Experiences of support for people who access voluntary, community and social enterprise (VCSE) organisations for self-harm: a qualitative study with stakeholder feedback

BACKGROUND

Prevalence of self-harm In England is rising, however contact with statutory services remains relatively low. There is growing recognition of the potential role voluntary, community and social enterprise sector (VCSE) organisations have in the provision of self-harm support. We aimed to explore individuals' experiences of using these services and the barriers and facilitators to accessing support.

METHODS

Qualitative, online interviews with 23 adults (18+) who have accessed support from VCSE organisations for self-harm in the Yorkshire and the Humber region were undertaken. Interviews were audio recorded and transcribed verbatim. Thematic analysis was undertaken using NVivo software.

RESULTS

Participants described how a lack of service flexibility and the perception that their individual needs were not being heard often made them less likely to engage with both statutory and VCSE organisations. The complexity of care pathways made it difficult for them to access appropriate support when required, as did a lack of awareness of the types of support available. Participants described how engagement was improved by services that fostered a sense of community. The delivery of peer support played a key role in creating this sense of belonging. Education and workplace settings were also viewed as key sources of support for individuals, with a lack of mental health literacy acting as a barrier to access in these environments.

CONCLUSIONS

VCSE organisations can play a crucial role in the provision of support for self-harm, however, pathways into these services remain complex and links between statutory and non-statutory services need to be strengthened. The provision of peer support is viewed as a crucial component of effective support in VCSE organisations. Further supervision and training should be offered to those providing peer support to ensure that their own mental health is protected.

Getting the pieces to fit: NHS and third sector collaboration to enhance crisis mental health service provision for young people

BACKGROUND

The increase in demand for young people's mental health services has been met by a growth of co-located mental health service provision in the NHS and third sector. This research explores the benefits and challenges of the NHS collaborating with a charity to provide a step-down crisis mental health service for young people in Greater Manchester, and suggests how the collaboration between the NHS and third sector may be improved for future projects.

METHODS

Working from a critical realist paradigm, this qualitative case study utilised thematic analysis of 9 in-depth interviews with operational stakeholders from 3 operational layers, to explore insiders' perspectives of the benefits and challenges of collaboration between the NHS and third sector in the context of the 'Safe Zones' initiative.

RESULTS

Themes relating to perceived benefits of collaboration were: doing things differently, flexibility, a hybrid approach, shared expertise, and shared learning. These were counterbalanced by perceived challenges: getting the pieces to fit, obtaining a shared vision, geography, lack of referrals, and timing. The importance of effective communication (e.g. of shared vision, standard operating procedures, key performance indicators) was noted as central to addressing challenges and reaping benefits.

CONCLUSIONS

NHS and third sector collaboration can yield a range of benefits, some of which can mitigate against the perceived inflexibility and restrictive nature of usual mental health service provision, thereby providing a vehicle for innovation in step-down crisis care for young people.

Creation of Work Integration Social Enterprises (WISEs) by Social Action Organizations: Proposal of a Model for Decision-Making

Successive crisis in Europe have contributed to rethink welfare state and the entrepreneurial role of Third Sector organizations in the provision of community services that progressively have created social enterprises. Its creation is the result of a decision-making process that is collective, not individual, and of a strategic nature, in which the organization's culture plays a relevant role. This work aims to describe and analyze the entrepreneurial process, and the key elements that determines the decision of creating a work insertion social enterprise by its promotor entity. As a result, this article proposes an explicative model of social enterprises creation and makes an empirical validation, using Delphi Method in Spanish work insertion social enterprises case.

Scientific Production on the Social Economy: A Review of Worldwide Research

The aim of this article is to assess the use of the term Social Economy, while being aware of its lack of concreteness, and to analyze the level of scientific production by means of a bibliometric analysis using WoS (JCR) and Scopus (SJR) as sources. Starting in 2004 and related to the Charter of Principles of the Social Economy, the material development of articles began. The most receptive countries are Spain, the USA, China, the UK and Canada. In terms of the most productive journals, Voluntas in JCR and CIRIEC-Spain and REVESCO in SJR stand out. Scientific production on this issue is linked to university institutions, namely the Chinese Academy of Sciences, the University of Valencia and the University of Quebec. The most prevalent subject are Economics and Business in the case of JCR and Social Sciences in SJR. The most recognized term is that of cooperatives and the most prevalent keyword trends being related to sustainable development, climate change, urbanization, management and China.

Context, complexity and cross-pollination: Nursing leaders' views of the role of the voluntary and community sector in nurse education

BACKGROUND

Placements in voluntary and community sector (VCS) organisations have long played an important part in student nurses' education in several countries. New standards for nurse education published by the Nursing and Midwifery Council in the United Kingdom include significant changes to practice supervision arrangements that enable students to spend more time in VCS organisations.

OBJECTIVES

To assess nursing leaders' views on the role of the VCS in nursing education and benefits of VCS placements for students and organisations.

DESIGN

Qualitative interview study.

PARTICIPANTS

Twenty-four nursing leaders from academic (n=15), practice (n=4) and regulatory (n=5) sectors.

METHODS

Semi-structured interviews were conducted face-to-face (n=21), by telephone (n=2) or Skype (n=1). Interviews were transcribed and analysed, using interview questions as structural themes, followed by inductive thematic analysis.

RESULTS

Nursing leaders identified three key roles for the VCS in nursing education: (1) determining knowledge needs; (2) developing curricula; (3) providing placements. Five key benefits of VCS placements for students were shared: (1) understanding the contribution of the VCS to care; (2) seeing the context and complexity of people's lives; (3) challenging attitudes and perceptions; (4) gaining confidence, knowledge and skills; and (5) supporting career decisions. Three benefits for VCS organisations were found: (1) cross-pollinating knowledge, skills and networks; (2) changing organisational cultures; (3) promoting careers in the VCS.

CONCLUSIONS

Changes to practice supervision models enabling closer relationships with the VCS were welcomed. Nursing leaders thought that VCS placements had potential to cross-pollinate ideas and harness the role of student nurses as knowledge brokers in increasingly integrated health and social care systems. Nurse educators should embrace opportunities offered through collaboration with the VCS for student learning and deeper partnerships across health and social care settings to enable students to gain deeper insight into the context and complexity of people's lives.

Marginal Players? The Third Sector and Employability Services for Migrants, Refugees and Asylum Seekers in the UK

Literature in the field of employability and the third sector has focused upon the impact of marketisation on third sector providers, elaborating how commissioning processes have led to a contraction of (smaller) third sector organisations (TSOs) and an expansion of larger private sector bodies. Extant research does not however explore the role of third sector organisations in the employability of migrants, refugees and asylum seekers. Therefore, our paper explores this gap by adopting a qualitative approach via a total of 36 interviews involving migrants, refugees, asylum seekers and managers of third sector organisations, alongside a categorisation of TSOs. Our findings reveal that TSOs are the primary (and for asylum seekers perhaps the only) providers of integration support services and training or education services. We found that only a limited number of organisations provide formal employability services or skills development services which seem to be only residual in terms of the range of activities that TSOs can organise. Thus, perhaps the main function that TSOs perform that enables integration into the UK labour market is providing a safe and trusted environment that people can use to increase their confidence, improve their well-being, broaden their social circle, learn the language or increase their work experience.

Family Club Denmark #strongertogether - a volunteer intervention for disadvantaged families: study protocol for a quasi-experimental trial

BACKGROUND

Need-oriented family support programs are examples of voluntary-based interventions increasingly recognized by the public sector as an important contribution to health and social care provision. Voluntary interventions are attractive because of their focus on activism, inclusion, and participation, but also their low cost and easy accessibility. There is an increasing demand for documentation of the effectiveness of family support programs. Methodologically sound studies are, however, limited and findings are generally inconsistent. This trial aims to assess the effectiveness of the volunteer-based intervention Family Club Denmark on parental stress, mental health, development and well-being of parents and children and to get insight into the experiences of both volunteers and families.

METHODS

This is a prospective quasi-experimental trial with two conditions: (1) intervention group participating in Family Club Denmark and (2) wait-list control group. Participants are families with children aged 2-12 years who wish to participate in the program. Participants are allocated to intervention primarily after a first-come-first-serve principle, and further families will join the wait-list and be offered participation after around 6 months. Quantitative data are collected through web surveys at three time-points: at baseline, post-intervention (6 months after baseline), and follow-up (12 months after baseline). The primary outcome is mental health. Secondary outcomes include parenting behavior, parenting stress, self-efficacy and self-worth, family routines and child well-being. Qualitative data are collected through observations, focus groups, and interviews.

DISCUSSION

This trial is among the first experimental studies of a group-based third sector need-oriented family support program offered to a wide array of families. The trial will provide important knowledge on the effectiveness of a volunteer-based family intervention on important outcomes such as mental health, self-efficacy, family routines. Furthermore, the trial will provide knowledge on volunteer, parent, and child experiences with participating in the intervention and knowledge on how to conduct experimental trails in a complex volunteer environment.

TRIAL REGISTRATION

ClinicalTrials.govNCT03657888 (registered 29.08.2018).

[Public, private or third sector management? Differences in the results in Primary Care in Catalonia]

Objetivo

Comparar los resultados de los equipos de atención primaria en Cataluña en función de su modelo de gestión y evaluar el impacto de un modelo de gestión conocido como gestión por entidades de base asociativa (EBA).

Diseño

Llevamos a cabo un análisis comparado multidimensional siguiendo una lógica cuasi-experimental a partir de comparar los centros gestionados a través del modelo EBA con otros centros gestionados por el sector público a través del Instituto Catalán de la Salud (ICS) o por el tercer sector a través de consorcios hospitalarios.

Localización

Barcelona, Cataluña, España.

Participantes

Tenemos en cuenta 368 observaciones (centros de atención primaria) y 18 parámetros medidos en 2015.

Intervenciones

Distintos métodos de gestión.

Mediciones principales

Comparación de indicadores de actividad, efectividad en el proceso asistencial y eficiencia antes y después de controlar por el indicador socioeconómico del área básica de salud y las características de la región sanitaria. Test de diferencias significativas en las medias de los indicadores según modelo de gestión una vez realizado el emparejamiento conforme a variables clave mediante la técnica Propensity Score Matching.

Resultados

Diferencias significativas en el indicador de carga de trabajo por profesional médico de familia, en cinco indicadores de efectividad en el proceso asistencial y en el coste por usuario.

Conclusiones

La diversificación del modelo de gestión a través del modelo EBA muestra resultados que se pueden interpretar a favor del mantenimiento o de la ampliación de la aplicación de este modelo de gestión. Si bien los centros gestionados a través del modelo EBA se han implantado en áreas de nivel socioeconómico medio o alto, sus resultados continúan siendo significativamente positivos una vez se controla por el nivel socioeconómico de su área.

Social enterprises and public health improvement in England: a qualitative case study

OBJECTIVES

To explore the contribution of social enterprises to publicly commissioned public health improvement and assess the risks and benefits of their role.

STUDY DESIGN

Qualitative case study of four south London boroughs.

METHODS

Documentary research; in-depth interviews with 19 key informants.

RESULTS

This study identified 24 social enterprises that were currently commissioned to contribute to public health improvement. These organisations ranged in size, longevity, and structure. They were widely reported as flexible and able to rapidly develop services responsive to local community needs. Their work often addressed upstream health determinants. However, to capitalise on securing contracts, they had to bureaucratise and establish provider alliances, which risked losing the very characteristics that make them unique. Social enterprises bore the financial risk of innovative service developments. Emerging mixed economies of public health were fragmented, limiting commissioners' abilities to plan strategically and evaluate the impact.

CONCLUSIONS

Social enterprises have an increasing role in providing potential solutions to intractable health improvement challenges, contributing to a broader vision around upstream action for health. However, the fragmentation and growing outsourcing of public health has risks for coherent and equitable service planning.

A feasibility study for NOn-Traditional providers to support the management of Elderly People with Anxiety and Depression: The NOTEPAD study Protocol

BACKGROUND

Anxiety and depression are common among older people, with up to 20% reporting such symptoms, and the prevalence increases with co-morbid chronic physical health problems. Access to treatment for anxiety and depression in this population is poor due to a combination of factors at the level of patient, practitioner and healthcare system. There is evidence to suggest that older people with anxiety and/or depression may benefit both from one-to-one interventions and group social or educational activities, which reduce loneliness, are participatory and offer some activity. Non-traditional providers (support workers) working within third-sector (voluntary) organisations are a valuable source of expertise within the community but are under-utilised by primary care practitioners. Such a resource could increase access to care, and be less stigmatising and more acceptable for older people.

METHODS

The study is in three phases and this paper describes the protocol for phase III, which will evaluate the feasibility of recruiting general practices and patients into the study, and determine whether support workers can deliver the intervention to older people with sufficient fidelity and whether this approach is acceptable to patients, general practitioners and the third-sector providers. Phase III of the NOTEPAD study is a randomised controlled trial (RCT) that is individually randomised. It recruited participants from approximately six general practices in the UK. In total, 100 participants aged 65 years and over who score 10 or more on PHQ9 or GAD7 for anxiety or depression will be recruited and randomised to the intervention or usual general practice care. A mixed methods approach will be used and follow-up will be conducted 12 weeks post-randomisation.

DISCUSSION

This study will inform the design and methods of a future full-scale RCT.

TRIAL REGISTRATION

ISRCTN, ID: ISRCTN16318986 . Registered 10 November 2016. The ISRCTN registration is in line with the World Health Organization Trial Registration Data Set. The present paper represents the original version of the protocol. Any changes to the protocol will be communicated to ISRCTN.

What are the barriers and facilitators for third sector organisations (non-profits) to evaluate their services? A systematic review

BACKGROUND

The third sector is becoming a more common provider of social and health services, but little is known about how third sector organisations (TSOs) evaluate their activities. Past research has reported that the third sector is under increasing pressure to evaluate its impact and performance by government and other commissioning bodies. However, in responding to this increased pressure to undertake evaluation, research suggests that many TSOs struggle to evaluate their activities following the principles of evidence-based practice (EBP). Yet, there has been no systematic effort to investigate why the third sector is struggling to provide good quality evidence of its effects.

METHODS

This systematic review is reported following the PRISMA guidelines. Ten interdisciplinary databases were searched using a search string developed following best practice and in consultation with an information systems expert. Included studies were primary research of any research design investigating barriers to and facilitators of the evaluation process of TSOs as identified by practitioners. All studies were quality appraised, and the results were synthesised as a thematic summary.

RESULTS

Twenty-four studies were included, which mainly investigated TSOs working within health and social services. The thematic summary identified the main barriers for TSOs to undertake evaluation to be related to the (1) lack of financial resources, (2) lack of technical capability and evaluation literacy and (3) challenges around identifying relevant evaluation systems and outcome indicators. Key facilitating factors involved (1) getting the appropriate support, (2) having an organisational culture that supports evaluation and (3) the motivation to be accountable to stakeholders. These findings were robust to study quality.

CONCLUSIONS

This review constitutes the first systematic effort to synthesise existing literature on factors supporting and preventing evaluation by TSOs. The prevalence of factors revolving around the lack of support, resources and clarity on appropriate outcome indicators suggests that many of the identified challenges may be met by applying evidence-based and stakeholder-inclusive strategies to develop shared evaluation requirements. Future efforts should address the application of EBP as part of the commissioning process of TSOs.

Developing a community-based psycho-social intervention with older people and third sector workers for anxiety and depression: a qualitative study

BACKGROUND

One-in-five people in the UK experience anxiety and/or depression in later life. However, anxiety and depression remain poorly detected in older people, particularly in those with chronic physical ill health. In the UK, a stepped care approach, to manage common mental health problems, is advocated which includes service provision from non-statutory organisations (including third/voluntary sector). However, evidence to support such provision, including the most effective interventions, is limited. The qualitative study reported here constitutes the first phase of a feasibility study which aims to assess whether third sector workers can deliver a psychosocial intervention to older people with anxiety and/or depression. The aim of this qualitative study is to explore the views of older people and third sector workers about anxiety and depression among older people in order to refine an intervention to be delivered by third sector workers.

METHODS

Semi-structured interviews with participants recruited through purposive sampling from third sector groups in North Staffordshire. Interviews were digitally recorded with consent, transcribed and analysed using principles of constant comparison.

RESULTS

Nineteen older people and 9 third sector workers were interviewed. Key themes included: multiple forms of loss, mental health as a personal burden to bear, having courage and providing/receiving encouragement, self-worth and the value of group activities, and tensions in existing service provision, including barriers and gaps.

CONCLUSIONS

The experience of loss was seen as central to feelings of anxiety and depression among community-dwelling older people. This study contributes to the evidence pointing to the scale and severity of mental health needs for some older people which can arise from multiple forms of loss, and which present a significant challenge to health, social care and third sector services. The findings informed development of a psychosocial intervention and training for third sector workers to deliver the intervention.

How size matters: exploring the association between quality of mental health services and catchment area size

BACKGROUND

The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size.

METHODS

To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors.

RESULTS

The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units.

CONCLUSIONS

Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.

Qualitative study investigating the commissioning process for older people's services provided by third sector organisations: SOPRANO study protocol

INTRODUCTION

The commissioning of third sector services for older people may influence the quality, availability and coordination of services for older people. The SOPRANO study aims to understand the relationships between and processes of commissioning bodies and third sector organisations providing health and social care services for older people.

METHODS AND ANALYSIS

This qualitative study will be based in the East Midlands region of England. An initial scoping survey of commissioners will give an overview of services to maintain the health and well-being of older people in the community that are commissioned. Following this, semistructured interviews will be conducted with 4 sample groups: health and social care commissioners, service provider managers, service provider case workers and older service users. A sample size of 10-15 participants in each of the 4 groups is expected to be sufficient to reach data saturation, resulting in a final expected sample size of 40-60 participants. Informed consent will be gained from all participants, and those unable to provide informed consent will be excluded. The interview data will be analysed by 2 researchers using framework content analysis.

ETHICS AND DISSEMINATION

Approval for the study has been gained from the University of Nottingham School of Medicine ethical review board, and the relevant approvals have been gained from the National Health Service (NHS) research and development departments for interviewing NHS staff. Early engagement with a wide range of stakeholders will ensure that the research findings are extensively disseminated to relevant stakeholders (including commissioners and third sector providers) in an accessible format using the extensive communication networks available to the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care CLAHRCs (applied health research organisations covering all of England). The study will also be disseminated through academic routes such as conference presentations and journal papers.

The Flexible Care Service: a third-sector service for older people with mental health needs

Demographic patterns indicate that by 2030, one in five people in England will be over 65. Together with the fact that as people age they are more likely to suffer from comorbidities, it is of paramount importance that local services are designed to meet the needs of individual older people. The Flexible Care Service is a resource for older people with mental health problems. Through the use of client case studies, the Department of Health's 'six Cs' (care, compassion, competence, communication, courage and commitment) are used as a framework to demonstrate how a third-sector service such as Flexible Care can offer a person-centred approach in order to meet the diverse needs of individual clients. The framework is also used to demonstrate the high level of skills needed by flexible carers in order to provide this support.

Envisioning the Third Sector's Welfare Role: Critical Discourse Analysis of 'Post-Devolution' Public Policy in the UK 1998-2012

Welfare state theory has struggled to come to terms with the role of the third sector. It has often categorized welfare states in terms of the pattern of interplay between state social policies and the structure of the labour market. Moreover, it has frequently offered an exclusive focus on state policy - thereby failing to substantially recognize the role of the formally organized third sector. This study offers a corrective view. Against the backdrop of the international shift to multi-level governance, it analyses the policy discourse of third sector involvement in welfare governance following devolution in the UK. It reveals the changing and contrasting ways in which post-devolution territorial politics envisions the sector's role as a welfare provider. The mixed methods analysis compares policy framing and the structural narratives associated with the development of the third sector across the four constituent polities of the UK since 1998. The findings reveal how devolution has introduced a new spatial policy dynamic. Whilst there are elements of continuity between polities - such as the increasing salience of the third sector in welfare provision - policy narratives also provide evidence of the territorialization of third sector policy. From a methodological standpoint, this underlines the distinctive and complementary role discourse-based analysis can play in understanding contemporary patterns and processes shaping welfare governance.