Tag: COCAPP

Returning to the REF

Photo by Antony Theobald (ant.photos) Creative Commons 2.0 (CC BY-NC-ND 2.0) licence

This is the month that universities in the UK make their submissions to the Research Excellence Framework (REF) 2014. The REF is a big deal, as I’ve written about before. It is also continuing to attract plenty of commentary, much of it critical. For some time Dorothy Bishop, Professor of Developmental Neuropsychology at Oxford University, has been using her personal blog to critique exercises in research rating. Her objections include their poor cost-effectiveness and the dangers of using journal impact factors as a proxy for the quality of individual papers. In his blog Peter Coles, Professor of Theoretical Astrophysics at Sussex University, has attacked the REF for becoming self-serving. Quoting from a Times Higher Education (THE) story he also writes of the practice in some universities of research-active academics not selected for REF return being shifted onto teaching-only contracts. This week, Professor Peter Scott from the Institute of Education writes in The Guardian that research assessment is now ‘out of control’ whilst the THE has recently reported on the case of Lancaster University historian Professor Derek Sayer who has appealed against the decision to include him in the REF on the grounds that the procedures used to exclude some of his colleagues have been discriminatory.

And so it goes on. In the REF proper, outputs (typically articles in journals) will be graded by experts as ‘world leading’ (4*), ‘internationally excellent’ (3*), ‘internationally recognised’ (2*), ‘nationally recognised’ (1*) or as either ‘sub-national’ or ‘not research’. These gradings will be made using the criteria of originality, significance and rigour. Universities get to select which of their staff will be included in their returns, drawing on their preparatory assessments of the quality of eligible outputs and underpinned by strategic ambitions of where they want to be in the HE firmament once the official REF results are published and institutions ranked. My guess is that, for most researchers and their employers, the most important distinction needing to be made will have been between outputs which are internationally excellent (3*) and outputs which are ‘only’ internationally recognised (2*). For reasons of reputation and likely future funding an article assessed as being at least the former is much more likely to be included in a REF submission than one which is not.

Quality assessments informing imminent REF returns will have been made by busy people with varying degrees of expertise in the (sub)areas in which the papers they have been reading lie. I’m going to speculate that there will be many hundreds (thousands?) of academics with outputs which will have attracted inconsistent scores from internal and external reviewers. Who knows, perhaps there are even some with individual outputs assessed by different people as simultaneously being ‘world leading’ and ‘unclassified’. Many will certainly have papers differentially judged as being 2* or 3*, leaving all sorts of tricky decisions to be made on submission or non-submission with all manner of possible consequences for both individuals and universities.

Back in the world of actually doing research, as opposed to the world of assessing research outputs and fretting over returns to assessment exercises, I am pleased to say COCAPP is now receiving questionnaires from service users and RISC is deep into phase 2. If you head over to this NISCHR page you’ll also find news of the Plan4Recovery project, led by Michael Coffey. This is a collaboration involving Hafal, and I’m very pleased to be a co-applicant along with Sherrill Evans and Alan Meudell. Plan4Recovery is advertising for a research officer, and is about to have its first advisory group meetings. Exciting times.

Divergence and difference in mental health policy

Yesterday’s main business was a there-and-back trip to the University of Nottingham to act as a PhD external examiner. Reading this (very interesting) thesis in advance, discussing with the candidate at viva and talking with supervisory and examiner colleagues over lunch has reminded me (again) how mental health policy and services in Wales and England are diverging.

As an example, there really is no equivalent to the Mental Health (Wales) Measure on the English side of the Severn Bridge. For those not in the know here, ‘measure’ in this context means ‘law’. The Welsh Government’s brief public summary of this piece of legislation says:

The Mental Health (Wales) Measure 2010 is a new law made by the Welsh Government which will help people with mental health problems in four different ways.
Local Primary Mental Health Support Services
The Measure will make sure that more services are available for your GP to refer you to if you have mental health problems such as anxiety or depression. These services, which may include for example counselling, stress and anxiety management, will either be at your GP practice or nearby so it will be easier to get to them.
You will also be told about other services which might help you, such as those provided by groups such as local voluntary groups or advice about money or housing.
Care Coordination and Care and Treatment Planning
Some people have mental health problems which require more specialised care and support, (sometimes provided in hospital). If you are receiving these services then your care and treatment will be overseen by a professional such as a psychiatrist, psychologist, nurse or social worker. These people will be called Care Coordinators and will write you a care and treatment plan – working with you as much as possible. This plan will set out the goals you are working towards and the services that will be provided by the NHS and the local authority and other agencies to help you reach them. This plan must be reviewed with you at least once a year.
Assessment of people who have used specialist mental health services before
If you have received specialised treatment in the past and were discharged because your condition improved, but now you feel that your mental health is becoming worse, then you can go straight back to the mental health service which was looking after you before and ask them to check whether you need any further help or treatment. You don’t need to go to your GP first, although you may wish to talk it through. You can ask for this up to three years after you are discharged from the specialist team.
Independent Mental Health Advocacy
If you are in hospital and you have mental health problems you can ask for help from an Independent Mental Health Advocate (IMHA). An IMHA is an expert in mental health who will help you to make your views known and take decisions in relation to your care and treatment (but will not take decisions on your behalf!)

COCAPP, as some readers of this blog will already know, is investigating care planning and care coordination in community mental health: so the Care Coordination and Care and Treatment Planning component of the Measure is a really important part of the study’s context. It will be interesting to see how far national-level legal and policy differences are ‘felt’ at the level of everyday practice.

There are other important differences in emphasis across the two countries, too. I hear anecdotally that to save money some of the work done by England’s assertive outreach and early intervention teams is being called back into comprehensive, locality-based, community mental health teams (CMHTs). Assertive outreach and early intervention teams, alongside crisis resolution and home treatment services, sprung up in England in the first decade of this century following the publication of the National Service Framework for Mental Health, the Policy Implementation Guide and the NHS Plan. Here the strategy document Adult Mental Health Services for Wales, which appeared in 2001, was strong in its commitment to CMHTs and as a result (I have always thought) we never had quite the range of differentiated services which England had. We have, of course, got crisis services in Wales, as I have previously written about here, here and here.

And it’s not only in the mental health field that policy and services are diverging. We have no clinical commissioning groups in Wales, for the obvious reason that the Health and Social Care Act 2012 applies to England only (for more on this, check out this post dating back to the time I heard Raymond Tallis speak at the Hay Festival).

Reflections on a pre-conference week

Funding for Welsh students and Welsh universities is in tonight’s news, I see, and I’m beginning to wonder how long the Welsh Government’s current policy in this area will survive. More immediately, it’s been a varied enough week for me personally: and that’s without my two days at the NPNR conference in Warwick which begin with a frighteningly early start tomorrow morning. But at least I’ll have Gerwyn Jones and Mohammad Marie in the car for company, so all will be well.

Highlights so far include a meeting of (most of) the excellent RiSC team (which includes the newly-professored Steven Pryjmachuk), to make further progress on our evidence review of ‘risk’ for young people moving into, through and out of inpatient mental health services. This is a two-phase project, and we’re now in the second segment. This is involving searches for research and other materials across a number of databases, and putting out calls for evidence to local services and other organisations.

Data has continued to be generated in COCAPP, and this week a date has been set for a first planning meeting for an exciting new project I am involved in led by Michael Coffey. More to follow on this in the fullness of time, I expect. And yesterday took me to a second meeting of the Mental Health Research Network Cymru Service User and Carer Partnership Research Development Group, an event convened at Hafal‘s premises located in the grounds of the magnificent St Fagans: National History Museum. A good place, St Fagans: well worth a visit.

Elsewhere there have been comments to make on students’ draft assignments, research ethics committee work, undergraduate teaching to prepare (on roles in health and social care teams) and writing plans to be laid. I’ve also been reading a PhD ahead of a viva scheduled in the next few weeks. So this short post will do for tonight: time to knock off, iron some shirts, pack a bag and have an early night.

COCAPP gets a blog

Time only this morning for a super-speedy post to draw readers’ attention to COCAPP’s new blog. COCAPP is funded by the NIHR Health Services and Delivery Research Programme, and is a cross-national study of care planning and care coordination in community mental health. I’ve written about COCAPP on my blog before, but now recommend interested people get over to the project’s dedicated site to meet the team and to find out the detail of what it’s all about.

Vivas, research projects and the Welsh Government on the Francis Report

There’s plenty going on in the continuing baking sun this week. I was pleased to spend yesterday at Sheffield University (where I was once a student) examining, and recommending awarding, a doctorate addressing the use of problem based learning in mental health nursing education.

Meanwhile COCAPP is now generating data, and the RiSC project has reached a critical point as a search strategy is devised for its second phase. And tomorrow and on Friday I’ll be in the classroom with a group of professional doctorate students, talking and learning about systems and complexity.

Elsewhere, via the twitter account of the Minister for Health and Social Services, Mark Drakeford I’ve spotted the Welsh Government’s response to the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. I see there will be an annual Quality Statement for the NHS in Wales from next year, and a future NHS Wales Quality Bill.

Summer sun

Just as predicted by those nice people at the Met Office, South Wales is warming up. The sun is high, and I hear the voices of schoolchildren playing football. I’ve been stuck inside all day, which in the circumstances has been something of a drag, but in the last hour or so I’ve gravitated outside to soak up some of this long-awaited summer.

This has been a working week as varied as any. I had a couple of School committees to chair (research ethics, and scientific review), some teaching (MSc), and a meeting with colleagues to plan some pre-registration interprofessional education in the autumn. This is a continuing mental health nursing/occupational therapy initiative (which I’ve posted about before), and on this occasion we’re planning some technological innovation involving the use of video recording and playback. On the research front I’ve been working on RiSC and keeping in touch with COCAPP, and found myself contributing to a rapidly convened meet-up to talk through a brand new project idea. I received page proofs for our new Critical junctures paper, peer reviewed a manuscript submitted for publication, and received a citation alert from Scopus. This was particularly pleasing as it took my ‘h’ index to 15, for what that’s worth. I also completed preparations for a doctoral examination taking place next Tuesday, and managed to squeeze in a pleasant catch-up with an esteemed colleague working in NHS mental health services. Mostly we exchanged news of developments in practice, services and research locally.

And with that, I’m off. Beer in the back garden calls.

First reflections on two days away

A series of train journeys home gives me space to mull over two days spent in London. Yesterday opened with a meeting of the COCAPP Lived Experience Advisory Group (LEAG), expertly chaired by the wonderful Alison Faulkner. Significantly, key parts of COCAPP are changing in response to LEAG recommendations. Our semi-structured interview schedules, for example, directly reflect the LEAG’s input. This is all good, and I am personally learning huge amounts from the opportunity to be involved.

Yesterday evening saw Alan Simpson give his Skellern Lecture followed by Malcolm Rae receiving his Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award.

As entirely anticipated Alan gave an informed, engaging and challenging talk, which took in his personal journey into mental health nursing and conveyed key messages from his research. Alan gave us plenty to think about. Might peer support workers be attractive to managers with squeezed budgets? Might they begin to replace members of more established groups, nurses included? Or, as Alan hoped, can peer support workers, nurses and others work side-by-side in harmonious fashion for the benefit of people using services?

Malcolm Rea I do not personally know, though based on the talk on leadership in mental health nursing he gave yesterday this has been my loss. I shall remember his contrasting of ‘drains’ and ‘radiators’ (and try personally to be more of the latter than the former).

Yesterday ended with a convivial social in a London pub, and today was more COCAPP: this time a team meeting followed by a Project Advisory Group (PAG) skillfully chaired by John Larsen from Rethink. Some of our discussion centred on the finer aspects of COCAPP’s design and methods, and for that the study will benefit.

So there we are then: only the shortest summary of some pretty involved discussions, but it will do for now. Home calls.

The Next Big Things

Riverside walk, Builth Wells

Here’s what will probably be a final Hay Festival-related post. Last Thursday the Nobel Laureate Professor Sir John Sulston chaired a discussion titled The Next Big Thing. This began with four researchers talking about what they do: Alison Rust, a volcanologist; Zita Martins, an astrobiologist; Nicole Grobert, a nanotechnologist; and Jenny Nelson, a physicist working on materials for solar cells.

All gave fascinating talks, and exemplified the art of conveying complex ideas to the interested but non-specialist listener. And who doesn’t want to hear about supervolcanoes (for the record, they’re bad news, and are definitely best avoided)? Or amino acids from space, the practical applications of graphene or comparing different ways of capturing energy from the sun?

This discussion has since got me thinking about the Next Big Things in nursing and midwifery research (and mental health nursing research in particular). Generally nurses do not do fundamental or basic science, and are not in the business of discovering how bits of the natural world work. So, no volcanoes or extraterrestrial chemicals for us. But practical applications of health-related technologies, and exploring and comparing different ways of doing health work? That’s more up our street, I think, even if graphene and solar power are unlikely to immediately feature.

River Wye, Builth Wells

To the applications-of-technology and exploring-and-comparing questions which might be asked within mental health nursing I would personally add some others related to the examination of health and health care experiences. We know that mental health nurses do ‘people work’ in a big way, spend much of their time coordinating (or ‘articulating’) complex trajectories of care and are often present during service users’ critical junctures. There are applications of skill and technology in this, and how nurses do their work and the effects this has are wide-open areas for study. COCAPP, as I’ve mentioned on this site before, is aiming to distil the components of care planning and care coordination associated with recovery-oriented and personalised mental health services, and is a great example of applied research in this broad field. I’d like to think that its findings will, in some way, be directly useful to practitioners and others in the fullness of time.

But these are just my thoughts, reflecting the things that happen to interest me personally. I wonder what mental health nursing’s current, collective, priorities for research would be if people were asked? What might members of the profession see as The Next Big Things for the period immediately ahead? There are plenty of past examples of this kind of exercise being undertaken within nursing. Over a decade ago the National Coordinating Centre for NHS Service Delivery and Organisation R&D commissioned a study to ‘identify priorities for research funding in the fields of nursing and midwifery’. More recently, the Academy of Nursing, Midwifery and Health Visiting Research (UK) conducted a Delphi study to establish areas for research commonly agreed by nurse leaders in health services and in academia. Within mental health nursing exclusively, I recall (because I’ve cited it in past publications) Ted White’s 1994 paper in the journal Mental Health Nursing titled, ‘Research priorities for community psychiatric nursing’. In its second position paper, appearing in 2004, Mental Health Nurse Academics UK set out its view of the principles to underpin future research studies and the areas it believed were in need of development.

Thinking of Graham Thornicroft’s recent editorial on the poor physical health of people using mental health services, referred to on this blog here, if asked to give their research priorities now perhaps some would make a case for researchers and practitioners to combine their efforts to seriously improve this situation. I know there are people working in this area already, but given the magnitude of the problem it seems to deserve some serious new investment. And how about extending research into the mental health nursing contribution to the vital care of older and vulnerable people, including those with dementia? Again, there are people, such as John Keady, doing this already, but possibly not in sufficient numbers. Or research in the area of quality improvement and safety? And what about workforce research, including studies into factors sustaining nurses’ resilience to provide care in conditions of adversity?

However they might be identified and emerge I suspect that any Next Big Thing candidates for nursing research will be the products of sustained collaborations. To return to last Thursday’s four discussants at Hay: all were explicit about interdisciplinarity, and the importance of crossing boundaries to do high quality research aimed at answering ‘big questions’. There are established academic mental health nurses doing this already (I’m thinking of people like Len Bowers, Karina Lovell, Patrick Callaghan and Alan Simpson), but more of us need to make friends with colleagues possessing specific substantive and methodological expertise relevant to our intended studies. Depending on the questions at hand this might mean finding collaborators with disciplinary backgrounds in various of the social and physical sciences and in the humanities, and if necessary with experience in the practical conduct of clinical trials, qualitative investigation and so on. Crucially, and arguably most importantly, it also means forging meaningful collaborations with people with experience of using services, whose priorities are the ones which really matter.

COCAPP: involving service users

Time this morning for a brief post drawing attention to two excellent opportunities for people with personal experience of using mental health services to contribute to COCAPP.

I’ve written about COCAPP on this site before, and we’re now looking for people to work with us in the recruitment of participants and with the generation of data.

Information about the positions can be found by clicking this link, then following the link onwards to ‘Managerial, Administration and Support’. The opportunities are listed as vacancy number 1007BR, ‘Service User Project Assistants’.

Using research

I very much hope that UK readers of this blog have enjoyed this year’s summer (which, at least, coincided with the early May bank holiday weekend). Right now we’ve been plunged back into autumn, or so it feels here in South Wales. Wind and rain are everywhere.

Here’s a wordcloud used during Friday morning’s teaching with students of mental health nursing, during which I shared something about COCAPP and other (past and present) research projects involving people working in the Cardiff School of Nursing and Midwifery Studies. One of the things I did was to draw students’ attention to my paper on complex trajectories in community mental health, as previously blogged about here. Unrelatedly, towards the end of Friday I also caught sight of some newly delivered reviewers’ feedback on a grant proposal on which I am a co-applicant. One of the points the reviewers made was to encourage us, as a research team, to plan to do more to get future findings into services and practice.

The first of these otherwise unconnected events was a modest attempt to close the gap between research and education. The second was a reminder of the importance of closing the gap between research and the world of health and social care. So with both experiences in mind this post is about getting research out of the hands of academics and into the hands of others who might use it: practitioners and students, service managers, policymakers, users, carers. Coming not long after my recent post on the assessment of outputs in the Research Excellence Framework, this post might also be thought of as an excursion into ‘impact’.

Within single university departments it ought to be reasonably straightforward to bring research and teaching closer together. This said, I can still clearly remember co-presenting with Cardiff colleagues at a nursing research conference in London in the late 1990s only to be told, by a student who had travelled from our own school, that she had had no previous idea who we were or that the research projects we had discussed were ongoing. That was a salutary moment, and since then I have taken opportunities to directly bring research (mine, my colleagues’, other people’s) into the modules I have led and contributed to. And of course, I am hardly alone in doing this kind of thing. But across the whole higher education sector demarcations are growing between ‘teachers’ and ‘researchers’, with universities routinely differentiating between staff on the basis of their expected roles. If researchers become less involved in teaching then the risk is run that naturally occurring opportunities for projects to be brought into the classroom, by those who are running them, will dwindle.

But if integrating research and teaching can be challenging then getting research findings out of universities’ doors for the benefit of all is harder still. In the health and social care fields the publication of findings in peer reviewed journals comes with no guarantee that these will be read, or used to inform anything which happens outside of academia. In nursing (and I imagine in many other practitioner disciplines too) this has often been seen as part of the ‘theory/practice gap’ problem. Nurses have spent a long time agonising over this, and typing some suitable search terms into Google Scholar produces some 200,000 documents (that’s the slightly obscured number circled in red in this screenshot) evidently devoted to its examination:

Nurses are not alone in having concerns of this type. The Cooksey review of UK health research funding talked about tackling the ‘translation gap’ through getting ‘ideas from basic and clinical research into the development of new products and approaches to treatment of disease and illness‘, and at the same time ‘implementing those new products and approaches into clinical practice‘. Universities are increasingly urged to do better with their ‘knowledge exchange’ activities. And, as we know, the Research Excellence Framework 2014 has introduced the idea of assessing ‘impact’.

‘Impact’ in the REF2014 Assessment framework and guidance on submissions document is defined ‘as an effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia‘. It’s about research being ‘felt’ beyond universities, and assessing this. The assessed bit is important in the formal REF exercise because impact (presented using case studies, and counting for 20% of the overall quality profile to be awarded to each individual submission) will be graded using this scale:

Four star Outstanding impacts in terms of their reach and significance.
Three star Very considerable impacts in terms of their reach and significance
Two star Considerable impacts in terms of their reach and significance
One star Recognised but modest impacts in terms of their reach and significance
Unclassified The impact is of little or no reach and significance; or the impact was not eligible; or the impact was not underpinned by excellent research produced by the submitted unit.

As in the case of the assessment of outputs I am struck by the fine judgements that will be required by the REF’s experts. I suggest that one person’s time-pressed ‘very considerable’ may well turn out to be another’s ‘considerable’, or even ‘modest’.

Issues of reliability aside, the inclusion of ‘impact’ in REF2014 has got people to think, again, about how to close some of the gaps I have referred to above. For researchers in health and social care there has been new work to do to demonstrate how findings have been felt in policymaking, in services and in the provision of care and treatment. Who would object to the idea that research for nursing practice should have benefits beyond academia? But as many of the documents I identified when searching for papers on the theory/practice gap (along with newer materials on ‘knowledge exchange’) will no doubt confirm, demonstrably getting research into policy, organisations and practice can be fiendishly hard.

There are many reasons why this is so. Not all research findings have immediate and direct applications to everyday health and social care. Even when findings do have clear and obvious application, university-based researchers may not be best-placed to do the necessary ‘mobilisation’ (to use the currently fashionable phrase), including in relation to knowledge which they themselves have created. And by the time peer reviewed findings have reached the public domain, policy and services in fickle, fast-moving, environments may have moved on. In cases where we think research has made a difference there is also the small matter, in the context of the REF, of marshalling the evidence necessary to demonstrate this to the satisfaction of an expert panel. In any event research is often incremental, with knowledge growing cumulatively as new insights are added over time. Given this we should, perhaps, have rather modest expectations of the likely influence of single papers or projects.

Beyond this it is always good to hear of new ways in which wider attention might be drawn to research and its benefits, and a rich resource for people with interests in this area is the multi-author blog and associated materials on the impact of the social sciences run by the LSE. This is a suitably interdisciplinary initiative, which can be followed on Twitter at @LSEImpactBlog. I recommend it (and not just to social scientists), and as a starting point its Maximising the impacts of your research document. This sets out to provide ‘a large menu of sound and evidence-based advice and guidance on how to ensure that your work achieves its maximum visibility and influence with both academic and external audiences‘, and as such has lots of useful observations and suggestions.