Hodges' Model: Welcome to the QUAD

- provides a space devoted to the conceptual framework known as Hodges' model. Read about this tool that can help integrate HEALTH, SOCIAL CARE, INFORMATICS and EDUCATION. The model can facilitate PERSON-CENTREDNESS, CURRICULUM DEVELOPMENT, HOLISTIC CARE and REFLECTION. Follow the development of a new website using Drupal (it might happen one day!!). See our bibliography, posts since 2006 and if interested please get in touch [@h2cm OR h2cmng AT yahoo.co.uk]. Welcome.

Tuesday, September 19, 2017

BCS Sociotechnical SG - Annual Symposium Rebooting the Role of Sociotechnical Perspectives in a hyper-connected, digitised society

27th of October 2017, 5 Southampton St, London WC2E 7HA

Register here https://events.bcs.org/book/2708/

The Sociotechnical Specialist Group of the British Computer Society has the pleasure to invite all its members and society at large to our first annual symposium. The event will provide an opportunity to interact with leading researchers in the field of sociotechnical systems and related areas. The symposium will be interactive and comprise keynote talks and panel discussions examining the role of sociotechnical perspectives in a hyper-connected, digitised society. Invited keynote speakers are:

Prof. Niels Bjørn-Andersen
‘The origin of Socio-Technical Information Systems Research in Scandinavia’

Socio-Technical IS research in Europe was founded by Enid Mumford, who applied the learnings from general S/T research within industry and coalmines to the IS/office context. The presentation will take its starting point in her early work (philosophy, methodology and tools), and it will be discussed how this learning was applied in a Scandinavian context. The challenges and conflicts with the so-called political school and the scientific IS school will be presented. One important issue for the S/T researcher was the inherent conflict between the humanistic and democratic ideal, which became a major practical issue. The presentation will end with some ideas for a reinvention of the Socio-Technical research, which seems more important than ever.

Prof. Angela Sasse
‘If security doesn't work for people, it doesn't work’

Traditionally, security experts have treated people as components whose behaviour can be controlled by policies and mechanisms - ignoring knowledge from decades of socio-technical systems research. In "Users Are Not The Enemy", co-authored with PhD student Anne Adams and published in 1999, we demonstrated the devasting consequences of this ignorance: frustrated users faced with impossible demands bypass security and consider it pain-in-the-neck, while organisational resources are wasted and performance reduced. I will present results from RISCS projects to show how STS approaches - user- and value-sensitive design, engagement and co-creation - lead to more effective solutions. The National Cyber Security Centre (NCSC) now has a 10-strong team advising UK organisations on this approach; their revised the guidance shifts the responsibility for passwords away from individual users, and prohibits the widely used but highly disrespectful "Users are the weakest link" slogan.

Prof. Tokil Clemmensen
‘Sociotechnical HCI: Reflections on Topics and Theories’

Human-Computer Interaction (HCI) builds on the ideology of empowering the end-users of computers, so that they understand what is happening and can control the outcome (Nielsen, 2005). How does that work for HCI in organizations and societies? While HCI historically has been based on applying cognitive psychology to understand the individual user (Card, Moran, & Newell, 1983), one strong trend in modern and contemporary HCI is to study applications in business, managerial, organizational, and cultural contexts. To design HCI for organizations, the big thing may be to do some kind of HCI design action research that constructs or modifies one or more HCI artefacts within their existing organizational contexts: sketches, prototypes, templates, running systems – anything that changes the interactions that managers and employees do and experience. Hence, the future topics and theory of HCI may indeed be socio-technical.

Member of the BCS Sociotechnical Specialist Group will also give talks and join the discussion panel (see program for more detail)

Registration Fee: £10 (BCS Members) £20 (General Public)



Registration and Coffee

Welcome talk from BCS Sociotechnical Group

Prof. David Wastell, Nottingham University

‘‘If security doesn't work for people, it doesn't work’
Prof. Angela Sasse, University College London

Coffee and Biscuits

‘Nurses Acceptance of Health Information Technology’
Dr Ip-Shing Fan, Cranfield University

Panel 1: Ken Eason (Loughborough University), Angela Sasse, Ip-Shing Fan


1:15pm – 2:00pm
‘The origin of Socio-Technical Information Systems Research in Scandinavia’
Prof. Niels Bjørn-Andersen, Copenhagen Business School

2:00pm -2:45pm
‘Sociotechnical Case Studies with SMEs in Portsmouth’
Dr. Peter Bednar, Portsmouth University


Coffee and Biscuits

‘Sociotechnical HCI: Reflections on Topics and Theories’
Prof. Torkil Clemmensen, Copenhagen Business School

3:45pm – 4:30pm
Panel 2: Niels Bjørn-Andersen, Peter Bednar and Torkil Clemmensen

4:30pm – 5:00pm
Day’s key learning points and Open Discussion – The Role of Sociotechnical Perspectives in a hyper-connected, digitised society
Dr. José Abdelnour-Nocera, University of West London

My source:
Jose Abdelnour-Nocera, SOCIOTECH at JISCMAIL.AC.UK

(I am planning to attend.)

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Sunday, September 17, 2017

Lines, opposites and unity

"The point, then, is that lines join the opposites as well as distinguish them. And that precisely is the essence and function of all real lines and surfaces in nature. They explicitly mark off the opposites while at the same time time they implicitly unify them. For example, let's draw the line representing a concave figure, as follows: 
concave   (convex) 
But notice immediately that with the very same line I have also created a convex figure. This is what the Taoist sage Lao Tzu meant when he said that all opposites arise simultaneously and mutually." (p.25)

Wilber, K. (2001) No Boundary,  Eastern and Western Approaches to Personal Growth. Boston: Shambhala.

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Saturday, September 16, 2017

"Invisible Countries": What are you saying? More to the point what on Earth are you thinking...?

The book in the previous post that prompts this has its own content and creative rationale, but taking the title literally...

humanistic --------------------------------------- mechanistic

So, you take your identity, country, 
nationality for granted?

You give scant regard for your citizenship when so many are stateless.

Do you possess a passport?

A national ID number of some sort?

There's no need for borders. But they do predict the struggles to follow over access to water, the position of dams. This is where we literally co-locate (with the political domain) the geo-political.

You may have a point though:

 "The first day or so we all pointed to our countries. The third or fourth day we were pointing to our continents. By the fifth day, we were aware of only one Earth." --Sultan bin Salman Al-Saud, astronaut

You also take your family heritage, possibly your 'good' family name for granted?

Who do you think you are?

Don't you realise you are history?

Are you a pacificist? That is what many will glean from such a stance.

What's that?
Oh, I see you are a citizen of the world?

"The love of one's country is a splendid thing. But why should love stop at the border?" --Pablo Casals

Stop struggling. We are all victims of history.

See also: iWish 2059

Quotations: c/o http://www.worldbeyondborders.org/quotes.htm

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Friday, September 15, 2017

iWish 2059 ....?

humanistic --------------------------------------- mechanistic

My source: Sylph Editions

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Thursday, September 14, 2017

Fallding: 'model'

"The ideal type, as a case of the heuristic, resembles what is now called a model. ... He [Nagel] makes model refer simply to the mental imagery with which we clothe our theoretical entities in order to have some pictorial grasp of them : ... essentially analogies, yet they do more than help us visualize; they help our thinking to unfold by taking it in new directions. 
[Model] is taken to mean a system of concepts that is useful in mapping the variables in a field under investigation. It may be a corner of a field or the whole field of the subject: a model may be of bureaucracy, for instance, or of society in general. ... in scientific work we do not start out with an empty mind, nor even with isolated hypotheses. We start with a guess about the whole structure of our universe of discourse. The coherence that goes into this system of concepts, a coherence whereby each concept is defined by the relationship in which it stands to the others, is analogous to explanation but is not explanation in fact. For it is not an account of reality as it has been experienced" (p. 510).

Harold Fallding. Explanatory Theory, Analytical Theory and the Ideal Type. In. Thompson, K. and Tunstall, J. (eds.): Sociological Perspectives, Penguin Books, Harmondsworth, 1971.

Excerpt from Harold Fallding. (1968) The sociological task. Prentice-Hall.

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Wednesday, September 13, 2017

Logical Levels Behavioural Model - mapped to Hodges' model

humanistic --------------------------------------- mechanistic

Beliefs & Values

(Interpersonal) Skills

Environment (cognitive access)
Environment (physical access)

Identity (Body image)

Practical Skills & Capabilities

(Social) Environment

Identity (Social Roles)

(Cultural) Values
(Work, Political status - Citizenry)

Environment (Accessibility)

My source: HIFA forum

Dear HIFA Colleagues

I would like to share with you what I have found to be a simple and practical behavioural model which can be used as a framework for designing, reviewing and enhancing health promotion interventions.

The “Logical Levels” model proposes that the change or maintenance of a particular behaviour must be supported at various ‘neurological levels’: “Environment”, “Skills and Capabilities”, “Beliefs and Values” and “Identity”. All levels must be appropriately and effectively addressed and failure to address any one of the levels can undermine the impact of a health promotion intervention.

For example, relating the model to condom use: Even if someone can get condoms easily (Environment), can use them properly and negotiate their use with a sexual partner (Skills and Capabilities) and believes they are highly effective at preventing HIV, other STIs and unintended pregnancy (Beliefs and Values), Identities such as “I am useless and worthless” or “I am a macho stud” may still prevent them from actually using condoms. In such cases, a shift at the level of Identity is also needed to support condom use.

This article (http://www.boht.org/key-concepts.aspx/#LogicalLevels) presents the Logical Levels model and how it can be used to enhance health promotion interventions, with the illustrative example of how it has informed the development of a training kit which addresses condom use at all the different logical levels.

Best Regards

Peter Labouchere
BRIDGES OF HOPE TRAINING - Transformational Training for Healthy Lives
E-mail: peter AT boht.org
Skype: peterlabouchere
Website: www.boht.org

HIFA profile: Peter Labouchere is a Training Consultant / Executive Director at Bridges of Hope Training, South Africa. Professional interests: Developing innovative training materials and engaging participatory training methodologies to address (throughout Africa and beyond) a spectrum of health and behaviour change issues including HIV-prevention, testing, treatment, stigma, positive living, PMTCT and Medical Male Circumcision. peter AT boht.org

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Monday, September 11, 2017

The Radical, Interpretative and Functionalist in Hodges' model

 SUBJECTIVE ------------------------------------ OBJECTIVE
humanistic --------------------------------------- mechanistic

This post (subject to further revision) is intended to highlight the similarities of the above structural and conceptual basis for Hodges' model and a table and figure in Keith Tudor's book from 1996 'Mental Health Promotion' from which I drew a post earlier in the year:

Inner model II: Hodges' model - helping to locate Social Sciences...

In this post I'm returning to what are some pivotal figures in regard to the status of Hodges' model. Viewing this below you are invited to simultaneously superimpose Hodges' model.


'Radical humanist'

individual experience of health and autonomy in making healthy choices
'Radical structuralist'

materialist view of natural and social world

actors involved in the social process


regulated behaviour - 
and regulating healthy behaviour (pp.46-49)


In the book Figure 1.4 is  reproduced above with the 'subjective' and 'objective' to the left and right respectively. I have placed these within the axes of Hodges' model topmost. I appreciate you do need the text (especially table 1.3 and the many references provided) to understand Tudor's purposes in defining mental health. The book is well worth locating - despite its age. I must admit I already have three books in the box for the next trip to Hay. This one though is a keeper. Whilst in Hodges' model the vertical axis is:
(dyad) group (population)

this is not challenged by the dual sociological form above and in the book. Health and social care are predicated on the individual in the first instance. Change lies with the individual. We are all social beings, socialised entities.

Keith Tudor writes (p.33):
Drawing on the notion of paradigm, developed by Kuhn (1970), and putting these two dimensions, the subjective-objective and the regulation-radical change, together as axes, Burrell and Morgan (1979) define four distinct sociological paradigms (figure 1.4).  
... First, although each paradigm will contain a variety of viewpoints there will be, nevertheless, a 'commonality of perspectives', an essential unity within the paradigm, defined and described by the differences between the paradigms. Secondly, 'all social theorists can be located within the context of these four paradigms according to the meta-theoretical assumptions reflected in their work' (Burrell and Morgan, 1979, p.24). The paradigms thus provide a useful map with which to explore conflicting theories and practices. Thirdly, the four paradigms are mutually exclusive: a synthesis is not possible' (Ibid., p.25).
I am still digesting this. Even to wondering that a synthesis may be possible, even if fudged through a series of overlays?

This occasional paper by Tudor may be also help:
Mental Health and Health Promotion

My source: Table 1.3 A scheme for analysing assumptions about the nature of society in relation to mental health. Figure 1.4 Four paradigms for the analysis of social theory (Burrell and Morgan, 1979, p.22) & In Tudor, K. (1996). Mental Health Promotion, Paradigms and practice, Part 1 Defining the field; Chapters 1-2. London: Routledge, pp.32-33.

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Sunday, September 10, 2017

Lancaster: Launch event for the AffecTech Innovative Training Network

We hope you will join us for a special evening at Lancaster’s beautiful Ashton Memorial Hall to celebrate the launch of AffecTech, a prestigious digital health research initiative.

Where: Ashton Memorial Hall, Williamson Park, Lancaster 

When: Monday September 18th 2017, 7pm-9.30pm 

Why: AffecTech is a Marie Curie Innovative Training Network funded by the European Commission, dedicated to delivering effective low cost self-help technologies to help sufferers of affective health conditions such as depression, anxiety and bipolar disorders. Coordinated by Lancaster University, and benefiting from leading European and global partners including the UK’s NHS, Oxford University and technology giant Philips, the goals, scale and expertise of AffecTech is unique, integrating the latest innovations in personal tech for mental health, with the most influential clinical psychology insights into emotion regulation. 

This event is organised by the School of Computing and Communications at Lancaster University and will be an exclusive opportunity to network with leading partners from the digital health sector, and learn more about innovations in wearable technologies for mental health.

There will be complementary drinks and canapés, music and a full bar.

Please confirm your participation by signing up on Eventbrite (password: AffecTech):

We are looking forward to seeing you there. 

For further information and contact details, please visit: http://www.affectech.org/

PRESS RELEASE: Tuesday 5 September 2017
Research into wearables technology set to transform the future of mental healthcare

[ I am planning to attend. My source: a direct message from @Affec_Tech ]

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Friday, September 08, 2017

Hodges' model: a New Invention

Created in the early 1980s, Hodges' model is clearly not a -

'New Invention' P. Halling

While Hodges' model is not a new invention, we have always needed to way-find. Maps are very powerful and even more so now that the world is literally within our grasp. What forms of way-finding can Hodges' model encompass ...

Psyche's journey: All aboard!?
The journey that is life and death... within which and beyond is the arrival of love.
The anatomy and physiology of the human body - the journey called development.
The wound healing journey, the granulated path.
The many skills to become more acutely aware of and honed to be a more effective communicator.
The ways and means by which a clinical procedure MUST be followed - with the essential detours that must include psychological considerations and assuring that 
dignity, respect and privacy are upheld.
This ineffable stuff called information how do we arrive there from data?
From information what is the direction of travel to knowledge - 
is W1S D0M a postcode?
This ineffable stuff called evidence, where is that to be found 
and then by what routes can it be applied?
The journey of the health and social care record from blank to comprehensive.
The journey past the signage (paper ... IT systems) that denotes local vocabularies.
The student's journey from novice to expert.
The patient's journey from illness to recovery; relapse to recovery, 
through palliative care to end of life.
Transitions: from care at home, to hospital, home or residential setting.
The patient's journey to hospital: paramedics, ambulance, corridors and bays, 
accident & emergency, ward, transfers, home.
The patient's narrative journey repeated to own doctor, paramedics, nurse, another doctor, social worker, physiotherapist, occupational therapist (not as long as it used to be?).
Crisis informational: worry - going for tests, scan ... attending clinic for results.
 Informational and temporal compression of the above due to headwinds of pressure on beds.
Self-referral journey to destinations (services) and agencies to be confirmed.
The medication journey (not yet personalised) absorption, distribution, metabolism, and excretion.
The other medication journey that precedes (reconnoitre) rationale, information giving, consent, titration, established regime, withdrawal, medication stopped.
The terrible journey that sees family losing their loved ones twice over.
Explicit and implicit journeys how closely observed formally and informally.
The trip around the other hubs that also turn: the bed hub, social services hub...
The journey through the calendar that is reflected in so many diaries.
The journey called supervision and why is the start session square so hard to find - time for?
The journey called allocation from referral to assignment of care coordinator. 
The journey through procedure land which includes a territory called complaints.
There is the healthcare journey that claims respect as it is predicated upon the postcode.
The journey of idealism and legacy that is called integrated, 
person centred, holistic care and reflective practice...?
Care programme approach review - initial, intermediate, discharge meeting and community review.
The path clearly delineated but less (not yet) travelled
 - health promotion, preventive medicine, self-care, self-efficacy and health literacy (education).
The journey through so many environments: inner - outer space.
The journey that is hope... and Psyche's way-finder...

How many of the care domains of Hodges' model 
do you ensure you pass through - including the spiritual?

Of course, this list only scratches the surface...

All these journeys can be found and navigated through Hodges' model.

WEST--------------------------------------- EAST

As for the sign 'New Invention'...

Last Saturday at 0700 I left WN4 and headed south for Hay-on-Wye. I arrived at 0930 after passing through Clun and the hamlet of New Invention. I returned with a box of secondhand books, including a couple on education history purchased on my last visit in November 2015. These were useful in the studies at Lancaster. Once sold, 22 books in all, I had £20. Six other books went to the charity shop. An enjoyable trip.

Photo by Philip Halling, CC BY-SA 2.0, Link

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Wednesday, September 06, 2017

In This Corner of the World

WEST--------------------------------------- EAST

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Tuesday, September 05, 2017

Last Day of June - A game of love & loss

humanistic --------------------------------------- mechanistic

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Monday, September 04, 2017

Ethical concerns: Four principles approach (in Hodges' model)

humanistic --------------------------------------- mechanistic

Noordraven, E.L., Maartje H. N. Schermer, M.H.N., Blanken, P., Mulder, C.L. & Wierdsma, A.I. (2017). Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: patients’ and clinicians’ perspectives after a 12-month randomized controlled trial. BMC Psychiatry, 17: 313. https://doi.org/10.1186/s12888-017-1485-x

Priebe, S., Bremner, S.A., Lauber, C., Henderson, C. & Burns, T. (2016). Financial incentives to improve adherence to antipsychotic maintenance medicationin non-adherent patients: a cluster randomised controlled trial. Health Technology Assessment, 20 (70). pp. 1-122. ISSN 1366-5278 DOI: 10.3310/hta20700

My source:

Gillon (below) highlights a debate that is ongoing and even more acute given the ethical challenges of today. Interesting also that in 1994 attention to scope could provide a level of assurance(?):

Gillon, R. Medical ethics: four principles plus attention to scopeBMJ. 1994;309(6948):184–8.

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Sunday, September 03, 2017

Book: Caring Activism

Brian E Hodges who created the model trained in what is now learning disability nursing. With that and teaching to mental health and district nurses plus health visitors Hodges' model was designed from the outset with regard to the function of power, the role for advocacy and need to consider the political environment in which the patient, client or carer and nurse are interacting.

There are a great number of posts tagged as 'activism'. This isn't a flippant 'tag and post' but is intended to convey this essential characteristic of the model. There is a political tension within Hodges' model if people care to use it?

In Hay-on-Wye today I came across a book and site that includes 'caring activism' as a secular concept:

"Caring activism is proposed as a secular concept of care for vulnerable people of any age who are struggling with ineffective support or with no support at all."

If I can help you to use Hodges' model please do not hesitate to contact me: h2cmng AT yahoo.co.uk

humanistic --------------------------------------- mechanistic

Team Around the Child

Book review: http://www.tandfonline.com/doi/full/10.1080/09687599.2017.1294389

My source: Spotted in Richard Booth Bookshop, Hay-on-Wye

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Saturday, September 02, 2017

21st Century Discipline(s): Trump - Deleuze

humanistic --------------------------------------- mechanistic
"The encounter between two disciplines ... does not take place when one reflects on the other, ...
but when one discipline realizes that it has to resolve, for itself, ...by its own means, a problem similar to one confronted by the other." – Deleuze

My source: http://thebeautifulbrain.com/

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Friday, September 01, 2017

Goodbye Vienna! Drupalcon early-bird tickets flash sale

As for the past eight years I had planned on attending Drupalcon (EU) this year in Vienna. The £-Euro exchange rate and local costs in Vienna mean that I have to forego the trip this year.

Szeged in 2008 remains a favourite, but the community and learning all along the way Paris, Copenhagen, London, Munich, Prague, Amsterdam, Barcelona, Dublin - has been brill and all despite having no new site! There's been quite a few Drupalcamp's in there too. Whether it was the travel, the lovely weather, the arrival of the iPhone which other delegates had, the help and welcome received it is no surprise I was hooked. What do I mean 'was'?

Quarter Moon in a Ten Cent Town
Well I'm not sure if I will attend in 2018 - I'm counting the pennies now. Perhaps I could play continental leapfrog and attend Nashville instead. That would be amazing. In my teens Elite Hotel took its turn on the turntable. Even now I listen to Country 105 on occasion. Whenever I see the newish moon I think of a Quarter Moon in a Ten Cent Town. Sadly, the £-$ exchange rate is similarly in Dire Straits (who were also played often). So, as I ask many of the 19 people on my clinical caseload about their aims and objectives I have to look critically at my own.

If you are reading this and just happen to be thinking about doing a PhD and you have no funding. Do go and address this: Now! On the cusp of transition from Part 1 to Part 2 end of 2016 early 2017 I was seeking funding, but it really is too late then. There were other family factors. In the end I stepped off the programme with a MRes.

Mental health has featured as a specific topic at local Drupal user group meetings NWDUG and since a few years ago at a Drupalcon. Topics have included dealing with anxiety, depression and imposter syndrome. As I still wish to revisit earlier (bedroom-based) programming experience I am in awe of the knowledge and skills within the Drupal community. Of course I am not trivialising the experience of the speakers, but with regard to being an imposter this is not lost on me. At least a Wallaby is a Wallaby. I'm just a wannabe nerd? Speaking. Takes courage. Speaking about your lived experience at work and in a keynote is quite a feat. This channel of communication also demonstrates the mature and supportive attitude of the community, that has had challenges of its own.

For the moment, the new hosting account mocks me. I'm sure I'm not alone. I've written before about stopping the blog, earning the Drupalcon trip (stripe) by producing a site - however in-complete. I am bound to continue with this.

If you've a space in your diary for Drupalcon Vienna I understand there are more early bird tickets in a flash sale: but today only.

I'll miss you Vienna!

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Thursday, August 31, 2017

14th Annual Internal Mental Health Conference ‘Quality and Compassion: Challenges and Opportunities for Mental Health'

Saturday 28th October 2017

Ulster University, Magee campus, Londonderry

This is our fourteenth Annual Mental Health Conference at Magee Campus. This conference will provide an opportunity to enhance the wealth of experience and knowledge that is gained through the exchange of ideas with conference delegates, within the mental health field and from the wider network of disciplines working within our schools and communities both statutory and voluntary. Inclusive to this invitation are persons who are experts by experience of mental health problems and their families. The theme for the one day conference on Saturday 28 October 2017 is ‘Quality and Compassion: Challenges and Opportunities for Mental Health, which focuses on the ‘recovery of individuals from mental health problems’

There have been many changes in recent years in the work of mental health practitioners and care providers. It is important that we consider our skills and services in the light of these changes and how they will impact on the future delivery of quality mental health care.

There are a limited number of concessionary places available by arrangement directly with conference organisers for registered charities and service users. The conference fees include lunch, refreshments and conference documentation.

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Tuesday, August 29, 2017

Book: Psyche on the Skin

humanistic --------------------------------------- mechanistic
Psyche on the Skin

"Psyche on the Skin
 charts the secret history of self-harm. The book describes its many forms, from sexual self-mutilation and hysterical malingering in the late Victorian period, to self-castrating religious sects, to self-mutilation and self-destruction in art, music and popular culture. Sarah Chaney’s refreshing historical approach refutes the notion that self-harm has any universal meaning – that it necessarily says something specific about an individual or group, or that it can ever be understood outside the historical and cultural context of a particular era. " Reaktion Books 

Sarah Chaney‏

My source:
RCN BULLETIN, February 2017, p.11.

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Monday, August 28, 2017

Book: Into the Grey Zone

humanistic --------------------------------------- mechanistic
Into the Grey Zone
Conscious <-------> Unconscious
'Basic' Nursing Care

While Hodges' model incorporates many dichotomies, the model also serves to highlight not all things are black and white, binary, analogue. ...

Owen, A.M. (2017). Into the Grey Zone: A Neuroscientist Explores the Border Between Life and Death, London: Guardian Faber.

My source:
Davies, H. (2017) News from the beyond. The Sunday Times, Culture, 27 August,  pp.34-35.

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Sunday, August 27, 2017

Paper: "Defining Health in the Era of Value-based Care ..." mapped to Hodges' model

humanistic --------------------------------------- mechanistic
Q. What is value?


(Individual) freedom to lead lives they have reason to value

[Why we need a global generic conceptual framework: 
Self care = 
transformation of Demand into Supply]

Reported Outcome Measures (PROMs)

'benefit' across Hodges' model?
'harm done' across Hodges' model?

Shared Decision Making - 
patient centred care, 
choice, autonomy, 

Right Care, Right Time, Right Place?*

Value = outcomes achieved – money spent (Porter)

1.Allocative value – how to allocate resources equitably in such a way that maximum value for the whole population is obtained
2.Technical value – increased value associated with improvements in quality and safety of healthcare
3.Personalised value – individual patient values, in combination with best evidence and assessments of the person’s condition. (Gray)

Supply - Outcomes
PROMS: hip replacement, knee replacement, groin hernia and varicose veins
Right Care, Right Time, Right Place

Chronic disease
Improving medical technology

Social determinants of health

"Unlimited healthcare intervention
provision may lead to increased harm."

Friends and Family Test

Person- and community-centred approaches, such as peer support, self-management education, health coaching, group activities and asset-based approaches.

Local - Community - National

Porter recommends classification of outcomes in three tiers [16]. Tier one is ‘Health status achieved or retained’, including measures such as survival at one or five years, or for those with life-limiting conditions, the degree of health or recovery achieved or maintained. Tier two, ‘Process of recovery’, includes the time taken to return to normal activities and disutility of care, such as errors and adverse events in care, incorrect diagnosis, and discomfort. Tier three is ‘Sustainability of health’ and includes recurrence and long-term consequences of treatment.

"The definition proposed by Gray ... defines value in healthcare as ‘the net benefit, that is the difference between the benefit and the harm done by a service, taking into account the amount of resources invested’"

Supply - Outcomes
Health Economics
limited healthcare budgets

Governments - Industries
demand - drug costs

Moving FROM: cost-effectiveness and pay for performance
TO: Value-based pricing

Healthcare-associated harm

Value-based healthcare has the potential to be used in local and national priority setting and
policy development.

International Consortium for Health Outcomes Measurement

*This brief paper provides a very good outline of value-based care. 'Mental' in this paper is mentioned early on in a definition of health, thereafter you will find 'mental' in funda-mental, environ-mental plus incre-mental. 'Mental health' and values-based care will no doubt be discussed elsewhere. This brief paper suggests however, that we really do need a generic conceptual framework for health and social care. To be fully-realised value-based care must also reach, encompass and incorporate mental health and public mental health.

Gentry S, Badrinath P (March 06, 2017) Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems. Cureus 9(3): e1079. DOI 10.7759/cureus.1079

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Thursday, August 24, 2017

Book: To Be a Machine

humanistic --------------------------------------- mechanistic
A robotic facsimile commissioned by Martine Rothblatt - of her wife, Bina, ...

A robotic facsimile commissioned by Martine Rothblatt - of her wife, Bina, ...

How do we judge someone's character. Appearance seems objective in one sense: please describe what you see? But as ever what is behind appearances? In terms of mind and body should these images be the other way around? Is intelligence vested in the physical brain? What of the mind, consciousness and personality?

O'Connell, M. (2017). To be a Machine: Adventures Among Cyborgs, Utopian, Hackers, and the Futurists Solving the Modest Problem of Death. UK & Comm Granta Books.

My source (and robotic facsimile images) Moody, O. (2017). Death? We'll soon have a cure for that, Saturday Review, The Times, April 1, 2017. p.13.

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Tuesday, August 22, 2017

Editorial: Exploring the relationship of threshold concepts and Hodges’ model of care from the individual to populations and global health

At the end of July I was contacted by the editor of the journal Revista CUIDARTE published by Programa de Enfermería de la Universidad de Santander UDES and invited to write an editorial. There were publication guidelines and a deadline: two weeks. Despite my astronautic aspirations my feet remained on the ground as I realised that I am surely filling a gap.

There were other family pressures at the time, but I already had the draft paper on Hodges' model and threshold concepts. After some thought and work the draft was reduced from 5600 words and 56 references to 3600 and 20 references. The example of Deprivation of Liberty was removed to include more generic subject matter in the themes of global health and development.

Whatever the reason (and editors please note...) I greatly appreciate this opportunity to further disseminate Hodges' model and threshold concepts. Greater still is the privilege to contribute to a community who provided me with one of the highlights of my nursing career in 2011.

Here is a video introduction (English):

Jones, P. (2017) Exploring the relationship of threshold concepts and Hodges’ model of care from the individual to populations and global health. Revista Cuidarte. 8(3): 1697-720.

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Sunday, August 20, 2017

NMC: Webinar - How should simulation be used in nursing and midwifery education?

HUMANISTIC--------------------------- MECHANISTIC
Intra- Interpersonal competence in 6Cs
Empathy and Rapport
Communication Skills
Learning modalities
Mental health training simulations

Simulation fidelity (Research)
Educational technology
Physical scenarios
Telecare - Patient

Learning Opportunities
Practice fidelity
Mentoring relationships
Simulation: correspondence :Practice

Public safety
Assessment assurance
Single action bias (completed simulation training - so that's OK then?)
Funding: Resources
(for Acute - Mental Health)
Telecare - Staff

Is there a tendency for simulation to be 'process' bound, that is, mechanistic? How can this be checked and if so, mitigated? What of the other P's - purposes, practice and policy and the basis for all these: values?

See also previous post: Editorial: "Living dolls and nurses without empathy" mapped to Hodges' model

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Saturday, August 19, 2017

Every Third Thought

humanistic --------------------------------------- mechanistic
Every Third Thought

First ...


Second ...

My source: Lewis, R. (2017) An immense personal insult - how the baby boomers see death. Saturday Review, The Times. p.13.

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Friday, August 18, 2017

"Mapping the drivers of overdiagnosis to potential solutions" (re-)mapped to Hodges' model

humanistic --------------------------------------- mechanistic
 the patient 

Beliefs: “More is better,” “new is better,” “early is better,” “wants to know/screen”—even if currently healthy, imperative of possibility (we have to test because we can)

overtreatment - emotional cost

Ethics: medical awareness of benefits vs harms

risk of overtreatment - as psycho-(somaticpathology)

 the patient 

the health system

industry, professionals

Rigorous assessment of impact of ever more precise tests and investigations

Medicalisation of life;
 fear of ageing, sickness, or death

QUANTITY (less is more)

Update medical curricula and -
culture - Beliefs: “More is better,” “new is better,” “early is better,” “wants to know -
screen”—even if currently healthy, imperative of possibility (we have to test because we can)

patients and the public

(social evolution of 'illness behaviour'?)

QUALITY - outcomes

overtreatment - social cost

Role of social media
- continuing education

  Ecological economics to frame overdiagnosis as overconsumption

Application of the 'precautionary principle'
(as adopted as a universal policy foundation?)

industry, professionals

medicolegal concerns regards 
missing or delayed diagnosis

overtreatment - economic cost

drivers of overdiagnosis
solutions of overdiagnosis
 (I have overlapped these.)

The medicalisation of life also fits with Hodges' model and the concept of the 'health career'.


See also: BBC Radio 4 22 August 2017
Too Much Medicine? The Problem of Overtreatment

My source:

Dear List
Ray Moynihan, a member of our list, sent me the following email about his very important work on Overdiagnosis:
---------- Forwarded message ----------
From: Ray Moynihan
Hi Mohammad,
Just wondering if you wanted to send this to the email list/s you run - we've put a bit of work into it- and it may be of interested to many of the people on the list.

Dear colleagues,
This piece of BMJ Analysis, based on explicit search of literature, just out in BMJ this morning, may be of interest:
Mapping the drivers of overdiagnosis to potential solutions


Cheers, Ray

Mohammad Zakaria Pezeshki, M.D.
Associate Professor
Department of Community Medicine,
Tabriz Medical School, Golgasht Avenue, Tabriz, Iran,

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