Online dementia training – the future?

In this guest post Professor Rose-Marie Dröes of the Department of Psychiatry at the VU University Medical Centre in Amsterdam relates her experience of developing an online training portal for carers of people with dementia.

It has been a long journey, but our new STAR Training portal was officially launched on 11 October 2013 at the Alzheimer Europe conference in Malta.

This European Lifelong Learning project (known as STAR) has created an online training portal with eight course modules covering the key competence areas for carers of people with dementia. Each module is available at two levels and we hope that the course will serve all kinds of carers, both family carers and professionals. The authors of the course modules are dementia experts from the Netherlands, UK, Sweden and Italy. The project has also included participants from Malta and Romania. Pilots are starting, and anyone can register and try it out.

STAR project

I have learned many things myself in this project, for instance, to really focus on the most relevant themes to include in the course modules so that they will be really useful for family carers and untrained volunteers, but also for professionals.  Also, I have had to learn how to effectively use different web-based interactive strategies to support the e-learning process.

What has been most exciting has been to work together both with dementia experts from different European countries and technology experts who have been able to help us to operationalize our ideas about e-learning for dementia care. This enabled us to compose an e-learning course in different languages and at the same time one that is adapted to different cultures.

But I have also found several things challenging as a researcher. For instance, the writing of the modules, adapting them to the different countries, developing and implementing games, film clips, and tests all took a lot of time. We probably underestimated this in the timeline of the project. As a result we had little time to evaluate the long term effects of the course, that is to say, how it impacts on the knowledge and attitudes of informal carers and professionals. This would be interesting to investigate.

Would I get involved in such a project again? Certainly yes! I think it is very rewarding to be involved in European projects in which educational products and psychosocial interventions are developed and evaluated which in the end may be used in dementia care throughout Europe.

My advice for new researchers, therefore, is to get in touch with international research groups, such as the Interdem network on research into timely psychosocial interventions, and to try to participate in joint international research projects.

Together we can make a much larger impact on innovations in dementia care in Europe.

Professor Rose-Marie Dröes is based at the Department of Psychiatry at the VU University Medical Centre, Amsterdam, the Netherlands: rm.droes@vumc.nl

The Alzheimer Europe conference in Malta at which STAR was launched took place 10-12 October 2013. Twitter hashtag: #23AEC. The conference was also attended by Social Care Workforce Research Unit Director, Professor Jill Manthorpe: see Unit news items.

Dreaming Spires: reflections on the 42nd British Society of Gerontology conference at Oxford

John Miles, PhD candidate with the Centre for Social Gerontology at Keele University and researcher on the Social Care Workforce Research Unit’s Rebuilding Lives study, reports from the British Society of Gerontology conference held earlier this month.

Beginning on Wednesday 11 September around 500 people turned up for the three days of the 2013 British Society of Gerontology (BSG) conference, held this year at Keble College, Oxford, and hosted by the Oxford Institute of Population Ageing. A combination of the Institute’s unique international connections, the prestige of the university itself, and the growing diversity of age-related research, came close to doubling the BSG’s annual attendance. Three linked events drew in well over 100 people in advance on the Tuesday. The turnout required the continuous use of two sites with some occasional overspill on to a few more. Delegates either got an unusual amount of exercise or found themselves grappling with the painfully slow evolution of disability access in a great, listed, Victorian building!

Despite such challenges the conference inspired a great deal of warmth and enthusiasm and its eclectic programme was a constant source of surprise and intrigue. Gerontology is something of a conglomerate, and by its very nature often interdisciplinary. Sessions tended to be grouped by theme rather than discipline, so that a presentation about a survey of 1000 people could be followed by an ethnography of work with ten people in a nursing home. But therein lies some of the conference’s power: as a social gerontologist with sociological inclinations, for example, I found myself in a couple of rich, and productive, post-match discussions with social psychologists. At the ‘Emerging Researchers in Ageing’ event on the Tuesday, cellist Claire Garabedian’s account of her research into playing music to people with dementia was exemplary. She identified herself as a musician and not a therapist. She explained how she had filmed her encounters to supplement and contest her subjective experience of playing one-to-one to individuals in their rooms. She accounted for the complex processes to which her presence in the home gave rise through her dealings with the staff, and with other residents. And she reported a benign impact for many of her auditors.

The cross-currents of such an account with the second plenary at the main conference the following day were significant for me. Literary scholar Helen Small showed four clips from the award-winning documentary Room 335, where the then 19 year-old documentary film-maker Andrew Jencks recorded his stay in a huge Florida nursing home over a period of several weeks. Jencks’ approach might have its drawbacks but it radically demystified the boundaries that supposedly make institutional lives so inaccessible. Moreover, as Small pointed out in a compelling analysis, Jencks’ film established in sociological terms the existence of a robust form of mutual support operating among the residents themselves, none of whom showed any interest in being looked after by their families. Su Su Liu, alongside whom I presented a couple of days later, identified something similar in the outlook of the sixty people she interviewed who attend elders’ community centres in Hong Kong. Friendship among these resilient survivors is more a performance of rhetorical support and social engagement than a pursuit of intimacy or personal trust. In the same session the family sociologist Eric Widmer from Geneva drew on a Bourdieusian perspective to examine the distribution of personal resources within older people’s family networks. This, he argued with me later, is where the social capital that counts is to be found, rather than among the vaguer configurations of ‘community’ into which Robert Putnam’s Bowling Alone has steered so many government-promoted behaviour change initiatives during the last decade. Bola Amaike and Funmi Bammeke from the University of Lagos presented papers about care and support in Nigeria. Their uncompromising demand for men to change their attitudes and expectations underpinned a bold if not quite credible attempt to reconcile the restoration of filial piety with the overthrow of patriarchy!

At the plenary sessions social gerontology itself was interrogated: in its distant relationship to the biological sciences by distinguished stem-cell researcher Paul Fairchild, and to the humanities by Small, and then for being insufficiently ecumenical in its inter-disciplinary relationships at policy level by the World Health Organisation’s John Beard. Whatever the objective justification for these critiques such challenges are welcome and appeared to be well-received. From my perspective, it is our too limited exchanges with economics and political science that remain of greatest concern. Gerontology needs to play a fuller part in challenging government inertia, and contesting destructive corporate agendas, as we plan for, and live in, our ageing society.

John Miles, who works on the Social Care Workforce Research Unit’s Rebuilding Lives study (funded by NIHR School for Social Care Research), has just completed six years on the BSG executive and is a PhD candidate with the Centre for Social Gerontology at Keele University.

Several Unit staff are members of BSG – we organised a symposium on dementia where our mental capacity study work was presented and Unit director Jill Manthorpe chaired a further symposium.

Avoiding more Winterbourne Views: What can we learn from history?

Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit at King’s College London, reports from the annual conference of the Social History of Learning Disability (SHLD) research group, which is based at The Open University (OU). The conference was held at the Milton Keynes OU campus on 8 July 2013.

The conference, Avoiding More Winterbourne Views: What can we learn from history?, highlighted the life histories and experiences of people with learning disabilities – whether living in institutions or in the community. Margaret Flynn, author of the Serious Case Review into Winterbourne View was keynote speaker and opened the conference with a presentation about the history of Winterbourne View and lessons learned. Margaret drew attention to the need for commissioning organisations to improve their performance – making better choices of providers and carrying out closer monitoring of contracts. Margaret questioned, for example, why commissioners are involved in building new long stay institutions and paying to keep service users with learning disabilities in them. Margaret also commented on how the individuals managing the private equity firm which ran Winterbourne View (which they regarded as one of their most profitable homes) managed to escape both media investigation and criminal prosecution. Margaret called for the introduction of a new law to make corporate negligence a crime, which could be used to prosecute unscrupulous private care home owners. Margaret also underlined the continuing need for better and customised inspections.

“No going back:  forgotten voices from Prudhoe Hospital”

“No going back: forgotten voices from Prudhoe Hospital”

From Newcastle, Tim Keilty and Kellie Woodley of self advocacy organisation Skills for People, gave a presentation about the production of a book based on residents’ memories of living at Prudhoe Hospital. They discussed the history of the institution (built in 1913 and only closed in 2005) which by the 1960s, housed 1,400 residents. Despite the harsh regime, former resident Kellie Woodley described lighter moments and the satisfaction of resistance, for example lying in wait for a disliked member of staff to enter the room, knowing she had balanced a bucket of water above a door or placing a contraband needle on the chair of another staff member.

Oxfordshire Family Support Network, a small charity run by carers for carers described their Changing Scenes Project, which offers peer to peer support for older families. Nationally, 60% of adults with a learning disability live with family carers. And approximately one-third of adults living in the family home live with carers aged 70 or over (source: Mencap Housing Time Bomb Report, 2002). This presentation consisted of conversations with four older family carers who related their experiences of battling on alone in the past without help, abusive incidents, and in more recent times standing up for their rights to get the services they wanted. One mother celebrated personalisation as a huge breakthrough in providing appropriate care for her family member.

Keeping the discussion in the present day, service user, Angela Still, from Central England, People First, presented the difficulties of community living such as isolation and her experiences of financial abuse by a neighbour. She outlined how, with the help of People First, she had been assigned a case manager, had managed to have her abuser prosecuted, and moved to a new house where she was now happy, safe and secure.

Sue Dumbleton and Jan Walmsley from the OU discussed how another Winterbourne View could be avoided. Sue, drawing on her experiences of being the parent of a young adult who has a learning disability, reflected on ‘what works’ in supporting people with a learning disability to enjoy a safe and productive life of their choosing and the role of personalisation in this.

This conference also included international perspectives with presentations from Norway and Ireland. We learned about the development of services for people with learning disabilities in Norway through the life history of Ruth, who was kept in an institution for 20 years. When Ruth finally moved to living in the community, the same staff from the institution were employed as her carers and she still had to battle to be treated as an individual and not be degraded. It was only when Ruth was given the power to choose her home care provider that she was finally free to live as she wished – “I am no longer angry because now I can decide for myself.” This presentation was given by Bjørn-Eirik Johnsen, Leif Lysvik and Terje Thomsen from Harstad University College.

Rob Hopkins and Joe McGrath

Rob Hopkins and Joe McGrath

From Ireland, Kelly Johnson, Rob Hopkins and Joe McGrath (Clare Inclusive Research Group) gave a talk about the difference between ‘belonging’ and ‘inclusion’ in a small village in County Clare with reference to the life history experiences of Joe McGrath.

Rachel Fyson from the University of Nottingham took the long view and highlighted how abuse is a constant and does not just happen in hospitals and large institutions. She argued more needs to be done to understand and prevent abuse wherever it takes place.

Mabel Cooper (1944-2013)

Mabel Cooper (1944-2013)

This annual conference was dedicated to Mabel Cooper, MA (1944-2013), a long standing member of the SHLD group, who passed away this year. The audience watched a video, shown on BBC2 in 1999, in which Mabel described her life in an institution – and the lasting impact this had on her. Mable left the institution in 1977 and during the 1980s, was Chairperson of Croydon and then London People First and worked with people with learning disabilities supporting others to speak up for themselves. Mabel’s gift for storytelling and her reflective ability meant her life story became famous around the world after it appeared, to great acclaim, in SHLD’s book Forgotten Lives (1997). Mabel’s personal testimony was also put to practical use in her work in schools. Drawing on personal experience, she was able to educate children about the lives of people with learning disabilities. Mabel’s friends Gloria Ferris, Jane Abraham and Dorothy Atkinson spoke movingly, remembering their friendship, including how they first met. “In making sure her story was told, and recorded, Mabel has left an enduring legacy”.

From my own personal viewpoint, working at SCWRU on a project about adult safeguarding, I found this conference particularly useful as it contextualised the history of care for people with learning disabilities, while at the same time raising current issues and debates. Best of all though – and what made this conference highly memorable – was it being characterised by inclusivity and forefronting the voices of people with learning disabilities throughout.

Caroline Norrie is Research Fellow at the Social Care Workforce Research Unit, King’s College London. She is working on: Models of safeguarding: a study comparing specialist and non-specialist safeguarding teams for adults – currently in its fieldwork stage.

Mobility and the researcher today

Dr Kritika Samsi

Dr Kritika Samsi

Kritika Samsi, Research Fellow at the Social Care Workforce Research Unit at King’s College London, was recently invited by the Irish University Association to attend the Researcher Careers & Mobility Conference in Dublin on 14-15 May 2013 (hosted by the European Presidency). Here she reflects on mobility and what it means for researchers today.

The Researcher Careers & Mobility Conference was a packed 24 hours, combining plenary sessions, with panel discussions, and interactive workshop discussions. Informative, challenging and controversial, the conference brought up some significant issues affecting researchers in Europe and globally today.

In our workshop on the subject of Mobility, four types of mobility were identified – geographic, when the individual physically moves countries for opportunities elsewhere; virtual, when the individual engages in collaborative work with partners in different countries; inter-sector, when scientists from academia make the move to industry; multi-disciplinary, when scientists moves between different disciplines within or beyond one single field of study.

Instead of focusing on the question “why is mobility good?” – our workshop group chose to discuss “is mobility good?” – clearly highlighting our orientation, and our need to explore thoroughly whether mobility was always necessary, and whether funding bodies give it too much or too little weight.

Geographic mobility is a significant criterion in most EU funding applications – it is considered useful for the applicant to have had international experience, to demonstrate networks and links with international universities, and to show the ability and willingness to move to other countries for collaborative research in the future. This is, no doubt, a wonderful opportunity for many researchers and one that many embrace with open arms. Not surprisingly, most conference participants had experience with mobility and almost all talked positively about it, saying that they were greatly enriched by the experience. Current initiatives at European immigration level, such as the introduction of the scientific visa that fast-tracks scientists from outside the EU to enable them to work in EU universities and research labs in Europe, were seen as a good development in this regard.

We, however, questioned whether geographic mobility was always possible or valuable, for a number of reasons…

The practicalities of moving are enormous – from understanding differences in tax structures, pension arrangements, and setting up other formalities like bank accounts. Although Euraxess provide some very practical assistance with this, there are additional stressors to finding and setting up home again, getting a new driving licence, that individual researchers have to take on themselves. Getting used to another workplace culture and lifestyle also takes time. If the move is not permanent, we wondered whether the set up costs outweighed the benefits, and whether the emphasis on geographic mobility takes all of these into consideration?

Do all of these practicalities weigh more heavily on certain groups of people – i.e. are some groups marginalized for being immobile? Men and women with families where dual jobs and incomes are necessary, researchers with physical disabilities or those reliant on social welfare for other reasons, researchers with responsibilities for caring for elderly family members, may all have commitments they are unable or choose not to disengage from. Does the stringent need for geographic mobility marginalise what are a significant group of researchers that may be forced into choosing alternative careers?

Another question that arose in discussion was whether it was necessary for a researcher to move if the best place to do research in a certain topic was in the very research centre they were currently based in? Did the current over-emphasis of the value of geographic mobility sometimes mean that researchers and funding bodies do not value their current situations, roles and research centres sufficiently, and so they do not capitalize on current opportunities as much as possible?

We also questioned the concept of ‘over-mobility’ – of moving too much and creating a network of international contacts and support, moving from one post-doc position to another in various international universities, but failing to have ‘put down research roots’ and created a track record in one university long enough to progress up the career ladder. While some agreed that geographic mobility often results in a drop in salary and grade, others felt that this was not always the case and moving to another university/country could be a promotion, thereby increasing the chances of moving up the career ladder.

We debated this and other issues in relation to Horizon 2020 – which means that shorter-term grants are likely to be available under the new funding framework, encouraging those previously discouraged from committing to long-term mobility to apply for shorter spaces of time in other locations. There is also likely to be greater emphasis on the other types of mobility. The effective use of technology may make it less necessary for people to physically move to achieve successful collaboration.

We finished hopeful that this may be the way forward to achieving the right kind of mobility for the right reasons.

Dr Kritika Samsi is Research Fellow at the Social Care Workforce Research Unit, King’s College London. She is also active in the Voice of the Researchers (VoR) network, which aims to act as a bridge between researchers and policy-makers, bringing together researchers and enabling them to take an active role in shaping the European Research Area.

Evidence Based Interventions in Dementia: What have we found?

Caroline Norrie reports on the presentation of findings yesterday from the major research programme known as EVIDEM, Evidence Based Interventions in Dementia.

Yesterday was a great day for those of us at the Social Care Workforce Research Unit, King’s College London who worked, together with colleagues from other universities, on the EVIDEM programme on changing practice in dementia care in the community. We joined an invited audience gathered at Friends House, Euston Road, London, to hear a summary of the EVIDEM programme research findings.

Presentations of the findings of this five year research programme were delivered to representatives from the Department of Health, the charity sector, health and social care professions, service user groups and research colleagues. This was the culmination of a huge amount of work and a fantastic opportunity to celebrate the project outputs.

EVIDEM was funded from a National Institute for Health Research (NIHR) grant of £2 million which ran from 2008-2012 with the aim of developing and testing interventions for people with dementia living in the community, including care homes.

Research teams were involved from King’s College London, UCL, LSE, St George’s & Kingston, University of London, University of Hertfordshire and Central and North West London NHS Foundation Trust.

The opening address was given by Professor Alistair Burns, the National Clinical Director for Dementia at NHS England, who outlined key policy goals in dementia such as: timely diagnosis and support for people with dementia; reduction in hospital admissions of people with dementia; improving services in care homes; reduction in the prescribing of anti-psychotic drugs; and care and support for carers. Professor Burns noted, “We are on the threshold of getting the data to change practice in dementia care.” 

Chairs Peter Ashley and Dr. James Warner, then introduced the five speakers and Professor Steve Iliffe from UCL gave an overview of the EVIDEM Programme. This consisted of: EVIDEM ED (education), EVIDEM E (exercise) EVIDEM C (continence) and EVIDEM MCA (Mental Capacity Act), EVIDEM EoL (end of life).

Professor Steve Iliffe opened the presentations with a discussion of EVIDEM ED. The aim of this intervention study was to test a customized educational intervention developed for general practice, promoting earlier diagnosis with management guidelines. Five NHS providers and two overseas organisations have now rolled out this training.This randomized trial, however, showed that the intervention did not appear to change the practice of GPs, which led to discussion of what other levers could be used to encourage GPs to follow best practice guidelines for dementia care.

Dr. James Warner from Central and North West London NHS Foundation Trust introduced EVIDEM E. He discussed results from this randomized trial of exercise as therapy for behavioral and psychological symptoms of dementia (BPSD). Dr Warner described how this was a simple intervention – a person with BPSD and a their carer went on a walk five times a week for 12 weeks. This study found that regular simple exercise does not improve symptoms of BPSD, but it does decrease caregiver burden.

Professor Vari Drennan from Kingston and St. George’s, University of London, presented EVIDEM C. Work on dementia and incontinence is of huge significance because this is a key factor in why people with dementia move into care homes. This group of studies included 4 elements: i) scoping the evidence on prevalence, effective interventions, local clinical guidance on provision of NHS funded incontinent products; and a nested study of the THIN database reporting incidents rates for the first time, for urinary and faecal incontinence in community dwelling people with dementia; ii) a longitudinal study exploring the experiences and strategies of people with dementia, their family carers and health and social care professionals; iii) a feasibility study of the investigation of the effectiveness and acceptability of different designs of continence pads; and, iv) the design of a continence assessment tool tailored to the needs of people with dementia. Findings from Professor Drennan’s research team showed that the incidence of incontinence in community dwelling people with dementia is at least double that in a matched population. The use of indwelling urinary catheters, a management strategy discouraged by international and national clinical guidelines was in fact found to be double the rate in people with dementia compared to a matched population. The presence of faecal incontinence was found to significantly increase expenditure by almost two-thirds from both a health and social care perspective. “This study suggests that there are strategies and responses that primary care professionals and others can employ to encourage greater openness, thereby lessening the taboo of incontinence within the stigma of dementia.” added Prof Drennan.

Professor Jill Manthorpe, Director of the Social Care Workforce Research Unit, King’s College London outlined EVIDEM MCA. This project involved developing practice in and building evidence on the use of the Mental Capacity Act 2005 (MCA). Professor Manthorpe’s research showed that dementia care services and practitioners have traditionally not conceptualised their practice as being framed by legal rules. The MCA has proved a major challenge to this and dementia care. Key points from this presentation were that practitioners in dementia care need to be legally literate and aware of the new clauses making neglect and abuse criminal offences. There are messages also for thinking about how future changes to the legal framework of social care contained within the Care and Support Bill may be sustained. (Jill Manthorpe and Kritika Samsi’s presentation from the event.)

Professor Claire Goodman, from University of Hertfordshire presented on EVIDEM-EoL: Quality of Care at the End of Life. The project team has found the trajectories of end of life in people with dementia (PWD) are often unclear to care home staff, family and healthcare practitioners. They used Appreciative Inquiry (AI) as a way to enhance professional relationships around the care home. It fostered rapid and sustained engagement between care home staff and GPs, did not increase resource use, reduced use of emergency services and appeared to improve the management of unexpected events and unplanned hospital admissions.

Finally, the afternoon was brought to a close by Professor Steve Iliffe who gave a short presentation on how EVIDEM has worked with the government funded Dementia and Neurodegenerative Diseases Research Network (DeNDRoN) to help build systems to give people with dementia who are interested  in research more choice and opportunity to get involved.

Overall, from the point of view of someone who worked as a researcher on one of the studies, this was a fantastic day, as it was highly satisfying to view the whole, complex programme of studies coming together and the wide range of evidence and research outputs produced.

Caroline Norrie is Research Fellow at the Social Care Workforce Research Unit, King’s College London. She is working on a NIHR School for Social Care Research funded project comparing the costs and benefits of different models of adult safeguarding.

Connecting people at King’s

Hannah Reidy

Meredith Newlin

Meredith Newlin

Meredith Newlin and Hannah Reidy from the Social Care Workforce Research Unit at King’s College London recently joined with the rest of the Connecting People Intervention team (from the University of Central Lancashire and the University of York) for a morning event at King’s to raise awareness and share experiences of the intervention.

Around 50 people attended the event from a range of backgrounds and services interested in this model of practice. Many of the attendees were new to the Connecting People Intervention (CPI) model and agency representatives from the pilot study also shared their experience, culminating in the room being filled with a breadth of perspectives and opinions, which lead to engaging discussions throughout the day.

Attendees at the workshop at King's on 15 February

Attendees at the workshop held at King’s on 15 February

After an introduction to the policy and research that fuelled the development of the intervention model, attendees were split into groups of workers who had experience of the intervention and those new to the study. This was the first time we’ve brought workers from the different intervention pilot sites together, and so this event served as a valuable opportunity to learn how other agencies are working with the intervention. We held a group discussion from which the consensus was that the event had been useful and more networking opportunities should be organised, which we will endeavour to do.

‘I feel that I am in a privileged situation – that the use of the model in practice is nearly honed through our own good practice, however I have learnt a lot on how we can improve these practices even further and fully intend to cascade to my colleagues’—a member of a participating agency taking part in the workshop

The attendees who were new to the model were given a ‘potted training on the intervention’ – short bite-size bits of training extracted from training sessions that we had run for the pilot agencies. This was no mean feat – we covered two training exercises that would normally take up to half a day in only 40 minutes – however we feel that we gave a good taster of the training days, and certainly helped to bring the intervention alive and place it in the context of their practice.

Attendees working through materials at the workshop

Attendees working through materials at the workshop

‘Will use this model when commissioning for new services’a comment of one worker new to the CPI model

The final activity of the morning was a panel discussion. Panel members had first-hand experience of the intervention and came from diverse backgrounds, allowing them to answer adeptly all of the questions asked from the room. The panel were: Prof David Morris (P.I. on the Connecting People Study and chair, UCLan); Andrew Hodson (Arts and Media manager, BlueSCI); Audrey Gallier (Social worker: Derby City CMHS Early Intervention Service); and Dr Darren Craddock (Consultant Psychiatrist: Coventry & Warwickshire Partnership NHS Trust).

Panellists, including social worker Audrey Gallier, discuss the Connecting People Intervention

(l to r) Darren Craddock, Audrey Gallier, Andrew Hodson and David Morris discuss the Connecting People Intervention

‘How do you incorporate changes in practice from the CPI model into agency culture such that its principles are sustained beyond the period of the research itself?’—one of the questions raised by a participant at the event

Attendees certainly made use of the networking lunch at the end of the day and many contacts were made for future correspondence. The agencies working within the pilot study had created posters for the event which were displayed during the lunch and allowed an insight into exactly how they had fitted their practice to the intervention.

We were busy taking photos, but that was not the only media coverage of the event. Old Trafford Community Television filmed the morning to form the basis of some of the training materials that we will be producing to allow new agencies to start to use the intervention. In addition, Andy McNicoll from Community Care attended the event and wrote a piece for the magazine, ‘The model that’s ‘reinvigorating’ social work’s role in mental health’. Sadly one of the Principal Investigators of the study – Dr Martin Webber – was unable to attend the event due to illness but he keeps a very active blog of his own, which will give you more insight into his thoughts about the Connecting People Intervention.

Our team thoroughly enjoyed the morning and judging from the feedback it seems that the attendees felt the same! We will be evaluating the event and aim to hold something similar in the North of England later in the year.

Meredith Newlin and Hannah Reidy are both Research Fellows at the Social Care Workforce Research Unit, King’s College London. Please visit the CPI study website for more, and see also the study newsletter, issue 2 of which was published earlier this month.

Invisible communities: Working with older people from Europe and beyond

Joan Rapaport

by Joan Rapaport

Our fifth annual older people conference hosted jointly with Making Research Count and Age UK London was held on 30 January at the Guy’s campus of King’s College London.
Joan Rapaport, one of over a hundred attendees and a Visiting Research Fellow at the Social Care Workforce Research Unit, reflects on the findings reported during the day.
Presentations from the day are on our website.

 

Professor Jill Manthorpe: Addressing ‘invisible’ inequalities in social careWhy now?

In her opening comments, Professor Manthorpe described an ‘elastic’ Eurovision definition of ‘White Other’ which included non-EU and EU nationals who were also often defined as White Other as well as the more frequently cited migrants from Canada, USA and Australia. As usual, she noted, London is a hotbed of change. The backgrounds of ‘White Other’ people are extremely diverse, with huge implications for appropriate social care provision. However, although the Equality Act 2010 is now in force, the needs of this population group as they age have not been explored.  Professor Manthorpe acknowledged the challenges faced by busy social workers and the constraints of assessment forms but asked:

  • How can appropriate services be provided if vital biographies and life stories have not been recorded?
  • What happens to people with memory problems or whose speech is impaired after a stroke – who provides the life experience to inform the care plan?
  • How can we help people to recall their memories and help care staff to see the person behind the care plan, so that social care truly reflects their needs?

Professor Karen Christensen: Older Scandinavians in London – how do they fare?

Professor Christensen identified the longstanding historical connections between Norway and Britain. Norway’s population is small (5 million) and scattered amongst 429 municipalities. It is difficult to find out the exact numbers of Norwegians living in the UK today, as the government figures are workforce related.

Her recent and unique life course interviews of seven Norwegians living in London, ages ranging from 59 – 75, revealed that these women came to London for love and marriage, au pair work, freedom from close knit communities and disappointment about Norwegian welfare services. Their passage was made easier because their fathers had encouraged them to learn English, as a ‘useful’ language. Those who had trodden the au pair and marriage route had stayed for family reasons and had chosen part-time work to suit. Others, who had come for career reasons and later married here, had made their decision to stay right from the start. These women juggled their careers with family responsibilities and worked until retirement. None had come ‘to get a better life’ in the traditional migrant sense.

Only one, married to a black man, had faced discrimination. Although settled in Britain, none wanted to become British citizens. They had all their rights, bar the right to vote. Professor Christensen considered that if there had been the option of dual nationality, their decisions might have been different. However, they could keep in touch with their Norwegian culture through their community networks and work and telling their grandchildren about Norway. There was also the Norwegian ‘injection’ of the holiday cottage – but then straight back to Britain! These women had no fear of getting old in Britain, as long as they could avoid residential care. They hoped for help from their families in return for caring for grandchildren. Those who had worked for Norwegian agencies received higher pensions than their British counterparts. They could thus afford private care.

Dr Shereen Hussein: Older Turkish migrants’ care needs in the UK: cultural encounters and unmet needshow do these compare?

Dr Hussein identified three distinct Turkish population groups: Turks, Alevi/Kurds and Turkish Cypriots living in the UK, sometimes referred to as ‘invisible minorities’. Although separate in their homeland, ethnic divisions are less apparent over here. However, each group has different ethnic histories. Old age is taking some by surprise.

With a Turkish colleague, Dr Hussein has been interviewing older Turkish men and women (ages ranging from 55 – 102) as well as Turkish care and community care workers. These interviews were conducted in Turkish (crucial to the study). Typically, and in stark contrast to the Norwegian experience, people came to London for a ‘better life’, to find work and possibly to flee persecution. The jobs they found, often through friends, were low-skilled, with poor working conditions and without ‘formalities’ (regulated). They did not have to speak English because the whole workforce spoke Turkish. Many had been over here for 50 years and never learnt English. Once they left the labour market, they found a ‘sudden’ need to speak English and know the system. Language posed a huge barrier, although those with adult offspring who had grown up in the UK were more aware of services and activities. However, for others retirement has meant ‘when I became old’, nostalgia for their homeland, loss of identity and feelings of disempowerment. Whilst inter-changeable care responsibilities from and for older people were assumed within the culture and elsewhere, these expectations could not always be met and older people were sometimes obliged to use social care services with trepidation. The gap between actual and perceived social care needs was large and culturally sensitive services were viewed by the research participants to be limited. Overall, the Norwegian participants painted a far rosier picture of growing old in London than their Turkish counterparts.

What needs to change?

  • Awareness that family is an important care provider but is not always available;
  • A focus on working with younger and older Turkish communities to bridge language and care barriers;
  • Assessment of the cost implications of not providing culturally sensitive early intervention and preventative measures, on crisis and intensive care services.

Jo Moriarty: The Equality Act 2010: Protected or ignored characteristics?

Jo Moriarty explained that most of the provisions of the Equality Act had come into force in October 2010, and those relating to Age Discrimination later in October 2012. Direct and indirect discrimination, harassment and victimisation are now outlawed. There are nine protected ‘characteristics’ of which seven apply in her review on the needs of older people: age – disability – gender reassignment – race – religion or belief – sex and sexual orientation. The study considered the impact of the Equality Act for Age UK across five different services. However, the task was very difficult because of the invisibility of the population in question and the dearth of research focusing specifically on equality and diversity. Routine monitoring for different protected characteristics is uneven, there are differing reporting standards and detail relating to the characteristics is not picked out. For example, in respect of Falls Prevention and the known benefits of exercise classes, areas such as accessible publicity, opportunities to socialise, religious preferences and single sex facilities have not been researched and the impact of discrimination on take-up is unknown. Day service provision is similarly neglected. Faith-based services may provide communal social activities, but these too are very under-researched. Furthermore, as more older lesbian, gay and bisexual people live alone than other groups – does this mean they have an increased need for home and hospital services?

Jo Moriarty warned of the risks of making assumptions and cited the example of the famous film star, Merle Oberon who was elusive about her Anglo-Indian background, to the extent she hid the fact that her Indian mother was actually her dresser. Jo highlighted the similar trap of erroneous assumptions of heterosexual relationships and the impact on people’s feelings.

What are the key messages?

  • Carry out more research on the needs of people with protected characteristics;
  • Provide inclusive publicity to reassure people;
  • Show staff have been trained in equality and diversity issues;
  • Avoid stereotyping;
  • Seek service users’ views even on sensitive matters; people like to be asked, especially if they are consulted on how to ask the question.

Dr Nan Greenwood: Does ethnicity matter? Working with older people from minority ethnic groups

Dr Greenwood said that her literature review had confirmed that health and social care issues for older people from minority ethnic groups were truly invisible. There was some information, but no one collates it. Statistics are unreliable and research is limited. Older refugees in particular may be isolated because of health and social problems and cultural differences and face multiple layers of disadvantage. If they have no permanent address they may have difficulties registering with a GP and thus accessing health services. Cultural perceptions about illness and the process of ageing may also act as barriers to accessing services more generally. The experiences of carers from minority ethnic groups are additionally compounded by disadvantage and marginalisation and culturally insensitive services. The effort to obtain help (phone calls and forms) is a major barrier to seeking help. Carers value information, accessible, culturally sensitive services and, most importantly, face-to-face contact and first language support.

People from lower socio-economic status groups from all minority ethnic groups describe their health as poorer. This information is complex as ethnicity is multi-faceted and changing and given the opportunity people may define themselves as belonging to more than one race. Homogeneity within groups may be overemphasised and mask heterogeneity. Ethnicity needs to be considered against other aspects of identity such as gender, age, religion, disability and health. Dr Greenwood stressed that the general principles of good care need to be embedded throughout and cited recent research that showed people from minority ethnic groups also wanted to be treated with dignity and respect.

Dr Greenwood acknowledged pros and cons in respect of separate or mainstream services. Separate services may be more culturally sensitive and innovative and mediate with general services. However, they may also bleach culture and set people apart. Evidence is as yet lacking to help tease out these and other issues.

What are the key messages?

  • Be aware that the concept of ethnicity may sometimes obscure other facets of identity and difference;
  • Health and social care evidence about the needs of people from ethnic minorities exist despite the limitations of the research;
  • Stop problematising ethnicity and blaming the characteristics of ethnic minorities e.g. for low take-up of services;
  • Keep abreast of changing patterns of health and disease to improve take up of screening and early intervention;
  • Keep the common factors of care in sight.

Jean Lambert MEP: Does London work for older Europeans?

Jean Lambert explained that it is assumed there about 100,000 EU nationals living in London who are over 60 years of age. They have come at different times and for different purposes, some as a result of WWII, refugees fleeing persecution, Jews from various parts of Europe, to join families, for work and so on. Under EU directives, discrimination is forbidden. Information is available in twenty-three languages on the EU website to help people attain their rights. Whilst discrepancies exist between different health and welfare systems across all member states, problems for non-EU nationals living within the EU are even greater.

In respect of workforce mobility issues and the UK, Jean Lambert expressed concern about attitudes in the UK in respect of transitional arrangements relating to people coming into the country from Bulgaria and other parts of Eastern Europe. Previously, even when apparently welcoming people from Poland, a whole host of problems had arisen: lack of support, language problems and people not understanding their rights and entitlements and often those on the administering side likewise. People when they arrive know they have rights but not what these are. Nothing has since changed.

This is the Year of European Citizenship and to mark the occasion one million Euro has been set aside to put on a number of events. As part of the Year, the European Parliament has commissioned and will report on discrepancies between the different systems, including those between Europe and the UK. In addition, funding from the Citizen Rights to Equality Programme (under the former European Year of Active Ageing) is expected to report on the needs of people needing dementia care.

What are the key lessons?

  • More research on the needs of older people from these minority groups could be helpful;
  • People need to be able to access information about their rights in their own language;
  • People need a single point of expert help and someone to assist them through the process.

Conclusions and closing comments

Professor Manthorpe highlighted the importance of ensuring that the histories of people from ‘White Other’ population groups were not forgotten, given their relevance to appropriate health and social care provision. The day had demonstrated that people have very different trajectories and these need to be acknowledged. In particular, the question remains how can social workers respond under their current work pressures at a time of dwindling resources? Attention to a person’s story may help at least to get things right first time by making sure that services are both accessible and acceptable.

Joan Rapaport is Visiting Research Fellow at the Social Care Workforce Research Unit, King’s College London. The Invisible Communities conference was organised by Jess Harris. Twitter hashtag for the conference is #olderpeople5

Research on older Turkish migrants in the UK – emerging findings from ROWM

Dr Shereen Hussein

by Shereen Hussein

With our conference on Invisible Communities: Working with older people from Europe and beyond coming up at the end of the month, Shereen Hussein, Senior Research Fellow at the Social Care Workforce Research Unit and co-founder of the Research On Workforce Mobility (ROWM) network, discusses her work on the Turkish community in the UK. 

There is increasing interest in the experiences of people who migrated in their youth during the mid-20th century and are now growing older in the UK and other European countries. While Turkish migrants are not as large a proportion of the UK migrant population as they are in other European countries such as Germany, they are a sizeable part of some migrant communities, especially in London.

We have recently been working on collaborative research focusing on the experiences of older Turkish migrants living in London. This has explored their perceptions of ageing, of possible long-term care needs and their access to services. Sixty-six interviews with older Turkish migrants (aged 55 years or more; 34 women and 32 men) revealed two major themes, 1) ageing and belonging, and 2) identity in old age.

Turkish migrants’ stories were full of accounts and examples of adjustments, compromises and nostalgia that surfaced in old age when labour participation and feelings of ‘importance’ started to fade. These feelings seem to be exacerbated by limited English language skills, resulting from living in relatively closed communities within the UK, working in ethnic economies and providing services for the Turkish community. Many older Turkish migrants interviewed showed signs of an ‘elective belonging’, referring to the way in which ‘place biographies’ have become less important when compared with personal biographies and identities. However, while the majority of older people interviewed appreciated being in the UK, they felt they had little choice over where they lived in retirement.

Early findings also show that older Turkish migrants who have educated offspring are more likely to be aware of their needs and how to access services. However, there were high expectations of family members, with family and kinship being centre-stage in later life. For some the strength of these ties could be tested in challenging situations. Moreover, older women felt strongly that their duty to care for their husbands, their children and their grandchildren was paramount. Despite or perhaps because of this, some older women did not feel that they were important or well supported.

The findings have wide implications for services and resonate with the experience of other older Black and Minority Ethnic communities in the UK. They highlight the need for more culturally appropriate services. It is also important to raise awareness of existing support to avoid social exclusion and facilitate access and participation, including volunteering, among older Turkish communities. The findings will be discussed in more detail at the upcoming event, Invisible communities: Working with older people from Europe and beyond (30 January 2013), taking place in London.

The experiences of older Turkish migrants living in Denmark is also a research interest of ROWM network member Dr Anika Liversage and her colleagues at the University of Copenhagen. In a recent visit to the Unit, Anika and I discussed potential similarities between Turkish migrants in the UK and Denmark. We observed the importance of migration history, changes over time or trajectories, and how the ways older Turkish people lived their lives shapes their ageing experiences.

I am conducting this research with Dr Sema Öglak (Dokuz Eylül University, Turkey). We are both members of the Research On Workforce Mobility (ROWM) network. The ROWM network is flourishing (new members are always welcome), with members from around the world intent on improving our understanding of the intertwined relationships between migration and long-term care, both for those receiving and providing such care.

Dr Hussein is Senior Research Fellow at the Social Care Workforce Research Unit, King’s College London. She tweets as @DrShereeHussein.

Mental health social work in challenging times: What should change?

Joan Rapaport

by Joan Rapaport

How does it feel to be confused or abused and needing or pleading for services? Given the damaging effects of trauma, what helps and hinders recovery? How do services respond, and do practitioners ask the right questions?

With reference to recent research, these and other questions were robustly addressed by experts in dementia care, domestic violence, substance misuse and women in secure settings at Making Research Count’s November 2012 event.

At a time when economic pressures put greater strain on people’s mental health, yet also threaten the existence of some services, what are the priorities when it comes to social work practice?

The speakers were: Professor Jill Manthorpe (Director, Social Care Workforce Research Unit) on older adults; Dr Roxane Agnew-Davies (Director of Domestic Violence Training Ltd) on domestic violence; Dr Sarah Galvani (Assistant Director, Tilda Goldberg Centre for Social Work and Social Care) on substance misuse; Kelly Alexander (Senior Lecturer, University of Bedfordshire) on women in secure settings; and, Mike Fisher (Professor at the University of Bedfordshire).

Older people and mental health: Professor Jill Manthorpe

No-one can fail to notice the current interest in dementia, but social work practice with older people needs to be equally aware of the distress and poor outcomes of other mental health problems in later life. Jill Manthorpe described such problems as not always arising in old age but often being of much longer duration. The value of social work’s attention to social circumstances, she argued, was that this could uncover long-standing concerns or, alternatively, simple acceptance among relatives or friends of the older person – the perception may have been, for example, that they had often been a ‘bit of a loner’ or ‘had always had trouble with their nerves’.

Common problems encountered were depression and anxiety, with some schools of thought seeing these as separate but others as very much connected. Social workers needed to know that people had seen their GP about troubling symptoms – and should ask older people directly about pain since that may overshadow other problems and also need attention. Jill noted that best practice here was not necessarily about changing the person but maybe the circumstances. As personal budgets are becoming so much more the norm, social workers will have new roles in interpreting mental health needs into desired outcomes, in devising workable support plans with contingencies, and with advising directly employed staff or brokers about situations that are puzzling them and might be related to an older person’s mental health.

So what should change?

Social workers should remember that it can be hard to differentiate depression from dementia – and that the two can co-exist. The high level of interest in dementia should not mean that other problems are marginalised – severe anxiety, for example, can have a very poor prognosis. Urgent help may be needed. Like other professionals, social workers should ask more about pain and encourage help-seeking behaviour. There are great continuities here in terms of social workers’ more general role as educators, team workers, advocates and ‘listening ears’.

The impact of domestic violence on women’s mental health: Dr Roxane Agnew-Davies

Dr Agnew-Davies described domestic violence as having a major impact on mental health. She urged social workers to ‘get personal’ and reflect on feelings arising from their own traumatic experiences. She also highlighted the importance of understanding ourselves to better understand the predicaments of others. She further asked for reflection on scenarios, such as the likely consequences of disclosures or non-disclosures and the burden of carrying secrets, especially where perpetrators of abuse and victims were in a close relationship.

Typically, women who are victims of domestic violence feel threatened, are severely physically and emotionally abused, isolated and demoralised. They suffer long-term effects of post-traumatic stress disorder (PTSD), depression and psychological distress. Medication is often prescribed. However, this cannot cure frustrated feelings of anger that are often misdirected towards their children or themselves, rather than the perpetrator of the abuse.  Strong links are found between domestic violence and the incidence of child abuse. Children who witness violence in the home are also exposed to emotional harm.

So what should change?

Dr Agnew-Davies highlighted the importance of staff training to ensure help was sensitively offered and nurtured trusting relationships and engagement. She stressed the importance of understanding the stage women were at when they came to the attention of services and asking the right questions. Thus, for a woman in crisis, it should not be ‘how did you get that black eye’? but ‘who harmed you’? to ensure the victim understood that perceptions of blame focused not on her but on the abuser.

In respect of child protection, citing a New York study, Dr Agnew-Davies cautioned against automatic removal of children in cases of domestic violence. In New York, child protection and domestic violence units work in partnership and are creating new initiatives to help prevent the violence from worsening with a prime objective of, wherever possible, keeping the children in the home.

In terms of prevention, it was important to work in schools to address misplaced attitudes legitimising violence towards women and help young people understand what makes for healthy relationships.

Problematic substance use and mental health: Dr Sarah Galvani

Commenting on the power of language, Dr Galvani said that users of services preferred and identified with the term mental distress rather than mental illness. The term ‘dual diagnosis’ could be misleading because, so often, personal histories reveal multiple co-existing psycho-social problems. Whilst the evidence regarding cause or effect and extent of overlap between substance use and mental distress is conflicting, strong associations are nevertheless clear.

Cannabis and alcohol are the nation’s favourite substances. Although cannabis is often implicated as a cause of mental illness, the scientific evidence is contradictory. The position is further confused by the different types and strengths of the substance which are now available. However, ‘a fair body of evidence’ suggests that early usage of the drug by young people is significantly damaging. At the other end of the life-span and in respect of alcohol intake, older people are now emerging as a new risk group. However, in spite of the prevalence of problematic substance usage, in 2008 40 percent of local authorities had no local strategies in place and later evidence highlights the need for better support for this group. People from minority ethnic groups are particularly poorly served. Although some evidence of creative practice exists, social workers tend to lack confidence in working with this client group.

So – what should change?

In terms of training and asking the right questions, it is important to recognise not only potentially damaging effects of substance use, but also people’s positive experiences, such as relaxation and reduction of unwanted side effects of prescribed psychotropic medication.

Assessments should focus on people’s needs, include ‘collateral’ information from friends and family, be conducted with empathy, demonstrate listening skills over and above form-filling, assess levels of mental distress, acknowledge cultural and religious beliefs and set realistic achievable goals.

Good practice should routinely include advocacy, partnership working and recovery rather than treatment approaches to help people regain control over their lives and a role in society and to establish healthy relationships.

Women and mental health in secure settings: Kelly Alexander

Women in secure settings have complex psycho-social profiles. Histories of childhood sexual abuse, having been ‘in care’ and evidence of social and economic deprivation are marked amongst this group. Unlike men who tend to enter secure psychiatric settings via the criminal justice system, most women in comparable units are detained under civil sections of the Mental Health Act 2007. Men in prison are more likely to have committed violent and sexual offences, whereas the incidence of violent offending is lower in respect of women prisoners. Many women in secure hospital units have histories of self-harming and aggressive behaviour and they are likely to have diagnoses of personality disorder. Over half of women prisoners report having suffered domestic violence. Substance misuse and mental health issues feature heavily amongst women who offend (located in both hospital and prison settings). Significantly, a Home Office study (2008) found that nearly 18,000 children are separated from their mothers by imprisonment each year but only 5 percent of these remain at home.

What should change?

Into the Mainstream (2002) addresses the psycho-social, economic and gender-related factors relevant to this client group. Ms Alexander highlighted the potential for social work to assert itself arising from the report by ‘filling the gaps’ in areas, such as:

  • promoting the social context of women’s experiences with particular reference to the abuse histories, which arguably should be placed at the centre of the care plan;
  • responding to the ‘brighter future’ identified by women who self-harmed when provided with social support;
  • seizing opportunities to challenge damaging ‘deficit-based constructions of women’ and reframe generally held perceptions;
  • addressing the apparent neglect of family and child care ‘separation’ issues;
  • identifying the specific needs of women from minority ethnic groups;
  • providing a bridge between the agencies involved, the woman and her community.

What were the main themes to emerge from the day?

At the concluding session of the conference Professor Mike Fisher noted:

  • The importance of sensitivity and understanding the feelings of people seeking help;
  • The potential for partnership working at strategic and grass root levels to develop and implement policy and promote innovation;
  • The need for assertive social work focusing on the social history, user needs and multi-agency working – and filling the gaps!

… And delegates’ unanswered questions?

  • How can social work retain its identity in the climate of economic constraints and dominance of healthcare models and mindsets?
  • How might the voices of survivors about their experiences of recent changes in services inform recovery models?
  • What is the role of ‘practitioner researcher’? What support can MRC provide to help practitioners to get started?

Finally, Professor Fisher urged delegates and wider MRC membership to engage in dialogue about ideas for future programmes and ways of supporting continuing professional development.

Thoughts…comments…suggestions? What are the priorities in mental health social work practice?

Dr Joan Rapaport is Visiting Research Fellow at the Social Care Workforce Research Unit, King’s College London and lay member of the Mental Health Review Tribunal. This is a report of a one day conference organised by Making Research Count and held 23 November 2012 at King’s College London. Making Research Count is an English initiative that facilitates the dissemination of research findings between academics, practitioners, carers and users in the social care field.

How should research evidence be used to improve adult social care policy and practice?

Martin Stevens

by Martin Stevens

This question has bothered me since I started as a social services research officer in 1992. Attending the NIHR School for Social Care Research (SSCR) Workshop: Maximising Research Impact in Adult Social Care last week was a chance to ponder this question and, more usefully, to hear other people’s ponderings. The event was very well attended, with a mix of academic (including Jo Moriarty, Jess Harris and me from the Social Care Workforce Research Unit) and local authority staff, with a small number of people who use services and carers. First up was a panel discussion, in which Martin Webber (York University); (Chris Rainey (West Sussex Social Services Research); and Deborah Rutter (Social Care Institute for Excellence – SCIE) gave short introductory accounts, followed by a long question and answer session. Three presentations followed: Sarah Carr (SCIE) emphasised the roles of service users and carers; George Julian (Research in Practice for Adults) gave some practical aspects using research evidence; and Jonathan Grant and Molly Morgan Jones (RAND Europe) presented various approaches to measuring research impact in social care.

Naturally, in the presentations and discussions, there was a sense of frustration about apparent lack of change over the years. Best metaphor of the day was from the Unit’s own Jess Harris, talking about the need to ‘bite people on the bottom’ when trying to encourage the use of research in policy. These feelings are understandable, the issues and barriers raised by all speakers – time, resources, attitudes of practitioners, managers and policy makers, levels of training, understanding of research methods, lack of good quality research presented in easy to understand formats, seem to have been around during my whole career as a researcher.

More positively, there was a welcome emphasis on dialogue and engagement of different stakeholders. This is valuable as there has often been a somewhat mechanical view of research evidence as a lever to change practice. This simplistic approach ignores important contextual factors, such as practitioners’ low level of discretion, making the direct application of research problematic. A focus on the need for dialogue and engagement, together with the idea of co-production, suggests an acceptance of the complexity of linking research evidence with policy and practice change.

However, I was left with three questions that need more attention in order to optimise the impact of research in policy and practice:

  • What is the most appropriate and proportionate impact we can expect from research compared to that from other influences (politics, values, professional and user knowledge), given the necessary uncertainty and contestability of research evidence in this sphere?
  • How should different kinds of evidence, which often arise from different assumptions about the nature of social world, be combined to make changes in policy and practice?
  • How can policy making be changed in order to make best use of research (in terms of timescales, but also increasing the influence of people using services, carers, practitioners and researchers)?

Dr Martin Stevens is Research Fellow at the Social Care Workforce Research Unit at King’s College London. With Jess Harris he is currently writing the final report for the evaluation of Jobs First (an initiative encouraging the employment of people with learning disabilities) for the Department of Health. He is also Principal Investigator in a study examining the vetting and barring of workers in the sector.