Policymakers across myriad jurisdictions are grappling with the challenge of complex policy problems. Multi‐faceted, complex, and seemingly intractable, ‘wicked’ problems have exhausted the repertoire of the standard policy approaches. In response, governments are increasingly looking for new options, and one approach that has gained significant scholarly interest, along with increasing attention from practitioners, is ‘place‐based’ solutions. This paper surveys conceptual aspects of this approach. It describes practices in comparable jurisdictions – the United Kingdom, the EU, and the United States. And it explores efforts over the past decade to ‘localise’ Indigenous services. It sketches the governance challenge in migrating from top‐down or principal‐agent arrangements towards place‐based practice. The paper concludes that many of the building blocks for this shift already exist but that these need to be re‐oriented around ‘learning’. Funding and other administrative protocols may also ultimately need to be redefined.

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BackgroundThere is a lack of research in forensic settings examining therapeutic relationships. A structured communication approach, placing patients’ perspectives at the heart of discussions about their care, was used to improve patients’ quality of life in secure settings.The objectives were to:• Establish the feasibility of the trial design• Determine the variability of the outcomes of interest• Estimate the costs of the intervention• If necessary, refine the interventionMethodsA pilot cluster randomised controlled trial was conducted. Data was collected from July 2012 to January 2015 from participants in 6 medium secure in–patient services in London and Southern England. 55 patients and 47 nurses were in the intervention group with 57 patients and 45 nurses in the control group. The intervention comprised 6 nurse-patient meetings over a 6 month period. Patients rated their satisfaction with a range of domains followed by discussions on improving patient identified problems. Assessments took place at baseline, 6 months, and 12 months. Participants were not blind to their allocated group. The primary outcome was self-reported quality of life collected by a researcher blind to participants’ allocation status.ResultsThe randomisation procedures and intervention approach functioned well. The measures used were understood by the participants and gave relevant outcome information. The response rates were good with low patient withdrawal rates. The quality of life estimated treatment effect was 0.2 (95 % CI: −0.4 to 0.8) at 6 months and 0.4 (95 % CI: −0.3 to 1.1) indicating the likely extreme boundaries of effect in the main trial. The estimated treatment effect of the primary outcome is clinically important, and a positive effect of the intervention is not ruled out. The estimate of the ICC for the primary outcome at 6 and 12 months was 0.04 (0.00 to 0.17) and 0.05 (0.00 to 0.18). The cost of the intervention was £529 per patient.ConclusionsThe trial design was viable as the basis for a full-scale trial. A full trial is justified to estimate the effect of the intervention with greater certainty. The variability of the outcomes could be used to calculate numbers needed for a full-scale trial. Ratings of need for therapeutic security may be useful in any future study.Trial registrationCurrent Controlled Trials ISRCTN34145189. Retrospectively registered 22 June 2012.

Introduction: This article describes the development of a first year occupational therapy module, 'Participation in Occupations', and the design and development of a mediating tool, Contexts of Participation: the Critical Thinking Tool, in a British university.Method: Using an action research process, the module content, learning and teaching strategy and new conceptual tools were designed to promote an enhanced understanding of the central importance of occupation to occupational therapy and, in particular, the role of participation in occupations in forming and reforming an individual within unique contextual situations. The inclusion of theory from disability studies and the use of a transformative approach to higher education were also investigated.Findings and discussion: The study spans 16 cohorts of students and reflects on the findings, which include increased client-centredness and greater appreciation of the complex nature of participation and its role in health and wellbeing.

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