GPs are often faced with patients seeking help and advice on non-clinical issues such as debt, unemployment and housing. Though these issues undoubtedly impact patients’ health and wellbeing, health professionals are not always the best qualified people to tackle them.
We investigated the impact of putting welfare advice, and welfare advisers in GP surgeries on
- the ability of low income groups to secure financial support they are entitled to
- patients’ anxiety and stress associated with financial related social worries;
- and, to GP time spent managing non-clinical issues
New CLAHRC BITEs offer a summary of two papers investigating the impact –
- A qualitative study to identify the processes by which co-located services can improve outcomes for GP practices
Co-location of welfare services has many benefits to patients including:
- Offering a signposting option for staff in contact with patients with ‘non-clinical’ social needs.
- Helping to address underlying patient social issues.
- Providing an alternative option for patients seeking help for such issues.
- Reducing bureaucratic pressures and time demands on practice staff.
Read the BITE
2. A quantitative study, using a controlled comparison, assessing the impact on mental health and service use of co-located welfare advice.
Key Findings – service users receiving welfare advice versus control group
- Had the advice service not been at the practice, nearly half of the advice group would not have sought help or consulted their GP instead.
- The majority of advice recipients reported improved circumstances after advice (e.g., stress, income, housing etc.)
Compared to those who did not get advice, after 3 months:
- Those in the advice group whose circumstances improved experienced a bigger improvement in their well-being.
- Those in the advice group experienced a bigger reduction in financial strain, reduced credit card and overdraft use.
- Those in the advice group experienced a bigger reduction in symptoms of common mental disorder, especially among recipients who were female, those who identified as Black and those who reported that their circumstances improved as a result of advice.
- There was, however no evidence for a reduced frequency of GP consultations.
- For every £1 of investment by funders, those receiving co-located advice gained £15 in entitlements on average
Read the BITE
We recently collaborated with colleagues at Peninsula CLAHRC to deliver a successful ‘Beyond Searching’ course.
Members of the PenCLAHRC Evidence Synthesis Team (EST) travelled to London to work with CLAHRC North Thames’ Dr Antonio Rojas–Garcia in delivering the workshop to 19 librarians from the NHS and various universities.
Beyond Searching was devised 5 years ago by members of the EST who have been running annual workshops ever since. The course is designed to show health information professionals that they already have the skills to effectively contribute to systematic reviews – reviews aiming to find as much as possible of the research relevant to the particular research question, and to identify what can reliably be said on the basis of these studies. The training gives them the confidence to get involved in the process and to advise others.
‘Librarians and other information professionals are highly skilled and motivated individuals with a drive to learn about new technologies and ways of working. They already have the skills needed to contribute to systematic reviews so our course is more about how they apply those skills. ‘It is always a joy to teach this workshop – often we learn a lot ourselves in the process – and it was particularly good this time to get the chance to collaborate with colleagues from CLAHRC North Thames.’
– Morwenna Rogers (EST member)
This was the second year that the course followed a flipped classroom model, which EST members learned about during their visit to the University of Michigan two years ago. The model frees up classroom time for discussions and active learning, by making some of the foundation lectures and reading material available to participants in advance.
Attendees were asked to complete a series of online tasks prior to the course, which introduced them to key concepts of systematic reviewing and comprehensive searching. This enabled attendees to focus on more detailed aspects of search techniques during the workshop.
Guest speaker Claire Stansfield from the EPPI-Centre was also invited to discuss the use of automation (employing machines, computers, or robots to help researchers identify relevant papers), and its implication for reviews in the future.
The beyond searching team were delighted with the positive feedback they received. One attendee said that it was:
“The best training [they] have ever attended”
Another attendee planned to use the knowledge she had gained to change practice in her own place of work, and another thought that the flipped classroom model was excellent preparation for the face to face teaching day.
Dr Rojas – Garcia (below) praised the cross CLAHRC co-operation behind the delivery of this workshop, remarking:
‘It was great to spend the day collaborating with colleagues from PenCLAHRC. I considered it a very positive experience, it has been really encouraging to see how other colleagues teach about systematic reviews.’
To read more about the Beyond Searching workshop collaboration, visit the EST blog.
New CLAHRC research has highlighted a lack of guidance for health and social professionals who encounter children exposed to domestic violence.
Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. Children can be directly impacted – leading to emotional and behavioural problems and risks of physical injury and death when children are caught up in the violence between adults. Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences. Health and social care workers are often the first professionals to have contact with a child experiencing these situations.
In a collaboration with CLAHRC East of England and international colleagues from the McMaster and Western Universities in Canada we examined the evidence on child, parent and professional views on acceptable approaches to identifying and responding to children exposed to domestic violence.
The resulting research paper, published in BMJ Open, highlighted conflicting views of children and mothers on the one hand and professionals on the other when it came an ideal response. Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals preferred to engage with children via the parent and they often did not perceive children exposed to domestic violence as patients or clients in their own right.
Guidelines for health professionals who encounter women who have experienced domestic violence provide various questions and prompts they can use in discussions, and a set of principles to follow. There are no equivalent recommendations on how to identify and respond to children exposed to domestic violence and limited evidence on which to base future guidance. Our analysis also revealed that professionals were not happy with the existing safety guidelines for children and mothers exposed to domestic violence and wanted changes.
The research was funded by the Public Health Agency of Canada through funding to the VEGA (Violence, Evidence, Guidance and Action) project. The VEGA Project is part of the Canadian Government’s Public Health Response to Family Violence. This research will inform the development of public health guidance, protocols, curricula and tools for health and social service providers. The research was supported by the NIHR CLAHRC North Thames and NIHR CLAHRC East of England.
Resources supporting this new research include a blog in The Conversation by lead researcher Dr Natalia Lewis, and we have worked with CLAHRC East of England on a joint BITE – a summary of the research with key learning for busy professionals interested in this work.
Read the paper
Natalia V. Lewis, Gene S. Feder, Emma Howarth, Eszter Szilassy, Jill R. McTavish, Harriet L. MacMillan, Nadine Wathen.
BMJ Open 2018. Published in BMJ Open. April 2018. Doi:. http://bmjopen.bmj.com/content/8/4/e019761
Read a BITE sized summary
Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. When adults are involved in an abusive relationship, their children bear the consequences.
The effects of domestic violence on a child can range from emotional and behavioural problems to physical injury and death when children are caught up in the violence between adults.
Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences.
Health and social care workers are often the first professionals to have contact with a child experiencing these situations. This could be when the abused parent seeks help, or when children undergo health checks. It can happen during assessments for emotional or behavioural problems, or when social services, a child’s school or the police become involved.
The World Health Organisation (WHO) recommends that health professionals who see women with clinical signs of domestic violence should ask them about safety in their relationship and at home. They advise that responses to disclosure should follow what is known as the “LIVES” principles: Listen, Inquire about needs and concerns, Validate, Enhance safety, and provide Support.
But there are no equivalent recommendations for children, and there is no agreed approach regarding how best to identify and respond to children who are exposed to domestic violence. So far, there has also been only limited evidence on which to base future guidance.
Now researchers at universities in the UK (Bristol, Queen Mary and Cambridge) and Canada (McMaster and Western) have combined existing evidence on the best ways to identify and respond to children experiencing domestic violence. This synthesis, the first of its kind, integrates findings from 11 studies with 42 children, 220 parents, and 251 health care and social services professionals.
We found that study participants’ opinions were strikingly consistent, and matched the LIVES principles. Children, parents (mostly mothers) and professionals agreed that identification of the problem should happen in the context of a good patient-professional relationship, and in a safe and supportive environment.
Health care professionals should enquire about the child’s safety when they see clinical signs of domestic violence and abuse in children. The ideal initial response should include emotional support, discussion about domestic violence and advice on local specialist services.
We also discovered that a professional’s ability to identify and respond to children’s exposure to domestic violence was heavily influenced by constraints within the health and social service system. Lack of time, funding cuts and poor inter-agency collaboration all have an impact. Professionals needed more training and resources to be able to respond to these children and their families in an appropriate and safe way.
However, there was a difference of opinion when it came to engaging directly with children and managing their safety.
A direct approach?
Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals, on the other hand, preferred to engage with children via the parent – and did not perceive children exposed to domestic violence as patients or clients in their own right. Also, professionals were not happy with existing safety guidelines and practices for children and mothers exposed to domestic violence. These elements are certainly subjects for future research and training.
Given the scale of the problem, and the long-term emotional, behavioural and physical impacts on children, we hope that the results of this study can form the basis of new, internationally agreed guidelines.
Our research findings have already been used to inform point-of-care responses to adults and children in Canada’s VEGA (Violence, Evidence, Guidance, Action) Project. That program is already developing the “Recognising and Responding Safely to Family Violence” Handbook for health and social care professionals.
And we hope our evidence will inspire development of professional training and resources elsewhere – so that front line practitioners feel better equipped to appropriately and safely respond directly to the needs of children. Too many children’s lives and futures could depend upon it.
Part of the CLAHRC’s mission is to raise awareness of new research evidence, and get it to the front-line where it can used by NHS staff. We are working with our host Trust NHS Bart’s Health to translate the new knowledge we generate into everyday practice among NHS professionals.
Bart’s Education Academy has developed an eCPD app available to download for free for users of Android and iPhone smartphones. The eCPD app aims to reduce the time staff have to leave the frontline to attend training courses in person, and give them more flexible learning they can fit around their busy schedules. The app allows staff to log in and create personal and professional development plans (including mandatory training) and optional learning modules. Once completed a notification is sent to both the member of staff and their supervisor, to show they have carried out the necessary training and are credited with CPD points where appropriate.
The CLAHRC has provided learning modules focused on our research findings, and more of our work will appear on the App in the near future.
We are now rolling out some of our popular CLAHRC Academy courses so that they can be accessed via the App – our Academy Director Dr Nora Pashayan (below right) and Academy Teaching Fellow Dr Silvie Cooper (below left) recently met Director of Academic Health Sciences at Barts Health NHS Trust Professor Jo Martin to launch our Introduction to Evaluation course via the App.
The Barts Education Academy provides clinical placements for 2,500 medical undergraduate students and trains 1,040 junior doctors, over 800 children, adult nursing and midwifery students and 275 allied health professionals. The Education Academy offers resuscitation skills training, moving and handling, simulation and clinical skills training and a range of skills based short courses, as well as ensuring the trust achieves high levels of compliance for its statutory and mandatory training.