successful in making such projects work to improve mental health and wellbeing among at-risk populations. Design/methodology/approach A total of 11 Mental Health Foundation programmes implemented over the past ten years were reviewed through reading manuals and publications and interviewing programme managers. Key data were extracted from each programme to analyse trends in aims, outcomes and recommendations. Findings Through a focus on peer-work, programmes taught individuals from a variety of societal sectors self-management skills to effectively deal with life stressors. Through sharing in non-judgmental spaces and taking ownership of programme design and content, individuals realised improvements in wellbeing and goal achievement. Practical implications Good practice, barriers and recommendations can be taken from this review and applied to future peer-focused self-management programmes. By better embedding quantitative and qualitative evaluations into programme development and implementation, programmes can add to the evidence base and effectively target needs. Originality/value This review lays out valuable experience on an innovative community service paradigm and supports the evidence on effectiveness of peer-focused self-management programmes with a variety of group populations.

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