The use of an implementation science theoretical framework to inform the development of a region wide Positive Behavioural Support Workforce Development approach.

BACKGROUND: Concern about the poor care of some people with an intellectual disability has highlighted the need for systemic, large-scale interventions to develop a skilled workforce. METHOD: We outline how an implementation science theoretical model informed the development of a region-wide Positive Behavioural Support (PBS) Workforce Development (WFD) approach. RESULTS: We provide an example of the application of the model in practice and demonstrate how this enabled us to understand the competencies and development needs of the workforce; engage effectively with stakeholders; and develop, deliver and evaluate a PBS WFD model. CONCLUSION: The application of the model helped us to identify, prioritise, and address the multiple and complex factors that were relevant to the implementation of the PBS WFD approach.

"Look, all our hard work is paying off": A qualitative evaluation of a system-wide, workforce development model to promote positive behavioural support.

BACKGROUND: Positive behavioural support (PBS) has been identified as a means of improving the quality of life and support of people with an intellectual disability. This qualitative study explored the views of service providers about a regional PBS programme, that was underpinned by a workforce development approach. METHOD: Semi-structured interviews were conducted with senior staff (n = 42), from organizations which provided services to people with an intellectual disability, about their views about, and perceived impact of, the PBS programme, Data were analysed using thematic analysis. RESULTS: Two themes were identified: "It's what PBS is about, isn't it?" emphasized the importance of the programme being systemic- and evidence-based; "Macro to micro" highlighted the different points in the systems of care at which the programme was seen to impact. CONCLUSIONS: We discuss the results in the context of the study limitations.

Whole systems approach.

PURPOSE: The purpose of this paper is to ascertain primary care advanced clinical practitioners' (ACP) perceptions and experiences of what factors influence the development and identity of ACP roles, and how development of ACP roles that align with Health Education England's capability framework for advanced clinical practice can be facilitated in primary care. DESIGN/METHODOLOGY/APPROACH: The study was located in the North of England. A qualitative approach was used in which 22 staff working in primary care who perceived themselves to be working as ACPs were interviewed. Data analysis was guided by Braun and Clarke's (2006) six phase method. FINDINGS: Five themes emerged from the data - the need for: a standardised role definition and inclusive localised registration; access to/availability of quality accredited educational programmes relevant to primary care and professional development opportunities at the appropriate level; access to/availability of support and supervision for ACPs and trainee ACPs; a supportive organisational infrastructure and culture; and a clear career pathway. ORIGINALITY/VALUE: Findings have led to the generation of the Whole System Workforce Framework of INfluencing FACTors (IN FACT), which lays out the issues that need to be addressed if ACP capability is to be maximised in primary care. This paper offers suggestions about how IN FACT can be addressed.

The views of carers about support for their family member with an intellectual disability: With a focus on positive behavioural approaches.

This qualitative study explored the views of family carers about the support that their adult children with an intellectual disability had received in relation to their behaviour that challenged. There was a particular focus on positive behavioural support (PBS), although some participants spoke more generally in terms of positive approaches. Semi-structured interviews with eight family carers were analysed using inductive thematic analysis. Four key themes were identified. Good support, of which PBS was an example, was seen as both having reduced behaviours that challenged and having a wider positive impact on the quality of life of the individual and their families. Key features highlighted were: technical knowledge and skill; a strong value base of warmth, acceptance and respect; a collaborative, consistent approach; open communication; and the extension of support to the family carer when needed. It was recognised that there is a need for broad systemic change and for the application of a workforce development model that takes account of the needs of staff, carers and those working in wider systems that have contact with people with an intellectual disability.

Integrated Working for Enhanced Health Care in English Nursing Homes.

BACKGROUND: The increasingly complex nature of care home residents' health status means that this population requires significant multidisciplinary team input from health services. To address this, a multisector and multiprofessional enhanced healthcare programme was implemented in nursing homes across Gateshead Council in Northern England. STUDY AIMS: To explore the views and experiences of practitioners, social care officers, and carers involved in the enhanced health care in care home programme, in order to develop understanding of the service delivery model and associated workforce needs for the provision of health care to older residents. METHODS: A qualitative constructivist methodology was adopted. The study had two stages. Stage 1 explored the experiences of the programme enhanced healthcare workforce through group, dyad, and individual interviews with 45 participants. Stage 2 involved two workshops with 28 participants to develop Stage 1 findings (data were collected during February-March 2016). Thematic and content analysis were applied. FINDINGS: The enhanced healthcare programme provides a whole system approach to the delivery of proactive and responsive care for nursing home residents. The service model enables information exchange across organizational and professional boundaries that support effective decision making and problem solving. CLINICAL RELEVANCE: Understanding of the processes and outcomes of a model of integrated health care between public and independent sector care home services for older people.