Michael Clark, Michelle Cornes, Martin Whiteford, Robert Aldridge, Elizabeth Biswell, Richard Byng, Graham Foster, James Sebastian Fuller, Andrew Hayward, Nigel Hewett, Alan Kilminster, Jill Manthorpe, Joanne Neale and Michela Tinelli
People experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse…
Abstract
Purpose
People experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.
Design/methodology/approach
The paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.
Findings
Supporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.
Research limitations/implications
The data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.
Practical implications
Integration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.
Social implications
Addressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.
Originality/value
This paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.
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Charlotte N. E. Tompkins, Joanne Neale, Laura Sheard and Nat M. J. Wright
Imprisonment is common among drug users. However, historically healthcare for injecting drug users in prison in England and Wales has not been equivalent to that offered in…
Abstract
Imprisonment is common among drug users. However, historically healthcare for injecting drug users in prison in England and Wales has not been equivalent to that offered in community settings. Fiftyone injecting drug users who had a history of imprisonment were interviewed. Interviews focused on the experiences of drug‐related care and treatment in prison. The interviews were analysed using the Framework method. Accounts of prison drug treatment experiences provided valuable insights into drug treatment in the English prison. The participants’ accounts provided a historical perspective, many of which reflected the different practices of different prisons and prison staff and the changes in policy and practice that have occurred in prison healthcare over recent decades. Positive and negative experiences of healthcare and drug treatment in prison were discussed. Issues that affected levels of drug use inside prisons and their receipt of care, support and treatment in prison included prescribing policies, illicit drug availability and prison staff and doctor attitudes. Whilst negative experiences of prison and drug treatment prevailed, users identified that recent policy and practice changes had positively influenced healthcare provision for drug users in prison, particularly the provision of opiate maintenance therapy. Drug users often saw prison as an opportunity to detoxify and contemplate their drug use. Further work needs to build on the positive experiences identified to ensure that prison drug treatment in England and Wales is consistent, effective and efficient in the future.
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Suzanne Sayuri Ii, Lisa Ryan and Joanne Neale
The purpose of this paper is to provide new insights into the diet and nutrient intake of people receiving opioid agonist treatment (OAT) in the UK, offering implications for…
Abstract
Purpose
The purpose of this paper is to provide new insights into the diet and nutrient intake of people receiving opioid agonist treatment (OAT) in the UK, offering implications for recovery-oriented treatment and care.
Design/methodology/approach
Diet and nutrient intake were assessed using quantitative methods. The research tools used were: a socio-demographic and drug use questionnaire, 24-hour dietary recall interview and anthropometry measures. A four-month follow-up was conducted using the same methods.
Findings
Mean (SD) body mass index for males (n=15) and females (n=10) exceeded the normal range (25.2 (5.9) kg/m2 and 33.3 (8.6) kg/m2, respectively) at baseline. Males decreased to the normal range at follow-up (mean (SD)=24.1 (±6.2) kg/m2]. Females increased to obesity Class II at follow-up (mean (SD)=35.1 (±8.0) kg/m2). Non-starch polysaccharide intakes were significantly lower than the reference nutrient intake (RNI). Iron intakes for females were significantly below the RNI. Saturated fat intake and sodium intake exceeded the RNI. In total, 11 (44 per cent) participants had multiple health conditions. Participants regularly consumed meals and reported frequent snacking events.
Research limitations/implications
There is a need for better understanding of nutrition-related issues and dietary deficiencies amongst people receiving OAT, including larger studies that explore differences between males and females, other sub-groups and changes over time.
Practical implications
Nutritional recommendations or guidelines and increased attention to nutrition and diet within treatment programmes are needed to help people receiving OAT.
Originality/value
This paper demonstrates how diet and nutrient intake are essential to recovery processes and outcomes.
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Cultural portraits usually begin with a description of the context, but as this material is covered elsewhere in this volume, this introduction will be mercifully brief. At any…
Abstract
Cultural portraits usually begin with a description of the context, but as this material is covered elsewhere in this volume, this introduction will be mercifully brief. At any time during the last four decades, there have been dozens, perhaps even hundreds, of Stanford University faculty and doctoral students interested in studying organizations. They have been scattered across the campus, often in small groups within larger schools and departments. They have been based in the Sociology Department and the Organizational Behavior and Strategy areas at the Graduate School of Business. There were always a handful at the Education and Engineering schools, as well as a scattering of individuals doing related work in Psychology, Political Science, and Anthropology. In spite of their numbers, before the Stanford Center for Organizational Research (SCOR) was founded in 1972, many of these faculty, postdoctoral fellows, and doctoral students felt rather isolated. They had little contact with colleagues across campus who shared their interest in organizations and little collective clout when resources were being distributed.
Emma Audrey Adams, Desmond Hunter, Joanne Kennedy, Tony Jablonski, Jeff Parker, Fiona Tasker, Emily Widnall, Amy Jane O'Donnell, Eileen Kaner and Sheena E. Ramsay
This study aims to explore the experiences of living through the COVID-19 pandemic for people who faced homelessness and dealt with mental health and/or substance use challenges.
Abstract
Purpose
This study aims to explore the experiences of living through the COVID-19 pandemic for people who faced homelessness and dealt with mental health and/or substance use challenges.
Design/methodology/approach
This qualitative study was comprised of 26 1:1 interviews (16 men and 10 women), conducted between February and May 2021 with people who experienced homelessness in North East England during the COVID-19 pandemic. An inductive reflexive thematic analysis was undertaken, with input from individuals with lived experience who were involved throughout the study.
Findings
Four themes were developed. The first theme, lack of support and exacerbation of mental health and substance use difficulties, highlighted how the lack of in-person support and increased isolation and loneliness led to relapses or new challenges for many people’s mental health and substance use. The second theme, uncertainty and fear during the pandemic, explored how the “surreal” experience of the pandemic led to many people feeling uncertain about the future and when things would return to normal. The third theme, isolation and impacts on social networks, discussed how isolation and changes to relationships also played a role in mental health and substance use. Finally, opportunity for reflection and self-improvement for mental health and substance use, explored how some people used the isolated time to re-evaluate their recovery journey and focus on self-improvement.
Practical implications
The experiences shared within this study have important implications for planning the future delivery and commissioning of health and social care services for people facing homelessness, such as sharing information accessibly through clear, consistent and simple language.
Originality/value
As one of the few papers to involve people with lived experience as part of the research, the findings reflect the unique narratives of this population with a focus on improving services.
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Cathryn Johnson, Karen A. Hegtvedt, Leslie M. Brody and Krysia Wrobel Waldron
Although cultural beliefs about gender differences in emotional experience and expression are pervasive, empirical evidence does not always bear out those beliefs. This…
Abstract
Although cultural beliefs about gender differences in emotional experience and expression are pervasive, empirical evidence does not always bear out those beliefs. This disjuncture has led scholars to argue for the examination of specific emotions in specific contexts in order to understand more clearly the conditions under which gender differences emerge. Heeding this call, we focus on the justice context, reviewing and investigating men's and women's feelings about and emotional displays regarding distributive justice. Using a vignette study, we specifically examine how gender and the contextual factors of procedural justice, legitimacy of the decision-maker, and gender of the decision-maker affect emotional responses of injustice victims. We argue that a focus on the gender combination of actors in a situation moves the study of gender and emotions beyond the assumption that gender-specific cultural beliefs dictate individual's feelings across situations. Our findings show few gender differences in the experience and expression of anger, resentment, and satisfaction. Rather, contextual factors, including the gender of the decision-maker, had stronger effects on emotional responses than gender of the victim. In our justice situation, then, context matters more than gender in understanding emotional responses.
Many operating managers view culture and culture change as something “soft” or “squishy” and remote from day‐to‐day concerns. They're worried about “making their numbers” and say…
Abstract
Many operating managers view culture and culture change as something “soft” or “squishy” and remote from day‐to‐day concerns. They're worried about “making their numbers” and say they haven't got time to think about organizational culture.
The evolution of the global village during the Information Age created a huge powershift from centralized bureaucracies to small decentralized organizations formerly on the edges…
Abstract
The evolution of the global village during the Information Age created a huge powershift from centralized bureaucracies to small decentralized organizations formerly on the edges of power and influence, essentially a shift from the centers to the margins. This phenomenon can be seen in every part of the country, throughout the world, and in every aspect of life—economic, cultural, social, and political. Once‐dominant centers of business power and influence such as New York and Chicago are giving way to a more widely diffused and distributed pattern of power, with, for example, major banks in North Carolina and software developers in Seattle.
This paper challenges readers to reflect on the terms ‘dual diagnosis’ and ‘recovery’ and to consider how the language and concepts that inform practice and policy shape the way…
Abstract
This paper challenges readers to reflect on the terms ‘dual diagnosis’ and ‘recovery’ and to consider how the language and concepts that inform practice and policy shape the way we think about our work and relate to service users.