Supporting safe swallowing of care home residents with dysphagia: How does the care delivered compare with guidance from speech and language therapists?

INTRODUCTION: Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. METHODS: Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations. RESULTS: Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. CONCLUSION: Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience. WHAT THIS PAPER ADDS: What is already known on this subject? Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents. There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia. Care for nursing home residents at mealtimes is often task-centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds? Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification. Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas. Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work? Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission. Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia. The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines. Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely. Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety.

2020 COVID-19-Related Lockdown: the Relationships Between Coping Strategies, Psychological Adjustment and Resilience Among a Non-clinical Sample of British Adults.

To curb COVID-19 infections, the British government enforced a series of lockdowns resulting in restrictions on movement and socialisation. This study assessed which groups may have been at higher risk of emotional distress among a non-clinical sample of British adults. It also examined which coping strategies, if any, related to more positive psychological adjustment and higher resilience scores. A cross-sectional, correlational study was carried out. Using a convenience sample, an online survey was conducted in April-June 2020. One hundred ninety-four participants completed the Brief COPE (coping), the GAD-7 (anxiety), the PHQ-9 (depression), the CD-RISC (resilience), and provided demographic information. Participants used mainly coping strategies considered to be adaptive. They exhibited mild/moderate anxiety and depression symptoms, and moderate resilience scores. However, some individuals displayed significantly higher distress symptoms and lower resilience scores than others, especially those aged under 35 (particularly 18-24), those not working, those who were single and/or childless. Results also show that coping strategies including substance use, behavioural disengagement and self-blame were associated with anxiety and/or depression symptoms, conversely, positive reframing related to lower anxiety symptomatology. Interventions promoting positive reframing may be helpful. Similarly, interventions promoting connection to others, a factor known to enhance resilience, may be beneficial. This is particularly relevant to groups who may be more at risk of psychological distress, such as young individuals.

The different faces of mental illness stigma: Systematic variation of stereotypes, prejudice and discrimination by type of illness.

Mental illness (MI) stigma has been characterized as multi-dimensional including problems of knowledge (stereotypes), attitudes (prejudice) and behavior (discrimination); however, most research practice is predominantly applying unidimensional behavioral measures such as social distance scales. Moreover, specific types of MIs and different forms of discriminatory behaviors are not being differentiated. The Stereotype Content Model predicts that group stereotypes (warmth, competence) are linked with different forms of discriminatory behaviors (harm or facilitation) via emotional prejudices (pity, envy, contempt). The present study sought to establish how differential stereotypic perceptions of MI subgroups elicit distinct forms of behavioral discrimination via emotional prejudices. A community sample (N = 60) was randomly assigned to one of three conditions representing MIs across the warmth-competence stereotype space. Patterns of self-completed measures for stereotypes, emotions and behaviors differed significantly between conditions. The association between stereotypes and behaviors were largely mediated by emotions. Systematic patterns of stereotypic perceptions, emotional prejudices and behavioral discrimination are present for individuals with different types of MIs. Hence, generic measures of discrimination, such as social distance scales, may be misleading. Intervention strategies should consider the systematic variation of the factors involved in stigma, differentiating by type of MI and discriminatory behaviors.

Living through lockdown: A qualitative exploration of individuals' experiences in the UK.

In response to the COVID-19 outbreak, the British government introduced a lockdown resulting in country wide restrictions on movement and socialisation. This research sought to explore individuals' experience of the first lockdown in the UK. A qualitative online survey was conducted between April and June 2020. Using a convenience sample, 29 individuals participated in the study. Data were analysed using thematic analysis. Four themes were identified: 'health and well-being', 'social connectedness and belonging', 'employment and finances' and 'personal and collective values'. Participants' experiences involved both challenges and opportunities. Participants reported challenges to their physical health, mental health, sense of connection to others as well as their employment and finances. However, they also viewed the lockdown as an opportunity to reassess their goals and values, and define a 'new normal' for society. Lockdown restrictions threatened individuals' well-being on many aspects of their lives. As anxiety, loneliness and a compromised grieving process may lead to severe mental health issues, early interventions are needed to prevent these and promote well-being. Interventions may include traditional therapies (e.g. Acceptance and Commitment Therapy), or focus specifically on developing social networks and social support (e.g. mutual help groups). These interventions may also be conducive to the experience of growth reported by some participants.

Associations among Adolescents' Relationships with Parents, Peers, and Teachers, Self-Efficacy, and Willingness to Intervene in Bullying: A Social Cognitive Approach.

We applied the Social Cognitive Theory to investigate whether parent-child relationships, bullying victimization, and teacher-student relationships are directly as well as indirectly via self-efficacy in social conflicts associated with adolescents' willingness to intervene in a bullying incident. There were 2071 (51.3% male) adolescents between the ages of 12 and 17 from 24 schools in Germany who participated in this study. A mediation test using structural equation modeling revealed that parent-child relationships, bullying victimization, and teacher-student relationships were directly related to adolescents' self-efficacy in social conflicts. Further, teacher-student relationships and bullying victimization were directly associated with adolescents' willingness to intervene in bullying. Finally, relationships with parents, peers and teachers were indirectly related to higher levels of students' willingness to intervene in bullying situations due to self-efficacy in social conflicts. Thus, our analysis confirms the general assumptions of Social Cognitive Theory and the usefulness of applying its approach to social conflicts such as bullying situations.

A Routine Activity Approach to Understand Cybergrooming Victimization Among Adolescents from Six Countries.

Little attention has been given academically to empirically tested theoretical frameworks that aim at measuring the risk of adolescents falling victim to cybergrooming. To this end, we have applied the routine activity theory (RAT) to investigate whether exposure to motivated offenders (PC/laptop ownership and Internet access in one's own bedroom), capable guardianship (parental mediation strategies of Internet use), and target suitability (adolescents' online disclosure of private information) might predict cybergrooming victimization among adolescents. Using data from a cross-sectional survey of 5,938 adolescents from Germany, India, South Korea, Spain, Thailand, and the United States, ranging in age from 12 to 18 (M = 14.77, SD = 1.60), we found that PC/laptop ownership and Internet access in one's own bedroom, parental mediation, and online disclosure are all directly associated with cybergrooming victimization. Although instructive parental mediation is negatively related to online disclosure and cybergrooming victimization, restrictive mediation is positively related to both. In addition, online disclosure partially mediated the relationship between parental mediation and cybergrooming victimization. The analyses confirm the effectiveness of applying RAT to cybergrooming. Moreover, this study highlights the need for prevention programs, including lessons on age-appropriate information and communication technology usage and access, to educate parents on using instructive strategies of Internet mediation, and inform adolescents about how to avoid disclosing too much private information online. RAT could function as a theoretical framework for these programs.

Adolescents' Viewing of Suicide-Related Web Content and Psychological Problems: Differentiating the Roles of Cyberbullying Involvement.

Possible links of cyberbullying with suicide and psychological problems have recently received considerable attention. Suicide-related behaviors have also been linked with viewing of associated web content. Studies on traditional bullying indicate that the roles of bullying involvement (bullies, victims, and bully-victims) matter in terms of associations with specific suicide-related behaviors and psychological problems. Yet, related research in the area of cyberbullying is lacking. The current study investigates the association of cyberbullying roles with viewing of specific suicide-related web content and psychological problems. Data from N = 19,406 (50 percent girls) 11-16-year-olds (M = 13.54, SD = 1.68) of a representative sample of Internet-using children in Europe were analyzed. Self-reports were obtained for cyberbullying role, viewing of web content related to self-harm, and suicide, as well as the emotional, peer, and conduct problem subscales of the Strengths and Difficulties Questionnaire (SDQ). Multinomial logistic regression analyses revealed that compared with those not involved in cyberbullying, viewing of web content related to suicide was higher for cybervictims and cyberbully-victims, but not for cyberbullies. Viewing of web content related to self-harm was higher for all cyberbullying roles, especially for cyberbully-victims. Rates of emotional problems were higher among cybervictims and cyberbully-victims, rates of peer problems were higher for cybervictims, and rates of conduct problems were higher for all cyberbullying roles. Moreover, the links between cyberbullying role and viewing of suicide-related web content were independent of psychological problems. The results can be useful to more precisely target efforts toward the specific problems of each cyberbullying role. The outcomes on viewing of web content also indicate an opportunity to enhance the presence of health service providers on Internet platforms.

Comparison of indices of clinically meaningful change in child and adolescent mental health services: difference scores, reliable change, crossing clinical thresholds and 'added value' - an exploration using parent rated scores on the SDQ.

BACKGROUND: Establishing what constitutes clinically significant change is important both for reviewing the function of services and for reflecting on individual clinical practice. A range of methods for assessing change exist, but it remains unclear which are best to use and under which circumstances. METHOD: This paper reviews four indices of change [difference scores (DS), crossing clinical threshold (CCT), reliable change index (RCI) and added value scores (AVS)] drawing on outcome data for 9764 young people from child and adolescent mental health services across England. RESULTS: Looking at DS, the t-test for time one to time two scores indicated a significant difference between baseline and follow up scores, with a standardised effect size of d = 0.40. AVS analysis resulted in a smaller effect size of 0.12. Analysis of those crossing the clinical threshold showed 21.2% of cases were classified as recovered, while 5.5% were classified as deteriorated. RCI identified 16.5% of cases as showing reliable improvement and 2.3% of cases as showing reliable deterioration. Across RCI and CCT 80.5% of the pairings were exact (i.e., identified in the same category using each method). CONCLUSIONS: Findings indicate that the level of agreement across approaches is at least moderate; however, the estimated extent of change varied to some extent based on the index used. Each index may be appropriate for different contexts: CCT and RCI may be best suited to use for individual case review; whereas DS and AVS may be more appropriate for case-mix adjusted national reporting.

School-level variation in health outcomes in adolescence: analysis of three longitudinal studies in England.

School factors are associated with many health outcomes in adolescence. However, previous studies report inconsistent findings regarding the degree of school-level variation for health outcomes, particularly for risk behaviours. This study uses data from three large longitudinal studies in England to investigate school-level variation in a range of health indicators. Participants were drawn from the Longitudinal Study of Young People in England, the Me and My School Study and the Research with East London Adolescent Community Health Survey. Outcome variables included risk behaviours (smoking, alcohol/cannabis use, sexual behaviour), behavioural difficulties and victimisation, obesity and physical activity, mental and emotional health, and educational attainment. Multi-level models were used to calculate the proportion of variance in outcomes explained at school level, expressed as intraclass correlations (ICCs) adjusted for gender, ethnicity and socio-economic status of the participants. ICCs for health outcomes ranged from nearly nil to .28 and were almost uniformly lower than for attainment (.17-.23). Most adjusted ICCs were smaller than unadjusted values, suggesting that school-level variation partly reflects differences in pupil demographics. School-level variation was highest for risk behaviours. ICCs were largely comparable across datasets, as well as across years within datasets, suggesting that school-level variation in health remains fairly constant across adolescence. School-level variation in health outcomes remains significant after adjustment for individual demographic differences between schools, confirming likely effects for school environment. Variance is highest for risk behaviours, supporting the utility of school environment interventions for these outcomes.

Comparación Directa de Niñas Adoptadas en China y Europa del Este: Ansiedad, Hiperactividad/Impulsividad, Inatención y Conductas Desafiantes / A Direct Comparison of Girls Adopted from China and Eastern Europe: Anxiety, Hyperactivity/Impulsivity, Inattention and Defiant Behaviours

Previous research looking at adopted children has shown that children adopted from Eastern Europe (EE) are more likely to show inattention and hyperactivity/impulsivity whereas girls adopted from China (CH) tend to have normative adjustment scores, although as they grow up, internalising behaviours might increase. We directly compare parental ratings of the SNAP-IV (Hyperactivity/Inattention) and SCARED (Anxiety) of girls adopted from CH (n = 42), EE (n = 34) and other countries (n = 32). EE were more likely to show inattention, hyperactivity/impulsivity and defiant behaviours than CH, independent of age at adoption and number of siblings. The age of the child only had a significant effect on defiant behaviours. No significant differences in anxiety were observed between groups. Overall anxiety levels were related to hyperactivity/impulsivity. Specific factors related to adoption in each region might account for differential levels in inattention, hyperactivity/impulsivity and defiant behaviours and should be taken into account to aid the adjustment of adoptees (AU)

Estudios previos sobre menores adoptados han mostrado que los menores adoptados en Europa del Este (EE) tienen más probabilidades de mostrar inatención e hiperactividad/ impulsividad mientras que las niñas adoptadas en China (CH) suelen obtener puntuaciones normales en adaptación, aunque a medida que crecen, puede que aumenten las conductas internalizantes. Comparamos directamente las puntuaciones obtenidas en el SNAP-IV (Hiperactividad/Inatención) y el SCARED (Ansiedad) por niñas adoptadas en CH (n = 42), EE (n = 34) y en otros países (n = 32). EE muestran más inatención, hiperactividad/ impulsividad y conductas desafiantes que CH, independientemente de la edad de adopción y del número de hermanos. La edad de adopción solo tiene un efecto significativo sobre las conductas desafiantes. No se observan diferencias significativas en ansiedad entre los grupos. En general, los niveles de ansiedad están relacionados con la hiperactividad/impulsividad. Factores específicos relacionados con la adopción en cada una de estas regiones podrían explicar parte de las diferencias en inatención, hiperactividad/inatención y conductas desafiantes y se deberían tener en cuenta para potenciar la adaptación de los adoptados (AU)

Routine outcomes monitoring as part of children and young people's Improving Access to Psychological Therapies (CYP IAPT) - improving care or unhelpful burden?

This brief commentary article considers the implications of intensive outcome monitoring which is central to children and young people's Improving Access to Psychological Therapies (CYP IAPT) in England and Wales. Services are being provided with a range of free software solutions to enable data collection, and guidance on interpretation of the measures, but there will still be some burden of data entry and collation for already overstretched services. It may be that the utility of the feedback will go some way to offset the sense of burden but this remains to be seen. Whether commissioners and others will rise to the challenge of supporting this aspect may prove crucial to the success or otherwise of such intensive ROM use. Many aspects of the CYP IAPT approach are new and whilst drawing on experience from earlier pilots of session by session monitoring in CAMHS both in the UK and abroad, and from Adult IAPT, there is likely to be much for us to learn. Time will tell whether the approach helps to improve the care children and young people receive but we are cautiously optimistic.