Jonathan Ward, Glyn Davies, Stephanie Dugdale, Sarah Elison and Prun Bijral
Multiple challenges remain in achieving sustainability of digital health innovations, with many failing to realise their potential due to barriers to research, development and…
Abstract
Purpose
Multiple challenges remain in achieving sustainability of digital health innovations, with many failing to realise their potential due to barriers to research, development and implementation. Finding an approach that overcomes these challenges is important if society is to derive benefit from these new approaches to healthcare. Having been commissioned by local authorities, NHS Trusts, prisons, charities, and third sector providers across the UK, Breaking Free Group, who in 2010 launched Breaking Free Online (BFO), a computer-assisted therapy programme for substance misuse, have overcome many of these challenges. This has been possible through close collaborative working with partner organisations, to overcome barriers to implementation and sustainability. The paper aims to discuss these issues.
Design/methodology/approach
This paper synthesises findings from a series of qualitative studies conducted by Breaking Free Group in collaboration with health and social care charity, Change, Grow, Live (CGL), which explore barriers and facilitators of implementation and sustainability of BFO at CGL. Data are analysed using thematic analyses with findings conceptualised using behavioural science theory.
Findings
This partnership has resulted in UK wide implementation of BFO at CGL, enhanced focus on digital technologies in substance misuse recovery, and a growing body of published collaborative research.
Originality/value
Valuable lessons have been learnt through the partnership between Breaking Free Group and CGL, which will be of interest to the wider digital health community. This paper outlines those lessons, in the hope that they will provide guidance to other digital health developers and their partners, to contribute to the continued evolution of a sustainable digital health sector.
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Sarah Elison, Glyn Davies, Jonathan Ward, Samantha Weston, Stephanie Dugdale and John Weekes
The links between substance use and offending are well evidenced in the literature, and increasingly, substance misuse recovery is being seen as a central component of the process…
Abstract
Purpose
The links between substance use and offending are well evidenced in the literature, and increasingly, substance misuse recovery is being seen as a central component of the process of rehabilitation from offending, with substance use identified as a key criminogenic risk factor. In recent years, research has demonstrated the commonalities between recovery and rehabilitation, and the possible merits of providing interventions to substance-involved offenders that address both problematic sets of behaviours. The purpose of this paper is to provide an overview of the links between substance use and offending, and the burgeoning literature around the parallel processes of recovery and rehabilitation.
Design/methodology/approach
This is provided as a rationale for a new treatment approach for substance-involved offenders, Breaking Free Online (BFO), which has recently been provided as part of the “Gateways” throughcare pathfinder in a number of prisons in North-West England. The BFO programme contains specific behaviour change techniques that are generic enough to be applied to change a wide range of behaviours, and so is able to support substance-involved offenders to address their substance use and offending simultaneously.
Findings
This dual and multi-target intervention approach has the potential to address multiple, associated areas of need simultaneously, streamlining services and providing more holistic support for individuals, such as substance-involved offenders, who may have multiple and complex needs.
Practical implications
Given the links between substance use and offending, it may be beneficial to provide multi-focussed interventions that address both these behaviours simultaneously, in addition to other areas of multiple and complex needs. Specifically, digital technologies may provide an opportunity to widen access to such multi-focussed interventions, through computer-assisted therapy delivery modalities. Additionally, using digital technologies to deliver such interventions can provide opportunities for joined-up care by making interventions available across both prison and community settings, following offenders on their journey through the criminal justice system.
Originality/value
Recommendations are provided to other intervention developers who may wish to further contribute to widening access to such dual- and multi-focus programmes for substance-involved offenders, based on the experiences developing and evidencing the BFO programme.
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Stephanie Dugdale, Heather Semper, Rachel Povey, Sarah Elison-Davies, Glyn Davies and Jonathan Ward
Despite overall reductions in levels of smoking in the UK, rates of offender smoking remain high. In 2016, it was announced that prisons in England and Wales would gradually…
Abstract
Purpose
Despite overall reductions in levels of smoking in the UK, rates of offender smoking remain high. In 2016, it was announced that prisons in England and Wales would gradually introduce a smoking ban. The purpose of this paper is to explore offenders’ perceptions around the upcoming smoking ban.
Design/methodology/approach
A total of eight focus groups were conducted in four prisons across the North of England. Both smoking and non-smoking offenders participated in the focus groups, and thematic analysis was used to explore the findings.
Findings
Themes generated from the data were “freedom and rights”, “the prison environment” and “guiding support”. Participants discussed how the smoking ban was viewed as a punishment and restricted their freedom, with perceptions as to why the ban was being implemented centring around others trying to control them. Participants expressed concerns around the financial implications of the smoking ban on already stretched prison resources. Participants also recommended improving the nicotine replacement therapy on offer, and increasing the range of leisure activities within the prison to prepare for the smoking ban.
Originality/value
Overall, it was apparent that participants’ awareness of the smoking ban was generally poor. It is recommended that offenders need to be made more aware of the smoking cessation support they will receive and given the opportunity to ask questions about the smoking ban. Increasing offenders’ awareness of the ban may reduce stress associated with a perceived lack of choice around their smoking behaviours.
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Sarah Elison, Jonathan Ward, Glyn Davies and Mark Moody
The purpose of this paper is to explore the adoption and implementation of computer-assisted therapy (CAT) using Breaking Free Online (BFO) in a social care and health charity…
Abstract
Purpose
The purpose of this paper is to explore the adoption and implementation of computer-assisted therapy (CAT) using Breaking Free Online (BFO) in a social care and health charity working with people affected by drugs and alcohol dependence, Crime Reduction Initiatives (CRI).
Design/methodology/approach
Semi-structured interviews were conducted with service managers, practitioners, peer mentors and service users. Data were thematically analysed and themes conceptualised using Roger's Diffusion of Innovation Theory (Rogers, 1995, 2002, 2004).
Findings
A number of perceived barriers to adoption of BFO throughout CRI were identified within the social system, including a lack of IT resources and skills. However, there were numerous perceived benefits of adoption of BFO throughout CRI, including broadening access to effective interventions to support recovery from substance dependence, and promoting digital inclusion. Along with the solutions that were found to the identified barriers to implementation, intentions around longer-term continuation of adoption of the programme were reported, with this process being supported through changes to both the social system and the individuals within it.
Research limitations/implications
The introduction of innovations such as BFO within large organisations like CRI can be perceived as being disruptive, even when individuals within the organisation recognise its benefits. For successful adoption and implementation of such innovations, changes in the social system are required, at organisational and individual levels.
Practical implications
The learning points from this study may be relevant to the substance misuse sector, and more widely to criminal justice, health and social care organisations.
Originality/value
This study is the first of its kind to use a qualitative approach to examine processes of implementation of CAT for substance misuse within a large treatment and recovery organisation.
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Sarah Elison, Jonathan Ward, Glyn Davies, Nicky Lidbetter, Daniel Hulme and Mike Dagley
In recent years there has been a proliferation of computer-based psychotherapeutic interventions for common mental health difficulties. Building on this, a small number of such…
Abstract
Purpose
In recent years there has been a proliferation of computer-based psychotherapeutic interventions for common mental health difficulties. Building on this, a small number of such interventions have now been developed to address substance dependence, one of which is Breaking Free Online (BFO). A new “eTherapy” self-help service, which was set up by the UK mental health charity Self-Help Services, has provided access to BFO to service users presenting with comorbid mental health and substance misuse difficulties. The purpose of this paper is to evaluate a range of clinical outcomes in the first cohort of service users accessing this dual diagnosis service.
Design/methodology/approach
A number of standardised psychometric assessments were conducted with service users at baseline and post-treatment at discharge from the service. Outcome data were available for 47 service users out of an original cohort of 74.
Findings
Statistically significant improvements were found in terms of measures of social functioning, depression, anxiety, alcohol and drug use and social anxiety. Clinically relevant gains were also identified, with fewer service users reaching threshold scores for depression and anxiety at post-treatment compared to baseline. Effect sizes also indicated that the identified improvements across the psychometric measures were robust and significant.
Research limitations/implications
These findings provide further support for the clinical effectiveness of BFO, and also provide evidence that an eTherapy self-help service may be appropriate for some individuals presenting with dual diagnosis. Further research is underway with larger and alternative clinical populations to examine the effectiveness of BFO and also this novel eTherapy self-help approach.
Originality/value
This paper has provided initial data to support effectiveness of a novel eTherapy service for dual diagnosis.
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M Garralda, Gillian Rose and Ruth Dawson
The aim of this article is to examine clinical outcomes in a child psychiatry inpatient unit using dedicated measures. Clinicians completed contextual (Paddington Complexity Scale…
Abstract
The aim of this article is to examine clinical outcomes in a child psychiatry inpatient unit using dedicated measures. Clinicians completed contextual (Paddington Complexity Scale - PCS) and clinical change (Health of the Nation Outcome Scales for Children and Adolescents - HoNOSCA) questionnaires on admission and discharge for consecutive admissions to the unit between 1999 and 2007 (n=167). Mean changes in HoNOSCA scores were analysed, and the predictors of HoNOSCA mean change were assessed using regression analysis. The results showed that the mean length of stay at the unit was 5.6 months (SD 3.1). PCS ratings identified high total, clinical, and environmental complexity scores. HoNOSCA ratings indicated high levels of psychological problems on admission and significant improvement at discharge (mean change 7.7 (SD 6.7)). Greater positive change was associated with higher initial HoNOSCA scores, diagnoses other than conduct disorder and schizophrenia, and a facilitative parental attitude. The authors conclude that the systematic use of standardised outcome measures in child psychiatric inpatient units is useful to document clinical features, complexity and clinical change.
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Annette McKeown and Sarah McCrory
The purpose of this single-case experimental design paper is to examine the efficacy of the high-dosage Life Minus Violence – Enhanced (LMV-E) programme with a small sample of…
Abstract
Purpose
The purpose of this single-case experimental design paper is to examine the efficacy of the high-dosage Life Minus Violence – Enhanced (LMV-E) programme with a small sample of four violent women in custody. All participants were undertaking LMV-E as one component of their treatment pathway in an Offender Personality Disorder (OPD) treatment service for women with personality disorder. The methodology employed an AB baseline design with a six-month baseline period, nine-month treatment period and six-month follow-up. Levels of direct and indirect aggression were recorded throughout the baseline, intervention, and follow-up period. In the follow-up period, women were engaging in further treatment. Psychometric measures linked to treatment domains were used to explore clinically significant and reliable change following the intervention. Clinical and reliable change was indicated in some treatment domains for each participant following the intervention. The pattern of these reductions varied between the women. The patterns of findings are discussed and recommendations presented.
Design/methodology/approach
The methodology employed an AB baseline design with a six-month baseline period, nine-month treatment period and six-month follow-up. Levels of direct and indirect aggression were recorded throughout the baseline, intervention and follow-up period. In the follow-up period, women were engaging in further treatment. Psychometric measures linked to treatment domains were used to explore clinically significant and reliable change following the intervention.
Findings
Clinical and reliable change was indicated in some treatment domains for each participant following the intervention. The pattern of these reductions varied between the female offenders. The patterns of findings are discussed and recommendations presented.
Practical implications
The LMV-E programme was associated with some positive improvements in treatment domains measured in a small sample of female violent offenders. Improvements to some degree were most commonly found in the domains of anger, emotional control and components of criminal thinking. It would be clinically useful to examine characteristics of individuals that appear to benefit most from particular interventions.
Originality/value
There are no existing published findings related to the implementation of LMV-E with females. Therefore, this paper provides preliminary contribution to the evidence base in this area.
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Andrew Stott and Helena Priest
Existing literature has examined what recovery means to people with co-occurring difficulties, but does little to examine experiences of recovery as a process. The purpose of this…
Abstract
Purpose
Existing literature has examined what recovery means to people with co-occurring difficulties, but does little to examine experiences of recovery as a process. The purpose of this paper is to use a narrative approach to explore the process of recovery as an individual journey in a social context. It focuses on people who use alcohol in order to explore the impact of alcohol’s specific cultural meanings on the recovery journey.
Design/methodology/approach
Ten interviews with people with coexisting mental health and alcohol misuse difficulties were conducted, audio-recorded, and transcribed. The transcriptions were analysed using narrative analysis.
Findings
Most participants’ narratives shared a three-part structure, from a traumatic past, through an episode of change, to an ongoing recovery phase. Change and recovery were attributed to several factors including flexible and practical support from services, therapeutic relationships with key professionals, and peer support. Some participants redefined themselves and their alcohol use in relation to ideas of what it is to be “normal”.
Research limitations/implications
The research excluded people who recover outside of services, replicating a shortcoming of much research in this area.
Practical implications
The value placed on professionals having specialised therapeutic skills in working with trauma highlights the need for training in this area. The role for practical and material support underlines the importance of multi-agency working.
Originality/value
The narrative methodology enables the study to draw links between personal stories of recovery and wider social influences, allowing comment on the implications for services. Further, the experiences of people with coexisting mental health and alcohol misuse difficulties have rarely been studied apart from the dual diagnosis population in general, so this paper is able to investigate the specific challenges for this population.
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Akshaya Vijayalakshmi, Russell Laczniak and Deanne Brocato
This study aims to uncover in-depth examples of how emergent media affects parents’ views and socialization efforts. The study examines these views and efforts in the context of…
Abstract
Purpose
This study aims to uncover in-depth examples of how emergent media affects parents’ views and socialization efforts. The study examines these views and efforts in the context of violent commercials.
Design/methodology/approach
The authors collected data for this paper using two studies. In Study 1, they collected data from the internet. Comments related to “violent ads” or “violent commercials” were collated and analyzed. For Study 2, they conducted in-depth interviews with mothers on their views on parental mediation and impact of media on their children.
Findings
The internet data helped develop a parental definition of violent ads and identify that parents lie on a continuum regarding their concerns about violent commercials. Further in-depth questioning of parents on the above finding led to the identification of four clusters of parents. “Media managers” attempt to control and restrict their child’s media environment while educating their child about the effects of violent commercials. “Enablers” spend abundant time co-viewing primetime TV while engaging their child in conversations on violence, but not on violent ads. To maintain harmony in the household, “Harmonizers” merely restrict viewing of violent commercials without educating their child about its effects. Finally, “Agent evaluators” are likely to co-view violent commercials, without discussing them with their child.
Research limitations/implications
First, several of the parental segments (media managers, enablers and harmonizers) tend to note some concerns with violence in advertising. Importantly, this concern for violence appears to be limited to gore and use of physical weapon. Second, while parents do not have homogenous views on violent ads, those who are concerned also have differing roots of concern. This influences their mediation efforts. Third, socialization is bi-directional at times.
Practical implications
Many parents do not approve are the use of physical violence, use of weapons and depiction of blood/gore even in ads for movies or videogames. Advertisers might be wise to avoid such content in ads directed to children. Second, if media and marketing managers could plan to sponsor TV shows (vs placing violent ads) that offer ad-free program time, parents might respond positively. Third, as socialization is bi-directional, advertisers could consider using ad scenarios where parents and children engage with the pros and cons of a certain product or content, thus enabling parent-child conversations to make an informed decision.
Social implications
Many parents notice violence in ads; policymakers could consider developing ratings for ads that consider the amount and type of violence while rating an ad. Second, a focus on increasing parental awareness on the harms of constantly exposing children to violent commercials might change the views of some parents who currently believe that a few or no violent commercials are being aired during children’s programs. Finally, parents envisage a greater role for media in their lives, and policymakers will have to suggest ways to effectively integrate media content in one’s lives rather than just suggest bans or restrictions.
Originality/value
The contributions of this paper include viewers’ (vs researchers’) definition of violent commercials, showcasing that parents are likely to manage media using new media options such as Netflix, and some parents are likely to co-create rules with their children.