Councils cut research capacity
28 September 2015
Austerity has led to a reduction in the capacity of local authorities to undertake in-house research in adult social care, according to a new report by the Social Services Research Group. The report suggests that the social care research infrastructure in councils in England is shrinking and that social care research activity is also at risk in the independent sector.
The study, Research Capacity, Knowledge, Skills and Use in Councils with Adult Social Care Responsibilities, by Dr Chris Rainey, Dr John Woolham and Dr Martin Stevens, was funded by the Social Care Evidence in Practice project led by the Personal Social Services Research Unit at the London School of Economics and Political Science with support from the NIHR School for Social Care Research.
It suggests that many research staff have been gradually stripped out of local authorities, so while councils retain an evidence-based approach to decision-making, staff cuts threaten the quality of research across a broadening range of activities. Recent research activities were most often linked to performance management and local information systems. Staffing cuts and restrictions on training and professional development are likely to have affected both research capacity and capability.
Research governance also appeared to be in decline in councils, as is the number of named senior managers with responsibility for championing research, which is considered a pre-requisite for effective local research.
The survey has revealed the difficulties faced by local authorities, and suggests the need for a national review of local authority research, which appears to receive little support or development resources. A priority would be to identify workforce requirements and core functions, such as completion of the Adult Social Care Survey and analysis of data returns for the Department of Health. Such a review should be extended across the social care sector.
Practitioner research brings inside knowledge to social care evidence base
17 September 2015
Research evidence needs to reach those who can use it, yet social care research carried out by practitioners as an adjunct to delivering services rarely gets publicised. Research carried out in academic settings generally finds its way into the public domain in some form, usually through a journal paper. In contrast, research carried out in local authorities or third sector organisations often circulates no further than the organisation where it originated.
The latest issue of Research, Policy and Planning draws together articles on the findings from five research studies led by or heavily involving social care practitioners:
“We are strongly committed to supporting improvements in the use of research and one aspect of this is awareness of current research, including research carried out in local authorities and the third sector. Through this initiative we hope to encourage others to consider publishing their research (in whatever form) to make findings from all research more accessible, and in turn improve the evidence base for social care practice in England”.
“We must make sure practice is informed by evidence of what we know works, as well as learning from the experiences of others, and to do that we not only need to improve the way in which research is shared between academic and practice settings, but also our learning with our colleagues in practice. That doesn’t mean we all have to write journal papers but we should consider different ways to share our learning more widely”.
Evaluating the Connecting People Intervention
7 August 2015
Social networks can be enhanced by social and health care workers to improve outcomes for service users. When the Connecting People Intervention (CPI) model is fully implemented it improves social outcomes for service users at no greater cost than when it is only partially implemented - a key finding from piloting the CPI model in a study led by Dr Martin Webber at the University of York.
The CPI model was developed in an earlier SSCR-funded study where Dr Webber's team explored good practice in six health and social care agencies, and illustrated the processes involved in connecting people through the model. The CPI was piloted in fourteen social and health care agencies in England from both the third and statutory sectors to evaluate its effectiveness and cost-effectiveness in enhancing the social participation of people with mental health problems or a learning disability.
The study team found that people in agencies where the CPI model was implemented more fully had better social outcomes over a nine-month period. Service use and the costs associated with this decreased for all participants receiving some level of CPI. Those who were in agencies where the CPI model was implemented more fully had lower costs throughout the study period. These participants also had higher ‘quality-adjusted life-years’.
In the agencies observed to be implementing the model more fully, there was a greater focus on the partnership between workers and service users. This enabled people to form new relationships and support existing relationships with friends and families.
The study team note that all but one of the agencies which implemented the CPI model more fully were in the third sector, where service costs are lower and individuals’ needs are also likely to be different. Implementation in the local authority and NHS sites was hampered by the lack of work capacity among staff to engage with the model. The findings of this study suggest that policy makers, commissioners and senior managers in provider services need to re-orientate social and health care services to be more focused on the communities in which they are located.
Read the full summary findings.
People with dementia benefit from participatory film-making
22 July 2015
Participating in film-making may enhance wellbeing and social participation for people with dementia, according to a study led by Dr Andrea Capstick from the University of Bradford.
The study explored the impact of participant-led film-making on engagement in meaningful activity, wellbeing and social participation for ten people with an average age of 87 living in long-term social care. Known as participatory video (PV), it involves helping people with dementia create slideshows on a PC.
Each participant had six one-hour sessions with the researchers to choose a subject for their films, identify images, develop a storyboard, create a slideshow and add a sound track. All themes related to early personal life history and the majority focused on a specific location.
Signs of wellbeing increased during the film-making activity, and did not significantly decrease when participants were watching their films after the intervention had ended. Viewing the completed slideshows encouraged social interaction and showed potential for breaking down barriers between residents with dementia and those without.
There was consistent evidence that the people who took part in PV had capacity for higher levels of social participation than were routinely offered. Although frequent, varied activities were on offer at the study site, participants were not always fully engaged. During the course of the study at the research site, there was some evidence of a general shift toward the provision of more meaningful activities.
Stakeholders considered PV a powerful medium for enabling the voices of people with dementia to be heard more widely. Costs of implementing PV were low, requiring only an internet-connected PC and free software. Wider implementation of the participatory film-making approach, however, might require changes in the current deployment of staff.
The project has shown that it is possible to adapt PV for people with dementia across a wide age-range and level of abilities. A step-by-step guide to PV has been produced for wider dissemination.
Housing with care can offer older people a better quality of life
10 July 2015
Housing with care can support residents with widely different abilities, needs and care packages and offers some older people a better quality of life than mainstream housing, according to a study conducted by researchers at the Universities of Worcester, Bristol and Kent, the Housing Learning and Improvement Network and Housing 21.
Led by Dr Simon Evans (Worcester), the study - Adult Social Care Environments and Settings (ASSET) – explored experiences of extra care housing and retirement villages, collectively known as housing with care. The study is the first to measure social care-related quality of life in these settings and found significantly improved outcomes, including greater independence, when compared with remaining in mainstream housing.
The evidence suggested housing with care effectively reduced the need for services, and that these settings can be cost-effective compared with mainstream community housing. The data confirms previous findings that housing with care residents are on average less dependent, both physically and cognitively, than those living in care homes.
There were large differences in care and support needs across the sample of residents who took part in the mixed methods study, with a substantial proportion receiving no planned care; outcomes were also good for these residents.
While retirement villages and extra care housing share some characteristics they are very different forms of provision. Housing with care is often complex, both in terms of funding streams and the provision of care and support. Local authority approaches to commissioning adult social care vary considerably. In retirement villages, the commissioning of adult social care appears to be extremely uncommon.
The study concludes that although housing with care is increasingly popular, there is an urgent need to provide better financial information to current and prospective residents and their families. This could include information on personal budgets, direct payments and charging arrangements.
Read the full summary findings.
Domestic violence and women with learning disabilities
1 July 2015
It is essential that social care practitioners involved in the lives of women with learning disabilities become more aware of the problem of domestic violence, and more training is required for the police in responding to those women who report domestic violence, according to research led by Dr Michelle McCarthy from the University of Kent's Tizard Centre.
The study conducted interviews with 15 women with mild and moderate learning disabilities about the domestic violence they had experienced, alongside an online nationwide survey of care practitioners and police to explore their views, attitudes and responses.
The women interviewed reported that the domestic violence they experienced was often severe (including the use of weapons, and violence during pregnancy), frequent and over long periods of time, and typically women would experience multiple forms of abuse (physical, sexual, emotional, psychological, financial, coercive control) at the same time.
Only 20% of police respondents felt they had had a lot or enough training in learning disability issues, compared to 58% of other practitioners. Only 12% of police said they had had a lot or enough training in communicating with people with learning disabilities, compared to 57% of practitioners.
The study suggests that women with learning disabilities are additionally vulnerable to abuse as the majority of local authorities in England no longer offer social care to people whose needs are ranked low or moderate – those at the most able end of the learning disability spectrum are effectively moved outside the social care system.
Suggestions from the study include a greater remit for social care practitioners to work with those with mild learning disabilities and utilising opportunities for colleagues in adult social care services to train police and work jointly with them.
Read the full summary findings.
View the video from the study.
Can whole family approaches help people with mental health difficulties?
12 June 2015
Whole family approaches can contribute to the reablement of people with mental health difficulties, according to research led by Dr Jerry Tew from the University of Birmingham. Although rarely embedded as a core service option available to all mental health service users, some family inclusive practice activity is taking place in many areas in England; these were accessed typically only by specialist referral.
The study explored how more inclusive service approaches that engage with families might enable people with mental health difficulties to lead fuller lives. It found that no one whole family approach worked for everybody in all situations but reablement outcomes as a result of these approaches were closely associated with reported improvements in wellbeing.
Different mechanisms of change both between models and for different families receiving the same service model were observed in the study's 22 family case studies. Bringing families together helped to mobilise activity to support the family member with mental health difficulties. It suggests that improving inter-personal relationships and communication could be a key step towards creating a ‘safe base’ (physically and/or emotionally) from which the service user could start to engage with their wider world.
Good outcomes could be achieved when family work was started when the service user was quite unwell and in hospital. Practitioners willing to support family members in wider activities achieved some of the best outcomes. Barriers to progress included the family service being offered later, where family relationship difficulties pre-dated the onset of a person’s mental distress, and where individuals failed to engage with family meetings in the early stages of the therapy.
Read the full summary findings
People with sight loss and dementia need joined-up support
5 June 2015
People living with the double burden of sight loss and dementia (some 123,000 people) often only have their needs in one area addressed, according to findings from an SSCR study focused on home settings led by Dr Karen Croucher from the University of York. Those who have to cope with both conditions are at greater risk of losing their independence, of falling, and of being socially isolated.
Many people with dementia and sight loss would benefit from joined-up working by practitioners in the two fields, but until now, little has been known about the complex challenges of providing support for people with both dementia and sight loss.
Only about half the people with dementia and sight loss in the study were receiving any formal support and, usually, that amounted to just a few hours of care a week. Most people who were not receiving services said that they wanted support but did not know who to ask or what was available.
The study suggests that assessments of care and support needs must draw on the expertise of both dementia and sensory impairment practitioners. Early diagnosis of both conditions helps enormously, as does post-diagnosis support. Any interventions and adaptations need to take into account an individual’s capacity to cope with change.
Familiarity of both people and place is crucial for people with the two conditions. Services should aim to provide more social and cognitive stimulation and enjoyable activities.
Other key findings include:
Children and young people with intellectual disabilities still placed in residential schools
26 May 2015
Despite the drive towards the provision of local, specialised support, hundreds of children and young people with intellectual disabilities are still placed in out-of-area residential schools. Behaviour that challenges is cited as one of the main reasons why they are moved out of mainstream schools.
A scoping review, led by Dr Nick Gore of the Tizard Centre, University of Kent, surveyed research into the use of residential schools for children and young people with intellectual disabilities. The review found a paucity of evidence about both the use of residential schooling for children and young people with intellectual disabilities in the UK and the transition to adult placements.
There is a lack of evidence on the quality of support these placements provide and on whether they produce positive outcomes. And there is concern that a high proportion of young people in residential schools may be transferred to out-of-area residential placements on reaching adulthood.
Out-of-area residential placements are associated with a range of poor outcomes for adults with intellectual disabilities and behaviours that challenge. After Winterbourne View, there is increased concern that out-of-area placements make people of all ages more vulnerable to poor care and abuse.
In recent years there has been an increased drive to reduce such placements. The review surveys examples of alternative forms of support for children, young people and adults with intellectual disabilities.
Read the full scoping review.
Managing change in social care
14 May 2015
There is little empirical evidence to guide how change can be successfully achieved within social care organisations. An 18-month study by the Health Services Management Centre (University of Birmingham) and Middlesex University London explored research evidence and the practice experience of those who have led and participated in change initiatives.
The study suggests that successful change management in adult social care should be:
The compendium was launched at Community Care Live 2015 on Tuesday.
Read the full summary findings.
Read the full change compendium.
Physically disabled young adults and their care and support arrangements
8 May 2015
While welcoming the opportunities afforded by personalised approaches within adult social care, young adults can feel daunted by the associated responsibilities. This study, led by Wendy Mitchell from the Social Policy Research Unit at the University of York, explored physically disabled young adults’ experiences of taking greater control and responsibility for their care and support arrangements.
The study found that many of the young adults interviewed expressed a desire to gain more control over their support arrangements. They had clear views about the types of personal assistants (PAs)/carers they preferred to use, but identified managing them as the most difficult aspect of having a personal budget or direct payment. Most young adults felt ill-equipped to deal with issues such as poor performance, and establishing employer/employee boundaries.
Some felt their carers did not have the proper training or experience to help them establish further independence, and those used to working with other age groups could be inflexible in what they were prepared to do. They wanted their PAs/carers to recognise and respect their interests, preferences and priorities.
Key sources of practical, informational and emotional support were parents and other personal budget users, especially those using direct payments, those at the same life stage and/or those with the same or similar condition. Social networking sites could be useful in making contact with peers. Young adults found information from statutory services was typically targeted at other audiences, for example older people.
Social workers with more experience of working with young adults identified specific issues that need to be accommodated including: young adults’ relative lack of life skills and experience; young adults’ preferences regarding parental involvement; and addressing parents’ support needs.
Read the full summary findings.
Watch the project video for practitioners.
For older news items, please see the News Archive.