Nicola Evans and Michelle Huws-Thomas
The aim of the review is to investigate the reasons for referral to this child and adolescent mental health (CAMH) service and determine whether these had been met by the service.
Abstract
Purpose
The aim of the review is to investigate the reasons for referral to this child and adolescent mental health (CAMH) service and determine whether these had been met by the service.
Design/methodology/approach
This is a retrospective case note analysis that was conducted of 66 referrals to CAMHS for children and young people serving a rural community of 132,000. Case notes were selected by the NHS CAMHS manager based on referrals during the pre-defined date set. Of the 66 referrals to CAMHS, 19 were not included in the analysis because they had not been accepted into the service. Data were analysed on the remaining 47 cases who were referred, accepted into the service and had been offered an assessment by the service.
Findings
General practitioners represented the most frequent health care practitioner to refer to the service (n = 33, 70.2%). Self harm, suicidal intent, thoughts or overdose represented the highest percentage of referrals to the CAMHS service (38.3%); depression, low mood and sadness represented the next highest figure (19%) and anxiety and depression (10.6%) broadly speaking 68% of referrals related to low mood. Out of the 44 cases that were examined, 14/44 (32%) were referred back to the GP and no specific intervention was provided. Interventions provided to five cases were unspecified.
Research limitations/implications
A number of opportunities for developing the service that allowed for a focus on the core business of helping children and young people with low mood were identified. One of the limitations of this retrospective review was the time frame selected because it had been identified as a particularly high period for referral into the service and may not have been representative of the usual trend.
Practical implications
This informed a training strategy and resource allocation and a redefinition of discrete roles within the service.
Originality/value
This study highlighted the evidence about where the demand was on this service and hence the requirement to focus on their core business. This evidence generated by the review prompted a redirection of resources within the service. Additional reflections and discussion informed the development of a new training strategy and a redefinition of discrete roles within the service.
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Kirstin Abraham, Huw Thomas and Alyson Bryden
The dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper…
Abstract
Purpose
The dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper aims to provide an overview of the planning and review of a highly efficient and effective dermatology service for a rural island population.
Design/methodology/approach
The service includes visiting dermatology consultants, enhanced electronic referral vetting, skin surgery services, a General Practice (GP) with extended role (GPwER) in dermatology, specialist virtual clinics, urgent advice for inpatients at the local district general hospital and remote systemic therapy monitoring. A new phototherapy service has been set up in an island GP practice.
Findings
Local GPs and consultant dermatologists find the enhanced vetting service useable, efficient and educational. Between August 2018 and November 2022, there have been 1,749 referrals. Of these referrals, 60% were seen in clinic or a GPwER surgery, with 40% managed remotely by providing advice back to the referring GP. The number of consultations performed by the GPwER has grown over the past 3 years, and in the last year, it accounted for more than 50% of patient appointments. The waiting time has been significantly reduced using this model.
Originality/value
This remote service uses an integrated approach of teledermatology (TD) whilst offering continual in-person services using local capabilities including a GPwER and island general surgeons. New treatment facilities are provided to the island population. Continual educational feedback to the primary care referrer is provided, and it enhances relationships that greatly aid the high-quality dermatology service provided.
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This paper aims to examine the extent to which micro businesses in tourism might influence the process of tourism policy formation and change in urban settings.
Abstract
Purpose
This paper aims to examine the extent to which micro businesses in tourism might influence the process of tourism policy formation and change in urban settings.
Design/methodology/approach
A conceptual framework that considers the motivations to participate in the policy‐making process and the resources needed to influence policy change informs a case study of micro businesses in Saltaire, UK.
Findings
The paper argues that, although the propensity of local micro firms to influence the local political agenda will be affected by structural considerations that manifest themselves differently from place to place, it is possible to identify key conditions that will need to be present if such enterprises are to challenge the power of other local interests.
Originality/value
The paper begins to redress the imbalance in the literature that has neglected micro business participation in policy formation and change.
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Huw Morris, Charles Harvey and Aidan Kelly
The purpose of this paper is to provide an outline of the arguments for and against different types of journal ranking lists, and, against this background, an account of the…
Abstract
Purpose
The purpose of this paper is to provide an outline of the arguments for and against different types of journal ranking lists, and, against this background, an account of the development of the Association of Business Schools' (ABS) Journal Quality Guide.
Design/methodology/approach
The paper identifies recent trends in academic journal publication that have increased the need for mechanisms to assess the overall quality of academic journals. Six approaches to ranking are outlined and evaluated including the hybrid approach adopted in producing the ABS Journal Quality Guide.
Findings
The ABS Journal Quality Guide provides wide journal coverage; has high levels of internal and external reliability; is sensitive to small variations in the ratings of journals, and is generally accepted as a fair means of ranking journals within its user community.
Research limitations/implications
This paper focuses on developments in the UK, and while the findings of this study may be of interest to researchers in other countries, the implications for policy and practice will be felt most keenly in British business schools.
Originality/value
This paper describes a hybrid, iterative and consensual approach to developing and validating a journal quality guide that is likely to be of value to researchers, academic managers, subject librarians and research auditors.
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Gareth Huw Davies, Sian Roderick, Michael D. Williams and Roderick Thomas
The Technium initiative started in 2001 with an initial Business and Innovation Centre established in the Swansea docklands area. Early success of this first Technium building led…
Abstract
The Technium initiative started in 2001 with an initial Business and Innovation Centre established in the Swansea docklands area. Early success of this first Technium building led to the concept being rapidly proliferated into a pan-Wales network of primarily sector-focussed centres. Although the Welsh Government withdrew its support for the Technium network initiative in 2010, the individual centres continued under a range of ownerships and the historic initiative of continued interest, particularly with respect to regional policy.
A vibrant policy and practice debate subsequently emerged together with strident media comment. Lack of coherence between Technium Centres and weaknesses in monitoring systems meant this debate has been poorly informed. This case study helps address the evidence deficit within this debate by revisiting the initial Technium Swansea initiative and its subsequent development.
The case study provides an insight into what can realistically be expected of such initiatives in the short, medium and long terms, with realistic time-horizons for ‘success’ and the role of learning for knowledge-based development in similar initiatives and regions.
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Graham F. Moore, Lawrence Raisanen, Laurence Moore, Nafees Ud Din and Simon Murphy
Primary-care referral to community-based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised…
Abstract
Purpose
Primary-care referral to community-based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised trial of the Welsh National Exercise Referral Scheme (NERS), demonstrated promising impacts upon physical activity and mental health. This paper presents a mixed-method process evaluation exploring how outcomes were achieved.
Design/methodology/approach
Structured observation, implementer interviews and routine data assessed the extent to which NERS was implemented as intended. Baseline trial data were combined with routine monitoring data for the purposes of profiling uptake and adherence. Semi-structured patient interviews explored processes of change and the emergence of social patterning in responses to the scheme.
Findings
NERS offered patients a programme of supervised, group-based discounted exercise. However, motivational interviewing, goal-setting and patient follow-up protocols were delivered poorly. The high degree of professional support was perceived as helping patients to build confidence and assimilate into exercise environments. Patient-only classes provided social contacts, a supportive context and realistic models. Patterning in uptake emerged from access issues, with uptake lower among non-car owners. Adherence was poorer among mental health patients, younger patients and those who were least active prior to referral to NERS.
Originality/value
In practice, although the NERS RCT demonstrated positive impacts on physical activity and mental health, process evaluation data indicate that the intervention was not entirely delivered as intended. Mixed-method process evaluation served crucial functions in understanding implementation and functioning, offering insights into the roles of professional support and exercise classes in promoting activity and mental health, and the emergence of social patterning in responses to an ERS.
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Alan M. Delamater, Adriana Guzman and Katherine Aparicio
The purpose of this paper is to consider mental health issues in children and adolescents with chronic illness or health conditions, including their treatment, and issues related…
Abstract
Purpose
The purpose of this paper is to consider mental health issues in children and adolescents with chronic illness or health conditions, including their treatment, and issues related to delivery of services.
Design/methodology/approach
A selective review of the literature was conducted to highlight significant mental health issues and their treatment in youth with various types of chronic illness.
Findings
A significant portion of youth experience mental health problems related to their chronic health conditions. While evidence-based treatments are available to address these problems, significant barriers exist that impede the delivery of psychological and behavioral interventions for many youth.
Research limitations/implications
More controlled studies are needed to demonstrate the effectiveness and cost offset of delivering psychological and behavioral interventions for the population of youth with various types of chronic health conditions, particularly in clinical and community settings.
Social implications
Policy reform can ensure that mental health issues are effectively addressed for children with chronic illness. Policy is needed that promotes integrated health care, whereby psychological and behavioral interventions are delivered in health care settings along with medical interventions to reduce barriers to care.
Originality/value
Significant numbers of children and adolescents have chronic health conditions and many experience mental health problems related to their conditions. While evidence-based treatments are available to address these problems, significant barriers impede the delivery of psychological and behavioral interventions for many youth. Health care policy promoting integrated health care to deliver psychological and behavioral interventions in health care settings along with medical interventions should reduce barriers to care and improve both physical and mental health outcomes for youth.
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Cristiano Codagnone, Athina Karatzogianni and Jacob Matthews