Person centred care, wormholes, pesterers and care domains (ii)

Person centred care, wormholes, pesterers and care domains (i)

Mentor: Sorry my friend where were we up to?

Student: I am still puzzled as to how we can define and represent person centered care? Where does person centered care fit in h2cm (Hodges' health career model)?

The INDIVIDUAL-GROUP vertical axis places the person, the individual - at the top of the model. That could be a positive if we are thinking hierarchically, but shouldn't a model that is situated AND person centred be explicit and put the person at the center?

Mentor: This is a good question and you are right to ask it. As our previous discussions have illustrated our models are idealised and yet they should reflect the real world and experiences they seek to model and re-present for us:

Student: but in this case....?

Mentor: Well, not so quick...

As we noted the World's governments get the citizenry they deserve and vice-versa. If peace, political engagement, legitimate government and contentment are not a given but have to be earned then is person centred care any different?

Student: So, you are saying that peace, being a citizen, and mm... well-being I suppose are in a sense similar to person centered care?

Mentor: Perhaps?

Student: That seems quite a leap.

Mentor: Well your question prompts exercise - a certain gymnastics even - and with that a daily requirement we'll save this point for another time.

For now though... I know we don't necessarily need a precise definition of person centered care at the moment, but humour me and see what you can come up with in terms of this model of care. As you have mentioned it includes the INDIVIDUAL, the GROUP. And with the interpersonal and science domains the person's mind and body are literally in the frame.

Student: Well unless we are talking medical emergency then person centered care is about ensuring the individual is taken into account across all the domains of care.

That is - intra-interpersonal, physically - through the sciences, socially and politically. 

Oh - and spiritually too of course.

Mentor: So person centered or being person centered concerns domains of care?

Student: No. It's the content that matters. Take the interpersonal and myself as an example - what are my beliefs, previous experiences, writing skills and interests, my mood, disposition and attitude towards others. That only scratches the surface.

Mentor: I see. Can you go on from there...?

Student: Well I suppose each domain is visited according to various cues - and this is where context and situation come in. These supply the cues. They determine what is significant, what counts as information. For experienced nurses and health care practitioners this travel within and across the care domains comes as second nature.

Mm... I suspect that even if someone was not using h2cm explicitly their cognitive - conceptual movement could still be traced through the model, like passes on a football pitch.

Mentor: Very poetic! So if these care domains are being reflected upon does that mean person centered care is a consequence?

Student: Well I suppose it could if you take your mention of 'reflection' literally. Yes, picture the patient - the person - in the center of the h2cm matrix. We might even argue that our reflections place them there? Within the model what is the position of the person? If our deliberations could be measured - and practically that would be quite a task given patient engagement and dialogue - then is there an average across the domains? And is that the center - hence person centered?

Mentor: An interesting idea. And yet as you questioned initially the INDIVIDUAL in the model is at the top, at the top of an irregular continuum, so...?

'Health coaching': One application for the Health Care Domains Model?

The following message from Helen Erickson (Univ. of Texas) was received through the Modeling and Role Modeling mail list MRM-L at LISTS.UFL.EDU. It is the patient education aspect of the post that is of interest to me as it highlights why I continue to champion Hodges' model near and far.

'Coaching' (in its various forms) is a potential application for h2cm which can be used explicitly by explaining the model to the (potential!) patient / carer, or implicitly used by the health care professional as an aide memoire - a conceptual framework.

More to follow as I referred to the matter of health care delivery vs. health education in my presentation and the delegates raised the question of applications of Hodges' came up in Paipa last week.

<->

Good afternoon,

Some of you know that the healthcare bill signed last year (HR3590) includes a section aimed at revamping the healthcare system from a disease model to a health promotion, disease prevention. Section 4001 particularly addresses care for those on Medicaid and Medicare. A national advisory committee is being named to study this, make recommendations, etc (see Section 4001). Among the representatives of specific groups (orientation to health care) being named to the advisory group is the "health coach".

STTI and ICN put out a manual on coaching a year or so ago, coupled with a short CE test. When I read the manual and took the test (it took about 10 minutes total), I discounted the movement, thinking that it was just another way to define what we call MRM. The only difference is that it requires some specific strategies and skills, most of which I've discussed with you through the years, e.g. contracting, The other difference will be determined by what happens at the national scene. It is possible that "coaching" will be reimbursed. Many think that it will, thus the national group out of Harvard, the University of MN, and others are meeting, talking, defining the construct, etc.

As Chair of American Holistic Nurses' Certification Corporation, I have been drawn back to the topic repeatedly. Most recently, AHNCC has decided to actively explore certifying nurses who practice holistic health coaching, i.e.certifying a holistic health nurse coach. I have added a poll to the ahncc website, eager to learn if nurses are interested in the movement, etc. if you are interested in the website or want to express your position on health coaching, please visit ahncc.org.

Hope to hear from you,

Best to all,
Helen

OERU / OERF / UNESCO Press release: Towards an OER university - Free learning for all students worldwide

Please circulate: Joint OER Foundation / UNESCO press release.

The Open Education Resource (OER) Foundation is to host a strategic international meeting in Dunedin on 23 February, to commence planning for the provision of free learning to all students worldwide. Support from the United Nations Science and Education Organisation (UNESCO) to stream the meeting on the internet will allow the participation of education leaders and interested persons from around the globe.
Join the meeting as a virtual participant and help make OER futures happen.

Read more.


(If you blog about this important meeting -- please use the #OERU tag).

2011 will be a quantum shift year for the mainstream adoption of OER.

Cheers
Wayne
Wayne Mackintosh , Ph.D.
Director OER Foundation
Director, International Centre for Open Education,
Otago Polytechnic, New Zealand.
Founder and elected Community Council Member, Wikieducator
Skype: WGMNZ1
identi.ca

You received this message because you are subscribed to the Google Groups "OER university" group.
For more options, visit this group at
http://groups.google.com/group/oer-university?hl=en?hl=en
Visit the OER university page on http://wikieducator.org/OER_university

Call for Papers: Special issue on Community Informatics for Health - Journal of Community Informatics

Abstract submissions due 14 March 2011

A special issue of the international Journal of Community Informatics (http://ci-journal.net) is going to be devoted to Health. Community Informatics (CI) is the study and the practice of enabling communities with Information and Communications Technologies (ICTs). This special issue will focus on how the social application of ICTs can empower and enable communities towards improving health. The issue is expected to be published in late 2011. The Journal of Community Informatics is a focal point for the communication of research of interest to a global network of academics, community informatics practitioners and national and multi-lateral policy makers.

The field of community informatics seeks to explore the potential of information and communication technologies and their applications for social and economic development efforts at the community level. It particularly seeks to ensure that marginalized individuals and communities can benefit from the opportunities that ICTs can provide. In the area of health, this is all the more important since those with poorer health status and poorer health outcomes are usually those with less (or no) access to ICTs, or are those who have fewer skills to make use of and benefit from ICTs.

For this special issue of the Journal on Health, we are inviting submission of original, unpublished articles. We welcome research articles, along with case studies and notes from the field. All research articles will be double blind peer-reviewed. Insights and analytical perspectives from practitioners and policy makers in the form of notes from the field or case studies are also encouraged - these will not be peer-reviewed.

Please read the full Call for Papers and more specific information on the intended 'flavour' of the issue at: http://www.flinders.edu.au/medicine/sites/southgate/research/projects/digital-tech-health/

Guest editors:

*  Lareen Newman PhD, Southgate Institute for Health Society & Equity, Flinders University - Australia
*  Ali Al Sanousi MD, King Faisal Specialist Hospital & Research Centre, Riyadh - Saudi Arabia

Contact for queries and abstract submissions:  lareen.newman AT flinders.edu.au

IMPORTANT DATES
Deadline for abstracts: 14 March 2011
Notification of successful abstracts:  9 May 2011
Deadline for submission of full papers/articles: 31 August 2011
Estimated publication date: November 2011

----------------------------------------
Dr Lareen Newman, DipEurLangs (Hons), BA (Hons), PhD
Senior Research Fellow
Southgate Institute for Health Society & Equity
Flinders University - Adelaide, South Australia
Personal page: http://www.flinders.edu.au/people/lareen.newman
Program page: http://flinders.edu.au/medicine/sites/southgate/
CRICOS Provider Number: 00114A

Additional link: h2cm in community informatics ....
Jones, P. (2004) The Four Care Domains: Situations Worthy of Research. Conference: Building & Bridging Community Networks: Knowledge, Innovation & Diversity through Communication, Brighton, UK.

Nursing: magnetic Force 5

Back in 2009 I came across a post - Nurse magnets crucial for recruitment and retention about the 14 Forces of Magnetism:

In 1983, the American Academy of Nursing conducted a survey of 163 hospitals to learn why some hospitals attracted and retained well-qualified nurses who were devoted to quality patient care.

The 14 Forces are listed and described by the ANCC. The forces themselves include:

• Force 1 Quality of Nursing Leadership
• Force 2 Organizational Structure
• Force 3 Management Style
• Force 4 Personnel Policies and Programs
• Force 5 Professional Models of Care
• Force 6 Quality of Care
• Force 7 Quality Improvement
• Force 8 Consultation and Resources
• Force 9 Autonomy
• Force 10 Community and the Hospital
• Force 11 Nurses as Teachers
• Force 12 Image of Nursing
• Force 13 Interdisciplinary Relationships
• Force 14 Professional Development

The professional, organizational, and political (policy) emphasis of the 14 forces is obvious and becomes clear when each is weighed in terms of where it sits within the domains of h2cm.

Try it as an exercise. ...

Recruitment is ALL about magnetism.

If you are unsure, ask a magnet about the meaning of retention.

Demographics are already applying pressure upon these forces of magnetism. Not just when referred to explicitly in the USA within organizational media; but globally. Demographics is another magnet - it approaches with increasing force.

From here in the UK (and readers elsewhere) we have to exercise care when models are mentioned. While the theorists and philosopher's of nursing nail their definitions to the mast (h2cm?) there remains a models muddle, not just in the variety of models of care, but in the levels at which they operate. This is not a criticism, it's an observation - consider Force 5:

Force 5: Professional Models of Care
There are models of care that give nurses the responsibility and authority for the provision of direct patient care. Nurses are accountable for their own practice as well as the coordination of care. The models of care (i.e., primary nursing, case management, family-centered, district, and holistic) provide for the continuity of care across the continuum. The models take into consideration patients’ unique needs and provide skilled nurses and adequate resources to accomplish desired outcomes.

In the US in particular 'models of care' (moc) often refer to finance and accountability of costs (the market process), in the UK moc might refer to commissioning. In Force 5 the addition of 'Professional' (as the original author's no doubt recognized) is crucial. If you repeat the above exercise, plotting Force 5 on the Health Care Domains Model then you see how Force 5 works for nursing and remains to this day a great achievement as a yardstick for quality, assurance and retentive power.

In the almost 30 years since the research on the 14 Forces, I do wonder though if there is a need to imbue the following with magnetic properties:

• person-centred care;
• self-care;
• carers and public engagement;
• prevention;
• public (mental) health
• and informatics?

Yes, many of the above can be assumed to lie within the existing Forces 1-14. Health and social care are not static. Nursing has much to contend with from the level of the individual practitioner through to the group within an organization. The 14 Forces of Magnetism are well established in the USA and deservedly so, they clearly deliver.

In the political and economical heat of an economic recession, however; magnets may reach their particular^* Curie point. Then they cease to work.

The constant bangs and knocks of change, the incessant hammering of party politics and the 'market' on the door of "high quality nursing care" can also take its toll on magnetism.

Nursing needs to take care.

Related post on Healthcare IT News:

Top 10 trends for 2011 include IT, new care models

*OK it should be constant, but like our patients these magnets are not all the same - they have varying levels of vulnerability.

To follow some definitions from an olde book ...

Shared Approach: 3 keys (and a certain conceptual framework)

Before we trip into 2011 let's make a quick return to 2008 and the three keys to the Shared Approach in mental health assessment [NIMHE, 2008] which are copied below.

In between each one I have highlighted how the Health Care Domains Model can contribute ...

1) active participation of the service user concerned in a shared understanding with service providers and where appropriate with their carers;

In the end (or at the beginning!) a model of care or assessment tool is only as good as the person using it.

To progress with key #1 there are in fact two locks to open. These are in the form of 'using' and 'user'. H2CM incorporates the individual from the outset. The model encourages consideration of the client's beliefs, preferences, and experiences ... Can the client and carer actually use the model themselves to help understand their needs, their care plan and interventions? Is there a homework exercise there for them?

Do they have capacity to decide? Do they need support - an advocate? How do we ensure the carer is factored into the care equation? Well, in h2cm that's through the social domain.

2) input from different provider perspectives within a multidisciplinary approach, and;

Do you know what "different provider perspectives within a multidisciplinary approach" look like?

Well just envisage that for a few moments. ...

A scary exercise, eh?

In order to take those different perspectives and integrate them a common framework is surely needed?

Artists are lucky they use perspective as an integrative lever on paper, canvas, or whatever medium.

Clients, carers, health and social care professionals need a canvas of their own, BUT one that is sufficiently generic and agnostic to be 'owned' by all. 

3) a person-centred focus that builds on the strengths, resiliencies and aspirations of the individual service user as well as identifying his or her needs and challenges. NIMHE (2008)

H2CM can support and foster person-centred care. The model is situated: there is one (changing) situation with the person at the center. Whatever the context -

strengths, resilience, stresses, vulnerabilities, aspirations, needs, challenges

- the care domains model is fit for purpose. Health and social care is dynamic, in person-centred care that focus needs to change accordingly. Our assessments and evaluations need to resolve the SCIENTIFIC, SOCIOLOGICAL, POLITICAL, INTERPERSONAL and SPIRITUAL dimensions of care while assuring the BIG picture.

Reference:
The National Institute for Mental Health in England (NIMHE) and the Care Services Improvement Partnership. 3 Keys to a shared approach in mental health assessment. London: Department of Health; 2008.
Available from: http://www.3keys.org.uk/downloads/3keys.pdf

Wonk - and the comprehensive health record

As the future unfolds the day will emerge when a 'wonk' - that is, "someone meant to know everything" (Prospect Magazine, Dec 2010, p. 19) is realised in software (or in a termin-ological mix with some "I'll be back" hardware).

The Internet is already envisaged as a giant global graph - a vast intelligence. The health care domains model provides a framework - a graph - to capture what someone or some group of people know about a situation. Policy, practice and values are often rightly based and measured against ideals. In health (and social-) care the comprehensive health record is the ideal. Throw information technology into the mix and you have an ideal of Platonic proportions.

Can you have a complete and ongoing record and still work smart and Lean?

I don't wonk, do you?

Before you measure ....

Fitness-to-work tests to be reformed after criticism

- you check your tools:

You calibrate, validate and balance ...

strengths - weaknesses

functional - diagnostic

humanistic - mechanistic
individual - group
purpose - policy
practice - process

physical - emotional

person centred - policy centered
sad (?) - (you will be -) happy

Additional links:
How to assess happiness? A tale of three measures
WWF: Manifesto - The Politics of Happiness
Frank Furedi: Why the ‘politics of happiness’ makes me mad

Information Revolution and Greater Choice and Control - webchat Nov 9

Put your questions about the Information Revolution and Greater Choice and Control direct to Andrew Lansley, Secretary of State for Health, on November 9 at 1.30pm.

People can ask questions in advance by emailing:
informationrevolution AT dh.gsi.gov.uk - or -

 by Tweeting their question, using the hashtag #inforevolution.

The webchat will be available from November 9 at www.dh.gov.uk/informationrevolution and you can watch the live Q&A on screen, ask questions and leave comments. We will also be tweeting Andrew Lansley's answers and the comments we receive. A transcript of the webchat will be available on the website after the event.

I would be grateful if you could bring this to the attention of any interested individuals or groups.

With best wishes

Anne Cooper
National Clinical Lead for Nursing
Office of the Chief Clinical Officer
NHS Connecting for Health
anne.cooper AT nhs.net
http://www.connectingforhealth.nhs.uk
NHS Connecting for Health supports the NHS in providing better, safer care by delivering computer systems and services which improve the way patient information is stored and accessed.
Additional link:
http://conversations.dh.gov.uk/2010/10/17/home/
My source:
British Computer Society Nursing Specialist Group

Healthy Active Ageing Virtual Global Discussion Forum: Int. Day of Older Persons 2010

Dear Colleagues,

The World Health Organization, Departments of Reproductive Health and Research, Human Resources for Health, University of Iowa Hartford Center of Geriatric Nursing Excellence, and Partners would like to invite you to join Healthy Active Ageing Virtual Global Discussion Forum - 1-12 October 2010.

Join us in creating an interprofessional network involving representatives from health professions, policy makers, programme managers, international organizations/agencies, universities, research institutes and our clients to share our knowledge and experience on issues that affect healthy ageing.

REGISTER NOW! http://knowledge-gateway.org/ahaa

Share your experience, your opinion on issues that affect us all, as individuals, families and health practitioners. Contribute through this forum to the policy and practice dialogue.

During this twelve day forum you will receive two emails per day; one email to introduce the day’s questions and one daily digest of the contributions. Daily questions will be disseminated within three topic areas:

• Challenges and opportunities to support healthy active ageing
• Sharing of success stories
• Caring for older persons with dementia

Once you have registered you can participate in the forum simply by responding to the daily emails or sending a message directly to ahaa at knowledge-gateway.org

You can also log into http://knowledge-gateway.org/ahaa to browse the archived discussions and resource materials.

For any questions on this Virtual Global Discussion Forum please contact the forum facilitator: 
Christina Fusco christyfusco at gmail.com

Please pass this invitation onto your colleagues and networks.

With kind regards,

Maggie Usher-Patel
Scientist/IBP Secretariat
WHO/RHR

My source: HIFA2015

Additional links:
Full of Life  - http://www.dwp.gov.uk/policy/ageing-society/full-of-life/
International Day of Older Persons - http://www.timeanddate.com/holidays/un/international-older-persons-day

'Well-being' and the dilution of 'caring'

This blog post was originally drafted on 15 October 2008. Back then I'd noticed how in the media - newspaper, internet, radio and journals - there was increasing references to 'well-being'. It was everywhere. Even now it graces lips, airwaves, video, digital and conference platforms.

I was prompted to write because I actually felt that perhaps the public were being somehow sold a pup. I mean 'well-being' - it sounds wholesome, reassuring and cuddly so go on - take hold, give it a hug and look after it. Maybe it literally is a case of - get up and take it for a walk. You know you need to!

What well-being does do is it forces acknowledgment of physical AND mental well-being. In the summer I bought a copy of the British Journal of Wellbeing [BJW]. BJW features physical and mental health with some really interesting features, reviews and interviews. So, I raised my hands, sighed, stretched (felt much better) and accepted "OK well-being (or wellbeing*) it looks like you will go far."

I just have a worry though. Because the concept of well-being is fuzzy, there is a risk that the care agenda could be diluted at a time when specific health and social care populations and issues arising need to be kept in clear and unequivocal focus. Looking at the content I am reassured - there is depth here too. I say this recognising that the concept of well-being can also serve the health career model very well.

More to follow on BJW and well-being ...

http://www.dictionary.net/well-being

*I like hyphens as in socio-technical

Drupal musings 16: 1% digital and analogue memories

At Drupalcon in his keynotes Dries Buytaert has highlighted that Drupal now powers approximately 1% of the web. While 1% is not much especially given the total size of the internet with its day on day, hour by hour growth this is nonetheless a significant milestone. Especially when Dries speculates on the growth of Drupal projected ahead to 2020.

Like all digital media Drupal is a tool that extends our personal and cultural memories. As all the keynotes showed Drupal, PHP, HTML[5] all have histories of their own and a role to play in providing a surrogate memory. The media and technology [IBM] regularly predict how technology will change our lives, including how we remember.

Amid such speculation memory still makes us who we are. You and I have a yesterday, today - and we pray - a tomorrow.

This is the bootstrap that counts

Bootstrapping or booting refers to a group of metaphors that share a common meaning:

a self-sustaining process that proceeds without external help. ...
en.wikipedia.org/wiki/Bootstrap

Striking then the news this week that - dementia costs 'equal to 1% of global GDP'.

Special Issue: The Challenges of Dementia: an International Perspective

Read the special issue on the -
Challenges of Dementia
- for free online!

This special edition of the International Journal of Geriatric Psychiatry contains a series of articles concerning current services and future plans for the care of people with dementia and their carers in a host of different countries. The articles reflect the myriad approaches in which various countries are improving the quality of life for people with dementia.

My source: Wiley

England: The future of the National Programme for IT

Department of Health - 09 Sep 2010 12:32
The future of the National Programme for IT
-----------------------------------------------------

A Department of Health review of the National Programme for IT has concluded that a centralised, national approach is no longer required, and that a more locally-led plural system of procurement should operate, whilst continuing with national applications already procured.

http://www.wired-gov.net/wg/wg-news-1.nsf/lfi/415392

My source: Wired-GOV

Retirement, memories of work & Bacon numbers

In the UK in July 2010 the much anticipated news about the government's plan to scrap the default retirement age in the UK from October 2011 throws up a complex future work place and nursing care space.

At the moment if a member of the staff in the NHS needs a psychiatric assessment and admission, then there is often a protocol that determines how their care is managed. Various factors are taken into account. For example, the work history of the person and the distance of available beds. This may entail admission for them to another area. Such arrangements help protect the staff member, their families and the local staff for whom being both carers and colleagues could be quite difficult.

Over two decades I have encountered health professionals who are diagnosed with dementia maintained in the community - in their homes - and in residential care. So far I have not known these individuals in their work capacity and professional lives. This is due in part of course to the incidence of dementia increasing with age and my previous status as a spring chicken. Today of course things have changed:

• Early onset dementia is more common as the overall older adult population rises.
• Suddenly (well at least after October 2011) we may find - despite the physical and emotional demands of the job - that the staff in residential and nursing homes are also older - working through that previous work | retirement barrier.
• There's another change: now I am a mature chicken.
• I wonder what the churn rate is in our nursing homes?
• While we usually think of high turnover for staff and the associated poor quality of care. As care and nursing homes are also businesses there are two churn rates:
• - senior and junior staff leave the sector, or move to other homes;
• - residents are moved for reasons of re-location - increased care needs, and the choices of family.

So....? Amid all this I wonder how many workers in the care sector working their extended years may potentially come across former work colleagues? This could be a delicate and haphazard negotiation. ...

Additional link:
The Oracle of Bacon

Frontline First campaign: cost-saving innovations whilst improving patient care

Dear Peter,

Innovations are the key to saving the NHS money. Every day, nursing staff on the frontline are finding new and better ways to deliver patient care.

As one nurse recently wrote to us:

"Without a working knowledge of clinical care provision how can ideas be practical and ensure quality of care is maintained? Nurses are in a prime position to look at care provision to identify better ways of working and therefore identify cost savings without sacrificing patient care and experience."

As part of our Frontline First campaign, the RCN is collecting examples of cost-saving innovations at NHS services across the UK. What nursing solutions have you seen in your workplace that could achieve savings without sacrificing patient care?

http://generalelection.rcn.org.uk/innovation

There are two ways the NHS can find billions of pounds in efficiencies:

discover innovative ways to save money
or
make cuts to staff and services

Every day, UK nurses are helping to devise and implement cost-effective solutions saving their employers money and helping to protect jobs. We've already heard from dozens of nursing staff who told us about innovations in their workplace, from changes to day-to-day practices to
whole new ways of working.

Please take a moment to report any cost-saving innovations you've seen at the workplace:

http://generalelection.rcn.org.uk/innovation

Thanks for speaking up and helping to protect patient care.

Yours sincerely,

Janet Davies
Director of Nursing and Service Delivery

My source:
Subject: Improving patient care
From: "Janet Davies, Royal College of Nursing"
Date: 04 August 2010 16:53:30

New challenging behaviour charter launched

I noticed the item below (with links and images added here) on the Foundation for People with Learning Disabilities Forum. It makes a very important point:

"The label 'challenging behaviour', has become misused over time."

My worry is that this finding is not just relevant to individuals with learning disability and their families, but other groups.

People with dementia, especially in the latter stages can present with behaviour that is increasingly described as 'challenging'. Care facilities are being commissioned and designed with the requisite care, staffing and environment to provide care for people in an effort to provide the highest quality and standard of nursing care.

To some extent these are distinct groups with specific needs. So the use of 'challenging' in one context obviously has a different currency and meaning in another. Whilst the practise and care environments may be separate, is there no place where cross-over may occur? I remember a local RCN meeting presentation that highlighted the demographic trend of dementia within the learning disability population.

To start a painting we often start with a wash:
efficiency - puts a broad brush in the hand.

As we aspire to provide person-centred care
what type of brush do you hold?

We paint with the words we use - take care.

---

The Challenging Behaviour - National Strategy Group has launched a charter to promote the human rights of individuals with learning disabilities who are perceived as challenging.

Up to 27,000 people with learning disabilities in the UK may have been given a label of challenging behavior, resulting in this group of people being - stigmatised and socially excluded denied the right to ordinary lives in the community, to education, recreation and employment placed in institutional settings a long way from home and families.

The label challenging behaviour, has become misused over time. Rather than being used as a term to encourage carers and professionals to understand the underlying reasons for a person's behaviour, 'challenging behaviour' has been used as a diagnostic label, viewed as being intrinsic to the person.

The Challenging Behaviour - National Strategy Group want people (and organisations) to sign up to the charter to register their support for the principles it contains and to commit to action to improve the lives of children and adults who are labelled as challenging. We need as many people as possible to support us, so please ask your friends and family to sign up too.

To read the charter, including an easy read version visit:

http://www.challengingbehaviour.org.uk/

ENDS

What is the Challenging Behaviour - National Strategy Group?

The Challenging Behaviour - National Strategy Group (CB-NSG) was launched on November 7th 2008. The CB-NSG is a key national group to address the needs of children, young people and adults with learning disabilities whose behaviour is perceived as challenging.

Members of the CB-NSG include family carers, representatives from the Department of Health, Royal College of Psychiatrists, British Psychological Society, Royal College of GP's, NHS Trusts, researchers, service providers and a range of practitioners, regulators, commissioners and third sector representatives. The group is action and outcome focused and comes together twice a year to monitor progress, share best practice and develop coordinated action plans.

What is challenging behaviour?

"Behaviour can be described as challenging when it is of such an intensity, frequency, or duration as to threaten the quality of life and/or the physical safety of the individual or others and it is likely to lead to responses that are restrictive, aversive or result in exclusion." (Challenging behaviour - a unified approach; RCPsych, BPS, RCSLT, 2007)

Challenging behaviour is things like hitting your own head against a wall, pulling curtains down or pulling someone's hair. Often people do this because they cannot communicate with words and they have little or no choice and control over what is happening to them. How do I find out more?

To find out more about the Challenging Behaviour National Strategy Group, please refer to 'All change' the Summer issue of 'Challenge' today. This issue focuses on the work of the National Strategy Group and includes articles from Dr Roger Banks (Consultant in the Psychiatry of Learning Disabilities), Jackie Edwards (Family carer) and Bob Tindall (United Response).


'Challenge' is the newsletter of the Challenging Behaviour Foundation and is available free of charge by emailing: info at thecbf.org.uk or downloading from www.challengingbehaviour.org.uk

Helen Marron
The Challenging Behaviour Foundation
Email: info at thecbf.org.uk

Book: "Outcome Measurement in Mental Health" Cambridge University Press

Outcome Measurement in Mental Health
Theory and Practice
Edited by Tom Trauer
Hardback
Published June 2010

In order to operate in an evidence-based fashion, mental health services rely on accurate, relevant, and systematic information. One important type of information is the nature of the problems experienced by recipients of mental health care, and how these problems change over the course of time. Outcome measurement involves the systematic, repeated assessment of aspects of health and illness, either by service providers, service recipients, or both. From outcome measurement clinicians and service recipients achieve a common language whereby they can plan treatment and track progress, team leaders and managers secure a basis to compare their services with others and to promote quality, while policy makers and funders derive evidence of effectiveness. This book will be an essential and practical resource for all members of the mental health clinical team as well as those responsible for establishing or managing services, and directing policy.

• Presents a global perspective on outcome measurement enabling readers to compare and contrast practices around the world
• Enables readers to identify the specific challenges presented in different groups and settings, the instruments to use, and how to use the results
• Emphasizes the relevance and use of outcome data to clinicians, to help them improve their effectiveness

Contents

Preface; 1. Introduction Tom Trauer; Part I. Outcome Measurement Around the World: 2. Mental health outcome measurement in Australia Jane Pirkis and Tom Callaly; 3. Outcome measures in New Zealand Graham Mellsop and Mark Smith; 4. Outcome measurement in England Mike Slade; 5. Outcome measurement in Ohio and the United States James Healy and Dee Roth; 6. The outcome questionnaire system: a practical application for mental health care settings Michael J. Lambert; 7. Outcome measurement in Italy Mirella Ruggeri; 8. Outcome measurement in Germany Sylke Andreas, Thomas Becker, Holger Schulz and Bernd Puschner; 9. Outcome measurement in mental health services in Norway Torleif Ruud; 10. Outcome measurement in Canada: one province's experience with implementation in community mental health David Smith; Part II. Outcome Measurement in Specific Groups and Settings: 11. Routine outcome measurement in child and adolescent mental health Peter Brann; 12. Outcome measurement in adult mental health services Tom Trauer; 13. Outcome measurement in older persons Rod McKay and Regina McDonald; 14. Outcome measurement with indigenous consumers Tricia Nagel and Tom Trauer; 15. Routine measurement of outcomes by Australian private hospital-based psychiatric services Allen Morris-Yates and Andrew Page; 16. Mental health outcome measurement in Non-Governmental Organizations (NGOs) Glen Tobias; 17. Outcome measurement in drug and alcohol services Maree Teesson and Mark Deady; Part III. Current Issues in Outcome Measurement: 18. Outcome measurement - applications and utility Tom Trauer; 19. Stakeholder perspectives in outcome measurement Tom Trauer; 20. Assessment of change in outcome measurement Tom Trauer; 21. Routine outcome measurement: perspectives on skills and training Tom Trauer and Tim Coombs; 22. A review of instruments in outcome measurement Tom Trauer; 23. Some economic and policy considerations for outcome measurement Rowena Jacobs; 24. Future directions Tom Trauer; Index.

http://www.cambridge.org/uk/catalogue/catalogue.asp?isbn=9780521118347

My source:
UK Routine Clinical Outcomes Network Forum

Born HIV Free campaign announces 11 million views for "Baby in the Sky" creative film

Dear Writer and Blogger,

In our series of news related to the 6-month Born HIV Free campaign, we are delighted to send you a press release focussing on the specially created film "Baby in the Sky" created by Les Bonzoms for this campaign.

The film has attracted a great deal of attention through YouTube and other broadcasts, helping to make people aware about the campaign.

Thanks as ever for your support,

Brendan
Ogilvy Public Relations Worldwide France, Paris

“Baby in the sky”: a stunning new film made by Les Bonzoms specially for the Born HIV Free campaign attracts more than 11 million viewers on dedicated YouTube channel

Geneva, 6 July 2010 – The YouTube channel dedicated to The Global Fund’s Born HIV Free campaign which was launched seven weeks ago, has already been seen by more than 11 million viewers. The channel features an exceptional animation film called “Baby in the Sky”, created by the design team Les Bonzoms and with music of Amy Winehouse. Euronews, the international news channel, joins the campaign by also featuring the video until October.

“The purpose of the Born HIV Free campaign is to encourage millions of people to support The Global Fund so we can finally put an end to the tragedy of 430,000 babies being born HIV-positive every year, when we have the means and the expertise to prevent this.” says Carla Bruni-Sarkozy, Global Ambassador for the protection of mothers and children against AIDS. “Hopefully this beautiful film will reach a wide audience because of its creative ingenuity, and inspire millions of people to support The Global Fund so we can finally put an end to this terrible injustice.”

“Baby in the Sky” is a highly creative and imaginative animated film that conveys the beauty of life ahead for an unborn child. The film artistically portrays an imaginary journey in a world full of adventurous landscapes and fantastic creatures. It ends with a call from Carla Bruni-Sarkozy for an HIV-free generation in which she says “Life is a beautiful journey. Don’t let AIDS kill it.”

The film owes its powerful soundtrack to multi-award winning and singer/songwriter artist Amy Winehouse, who offered the pro-bono use of her “Back to Black” song for the film.

“It was a question of finding a true resonance with the images in the film created by Bonzoms”, says musician / producer Julien Civange, who conceived the Born HIV Free campaign, about the use of Winehouse’s music. “We wanted to find a piece that was modern but also well known, something that carried the same sensibility as the film. The magic came with the soundtrack by Amy Winehouse, an artist that Carla considers one of the greatest and most talented of her generation and who was generous enough to participate in the campaign.”

The animation can be viewed on the Born HIV Free YouTube channel and will also be distributed through various social and mass media platforms during the course of the campaign.

Since June 20, Euronews, the international news channel, has been broadcasting “Baby in the Sky” on its network in 155 countries. The film is shown in 90-second slots an average of three times a day for the first month and then once a day thereafter. Broadcasting of the film will continue until 5 October 2010.

"All of us at Euronews are very proud to be associated with this initiative, which is supported by an incredible positive animated film" said Philippe Cayla, Chairman of the Executive Board of Euronews. "We are glad to open Euronews' influential and far-reaching network to such professionals and experts fighting to eradicate HIV transmission during pregnancy. We are mobilized to make a success of this campaign and we strongly believe that Euronews' viewers will be deeply moved and will want to participate in the Born HIV Free campaign," Mr Cayla added.

CNBC has also been broadcasting the video on its network in Europe, Middle East and Africa since the launch of the campaign.

Speaking about the distinctive nature of the “Baby in the Sky” project, Jack-Antoine Charlot, a designer from Les Bonzoms said: “It was necessary to stop playing with the notion of guilt as an incentive for people to act and instead to reinforce a sense of wanting to share and take part in something. In the case of mother-to-child HIV transmission, the medications already exist to stop it. The problem is one of mobilization.”

After the film, viewers are invited to show their support by signing their name on the campaign’s “virtual wall of support”, on the www.bornhivfree.org website. The campaign asks people - by the simple act of clicking a button - to register their support for the work of The Global Fund and for the elimination of mother to child transmission of HIV by 2015.

Watch the videos on: www.youtube.com/bornhivfree

Editorial JRN. Coalition in leadership: Politics - the big picture and the big game

In the Journal of Research in Nursing, Veronica Bishop's editorial -

Coalition in leadership.
Politics - the big picture and the big game

- explores the state of the body politic in nursing. Bishop's focus is research, but the implications extend beyond the UK, to nursing globally. The body is indeed immersed in politics, but it seems the feet are dry and there is no one at home.

Considering that The Politics of Nursing by Jane Salvage was published c. 1991 political maturity is long overdue?

While the sexual politics of nursing have been campaigned for in the nursing media and vigilance is needed, it seems that a political birth for nursing needs to be induced. There is a political mentality there, there has to be. The future is too challenging, too fraught, too close to be mollified by appeals of "Anything for an easy life (and death)!."

Bishop begins with a quote:

The very essence of leadership is that you have to have a vision. It’s got to be a vision you articulate clearly and forcefully on every occasion. You can’t blow an uncertain trumpet.
Theodore Hesburgh (1917–)

If you are familiar with the health career model then you know what is coming. ... In quantitative terms 25% of our deliberations using Hodges' model can be POLITICAL. This is not just the political dimensions of the patient, carer and the health and social care enterprise. The model includes the practitioner, but back to Bishop:

Having ‘power’ is a concept that sits uncomfortably with many nurses – it does not fit with the ideal of caring and many clinical nurses are quite open in their lack of regard for those in management, seeing them as power-seekers rather than power-movers. Clearly nurse leaders have in many cases failed to take their clinical colleagues with them in the drive to put nursing where it belongs, at the decision-making point that drives the agenda for health services, a point borne out by Stanley (2009).

How ironic that 'comfort' itself has been the subject of concept analysis and theorising in the nursing literature. If student nurses are exposed to the POLITICAL from the outset of their careers, then surely at the very least they will be more comfortable dealing with the guises and disguises of power?

Bishop refers to leadership and ownership and the two are frequently conjoined. The question of politics in nursing - in thought, practice, management and policy (research!) - makes me wonder ownership of what?

If the political domain is so frequently a vacant lot as far as nurses are concerned, then perhaps when we do put in an appearance we are not taken seriously. It really is a case of: what are you doing here?! As Bishop points out through -

Nurses are scientific. When they want to get to the core of a problem they always try to drill down. Yet politics are about the big picture. Nurses are agriculturalists in that they grow and nurture things but politicians are hunters – they’re always after the big game. It’s these kinds of differences nurses need to start to understand. (Cumberlege, 2007).

Nurses are there in the POLITICAL domain: they are constantly trying to complete the big picture.

... we were considering the best way for her [Baroness Cumberlege] to approach an interview the following day, and eventually, after we had viewed the uppermost issue of the day from every angle she said ‘Oh, nursing is so big!’. How right she was – there is hardly any aspect of life that it does not overlap or impinge on, so considering the big picture is a mammoth task! And again, she was right, we need leaders who have clarity and energy, and can cut through the detail and focus on the professional entity.

Yes, the big 'P'-icture is a mammoth task, hence the need to uncover, compose and frame it early. POLITICS is not just a matter of whistle blowing, industrial relations, policy, the system, us-and-them, banner headlines. ...

Politics is much more and crucial to research as Bishop attests. So, if our students do not reflect upon and articulate the politics of health: ill-health, well-being, equality and inequality, wealth and poverty ... then that professional entity will be a political ghost. A ghost playing a little game in an alien and alienating domain.

Veronica Bishop (2010) Coalition in leadership. Politics - the big picture and the big game, Journal of Research in Nursing; 15; 291.
DOI: 10.1177/1744987110374692