• Barriers facing social workers undertaking direct work with children and young people with a learning disability who communicate using non-verbal methods

      Prynallt-Jones, Katherine A.; Carey, Malcolm; Doherty, Pauline; University of Chester (Oxford University Press, 2017-03-03)
      Abstract: This paper analyses data drawn from a small group of qualified social workers’ specialising in work with disabled children who communicate using non-verbal methods. While a number of studies have criticised social services for neglecting disabled children, this paper re-evaluates evidence from the standpoint of a small group of experienced practitioners. Three substantive themes are explored which include: problems faced by practitioner’s communicating with children and young people; barriers to direct work; and positive engagement or use of creative methods. Among other findings, the paper highlights the complexity of communication techniques when seeking to accommodate diverse service user and carer needs, as well as creative responses used by practitioners despite significant barriers that include limited available training, technology and financial resources. Despite policy initiatives and legal requirements emphasising the importance of direct work and participation with disabled children, the conclusion reiterates the narrow focus of current risk-averse social work around disability, as well a need for additional resources and training to improve relationships, communication and meaningful support for children and young people that meet basic legal requirements.
    • Cannabis use is associated with increased psychotic symptoms and poorer psycho-social functioning in first-episode psychosis: A report from the UK National EDEN study

      Seddon, Jennifer L.; Birchwood, Max; Copello, Alex; Everard, Linda; Jones, Peter B.; Fowler, David; Amos, Tim; Freemantle, Nick; Sharma, Vimal; Marshall, Max; et al. (Oxford University Press, 2015-11-04)
      Background: The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode psychosis (FEP) and the link with symptomatic course and outcome over one year post psychosis onset. Method: 1027 FEP patients were recruited upon inception to specialised early intervention services for psychosis in the UK. Participants completed assessments at baseline, six and twelve months. Results: The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psycho-social functioning. Continued use of cannabis following the first episode of psychosis was prognostic of outcome at one year. These associations were significant after adjusting for age, gender, DUP, age of psychosis onset, ethnicity and other drug use. Conclusion: This is the largest cohort study of first-episode psychosis patients receiving care within early intervention services. Cannabis use, in particular continued use, is associated with poorer symptomatic and functional outcome during the first-episode of psychosis. The results highlight the need for effective and early intervention for cannabis use in FEP.
    • Dietary assessment in minority ethnic groups: A systematic review of portion size estimation instruments relevant for the UK

      Almiron-Roig, Eva; Aitken, Amanda; Galloway, Catherine; Ellahi, Basma; MRC Elsie Widdowson Laboratory, Cambridge, UK. Centre for Nutrition Research, University of Navarra, Pamplona, Spain. Faculty of Health and Social Care, University of Chester, Chester, UK (Oxford University Press, 2016-03-14)
      Context: Dietary assessment in minority ethnic groups is critical for surveillance programmes and for implementing effective interventions. A major challenge is the accurate estimation of portion sizes for traditional foods/dishes. Objective: To systematically review published records up to 2014 describing a portion size estimation element (PSEE) applicable to dietary assessment of UK-residing ethnic minorities. Data sources, selection, extraction: Electronic databases, internet sites, and theses repositories were searched generating 5683 titles from which 57 eligible full-text records were reviewed. Data analysis: Forty-two publications aimed at minority ethnic groups (n=20) or autochthonous populations (n=22) were included. The most common PSEE (47%) were combination tools (e.g. food models and portion size lists); followed by portion size lists in questionnaires/guides (19%); image-based and volumetric tools (17% each). Only 17% PSEE had been validated against weighed data. Conclusions: When developing ethnic-specific dietary assessment tools it is important to consider customary portion sizes by sex and age; traditional household utensil usage and population literacy levels. Combining multiple PSEE may increase accuracy but such tools need validating.
    • Exploring peer mentoring as a form of innovative practice with young people at risk of child sexual exploitation.

      Buck, Gillian; Lawrence, Angela; Ragonese, Ester; University of Chester; Liverpool John Moores University (Oxford University Press, 2017-09-02)
      Peer-led approaches hold unique and innovative potential as a response to child sexual exploitation (CSE), yet little is known about such approaches in this field. This study aims to increase understanding by listening to young people using one such service. Qualitative methods were adopted in an attempt to understand how young people make sense of peer mentoring, data were collected through self-completion booklets, interviews and a focus group, and analysed using thematic analysis and Gilligan’s listening guide (see Kiegelmann, 2009). Given the small and local sample, the findings presented are not representative; rather they provide a snapshot, which enables us to consider the approach with this client group and the broader implications for peer-led practices. Peer mentoring emerges here as a method which may have emotional, practical and inter-personal benefits for young people facing multiple vulnerabilities. It also, importantly, reaches young women from hidden populations, who are often missing from, or missed by, support services. The article concludes by reflecting on the dilemmas associated with peer-led work and by outlining suggestions made by young people themselves, in the hope that inherent strengths in the approach can be recognised and embedded.
    • Finding the Forgotten: Motivating Military Veterans to Register with a Primary Healthcare Practice

      Finnegan, Alan; Jackson, Robin; Simpson, Robin; University of Chester; NHS Bury Clinical Commissioning Group; Ministry of Defence Deanery (Oxford University Press, 2018-05-09)
      Introduction: In the UK, primary healthcare practices choose from a series of Read codes to detail certain characteristics onto a patient's medical documentation. One of these codes is for military veterans indicating a history relating to military service. However, veterans are poor at seeking help, with research indicating that this code is only applied in 7.9% of cases. Clinical staff have a clear role in motivating veterans to declare their ex-Forces status or register with a primary healthcare center. The aim of this study was to motivate veterans to notify primary healthcare staff of their armed forces status or register with a general practitioner, and to improve primary healthcare staff's understanding of veterans' health and social care issues. Materials and Methods: Data were provided by four primary healthcare centers' containing 40,470 patients in Lancashire, England during 2017. Pre- and post-patient medical record Read Code searches were conducted either side of a 6-wk intervention period centered on an advertising campaign. The data identified those veterans with the military specific Read code attached to their medical record and their age, gender, marital status and mental health disorders. Further information was gathered from interviews with eight members of staff, some of whom had completed an e-learning veteran healthcare academic module. The study was approved by the University of Chester's Research Ethics Committee. Results: The pre-intervention search indicated that 8.7% (N = 180) of veterans were registered and had the correct military specific code applied to their medical record. Post-intervention, this figure increased by nearly 200% to N = 537. Mental health disorders were present in 28% (N = 152) of cases, including 15% (N = 78) with depression. Interviews revealed the primary healthcare staff's interpretation of the factors that motivated patients to declare their ex-Forces status and the key areas for development. Conclusion: The primary healthcare staff took ownership and responsibility for this initiative. They were creative in introducing new ways of engaging with the local armed forces community. Many veterans' and staff were unaware of veterans' entitlement to priority medical services, or the wider provisions available to them. It is probable that veterans declaring their military status within primary healthcare, or registering with a general practitioner for the first time is likely to increase. Another review will be undertaken after 12 mo, which will provide a better indication of success. There remains however an ongoing need to reach out to those veterans who never access a primary healthcare practice. This paper adds to the limited international empirical evidence undertaken to explore help-seeking behavior in an armed forces community. The positive outcomes of increased awareness and staff commitment provide a template for improvement across the UK, and will potentially stimulate similar initiatives with international colleagues.
    • The fragmentation of social work and social care: some ramifications and a critique

      Carey, Malcolm; University of Chester (Oxford University Press, 2015-09-29)
      This paper critically appraises the impact of the fragmentation of social care and social work. In particular it examines the impact of splintered services and roles upon employees, service users and carers. The article concentrates upon three inter-related areas as part of a more general critique: first, reliability of services; second, relations with stakeholders; and finally, the identity of employees. Despite differences across sectors and some largely collateral benefits it is proposed that fragmentation has promoted inconsistent and unreliable services, the development of superficial relations with users and carers and the loss of belonging and fractured identities of social care employees. Fragmentation regularly spoils professional identities and generates uncertainty amidst attempts to provide effective or reliable services. Indeed fragmented, disorganised or reductive provisions often generate new risks for the recipients of services.
    • Mind the Gaps: The rise and implications of cynicism within social work

      Carey, Malcolm; University of Chester (Oxford University Press, 2012-08-24)
      This paper explores the notable rise of cynicism among state social workers in Britain. Theoretically, cynicism has been viewed as ‘deviant emotion’ and pathology or as offering a type of employee resistance that may protect or support a person’s identity. Drawing upon case study research with practising social workers, the article looks at three different case examples of employee cynicism. These include the cynic as organisational survivor, disenfranchised sceptic or altruist. It was found that, although cynicism within social work predominately emerges as an emotional response to structural change, other factors such as those embodied within professional discourses and government or academic rhetoric can also impact. Other factors such as risk-averse assumptions that distance the practitioner from the ‘service user’ or colleagues can also have influence. Although often viewed negatively, cynicism can greatly benefit an organisation or motivate a practitioner to challenge normative principles and promote the needs of service users and carers.
    • New psychoactive substances: the use and the associated health and social harm in Telford and Wrekin

      Mabhala, Mzwandile A.; University of Chester (Oxford University Press, 2017-10-20)
      Background: Although NPS use is increasing, the scale of their use and harms remains unclear. Reports from the United Kingdom show downward trends in drug use in England and Wales among 11 to 15-year-olds, but also a steady increase in NPS use. However, NPS use remains lower than that of many traditional illicit drugs. This paper presents the correlations between age and the awareness, use and accessibility of NPS in Telford and Wrekin local authority, England. Methods: A self-administered questionnaire completed by 204 participants assessed socio-demographic information and awareness, accessibility, effects, uses, and health and social harms of NPS. Their mean age was 25.7 years (SD = 10.9). Data analysis used the IBM SPSS statistical package version 21, with significance level set at p < 0.05 and confidence interval at 95%. Spearman’s correlation coefficiencies (rho) determined associations between variables. Results: Descriptive statistics showed that 85.8% of respondents were aware of NPS, 33% knew other users, and 9.8% had ever used it. 40.2% said that access to NPS was easy, 35.8% very easy. The study showed a rho of 0.3 between age and knowing of NPS (P ≤ 0.000); rho of 0.5 between age and knowing NPS users (P ≤ 0.000); rho of 0.28 between age and number of NPS users they knew (P ≤ 0.000); rho of 0.14 between age and the number of times they accept and consume NPS (P ≤ 0.040); rho of 0.042 between age and being offered NPS by someone you know (P = 0.548); rho of 0.11 between age and being offered NPS by strangers (P = 0.097); and rho of 0.08 between age and perceived ease of access to NPS (P = 0.253). Conclusion: While young people’s NPS use remains low, they are more likely to use them than the general population. Despite young people’s high levels of NPS awareness, their knowledge of higher numbers of NPS users raises concerns about their exposure. We recommend making more effort to prevent uptake of NPS amongst this group.
    • This is how it feels: activating lived experience in the penal voluntary sector

      Buck, Gillian; Tomczak, Philippa; Quinn, Kaitlyn; University of Chester; University of Nottingham; University of Toronto (Oxford University Press, 2021-10-21)
      Increasing calls for ‘nothing about us without us’ envision marginalised people as valuable and necessary contributors to policies and practices affecting them. In this paper, we examine what this type of inclusion feels like for criminalised people who share their lived experiences in penal voluntary sector organisations. Focus groups conducted in England and Scotland illustrated how this work was experienced as both safe, inclusionary and rewarding and exclusionary, shame-provoking and precarious. We highlight how these tensions of ‘user involvement’ impact criminalised individuals and compound wider inequalities within this sector. The individual, emotional and structural implications of activating lived experience therefore require careful consideration. We consider how the penal voluntary sector might more meaningfully and supportively engage criminalised individuals in service design and delivery. These considerations are significant for broader criminal justice and social service provision seeking to meaningfully involve those with lived experience.
    • Welfare conditionality, ethics and social care for older people in the UK: From civic rights to abandonment?

      Carey, Malcolm; University of Chester (Oxford University Press, 2021-12-13)
      Welfare systems are becoming ever more conditional, with access to state support increasingly rationed via a legion of legally-defined and financially-driven restrictions and rules. Civic protection and economic rights for older citizens within Western policy systems are subsequently diminishing and continue to give way to neoliberal discursive practices which prioritise welfare activation, autonomy, participation, asset-based yet precarious self-care, the aversion of health-centred risks and much higher levels of eligibility for support. This article looks at welfare conditionality and its relationship to older people, ethics and governance within social care. By using three examples of welfare conditional reforms from the UK, it is highlighted that strains typically persist between the altruistic components of some ethical frameworks and the everyday experiences of many older people. The relative gatekeeping powers of welfare professionals and expectations placed on family members and carers have also increased, especially upon older people with higher needs and who may lack economic and cultural capital. This is despite rhetorical policy-led claims of increasing choice and control, and allowing support to be more asset-based and personalised.