scholarly journals Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Michael Clark ◽  
Michelle Cornes ◽  
Martin Whiteford ◽  
Robert Aldridge ◽  
Elizabeth Biswell ◽  
...  
Keyword(s):  
Integrated Care ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Policy Issue ◽  
Content Type ◽  
Complex Needs ◽  
Integration Of Services ◽  
Key Issues ◽  
Discharge From Hospital ◽  
High Degree

PurposePeople experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.Design/methodology/approachThe paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.FindingsSupporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.Research limitations/implicationsThe data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.Practical implicationsIntegration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.Social implicationsAddressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.Originality/valueThis paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.

scholarly journals Choosing to be homeless? Persistent rough sleeping and the perverse incentives of social policy in England

2020 ◽  
Vol 23 (3/4) ◽  
pp. 135-147
Author(s):  
Graham Bowpitt
Keyword(s):  
Service Providers ◽  
Secondary Analysis ◽  
Primary Data ◽  
Personal Factors ◽  
Content Type ◽  
Complex Needs ◽  
Perverse Incentives ◽  
Intimate Knowledge ◽  
The Uk ◽  
Recent Policy

Purpose With the temporary housing of rough sleepers in response to the Covid-19 emergency, some commentators have been tempted to believe that the rising population of rough sleepers in the UK has finally been reversed. This paper aims to examine the choices made by persistent rough sleepers and how far they are influenced by the perverse incentives of social policies, in order to challenge the view that they sleep rough out of choice. Design/methodology/approach Evidence for this paper is derived from two teams of frontline service providers with routine familiarity with the rough sleeping population: a street outreach team and a team of support workers working with adults with multiple and complex needs. Primary data from focus groups were combined with the secondary analysis of both numerical and narrative accounts routinely recorded by both teams. Findings The exercise of agency by persistent rough sleepers is constrained by a mixed baggage of complex needs, past negative risk assessments, limited resources and regulatory deterrents to generate choices to reject help that appear irrational. These need to be understood if recent policy initiatives to end rough sleeping are to be effective. Originality/value The paper draws on the experience and comprehensive records of practitioners with intimate knowledge of the rough sleeping population. It extends narrative accounts of causes by focusing on key choices to show how the perverse incentives of policy combine with personal factors to incline rough sleeping to persist.

scholarly journals Integrating the voluntary sector in personalised care: mixed methods study of the outcomes from wellbeing co-ordination for adults with complex needs

2020 ◽  
Vol 28 (4) ◽  
pp. 405-418
Author(s):  
Felix Gradinger ◽  
Julian Elston ◽  
Sheena Asthana ◽  
Chloe Myers ◽  
Sue Wroe ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Integrated Care ◽  
Group Analysis ◽  
Voluntary Sector ◽  
Mixed Data ◽  
Content Type ◽  
Complex Needs ◽  
Care Organisation ◽  
Before And After ◽  
Diagnostic Pathways

PurposeThis integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care.Design/methodology/approachThis is a naturalistic, mixed method and mixed data study. It is complementing a before-and-after study with a sub-group analysis of people receiving input from the wider hub (including Wellbeing Co-ordination and Enhanced Intermediate Care), qualitative case studies, interviews, and observations co-produced with embedded researchers-in-residence.FindingsThe cross-case analysis uses trajectories and outcome patterns across six client groups to illustrate the bio-psycho-social complexity of each group across the life course, corresponding with the range of inputs offered by the hub.Research limitations/implicationsTo consider the effectiveness and mechanisms of complex system-wide interventions operating at horizontal and vertical interfaces and researching this applying co-produced, embedded, naturalistic and mixed methods approaches.Practical implicationsHow a bio-psycho-social approach by a wellbeing co-ordinator can contribute to improved person reported outcomes from a range of preventive, rehabilitation, palliative care and bereavement services in the community.Social implicationsTo combine knowledge about individuals held in the community to align the respective inputs, and expectations about outcomes while considering networked pathways based on functional status, above diagnostic pathways, and along a life-continuum.Originality/valueThe hub as a whole seems to (1) Enhance engagement through relationship, trust and activation, (2) Exchanging knowledge to co-create a shared bio-psycho-social understanding of each individual’s situation and goals, (3) Personalising care planning by utilising the range of available resources to ensure needs are met, and (4) Enhancing co-ordination and ongoing care through multi-disciplinary working between practitioners, across teams and sectors.

scholarly journals Roles and responsibilities in integrated care for dementia

2019 ◽  
Vol 27 (2) ◽  
pp. 131-140
Author(s):  
David Robertshaw ◽  
Ainslea Cross
Keyword(s):  
Integrated Care ◽  
Analytical Framework ◽  
Discussion Board ◽  
Framework Analysis ◽  
Role Conflicts ◽  
Content Type ◽  
Roles And Responsibilities ◽  
Massive Open Online Course ◽  
It Systems ◽  
Key Issues

Purpose Effective integrated healthcare systems require capable, trained workforces with leadership, shared governance and co-ordination. The purpose of this paper is to characterise roles and responsibilities in relation to integrated care from the perspective of massive open online course (MOOC) participants. Design/methodology/approach MOOC discussion board posts were analysed using framework analysis consisting of transcription, familiarisation, coding, developing an analytical framework and application of the framework. Findings Boundaries and key issues surrounding roles and responsibilities were highlighted and participants suggested a number of enablers which could enhance integrated care in addition to barriers to consider and overcome. Originality/value Enablers included introduction of shared communication and IT systems to support continuity of care. Awareness and understanding of dementia was seen as crucial to promote person-centred care and care planning. The roles of education and experience were highlighted. Barriers preventing effective roles and suitable responsibility include funding, role conflicts, time constraints and time-consuming paperwork.

Variation in rates of inpatient admission and lengths of stay experienced by adults with learning disabilities in England

2017 ◽  
Vol 22 (4) ◽  
pp. 218-221 ◽  
Author(s):  
Anne MacDonald
Keyword(s):  
Learning Disabilities ◽  
Inpatient Admission ◽  
Content Type ◽  
Complex Needs ◽  
Lengths Of Stay ◽  
Adults With Learning Disabilities ◽  
Government Project ◽  
Scottish Government ◽  
Discharge From Hospital ◽  
A Current

Purpose The purpose of this paper is to provide a commentary from a Scottish perspective on some of the issues raised in the paper “Variation in rates of inpatient admission and lengths of stay experienced by adults with learning disabilities in England”. Design/methodology/approach The policy context in relation to people with learning disabilities in Scotland is reviewed, alongside an update about a current Scottish Government project focussed on understanding and addressing the issue of people with learning disabilities whose discharge from hospital is delayed. Findings As regards to people with learning disabilities who are inpatients in hospitals in Scotland, there are similar themes in common with those in the paper by Elaine James and colleagues; however Scottish policy has developed differently from that in England in this area. Originality/value This commentary adds to the discussion by contributing a Scottish perspective on issues and outlines work being done to address the need for people with learning disabilities and complex needs in Scotland to live within their local communities.

The 2016 Police and Crime Commissioner elections

2017 ◽  
Vol 16 (2) ◽  
pp. 41-54 ◽  
Author(s):  
Peter Joyce
Keyword(s):  
Public Awareness ◽  
Primary Source ◽  
Source Material ◽  
Content Type ◽  
The Public ◽  
The Social ◽  
Key Issues ◽  
The Subject ◽  
The Government

Purpose The purpose of this paper is to analyse the 2016 elections for Police and Crime Commissioners (PCCs) and to compare them with those that took place in 2012. It seeks to evaluate the background of the candidates who stood for office in 2016, the policies that they put forward, the results of the contests and the implications of the 2016 experience for future PCC elections. Design/methodology/approach This paper is based around several key themes – the profile of candidates who stood for election, preparations conducted prior to the contests taking place, the election campaign and issues raised during the contests, the results and the profile of elected candidates. The paper is based upon documentary research, making particular use of primary source material. Findings The research establishes that affiliation to a political party became the main route for successful candidates in 2016 and that local issues related to low-level criminality will dominate the future policing agenda. It establishes that although turnout was higher than in 2012, it remains low and that further consideration needs to be devoted to initiatives to address this for future PCC election contests. Research limitations/implications The research focusses on the 2016 elections and identifies a number of key issues that emerged during the campaign affecting the conduct of the contests which have a bearing on future PCC elections. It treats these elections as a bespoke topic and does not seek to place them within the broader context of the development of the office of PCC. Practical implications The research suggests that in order to boost voter participation in future PCC election contests, PCCs need to consider further means to advertise the importance of the role they perform and that the government should play a larger financial role in funding publicity for these elections and consider changing the method of election. Social implications The rationale for introducing PCCs was to empower the public in each police force area. However, issues that include the enhanced importance of political affiliation as a criteria for election in 2016 and the social unrepresentative nature of those who stood for election and those who secured election to this office in these contests coupled with shortcomings related to public awareness of both the role of PCCs and the timing of election contests threaten to undermine this objective. Originality/value The extensive use of primary source material ensures that the subject matter is original and its interpretation is informed by an academic perspective.

scholarly journals Greater fit and a greater gap

2019 ◽  
Vol 26 (4) ◽  
pp. 561-594
Author(s):  
Steven A. Brieger ◽  
Dirk De Clercq ◽  
Jolanda Hessels ◽  
Christian Pfeifer
Keyword(s):  
Life Satisfaction ◽  
Institutional Environment ◽  
Entrepreneurial Activity ◽  
Worker Rights ◽  
Content Type ◽  
Person Environment Fit ◽  
High Power Distance ◽  
High Degree ◽  
The Impact ◽  
Low Uncertainty

Purpose The purpose of this paper is to understand how national institutional environments contribute to differences in life satisfaction between entrepreneurs and employees. Design/methodology/approach Leveraging person–environment fit and institutional theories and using a sample of more than 70,000 entrepreneurs and employees from 43 countries, the study investigates how the impact of entrepreneurial activity on life satisfaction differs in various environmental contexts. An entrepreneur’s life satisfaction arguably should increase when a high degree of compatibility or fit exists between his or her choice to be an entrepreneur and the informal and formal institutional environment. Findings The study finds that differences in life satisfaction between entrepreneurs and employees are larger in countries with high power distance, low uncertainty avoidance, extant entrepreneurship policies, low commercial profit taxes and low worker rights. Originality/value This study sheds new light on how entrepreneurial activity affects life satisfaction, contingent on the informal and formal institutions in a country that support entrepreneurship by its residents.

scholarly journals Mortality Outcomes in People Experiencing Homelessness Across England: a population-based study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Menezes ◽  
D Lewer ◽  
A Yavlinsky ◽  
M Tinelli ◽  
R Aldridge
Keyword(s):  
Hospital Discharge ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Population Based ◽  
Mortality Data ◽  
Additive Interaction ◽  
Population Based Study ◽  
Group A ◽  
Healthcare Interventions ◽  
Discharge From Hospital

Abstract Introduction The number of people experiencing homelessness in England has increased since 2010 and a recent systematic review and meta-analysis demonstrated high levels of mortality in this group across high-income countries. In this study we examine the death rates in people experiencing homelessness after discharge from hospital. Methods This is a study of linked hospital admission records and mortality data for two groups. First, a “Homeless group”: people seen by 17 specialist homeless discharge schemes between 1 November 2013 and 30 November 2016. Second, an “IMD5 group”: A matched group of patients who live in deprived areas and have the same age and sex, and were discharged from the same hospital in the same year as the homeless patient. Our analysis entailed calculating mortality rates across each group and by the number of comorbidities. Results The mortality rate for the IMD5 group was 1,935 deaths per 100,000 person years, compared with 5,691 for the homeless group, giving a rate ratio of 2.9 (95% CI 2.5-3.5). The mortality risk increased with the number of comorbidities. Individuals in the IMD5 group with zero comorbidities had a death rate of 831 per 100,000 person-years, compared with the homeless group for which the corresponding figure was 2,598 and or those with 4+ comorbidities were 7,324 (IMD5) and 12,714 (homeless). This suggests a 'super-additive' interaction in which the effect of morbidity on mortality risk after discharge is greater for homeless patients. Survival at 5 years for the homelessness group was for men 80% (95% CI 77-85) and women 85 (95% CI 81-87). Conclusions This study shows that the well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population. Key messages The well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population.

Lactation Consultation by an International Board Certified Lactation Consultant Improves Breastfeeding Rates for Mothers With Gestational Diabetes Mellitus

2021 ◽  
pp. 089033442110186
Author(s):  
Laurie Beth Griffin ◽  
Jia Jennifer Ding ◽  
Phinnara Has ◽  
Nina Ayala ◽  
Martha B. Kole-White
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Hospital Discharge ◽  
Exclusive Breastfeeding ◽  
Secondary Analysis ◽  
Feeding Preference ◽  
Lactation Consultant ◽  
Breastfeeding Rates

Background In patients with gestational diabetes, breastfeeding decreases the lifetime risk of Type 2 diabetes by half. Lactation consultation has been shown to increase breastfeeding rates in the general population but has not been assessed in a gestational diabetes population. Research Aims To determine if (1) a postpartum International Board Certified Lactation Consultant (IBCLC) consultation during delivery hospitalization improved inclusive (any) or exclusive breastfeeding rates at hospital discharge and 3 months postpartum in participants with GDM; and if (2) obstetrical providers’ acknowledgement of maternal feeding preference affected the rates of IBCLC consultation for patients. Methods This was a retrospective, comparative, secondary analysis of a prospective cohort ( N = 517) study of women gestational diabetes. Participants who received a IBCLC consultation ( n = 386; 74.5%) were compared to those who did not ( n = 131; 25.5%). Baseline demographics, antepartum characteristics, neonatal information, mode of infant feeding at hospital discharge and 3 months postpartum, and IBCLC consultation during postpartum hospitalization were measured. Results After adjusting for baseline differences, participants who received an IBCLC consultation were more likely to report any breastfeeding at postpartum discharge (aOR 4.87; 95% CI [2.67, 8.86]) and at 3 months postpartum (aOR 5.39; 95% CI [2.61, 11.16]) compared to participants who did not. However, there was no difference in exclusive breastfeeding rates between those who did and did not receive IBCLC consultation. Conclusion Inpatient IBCLC consultation during the immediate postpartum period was associated with improved rates of any breastfeeding in participants with GDM.

Archiving in the networked world: authenticity and integrity

2012 ◽  
Vol 30 (3) ◽  
pp. 545-552
Author(s):  
Michael Seadle
Keyword(s):  
Design Methodology ◽  
Economic Value ◽  
Digital Environment ◽  
Content Type ◽  
Digital World ◽  
Digital Work ◽  
Mathematical Algorithms ◽  
Key Issues ◽  
Technical Sense

PurposeThis article aims to discuss how concepts from the analog world apply to a purely digital environment, and look in particular at how authenticity needs to be viewed in the digital world in order to make some form of validation possible.Design/methodology/approachThe article describes authenticity and integrity in the analog world and looks at how to measure it in a digital environment.FindingsAuthenticity in the digital world generally means, in a purely technical sense, that a document's integrity has been checked using mathematical algorithms against other copies on independently managed servers, and that provenance records show that the document has a clearly established succession from a clearly defined original. Readers should recognize that this is different than how one defines authenticity and integrity in the analog world.Originality/valueMost of the key issues surrounding digital authenticity have not yet been tested, but they will be when the economic value of an authentic digital work reaches the courts.

Living in the end times: a short course addressing end of life issues for older people in an English parish church setting

2015 ◽  
Vol 19 (3) ◽  
pp. 140-149 ◽  
Author(s):  
Joanna Collicutt
Keyword(s):  
Older People ◽  
End Of Life ◽  
Group Dynamics ◽  
Death And Dying ◽  
Community Context ◽  
Content Type ◽  
End Of Life Issues ◽  
End Times ◽  
High Level ◽  
High Degree

Purpose – The purpose of this paper is to report a pilot study that evaluated an innovative practice in a faith community context designed to help older people live well at the end of life and prepare for death. Design/methodology/approach – A simple audit of the intervention using a contemporaneous journal kept by the author, and a follow up questionnaire completed by participants. Findings – Rich findings on the process are reported. These indicate a high degree of engagement by participants, the establishment of a high degree of group intimacy and trust, a high level of articulation of wisdom, the emergence of significant anxiety in some isolated cases, and the use made of tea and cake to manage the transition between the existentially demanding nature of the discussions and normal life. The outcome indicated very high levels of appreciation and increased confidence in relation to issues of death and dying. Practical implications – The findings of the pilot have been used to inform training of clergy in the principles of working in this area (e.g. in ways of managing group dynamics and anxiety, pacing, tuning in to archetypes and the natural symbols that people use to talk about death and dying, self-care and supervision of the programme leader/facilitator). Originality/value – The paper adds to knowledge in terms of an in depth description of processes at work in a group of older people working on spiritual and practical issues in relation to death, and offers ideas for supporting older people in this process, some of which are specific to the Christian tradition, and some of which are more widely applicable to people of all faiths and none. It gives a specific worked example of what “spiritual care” in this area might look like.

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