862768fa-36ea-4f23-802a-07ca10e5572b Social Prescribing Link Workers framework: supporting complex needs of adults living with physical and mental health long term conditions Chief Investigators: Dr Leire Ambrosio. Lecturer. School of Health Sciences, University of Southampton and Mari Carmen Portillo. Professor of Long-term Conditions. School of Health Sciences, University of Southampto. Team: Skaiste Linceviciute. Research Fellow. Faculty of Medicine, University of Southampton, David Baldwin. Professor of Psychiatry and Section Head, Clinical Neuroscience, Faculty of Medicine, University of Southampton Joseph Jenness. Senior Manager at Southampton Voluntary Services. SO:Linked Jade Topham. Social Prescribing Link Worker, Southampton North PCN William Barnaby Jones. NIHR ARC Wessex PPIE, University of Southampton Traci Carroll. PPIE Representative as part of the NIHR ARC Wessex PPIE group, University of Southampton Siân Brand. Chair of Social Prescribing Network, Social Prescribing Network Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Anxiety UK, Social Prescribing Network, SO: Linked. Start: 1 October 2024 End: 31 March 2026 Background to the research As part of the NHS Long Term Plan in rolling out an integrated approach built around personalised care, NHS England has initiated the Social Prescribing Link Workers (SPLW) model to offer personalised support for patients in primary care facing continued pressures with long-term conditions, and to bridge fragmented healthcare systems with key community stakeholders through joined-up approaches (NHS, 2019). Our recent SPLW project demonstrated that despite Link Workers’ positive and multifaceted impact, the current efforts lack standardised approach and robust guidance that delay and complicate the work of SPLWs in delivering coordinated support for addressing the needs of adults with long-term physical and mental health conditions. Key challenges related to the lack of collaborative planning, expectations management, and limited communication with multidisciplinary teams. This leaves SPLWs managing complex cases with overstretched workload and with patients struggling to achieve sustainable, long-term support for the management of their physical and mental health LTCs. Aims of the research Informed by the findings of our previous SPLW project, a need has emerged to develop a consistent SPLW framework that sets out sustainable and integrated pathway that can optimise social prescribing services in the community, standardise guidance for training support and is equipped to support the long-term management of complex needs of adults with physical and mental health LTCs. Publications Understanding the potential role of Social Prescribing Link Workers in supporting identified needs of people with physical and mental long-term conditions: a qualitative study | BMC Primary Care | Full Text

c3f60ada-92b2-427a-992e-e9d18e00b011 ADOPTED: Mobility assessments in hospitalised older adults: study protocol for an e-survey of UK healthcare professionals PhD Candidate: Catherine Wharfe University of Portsmouth; Team: Maria Perissiou University of Portsmouth; Zoe Saynor University of Portsmouth; Jim Briggs University of Portsmouth; Carolina Gonçalves University of Portsmouth & University Hospitals Sussex NHS Foundation Trust Start : 1/11/2023 Ends: 1/05/2025 Abstract Hospitalisation in acute care poses a significant risk of adverse outcomes in older adults, including loss of functional independence, disability, and death. Research carried out in hospitalised older adults suggests functional mobility tools or scales can predict adverse events and care needs in this population, which facilitates prompt escalation of care and discharge planning procedures. As such, a need to develop a standardised methodology for assessing or measuring mobility has been recognised. However, the degree to which standardised mobility tools are routinely used, how data is collected, and/or which clinical assessment processes are utilised in hospitals across the UK is currently lacking. The aim of this national survey is to identify the current practice of mobility assessment in older adults admitted to NHS Trusts and Private Health Organisations, with a view to informing further research on a standardised approach or best practice guidelines to assessing or measuring mobility in hospitalised older adults.

fa252260-9b08-4bee-8ac4-2e68a124d401 Qualitative Data Preservation and Sharing (Q-DaPS) Principal Investigators: Prof. Fiona Stevenson ,, Professor of Medical Sociology, University College London, Head of the Research Department of Primary Care and Population Health; Prof. Geraldine Leydon-Hudson , , Professor of Primary Care Research, University of Southampton . Co-applicants: Dr Barbara Caddick Senior Research Associate in Primary Care and Honorary Senior Research Associate Department of History, University of Bristol; Dr Rebecca Barnes , Senior Qualitative Researcher, University of Oxford; Prof Carolyn Chew-Graham , Professor of General Practice Research, Keele University; Prof Sue Latter , Professor of Health Services Research, University of Southampton; Dr Emma Pitchforth , Senior Lecturer & Senior Research Fellow in Primary Care, University of Exeter. Prof. Catherine Pope , Professor of Medical Sociology, University of Oxford; Dr. Benjamin Saunders , Lecturer in Applied Health Research, Medical Sociology, University of Keele; Prof. Katrina Turner , Professor of Primary Care Research, University of Bristol; Prof Sue Ziebland Professor of Medical Sociology and Co-Director of the Medical Sociology and Health Experiences Research Group (MS & HERG) in the Nuffield Department of Primary Care Health Sciences, University of Oxford. Colaborators: Dr Ian Maidment , Reader in Clinical Pharmacy at Aston; Lynn Laidlaw is an experienced public contributor involved in UK wide and international research projects; Ali Percy, public co-applicant. Start: 1 June 2022 End: 31 May 2024 Background: Researchers may use different types of data to increase understanding of issues in relation to health and social care. Data may include audio or video recordings of interviews, focus groups (group discussions), and consultations between professionals and patients / service users, as well as written data, such as notes about research. These types of data are referred to as qualitative data. Funders of research increasingly encourage researchers to make their data available to be reused by other research teams. This is in part because qualitative data collection takes a lot of time and costs a great deal of public money. It is also considered ethical to make maximum use of data. Importantly, many people who participate in research tell us it is important to them that their contribution to research is used as much as possible. The project: Despite the increasing need and wish to safely store and share qualitative data, there is no central place to store and provide access to qualitative research data collected about health and social care. We will work with a company that specialises in keeping data secure and has a track record of working with university and health care organisations to develop secure digital storage (a repository) for qualitative data about health and social care. Part of the work will involve taking account of the views of members of the public about consent and use of data as well as data security. This will make sure the guidelines we put in place for people putting data into the repository or using data from the repository are acceptable to both researchers and participants in research. We will publicise the repository to encourage researchers to store their study data and allow access for researchers to answer their research questions. We will also provide a description of what is in the repository on a website so researchers can plan if they could use data from the repository rather than collecting new data. We will charge for use of data so the repository can be self-funding and sustainable in the long term. Expected impact : Increasing access to existing qualitative data from research projects in health and social care will make better use of what we already know about health and social care, saving time and money that would otherwise be spent on collecting new data. It will also satisfy the expectations of funders of research that data should be reused where possible. This project is particularly important as the COVID 19 pandemic has made data collection even more challenging in health and social care sites meaning we need to make the best use of the data we already have.

Justin Strain < Back Thinker, sailor, author, physio Justin's journey so far.. Justin Strain Justin Strain I began my healthcare career a little later than most. At the age of thirty, after a short career in the Royal Navy, I took my first steps into the University of Southampton’s School of Health Professions. I was interested in research from day one. The importance of evidenced-based practice was drummed into us throughout our time at university. From the moment we first wielded a tendon hammer or a stethoscope we were encouraged to ask ourselves those all-important questions: What is the best treatment? Does it work? Why am I doing this? Starting out as a musculoskeletal physiotherapist, I threw myself into clinical practice, desperate to learn every treatment technique and test I could get my hands on. I believed that being a great clinician was about perfecting those tricky manual techniques and learning everything there was to know about anatomy. Or so I thought. Thinking differently Later, as I developed in confidence, I began to think differently about my practice. It seemed to me that what made most difference to my patients was the therapeutic relationship. Understanding the patient’s experience and learning to listen more and communicate better (and sometimes talk less!) started to seem more important than having the biggest toolbox of treatment techniques. Specialising in pain management helped me to appreciate how peoples’ experiences of health-conditions and healthcare were shaped by a complex web of social and personal interactions, making each person’s experience unique to them.The need to understand these unique experiences drew me to qualitative research. I wanted to go further than comparing different interventions. I wanted to understand the stories of the people at the heart of those interventions – our patients. The importance of narrative was not new to me. In my non-clinical life, I write children’s novels – I’ve written two so far and I’m working on a third. In my novel writing, I enjoy the magic of exploring fictional worlds from other peoples’ perspectives. I’ve always found that what brings a novel to life is the personal connection between the reader and the characters. I wanted to apply a similar approach to understanding patients’ stories - listening to, understanding and recording other peoples’ perspectives, and acknowledging the role of the researcher and the reader in interpreting those perspectives. While I was taking my first tentative steps towards qualitative research, the world of healthcare research was changing. The n=1 campaign was gathering momentum, and recognition of qualitative research was increasing. I wanted to get more involved, and found myself looking for the right opportunity. Then, at the beginning of 2020, the world turned upside down with the advent of the COVID 19 pandemic. Along with many other things, the COVID 19 situation has highlighted the need for research – to explore the impact of immediate responses to the crisis, and also to understand how the pandemic will influence longer term changes in how healthcare is delivered. One of those long-term changes is likely to be the proliferation of online healthcare. The plethora of online health interventions now on offer enables people to access consultations and courses that might previously not have been available to them, in a safe, socially distant way. I felt this area was worthy of more exploration, and I wanted to listen to the stories of service users, to understand how these changes had impacted on their experiences. I resolved to start a research project looking at patients’ experiences of online pain management in our own service, but I was struggling to find the time - alongside a busy job in clinical practice, dealing with redeployment and the current challenges of COVID 19, and being dad for our two wonderful children. The NIHR ARC Wessex Clinical Academic Internship has given me that time. It has enabled me to build and apply my skills in research as part of my clinical job, making a difference to how I can support patients within my service. So where am I now? I am in the early stages of my project – a systematic review of qualitative literature about patients’ experiences of online pain management, combined with semi-structured interviews with patients who have completed the online pain management programme within our own service.As well as time, the Clinical Academic Internship has provided a network of similarly minded people, interested in research and qualitative exploration of issues. The excellent events run by NIHR ARC Wessex have introduced me to new research concepts and skills. My supervisors, Dr Euan Sadler and Dr Lindsay Welch , have been extremely supportive and with their help my skills and confidence are growing. I am planning to complete my project in Autumn this year and I am hopeful that this will lead on to a pre-doctoral, and eventually a doctoral fellowship with NIHR ARC Wessex in the future. Dr Euan Sadler is an Associate Clinical Professor of Older People and Frailty within Health Sciences at the University of Southampton. Dr Lindsay Welch is a Lecturer in Adult Nursing and a Researcher in long term conditions. Previous Next

35fc5ade-22b2-4685-9329-21c42b28a888 Testing the living with chronic illness scale Validation of the living with chronic illness scale in an English-speaking population with Long-term conditions Principal Investigator: Professor Mari-Carmen Portillo (Professor of Long-Term Conditions. School of Health Sciences. University of Southampton) Team members: Dr Kelly Hislop-Lennie (Principal Investigator). Senior Lecturer in Adult Nursing. University of Bournemouth. Dr Leire Ambrosio. Senior Research Fellow. School of Health Sciences and NIHR Applied Research Collaboration Wessex, University of Southampton. Ms Hannah Barker. PhD student at the School of Geography, University of Southampton. Dr David Culliford. Principal Research Fellow and Senior Medical Statistician. School of Health Sciences, University of Southampton. Dr Emily Arden-Close. Principal Academic in the Department of Psychology, Bournemouth University. Dr Jo Hope. Lecturer. School of Health Sciences and NIHR Applied Research Collaboration Wessex, University of Southampton. Dr James Bennet. Primary Care Research Locality Lead, Clinical Research Network Wessex. Dr Simon Fraser. Associate Professor of Public Health. University of Southampton Dr Corine Driessens. Senior Research Fellow in Statistics. NIHR Applied Research Collaboration Wessex, University of Southampton. Dr Nestor Serrano-Fuentes. Senior Research Fellow. School of Health Sciences and NIHR Applied Research Collaboration Wessex, University of Southampton. Start: 1 October 2019 Ends: 30 September 2021 Project Partners: Clinical Research Network (CRN) Wessex, Primary Care Dorset, Bournemouth University, University Hospital Southampton NHS Foundation Trust NHS: Alresford Surgery. Alresford, Angel Hill Surgery. Bury St. Edmunds, Banbury Cross Health Centre. Oxfordshire, Buchanan Road Surgery. Sheffield, Buttercross Health Centre. Somerton, Glastonbury Health Centre. Glastonbury, Heeley Green Surgery. Sheffield, Ixworth Surgery. Ixworth, Newquay Health Centre. Newquay, Oaks Healthcare. Waterlooville, Park Road Surgery. Teddington, Rosedale Surgery. Lowestoft, Shreeji Medical Centre. Slough, Swanage Health Centre. Swanage, The Park Medical Practice. Shepton Mallet, Trafalgar Medical Group Practice. Portsmouth, Wareham Surgery. Wareham, White Horse Medical Practice. Faringdon. Charity Partners: Parkinson’s UK , Diabetes UK and Asthma UK What did we find out? The scale successfully measures individuals’ experiences of living with one or more long-term conditions We found that the scale was acceptable to 577 people from the United Kingdom living with different long-term conditions. The results recommend shortening the original version of the scale for better use in clinical practice. What difference can this new knowledge make? The scale does not focus on the disease but on how the person lives with the disease; therefore, identifying physical, emotional, spiritual, and social complex needs and what is meaningful and relevant to people. Utilising the scale as an assessment and diagnostic tool in primary care could result in better health care. For example, it could support the development of more comprehensive and individualised care plans, a more effective and directed referral to specialists and community support groups, and regular monitoring. Its use could bridge health and social care services, developing and evaluating care pathways based on the commonalities across conditions (not medical diagnosis), and improving patient experience. Why is this important? This work has led to a new understanding of key elements that health and social care interventions must address to improve the lives of people living with long-term conditions. It highlights the need to focus on capturing the things that matter to people living with one or more long-term conditions in the UK. What next? The next step is to carry out a feasibility implementation study of the scale in clinical practice, particularly for people living with type 2 diabetes. The use of this scale in clinical practice has the potential to improve the daily lives of people with multiple conditions, improving their quality of life and well-being. It can also help improve referral processes and coordinate care. Outputs from research: Ambrosio, L., Hislop-Lennie, K., Serrano-Fuentes, N., Driessens, C., & Portillo, M. C. (2023). First validation study of the living with long term conditions scale (LwLTCs) among English-speaking population living with Parkinson's disease. Health and quality of life outcomes, 21(1), 69. https://doi.org/10.1186/s12955-023-02154-6 Ambrosio, L., Hislop-Lennie, K., Barker, H., Culliford, D., & Portillo, M. C. (2021). Living with Long term condition Scale: A pilot validation study of a new person centred tool in the UK. Nursing open, 8(4), 1909–1919. https://doi.org/10.1002/nop2.859 Ambrosio L, Navarta-Sánchez MV, Portillo MC, Martin-Lanas R, Recio M, Riverol M. Psychosocial Adjustment to Illness Scale in family caregivers of patients with Parkinson's Disease: Spanish validation study. Health Soc Care Community. 2021 Jul;29(4):1030-1040. https://doi.org/10.1111/hsc.13137 Ambrosio L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC. Psychometric properties of the living with long term conditions scale in an English-speaking population living with long term conditions in the UK. BMJ Open. 2024 Jan 10;14(1):e077978. https://doi.org/10.1136/bmjopen-2023-077978 Background and origina lay summary Long term conditions (LTCs) are a worldwide challenge because of their complications, increasing numbers, costs and impact on people’s lives. In order to develop interventions that improve the adaptation to illness and quality of life, we need appropriate, reliable and valid tools, which reflect cultural and language diversities and individual needs. This would benefit both patients and health/social care professionals in the management of LTC, by allowing the patients a way to express their needs and therefore, allow the health/social care professional to direct the patient to specific, relevant resources. The present study aims to produce an English version of the Living with Chronic Illness Scale and establish if it can be useful and applicable to English speaking people with LTCs in the UK. The Living with Chronic Illness Scale is the only available tool, which comprehensively evaluates the experience of living with a long-term condition, focusing on the person and not on the disease. This scale was created after previous research, and successfully used with people with Parkinson’s Disease from Spain and South America, in Spanish. In this study we will first translate the Spanish version of the scale into English, making any necessary cultural changes. After this, we will test the understanding of the approved English version with 15 people with LTCs. Then, we will use the final English version of the scale with at least 1,650 people with different LTCs in community settings from Wessex. Apart from the Living with Chronic Illness Scale, we will ask participants about perceived social support, life satisfaction, quality of life, and the perceived severity of their LTC(s), using tools for English speakers. Finally, 2 discussion groups will take place with people with LTC, 2 with family-carers and 2 with health professionals to explore and compare their views about the usefulness of this scale in the daily management of LTC. People with long-term conditions and associations have contributed to the choice of topic, research and dissemination plan.

45c5bd14-475f-4afa-ac9a-403f77123c69 CHAMPION: Children whose mothers are involved in the criminal justice system in Dorset & Hampshire: developing health and social care outcome indicators Chief Investigator Professor Julie Parkes Professor in Public Health Head of School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, Dr Emma Plugge Associate Professor in Public Health School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, Co-Investigators Dr Donna Arrondelle , Research Fellow, University of Southampton Dr Naomi Gadian, Public Health Specialist Registrar, University of Southampton Donna Gipson, Director EP:IC Consultants Ltd, West Malling, Kent Dr James Hall , Associate Professor of Educational Psychology, University of Southampton Paula Harriott , EP:IC Professor Kathleen Kendall , Professorial Fellow of Sociology as Applied to Medicine, University of Southampton Dr Sara Morgan , Associate Professor in Public Health, Faculty of Medicine, University of Southampton Professor James Raftery , Faculty of Medicine, University of Southampton, Dr Lucy Wainwright , Director of Research, EP:IC Consultants Ltd, West Malling, Kent Ms Natalie Austin , Public Health Specialist Registrar, University of Southampton Starts: 1st April 2023 Ends: 30th September 2024 Summary In this study, we will identify important features of children’s health and wellbeing that are affected when their mother is sent to prison. For example, it might be their mental wellbeing or their behaviour. If we know what the important features are, then researchers and organisations providing services (such as the NHS) can monitor these for change; this is important to see how the child is but also to see if services are helping him or her. In the past, researchers have not looked in depth at the health and wellbeing of these children. We want to look at all the studies conducted so far to see what areas of their health have been looked at and also to find out areas of their health where the evidence is lacking. We will also speak with adults who were children when their mother was imprisoned to hear their views about what health issues are important and what would have helped them at that time. We will also speak to children who are living with their mother in a prison alternative in the community to find out from them about their health and what has helped them in this particular place. Finally, we will speak with a range of professionals, from doctors to teachers, who work with children whose mother has been imprisoned. We will ask them to tell us about the aspects of these children’s health and wellbeing that they think are important and likely to be affected by the child’s mother going to prison. When we have the information from published studies, from the children themselves and from the professionals, we will bring together a group of people with experience of their mother being imprisoned and also professionals. We will work with them to agree the most important features of children’s health and wellbeing that are affected when their mother is sent to prison. These ‘outcome measures’ are helpful to developing services for these children. People with experience of their mother being imprisoned have helped design the project and will lead on data collection and analysis. They will also be important in spreading the word about the study. This will enable us to reach not just academic audiences and policy makers through publishing in journals or presenting at research conferences, but also people with lived experience and charities that work in this area. Informing a wide range of people will be important in ensuring that the findings from this study are acted on.

e3705a45-1f6d-4b9b-9466-a536d5b062ff Shift Pattern Feasibility https://vimeo.com/823738288 Feasibility of collecting and using nursing shift patterns data in acute, community and mental health wards Principal Investigator: Dr Chiara Dall’Ora Team members: Dr Chiara Dall'Ora (Senior Research Fellow in Nursing Workforce, School of Health Sciences, University Of Southampton), Professor Peter Griffiths (Chair of Health Services Research, School of Health Sciences, University of Southampton), Ms Nicky Sinden (Head of Nursing Workforce at Portsmouth Hospitals NHS Trust), Dr Sarah Williams (Associate Director of Research & Improvement, and Academy Lead at Solent NHS Trust), Ms Catherine Smith (Associate Director Workforce Research and Innovation, Southern Health NHS Foundation Trust), Professor Jane Ball (Deputy Head of School (Research & Enterprise), School of Health Sciences, University of Southampton), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University of Southampton), Mr Anthony Austin, PPI contributor Start: 1 October 2020 Ended: 31 December 2022 Partners: University of Southampton, Portsmouth Hospitals NHS Trust, Solent NHS Trust, Southern Health NHS Foundation Trust. UNISON, Royal College of Nursing Lay summary Nurses and care assistants form the largest group of NHS staff. Most work in services that provide care across 24 hours of the day. Research indicates that the organisation of nursing shift patterns might affect the productivity of health services. The introduction of long shifts in nursing was offered as a strategy to maintain service levels while eliminating overlaps. However, research has found that long shifts are associated with higher rates of sickness and poorer patient care. So far, there has been little research exploring individual factors influencing shift work experiences among nurses, and research has been largely confined to acute hospitals. What did we learn/find out? Working long shifts (12-h or longer) leads to more burnout for nursing staff Having little choice around shift patterns leads to more nursing burnout Nurses working 12-h shifts reported lower choice around shift patterns than nurses working 8-h shifts When wards in Mental Health and community hospitals operated with high proportions of long shifts, there were higher rates of patient incidents This was particularly the case for self-harm incidents and incidents of patient disruptive behaviour What difference can this new knowledge make? It will help nurse managers and those in charge of creating nursing rotas It will help nurses working in inpatient settings choose their shift patterns It will keep patients safer because they will be cared for by nurses who are less tired Why is this important for patients, health and care providers and policy makers ? Nursing burnout is at an all time high, and we provided evidence that can help alleviate burnout Improving patient safety is of paramount importance for any health organisation, and our findings support changes to work organisation to improve patient safety What we are going to be doing next? We will keep disseminating our findings by publishing further papers We are now co-developing feasible changes to shift patterns with nursing staff and their managers as part of our new project We have applied for further funding to maximise analysis of datasets we have created as part of this study Publications https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-022-00731-2 Shift work characteristics and burnout among nurses: cross-sectional survey | Occupational Medicine | Oxford Academic https://onlinelibrary.wiley.com/doi/10.1155/2023/6626585 https://onlinelibrary.wiley.com/doi/10.1111/jocn.16974

5fde61a4-c4bf-4d47-8ae3-3eed94045497 ADOPTED PROJECT: Evaluating the Operation Encompass Scheme: A Qualitative Scoping Study Principal Investigator: Dr Sara Morgan Project Team: Dr Maddy Greville Harris (Bournemouth University) Start Date: 1st August 2019 End Date: 21st December 2020 Background For young people, experience of domestic violence or abuse (DVA) is associated with an increased likelihood of experiencing mental health problems, poor academic attainment and later criminal or violent behaviour. The importance of early identification and support for children experiencing DVA is therefore paramount. One safeguarding scheme that is implemented in the UK is Operation Encompass (OE). This scheme involves partnership working between police and schools, to ensure that school safeguarding leads are informed of incidents of DVA involving children from their schools by the start of the next school day. Whilst the OE scheme has been implemented nationally, there is no existing published research exploring implementation of the scheme. What we did This qualitative scoping study carried out semi-structured interviews with 13 police workers and 12 school designated safeguarding leads. Thematic analysis explored three main themes: 1) Information sharing: “the beauty of Encompass is that it’s a conversation” , describing, for example, how OE is invaluable, although seen by some as resource-intensive 2) Facilitators and barriers of the OE scheme , such as staff responsiveness, funding, and resources 3) School support and outcomes: “Now they knew about it, they could go on to help” , such as the usefulness of identifying DVA cases, providing family and wellbeing support. While the OE scheme was considered invaluable in identifying and supporting children following OE, further research into the scheme could assist in a better understanding of how to optimise support for children in schools following a notification of an incidence of DVA. What did we find out? We identified three key themes from our interviews with educators and police involved in delivering Operation Encompass (OE). These were 1. Parameters of the scheme: defining DVA; stages to police implementation; extent and scope of information sharing; expanding and tailoring the scheme. 2. Barriers and facilitators: sustainability; attitudes towards the scheme; compliance and engagement; providing useful, timely contact; systemic promotion, and funding and resources. 3. Outcomes of OE and school support making allowances; check-in and monitoring; providing a safe nurture space; family work, and prioritising wellbeing. There was overwhelming support for the OE scheme from police workers and school safeguarding leads, although several potential challenges to implementation were discussed. The parameters of the OE scheme across regions were discussed, with debate around the content of OE notifications, and how best this should be shared. Although making contact with schools was sometimes challenging, schools agreed that timely information sharing via the OE scheme was useful for providing support to children and their families. Schools discussed the types of support they offered following and OE notification, such as checking in with the child and/or family, and providing a nurture space. Several key recommendations were made, such as the potential usefulness of sharing best practice between schools and the importance of promotion and awareness of the OE scheme. What did we do with this new knowledge? • Findings from the evaluation have been cited in a recent impact report from Operation Encompass, which goes out to all areas in England and Wales delivering OE OE-impact-Report-2023.pdf • The findings on the OE scheme have implications on best practice across police, education, social care settings. • The work was presented through the Association for Children and Adolescent Mental Health Supporting children and families experiencing domestic violence: A Devon and Cornwall perspective - Recording - ACAMH • The work was also used to inform a further grant application on children experiencing domestic abuse and led to a funded UKRI ESRC-funded PhD project by Miss Rebecca Harris | University of Southampton What next? Through my work evaluating violence prevention programmes, and how to support those experiencing domestic abuse, including this evaluation of OE, I’m looking to pursue further research work that understands how to prevent the intergenerational cycle of domestic abuse and how to prevent victims being revictimized or becoming perpetrators as adults. This will involve work with the community in non NHS settings, including partnerships with the police, education, social care and the healthcare system.

1c23cf8b-3886-4a98-9ca5-1588bcdda392 ADOPTED PROJECT: Development of a decision aid for offloading device selection for people with diabetic foot ulceratio ADOPTED PROJECT: Development of a decision aid for offloading device selection for people with diabetic foot ulceration Principal Investigator: Dr Lindsey Cherry , Associate Professor University of Southampton Research team: Dr Michael Backhouse, Associate Professor, University of Warwick; Dr Kate Lippiet, University of Southampton & Wessex Cancer Alliance, Dr Surussawadi Bennett – Research Fellow, Ms Joanne Casey – Senior Research Administrator Partners: Great Foundations Charity (Funder) University of Southampton & Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Diabetes UK, University of Warwick, University of Plymouth & Wessex Cancer Alliance So far, we found that people have different priorities when needing to choose between treatment options. There are pros and cons for each treatment. Treatment choice can be summarised into removable (‘ROD’ e.g., a specialist boot) and non-removable (‘NROD’ e.g., a plaster cast) offloading devices. Choosing between ROD and NROD is important to people. Evidence to support one treatment over another differs depending upon the treatment goal. For example, NROD is likely to heal the wound quickly. ROD is likely to be more comfortable and people can still drive. People (staff and patients) are often unclear about what a decision aid is and how it could be used to support discussion about treatment choice – so we made a helpful animation: OFFLOAD: what is shared decision making? https://vimeo.com/1158396239 We talked with patients about their experience of using ROD/NROD and making a treatment choice. We found out what people need that is currently missing in their care. We talked with clinicians about their experience of prescribing ROD/NROD and supporting people to make treatment choices. We found out what the barriers or enablers are to supporting choice in routine practice. We worked with patient and professional advisors and our PPIE partner Debs to create an animation that explains what a decision aid is and how to use it. The animation will be made publicly available on completion of the study. We completed an in-depth review of the literature to identify evidence supporting each treatment option. We used the learning from patient & clinician experience and the literature review to create a decision aid (a written summary of the choice to be made and comparative evidence for each treatment option based upon factors identified as important to people e.g., speed of wound healing, risk of infection or amputation, mobility, ability to drive, comfort etc.). We tested and refined the decision aid in clinical settings. Our next step is to evaluate the difference in health and wellbeing that use of the aid makes. We worked with a design company, our study advisory board and our PPIE partner to create a user-friendly version of the decision aid. This ensures people with differing health literacy have access to decision support. We plan to: Publish our research findings (interviews with patients and clinicians, literature review, development of the DA) Apply for NIHR RfPB funding to evaluate the clinical and cost-effectiveness of using the decision aid in clinical practice Continue working with PPIE and Charity partners to understand the challenges and opportunities to access OFFLOAD devices and enable choice Work with industry partners to explore routes to supporting knowledge mobilisation about offloading decision support and use of the DA in the UK and internationally Work with international partners to share the animation in Canada; to explore French translation and cultural adaptation

60f9f2f4-ec86-4835-abb5-cb3e74214a4f Domestic Abuse and Life-Limiting Illness: identifying and supporting adults at risk (DALLI Study) Principal Investigator: Dr Michelle Myall Team Members: Dr Michelle Myall (Principal Research Fellow ARC Wessex, School of Health Sciences, University of Southampton); Sophia Taylor (Senior Research Assistant , School of Health Sciences, University of Southampton); Dr Susi Lund (Visiting Research Fellow, School of Health Sciences, University of Southampton); Karen Drake (Matron in Specialist Palliative Care, Salisbury NHS Foundation Trust); Sally Dace (Patient and Public Representative) Start : 1 January 2021 Ends: 30 September 2024 Project Partners: University of Southampton; University Hospital Southampton NHS Foundation Trust (UHS); Weldmar Hospicecare, Dorset; Salisbury NHS Foundation Trust; Yellow Door Domestic and Sexual Abuse Charity; Southampton City Council; The Rowans Hospice, Portsmouth; Body Positive, Dorset ; Citizens Advice Southampton; Hampshire Macmillan Cancer Support Citizens Advice Service Summary of Findings Why the study is important In England and Wales an estimated 2.4 million adults experience domestic abuse (DA). People living with a life-limiting illness (LLI) are at increased risk of DA because they are vulnerable, frail, isolated and dependent on others. They may spend long periods of time in the home, in close proximity to the abuser, who is often their carer, and have difficulty accessing help and support. To date, little attention has been paid to the experiences of those living with a life-limiting-illness who are victims of DA, their specific needs and the extent to which these are being met by statutory and specialist and non-specialist services. Furthermore, we know little about the views and experiences of health and social care professionals who provide support to them. What we did Between 2021-2024 we conducted the mixed-method DALLI (Domestic Abuse and Life-Limiting Illness) study, which explored DA where it co-exists with LLI. Initially we carried out scoping work comprising a literature review; survey to map local service provision; and held informal discussions with those with lived experience, health and social care professionals working in hospice and palliative care services, and specialist domestic abuse organisations. This helped to identify research priorities and focus of the study. What we found Our scoping review highlighted the impact that DA has on mental health and wellbeing which can result in delays in screening, leading to late diagnosis and an illness advancing with only palliative rather than curable treatments being available. We know many people living with a LLI and at end-of-life are likely to access palliative and other health and care services frequently. Trusted relationships with healthcare professionals (HCP), enhanced by continuity of care can lead to the development of interpersonal trust between patient and HCP, increasing the likelihood of disclosures of abuse. However, interviews with health and social care professionals highlighted a lack confidence to ask about abuse, and challenges with recognising signs of abuse amongst the complexities of DA in the LLI context. This highlighted the need for increased training, education, and continued professional development in this area. Working with hospice and palliative care professionals, specialist and non-specialist third sector organisations, and people with lived experience, we established a Community of Practice and held a series of workshops with them over 15 months to co-develop the DALLI Toolkit. We also conducted interviews with health and care professionals and people from relevant third sector organisations to help inform Toolkit content. The Toolkit, which complements existing safeguarding policies, aims to increase practitioners’ confidence and understanding offering resources to support health and social care professionals working with people with a LLI identify and respond to DA encountered in practice. Outcomes Following piloting and evaluation the Toolkit has been adopted in a small number of hospice and palliative care settings in Wessex, and following discussions with Marie Curie’s Head of Safeguarding, is to be implemented in Marie Curie Hospices nationwide and included on their website as a resource for healthcare professionals. The Toolkit is also being used by domestic abuse services in local authorities and as an educational resource for social workers at a local university. Next steps It is now our aim to achieve greater impact and encourage adoption and spread to extend the Toolkit’s reach to other hospice and palliative care organisations and potentially other health and social care services. We have secured Impact Funding from Marie Curie to enable us to work with a professional production company to create a short promotional film about the DALLI Toolkit, and its use in practice, and hold a launch event in the Autumn 2024 to publicise the film and Toolkit and encourage wider adoption. Embedding and integration of the Toolkit will enable health and social care professionals to improve understanding of the complexities of DA in the LLI context and increase confidence to ask about and respond to DA. WATCH: ITV News report here Please see below copies of the DALLI toolkit and quick reference guide DALLI Toolkit v6.0 030924[58] .pdf Download PDF • 1.26MB DALLI Toolkit Quick reference Guide v0.3 140623[9] .pdf Download PDF • 260KB Publications: Domestic Abuse in the Context of Life-Limiting Illness: A Systematic Scoping Review: Michelle Myall ,1,2 Sophia Taylor,1,2 Sally Wheelwright,3 and Susi Lund1 1School of Health Sciences, University of Southampton, Southampton, UK 2NIHR ARC Wessex, University of Southampton, Southampton, UK 3Brighton and Sussex Medical School, University of Sussex, Brighton, UK Correspondence should be addressed to Michelle Myall; m.myall@soton.ac.uk https://doi.org/10.1155/2023/1841944

9651ede0-0793-4179-aed8-009aca83e877 Developing Pathways for older adults who are also drinking at increased-risk levels: Hampshire Older adults Alcohol Pathway (HOAAP) Chief Investigator: Julia Sinclair , Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton. Co-Investigators: Skaiste Linceviciute, Research Fellow, NIHR ARC Wessex, University of Southampton Gabrielle A Palermo, Senior Research Assistant, NIHR ARC Wessex, University of Southampton Stephanie Hughes, Research Fellow, NIHR ARC Wessex, University of Southampton Becky Band, Associate Professor, University of Swansea Melinda King, Lived Experience Consultant Stephen Lim, Consultant Geriatrician, NIHR ARC Wessex Ageing and Dementia Theme Lead, University Hospital Southampton Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Hampshire County Council, Southampton City Council, Wessex Health Partners, Inclusion (community treatment provider of addiction services), CGL, ‘With you’ Community Addiction Services Bournemouth and Poole, NIHR School of Primary care Start: 1 October 2024 End: 31 March 2026 Summary Alcohol once swallowed is absorbed into every organ of the body as well as affecting the mind. Although approximately 80% of people in Wessex drink alcohol, many people remain unaware of the harm it causes even at relatively low levels. As people age, they are more likely to develop long term health conditions, which alcohol can adversely affect as well as putting them at increased risk of medication interactions, memory problems, and falls. We know that older adults may feel more uncomfortable talking about their alcohol use compared with younger people. This can create barriers to accessing help. Beyond this, very little is known about the reasons why older adults drink alcohol and how this may interact with other aspects of their lives. The aim of this project was to build on our first study funded by the ARC Wessex, Older Adults, Loneliness and Alcohol (OLA), which recruited individuals over 65 years admitted to University Hospital Southampton (UHS) whose alcohol consumption was at increased risk levels. In collaboration with local clinicians and researchers, the study generated evidence that informed a follow-on project focused on alcohol use among community-dwelling older adults. To date we have undertaken the following studies: “Modelling the Impact of People with Alcohol Use Disorder on Clinical Outcomes and Healthcare Use” - in collaboration with Southampton Emerging Therapies and Technologies (SETT) Centre, and the Wessex Secure Data Environment (SDE). We have accessed and begun the analysis of retrospective, routinely collected data from all patients admitted to UHS between January 2017 - June 2025. There are over 95,000 inpatient discharges during this time. This work is supporting the investigation of associations between alcohol use disorder, clinical outcomes and healthcare use, as well as helping to refine the processes required to analyse data in the SDE. “Understanding lifestyle and alcohol consumption in older adults: a qualitative study” - We interviewed a community sample of individuals across Wessex over the age of 65 years, who consume alcohol and experience other potentially challenging contributing factors, to learn about their lifestyle choices, daily routines and demands with a scope for exploring alcohol consumption and related experiences. This study identified a range of alcohol consumers with diverse life factors, demonstrating the need for tailored health messaging/ advice and wellbeing support. Brought together an engaged and active stakeholder group of experts by experience and training in this field; including patients, carers, clinicians, social care workers, community support providers, commissioners and academics to inform our research planning and undertaking, to exchange and disseminate the learning and to build a network of collaborations to apply for further funding to take this work forward. These three strands of work have supported necessary evidence and partnership infrastructure building that will now require to be taken forward.

6dc4c269-ddb7-41c3-afd8-8173c69a4651 ADOPTED ActMed-VW - Healthcare professional's experiences of Access to Medication for people on Virtual Wards who are in their last year of life Virtual wards provide acute, hospital-level care in an individual’s own home, rather than in a hospital or hospice. They are also known as Hospital at Home services. We know that virtual wards can care for people who are in their last year of life. For individuals approaching the end of life, control of symptoms requires prompt access to medication. We know access to palliative care medication can be challenging in the community. There have also been reports of difficulty accessing medication on virtual wards; however, it is not known if there are specific issues accessing palliative care medications on virtual wards. This study aims to investigate access to medication for adults on virtual wards who are in their last year of life. We aim to understand the experiences of healthcare professionals so that we can make recommendations on how to improve access to medication in the future. We will ask healthcare professionals working in virtual wards to answer questions in an online survey. We will ask doctors, nurses, pharmacists, and allied health professionals such as physiotherapists to complete the survey. We will ask them about what works well and what does not. We will ask them about the challenges they have faced, and what would help them to minimise or eradicate these. We will also interview 20 healthcare staff. This will include both professionals who completed the survey and individuals who oversee the management of virtual ward services. We will explore in more detail examples of good practice and the processes that need to be in place to ensure straightforward, fast access to medication. We will consult with clinical and policy experts on potential solutions to the challenges identified in the study findings. We will also work with these experts to develop recommendations for policy and practice. Project team includes: Co-PI - Dr Nicola Andrews Co-PI - Prof Sue Latter Co-I Dr Natasha Campling Co-I Dr Sara McKelvie Research Fellow Dr Dan Aze