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UOA 12 - Allied Health Professions and Studies

Canterbury Christ Church University

RA5a: Research environment and esteem

Research Environment

 

Canterbury Christ Church University, through both its Faculty of Health and Social Care and its Centre for Applied Social and Psychological Development, contributes significantly to applied, practice-based and policy research designed to benefit patients/clients and the wider health and social care economy. The Centre and the Faculty have successfully met their overall objectives of responding to the needs of European, national, regional and local NHS organisations and public and voluntary sector agencies within the context of their work on psychosocial and ethical aspects of health and healthcare and Arts and Health. There has been an overall improvement in performance criteria for Allied Health Professions and Studies since the 2001 submission in which a score of two was achieved. For example, per capita income has increased from £35,739 in 2001 to £90,318 in 2007 and with the support of University research student bursaries there has been a significant increase in PhD and MPhil completions (11 PhD and 5 MPhil in the Faculty of Health and Social Care compared with 3 PhD completions in the 2001 RAE).

 

Research Structure

 

Following the 2001 RAE a three - pronged strategy for building research capacity was developed. The first set of initiatives involved strengthening and building critical mass in our RAE research by streamlining our research groups under the unifying broad theme of ‘psychosocial and ethical aspects of health and healthcare and its context’.  The second entailed extending our expertise in the field of health promotion into Arts and Health and establishing a dedicated Arts and Health Research Centre. The third focussed on implementing mechanisms to build the overall level of practice- related outputs (not initially geared to meeting the RAE definition of research). These initiatives included engaging with users and promoting professional practice amongst teaching staff as a basis for strengthening future research.

 

RAE Research Groups

 

Research into the psychosocial and ethical aspects of health and healthcare has been a long-standing theme of our work, and as such has provided a basis for the inter-faculty, inter-disciplinary ‘Psychosocial Research Group’ whose work focuses on two broad themes:

  • Developing an evidence-based psychology/mental health workforce.
  • Understanding the psychosocial and ethical context of professional practice.

 

A natural overlap in the topics and staff involvement in research across themes has led to fruitful cross-fertilisation in the research activities of this group.

 

The second research group, the ‘Arts and Health Group, represents a collaboration between the Faculties of Health and Social Care and Arts and Humanities with the overall aim of promoting health and wellbeing through arts.

 

 

Psychosocial  Research Group

 

Investigators: Lavender, Sperlinger, Holttum, Ruston, Holmes, MacInnes, Brown, Burns, Greenstreet, Clift  and Colyer.

 

The overall aim of this research group is to undertake research which - through contributing to our understanding of professional training, professional behaviour and  ethical practice - seeks to achieve evidence-based, patient-centred care.

 

Theme 1. Developing an evidence-based psychology/mental health workforce

 

There are two strands to this work. The first identifies ways in which the roles and the education of psychologists and mental health workers can be further developed to meet future workforce and service re-design needs. The second, and related, strand supports professional competence through the production and implementation of an evidence-based approach.

 

Extending the workforce

The key distinctiveness of this area of work is research on the development of the mental health workforce. For example, Lavender’s work has focussed on gaining evidence to support decisions about the future development of applied psychologists and other mental health workers. He has taken a national lead in the workforce planning of applied psychologists — in respect of which he conducted a national survey that was the first of its kind — and in estimating the future demand for psychologists. This work has been used by the Department of Health and has influenced the number of applied psychology training places currently being commissioned. He was also contracted to undertake research examining the provision of applied psychology services in London and a longitudinal study about the career progression of trainee psychologists. Building on this he has just completed chairing the ‘National New Ways of Working for Applied Psychologists’ project and is now leading on implementation. He has also conducted research to examine the role of the new Primary Care Mental Health Workers for Trent Strategic Health Authority. Linked to this is the work he has undertaken to examine and improve the status of mental health education across psychiatry, nursing, social work/policy and psychology and to evaluate mental health awareness training for interpreters (Home Office). He has responded to needs identified by policy makers and influenced workforce development at both national and local levels.

 

Extending Lavender’s work, Holttum also carried out research aimed at improving the training of clinical psychologists. She examined how personality style and adaptation in clinical psychology trainees can affect their development during training.  She pointed to ways in which expectations regarding the likely impact of training might be better managed, and more attention paid to trainees’ personal and professional development including the enhancement of their stress management capacity.

 

 

Producing and implementing evidence

The application of the principles of evidence-based healthcare is regarded as vital to the delivery of effective mental health services. This in turn is dependent on the development of high quality standardised measures. A strong and distinctive research profile, focussed on assessing and developing the psychometric robustness — and  relevance to the UK — of a number of well-used measures, has been achieved by members of this group.  Following a large grant awarded during the last RAE period for the development of UK norms for the Weschler Adult Intelligence Scale (worldwide the most widely used measure of IQ) and Weschler Memory Scale, and for subsequent published work by Lavender and Holttum, the commercial test publishing company Harcourt has awarded £225,140 (payable over the two-year period 2006-2008),  to allow norms to be established and clinical data collected for a battery of psychometric tests looking at executive and memory functioning. This work complements the work carried out by Sperlinger for the CORE (Centre for Outcome Research and Effectiveness, a part of NICE) evaluating treatment measures for older people and Lavender’s work into executive functioning of people with Down’s Syndrome who are at risk of dementia.

 

MacInnes has conducted similar work developing measurement scales (e.g. Forensic Satisfaction Scale) and examining the reliability and validity of the Shortened General Attitude and Belief Scale, now one of the measures of irrational beliefs used by the psychological services of Kent and Medway NHS and Social Care Partnership Trust. As part of an evaluation of the provision and efficacy of Cognitive Behaviour Therapy in East Kent Community Health and Social Care Trust he produced a measurement tool to enhance the contribution of CBT to clinical practice. This has now been adopted by services in Scotland, Humberside and Teesside.

 

Additionally, the taught Doctoral programme in Clinical Psychology is supported by members of this research group. This highly rated programme trains students to use their research skills to carry out Service Quality Improvement Projects, in addition to Major Dissertation projects. Thirty-two quality improvement projects and Major Dissertation projects are produced each year, and contribute to the development of evidence-based services through peer reviewed papers and local, national or international conference presentations. Holttum has also published a model, based on theory and evidence, for understanding the factors influencing research activity in clinical psychologists.

 

 

 

Theme 2. Understanding the psychosocial and ethical context of professional practice

 

The social organisation of healthcare is currently being challenged by changing relationships between health professionals and the public and by the policy imperative to deliver patient-centred care. Understanding the context of modern health and social care necessitates an understanding of psychosocial and ethical aspects of care. Of particular importance are patients’ or clients’ beliefs and behaviours and the factors that influence professional behaviour.

 

Brown’s research in this area has contributed to local, national and European policy- making. She has produced a number of key for the Council of Europe reports on preventing abuse and, nationally, her work has attracted funding from a range of agencies concerned with safeguarding the rights and well-being of vulnerable people. This has included research into the service needs of people with learning disabilities who are dying (funded by the Mental Health Foundation), and a range of projects concerned with the protection of vulnerable adults from financial and physical abuse (funded by the Public Guardianship Office, the Nuffield Foundation, the Lord Chancellor’s Department, the National Patient Safety Agency, and Connexions).  The Public Guardianship Office also commissioned research on its role in health and social welfare decision-making. This work has led to her being invited to assist with the drafting of policy on vulnerable adults for England, Wales and Northern Ireland. Locally, Brown’s research impacts on improving service provision in Kent Social Services e.g. person-centred planning and adult protection; assessment of post-abuse support needs. 

 

Burns has also made a significant contribution to the group’s work on vulnerable people through research, conference presentations and publications on challenging behaviour, women with learning disabilities and the sexuality of people with learning disabilities. Her work with the homeless and on forensic mental health contributes further to this area. She alsocompleted the Donor Conception project (funded by the Department of Health) which investigated the concerns and experiences of couples receiving infertility treatment resulting in an information resource for prospective parents. Other work by Burns focussed on the experience of living with HIV and the cognitive functioning of children with HIV. Holttum has studied the determinants of quality of life for black African women living with HIV in London and investigated the role of acceptance on a pain management programme, while Lavender has researched the physical health of women with mental health problems. Greenstreet’s work has examined the role of nurses in relation to spirituality in the dying patient. Clift has undertaken research to promote the role of Further Education in assisting the recovery and social inclusion of people with long-term mental health problems through programmes of supported education. This work culminated in a significant survey of FE Colleges and PCTs across the South East of England, funded by the National Institute of Mental Health England and two local PCTs, and aimed at assessing provision and prospects for further development.

 

MacInnes’s contribution to this theme involved a Department of Health funded project, with Oxleas NHS Trust and South London and Maudesley NHS Trust, which assessed levels of service user satisfaction with in-patient services, involving users in all stages of the work. The resultant Forensic Satisfaction Scale is now used by 10 forensic services in the UK and Ireland (www.nfmhp.org/research.htm#cppr).

 

Ruston has conducted a range of studies during this RAE period on patients’ and the public’s experiences of health and social care. The topics studied  include women’s experiences and understanding of coronary heart disease (funded by the BUPA Foundation), patients’ perceptions of cardiology services following the implementation of the National Service Framework for coronary heart disease (funded by a local social care trust), lay perceptions of the ‘Choose and Book’ policy relating to choosing the time and location of hospital appointments (funded by the Patient Involvement Forum) and the public’s perceptions of factors that influence their health (funded by PCTs). Holmes is developing a body of work, utilising the internet, on patients’ experiences and perceptions of quality of life.

 

Research to gain an understanding of factors that influence professional behaviour in healthcare settings has also been undertaken by members of the group. For example, Sperlinger undertook a national survey of clinical psychologists to examine dual relationships between clinical psychologists and their clients and highlighted a lack of consensus regarding the impact of dual relationships on efficacy and the need to develop more explicit codes of practice for clinical psychologists. Ruston conducted a study, funded by NHS Direct, which explored the influence of professional autonomy on the use of computer driven protocols and on the advice provided to callers. This work resulted in the re-design of working practices in one of the NHS Direct sites in the South East of England. Her published work on professional behaviour has included a national survey, funded by the Royal Pharmaceutical Society of Great Britain, which identified those characteristics of the community pharmacy and pharmacists that influence the adoption of an ‘extended role’. She has also conducted a variety of studies examining GPs’ and nurses’ behaviour and decision-making in relation to implementing evidence-based practice and in responding to national policy initiatives. This research suggests that current measures to improve the uptake of clinical guidelines are too simplistic within high-risk contexts.  Her current work includes examining professionals as change agents within the context of the New General Medical Services (nGMS) contract (funded by Medway and East Kent Teaching PCT) and examining the potential for professionalising the public health and health promotion role of the voluntary and community sector (funded by Medway CVS and Pfizer). She has recently been awarded a British Academy grant to examine how contested principles of the craft knowledge of complementary medicine are used by nurses and midwives in conventional, scientific-bureaucratic healthcare settings.

 

Colyer has sought in her work to provide a greater understanding of professional knowledge and the construction of health professions.  She has explored how inter-professional education can facilitate practice and patient-centred care and was awarded a Department of Health grant to develop an inter-professional curriculum. She has also examined radiographers’ professional practice in relation to informed consent. Holmes has undertaken research projects, funded by West Kent Shared Services Agency and Medway and East Kent Teaching PCT, which examined the behaviour and learning needs of practice nurses. This has been influential in informing service reconfiguration in local trusts.  

 

Lavender has been involved in delivering a significant project, commissioned by the NHS R&D Programme (South East), in knowledge management. This work provided insights into professional behaviour, impacted on the e-culture of the NHS - presenting data on the infrastructures needed for  e-learning across dimensions of culture, content and programmes - and led to significant national developments in evidence-based practice, learning and strategic planning (NHS Direct Online;  E-resource development; ECDL;  KM Skills Toolkit;  e-learning curricula in medical schools).  Further work was commissioned by the DH on Knowledge Harvesting, a software programme for knowledge sharing and management. 

 

Arts and Health Group

 

Investigators: Clift (from the Faculty of Health and Social Care), Camic (entered into the Education UoA) and Hancox (entered into the Music UoA)

 

Theme – Arts, Health and Wellbeing.

The aim of this research programme is the promotion of health and wellbeing through arts in health. The work within this group has involved a planned transition from a major focus on Health Promotion and Health Promoting Schools to the development of research into Arts and Health.

 

Clift was Director of the World Health Organisation Collaborating Centre for the European Network for Health Promoting Schools (ENHPS) between 2001 and 2006. The collaborative arrangement ended when the Secretariat for the Network moved from WHO in Copenhagen to the Dutch National Centre for Health Promotion. During his association with the WHO, Clift edited a collection of papers from the European Education and Health Conference and worked with the Task Force of the Network to develop a resource on indicator development.  He was part of the research team developing the concept of the Health Promoting School and devising an assessment tool for health promotion in schools (supported by Health Promotion Wales and collaboration with WHO Europe and ENHPS).

 

From 1999 onwards he has worked with Prof. Grenville Hancox (Head of the University’s Music Department) to develop research in the area of 'Arts and Health'. Successful progress in this field led, in 2004, to the establishment of the Sidney De Haan Research Centre for Arts and Health in Folkestone which is supported by a significant grant from the Roger De Haan Family Trust (£612,000 over the period 2004-2009). The Centre has received approximately £270,000 in research and other income since 2004. For the present RAE return the research income component has been divided equally between the Allied Health Professions and Studies and the Music UoAs.

 

Its current research portfolio involves three strands of work: systematic mapping and reviewing of key issues in music and health; a major cross-national (UK, Germany, Australia) survey on the effects of choral singing on dimensions of wellbeing, and an evaluation of the Silver Song Clubs to establish their impact on the lives of older people and develop an evidence base for a Singing on Prescription scheme (Clift and Hancox, 2001, 2006; Clift et al, 2007, 2008 (in press)). In addition to work supported by the De Haan grant, Clift also secured funding from Youth Music and the Isle of Wight NHS Trust to undertake an evaluation of an innovative community project 'MusicStart', based on the Isle of Wight, which aimed to encourage music making and singing with children aged 0-5 years in family and early years settings (in press, International Journal of Music Education).

Recent successes in this group include agreed publishing rights for Clift (and Camic) for an international peer reviewed journal to be launched in 2008-2009: Arts and Health: Research, Policy and Practice. The Society for Arts in Healthcare in the U.S. is providing sponsorship and Routledge is the official publisher. In addition, a member of the group (Camic) has been successful in the 2007 British Psychological Society Research Seminar Competition and gained an award to support a series of research seminars in the arts and health, to take place in Canterbury and Manchester in 2008-09. These seminars are expected to facilitate the development of psychological research in arts and health.

Substantive progress has already been made in establishing this body of work, although outputs will not be available until after the current RAE period.

 

Mechanisms for promoting research, sustaining and developing a research culture and building capacity.

In addition to streamlining our RAE related research, under the broad themes identified above, a range of other strategies have been implemented to strengthen and build our overall research capacity. These involve utilising support provided by the University, including its pump-priming research grants, arrangements for study leave, financial support for conference presentations, provision of information on the policies and priorities of potential funding agencies, and expertise in applying for external grants. The University has also provided computers, equipment, accommodation and research bursaries for PhD students. These students undertake specialised induction, core and optional training modules relevant to their research and are supported by a panel of trained supervisors comprising first/second supervisor and chair. There is a student-led postgraduate association which also offers regular seminars.

Faculty support systems include: multidisciplinary and specialist seminar programmes designed to bring staff together across traditional boundaries and foster networking; mentoring of less experienced staff to define and develop their research and publications; establishment of research co-ordinators who provide support, expertise and leadership for research and act as team leaders for research teams within Faculty departments.  This helps all staff towards a comprehensive understanding of the research process from grant applications through to the production of academic papers.  A regular research newsletter is also produced and distributed to staff and external partners. The University acts as a Research Sponsor for Research Governance purposes, has its own Research Governance and Ethics Committees, and provides support for staff and students in completing the procedures for gaining NHS research approval. It ensures that all research meets the required standards through regular monitoring.

 

Staffing policy

The staffing policy has been to recruit individuals with research potential wherever possible, including two professors, two visiting professors and an internal promotion to readership. During the RAE period eight members of staff have been supported in the successful completion of PhDs, five are currently registered for MPhil/PhD at Canterbury Christ Church University, and six more are registered at other universities. A further six are undertaking professional doctorates. Each member of staff negotiates research training needs, targets and a reduction in teaching load, where appropriate, as part of their annual appraisal. This has been a successful strategy for ensuring that staff can excel. For example, Colson’s (staff/PhD student) originality, innovation and excellence in scholarship were rewarded with the RCN Justus Akinsanya Award for Innovation in Doctoral Studies.

 

Relations with the NHS, public sector and other research users

We ensure our work is applicable and significant for policy, practice and service and research users though four main mechanisms: 1) It is funded at European and national level in order to advance knowledge and understanding of policy issues e.g Lavender’s work on workforce development, Brown’s work on vulnerable people.  2) It is funded in response to local healthcare providers needs for research to enable them successfully to implement national policy and to improve practice within the local context e.g. Ruston’s work on ‘Choose and Book’ policy, the implementation of the nGMS contract and National Service Frameworks etc. 3) Research is often carried out in partnership  with providers, ensuring that our work is relevant to their needs and that it informs local practice e.g.  MacInnes’s work with Oxleas and South London and Maudesley NHS Trust which was funded by the Department of Health. 4) We actively build service users’ and carers’ research skills through involvement in research and research training e.g  MacInnes’s project ‘Services Users in Secure Settings’, funded by the UK Clinical Research Network and conducted jointly with Oxleas Trust, which seeks to develop the writing and research skills of services users and carers.

In addition, we are  active members of a variety of formal R&D consortia, which includes sitting on NHS Trust R&D committees, Primary Care Research networks, Strategic Health Authority R&D Boards and Clinical Research Networks.

 

Research Strategy and Future Plans

The streamlining of our research groups following the 2001 RAE has provided the mechanism for establishing a sustainable research record and culture. During 2008-2013 we will focus on addressing the needs of the health and social care economy by delivering timely policy and practice-related research. However, we also intend to build the coherence and academic standing of the work by identifying and drawing on common theoretical concepts in each of the themed areas. We intend:

  1. to extend our research on workforce development and practice (including building the evidence base) to cover a wider range of professional groups and settings by using common theoretical concepts and continue to link closely with practice (gaining funding from a variety of sources to deliver work of wider relevance) in order to ensure that economies of scale are made and that the work informs practice.
  2. to strengthen our work on the patient/client’s perspective applying rigorous qualitative methods and producing both practice-based and academic, theoretical outputs. We also intend to build capacity by recruiting patients/clients, alongside faculty academic staff, to the research team for each funded project.
  3. to reinforce research capacity, and ensure our research informs education and training, by extending our work on professional behaviour to include more coverage of the context and experience of inter-professional and ethical working (a key area of our educational delivery). Members of academic staff will be recruited to the group to build this area of work.
  4. to capitalise on our excellent progress in the field of Arts and Health, where our priorities include building a significant body of research into the effects of music on health and wellbeing.
  5. to increase our funded research from Research Councils and the British Academy.

 

Evidence of Esteem 

 

Editorial activities

Journal Editing

Holmes:           Assistant Editor:  International Journal of Nursing Studies

 

Editorial Board membership

Brown:            Journal of Applied Research into Intellectual Disabilities

Clift:                Journal of the Royal Society of Health

Holmes:          International Journal of Palliative Nursing, European Journal of  Oncology Nursing

Lavender:       Clinical Psychology and Psychotherapy

Ruston:           Health, Risk and Society

 

Peer Reviewing

Clift:      Health Education, Journal of the Royal Society for the Promotion of Health

Burns:   British Journal of Clinical Psychology, Journal of Intellectual Disabilities Research, British Journal of Learning Disabilities.

Holmes:  International Journal of Nursing Studies, Nursing Management, International Journal of Palliative Nursing, Age and Ageing, Journal of the Royal Society of Health, Nursing Standard, Health, Risk and Society, European Journal of Oncology Nursing

Lavender: British Journal of Clinical Psychology, Clinical Psychology and Psychotherapy, Journal of Mental Health

MacInnes:  International Journal of Nursing Studies, Journal of the Royal Society of Health, Health, Risk and Society, Journal of Psychiatric and Mental Health Nursing, Journal of Clinical Nursing

Ruston:  Health and Social Care in the Community, Health, Risk and Society, Journal of Interprofessional Care, Patient Education and Counselling.

 

Research Review activities

Holmes:  Smith and Nephew Foundation (Postdoctoral Awards), The Community Fund (Medical and Social Panel), The Health Foundation, World Cancer Research Fund, Research in Ageing, Health Review Board for Ireland, East Kent NHS Hospitals Trust, St Bartholomew’s Hospital  (Research) Trust

MacInnes: NHS R&D Programme in Forensic Mental Health, Health Review Board for Ireland, DH  Research for Patient Benefit Programme,

Ruston:  ESRC, British Heart Foundation, Starnet (London), Research for Patient Benefit Programme.

 

Appointment, service and awards

Staff maintain high local, regional, national and, in some cases, international profiles including advising the DH in Mental Health (Lavender), Home Office (Lavender), Council of Europe (Brown), Safeguarding Adults Forum (Brown) and the British Board of Film Censors (Burns). Holmes and Ruston are members of the SHA Research Consortium; Ruston of the Medway Teaching PCT Board; and Holmes of the Project Board of the Kent and Medway Clinical Research Network.  Holmes was a member of RAE2001 Panel 10 (Nursing and Midwifery). Clift remains a WHO advisor (Health Promoting Schools). MacInnes is an expert reviewer for the NHS R&D programme in Forensic Mental Health.

 

Staff  hold clinical consultancies in local and national trusts. MacInnes was appointed by the Mental Health Commission of Ireland to the inquiry team examining care and treatment practices in the in-patient units of the National Forensic Service (Ireland). He has been appointed to the Royal College of Psychiatrists Working Group on Violence.

 

Brown is a consultant for the Council of Europe, reviewing work on violence against vulnerable groups, and contributes to ongoing work on the policy needs of people with disabilities which includes drafting policy on disabled people with complex support needs, the deinstitutionalisation of services for disabled children, and the Ten year Disability Action Plan for Europe (launched  September 2006).  She has worked with the European Association of Service Providers for People with Disabilities on measures to protect people with learning disabilities from sexual abuse. In 2006, she completed a substantive review and series of seminars for the National Disability Association of Ireland mapping the knowledge base on abuse and people with disabilities. She chairs Serious Case Reviews under local multi-agency protocols and is a member of the national Safeguarding Adults network, sponsored by the Association of Directors of Social Services.

 

Burns has a national reputation for research involving vulnerable people, having been invited to deliver a invited keynote address at a national conference (Women’s Conference, Valuing People Support Team, (2006)) and contributed to international symposia (International Association for the Scientific Study of Intellectual Disability (2002), Nordic Network on Disability Research (2002)). She chairs the training subgroup of the BPS/NIMHE New ways of Working for Applied Psychologists.

 

Lavender was BPS representative on the NSF Mental Health Workforce Action Team and now on the New Ways of Working National Steering Group. He was joint leader of the first national joint BPS/NIMHE/CSIP initiative reviewing provision of Applied Psychology Services to Health and Social Care. He was a founder member of the BPS Workforce Planning Advisory Group and is BPS Advisor to the NHS Workforce Review Team.

 

Evidence of esteem for Sperlinger is found in the published reviews/guides funded through the British Psychological Society, with the Centre for Outcomes, Research and Effectiveness (CORE).

Holmes's 1987 paper on 'Measuring the quality of life' was republished in 2003 as one of the twelve most cited papers in the forty-year history of the International Journal of Nursing Studies.

 

Clift’s paper on ‘Mental health promotion through supported education: the value of Antonovsky’s salutogenic model of health’ (Health Education) was ‘Highly Commended’ by the Emerald Literati Network.

 

Holttum is Chair of the first Research Committee for the British Autogenic Society.