Background The incidence of self-harm in young people in primary care is increasing dramatically, and many young people who self-harm visit their GP surgery as a first point of contact for help. Objective To explore with young people, GPs and practice nurses (PNs): (i) why young people present with self-harm to primary care and (ii) whether young people, GPs and PNs can take steps to have more helpful consultations about self-harm in GP surgeries that include self-help materials developed by young people being used to support such consultations to take place. Methods Participatory action research with GPs, PNs and young people employed mixed methods to collect statistical and narrative data. Statistics from 285 young people’s medical records were captured, including more detailed analyses of a random sample of 75 of these records. A series of 24 focus groups with a total of 45 GPs, PNs and young people, with an average number of eight participants in each group, was conducted. Statistical data were subject to descriptive and inferential analyses, and thematic analysis was applied to the transcripts from the focus groups. Results and conclusion The type of self-harm young people presented with influenced whether they would see a GP or PN. While self-help materials were welcomed and deemed helpful, young people, GPs and PNs were ambivalent about using these in short consultations where time was an overriding constraint. More research is needed on the feasibility of adopting self-help assisted interventions in GP surgeries.

PurposeThis study examined the contribution of adult social work in integrated teams in the UK.Design/methodology/approachThe study design was realist, evaluation research using a mixed methods approach. Data collection methods included interviews and focus groups. Types of social work activities were extracted from older adults' case records and used to calculate costs of care. The presence or absence of indicators of care quality was recorded using the same sample of case records. Data were collected from three primary care teams in which social work was integrated. They were compared with data from three social-work-only teams in the same districts. Narrative data was analysed thematically. Inferential and descriptive statistics were used to compare costs and care quality.FindingsWhen social work was embedded or attached to a primary care team, costs of care delivery were lower than in their social-work-only team and more indicators of good quality care outcomes were recorded. Results suggest that embedding social work in integrated primary care teams contributes to cost-effective, quality care for older people if certain conditions for integration are met.Originality/valueThis is the first study to triangulate three data sources to quantify the social work contribution to integrated primary health care teams for older adults.

Purpose The purpose of this paper is to explore the way gender and gender roles are socially constructed by those who have experience of females committing sexual offences against children. Design/methodology/approach Using a discursive approach, supported by membership category analysis, a secondary analysis of qualitative data illustrates how the social construction of gender and gender roles impacts on society’s perception of females who commit sexual offences against children. Findings Discourse analysis found three patterns employed within conversation that demonstrate how the construction of women influence society’s incomprehension of females who commit sexual offences against children: women can be trusted, women do not manipulate and groom and, women are not sexually aggressive. Research limitations/implications A limitation of this study is the use of secondary data, which cannot provide the richness or detail found in primary accounts from people with this lived experience. The difficulty in accessing this sub-population highlights the hidden nature of the topic and the need for further research in this area. Originality/value This is the first study to explore how gender discourse is used in discussions of females who commit sexual offences against children. The value of this exploration highlights the need of society to adjust their perceptions of the offending capabilities of women and to ensure the experiences of people who experience this form of sexual abuse receive support.

PurposeThe aim of this study was to explore the experiences and outcomes for adults with complex needs over time, within and between two teams that delivered integrated care across different Councils' services. The teams' approach to integration included two key features: a “case lead” way of working and the team itself operating as a single point of access (SPA) for residents in given neighbourhoods with high deprivation.Design/methodology/approachThe study was designed as evaluation research located in the realist tradition. Two teams acted as a case study to provide an in-depth understanding of how the case lead approach and SPA delivered the craft and graft of integrated working in the teams. Mixed methods of data collection included residents' ratings of their quality of life on five domains in an outcome measure over a six-month period. Residents and staff working in the teams also participated in semi-structured interviews to explore their respective experiences and receiving and delivering integrated care. The costs of care delivery incurred by residents were calculated based on their demands on public services in the year leading up to the teams' intervention and the projected costs for one year following this.FindingsThe relationship between team context, case leads' inputs and residents' outcomes was mediated through the managerial style in the integrated teams which enabled case leads to be creative and do things differently with residents. Case leads worked holistically to prevent residents being in crisis as well as giving practical help such as sorting debts and finances and supporting access to volunteering or further education. Residents rated their quality of life as significantly improved over a six-month period and significant savings in costs as result of the teams' support were projected.Originality/valueThe study used a multi-evaluation realistic evaluation methodology to explore the relationship between team context, case leads' inputs and residents' outcomes in terms that integrated services across different District and County Council Departments.

BackgroundDespite the policy agenda for health and social care collaboration currently focused on integrated care systems, there is limited evidence that examines whether embedding social workers in integrated primary health and social care teams working with older adults is effective.AimThe study aimed to establish whether embedding social workers in integrated primary care teams (IPCTs) for older adults in Nottinghamshire was cost-effective.MethodA mixed methods approach collected quantitative and qualitative data that was triangulated using a TRI-Q model. Cost and care quality data were collected from patients in receipt of social worker involvement in three different IPCTs. Patients with similarly complex needs, who were receiving involvement from social work only district teams in the same localities acted as a comparator group. Interviews were conducted with patients and carers and with social workers and GPs working in the IPCTs. Seven focus groups were conducted with IPCT members representing social work and health disciplines.ResultsThe cost data were analysed using ANCOVA to identify any significant differences in costs across the teams. The result showed costs in two of the IPCTs were significantly lower than controls. Care quality indicators were also greater in these IPCTs. Thematic analysis highlighted the important of knowledge exchange that arose from social work embeddedness as indicative of the optimal conditions for effective integrated working and care delivery to be achieved.ConclusionThe findings suggested that embedding social workers in IPCTs offers both higher quality and more cost-effective care for older people if the optimum conditions for integration are met.