Using administrative data from a national shared services database to target the delivery of homeless services in the Dublin Region

BackgroundPASS is a national shared services database that captures live information on service user interactions with all state funded NGO and local authority homeless services. In the Dublin region, which accommodates in excess of 70% of the nationalhomeless population, this data was mined and cleansed in order to carry out a k-mean cluster analysis. ObjectiveThe objective was to determine the rate of movement through homeless services and the consumption of resources of different clusters cohorts and to compare these findings with other regions internationally. MethodsFollowing extensive data preparation, the Kuhn and Culhane (1998) k-mean cluster analysis was applied in 2017 to five years of PASS data (2012-2016) and results categorised to align to their typology of homelessness. FindingsResults for Dublin showed patterns similar to those reported in the US, Canada and Denmark, with approximately 80% of services users transitioning quickly through services. These transitional service users accounted for just over one third of total bed-nights while the remaining 20% of episodic and long-term service users accounted for almost two thirds of the bed-nights over the five years. Uniquely, the analysis also considered the patterns of engagement of people sleeping rough and results revealed similar but more extreme patterns with 86% of those rough sleeping accounting for only 28% of outreach contacts with a small number adults accounting for over 70% of all street contacts. ConclusionThe results from the analysis of administrative data were used to inform operations so appropriate ‘Housing First’ responses were developed for those episodically or chronically experiencing homelessness and engaged in sleeping rough.

Description and evaluation of a novel service for “difficult to manage” psychiatric in-patients

Purpose – A new service was developed to provide transitional care between acute and secure services for people with serious mental illness who are considered “difficult to manage”. The purpose of this paper is to evaluate the work of the service by examining referrals made, strategies employed for each referral, and patient outcomes, as well as investigating issues in the service's development and implementation. Design/methodology/approach – A retrospective descriptive study by review of 38 case notes, and qualitative interviews of 47 staff within the service and those referring to the service. Findings – In the first eight months, 38 patients were referred due to violence, aggression and management problems. Most interventions provided by the service involved working with referring staff, rather than direct patient contact. Subsequently, 16 per cent required referral to higher levels of security. Interviews showed the team's aims needed to be more clearly established, but that ward staff found the service to be a useful and productive resource. Research limitations/implications – The study is descriptive and retrospective, but showed that the service provided appropriate interventions for managing patients with serious mental illness and challenging behaviour. Practical implications – A transitional service may have value in keeping patients in the least restrictive setting. Careful planning is needed in designing novel interventions, ensuring clear aims and effective management. Originality/value – The service under study was novel, and may be useful in facilitating successful transfer from, or preventing admission to, secure services.

The Development of an Adult ADHD Transitional Service

Aim:To describe the development of a service addressing the needs of adults with ADHD, and to survey the caseload of this service.Method:This review describes the process of setting up a new service for adults with ADHD. This includes drawing up a service plan to look at the resources required, and arranging shared-care agreements with general practitioners. The service was developed in two phases, with the initial phase accepting transitional patients with an established diagnosis of ADHD, and phase two looking at the assessment of individuals without a previous diagnosis. All referrals to the service were surveyed, and information was collated on age, gender, diagnosis, co-morbidity, medication and employment.Results:The service was set up in November 2007, and over a period of 10 months, 32 referrals were accepted, having met the criteria for assessment. Cases were accepted on the basis that they had a previous diagnosis of ADHD, the majority originating from Child and Adolescent services.The caseload review revealed high levels of comorbidity. The majority of patients were treated with stimulant medication. The ratio of male to females was higher, as expected. The incidence of substance misuse and conduct disorder was consistent with other studies.Conclusion:The demand for a service addressing the needs of adults with ADHD has been high, as evidenced by the volume of referrals received. ADHD persists into adulthood in approximately 50% of children with the diagnosis so follow up into adulthood is crucial.