Nick Gould

The social care component of multidisciplinary mental health teams: a review and national survey.

Background The study reviewed the disciplinary composition of community mental health teams (CMHTs) and conducted a national survey of mental health providers in England and Wales to explore the determinants of the social care component of CMHTs. Methods A comprehensive literature review and a national survey of NHS mental health Trusts in England and Wales. Results The literature review showed that team composition was rarely well justified with regard to effectiveness, despite some evidence that greater professional diversity (i.e. inclusion of social workers) was associated with higher effectiveness. Forty-two mental health Trusts responded (53.2%) to the survey. There were no staffing differences between responding and non-responding Trusts. Social workers accounted for 19.3% of the staffing total. Nurses formed a third of the workforce and social support workers made up a further 10%. We found that there continues to be a shortage (compared to policy targets and previous research) of psychiatrists, psychologists and occupational therapists, whereas the numbers of nurses employed far exceeds their target numbers. Total staffing numbers appeared to be slightly higher in Trusts citing ‘financial resources’ as a determining factor of team composition. Despite being statistically non-significant, the ‘financial resource’ effect was of medium magnitude. Similarly, there was a non-significant but approaching medium-sized effect of higher numbers of social care support staff when guidance was cited as a rationale for CMHT composition. There was a non-significant (P = 0.076) medium magnitude (η2p 5 0.067) trend towards higher staff numbers in more integrated trusts that did not cite financial resources as a driver of team composition. Conclusions If service recipients are to gain equal access to appropriately staffed services, further attention needs to be paid to supporting an adequately skilled multidisciplinary workforce. The workforce needs to be organised in a way that best provides for local needs rather than a service based largely on the existing supply of different professionals and disjointed workforce planning.

Social services, social work, and information management: Some european perspectives

Abstract Social services are entering the information society. Over the past decades, information technology applications have slowly permeated service agencies. Although originally the domain of administrative and management staff, now core operational staff are also confronted with making increased use of technology. The way information management in human services is shaped is not only dependent upon technology, but increasingly seems to result from an interaction between social policy developments and information technology opportunities. Similarly, social policy developments are shaped by the existing information management infrastructure. One of the purposes of this paper is to explore–taking social services and social work as the exemplar, and mainly drawing upon experiences from the UK and the Netherlands–the relationship between new technology and the policy environment. We also reflect on whether or not this relationship is more complex than indicated by globalization and related post-Fordist th...

Parent‐training/education programmes in the management of children with conduct disorders: developing an integrated evidence‐based perspective for health and social care

This article reports on the first health technology appraisal conducted jointly between the National Institute for Health and Clinical Excellence (NICE) and Social Care Institute for Excellence (SCIE). The appraisal systematically reviewed evidence for the clinical effectiveness of parent‐training/education programmes in the management of children with conduct disorders. This appraisal is highly topical in the light of cross‐cutting policy agendas concerned with increasing parenting capacity. It is also methodologically innovative in its approach to synthesising the meta‐analysis of trial evidence on outcomes of programmes with qualitative evidence on process and implementation. The appraisal found parent‐training/education programmes to be effective in the management of children with conduct disorders, and it identifies the generic characteristics of effective programmes. It is concluded that this approach offers an exemplar for the development of systematic reviewing of complex psychosocial interventions that are relevant to integrated childrens services.

Guidelines across the health and social care divides: The example of the NICE-SCIE dementia guideline

Abstract Increasingly, mental health services are delivered through multidisciplinary teams and settings. This creates particular challenges for the development of evidence-based practice guidelines when different professional groups represented within teams might have different traditions and cultures in relation to what counts as ‘evidence’, and how that might be synthesized to produce guidance that supports best practice across professional divides. These challenges are explored in relation to integration between health and social care services, where social work in particular has traditionally expressed scepticism about guideline development where it does not incorporate knowledge drawn from qualitative research and perspectives of stakeholders such as service users and carers. This article takes the NICE-SCIE guideline on dementia care as an exemplar of how an integrated process of guideline development can deliver guidance for best practice across integrated mental health services. Finally, some of the issues still facing inter-professional guideline development are considered, and pointers given to eclectic approaches that are beginning to emerge from within social work.

Social inclusion as an agenda for mental health social work:Getting a whole life?

Summary Following New Labours election to office in the UK in 1997, policy initiatives have proliferated relating to mental health. Much of this policy innovation emphasises the social dimensions of mental health and distress, with an emphasis on employment and social inclusion. Paradoxically, this modernization of the mental health agenda comes at a time when mental health social work is struggling to establish its role and contribution within recently integrated health and social services. The paper considers whether New Labours flagship programme, Mental Health and Social Exclusion, constitutes a “New Deal” for mental health, and whether it provides a perspective that will help mental health social work to define its distinctive contribution to integrated services.

Finding a Direction for Social Research in Mental Health Establishing Priorities and Developing Capacity

• Summary: In the UK the modernization of mental health services has been underpinned by integration of health and social care. However, these two sectors bring to integrated services very different legacies in relation to research and development. Although there are notable exceptions, social science in general, and social work research in particular, operate with limited capacity and with little influence relative to the volume of research undertaken within medical psychiatry. This article reports on a survey commissioned by the UK Department of Health to scope the views of stakeholders on the priorities for future development of social research in mental health and to look at practical ways of building research capacity in this area. • Findings: The survey identified two clusters of research topics as future priorities for the social research agenda: the first is social inclusion/social capital and social networks, and the second is resilience and recovery. Despite this headline consensus, the survey also uncovers some underlying tensions between health and social care professionals in the prioritization of medical and social research topics. • Applications: The findings of this survey will contribute directly to the identification of funding priorities for research in mental health and to strategies for building research capacity in social care and mental health.

Using Repertory Grid Technique with Participants in Parenting Programmes--A Pilot Study

Parenting programmes have become a core element of New Labours approach to strengthening families. Although parenting programmes originally were focused on the parents of young children, they are now also seen as an important intervention to support parents of adolescents. This paper suggests that repertory grids can be an illuminating method for identifying the aspects of construing parenting of adolescents that are influenced through participation in parenting programmes, as well as an aid to reflection. Reporting on the use of repertory grids in one project, it was found that the parenting programme significantly influenced anxiety about parenting, and also affected other factors associated with inconsistent and harsh parenting. It is suggested that repertory grids can usefully be added by practitioners to the methods used to evaluate parenting programmes.