fb112e5b-f7be-4ada-a37c-8e959119e1c3 Adolescent Resilience to OVercome Adversity: EmpoweRment and intervention development – the ROVER study Lead applicant: Anne-Sophie Darlington Co-applicants : Professor Graham Roberts , Professor Mary Barker , Dr Ivo Vassilev University of Southampton, Dr Catherine Hill Associate Professor in Child Health at the University of Southampton, Dr Jana Kreppner Associate Professor in Developmental Psychopathology within Psychology at the University of Southampton , Dr Luise Marino , Abigail Oakley Project Summary: Mental health conditions and symptoms in children and young people are increasing. Children and young people (CYP) with a chronic physical health condition often report having mental health problems such as feelings of anxiety and depression. A lot of research has focused on risk – circumstances that make it more likely for young people to experience mental health problems. In this project we want to focus on resilience - the young person’s ability to use their strengths and support from family and friends to overcome challenges in their life. Resilience has not often been a focus of support programmes for CYP with a physical condition. We would like to find out what experiences are common for young people living with physical health conditions, so that we can develop a support programme that applies across Child Health. We will use knowledge from these shared experiences to co-create the support programme with young people – called ‘tools for life’ (suggestion by CYP). We will also partner with national charities (partnerships have already been developed) who have worked with us before and who are very interested in supporting CYP around their mental health. The charity partners could help us to develop support components that are very specific to the condition (for example, fear of cancer coming back), which can be included in the overall support programme. Finally, work with young people has taught us that flexibility is very important: flexibility in when they access support, the way they access it and how it is offered to them. We will work together with young to shape this flexibility in support. The project will have four parts: Part 1 – Finding out what might work: List successful support components from 15 existing summaries of the evidence (reviews of the literature) to date and a report from Wellcome (an independent global charitable foundation which focuses on research), and identify the support elements (e.g., building confidence) which work well, and are acceptable to young people. Part 2 – Developing partnerships: Develop a partnership with local stakeholders (e.g., Paul Hughes and Laura Renishaw-Villier – Hub stakeholders; SolentMind, No Limits) and national charities (e.g., Children’s Cancer and Leukaemia Group, Kidney Care UK, Asthma UK). who can support the development of the support programme, both the general as disease-specific elements. We will hold several workshops with stakeholders to develop the partnership and agree on the goals of the partnership and ways to work together. Part 3 – Developing the support programme: We will co-create (develop together with young people) the support programme– ‘tools for life’ - to increase resilience. We will focus on flexibility in the way the programme is offered to young people, and when young people access the programme, to suit their needs. This flexibility will make young people more likely to use the programme. Part 4: Testing the support programme: We will test the support programme with 30 young people, to find out how many young people use the programme, if the programme is acceptable, how they use the programme, and how much they use the programme. We will also find out what the most important indicators of success are for the programme, such as young people experiencing less symptoms of anxiety and depression, and a better quality of life. What did we find out? The problem: Children and young people with a physical health condition are at a higher risk of developing mental health problems. Existing support programmes do not focus on building resilience – the ability to bounce back and stay mentally strong by using available resources and support networks when facing challenges. Also, many programmes fail to keep young people engaged. This project aimed to explore the support needs of young people and the best way to deliver a programme that builds resilience. What we did: We reviewed existing support programmes from the literature. Then we interviewed young people (32 with a physical health condition, and 25 without, ages 11-18 years), 12 parents of young people aged 11-17 years, and 5 healthcare providers from hospitals, charities and schools across the UK. A range of health conditions were represented, including cancer, heart disease, type 1 diabetes, and asthma. The interviews explored key stressors young people face, the support they need, and preferences for how support should be delivered. What we found: Priority stressors were related to managing the health condition, school/social life, and the future. Key support strategies identified included: 1) Normalisation through connection with other young people (e.g. chat forums), peer training (e.g. ‘living with a health condition’ in school curriculum); 2) Coping, including practical methods (e.g. knowing what to expect during hospital visits), and skills for navigating changes in peer relationships; 3) Prompt reassurance from healthcare providers during hospital visits, via text messaging service, and access to youth workers. Participants preferred a flexible approach that combined online resources with in-person support. Potential impact: Based on our findings, we have developed a prototype support programme that combines online resources with access to healthcare providers for timely reassurance and problem-solving. We are now seeking feedback from young people on this prototype and will use their input to create a full-scale version. If the support programme proves effective, it could help improve the mental health of young people with a physical health condition. What is the impact of this knowledge? • Relationship building: We established strong links with key stakeholders, including clinical colleagues across paediatric specialties at University Hospital Southampton (UHS), representatives from Hampshire and Isle of Wight ICB, Dorset HealthCare, and national and regional disease charities. These collaborations supported participant recruitment and informed intervention development. In the long-term, these relationships will be crucial in ensuring the widespread implementation of the intervention across the health and care system. • Embedding of EDI and PPIE: We conducted extensive PPIE work with community groups, including Winchester Youth Council, Breakout Youth, and Yellow Brick Road, ensuring that the voices of children and young people (CYP) from diverse backgrounds, including those from the LGBTQIA+ community and socioeconomically disadvantaged areas, were represented in the study. • Empowerment of young people: CYP gained a strong sense of empowerment and an enhanced awareness of their own resilience and well-being while contributing to the study. This impact was far-reaching, as the study included patients from UHS paediatric units, and students from local schools (Toynbee and Applemore) and colleges (Eastleigh College and Sparsholt College). • Novel insights into well-being: This study provided novel insights into resilience and well-being for CYP, enriching the broader narrative on CYP mental health. We also co-developed several prototype intervention proposals, which will pave the way for creating an intervention to improve resilience and mental health for young people within healthcare settings. What Next • We are currently: seeking feedback from young people on the prototype resilience intervention preparing a manuscript for submission to a high-impact a peer-reviewed journal. The findings from this study will be inform the development of a grant application, aimed at co-creating the full-scale resilience intervention with input from young people and their support networks. If the intervention proves effective, it will be implemented in practice to bolster mental health outcomes for young people with a physical chronic condition, while also reducing the burden on health and social care services.

596abb82-50f3-40e1-8d8d-a89073038260 ADOPTED: DASA - Domestic abuse and housing: local authorities' provision of safe accommodation for adults living with disabilities and/or long-term/life-limiting illness: a mixed-methods study Principal Investigator: Dr Michelle Myall , School of Health Sciences, University of Southampton. Team: Dr Sophia Taylor and Dr Susi Lund , School of Health Sciences, University of Southampton. Professor Parveen Ali University of Sheffield. Professor Lee-Ann Fenge Bournemouth University Mrs Samantha Dawson, Body Positive Dorset - Public and Patient Contributor Summary In 2025 an estimated 3.8 million adults experienced domestic abuse in England and Wales. Some people are at increased risk because of additional inequalities, vulnerabilities, and other factors. This includes adults with complex health and social care needs such as those living with physical disabilities and long-term/life-limiting illnesses. In April 2021 the Domestic Abuse Act was introduced in England. This created a new definition of domestic abuse to include any incidents of controlling, coercive, or threatening behaviour, violence or abuse between those aged 16 or over, who are or have been, intimate partners or family members regardless of gender or sexuality. Domestic abuse also includes psychological, physical, sexual, financial and emotional abuse. Domestic abuse can happen to anyone and is a leading cause of homelessness. In England, the Domestic Abuse Act has changed housing law to give priority accommodation to a person made homeless because of domestic abuse and requires local authorities to offer support in safe accommodation and alternatives to refuge provision. Refuges are not suitable for all victim-survivors, particularly those who have additional and specific health and care needs. There is little research on the housing needs of domestic abuse victim-survivors with physical disabilities, long-term conditions or life-limiting illnesses. Understanding the requirements of these groups and how local authorities are meeting their responsibilities under the Domestic Abuse Act is important and timely. What are the study aims? Working with people with lived experience, local authorities, and domestic abuse organisations we aim to: 1) identify and explore the experiences of victim-survivors living with a physical disability and/or long-term/life-limiting illness affected by domestic abuse and 2) understand how local authorities are meeting their responsibilities in providing safe accommodation and prioritising those made homeless because of domestic abuse. We will explore what local authorities already provide and how they are responding to the requirements of The Domestic Abuse Act. We will review published research and policies, map existing housing provision, and undertake interviews with key stakeholders. To ensure the voices of people with lived experience are included and listened to, we will hold creative workshops, using art, poetry or stories to explore their experiences. Findings will be used to develop a toolkit for local authorities and their partners to inform practice and improve user experience. What will happen to the study findings? We will work with our project partners and people with lived experience to identify who we need to engage and how to reach them. We will hold an event at the end of the study to share findings with stakeholders. Findings will be reported on social media for the wider public, and attendance at conferences and publications in academic and professional journals.

27d064e4-2601-492e-b882-a0ef85373d44 ADOPTED: (SIFT) Sensors in Fatigue Tracking in Parkinson’s. Exploring the relationship between perception of Fatigue and the performance of physical activities in people with Parkinson's with fatigue using wearable sensors Fatigue is one of the three most debilitating symptoms in Parkinson’s. Fatigue is difficult to diagnose, it often goes unrecognised, and is challenging to treat. The SIFT-PD study is exploring how fatigue impacts physical activity in people with and without Parkinson’s over a 3-day period. It asks participants to fill in fatigue diaries and uses wearable sensors to monitor the how people move over a period of three days. The sensors are small and light and worn on a belt. The sensors track activity (the amount, type and quality of movement). This research looks at whether the sensors can reveal how people’s movements change over the course of three days when they are fatigued. Furthermore, information from sensors might help understand what makes people fatigued and allow it to be measured. Knowing more about fatigue will help to recognise its impact and help develop ways of managing it better.

af50ff28-5b02-41fa-bc1f-f9689464860e EnTech (Enabling Technology): Investigating the enabling and inhibiting factors to the use of internet-based support tools for caregivers of people with dementia, and how to promote engagement. Chief investigator: Prof Chris Kipps Neurologist, Clinical Director R&D University Hospital Southampton Dr Sarah Fearn Senior Research Fellow NIHR ARC Wessex (Ageing & Dementia) University of Southampton Team: Prof Cathy Murphy, Professorial Fellow Research, School of Health Sciences University of Southampton Prof Eneida Mioshi Professor in Dementia Care Research University of East Anglia NIHR ARC East of England Jane Ward Dementia Friendly Hampshire Amanda Wollam Public contributor with personal and professional (social care) experience of caregiving to people with dementia Start: 1 October 2024 End: 31 March 2026 Partners: Do rset HealthCare University NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, University of East Anglia / NIHR ARC East of England, Dementia Friendly Hampshire, My Dementia Support. Our research We found that there were seven factors that influenced how able and/or willing care partners were to engage with online tools. Care partner-related factors included time, emotional impact & preparedness, support networks and signposting, personal preferences, the relevance and sensitivity of information, and digital access and skills. Website-specific factors included design and usability, as well as trust and credibility. Public involvement We are working with caregivers of people with dementia and local dementia charities in this project. On our team, we have two public contributors who both have lived experience of caring for someone with dementia. They will help us to design and carry out the research, to make sure it is relevant to caregivers and benefits them. 60 caregivers will participate in the research in interviews, focus groups or workshops. What we did with our new knowledge We have worked with the research teams / developers of the DemCon website and the FTDToolkit (both internet-based support tools) to improve their tool. We have worked with participants to co-produce recommendations for the design and implementation of internet-based support tools for carers of people with dementia in the future. We are connecting with other research teams / developers of internet-based support tools to advise on their design and implementation (including in France and Australia). We are looking to share the findings widely with research teams / developers working in this area to ensure design and implantation of these resources is maximised. We have contacted national charities and funders in the area to make them aware of our findings. Email lead researcher

eb290c7e-cd77-4244-9d45-322994af9f69 ADOPTED PROJECT: Comparing pharmacological and non-pharmacological interventions for adults with Attention-Deficit/Hyperactivity Disorder (ADHD): systematic review and network meta-analysis Chief Investigator: Professor Samuele Cortese – University of Southampton Project Team Members: Professor Andrea Cipriani – University of Oxford, Associate Professor Corentin Gosling – University of Paris Nanterre, France, Dr Luis Faraht – University of São Paulo, Brazil / Yale University Child Study Center, USA, Dr Cinzia Del Giovane – University of Modena and Reggio, Italy Project partners: Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK. Electronic address: edoardo.ostinelli@psych.ox.ac.uk . Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK. Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK. Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy; Institute of Primary Health Care, University of Bern, Bern, Switzerland. Hampshire and Isle of Wight NHS Foundation Trust, Southampton, UK; Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK. Psychology Services, London, UK; Department of Psychology, Reykjavik University, Reykjavik, Iceland. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK. The National Attention Deficit Disorder Information and Support Services, Edgware, UK. Hampshire and Isle of Wight NHS Foundation Trust, Southampton, UK Full team listing including PPI :O stinelli EG, Schulze M, Zangani C, Farhat LC, Tomlinson A, Del Giovane C, Chamberlain SR, Philipsen A, Young S, Cowen PJ, Bilbow A (PPI), Cipriani A, Cortese S Ended: 28th February 2024 Background: It is currently unclear how different treatment options for preschool children with ADHD compare with each other in terms of efficacy and safety. We will use data from available randomised controlled trials (RCTs) and apply an advanced and innovative statistical approach (network meta-analysis) to answer this question. What did we find out? We found that Stimulant medications and atomoxetine are the only treatments that clearly help reduce the main symptoms of ADHD in the short term, based on both what patients say and what doctors observe. However, people were less likely to stick with atomoxetine than with a placebo (a dummy pill). There was no evidence available other important things like improving quality of life, and we don’t know much about how well they work in the long run. Non-medication treatments had mixed results depending on who was doing the rating. This study gives the most complete picture so far of how different treatments for adult ADHD compare to each other. It can help guide treatment choices, but those choices should always be based on a careful look at both the benefits and risks — and on what matters most to the individual. The study is already informing clinical guidelines, e.g., the ongoing guidelines from APOSARD (USA). The study has informed a freely available platform ( https://ebiadhd-database.org/ ) that has been utilised by 15,000 colleagues around the world and improved through feedback from 1,000 stakeholders worldwide See medication and treatment ratings Next Steps To test the impact of the platform on knowledge and clinical practice To contact guideline bodies in the UK (eg NICE) and abroad to bring the network meta-analysis and the related platform to their attention. Publications Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis - ScienceDirect

ff477b29-43df-41e3-8562-aeeb2cfcbef7 ADOPTED: Investigating Quality of Care for People with Dementia Undergoing Cancer Treatment in Ambulatory Care (ImPaCT) Principal Investigator: Dr Naomi Farrington Team members: Dr Naomi Farrington (Advanced Nurse Practitioner and NIHR Clinical Lecturer, University Hospital Southampton and University of Southampton), Professor Jackie Bridges (Professor of Older People’s Care, School of Health Sciences, University of Southampton), Professor Alison Richardson (Clinical Professor of Cancer Nursing and End of Life Care, University of Southampton and University Hospital Southampton). Start: 01 January 2019 End: 31 May 2022 Project partners: University Hospital Southampton NHS Foundation Trust, University of Southampton. S tudy is funded as part of a HEE/NIHR Clinical Lectureship Lay summary: There is not much information about people with dementia having cancer treatment. This study aims to understand how high quality care can be provided for people with dementia undergoing outpatient cancer treatment (radiotherapy, chemotherapy or other anti-cancer treatment). The study uses a research method called ethnography, which is where a researcher conducts ‘fieldwork’ to study a group of people to better understand that group. It will look at: The environment (surroundings and conditions) of the outpatient clinics and treatment areas; How people in the outpatient clinics and treatment areas behave and interact with each other; How treatment and support is organized in the outpatient clinic and treatment areas. Fieldwork will take place in the outpatient departments of University Hospital Southampton NHS Foundation Trust. It will include observations, interviews and review of patient notes. The people who will be invited to take part in the study are: People with dementia having cancer treatment; Friends or family supporting people with dementia having cancer treatment; Staff involved in the care of people with dementia having cancer treatment (doctors, nurses, support workers, administrative staff, and others). All those who take part in the study will be asked to give consent. The study includes: Observation . this will be carried out in cancer outpatient clinics and treatment areas. This will look at the environment (surroundings and conditions); the everyday interactions that happen between patients, carers and staff; and way in which care and support take place. Observation will take place in the general clinic areas as well as during doctor appointments and when treatment is being given. The researcher will take detailed notes. Interviews . these will be carried out with patients, carers and staff. These will focus on how people in the study speak and act to understand more about how they think and feel. Interviews will be digitally recorded, and a written transcript will be made. Patient notes . Researchers will look at patient notes to add to the information from observation and interviews. They will look at the notes to find out about diagnosis, treatment and support offered to patients. These 3 methods of data collection will help the researchers put together a detailed picture of the outpatient setting including how people act ( behaviour ), the surroundings and conditions ( environment ), and the way treatment and support is organised ( processes ). This will reveal ways in which healthcare organisations might best provide cancer treatment for people with dementia that is person-centred (focused on the needs of the person themselves) and of a high quality. What did we learn? The cultural environment of the outpatient care setting reflects and supports the standardized processing of people for cancer treatment. Dementia introduces a wider set of care requirements not catered for by a standardized treatment model. The needs of patients with dementia could be addressed most effectively when individualized care, was offered. This was possible when services were responsive to patient need. What difference did this new knowledge make? Outpatient cancer services can ensure responsiveness by: having an established way of eliciting needs, preferences and expectations a belief that a person's needs and expectations are legitimate, and that effort should be made to address them ability to accommodate these needs and expectations. Why is this important for patients, health and care providers, and policy makers? Managers of outpatient cancer care services have a better understanding of how to design and organize settings so that the needs of people with dementia can be addressed. Patients with dementia and their families will be more likely to receive personalized care that meets their needs. Policy makers will be more aware of the need to incorporate principles of personalized care into policies guiding the care and treatment of people with multiple health conditions. What have we done? This work has been part of building momentum to increase the profile of how people with cancer and dementia receive care and treatment. A national symposium was carried out with clinicians and academics in 2022 showcasing work addressing cancer and dementia. Dr Naomi Farrington is presenting this work as part of a session on ‘Person-Centred Care’ at the European Oncology Nursing Society in Madrid, October 2023. 3 papers have been published on this study: Understanding the cultural environment of the outpatient care setting for patients with dementia receiving cancer treatment: a qualitative study. https://pubmed.ncbi.nlm.nih.gov/36382351/ How can I improve cancer services for people with dementia? https://journals.rcni.com/cancer-nursing-practice/evidence-and-practice/how-can-i-improve-cancer-services-for-people-with-dementia-cnp.21.5.22.s10/full 'A rea l fine balancing act’: A secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting. https://pubmed.ncbi.nlm.nih.gov/36929372/ C LEAR steps for a responsive outpatient cancer service • C larify needs, expectations, preferences and goals • L egitimise these as valid • E nable these to be met by implementing strategies • A udit to ensure this is working for patients caregivers and health service • R ecord for the future https://vimeo.com/688041079

bfee6430-aafd-44b2-bd89-074b9c7bf0b9 ADOPTED PROJECT: ADAPT: The cross-sector implementation of NICE-recommended CBT-based interventions for young people in care: Framework Chief Investigator: Dr Rachel Hiller– University of Southampton Project Team Members: Dr Gretchen Bjornstad– University of Exeter, Dr Tim Clarke – Norfolk & Waveney Children and Young People Care Group, Dr Kristian Hudson– Improvement Academy Bradford Teaching Hospital NHS Foundation Trust, Professor John Macleod– University of Bristol, Dr Ruth McGovern– Newcastle University, Dr Hugh McLeod– University of Bristol, Professor Richard Meiser-Stedman– University of East Anglia, Dr Sara Morgan– University of Southampton, Dr Beverley Slater– Bradford Institute of Health Research, Professor Paul Stallard– University of Bath, ProfessorJohn Wright– Bradford Institute of Health Research, Dr Patrick Smith– King’s College London. Organisations Involved: Swindon Borough Council, Bath and North East Somerset (BaNES) Children’s Services, Thinking Allowed specialist-service, Bristol, Newcastle City Council Children’s Social Care, Child and Adolescent Mental Health Services (CAMHS) (East) Background: Young people in care (care-experienced young people; CEYP) have substantially higher rates of mental health difficulties compared to their peers. Their unaddressed mental health needs have been identified as a key driver of a range of poor outcomes that categorise this group. For example, CEYP they are five times more likely than peers to be excluded from school, comprise 50% of the young male prison population, and 25% of the homeless population. Such outcomes are not inevitable. Yet services are often struggling to effectively address the mental health needs of this group, and thus prevent some of these wide-ranging consequences. To begin to address this complex issue, we are proposing a pilot implementation project, working with CAMHS, social care and third- sector mental health services across four target ARCs. Our pilot project aims to address this via overlapping stages that form the essential framework for a full-scale implementation trial. These are: (1) A scoping review and consultation with CEYP, carers, and services to develop an initial implementation framework, based on the consolidated framework for implementation research (CFIR) (2) The development of our implementation resources, including training materials What did we find out? We found that young adults aged 18-25 did not engage with the RADAR/ADAPT programme, and may not engage with perpetrator services, if they do not have motivation to do so. The implications are that this poses a risk to victims, particularly if perpetrators have high risk behaviours. To address this, more work should be done to disrupt high risk individuals and refer them on to workshops that require less time commitment; in order to initiate self-awareness around their behaviors and their impact on others. Given that children were a strong motivation for completing a programme, it seemed almost paradoxical that there were no specialist services made available for children within the DAPP model. Although there is compelling evidence to suggest that men changed their behaviours following the programme, police reoffending data suggests that, for a minority of individuals, more work is required to fully embed positive behaviours. A mentoring service may support such aims. To further support evidence on behavioural change, long term outcomes related to victim harm should be measured; for example, through a short questionnaire filled out by current or former partners. The RADAR/ ADAPT programme is specific to the domestic abuse experienced between intimate partners within heterosexual relationships. The implications are that a number of individuals may not find the programmes appropriate to their context. Therefore pilot programmes should be developed to tackle different relationship dynamics and types of abuse, including lesbian gay bisexual transgender queer (LGBTQ) relationships, and Elder Abuse. Finally, to full achieve a community coordinated response, and make the most of the resources available, pathways of referrals and a mutual understanding of roles and responsibilities should be clearly set out, to cover both statutory and non-statutory organisations. What did we do with this knowlege? •The findings from the research were communicated with the commissioners of future services in Domestic Abuse in Hampshire. •The next commissioned service considered the findings of the research in the tender. •For example, given the risk of non-engagement of younger adults, a specific service for 18-24 year olds, was set up that working on the specific needs of this population group. •The findings added to the limited knowledge around voluntary community perpetrator programmes. •It was published in the Open Access journal PloS ONE https://doi.org/10.1371/journal.pone.0218408 •Dr Sara Morgan was interviewed alongside Tracy Rutherford (Hampton Trust) on the Patrick Sisson show (BBC Radio Solent) Where next? •The work on ADAPT has led to further research in this area through existing partnerships, including a national evaluation of CARA •We have continued relationships with police partners who were interested in further evaluation work, which led to co-funding of other projects including Operation Foundation and MASP •Personally, Chief Investigator is interested in the findings around younger perpetrators, and how to engage them better in the health and social care system, and improve their life-chances. •Where many perpetrators on ADAPT have experienced domestic abuse as children, and they themselves have children, I’m interested in pursuing work around preventing the intergenerational transmission of domestic abuse. Publications Baseline characteristics and outcomes of the main perpetrator programme within the Hampshire Domestic Abuse Prevention Partnership, UK: A mixed methods study | PLOS One

53b76e5e-c361-4791-8e01-f147de703463 SOCIAL CARE: Evaluation of Southampton City Council’s Male Engagement Worker (MEW) Project Chief Investigator: Dr Michelle Myall, Associate Professor, University of Southampton Co-Investigators: Dr Sophia Taylor, Senior Research Assistant, University of Southampton; Dr Susi Lund, Visiting Research Fellow, University of Southampton Partners who collaborated on the research: Anjelica Finnegan, Senior Male Engagement Worker, Southampton City Council; Caroline Bate, Domestic Abuse Coordinator, Southampton City Council; Colin McAllister, Senior Public Health Practitioner, Southampton City Council; Francesca Mountfort, Male Engagement Worker, Southampton City Council; Kate Harvey, Public Health Consultant, Southampton City Council Start Date: 19 October 2023 End date: 30 September 2024 Why is this research needed? An estimated 2.4 million adults experienced domestic abuse in 2019 in England and Wales. In April 2021 the Domestic Abuse Act was introduced in England and Wales. This created a new definition of domestic abuse to include “any incidents or patterns of incidents of controlling, coercive, or threatening behaviour, violence or abuse between those aged 16 or over, who are or have been, intimate partners or family members regardless of gender or sexuality. Domestic abuse can encompass, but is not limited to psychological, physical, sexual, financial and emotional abuse”. The Act required local authorities to expand their support and provision available to those experiencing domestic abuse. As part of a review by Southampton City Council into whether it meets the requirements of the new Act it found that alleged perpetrators of domestic abuse are not being effectively assessed or adequately supported. This is particularly true of young (step-) fathers. To address this gap, in 2020 Southampton City Council established a Male Engagement Worker (MEW) Project to work with high-risk male perpetrators of domestic abuse who have (step-) children and have local authority children’s services involved. This newly established service has yet to be evaluated. What were the aims? To evaluate Southampton City Council’s new domestic abuse service focusing around the newly created Male Engagement Worker Project. How was the study carried out? We carried out interviews with key informants and relevant stakeholders and analysed audit data collected about the service. What we found Overall, the MEW project was seen as valuable in supporting early intervention, improving safety, and helping individuals reflect on and change harmful behaviours. The referral process, particularly case consultation, was viewed positively for improving communication between professionals. As a small, non-statutory service, MEW faced challenges around funding, visibility, and capacity, and its work was complex, requiring long-term engagement. Integration into the Family Safeguarding Model which was introduced by the Council in September 2024, and brings together expert practitioners in multi-agency teams who can support parents who are experiencing domestic abuse, mental ill-health, alcohol and substance use, to address issues that could result in children and young people being at risk of harm or needing to come into care has strengthened multi-agency working but also created challenges, particularly around maintaining relationships and ensuring access to the service. Outcomes We shared findings with stakeholders through a presentation. We also produced a report and executive summary of findings and recommendations for Southampton City Council and shared learnings with other relevant local authority and third sector organisations. Findings were also shared at the Southampton City Council’s Domestic Abuse and Violence against Women and Girls Strategic Partnership Board to inform further funding and commissioning decisions of the MEW project.

Research areas Key research themes Ageing and Dementia Read More Long Term Conditions Read More Healthy Communities Read More Workforce & Health Systems Read More Cross-cutting research projects Mental Health Hub Read More Social Care Read More

db1daab2-c480-4960-beba-7955afeebc20 Wessex Frail2Fit – A feasibility and acceptability study of a virtual multi-modal intervention delivered by volunteers to improve functional outcomes of older adults with COVID-19 discharged from hospital Lay project title: Can we train volunteers to deliver exercise and nutrition support to older adults with frailty after a hospital stay? Project Partners: University of Southampton; University Hospital Southampton NHS Foundation Trust; Bournemouth University; Swansea University Principal Investigator: Dr Stephen Lim Team members: Dr Stephen Lim ( NIHR Clinical Lecturer in Geriatric Medicine, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Samantha Meredith ( Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton ), Professor Mike Grocott ( Professor of Anaesthesia & Critical Care, Clinical and Experimental Science, University of Southampton), Professor Sandy Jack (Consultant Clinical Scientist in Anaesthesia and Critical Care, University Hospital Southampton NHS FT), Professor Jane Murphy (Professor of Nutrition, Ageing and Dementia Research Centre, Bournemouth University), Dr Judit Varkonyi-Sepp (Chartered Psychologist, Manager Behavioural Science Theme, NIHR Biomedical Research Centre, University of Southampton), Andrew Bates (Clinical Academic Intensive Care Nurse and Critical Care, Clinical and Experimental Science, University of Southampton), Luisa Holt (Physiotherapist, Research Fellow, University of Southampton), Professor Kelly Mackintosh (Professor in Sport and Exercise Sciences, Swansea University), Professor Melitta McNarry (Professor in Sport and Exercise Sciences, Swansea University), Cynthia Russell (patient representative), Steph Keith (Volunteer services - Patient Support Hub Coordinator), Kieran Fifield (Volunteer services - Project Support Officer) Start: 31/10/2022 Ended: 10/01/2024 Lay Summary Around half of older people over the age of 65 in hospital are affected by frailty. Frailty is a long-term health condition where your body loses its natural reserves. People with frailty take longer to bounce back from simple things, like a common cold, they tire easily, and need a bit more help to do things. Exercise and good nutrition are important to build strength in older people with frailty and can help them to perform their normal daily activities, like dressing, or cooking a meal. However, the motivation to eat well and to move more after a hospital stay can be hard for many older adults living with frailty. We found that we could train volunteers to encourage older people with frailty to eat well and exercise after a hospital stay. Hospital volunteers were trained by a health professional to deliver 3-month support to older people online through Zoom, or over the telephone. Five hospital volunteers completed the training. The volunteers were college students (3 female) with an average age of 16 years and were interested in gaining experiences working in a health setting. The exercises were seated strength movements using resistance bands. Volunteers were also taught to use the ‘nutrition wheel’ which is a tool to help start conversations with older people about their eating and whether they had lost any weight. Older people who were identified as at risk of undernutrition (not getting enough nutrients to support their health) were given booklets containing suitable nutrition advice. Twenty-seven older people with frailty signed up to receive support from the volunteers, and seventeen completed the 3-month programme. Eight older people completed the intervention online, and 9 opted for telephone support. The volunteers delivered 45 online sessions and 90 telephone calls from January 2023 to October 2023. After the programme we found that older peoples’ physical activity levels, quality of life, and appetite improved, and they maintained these improvements at 3-month follow-up. Only 1 minor incident happened during exercise where an older person strained their shoulder muscle using the resistance band. We interviewed volunteers, older adults, and their carers to find out more about what they thought of the exercise and nutrition support. Participants completing the online sessions enjoyed the group interactions and described the sessions like ‘a virtual cuddle’. They appreciated the support of the younger volunteers, who helped motivate and guide their exercise and nutrition behaviours. Participants receiving support through weekly telephone calls felt the volunteers were very encouraging and provided non-judgmental support. Overall, participants thought the online sessions helped build a better exercise routine, but the one-to-one telephone calls allowed more in-depth, personal conversations around nutrition. The young volunteers found listening to some of the illness stories of older people leaving hospital quite emotionally difficult. But they found the experience changed their perceptions on ageing. The volunteers had support from the trainer to help with any challenging conversations. Some older people found a key barrier to participating in the programme was their unmet care needs. Older people with better social care had resources to focus on their health, whereas older people who were alone and unsupported were more focussed on meeting their basic care needs rather than participating in the support programme. Overall, it was safe and feasible for volunteers to deliver exercise and nutrition support to older people living with frailty after a hospital stay. What we did with the new knowledge Our findings are helping to develop a volunteer toolkit, including recruitment packages, and training and support materials for future volunteer-led projects in hospital and in the community. Where next? We are working with various Universities and community organisations to develop a volunteer-led intervention to improve health and wellbeing of older people in different regions and for older people from diverse ethnic backgrounds. What did people say about the work? Volunteer: “It (training) was very thorough, and I knew what I had to do when I first started. Especially at the beginning, when I was invited to join one of the zoom sessions, to see the volunteer delivering the exercises. And also, the nutrition support; that was really helpful to understand how everything worked. Not only how it was meant to, but how someone delivered it. I thought the training was amazing, and I felt comfortable with what I was doing when I first started.” Participant receiving telephone support: “ What was very good was they (volunteers) didn’t push it too much. When I said I exercise 3 times a week, they didn’t push that and say, ‘oh, you should be doing this; you should be doing that’ - they didn’t push anything… They just encouraged you, which was good…. They were polite, finding out what I’d been doing, and what I hadn’t been doing I s’pose but not criticising me for not doing it… They’re concerned about you, getting people back to normal, aint they?” Participant receiving online support: “ I enjoyed doing the one online. It was interesting talking to people to see what other people were feeling and how they were all doing…. You sort of get that feeling that you’re part of something… it was fun. Strangely enough, I would find myself looking forward to the next one…” Participant receiving online support: “ Full of enthusiasm.. They (volunteers) weren’t just telling you what to do, they were rooting for you too, ‘come on, we can do this!” Publications Frail2Fit study protocol: a feasibility and acceptability study of a virtual multimodal intervention delivered by volunteers to improve functional outcomes in older adults with frailty after discharge from hospital | BMJ Open

de23ed25-467a-496e-b29a-68a949839608 ADOPTED: FLOWS Planning for Frailty: Optimal Health and Social Care Workforce Organisation Using Demand-led Simulation Modelling Principal Investigator: Dr Bronagh Walsh, Associate Professor, School of Health Sciences, University of Southampton. Team: Professor Peter Griffiths , School of Health Sciences, University of Southampton: Dr Carole Fogg, School of Health Sciences, University of Southampton: Mr Mike Hepburn, Southampton Business School, University of Southampton: Dr Abigail Barkham, Southern Health NHS Foundation Trust: Honorary Professor Martin Vernon, Tameside and Glossop Integrated Care NHS Foundation Trust: Professor Lee-Ann Fenge, Department of Social Work and Social Sciences, Bournemouth University: Professor Jane Ball, School of Health Sciences, University of Southampton: Professor Sally Brailsford, Southampton Business School, University of Southampton: Ms Francesca Lambert, PPI lead, School of Health Sciences, University of Southampton. Start: 01/11/2022 End: 31/10/2025 Background: As the population ages, robust workforce planning to meet future demands for health and social care by older people is needed. A lack of evidence in this area has led to a mis-match between the health and social care demand from the ageing population and the current workforce capacity. The proposed study will use demand-led simulation modelling of the workforce required to address the specific challenge of providing health and social care for the growing numbers of older people living with frailty. Aims & Objectives: The aim of the study is to use simulation modelling to explore long-term trends in frailty-related health and social care use in the ageing population and its implications for future workforce size and competencies to support high quality care. The primary objective of this study is the creation of a simulation model that will inform service and workforce planning to meet health and social care needs associated with frailty. Methods: The study will use a System Dynamics design to develop and test the simulation model. Work packages comprise a scoping review, gathering of public and professional perspectives on service provision via a survey and stakeholder engagement activities, and analysis of linked health and social care data, all of which inform the simulation modelling work package and development of a workforce planning toolkit. Timelines for delivery: The scoping review will be completed in year 1. Routine health and social care data specification and extraction will occur in year 1, as will service mapping and classification and survey preparation. Survey data collection and analysis will occur in year 2. Simulation modelling will commence in year 2, with validation, sensitivity analyses and scenario modelling in year 3. Development of workforce guidelines and toolkit will occur in. year 3 Stakeholder engagement, including patient public involvement, will run throughout the study, reviewing study results and informing development of the other work packages. Anticipated impact & dissemination: This study will provide new, direct evidence about the impact of frailty on health and social care workforce requirements within the ageing population The improved understanding of workforce requirements offered by this study will inform workforce planning for frailty services across health and social care, ensuring future benefit for patients through provision of timely and appropriate care and a workforce planning toolkit to support local decision-making.

dcd0d821-4fe8-4cdb-b80d-1d7503b45f61 Wessex DIET: Determining the Impact of covid-19 on food sEcurity in young families and Testing interventions Joint Lead: Professor Nisreen Alwan and Dr Dianna Smith . Co Applicants : Nida Ziauddeen , Tim Lloyd, Dr Marta Disegna , Ravita Taheem, Sally Shillaker, Fran Richards, Duncan House, Sara Crawford. Partners: Southampton City Council, University of Southampton, Bournemouth University, Solent NHS Trust. starts: 1 November 2021 Ends: 31 March 2024 Publications: Household food insecurity risk indices for English neighbourhoods: Measures to support local policy decisions News: New map shows regions in the UK with a higher risk of food insecurity Lay Summary Aim of the research : We will explore the impact of system shocks on food security, diet quality and health in young families across Wessex, using the covid-19 pandemic and lockdowns as an example of such shocks. We will find out if Council-supported food aid initiatives to counter difficulties around adequate and healthy diet are acceptable, well taken-up and impactful in local populations. This will lead to a toolkit that can be used by Councils to decide which initiatives are best for their populations. Background: The covid-19 pandemic restrictions are likely to have negatively impacted UK families in many ways, including food insecurity (not having enough food because of cost or other barriers, or not having good quality food). Food insecurity has negative health impacts in the short-term including weight gain, malnutrition, poor mental health; these may lead to longer term health outcomes including obesity, diabetes, anxiety, and depression. Local Councils in Wessex have a range of initiatives to help this situation, including food pantries, where eligible families can purchase a range of items at a greatly reduced price, and recipe boxes. Design and methods During this 2-year project we will: Use statistical modelling to explore the effect of the covid-19 pandemic on important aspects of health and wellbeing in Wessex’s families with children under age 12, including their diet quality, food availability, weight status and mental health. Interview families to explore how they coped with the changing social and economic circumstances during the pandemic particularly in relation to their food quality and purchasing behaviours, Work with the local Councils in Southampton and Dorset to evaluate the initiatives to improve diet in disadvantaged families including food pantries. Public Patient Involvement: We involved public contributors in the design of this research through three meetings with 12 contributors overall. We have a public contributor as a co-applicant. Our PPI activities will ensure the interventions reflect the individual needs of young families in the target groups, and that the outreach activities to support the interventions are properly communicated. We already have ongoing public engagement activities involving Sure Start within our existing ARC project which we will continue to utilise. We have and willcontinue to actively involve people on the frontline of food aid systems in shaping this research. Dissemination: We will produce an implementation toolkit for Councils to aid decision-making on food-aid initiatives. Non-academic outputs will be specific to the audience and will include videos, presentations, social media posts and flyers. For public health/councils, short reports on the findings in the form of policy briefs will add to academic content and presentations. We will follow successful models like the oral health posters to Family Hubs delivered by Solent Health. What did we find out? We explored the impact of system shocks on food security, diet quality and health in young families across Wessex, using the covid-19 pandemic and lockdowns as an example of such shocks. We used statistical modelling to explore the effect of the covid-19 pandemic on diet quality, food availability, weight status and mental health in England. We wanted to find out if food aid supported by local councils to counter difficulties around adequate and healthy diet are acceptable, well taken-up and impactful in local populations. We carried a review of the literature on the impact of food aid initiatives in households with children and found that accessing food aid was linked to reducing food insecurity and improving diet quality in some studies. Food aid initiatives that allow users to choose food items and provide other support services are most effective. We also carried out a review of the literature on the impact of the COVID-19 pandemic on food insecurity in households with children and found that most studies showed that the pandemic worsened food security. We assessed the impact of food clubs (a type of food aid initiative that charges a small fee for a set number of items) on food security, diet quality and wellbeing in households accessing these clubs. We did this by recruiting people accessing food clubs to our study and asking them to complete a survey at recruitment and after at least three month of using food clubs in Southampton and Dorset. 90 people took part in the study and 52 people completed a follow-up survey. We calculated food security at baseline, with 42% reporting low and 43% very low food security. Among participants with follow-up (n = 52), low food security was 41% and very low food security was 18% at follow-up.11 participants also took part in a semi-structured interview that explored how they coped with the changing circumstances during the pandemic and their views on food clubs. Two themes explored impact and experiences of food club. Impact illustrated how participants consumed a more varied diet, experienced less financial pressure, and improved health, wellbeing and social interaction. Experiences of food clubs explored limitations of time and food range at clubs, developing a sense of community and overcoming stigma. There is a sense of a positive impact of food clubs on the food security, diet quality and mental wellbeing of participants when exploring both survey and interview data. What did we do with this new Knowledge? We have produced a toolkit to aid decision-making on food aid initiatives, to allow them to assess the impact of the interventions and consider how best to implement new interventions. This can be used by local councils to plan new initiatives or by the interventions themselves to monitor impact. We visited the food clubs we recruited participants from and shared the study results with the people accessing the clubs, as well as the staff and volunteers there. What Next? Future research will evaluate the process and impact of food aid interventions using the toolkit. We have applied for further funding to explore how to improve the quality of food provided through aid. Publications The impact of food aid interventions on food insecurity, diet quality and mental health in households with children in high-income countries: a systematic review | Public Health Nutrition | Cambridge Core . The COVID-19 pandemic and food insecurity in households with children: A systematic review | PLOS One A mixed methods study exploring food insecurity and diet quality in households accessing food clubs in England | BMC Public Health