Out-of-school lives of physically disabled children and young people in the United Kingdom: A qualitative literature review

Currently there appears to be few opportunities and little evidence of physically disabled children and young people (C&YP) participating in mainstream social activities. A qualitative review was undertaken to examine the factors affecting physically disabled C&YP (8–15 years) in the United Kingdom participating in out-of-school activities. Views and experiences were explored from the perspective of the service users and providers to assess current provision and to determine the need for future research into factors that may affect participation. Searches were conducted across eight databases, the references of the included studies were checked and the websites were searched. Studies that used a qualitative design that examined the views relating to out-of-school activities were included. Nine papers were identified, which included three peer-reviewed papers and six pieces of grey literature and pertinent government documents to include views and experiences of out-of-school activity provision. The main themes emerging from the review were the need for social inclusion, out-of-school activities run by volunteers and accessibility, with threads throughout, which require further research including parental influence, provision, training and attitudes. This review highlights the absence of the service user’s voice and sheds light on the limited provision and barriers affecting participation in out-of-school activities

Exclusionary employment in Britain’s broken labour market

There is growing evidence of the problematic nature of the UK’s ‘flexible labour market’ with rising levels of in-work poverty and insecurity. Yet successive Governments have stressed that paid work is the route to inclusion, focussing attention on the divide between employed and unemployed. Past efforts to measure social exclusion have tended to make the same distinction. The aim of this paper is to apply Levitas et al’s (2007) framework to assess levels of exclusionary employment, i.e. exclusion arising directly from an individual’s labour market situation. Using data from the Poverty and Social Exclusion UK survey, results show that one in three adults in paid work is in poverty, or in insecure or poor quality employment. One third of this group have not seen any progression in their labour market situation in the last five years. The policy focus needs to shift from ‘Broken Britain’ to Britain’s broken labour market

The identification of research priorities for UK occupational therapists in work rehabilitation

Background/Aims: UK occupational therapists are recognised as having key skills in work rehabilitation, but there is limited evidence to underpin this. In order to use research resources to best effect, it is vital to identify the research priorities of occupational therapists in work rehabilitation. This study aims to gather the views of those with a special interest in the field in order to identify their research priorities. Methods: An online survey was developed and administered electronically to members (n=173) of the College of Occupational Therapists Specialist Section-Work (COTSS-Work). Respondents were asked to: i) prioritise and comment on research areas; ii) propose research questions. A final sample of 42 surveys was collected and analysed thematically Results: Responses reflected the diversity and complexity of work rehabilitation. Identifying a rank order of research priorities proved challenging as the majority (≥62%) of respondents considered all of the topic areas listed a high priority. Research into the following areas were included in the survey: interventions; outcome measurements; assessments; management and/or service delivery; planning and/or commissioning; and education. However, 'interventions' was rated highest overall. Conclusions: Occupational therapists in the UK need more evidence to justify their role in the work and health arena. Greater opportunities are required for occupational therapists in clinical practice, as well as those involved in research, to address areas in which evidence-based practice is lacking and the mechanisms to disseminate this knowledge base

Development and evaluation of an early specialised traumatic brain injury vocational rehabilitation training package

Background: In a feasibility randomised controlled trial, training was developed to equip Occupational Therapists to deliver Early Specialised Traumatic Brain Injury Vocational Rehabilitation in the English National Health Service. Methods: The package was developed by "experts" in vocational rehabilitation and traumatic brain injury and included a manual, direct instruction by six trainers and opportunity for mentorship by four therapists. Following training, therapists were interviewed regarding the effectiveness and "ease of use" of the package. Interviews were analysed using the framework approach. Results: Five trained therapists were interviewed regarding the package. Results were organised into 6 categories: (1) motivation to participate in research; (2) impact of the learning environment; (3) changing confidence levels over time; (4) growing appreciation of complexities about the intervention; (5) acceptability of the training package; (6) lessons for future implementation. Conclusions: Therapists reported acquiring knowledge necessary to implement the intervention. Data indicates that training packages require detailed descriptions of the interventions being taught for local implementation in the NHS and for future research. Training materials are valued by therapists but require time for familiarisation and reminders from mentors help put training into practice. Therapists have concerns about implementing interventions within a research context, which researchers should address

Health of community nurses: a case for workplace wellness schemes

Community nursing is associated with stress and burnout, which can impact heavily on the individual and the NHS both economically and on the quality of patient care. Recent Government publications have called for an increase in workplace health schemes, with the public sector ‘leading by example’. As the largest employer in Europe, the NHS is well placed to develop workplace wellness schemes to address the health needs of staff and to indirectly influence primary prevention among patients. Lessons from an innovative employee wellness programme in an NHS hospital setting demonstrates that such schemes may positively alter individual health and attitudes towards the employer. There is scope for development of such schemes to improve health and well-being in community nurses

Experiences from the frontline : an exploration of personal advisers’ practice with claimants who have health-related needs within UK welfare-to-work provision

Recent UK welfare reforms have been less successful than expected by the Government in supporting unemployed people with long-term illness into work. Frontline workers remain a core element of the new welfare-to-work machinery, but operate within a changed organisational and policy landscape. These changes raise important questions regarding whether and how claimants’ health-related barriers to work are considered. This paper examines the UK welfare-to-work frontline worker’s role with claimants who have long-term illness. Fieldwork observations in three not for profit employment support services, and semi-structured interviews with 29 participants (claimants, frontline workers, healthcare professionals and managers) were conducted between 2011 and 2012. Participant observation of the wider welfare-to-work arena was initiated in 2009 and continued until 2013. A qualitative methodology drawing on ethnographic principles was adopted. Thematic analysis of the data was carried out. The findings show that the frontline worker plays a key role in assessing and addressing claimants’ health-related barriers to work. Two important health-related role dimensions were identified: a health promoter role which involved giving health promotional advice to claimants about their general health; and a health monitor role which involved observing and questioning claimants about their general health. Frontline workers’ practice approaches were shaped by organisational and individual factors. Integration between the National Health Service (NHS) and employment support services was limited, and the findings suggested improvements were required to ensure an adequate response to claimants’ health-related needs to support their journey into work

Older people maintaining mental health well-being through resilience : an appreciative inquiry study in four countries

Aim. To explore the experience and strategies of mental health well-being through resilience in older people across the four participating countries. Background. While there is increasing evidence of the way older people maintain physical well-being, there has not been the same emphasis when examining the ways in which older people enhance their resilience and so promote mental health well-being. Design. An Appreciative Inquiry approach was used. Method. A convenience sample of 58 people over the age of 65 years from Australia, UK, Germany, and South Africa were interviewed. Data were analysed using thematic analysis. Results. Participants described their experiences of mental health well-being in relation to: social isolation and loneliness; social worth; self-determination; and security. Strategies utilised include promoting resilience by maintaining community connections and relationships, keeping active, and emotional, practical and spiritual coping. Conclusion. The findings highlight the importance of maintaining mental health well-being through resilience. Although there were some variations between countries, these strategies for maintaining well-being transcended culture and nation. Relevance to clinical practice. Listening to older people through research such as the current study will help to determine what help is needed and how healthcare and policy makers can assist

Rethinking energy demand governance : Exploring impact beyond 'energy' policy

The challenges of climate change and energy security, along with problems of fuel poverty and energy justice bring imperatives to create transitions in energy demand. Academic research and theory have begun to highlight the ways that government policies, strategies, and processes across wide-ranging areas of policy, from health to work and the economy, shape everyday practices with significant implications for energy demand. This brings focus on the role of governance in shaping energy demand far beyond what might traditionally be characterised as ‘energy’ policy. Situating these ideas in terms of relational geographical concepts of governance, this paper analyses qualitative interview data with actors involved in governing along with documentary material, to highlight four different ways in which non-energy related governance can have important implications for energy issues. The central contribution of the paper is to set out a distinctive analytic framework for making visible ‘non-energy’ policy impacts, which might otherwise be obscured within analysis. The article concludes reflecting on the implications of the analysis for rethinking the governance of energy demand to meet contemporary challenges

Prevalence of childhood disability and the characteristics and circumstances of disabled children in the UK : secondary analysis of the Family Resources Survey

Background: Robust data on the prevalence of childhood disability and the circumstances and characteristics of disabled children is crucial to understanding the relationship between impairment and social disadvantage. It is also crucial for public policy development aimed at reducing the prevalence of childhood disability and providing appropriate and timely service provision. This paper reports prevalence rates for childhood disability in the United Kingdom (UK) and describes the social and household circumstances of disabled children, comparing these where appropriate to those of non-disabled children. Methods: Data were generated from secondary analysis of the Family Resources Survey, a national UK cross-sectional survey, (2004/5) which had data on 16,012 children aged 0-18 years. Children were defined as disabled if they met the Disability Discrimination Act (DDA) definition (1995 and 2005). Frequency distributions and cross-tabulations were run to establish prevalence estimates, and describe the circumstances of disabled children. To establish the association between individual social and material factors and childhood disability when other factors were controlled for, logistic regression models were fitted on the dependent variable 'DDA defined disability'. Results: 7.3% (CI 6.9, 7.7) of UK children were reported by as disabled according to the DDA definition. Patterns of disability differed between sexes with boys having a higher rate overall and more likely than girls to experience difficulties with physical coordination; memory, concentration and learning; communication. Disabled children lived in different personal situations from their non-disabled counterparts, and were more likely to live with low-income, deprivation, debt and poor housing. This was particularly the case for disabled children from black/minority ethnic/ mixed parentage groups and lone-parent households. Childhood disability was associated with lone parenthood and parental disability and these associations persisted when social disadvantage was controlled for. Conclusion: These analyses suggest that UK disabled children experience higher levels of poverty and personal and social disadvantage than other children. Further research is required to establish accurate prevalence estimates of childhood disability among different black and minority ethnic groups and to understand the associations between childhood disability and lone parenthood and the higher rates of sibling and parental disability in households with disabled children

Can the UK’s birth registration system better serve the interests of those born following collaborative assisted reproduction?

Current birth registration systems fail to serve adequately the interests of those born as a result of gamete and embryo donation and surrogacy. In the UK, changes to the birth registration system have been piecemeal, reactive and situation-specific and no information is recorded about gamete donors. Birth registration has thereby become a statement of legal parentage and citizenship only, without debate as to whether it should serve any wider functions. This sits uneasily with the increasingly accepted human right to know one’s genetic and gestational as well as legal parents, and the duty of the State to facilitate that right. This commentary sets out one possible model for reform to better ensure that those affected become aware of, and/or have access to, knowledge about their origins and that such information is stored and released effectively without compromising individual privacy. Among other features, our proposal links the birth registration system and the information stored in the Human Fertilization and Embryology Authority’s Register of Information, although further work than we have been able to undertake here is necessary to ensure a better fit where cross-border treatment services or informal arrangements have been involved. The time for debate and reform is well overdue