Applying a new concept of embedding qualitative research: an example from a quantitative study of carers of people in later stage dementia.

Background: Qualitative methods are increasingly included in larger studies to provide a richer understanding of people's experience. This paper explores the potential of using a novel approach to embedded qualitative design as part of an observational study examining the effectiveness of home support for people in later stage dementia in England. The method involved collecting and analysing unsolicited conversational comments made by participants as they completed standardised measures.

Practitioners preferences of care coordination for older people: A discrete choice experiment.

These findings demonstrate the importance of organisations providing care coordination for older people receiving long-term funding. Further research is required to investigate the influence of service setting on practitioner preferences. This study explored practitioner preferences about the relative value of attributes of care coordination services for older people.

Systematic review: Effective home support in dementia care, components and impacts - Stage 2, effectiveness of home support interventions.

Aim: The aim of this study was to explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research.

Background: Most people with dementia receive support at home. However, components and effectiveness of home support interventions have been little explored.

Support workers in community mental health teams for older people: roles, boundaries, supervision and training.

Aims: The aim of this study was to explore the support worker functions in community mental health teams for older adults in relation to roles, boundaries, supervision and training.

Background: Support workers in community mental health teams provide important help to older people with complex mental and physical health needs in their own homes. Their numbers have grown substantially in recent years, but without professional registration there is concern that boundaries with qualified practitioners are insufficiently clear and that they do not receive the support they require.

Care co-ordination for older people in the third sector: scoping the evidence.

The third sector has played a significant role internationally in the delivery of adult social care services for many years. Its contribution to care co-ordination activities for older people, however, in England and elsewhere, is relatively unknown. A scoping review was therefore conducted to ascertain the character of the literature, the nature and extent of third sector care co-ordination activity, and to identify evidence gaps.

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England.

Objectives: To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission.

Methods: An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent 'high' or 'low' levels of integrated working practice and patients were followed-up for seven months.

Identifying alternatives to old age psychiatry inpatient admission: an application of the balance of care approach to health and social care planning.

Background: Mental health problems in older people are common and costly, posing multiple challenges for commissioners. Against this backdrop, a series of initiatives have sought to shift resources from institutional to community care in the belief that this will save money and concurs with user preferences. However, most of this work has focused on the use of care home beds and general hospital admissions, and relatively little attention has been given to reducing the use of mental health inpatient beds, despite their very high cost.

Community mental health teams for older people: variations in case mix and service receipt (I).

Objectives: The study sought to identify the characteristics of community-dwelling older people supported by community mental health teams (CMHTs) in England and, in particular, to determine whether there is a common threshold for CMHT entry and/or a core client group.

Methods: Data were collected about a random sample of 15 CMHTs' caseloads, including information about their sociodemographic characteristics, physical health, dependence, mental health, risks and service receipt. The sample was divided into 16 subgroups of people with similar needs for care (case types), and differences between teams were explored.

Community mental health teams for older people: variations in case mix and service receipt (II).

Objectives: To determine the extent to which services provided to older people via community mental health teams (CMHTs) vary in duration, composition and intensity. In particular, to identify the degree to which differences between teams are due to casemix.

Methods: Data were collected about the services provided to a random sample of patients from 15 CMHT caseloads, including contact with CMHT staff, other specialist mental health and social care services.

An examination of assessment arrangements and service use for older people in receipt of care management.

With anticipated greater demand for formal care services globally, this article examines the sociodemographic and health characteristics of frail older people in receipt of community support. Data were collected from audits of case files of older people receiving care management at two time points during which two government policy initiatives were implemented to promote greater standardization in health and social care provision for older people in England. Findings at Time 2 revealed that there were higher levels of physical and mental impairment and more health care assessments undertaken.

Cost effectiveness of pilot self-assessment sites in community care services in England.

Objective: Self-assessment has been advocated in community care but little is known of its cost effectiveness in practice. We evaluated cost effectiveness of pilot self-assessment approaches.

Methods: Data were collected from 13 pilot projects in England, selected by central government, between October 2006 and November 2007.

All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey.

Objective: The objective of this study is to identify the extent of outreach activity community mental health teams (CMHTs) for older people provide to mainstream services in light of the recommendations of the National Dementia Strategy. In particular, to determine the range of settings in receipt of support; to specify the form of this activity; to identify the professionals involved; and to explore the factors associated with the provision of such support.

Methods: A self-administered postal questionnaire was sent to all CMHTs in England.

Membership and management: structures of inter-professional working in community mental health teams for older people in England.

Background: Community mental health services are regarded as the preferred first tier of specialist psychogeriatric support, with integrated multidisciplinary teams believed to offer improved decision-making and greater continuity of care than separate single-profession services. In England over 400 community mental health teams (CMHTs) form the cornerstone of such support, yet research has neither assessed progress toward integrating key professional disciplines nor the nature of their membership and management arrangements.

Methods: A self-administered questionnaire was sent to all CMHTs for older people in England, seeking a combination of objective and subjective information on team structure and management.

Identification and recognition of depression in community care assessments: impact of a national policy in England.

Background: Depression continues to be under-recognized in older people. Most policies addressing this issue focus on the primary health care team. However, recognition may be improved by use of assessment tools and collaboration between secondary health and social care, particularly at the assessment stage.

Towards integrated community mental health teams for older people in England: progress and new insights.

Objective: To investigate progress in joint working within community mental health teams for older people (CMHTsOP) against a range of national standards, and to consider team characteristics that may hinder or facilitate integrated practice.

Methods: A postal questionnaire was sent to the managers of all CMHTsOP in England. A total of 376 teams responded representing a response rate of 87.

Developing multidisciplinary assessment--exploring the evidence from a social care perspective.

Background: This paper provides an initial evaluation of the impact of the Single Assessment Process (SAP) in England upon practice regarding multidisciplinary assessment.

Objectives: To investigate changes in recorded health needs of older people and in the number of multidisciplinary assessments undertaken using social care agencies' case files. To examine differences in approaches to the use of multidisciplinary assessment for older people with different health needs.

Standards of care in day hospitals and day centres: a comparison of services for older people with dementia.

Background: Current policy in England emphasises the importance of caring for highly dependent older people for as long as possible at home. It is therefore crucial that day care services are effective and widely available.

Aim: To compare the type and standard of care provided for older people with dementia in day centre and day hospital settings.

Levels of integration and specialisation within professional community teams for people with dementia.

Background: Delivering integrated and specialist mental health services for the growing population of older people with dementia in Britain is a key concern of the present government.

Aims: To consider the nature of current practice among multi-disciplinary and single discipline health and social care teams providing a service to people with dementia and compare the quality of service offered.

Methods: A postal survey of professional community teams in North West England, providing services to people with dementia.

The struggle for sanitary reform in the Lancashire cotton mills, 1920-1970.

Aim: This paper reports one aspect of a larger study. The aim of this aspect was to explore the role of the "welfare officer" in promoting the health of cotton mill workers during this period.

Background: The paper considers one element of a broad exploratory study of the health of women cotton mill workers in the North West of England.