Online dementia training – the future?

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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.

Personalisation of adult social care – do we have to decide between choice or quality?

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Martin Stevens, Research Fellow at the Social Care Workforce Research Unit at King’s, discusses personalisation and the risks associated with an exaggerated concentration on choice in the context of adult social care.

Personalisation of adult social care (and other publicly funded services) is still an important goal of government policy and local practice. The claims about the benefits of personalisation are well known—choice and control produces better outcomes and is achieved primarily through an up-front allocation of resources to individuals to make decisions about what to purchase and from whom. ‘Think Local Act Personal’ is a sector partnership of voluntary and statutory organisations, which offers advice and information to councils and professionals in implementing personalisation and is a leading proponent of personalisation, particularly in relation to personal budgets.

The roots of personalisation lie in two strands of philosophical and political thought. First is a view that markets are the best way (if not the only way) of providing services. Second is an emancipatory perspective that identified professionally organised services as oppressive and restrictive, leading to a campaign for greater control. This was led by young disabled people.

John Clarke and his colleagues (2008) have raised three concerns over the value of emphasising choice in this context. First, they argued that focusing on increasing choice favours those with the best ability to exercise it (or with the most supportive networks), thus increasing inequality. Second, they maintained that a focus on choice ignores the complexities of power relationships and fails to recognise the public interest in decisions about public services, such as social care. Findings from the IBSEN study (evaluating the pilot individual budget sites) also supported this critique (see Stevens et al. 2011). While there has been great emphasis on increasing choice of provider within a market, this has possibly been at the expense of exploring the best ways to support people to exercise choice and control over their lives. Similarly, less attention has been paid to ensuring the quality of the support provided. Some commentators have therefore questioned the extent to which personalised funding should be the sole means of arranging services, arguing for the need for maintaining some collective provision (see Needham 2012).

This is not to argue against choice, but to caution against the adoption of choice as a goal in itself, separate from other aims of improving outcomes. It can be argued that personalisation policy has become focused on the means of choosing services, and how money is spent, rather than the kinds of support that is valued, although Think Local Act Personal has produced some guidance for people using direct payments to employ personal assistants.

The financial recession has led to several years of public sector spending restraint, which has coincided with a strengthening political will towards marketisation. This has become a dominant driver of personalisation. It has exacerbated the emphasis of choice over quality. In practice terms, this presents difficulties for social workers and others working to support people making choices about the use of public money allocated for their support, as there are fewer ‘levers’ to pull in terms of ensuring quality of service and outcomes. Where abuse is suspected, a safeguarding team can investigate and attempt to improve the quality of support if necessary, but this is a safety net approach. It is interesting that two recent evaluations have not emphasised the value of choice in contributing to outcomes, but have highlighted the importance of quality of support (these evaluations were launched at a joint King’s College London and Ipsos MORI event on 25 September (Personalised support services for disabled people: What can we learn?).

Great emphasis has also been placed on the support that disabled people and carers may need to use direct payments. User-led organisations can provide this support and are valued where this happens—see Think Local Act Personal’s guidance document: Best practice in direct payments support – a guide for commissioners. However, there is also a case to be made for professional support for this kind of decision making. Good relationships with individual disabled or older people may be one way of ensuring the availability of advice about the best kinds of support and how to assess the quality of care. Similarly, engagement with organisations of disabled or older people may help to identify concerns and lead to policy and practice questions being addressed. While this support does not necessarily need to be provided by social workers, their value as people trained in understanding the significance of major psycho-social decisions and (hopefully) a good knowledge of the different kinds of support, should not be dismissed.

Dr Stevens is Research Fellow at the Social Care Workforce Research Unit at King’s College London. Recent work includes the Jobs First Evaluation (launched at the 25 September event mentioned in this post). Current work includes Models of safeguarding: a study comparing specialist and non-specialist safeguarding teams for adults.

Follow @MartinStevens2 | Follow @scwru

References:

Clarke, J., Newman, J. and Westmarland, L. (2008) The antagonisms of choice: New Labour and the reform of public services, Social Policy and Society, 7: 2, 245–53.

Needham, C. (2013) Personalized commissioning, public spaces: the limits of the market in English social care services, BMC Health Services Research 13 (Suppl 1): S5 9 pages.

Stevens, M., Glendinning, C., Jacobs, S., Moran, N., Challis, D., Manthorpe, J., Fernández, J-L., Jones, K., Knapp, M., Netten, A., Wilberforce, M. (2011) Assessing the role of increasing choice in English social care services, Journal of Social Policy. 40(2), 257–274.

 

A new approach to social work recruitment in the United States

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Dr Mary Baginsky

Dr Mary Baginsky

Mary Baginsky, Visiting Senior Research Fellow at the Social Care Workforce Research Unit at King’s and an expert on the UK Step Up to Social Work programme, reports on a New York initiative, the Children’s Corps.

I have also come to learn the difference between ‘feeling unsafe and just feeling out of place’. There have been many times when I feel out of place but I am getting over that.—A Children’s Corps Programme member

There is an increasing interest in the United States (US) in trying to ensure that those who are employed in children’s welfare services know what is ahead of them. What have been called ‘realistic job interviews’ attempt to give applicants a deeper insight into what the job entails. They are proving to be reasonably effective where the job is complex or difficult and where there are high turnover rates early on in careers, as well as where aspects of the work may not be fully understood by applicants. By giving them a real idea of the challenges the chances of retaining good staff increase. In the UK many of those recruiting onto social work programmes already do this explicitly or implicitly. We are also seeing some targeting of resources (such as the bursary) at people with prior experience with the idea that this will pay dividends in quality and retention.

The UK Step Up to Social Work programme has now recruited its third cohort. It is targeted at those with a good degree (defined as a first or upper second) as well as significant experience with children and young people. Time will tell what the retention rate is like but the feedback from trainees indicated that their prior experience was invaluable, even if they felt it was not always recognised by the universities or agencies where they were based. On the other side of the Atlantic another similar initiative has also just recruited its third cohort. Once again experience is at the heart of the thinking about how to attract and retain good social workers of the future.

Based in New York, Fostering Change for Children recruits college graduates as well as existing professionals on to the Children’s Corps programme. They all have to be prepared to commit to work in foster care and preventive services in New York City (NYC) for two years. The hope is that many of those who are accepted onto the programme will go on to qualify and practise as social workers. In fact some of those in all three cohorts already have a Bachelors degree in Social Work and see the programme as a way of gaining experience before embarking on a Master’s course. Since 2011, 88 Children’s Corps members have been placed in jobs in foster care agencies and preventive programmes across NYC. The receiving agencies are not expected to provide any additional support and the Corps members are no different from any other employee.

The Children’s Corps programme was inspired by Teach for America and shares its hallmark traits of emphasizing selection, training and support. Its message is that child welfare work is rewarding, but is also complex and demanding; it takes a strong and motivated individual to succeed in the field. The application and recruitment process is rigorous and involves realistic interviewing techniques and resilience testing to try to ensure they get people prepared for tough work in difficult environments. The programme starts with a five-week intensive summer school, but there is no funding to support the participants so they must have or need to find the resources to survive in New York without a stipend. The staff of Fostering Change for Children realise that there is a danger that it will therefore tend to attract those who have enough funds or supportive parents to see them through.

In May I was fortunate enough to be able to spend time with four Corps members while I was in the US as part of my Churchill Fellowship. Two of the four did not fit this profile. One had come to the US from the Caribbean when she was eight and said she had always been encouraged by her mother to give back to the society where they had made their home. She had recently married and the couple was able to live on one salary until she started earning. Another member had borrowed money from her family that she paid back when she started to receive a salary.

While the summer school was said to be excellent they all admitted that they had faced a steep learning curve when they joined their agencies. The average turnover in fostering agencies in NYC is 40 per cent, which meant that those coming towards the end of their second year had seen almost all their original colleagues leave. To say they were dealing with very difficult cases is an understatement and, at times, they had all wondered if they could go on. The quality of the supervision they received in the agencies had varied as this person told me:

For the first nine months of my job when all these workers were leaving it was a very negative work environment – it was not supportive and you were very much on your own. You had seven families assigned to you – I had 19 children assigned as a result. Sometimes I wouldn’t even know what I was supposed to be doing. I had some really old cases that were very hard. I thought about quitting every other day – may be at one point every day. I used to come home late at night after working a 12-hour day and I would cry – I was so exhausted. I did not know how I’d be able to go back the next day. It was very hard.

This person did not quit and is now studying for a MSW. But, as with her colleagues, she attributed her survival to the support she received from Children’s Corps. Not only does each member have a mentor whom they can use as much or as little as they want, the organisation provides monthly training sessions that also offer the opportunity for peer support as well as additional training. The retention level has been good across the early cohorts. Of the four Corps members I met three intended to qualify and practise as social workers and the fourth is deciding between that and going on to become a clinical psychologist, where she admitted she would earn more and probably attract more professional respect. The experience they have gained means that those going into the profession do so with a very realistic expectation of what the work is like. They have also learnt that if they are to stay in the profession they will have to seek out support if it is not immediately available.

Mary Baginsky is Visiting Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. She is author, with Claire Teague, of Speaking from Experience: the views of the first cohort of trainees of Step Up to Social Work (Department for Education, June 2013). Follow Mary on Twitter: @abbotsky

Go to the Fostering Change for Children website | Children’s Corps blog

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

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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.

Abuse of vulnerable adults – referrals for investigation up 4% this year

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Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit, examines figures published by the Health and Social Care Information Centre on the abuse of vulnerable adults in England in the context of the Models of Safeguarding research project being undertaken at the Unit.

English councils referred 112,000 cases of alleged abuse against vulnerable adults for investigation in 2012-13, a 4 per cent rise (from 108,000 in 2011-12) for the 151 councils which submitted data in both years. This is according to figures just released from the Health and Social Care Information Centre (HSCIC). This provisional report – Abuse of Vulnerable Adults in England 2012-13: Experimental Statistics – finds the rate of referrals per 100,000 population was highest in the West Midlands (320), North West (300) and London (295) regions in 2012-13.

Safeguarding alerts (which are the initial point at which concerns are raised) have also increased during 2012-13.  A total of 173,000 alerts were recorded by 140 (out of 152) councils. Considering the 117 councils who recorded alerts in both years (comparing 2012-13 provisional data and 2011-12 final data), this is a sharp increase of approximately 19 per cent (rising from 134,000 to 159,000). However figure readers need to take into consideration councils’ different methods of categorising and defining alerts.  In some councils, all concerns received are recorded as referrals and cannot be split up for reporting, making this data complex to interpret.

We don’t know whether this steep rise is due to increased reporting as a result of greater public awareness about adult safeguarding, an actual rise in abuse – or a combination of the two.  From the point of view of public services however, it means more work at a time when resources are being cut.

HSCIC chair Kingsley Manning said the report, ‘plays an important role in laying bare issues affecting some of the most vulnerable in society, the role of our local authorities and also that of the public in alerting councils to cases of alleged abuse.’

A very similar picture to last year is presented with regards to the characteristics of the people alleged to have suffered abuse, alleged perpetrators, locations and forms of abuse.  In 109,000 (of 112,000) cases referred for investigation in 2012-13, the following key information was known:

About the person alleged to have suffered abuse:

  • Just over three in five (61 per cent, or 67,000)1 were aged 65 or over.
  • Half (50 per cent, or 55,000) had a physical disability.
  • Just over three in five (61 per cent, or 66,000)1 were women.

Considering the case details of those 109,000 referrals (noting that an individual referral can contain more than one type, location or perpetrator of alleged abuse):

About the types of alleged abuse

  • Physical abuse was recorded in 39,000 allegations (28 per cent)
  • Neglect was recorded in 37,000 allegations (27 per cent)

About the alleged perpetrators:

  • Social care workers were recorded in 35,000 allegations (31 per cent)
  • A family member was recorded in 25,000 allegations (23 per cent)

About the Location of alleged abuse

  • The vulnerable adult’s own home was recorded in 43,000 allegations (39 per cent)
  • A care home was recorded in 40,000 allegations (36 per cent)

About the Case outcomes

Considering the 86,000 completed referrals where a case conclusion was recorded:

  • 37,000 were either partly or fully substantiated (43 per cent)
  • 26,000 were not substantiated (30 per cent)
  • 23,000 were inconclusive (27 per cent)

HSCIC chair Kingsley Manning noted, ‘This report in many ways makes for uncomfortable reading, not only that thousands of cases of potential abuse against vulnerable adults are being investigated each year, but more particularly that a substantial number are proven to be of substance’.

A final, more detailed AVA Report 2012-13 will be published in March 2014 when post-submission validation checks will have been carried out on the data submitted by councils.

I am currently part of a research team investigating the advantages and disadvantages of different models of adult safeguarding. Our study has been funded by the NIHR School for Social Care Research and continues our long tradition at King’s College London of research on this subject. A key part of our present study will be analysing and comparing the AVA data for six selected councils which use different approaches to organising their adult safeguarding services. As part of this study, we have recently interviewed 24 adult safeguarding managers about how they organise adult safeguarding in their areas.  Comments about the AVA returns made during these interviews include that the AVA returns are valuable in making comparisons between local authorities, but the information is viewed as provisional, given the complexity of data collection.

Some difficulties with the AVA collection are outlined in the HSCIC report. There may be a great deal of under-reporting as the data does not include cases where partner agencies dealing with an allegation do not share the information with the council. The collection only covers abuse perpetrated by others (it does not include self -harm or self-neglect)  – and these issues also need to be addressed when considering the most effective ways to support adults at risk who may decline help or care. Also, a single referral can relate to different types of alleged abuse, locations or perpetrators and may have more than one outcome for the alleged victim and/or alleged perpetrator. It is also important to remember that these figures do not represent the number of adults at risk who have been referred. They relate to individual referrals: the same person may have multiple referrals in a year.

Councils in England submitted data voluntarily to the national Abuse of Vulnerable Adults (AVA) collection in 2009. Since 2010-11, the Minister for Care and Support mandated submission of AVA collections to the HSCIC, and for the 2012-13 period, 151 out of 152 local authorities have complied. This is a major development and one which is enriching our knowledge and helps develop services.

2012-13 is the last year for collection of the AVA return.  Information about adult safeguarding activity will be then be collected through a new Safeguarding Adults Return (SAR). The SAR is one of the outcomes of a review of adult social care data collections.  Many of the same data will be collected, but it will be more focused on outcomes of safeguarding and alert data will no longer be collected.

We look forward to studying the 2013 AVA returns in greater detail – and to making comparisons with the SARs in the future. If you are interested in receiving information about our current study or having a copy of our bibliography covering our other research and publications on adult safeguarding please get in touch.

You can contact Caroline Norrie at King’s here: caroline.norrie@kcl.ac.uk

  1. Figures have been rounded to the nearest thousand.

The value of advocacy support for older people affected by cancer

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In a guest post Kath Parson, Chief Executive of the Older People’s Advocacy Alliance (OPAAL), writes about a project supporting older people affected by cancer.

‘Cancer, Older People and Advocacy’ is about supporting older people affected by cancer to find their voice and say what it is they want. Evidence from Macmillan Cancer Support, our project partner, and the Department of Health indicates ingrained age discrimination in cancer services: ‘Older people with cancer receive less intensive treatment than younger people. …… there is increasing evidence that under-treatment of older people may occur‘

image001We’re doing our best to change that by recruiting, training and supporting older people who have themselves been affected by cancer to become peer advocates. We’re working on the basis that those who’ve lived through the experience of cancer, either because they or someone close to them have had a cancer diagnosis, are best placed to empathise and support others in the same situation.

I’ve also been affected by cancer and lost relatives and very close friends – so I can relate to a lot of the issues that people have and some of the unfairness that happens… I’m not afraid to challenge. That’s the kind of thing people haven’t got when they have an illness. All those strengths are taken out because of the day to day – the appointments, the pain, and the personal issues they have to deal with. Advocate

image003

Where we’ve struggled so far has been in helping health professionals understand that there might be a problem in cancer services for some older people. Despite the evidence there seems to be a reluctance to refer to independent advocacy. Maybe it’s because they don’t like being questioned or maybe they simply don’t see the need. Whatever the reason, it is a problem. One advocate explains:

That was a difficult session, particularly because there were three consultants in the room. The consultants were quite apprehensive really, I would say, about me being there… One of them actually did ask what my role was, which I explained. I emphasised that my role was not to make decisions for my client. It was to help him to understand the situation, what was on offer, to help him to make some informed choices, and decisions about his treatment and that was OK after that.

To find out more about Cancer, Older People and Advocacy, check out our blog.

Making positive changes

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In this guest post, Natalie Atkinson, a student at the University of Cumbria, recounts her own experience of entering further education as a care leaver and ex-offender. Natalie took part in the Communities of Practice programme: Delivering on the integration agenda for people with multiple and complex needs as an ‘expert by experience’. The project was run by the Social Care Workforce Research Unit (SCWRU) at King’s and Revolving Doors.

Having taken part in the ‘Communities of Practice’ programme run by SCWRU and Revolving Doors Agency as an ‘expert by experience’ I learnt a lot about the professional practices which are intended to support people like myself. Much so called recovery orientated practice for example, is about ‘encouraging’ excluded people to take up education, training and employment opportunities.

However, despite these ‘good practices’, I still experience many barriers on a daily basis including financial, discriminatory, stereotypical views that exist around care leavers and ex-offenders. I had to fight to be accepted into University and be given a chance to prove I was a ‘worthwhile’ candidate as I was not the typical ‘safe’ option that would be guaranteed to succeed. Some people still seem to look in shock if they find out I am a care leaver and previous prolific offender studying a Policing and Criminology degree, but I just highlight that I have got all the relevant experience to be successful. Who’s better to work with those in the Criminal Justice System and Care System? Those people with a degree or those with life experience and a degree? I would have to settle for the latter.

It has only just come to my attention that even though Social Services had closed my case at 21, I am entitled to request support for financial assistance for my undergraduate fees and accommodation as a former relevant care leaver… Not that I am expecting a quick response, as it concerns requesting money from a Local Authority. I would not have known about this support if I had not come about it by chance while doing University work. The question that needs to be asked is how many other former relevant care leavers are unaware of their entitlement to support when accessing higher education between the ages of 21 – 25? From my own personal experience I presume this is a substantial amount of people.

I am now entering my third year at University and have recently started to look for funding for a Masters Degree in Criminal Justice that I hope to start in 2014. Yes that’s right; I want to carry on studying in order to better myself and to be able to be in a position to encourage those who have been ‘excluded’ and ‘labelled’ by society to have the confidence and belief in themselves to return to education, training and employment, and build the future that they deserve. I have taken the first steps by nearly completing a degree and securing employment working as a support worker in homeless hostels through my own determination, but how many other people would have given up due to lack of support, knowledge, confidence and funding?

Natalie Atkinson was an expert by experience on the Communities of Practice programme. Lead researcher at King’s on this project was Senior Research Fellow, Dr Michelle Cornes.

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

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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

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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.

Practice into Research

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Katie Graham, who recently joined the Social Care Workforce Research Unit at King’s College London, reflects on practice, research and the recent Department of Health conference on Adult Safeguarding.

The connections between practice and research seem pretty obvious in theory given the emphasis in social work training upon becoming ‘research-minded practitioners’. But they are often difficult to realize, with increasing workloads and the pressure of daily practice pressures of risky, even worrying, situations. I started working at the Social Care Workforce Research Unit at the beginning of April after having been a social worker in a specialist adult safeguarding team in a local council.

My transition between practice and research has been a fairly smooth one – particularly once I’d overcome the urge to case note each conversation I had! I am working on the ‘Models of Safeguarding’ project, so this research is directly connected to my recent practice. Last week I attended a Department of Health organised conference ‘Adult Safeguarding: A Return to Practice’ which further helped to ease my transition as it was a conference specifically designed to make research available to practitioners. The event was an interesting mix of policy discussion related to the Care and Support Bill and practice guidance from ADASS. There was a discussion of the neglected role of housing in adult safeguarding and practice innovations in the prevention in adult safeguarding. Of great relevance to the Unit was a discussion by representatives from SENSE about the complexity of safeguarding alerts with adults who may be perceived to be ‘at risk’ but where no intentional harm is evident. The speakers from SENSE described their approach to safeguarding when working with deafblind people who communicate through touch. I will be talking more to the Unit’s Phd student, Peter Simcock, about this – since this topic is the focus of his doctoral research. A final presentation from Dr David Orr related to his research around self-neglect.

Mike Briggs from ADASS (2013) outlined its new ‘top tips’ for adult safeguarding. His presentation contained vital information for any practitioner and researcher in this area. However, what was striking was how policy statements hide the complexity of daily work in social care, whether working as a social worker, personal assistant (independently for an employer) or support worker in a large organisation. The potential to place adult safeguarding on a firmer statutory footing with the Care and Support Bill (2012) is welcome, however it will be its eventual guidance that will likely be most useful to social workers’ daily decision-making. Jeremy Hunt, the Secretary of State for Health, has said of adult safeguarding that councils have been “ticking the box, but missing the point” (in ADASS 2013: 3) suggesting an over-reliance on processes rather than outcomes for people.  Rigid constructions of ‘abuse’ and ‘harm’ and a person ‘at risk’ may be as damaging as inaction but, as a recent article by Angie Ash (in the British Journal of Social Work) suggests, social workers often do not take action.

The conference emphasized that adult safeguarding is ‘everybody’s business’. However, from my own perspective finding my feet in a research environment, it is also clear to me that research and practice are not (and should not be) far apart in this area of work. It is through dialogues (and the potential of action research –  see Joan Rapaport’s earlier blog), including the experiences of people perceived to be ‘at risk of harm’, that we can develop interventions and gain the skills and confidence to effectively minimise the risk of harm. Social workers have a strong tradition of respecting people’s rights to self-determination but also their rights to protection. The Models of Safeguarding project, investigating how different councils organise their safeguarding adults responsibilities, is engaging with these complexities.  I think that this resonates with everyday social work practice.

Katie Graham is Research Associate at the Social Care Workforce Research Unit.