Barriers and facilitators to partnership working between Early Intervention Services and the voluntary and community sector

Partnership working between health and the voluntary and community sector has become an increasing political priority. This paper describes and explores the extent and patterns of partnership working between health and the voluntary and community sector in the context of Early Intervention Services for young people with a first episode of psychosis. Data were collected from 12 Early Intervention Services and through semistructured interviews with 47 voluntary and community sector leads and 42 commissioners across the West Midlands of England. Most partnerships were described as ad hoc and informal in nature although four formal partnerships between Early Intervention Services and voluntary and community sector organizations had been established. Shared agendas, the ability to refer clients onto an organization that could provide a service they could not and shared training facilitated partnership working in this context. Barriers to closer working included differences in culture such as managing risk, the time required to make and maintain relationships and recognition of the advantages of remaining a small and autonomous organization. The four more formal partnerships were also built on the organizations' experience of working together informally, in one case through a specific pilot project. The voluntary and community organizations involved were also branches of larger national organizations for whom finding sustainable funding was less of an issue. In theoretical terms, eight Early Intervention Service: voluntary and community sector partnerships were at a stage of 'pre-partnership collaboration', three at 'partnership creation and consolidation' and one at 'partnership programme delivery'. The empirical data viewed through the lens of the partnership life-cycle model could help early intervention services, and voluntary and community sector professionals better understand where they are, why they are there and the conditions needed to realise the full potential of partnership working.     

Healthy partnerships,healthy citizens? An international review of partnerships in health and social care and patient/user outcomes

As a result of changes in the governance of health and social care organizations across developed welfare states they are under increasing pressure to work in partnership with each other (at an organizational and inter-professional level) and with the private and voluntary sector. Drawing on a comparative literature review of the theoretical and empirical evidence from health and social care partnerships across developed welfare states, this paper aims to examine the policy drivers behind such changes and the effects the changes have had on the governance of health and social care, the results for service commissioners and practitioners, and particularly the results for patients and service users. It examines some of the evidence that suggests that patient/user involvement and outcomes may at best be unaffected, and at worst be negatively compromised by shifts towards increasing partnership working in health and social care. It will conclude by discussing what lessons can be drawn about service re-organization and user involvement in welfare organizations generally, and how best to protect the interests of vulnerable and disenfranchised groups of service users.     

Healthy partnerships,healthy citizens? An international review of partnerships in health and social care and patient/user outcomes

As a result of changes in the governance of health and social care organizations across developed welfare states they are under increasing pressure to work in partnership with each other (at an organizational and inter-professional level) and with the private and voluntary sector. Drawing on a comparative literature review of the theoretical and empirical evidence from health and social care partnerships across developed welfare states, this paper aims to examine the policy drivers behind such changes and the effects the changes have had on the governance of health and social care, the results for service commissioners and practitioners, and particularly the results for patients and service users. It examines some of the evidence that suggests that patient/user involvement and outcomes may at best be unaffected, and at worst be negatively compromised by shifts towards increasing partnership working in health and social care. It will conclude by discussing what lessons can be drawn about service re-organization and user involvement in welfare organizations generally, and how best to protect the interests of vulnerable and disenfranchised groups of service users.     

National survey of the injury prevention activities of children's centres

Children's centres were established across England to provide a range of services including early education, social care and health to pre‐school children and their families. We surveyed children's centres to ascertain the activities they were undertaking to prevent unintentional injuries in the under fives. A postal questionnaire was sent to a sample of children's centre managers (n = 694). It included questions on current activities, knowledge and attitudes to injury prevention, health priorities and partnership working. Responses were received from 384 (56%) children's centres. Overall, 58% considered unintentional injury prevention to be one of the three main child health priorities for their centre. Over half the respondents (59%) did not know if there was an injury prevention group in their area, and 21% did not know if there was a home safety equipment scheme. Knowledge of how child injury deaths occur in the home was poor. Only 11% knew the major cause of injury deaths in children under five. Lack of both staff time and funding were seen as important barriers by children's centre staff to undertake injury prevention activities. Nearly all stated that training (97%) and assistance with planning injury prevention (94%) would be helpful to their centres. Children's centres need further support if they are to effectively tackle this important public health area.     

Exploring the influence of service user involvement on health and social care services for cancer

Background Service user involvement in health and social care is a key policy driver in the UK. In cancer care it is central to developing services which are effective, responsive and accessible to patients. Cancer network partnership groups are set up to enable joint working between service users and health care professionals and to drive service improvements. Aims and objectives The aim of this study was to explore the influence of the cancer network partnership groups’ service user involvement activities on cancer care. Design This was a qualitative study involving documentary analysis and in‐depth case studies of a sample of partnership groups. Setting and participants Five partnership groups were purposively selected as case studies from Macmillan regions across the UK; documents were collated from a further five groups. Forty people, including core group members and key stakeholders in cancer services, were interviewed. Results and conclusions The evidence from this study suggests that cancer network partnership groups are at their most influential at ‘grass roots’ level – contributing to patient information resources, enhancing access to services, and improving care environments. While such improvements are undoubtedly important to patients, the groups’ aim is to influence strategic changes, for example in cancer care commissioning or macro‐level policy decision‐making. The evolution of open, participatory relationships between service users and professionals, and recognition of the value of experiential knowledge are seen as key factors in influencing cancer care. The provision of dedicated resources to strengthen service user involvement activities is also vital.     

Evaluation of the use of rural health clinics: attitudes and behaviors of primary care physicians in service areas of nurse practitioner clinics.

In response to concerns of the directors of Rural Health Initiative projects in Mississippi, a study was conducted to examine factors related to use of rural health clinics. This report focuses on attitudes and behaviors of primary care physicians in the service areas of four clinics staffed by nurse practitioners. Data for this evaluation were obtained via mail questionnaires sent to 41 primary care physicians in the service areas of the clinics. Usable responses were received from 25 (61.0 percent) of the physicians. The data indicate that a majority of these physicians approve of the nurse practitioner concept. Although there is evidence to support a positive correlation between previous experience and knowledge concerning nurse practitioners and physician acceptance of the nurse practitioner concept, only about half of the physicians reported that anyone had ever contacted them to talk about the clinic. Only about a quarter of the physicians had ever visited the rural health clinic, but 60 percent indicated that they would like to do so. These findings indicate a need to develop closer working relationships with all primary care physicians in the service area of a rural health clinic. The data indicate that when such a closer relationship existed, physicians were satisfied with the outcome of interactions. Twelve (48 percent) physicians stated that they had patient(s) referred to them by the clinic. Among these physicians 77.8 percent were satisfied with the information that they had received on the patient''s condition. Fewer physicians (8 or 32.0 percent) reported that they had received a call from the nurse practitioner clinic to consult about one of the physician''s patients. The physicians were satisfied with the outcome of the consultation in each instance that was reported.     

Social class,anxieties and mothers' foodwork

In the context of concerns about childhood obesity, mothers are placed at the forefront of responsibility for shaping the eating behaviour and consequently the health of their young children. This is evident in a multitude of diverse sites such as government reports, health promotion materials, reality TV shows and the advice of childcare nurses and preschools. These sites produce a range of resources available to mothers to draw on to constitute themselves as mothers in terms of caring for their children's health. Drawing on a qualitative study of mothers recruited through three Australian preschool centres, this article examines how the working‐class and middle‐class mothers of preschool‐aged children engage with knowledge about motherhood, children and health and how those engagements impact on their mothering, their foodwork and their children. We argue that, unlike the working‐class mothers pathologised in some literature on obesity, these working‐class mothers demonstrated a no‐nonsense (but still responsibilised) approach to feeding their children. The middle‐class mothers, on the other hand, were more likely to engage in practices of self‐surveillance and to demonstrate considerable anxieties about the appropriateness of their practices for their children's current and future health.     

Supporting Parental Involvement in Children's Early Learning: Lessons from Community Childcare Centres in Dublin's Docklands

Recently in Ireland attention has been placed on the importance of parental involvement in early childhood care and education settings as seen in the Síolta Quality Standards and Aistear Curriculum Framework. Yet there is little Irish empirical evidence on parental involvement in childcare settings; on the involvement models being used, or on the benefits and limitations of efforts to involve parents. This paper reports on research in five Dublin Docklands community childcare centres where practitioners had been trained in the Pen Green Parental Involvement in Children's Early Learning programme (PICL). The research aimed to understand how practitioners were able to implement new parental involvement techniques as a result of their training, how the training impacted on centres' understandings of, and approach to, parental involvement; and barriers and facilitators to the implementation of a parental involvement model from a different cultural context in community childcare settings in Dublin. A participatory research strategy involved a stakeholder reference group; documentary analysis; interviews; and focus groups conducted with childcare practitioners, and with parents. Their involvement in PICL has benefited childcare workers in a variety of ways that include: improved image as professional childcare practitioners— (they are not just “babysitters”), the validation of existing practices, the introduction of new techniques and the confidence to communicate with parents. A number of structural issues impede practitioners' efforts to involve parents in their children's early learning. These include childcare regulations, short-term staffing, police clearance, resources, and dependence upon Community Employment Scheme staff. Involving parents in their children's early learning may also be constrained by attitudes about the role of child-minders and childcare centres. While there has been considerable practice change, there is still some distance to go in the Docklands childcare centres to develop the partnerships between practitioners and parents envisaged in the PICL framework. Consistent work is required to change parental values and attitudes about the role of the childcare practitioner, and to embed the idea of parents as partners in early education amongst both practitioners and parents.     

筑牢网底需多管齐下

新医改实施以来,作为我国农村三级医疗卫生网网底的村卫生室硬件房屋设备有所改善,村医队伍有所壮大,但村卫生室和村医的定位与发展方向不明确,村医技术水平与服务能力较低,数量不足与年龄老化并存,待遇偏低和养老保障缺失,村卫生室设施不全和条件简陋。要筑牢这个网底,应明确村卫生室性质及功能定位,加快村卫生室标准化建设与规范化管理,落实财政各项补助政策,明确村医生定位与发展方向,提升乡村医生服务能力和技术水平,建立养老、工伤和医疗安全责任保险,推进全科医生和家庭医生制度建设。     

“Keeping Control”: A user‐led exploratory study of mental health service user experiences of targeted violence and abuse in the context of adult safeguarding in England

The situation for people with mental health problems as a group of disabled people who experience targeted violence and abuse is a complex one. Disabled people, particularly those with mental health problems, are at higher risk of targeted violence and hostility with few effective evidence‐based prevention and protection strategies. Achieving effective safeguarding for adults with mental health problems is characterised by differential attitudes to and understandings of abuse by safeguarding practitioners, as well as systemic issues arising from multi‐agency working. “Keeping Control” was a 16‐month user‐led, co‐produced exploratory qualitative study into service user experiences of targeted violence and abuse that was examined in the context of Care Act 2014 adult safeguarding reforms in England. User‐controlled interviews of mental health service users (N = 23) explored their experiences and concepts of targeted violence and abuse, prevention and protection. Preliminary findings from these interviews were discussed in adult safeguarding and mental health stakeholder and practitioner focus groups (N = 46). The data were also discussed via two facilitated Twitter chats (responses N = 585 and N = 139). Mental health service users’ experiences and concepts of risk from others, vulnerability and neglect can be different to those of practitioners but should be central to adult safeguarding. Histories of trauma, multi‐factorial abuse; living with fear and stigma as well as mental distress; the effects of “psychiatric disqualification” and individual blaming should be addressed in adult safeguarding in mental health. Fragmented responses from services can mean a person becomes “lost in the process”. Staff can feel disempowered, afraid or lacking in confidence to “speak up” for individuals in complex service systems with poor communication and lines of accountability. Adult safeguarding practitioners and stakeholders need to be confident, accessible and respond quickly to service users reporting incidents of targeted violence and abuse particularly in closed environments such as wards or supported housing.     

Child Protection Work and Family Support Practice in Five Family Centres

Academic interest in the work of family centres in the United Kingdom has largely been concerned with categorising the work of such centres in terms of issues of childcare ideology, working practices and degree of service user control. Meanwhile, the re-focusing of child protection services in order to develop child welfare services has largely dominated childcare social work in recent years, with scant attention paid to the role of family centres in relation to this debate. This study is concerned with examining the perspectives of staff and service users in five 'client focused' family centres in Northern Ireland in relation to how child protection issues are understood and dealt with. It was found that staff enter into negotiations with both referrers and service users to conceptually reframe child protection work as family support practice. This leads to the development of partnership relationships between staff and service users based upon mutual high regard. The work of such centres leaves them well placed to provide integrated services to children-in-need in line with current government priorities, but could leave some children vulnerable where child protection issues are not amenable to conceptual reframing along family support lines.     

Long-term benefits for Mäori of an asthma self-management program in a Mäori community which takes a partnership approach

Background: In 1991, an intervention trial of the efficacy of an asthma self-management plan was carried out in partnership with a rural Mäori community. The program relied on Mäori community health workers and other health professionals working in partnership, was delivered through clinics in traditional Mäori community centres and Mäori processes were followed throughout. The plan was shown to be effective in reducing asthma morbidity.     

Public service application of an effective clinic approach to smoking cessation

A unique partnership has been established between researchersat Iowa State University and the American Lung Association ofIowa. This partnership has resulted in the statewide applicationof an effective clinic method for smoking cessation.From a verymodest beginning (four public service clinics were held in the1979–1980 fiscal year) the program has evolved to a totalof 103 clinics in the 1987–1988 fiscal year. The publicservice clinics are continually revised to reflect current laboratoryfindings. Long-term follow-up data are routinely collected onall clinic participants. Costs are kept at relatively modestlevels through use of lay facilitators and donated clinic sites.Quality control and evaluation are systematically maintained.One-year abstinence levels have averaged 33%. The clinics arenow continuing under the auspices of the American Lung Associationof Iowa. This model of laboratory research combined with fieldapplication should be replicable in other locations and withadditional types of public health problems.     

A Global Research Agenda for Children's Rights in the Digital Age

Taking the UN Convention on the Rights of the Child as a starting point for evidence-based policy regarding children's rights in the digital age, we offer a global research agenda designed to produce evidence of value for policy-makers working to promote children's rights. Informed by research reviews and interviews with international stakeholders, four priorities for theory and evidence are identified: (1) the provision of opportunities that confer benefit, recognising that this may be defined diversely according to the cultural context, (2) the protection of children from risk of harm, including understanding the relation between vulnerability and resilience, (3) the balance between risk and opportunities, especially to allow for children's participation even in risky opportunities and (4) the framing of the research agenda (in terms of concepts, design, measures and priorities) and the evaluation of policies and initiatives in collaboration with researchers and practitioners from the global South.     

New jobs old roles – working for prevention in a whole‐system model of health and social care for older people

The Partnerships for Older People Projects programme provided government funding for local and health authorities to pilot prevention and intervention services in partnership with the voluntary sector and older people between 2006 and 2009. This local evaluation of a pilot in southern England undertaken between 2007 and 2009 used a Theory of Change approach to gathering and reflecting on data with different groups involved in the delivery of this whole‐system based model of prevention. The model was delivered in the same way in seven social services locality areas within a large county authority. The method of data gathering enabled structured reflection on the implementation, development and projected outcomes of the model and a consideration of the key learning of working in a whole‐system way with partners and stakeholders. The whole‐system model, although complex and challenging to implement, was considered overall to have been a success and provided significant learning for partners and stakeholders on the challenges and benefits of working across professional and sectoral boundaries. New posts were created as part of the model. Two of these, recruited to and managed by voluntary sector partners, were identified as ‘new jobs’, but echoed ‘old roles’ within community and voluntary sector based health and social care. The authors reflect on the parallels of these roles with previously existing roles and ways of working and reflect on how the whole‐system approach of this particular pilot enabled these new jobs to develop in particularly appropriate and successful ways.     

Developing evidence-based recommendations in public health – incorporating the views of practitioners, service users and user representatives

Background  Guidance based on a systematic assessment of the evidence base has become a fundamental tool in the cycle of evidence‐based practice and policy internationally. The process of moving from the formal evidence base derived from research studies to the formation and agreement of recommendations is however acknowledged to be problematic, especially in public health; and the involvement of practitioners, service commissioners and service users in that process is both important and methodologically challenging. Aim  To test a structured process of developing evidence‐based recommendations in public health while involving a broad constituency of practitioners, service commissioners and service user representatives. Methods  As part of the development of national public health recommendations to promote and support breastfeeding in England, the methodological challenges of involving stakeholders were examined and addressed. There were three main stages: (i) an assessment of the formal evidence base (210 studies graded); (ii) electronic and fieldwork‐based consultation with practitioners, service commissioners and service user representatives (563 participants), and an in‐depth analytical consultation in three ‘diagonal slice’ workshops (89 participants); (iii) synthesis of the previous two stages. Results and conclusions  The process resulted in widely agreed recommendations together with suggestions for implementation. It was very positively evaluated by participants and those likely to use the recommendations. Service users had a strong voice throughout and participated actively. This mix of methods allowed a transparent, accountable process for formulating recommendations based on scientific, theoretical, practical and expert evidence, with the added potential to enhance implementation.     

Integrating children's services in England: national evaluation of children's trusts

Background Poor co‐ordination of services can have severe consequences for disadvantaged children with complex needs. Since 2003 national and local governments in England embarked on sweeping reforms aimed at improving and integrating local health, education and social services for children. These were to be organized locally by children's trusts and piloted by 35 children's trust pathfinders. Methods This study described and compared the experience of integrating children's services in all 35 children's trust pathfinders, covering 20% of children in England. It had a prospective mixed‐methods design. Over 3 years we interviewed 147 managers and professionals working in the children's trusts, including 172 semi‐structured interviews, carried out two questionnaire surveys of the 35 children's trusts and analysed official documents. Results In most areas different agencies jointly commissioned children's services, especially for mental health, disabilities and multi‐purpose children's centres, and increasingly pooled finances. Provision of multi‐agency and multi‐professional services was increasing. Professionals generally supported these changes but found them stressful. All children's trusts appointed directors of children's services and established boards representing multiple agencies. Systems for sharing information about individual children were mostly in place but were still underused. Health services were generally less involved in joint work than were local authorities' education and social care services, with notable exceptions. Areas where local authorities and health authorities shared geographical boundaries made most progress. Some children's trusts made few changes beyond their statutory obligations. Conclusion Children's trusts enabled major changes to services in areas where local actors and organizations were motivated and empowered. In other areas the remit of children's trusts was often too broad and vague to overcome entrenched organizational and professional divisions and interests. Policymakers need to balance facilitation of change in areas with dynamic change agents with methods for ensuring that dormant areas and agencies are not left behind.     

Quality of research on community partnerships: developing the evidence base

Recent years have witnessed broad public health transformations. Central to these changes is that partnership work is increasingly mandated and employed as a vehicle for health education and promotion and disease prevention. Such efforts involve partnerships that span National Health Service bodies, local authorities and health and social care organizations, with stakeholders from the public, private, voluntary and community sectors. However, a more adequate evidence base is required to guide policy and action. The aims of this paper are to draw attention to some of the issues that have hampered the quality of partnership research and to discuss ways in which this research can be improved, in an effort to encourage the development of a more valuable evidence base for researchers, practitioners and policy makers. Multimethod approaches to research on partnership context, functioning and outcomes are advocated, and policy recommendations are made.     

Improving health services to displaced persons in Aceh, Indonesia: a balanced scorecard

Problem

After the Indian Ocean tsunami in December 2004, the International Organization for Migration constructed temporary health clinics to provide medical services to survivors living in temporary accommodation centres throughout Aceh, Indonesia. Limited resources, inadequate supervision, staff turnover and lack of a health information system made it challenging to provide quality primary health services.

Approach

A balanced scorecard was developed and implemented in collaboration with local health clinic staff and district health officials. Performance targets were identified. Staff collected data from clinics and accommodation centres to develop 30 simple performance measures. These measures were monitored periodically and discussed at meetings with stakeholders to guide the development of health interventions.

Local setting

Two years after the tsunami, 34 000 displaced persons continued to receive services from temporary health clinics in two districts of Aceh province. From March to December 2007, the scorecard was implemented in seven temporary health clinics.

Relevant changes

Interventions stimulated and tracked by the scorecard showed measurable improvements in preventive medicine, child health, capacity building of clinic staff and availability of essential drugs. By enhancing communication, the scorecard also led to qualitative benefits.

Lessons learnt

The balanced scorecard is a practical tool to focus attention and resources to facilitate improvement in disaster rehabilitation settings where health information infrastructure is poor. Introducing a mechanism for rapid improvement fostered communication between nongovernmental organizations, district health officials, clinic health workers and displaced persons.     

Developing community mental health services: an evaluation of Glasgow's mental health resource centres

Greater Glasgow Health Board's strategy for the development of community mental health services includes the establishment, over a 7-year period, of multi-disciplinary community mental health resource centres throughout Glasgow. An evaluation of the first phase of the development was carried out in three resource centres. This focused on three key themes: the establishment of multi-disciplinary teams, targeting of those with the most severe illnesses and the participation of users in the care process. The evaluation exercise comprised five substantive elements: analysis of the clinical database; interviews with staff within each of those centres, interviews with representatives of key external agencies associated with each centre; a survey of general practitioners; and a survey of the views of clients, their carers, their key workers, and their general practitioners (GPs). Clients were generally very satisfied with the services and felt that the resource centres met all their mental health needs. Although the majority of current centre cases had severe mental illnesses and those with the more severe conditions had the highest contact rates there was evidence that in the absence of a clear framework for referral the centres were also providing services for those with less severe illnesses. Despite a wish by centre staff to move towards modes of working less dominated by health professionals and more inclusive of other resources and especially of clients themselves, these goals remained to be achieved: there was a lack of clarity in the definition of the appropriate target groups for the centres; access to crisis support was regarded as problematic; the concept of multi-disciplinary team working had yet to be fully realized with evidence suggesting that some psychiatrists working in the resource centres had not embraced many aspects of the new approach to service delivery including a focus on the severely ill; and progress towards the ideal of active client involvement had been slow.