• Understanding the Processes Involved in Implementing an Improving Access to Psychological Therapies Service: An Exploratory Study that Investigates Practitioner and Client Experience Regarding its Effect on Patient Pathways, Service Design and Overall Outcomes

      Pietroni, Patrick; Thomas, Mike; Steen, Scott (University of Chester, 2015-12-31)
      The English Improving Access to Psychological Therapies (IAPT) programme is a government-funded initiative that aims to provide timely and equitable access to evidence-based psychotherapeutic interventions, within a primary care setting. Despite the many achievements of the programme, there are several issues regarding research to clinical gaps, as well as a high rate of variation between sites concerning outcomes and attrition. This thesis explores the implementation process of the IAPT delivery model to understand which factors are influential in the successful uptake and integration of evidence-based psychotherapeutic interventions. The aims of this thesis are:  To explore, identify and analyse the implementation process involved in establishing and delivering an IAPT service.  To uncover the factors that either facilitate or impede its development to provide a more in-depth and detailed account of the implementation and operation of services.  To develop an understanding regarding the applicability of evidence-based practice and the IAPT delivery model in a clinical setting, for the provision of psychological therapies. I conducted a series of semi-structured interviews with practitioners delivering and implementing services, across seven sites, and clients, across three sites. The design and analysis followed an Interpretative Phenomenological Analysis, focusing on personal meaning and sense-making processes. The objective of the interview was to understand the implementation process regarding the IAPT delivery model, exploring how this influences personal experiences and client engagement. Additionally, participant narrative was set in context using open-access data collected and published by the programme. The analysis generated three master themes for practitioners delivering and implementing services including: ‘A Call to Action’ describing how participants regarded this process as a genuine opportunity to make a real impact in mental healthcare; ‘Contextual Influences on Service Operation’ which explores the activities in becoming a locally determined, adaptable and relevant service; and a ‘Focus on Relationships’ outlining the relational and collaborative work involved during implementation. For the client group, three master themes were generated including: ‘A Personal Journey: From Discovery to Advocacy’ illustrating the changing experiences involved during service access and engagement; ‘Perception of Self’ which portrays how individuals made sense of their engagement by judging what it meant to them; 5 and ‘Outside Factors’ which explores the role of others and the physical journey made in getting to services. The analysis suggested that both groups made sense of their experiences in complex and varied ways. Heavily influencing the implementation of the IAPT delivery model is the over-arching need to boost throughput and quantity, possibly at a cost of quality. Additionally, it is argued that the use of routine outcome monitoring in services is useful for reflecting on the implementation process and engaging clients. The key to successful implementation appears to be about achieving integration, requiring a whole-systems based approach that considers the mediating pathways into and out of services. In light of the findings and literature, the thesis proposes several recommendations for future practice and further research.
    • Understanding violence when the perpetrator has an intellectual disability: The perceptions of professionals

      Lovell, Andy; Skellern, Joanne; University of Chester (SAGE, 2017-12-18)
      Aim: The research sought to enhance professional understanding of the violence perpetrated by some people with an intellectual disability. Background: The violent behaviour exhibited by some people with intellectual disabilities remains poorly understood, particularly with regard to a clear and informative definition. Design: A qualitative study investigating the views and perceptions of professionals working directly with people with an intellectual disability in different settings. Methods: 22 semi-structured interviews were undertaken with professionals from a variety of backgrounds and four themes were generated through data analysis. Findings: Themes produced comprised the degree of intellectual disability, impulsivity, intentionality and unpredictability. Findings indicated tension between understanding violence as purposeful and explaining it in relation to the intellectual disability and/or additional conditions. Conclusion: Intellectual disability is central to understanding the impact of the other three themes, though there is a professional reluctance to use such knowledge as evidence to inform practice.
    • Universal credit, Lone mothers and poverty: Some context and challenges for social work with children and families

      Carey, Malcolm; University of Chester
      Universal Credit is a streamlined benefits delivery system initially introduced in the United Kingdom (UK) in 2008. Conditionality-based welfare policies are increasingly international in scale, and are now widely adopted by neoliberal governments on the basis that paid employment offers the most efficacious route out of poverty for citizen-subjects. Numerous studies suggest otherwise, and highlight their negative impact upon the social rights, lived experiences, and attempts to alleviate poverty for service users. This article analyses the reformed benefit system and wider workfare policies effect upon lone mothers, including as a consequence of engagement with an ever more stigmatizing benefit system, and associated risks posed by sanctions or precarious low-paid employment. It highlights some of the consequences for social work with children and families of Universal Credit: including ongoing tensions and challenges created for the profession by the punitive policies of the workfare-orientated centaur state.
    • Universal credit, lone mothers and poverty: some ethical challenges for social work with children and families

      Carey, Malcolm; University of Chester (Taylor and Francis, 2021-06-22)
      This article critically evaluates and contests the flagship benefit delivery system Universal Credit for lone mothers by focusing on some of the ethical challenges it poses, as well as some key implications it holds for social work with lone mothers and their children. Universal Credit was first introduced in the United Kingdom (UK) in 2008, and echoes conditionality-based welfare policies adopted by neoliberal governments internationally on the assumption that paid employment offers a route out of poverty for citizens. However, research evidence suggests that the risks of conditionality polices for lone parents can often include increased poverty, a deterioration in mental health or even destitution posed by paternalistic sanctions or precarious low-paid employment, which can undermine parenting capacities and children’s well-being. The article also critically appraises and questions challenges posed by an increased reliance upon contractual ethics by governments, alongside the wider behaviour modifying policies of the workfare-orientated state. This includes that working-class lone mothers can erroneously be stigmatised as representing a morally challenged dependent burden through activation policies and risk-averse social work practices.
    • University-Trust collaboration: A secure learning disability service in transition

      Lovell, Andy; University of Chester (RCN Publishers, 2011-06)
      This article describes how a research project, looking at the management of change within a learning disability service in transition from medium to low security, confirms the importance of staff involvement in the process.
    • The use of a mobile app in health visiting to support school readiness

      Lee, Fiona; Wright, Paula; University of Chester; Bridgewater Foundation Trust (Mark Allen Group, 2016-08-24)
      Starting school is a major milestone in family life, and there is increasing awareness that a child who is ‘ready for school’ when they begin full-time education is more likely to reach their full potential. This is not only in terms of academic achievement, but also social and behavioural skills, which have an impact later in adulthood (UNICEF, 2012). Health visitors’ responsibilities include supporting parents to maximise their child’s health and development from birth onwards—a complex and challenging remit for which they need to be continually developing engaging strategies and tools (Department of Health, 2009). This article reviews the collaborative development of a school readiness mobile app for Bridgewater Community Foundation NHS Trust. The project won the prestigious 2016 Journal of Health Visiting Award for School Readiness, and the University of Chester was recognised as a key collaborator in this innovative development. The article seeks to inspire health visiting colleagues to search for collaborative partners to address school readiness in an engaging way with parents.
    • The Use of Language in Hospice Care and the Impact on Patients and Families

      Gant, Valerie; University of Chester (Sage, 2017-07-01)
      Whilst there is an expanding literature and a growing knowledge-base relating to patient and family experiences in hospice settings (1,2,3), there is a much more limited corpus reflecting the first-person perspective of patients and their families. These accounts can be helpful in highlighting perceived gaps between current practice and family needs (4). This narrative account reflects upon the perspective of a hospice patient’s family during her last week of life and notes how the actions and language of staff members and volunteers had a major impact on the overall experience and subsequent grieving processes of family members.
    • The use of photo elicitation to explore the impact of social work student’s perceptions of placements on social work tutors and consider their role in practice learning

      Caffrey, Bridget; Fruin, Helen; Bailey-McHale, Julie; Ridgeway, Victoria; Bailey-McHale, Bex; University of Chester (Taylor & Francis, 2020-12-22)
      The importance of learning in practice is acknowledged across health and social care professions. Social work students’ experiences in practice settings has attracted some attention in academic literature, and the role and impact of the Practice Educator (PE) on student learning is increasingly recognised. However, there is a paucity of research examining the role of the social work tutor generally and particularly within practice learning settings. This paper presents a small-scale qualitative study exploring the impact of visual images produced by social work students reflecting their practice experiences on six social work tutors. Photo elicitation prompted discussion in a focus group setting which was subsequently thematically analysed, with four themes emerging. These were dichotomous relationships, difference and diversity, tutor brokerage skills, and student support. The images encouraged tutors to reflect upon the complexity of their relationship with social work students and question whether they were professionally equipped to support students in complex placement situations. In addition, the effectiveness of the curriculum in preparing social work students for practice was considered, particularly space afforded to students to reflect on practice learning in a safe environment. Opportunities to support SW tutors in their role and SW students in practice are deliberated.
    • Use of storytelling and audio podcasts in qualitative research

      Sutton, Julie E.; University of Chester (RCNI, 2019-08-01)
      The author discusses the use of service user story telling through the medium of audio podcasts, in service evaluation. The author argues this is an effective way to promote service user participation in service improvement projects and highlights how audio podcasts can stimulate emotional connections in service evaluators leading to informed identification of priorities for change
    • User involvement

      Dulson, Julie; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses user involvement policy, the user involvement continuum, and barriers to user involvement and their solutions.
    • Using a feminist standpoint to explore women’s disclosure of domestic violence and their interaction with statutory agencies

      Mason, Tom; Keeling, June J. (University of ChesterUniversity of Chester, 2011-11)
      This thesis explores women’s disclosure of domestic violence, and is based on the findings of two research studies. The first study explored prevalence rates of domestic violence reported by women following childbirth. The subsequent narrative study explored women’s experiences of disclosure and their interactions with statutory agencies. The research was influenced by a feminist epistemology, recognizing the marginalisation of the women’s experiences from a subjugated relationship, addressing the power relationship between the researcher and participants and because of the significant disparity between gendered lives. The study was conducted in two parts. A survey of five hundred women in the immediate postnatal period within a large NHS Hospital participated in the first part of the study. The second study involved narrative interviews with fifteen women living within their own community who talked about their experiences of domestic violence and issues surrounding disclosure. Women’s stories about disclosure including the responses they received were influenced by cultural narratives. The theories of social power have been utilized as an explanatory framework and provide the theoretical basis of the analysis. The study found low levels of disclosure at two specific points along the pregnancy/childbirth continuum; during booking in clinic and in the immediate postnatal period. Furthermore, the findings revealed three specific tactics used by perpetrators to engage women in the early relational stage with the intentionality of exerting control and subjugation. These have been termed feeling special, feeling vulnerable and commitment. Whilst women talked of coercion and subjugation by their partners, they also talked of how their interactions with statutory agencies limited their agency. The significance of this study is that the thesis was able to challenge contemporary policies developed by statutory agencies in the provision of support to women who experience domestic violence. The thesis develops some understanding of the nature and role of cultural narratives and patterns of disclosure before suggesting new directions to further advance the findings presented. Finally, the thesis proposes recommendations to improve training for statutory agencies in providing a response to women disclosing domestic violence, suggesting a new direction in thinking about the facilitation of this training.
    • Using and developing evidence in health and social care practice

      Chapman, Hazel M.; University of Chester (Sage, 2020-03)
      [A] Overview This chapter outlines the processes of developing evidence-based practice and carrying out research and highlights the similarities and differences between the two. This chapter aims to increase your skills and motivation in utilising research evidence to improve your practice, introduce you to the process of research and develop your research skills. [A] Learning Outcomes At the end of this chapter you will be able to: • Critique research papers. • Share best practice with your colleagues. • Assist with research in practice. • Develop your research skills with a view to becoming a researcher.
    • Using codes of ethics for disabled children who communicate non-verbally - some challenges and implications for social workers

      Carey, Malcolm; Prynallt-Jones, Katherine A.; University of Chester (Taylor & Francis, 2018-02-09)
      This article evaluates the use of professional codes of ethics by social workers specialising in work with disabled children who communicate non-verbally. It draws upon phenomenological interviews and other studies to highlight challenges faced by practitioners in a complex role which demands high-levels of skills and knowledge. Supporting other research, codes of ethics were rarely utilised by practitioners who typically maintain a vague appreciation while often compelled to focus upon pragmatic and quick responses to a complex role. Despite this, it is argued that principle-based frameworks embedded within codes of ethics carry important political implications. These include the potential to strengthen existing utilitarian and bioethical discourses embedded in policy or dominant professional narratives, and which can at times marginalise or exclude disabled children.
    • Using consultative methods to investigate professional–client interaction as an aspect of process evaluation

      Hogard, Elaine; University of Chester (American Evaluation Association, 2007-07-01)
      This article discusses a consultative method called reconstitutive ethnography, which is considered useful for the in-depth description and analysis of the interaction between a professional and client in the delivery of a health or social care program.
    • Using visual methodology: Social work student's perceptions of practice and the impact on practice educators.

      Bailey-McHale, Julie; Bailey-McHale, Rebecca; Caffrey, Bridget; Macleand, Siobhan; Ridgway, Victoria; University of Chester; Kirwin Maclean Associates (Taylor & Francis, 2018-06-21)
      Practice learning within social work education plays a significant part in students’ educational journey. Little is understood about the emotional climate of placements. This paper presents a small scale qualitative study of 13 social work students’ perceptions of their relationship with a practice educator (PE) and 6 PE’s perceptions of these emotional experiences. Visual methodology was employed over a two-phased research project, first social work students were asked to draw an image of what they thought practice education looked like, phase two used photo eliciation, PEs were then asked to explore the meaning of these images. Results demonstrated that social work students focused on their own professional discourse, the identity of PEs, power relationship and dynamics between themselves and PEs, the disjointed journey and practice education in its entirity. Whilst the PEs shared their personal views of practice education and reflected on this, both groups had a shared understanding of practice education including its values and frustrations. Keywords: social work placements, visual methodology, practice educators
    • Utilising a Bourdieusian lens to explore emerging health visitor practice education experiences within the context of the Health Visitor Implementation Plan

      Gidman, Jan; Taylor, Lou; Haydock, Deborah (University of Chester, 2019-05-14)
      The Health Visitor Implementation Plan (HVIP) (DH, 2011a) changed the recruitment criteria for health visiting and the way health visitor (HV) practice placements were supported. Several universities offered accelerated '2+1' programmes, where a graduate with a health related degree obtained accreditation of prior learning and completed pre-registration nurse training in two rather than three years. This was then followed by a one-year post-registration Health Visitor programme. This widening of recruitment afforded a unique opportunity to explore the experiences of 2+1 HV students, practice teachers (PTs) and mentors, and emerging practice education models within the context of the HVIP. Findings are considered through the lens of Bourdieu’s theory of practice. The study adopted an interpretive phenomenological design to gain a deeper understanding of the experiences of students, PTs and mentors. In-depth semistructured conversational interviews were undertaken with four HV 2+1 students, two PTs and two mentors. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis. Findings viewed through a Bourdieusian lens indicate that policy change in the form of the HVIP affected the structure of the social field, resulting in a period of transition when some participants had difficulty adapting to the changed social context. Long arm models of practice education added to the complexity of the PT role, including the additional responsibility of overseeing numerous students and mentors. Mentors reported feeling under pressure, exacerbated by working in inexperienced teams; and frustration that their contribution to the HVIP was disregarded, compounded by a lack of opportunity for professional progression. Students undertaking different routes into nursing are affected by extrinsic views and this affects evolving habitus and enculturation. When students’ prior experience is valued, this strengthens the students’ perception of their ‘field’ position. Placement changes, particularly during consolidation, can be detrimental as they affect habitus formation and student learning and impact upon assessment processes. The research offers new insights into health visiting practice education and the impact of policy change on practice settings. The findings have implications outside health visiting in the current context of changes to nurse education and the introduction of the new NMC (2018b) standards for student supervision and assessment. New knowledge is offered with regards to the significance of transition periods, changing roles, and the potential impact upon the provision of student practice placements and those who support them. Recommendations are made for further areas of research, practice placement providers and HEIs.
    • Vaginal breech birth or Caesarean?

      Steen, Mary; Kingdon, Carol; Royal College of Midwives/University of Central Lancashire (2007-11-08)
      This presentation will firstly explore the evidence in supporting the phenomenal shift in clinical practice from vaginal breech birth to routine caesarean breech birth, in particular the impact of a single research trial, the Term Breech Trial (TBT) on current worldwide policy and practice. Secondly, will explore the best available evidence for the use of External Cephalic Version (ECV)and moxibustion to turn a breech baby to a cephalic presentation as this may reduce a woman’s risk of having a caesarean section.
    • Vaginal or caesarean delivery? How research has turned breech birth around

      Steen, Mary; Kingdon, Carol; RCM/UCLan ; UCLan (T G Scott, 2008-09)
      Background: Breech presentation, where a baby is buttocks or feet first rather than head occurs in about 3 to 4% of singleton pregnancies at term. Worldwide, the vast majority of babies identified as breech are now delivered by planned caesarean section. Aim: to identify relevant published research evidence relating to vaginal and caesarean breech birth and then to discuss the evidence, subsequent controversy and clinical implications that have influence an ongoing obstetrical debate. Method: A structured literature review was undertaken using the Cochrane Library, CINAHL, EMBASE and MEDLINE databases. Different permutations of 'breech' ('frank' or 'complete' or 'extended' or 'flexed') and 'vaginal' or 'caesarean' ('cesarean' or 'cesarian' or 'caesarean') and 'term' and 'singleton' in the title, key words or abstracts were the terms used. Results: Over the last 50 years, there has been an increasing trend toward the routine use of caesarean section as a preventive way of reducing the poor outcomes associated with breech presentation. Research evidence has also played a pivotal role in influencing the routine use of caesarean breech birth and, in particular, a single research trial, the Term Breech Trial (TBT) has substantially influenced current policy and practice. There is no other area of research that has such an impact upon clinical practice in such a short period of time. Conclusions: The speed and extent to which the recommendations of the TBT were implemented has given rise to new controversy surrounding the safety of breech birth, while raising important questions about how the findings of research are used in practice.
    • The value of embedded secondary-care-based psychology services in rheumatology: an exemplar for long-term conditions

      Barnes, Theresa; Taylor, Lou; Eost-Telling, Charlotte; Joy, Thomas; Countess of Chester Hospital; University of Chester; University of Chester; Cheshire and Wirral Partnership (Royal College of Physicians, 2020-02-29)
      Rheumatoid arthritis is an exemplar long term condition, complicated by pain, disability, co-morbidities and long term medication use. It has significant effects on mobility, work performance, social role, sexual function and relationships. It is commonly associated with fatigue and mood disturbance as a result of complex interactions of physical (disease related) and psychosocial factors. NICE guidance recommends the availability of psychological support for these patients. We have implemented a psychology service for our patients with chronic rheumatological conditions. This study was set up to capture the value of this service.
    • Value of life

      Baldwin, Moyra A.; Greenwood, Joanne M.; University of Chester (SAGE, 2010-10-15)
      This book chapter explores the concept of the value of life.