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id="_NBK588853_"><span itemprop="name">Improving access to advocacy</span></h1><div class="subtitle">Advocacy services for adults with health and social care needs</div><p><b>Evidence review D</b></p><p><i>NICE Guideline, No. 227</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 Nov</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4782-9</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div><div class="bkr_clear"></div></div><div id="niceng227er4.s1"><h2 id="_niceng227er4_s1_">Improving access to advocacy</h2><div id="niceng227er4.s1.1"><h3>Key theme</h3><ul><li class="half_rhythm"><div>Improving access to advocacy (including addressing barriers)</div></li></ul><div id="niceng227er4.s1.1.1"><h4>Introduction</h4><p>The aim of this review is identify ways of improving access to advocacy.</p><p>Recommendations about advocacy have been made in a number of existing NICE guidelines. However, these have identified a lack of evidence relating to advocacy that would meet inclusion criteria for standard evidence reviews. Therefore, it was agreed that recommendations for this guideline would be developed by adopting and adapting advocacy-related recommendations from existing NICE guidelines, using a formal consensus process based on statements generated from a call for evidence, and documents identified by the guideline committee, and informal consensus methods to address any areas of the guideline scope that are not covered by the existing NICE guidelines or the formal consensus process.</p></div><div id="niceng227er4.s1.1.2"><h4>Summary of the inclusion criteria</h4><p>Please see <a class="figpopup" href="/books/NBK588853/table/niceng227er4.tab1/?report=objectonly" target="object" rid-figpopup="figniceng227er4tab1" rid-ob="figobniceng227er4tab1">Table 1</a> for a summary of the inclusion criteria applied to evidence received in response to the call for evidence and identified by the guideline committee.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng227er4tab1"><a href="/books/NBK588853/table/niceng227er4.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng227er4tab1" rid-ob="figobniceng227er4tab1"><img class="small-thumb" src="/books/NBK588853/table/niceng227er4.tab1/?report=thumb" src-large="/books/NBK588853/table/niceng227er4.tab1/?report=previmg" alt="Table 1. Summary of the inclusion criteria." /></a><div class="icnblk_cntnt"><h4 id="niceng227er4.tab1"><a href="/books/NBK588853/table/niceng227er4.tab1/?report=objectonly" target="object" rid-ob="figobniceng227er4tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the inclusion criteria. </p></div></div></div><div id="niceng227er4.s1.1.3"><h4>Methods and process</h4><p>The process for identifying, adopting and adapting recommendations from existing NICE guidelines, the call for evidence and formal consensus <a href="/books/NBK588853/bin/supplement-1-methods-pdf-11258616349.pdf">methods</a> are described in <a href="#niceng227er4.appa">appendix A</a>, with further detail in supplementary material 1.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s 2019 conflicts of interest policy (see Register of Interests)</a>.</p></div><div id="niceng227er4.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng227er4.s1.1.4.1"><h5>Included studies</h5><div id="niceng227er4.s1.1.4.1.1"><h5>Existing NICE guidelines</h5><p>Existing recommendations relevant to improving access to advocacy (including addressing barriers) were identified from 3 NICE guidelines ([NG119] Cerebral palsy in adults, [NG189] Safeguarding adults in care homes, [PH50] Domestic violence and abuse: multi-agency working). The audiences for these guidelines included: people with the condition or users of a services and their families and carers; health and social care professionals, practitioners and providers; service managers; commissioners, local authorities and safeguarding adult boards; and other staff who come into contact with people using services (for example, education, voluntary and community sector, and criminal justice staff). Only NG189 specifically listed advocates among their target audiences.</p></div><div id="niceng227er4.s1.1.4.1.2"><h5>Formal consensus</h5><p>A single call for evidence was undertaken for all topics included in the scope of this guideline. Additional documents were identified by the guideline committee. See the study selection flow chart in <a href="#niceng227er4.appa">appendix A</a>.</p><p>Fourteen documents were identified for this review (<a class="bibr" href="#niceng227er4.s1.1.ref4" rid="niceng227er4.s1.1.ref4">Chatfield 2017</a>, <a class="bibr" href="#niceng227er4.s1.1.ref5" rid="niceng227er4.s1.1.ref5">Harflett, 2015</a>, <a class="bibr" href="#niceng227er4.s1.1.ref6" rid="niceng227er4.s1.1.ref6">Lawson 2017</a>, <a class="bibr" href="#niceng227er4.s1.1.ref7" rid="niceng227er4.s1.1.ref7">Lawson 2020</a>, <a class="bibr" href="#niceng227er4.s1.1.ref8" rid="niceng227er4.s1.1.ref8">Mercer 2020</a>, <a class="bibr" href="#niceng227er4.s1.1.ref9" rid="niceng227er4.s1.1.ref9">National Development Team for Inclusion [NDTi] 2012</a>, <a class="bibr" href="#niceng227er4.s1.1.ref10" rid="niceng227er4.s1.1.ref10">NDTi 2016a</a>, <a class="bibr" href="#niceng227er4.s1.1.ref11" rid="niceng227er4.s1.1.ref11">NDTi 2020a</a>, <a class="bibr" href="#niceng227er4.s1.1.ref12" rid="niceng227er4.s1.1.ref12">NDTi 2020b</a>, <a class="bibr" href="#niceng227er4.s1.1.ref13" rid="niceng227er4.s1.1.ref13">Newbigging 2011</a>, <a class="bibr" href="#niceng227er4.s1.1.ref14" rid="niceng227er4.s1.1.ref14">Newbigging 2012</a>, <a class="bibr" href="#niceng227er4.s1.1.ref15" rid="niceng227er4.s1.1.ref15">Roberts 2012</a>, <a class="bibr" href="#niceng227er4.s1.1.ref16" rid="niceng227er4.s1.1.ref16">SERIO 2021</a>,<a class="bibr" href="#niceng227er4.s1.1.ref17" rid="niceng227er4.s1.1.ref17">Turner 2012</a>).</p><p>Four documents focused on people living with autism and/or people living with learning disabilities, including those who are most isolated (<a class="bibr" href="#niceng227er4.s1.1.ref9" rid="niceng227er4.s1.1.ref9">NDTi 2012</a>, <a class="bibr" href="#niceng227er4.s1.1.ref5" rid="niceng227er4.s1.1.ref5">Harflett 2015</a>, <a class="bibr" href="#niceng227er4.s1.1.ref15" rid="niceng227er4.s1.1.ref15">Roberts 2012</a>, <a class="bibr" href="#niceng227er4.s1.1.ref17" rid="niceng227er4.s1.1.ref17">Turner 2012</a>). Three documents focused on providers and commissioners of independent advocacy (<a class="bibr" href="#niceng227er4.s1.1.ref6" rid="niceng227er4.s1.1.ref6">Lawson 2017</a>, <a class="bibr" href="#niceng227er4.s1.1.ref7" rid="niceng227er4.s1.1.ref7">Lawson 2020</a>, NDTi 2016). Three documents focused on advocacy services (<a class="bibr" href="#niceng227er4.s1.1.ref7" rid="niceng227er4.s1.1.ref7">Mercer 2020</a>, <a class="bibr" href="#niceng227er4.s1.1.ref11" rid="niceng227er4.s1.1.ref11">NDTi 2020a</a>, <a class="bibr" href="#niceng227er4.s1.1.ref12" rid="niceng227er4.s1.1.ref12">NDTi 2020b</a>). One document each focused on people detained under the amended Mental Health Act 1983 (<a class="bibr" href="#niceng227er4.s1.1.ref14" rid="niceng227er4.s1.1.ref14">Newbigging 2012</a>); African and Caribbean men using mental health services (<a class="bibr" href="#niceng227er4.s1.1.ref13" rid="niceng227er4.s1.1.ref13">Newbigging 2011</a>); critical care unit clinicians, relatives of critical care patients and Independent Mental Capacity Advocates (IMCAs; <a class="bibr" href="#niceng227er4.s1.1.ref4" rid="niceng227er4.s1.1.ref4">Chatfield 2017</a>); and Veterans and their families (<a class="bibr" href="#niceng227er4.s1.1.ref16" rid="niceng227er4.s1.1.ref16">SERIO 2021</a>).</p></div></div><div id="niceng227er4.s1.1.4.2"><h5>Excluded studies</h5><div id="niceng227er4.s1.1.4.2.1"><h5>Formal consensus</h5><p>Documents not included in this review are listed, and reasons for their exclusions are provided in <a href="#niceng227er4.appd">appendix D</a>.</p></div></div></div><div id="niceng227er4.s1.1.5"><h4>Summary of included studies</h4><p>Summaries of documents included in the formal consensus process for this review are presented in <a class="figpopup" href="/books/NBK588853/table/niceng227er4.tab2/?report=objectonly" target="object" rid-figpopup="figniceng227er4tab2" rid-ob="figobniceng227er4tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng227er4tab2"><a href="/books/NBK588853/table/niceng227er4.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng227er4tab2" rid-ob="figobniceng227er4tab2"><img class="small-thumb" src="/books/NBK588853/table/niceng227er4.tab2/?report=thumb" src-large="/books/NBK588853/table/niceng227er4.tab2/?report=previmg" alt="Table 2. Summary of documents included in the formal consensus process." /></a><div class="icnblk_cntnt"><h4 id="niceng227er4.tab2"><a href="/books/NBK588853/table/niceng227er4.tab2/?report=objectonly" target="object" rid-ob="figobniceng227er4tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of documents included in the formal consensus process. </p></div></div><p>See the full evidence tables for documents included in the formal consensus process in <a href="#niceng227er4.appb">appendix B</a> and a summary of the quality assessment of these documents in <a href="#niceng227er4.appc">appendix C</a>.</p></div><div id="niceng227er4.s1.1.6"><h4>Summary of the evidence</h4><div id="niceng227er4.s1.1.6.1"><h5>Existing NICE guidelines</h5><p>A total of 3 existing recommendations related to improving access to advocacy (including addressing barriers) were identified from the 3 NICE guidelines<b>Error! Reference source not found.</b>. The committee agreed 1 recommendation should be adapted and 2 recommendations should not be used in this guideline.</p><p>See <a href="#niceng227er4.appf">Appendix F</a> for a list of the existing recommendations, a summary of the supporting evidence behind these recommendations, and the decisions made based on the committee’s discussion of these recommendations.</p><p>The quality of existing NICE guidelines was assessed using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II). See the results of the quality assessment in <a href="#niceng227er4.appc">appendix C</a>.</p></div><div id="niceng227er4.s1.1.6.2"><h5>Formal consensus round 1</h5><p>Three included documents (<a class="bibr" href="#niceng227er4.s1.1.ref6" rid="niceng227er4.s1.1.ref6">Lawson, 2017</a>; <a class="bibr" href="#niceng227er4.s1.1.ref9" rid="niceng227er4.s1.1.ref9">NDTi, 2012</a>; <a class="bibr" href="#niceng227er4.s1.1.ref10" rid="niceng227er4.s1.1.ref10">NDTi, 2016a</a>) were assessed using AGREE II, 3 documents (<a class="bibr" href="#niceng227er4.s1.1.ref5" rid="niceng227er4.s1.1.ref5">Harflett, 2015</a>; <a class="bibr" href="#niceng227er4.s1.1.ref8" rid="niceng227er4.s1.1.ref8">Mercer, 2020</a>; <a class="bibr" href="#niceng227er4.s1.1.ref13" rid="niceng227er4.s1.1.ref13">Newbigging, 2011</a>) were assessed using the Risk of Bias in Systematic reviews (ROBIS) checklist ,and 8 documents (<a class="bibr" href="#niceng227er4.s1.1.ref4" rid="niceng227er4.s1.1.ref4">Chatfield, 2017</a>; <a class="bibr" href="#niceng227er4.s1.1.ref7" rid="niceng227er4.s1.1.ref7">Lawson, 2020</a>;, <a class="bibr" href="#niceng227er4.s1.1.ref11" rid="niceng227er4.s1.1.ref11">NDTi, 2020a</a>; <a class="bibr" href="#niceng227er4.s1.1.ref12" rid="niceng227er4.s1.1.ref12">NDTi, 2020b</a>; <a class="bibr" href="#niceng227er4.s1.1.ref14" rid="niceng227er4.s1.1.ref14">Newbigging, 2012</a>; <a class="bibr" href="#niceng227er4.s1.1.ref15" rid="niceng227er4.s1.1.ref15">Roberts, 2012</a>; <a class="bibr" href="#niceng227er4.s1.1.ref16" rid="niceng227er4.s1.1.ref16">SERIO, 2021</a>; <a class="bibr" href="#niceng227er4.s1.1.ref17" rid="niceng227er4.s1.1.ref17">Turner, 2012</a>) were assessed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. See the results of the quality assessment in the evidence tables in <a href="#niceng227er4.appb">appendix B</a> and quality assessment tables in <a href="#niceng227er4.appc">appendix C</a>.</p><p>The committee were presented with 53 statements in round 1 of the formal consensus exercise; responses were received from 11 of 13 committee members. Thirty-two of these statements reached ≥80% agreement in round 1 and were included for the discussion with the committee. Seventeen statements had between 60% and 80% agreement; 15 of these were re-drafted for round 2 and 2 were discarded as the suggestions for revision were covered by existing statements. Four statements had <60% agreement and were discarded.</p><p>See <a href="#niceng227er4.appg">appendix G</a> for the statements that were rated by the committee and results of round 1, which are provided in Table 10.</p></div><div id="niceng227er4.s1.1.6.3"><h5>Formal consensus round 2</h5><p>The committee were presented with 15 statements in round 2 of the formal consensus exercise; responses were received from 10 of 13 committee members. Ten statements reached ≥80% agreement in this round and were included for the discussion with the committee. Four statements had between 60% and 80% agreement and one statement had <60% agreement. Statement 43 was included for the discussion with the committee as comments from the committee related to a minor issue with the population that could be addressed during the discussion of recommendations. The remaining statements were discarded.</p><p><i>See <a href="#niceng227er4.appg">appendix G</a> for the statements that were rated by the committee and results of round 2, which are provided in BME: Black and Minority Ethnic; IMHA: Independent Mental Health Advocate; MH: mental health</i> Table 11.</p></div></div><div id="niceng227er4.s1.1.7"><h4>Economic evidence</h4><p>Economic considerations will be taken into account together with resource impact.</p></div><div id="niceng227er4.s1.1.8"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="niceng227er4.s1.1.8.1"><h5>The outcomes that matter most</h5><p>In the methods used for this guideline (adopting and adapting existing recommendations and formal consensus) no outcomes were considered formally by the committee; therefore, the committee were not required to determine which outcomes were critical or important.</p><div id="niceng227er4.s1.1.8.1.1"><h5>The quality of the evidence</h5><div id="niceng227er4.s1.1.8.1.1.1"><h5>Existing NICE guidelines</h5><p>The quality of the existing NICE guidelines was assessed using AGREE II. Overall, the guidelines are of a very high quality (2 or more domains scored ≥90%) and are recommended for use. Two guidelines scored lower in stakeholder involvement because there were fewer experts by experience included in the committee group compared to other guidelines. In addition, the committee considered whether the recommendation could be generalised to a new context when making a decision about adopting or adapting the recommendations, which is documented in the benefits and harms section and <a href="#niceng227er4.appf">appendix F</a>.</p></div><div id="niceng227er4.s1.1.8.1.1.2"><h5>Formal consensus</h5><p>The quality of some of the documents identified by the committee and through the call for evidence was assessed using ROBIS and the AGREE II tool, which is explained in detail in the methods supplement for this guideline. ROBIS is intended for use in assessing the quality of systematic reviews but was also used for the purpose of this guideline to assess a number of reviews that were not intended by the authors to be systematic as it was the best available tool. The AGREE II instrument is intended for use assessing the quality of systematically developed clinical practice guidelines, including assessments of methodological rigour and transparency. Therefore, some domains of ROBIS and the AGREE II tool may be less relevant for these documents and they would not have followed reporting guidelines for systematic reviews. All supporting material published with documents was reviewed to inform quality assessment, however it was not feasible to contact the authors of each document. Therefore it is plausible that the documents may have scored lower on quality assessments than the underlying methodology would warrant had authors made their full methodology available or if more appropriate tools were available. The committee were aware of this in their discussions of the existing recommendations and statements extracted from documents identified from the call for evidence. Where shortcomings in the quality of documents impacted the committee’s opinions about using the statements, this is described in the benefits and harms section below. On the whole however, where there was full committee support for a statement extracted from a lower quality document, the committee made the recommendation because their experiential knowledge corroborated the statement and strengthened the argument to use it as the basis for a recommendation.</p><p>The quality of 3 documents (<a class="bibr" href="#niceng227er4.s1.1.ref6" rid="niceng227er4.s1.1.ref6">Lawson, 2017</a>; <a class="bibr" href="#niceng227er4.s1.1.ref9" rid="niceng227er4.s1.1.ref9">NDTi, 2012</a>; <a class="bibr" href="#niceng227er4.s1.1.ref10" rid="niceng227er4.s1.1.ref10">NDTi, 2016a</a>) was assessed using the AGREE II instrument. High quality documents were defined as those where any two domains scored ≥ 70%. The 3 documents were not deemed to be high quality. The included documents scored between 16% and 28% for stakeholder involvement and between 4% and 21% for applicability. The documents scored between 8% and 19% for rigour of development and between 0% and 17% for editorial independence. Overall, the documents did not provide sufficient information on the stakeholder involvement in the development of the document. It was unclear whether the likely barriers and facilitators to implementation, strategies to improve uptake, and resource implications of applying the document were considered. The methods used to formulate and update the recommendations, and details on whether a systematic process had been used to gather and synthesise the evidence, were not clearly described. Declaration of any bias or competing interests from the document development group members were not reported.</p><p>The included documents scored between 22% and 83% for scope and purpose, and between 22% and 56% for clarity of presentation. Generally, the overall aim, specific health questions and target population for the documents were described, but details were sometimes limited. The document did not present recommendations in a clear and concise structure and format.</p><p>The quality of 3 documents (<a class="bibr" href="#niceng227er4.s1.1.ref5" rid="niceng227er4.s1.1.ref5">Harflett, 2015</a>; <a class="bibr" href="#niceng227er4.s1.1.ref8" rid="niceng227er4.s1.1.ref8">Mercer, 2020</a>; <a class="bibr" href="#niceng227er4.s1.1.ref13" rid="niceng227er4.s1.1.ref13">Newbigging, 2011</a>) was assessed using the ROBIS checklist for systematic reviews. Two documents (<a class="bibr" href="#niceng227er4.s1.1.ref5" rid="niceng227er4.s1.1.ref5">Harflett, 2015</a>; <a class="bibr" href="#niceng227er4.s1.1.ref13" rid="niceng227er4.s1.1.ref13">Newbigging, 2011</a>) were judged to have unclear risk of bias because insufficient details were provided to enable a judgement to be made. The remaining document (<a class="bibr" href="#niceng227er4.s1.1.ref8" rid="niceng227er4.s1.1.ref8">Mercer, 2020</a>) was judged to have high risk of bias because some eligible studies are likely to have been missed from the scoping exercise and some bias may have been introduced through the data collection, and no risk of bias assessment was completed.</p><p>The quality of 8 documents (<a class="bibr" href="#niceng227er4.s1.1.ref4" rid="niceng227er4.s1.1.ref4">Chatfield, 2017</a>; <a class="bibr" href="#niceng227er4.s1.1.ref7" rid="niceng227er4.s1.1.ref7">Lawson, 2020</a>; <a class="bibr" href="#niceng227er4.s1.1.ref11" rid="niceng227er4.s1.1.ref11">NDTi, 2020a</a>; <a class="bibr" href="#niceng227er4.s1.1.ref12" rid="niceng227er4.s1.1.ref12">NDTi, 2020b</a>; <a class="bibr" href="#niceng227er4.s1.1.ref14" rid="niceng227er4.s1.1.ref14">Newbigging, 2012</a>; <a class="bibr" href="#niceng227er4.s1.1.ref15" rid="niceng227er4.s1.1.ref15">Roberts, 2012</a>; <a class="bibr" href="#niceng227er4.s1.1.ref16" rid="niceng227er4.s1.1.ref16">SERIO, 2021</a>; <a class="bibr" href="#niceng227er4.s1.1.ref17" rid="niceng227er4.s1.1.ref17">Turner, 2012</a>) was assessed using the CASP checklist for qualitative research. One document (<a class="bibr" href="#niceng227er4.s1.1.ref14" rid="niceng227er4.s1.1.ref14">Newbigging, 2012</a>) was judged to have minor methodological limitations. One document (<a class="bibr" href="#niceng227er4.s1.1.ref4" rid="niceng227er4.s1.1.ref4">Chatfield, 2017</a>) was judged to have moderate methodological limitations because the authors did not adequately consider the relationship between researcher and participants. Six documents (<a class="bibr" href="#niceng227er4.s1.1.ref7" rid="niceng227er4.s1.1.ref7">Lawson, 2020</a>; <a class="bibr" href="#niceng227er4.s1.1.ref11" rid="niceng227er4.s1.1.ref11">NDTi, 2020a</a>’ <a class="bibr" href="#niceng227er4.s1.1.ref12" rid="niceng227er4.s1.1.ref12">NDTi, 2020b</a>; <a class="bibr" href="#niceng227er4.s1.1.ref15" rid="niceng227er4.s1.1.ref15">Roberts, 2012</a>; <a class="bibr" href="#niceng227er4.s1.1.ref16" rid="niceng227er4.s1.1.ref16">SERIO, 2021</a>; <a class="bibr" href="#niceng227er4.s1.1.ref17" rid="niceng227er4.s1.1.ref17">Turner, 2012</a>) were judged to have serious methodological limitations because of insufficient detail relating to participant recruitment, data collection and data analysis. Other concerns related to the lack of adequate consideration for the relationship between researcher and participants, and lack of consideration regarding ethical issues.</p></div></div></div><div id="niceng227er4.s1.1.8.2"><h5>Benefits and harms</h5><p>The committee acknowledged that most of the statements below had been extracted from documents judged to be of lower quality. The committee discussed that although the quality was low, the content of the statements was relevant and important to include. Although there was some variation in the percentage agreement of statements, the majority of committee members agreed with the statements, which chimed with their own knowledge and experience. They concluded it would be important to make recommendations on that basis and that the benefits of doing so outweighed any risks of excluding these statements altogether.</p><div id="niceng227er4.s1.1.8.2.1"><h5>Meeting in-person</h5><p>Statement 7 covered professional visitors, including advocates, being able to meet with people in-person. The committee agreed it was important that advocates are able to meet with people in person, especially in order to facilitate the person’s initial access to advocacy services. In the committee’s experience, an initial in-person meeting could improve access as some people are less willing to use advocacy services if this option isn’t available as a first step into a service. In the committee’s experience, meeting with people in person was routine practice prior to the COVID-19 pandemic, but has become more difficult since the pandemic. They said that motivated by cost savings, many services planned to continue this remote practice even after COVID-19 restrictions lifted. The committee expressed some concern about this, agreeing that this approach to interaction really undermined the advantages of face to face meetings described above.</p></div><div id="niceng227er4.s1.1.8.2.2"><h5>Blanket restrictions preventing advocates access to people</h5><p>Statement 8 covered that there should not be universal restrictions that prevent advocates accessing where people are, including care homes and hospitals. The committee agreed to adapt this recommendation to also include prison settings as the committee were aware of advocates also having difficulty in accessing these settings. In the committee’s experience, this recommendation is needed as there are concerns that restrictions, such as social distancing and limits on hospital and care home visiting, brought on by COVID-19 might become the new norm. Further, the committee agreed that it seems to have been more difficult for advocates to access such settings during the pandemic than it has been for other professionals and that it was important that people have continued access to advocates so that rights are upheld.</p></div><div id="niceng227er4.s1.1.8.2.3"><h5>Single and multiple points of access</h5><p>Statement 22 covered commissioners considering having a single point of access to advocacy services so that individuals do not need to know what type of advocacy they require. The committee agreed that it is important to have a central route into advocacy services, such that referrals for different types of advocacy can be coordinated, in order to maximise access to advocacy. In their experience referrals are often sent back because the right information was not included, which delays and may deter people accessing services. However, the committee agreed that this does not mean there should only be one way to access advocacy services as having only a single point of access could create a barrier and limit empowerment and self-advocacy. On the other hand, the committee agreed that having multiple access points may help to reach seldom-heard groups. Therefore, the committee concluded that it was important for the recommendation to address both these points so that people do not need to go to different places according to which type of advocacy they need and at the same, people should have flexibility in how they access services.</p></div><div id="niceng227er4.s1.1.8.2.4"><h5>Keeping the same advocate</h5><p>Statement 25 covered people not having access to advocacy when they no longer qualify for independent mental health advocate (IMHA) services, unless the advocacy service has a strategy for ensuring continuity of access. The committee agreed that the best way to address this would be for people to keep the same advocate when they transition between different types of advocacy as effective advocacy depends on the development of trust and mutual understanding between the advocate and the person using advocacy support. In the committee’s experience, this happens in some areas and services, where multi-skilled advocates are available that can provide different types of advocacy, but does not happen everywhere. Therefore, the committee acknowledged that it would not always be possible to keep the same advocate and recommended that systems are in place for handover when needed so that people do not require a new referral and are not lost to services as they ‘drop out’ out of one advocacy provider. The existing recommendation in enabling and supporting effective advocacy from the NICE guideline on people’s experience in adult social care services [NG86] about commissioners and managers in all settings ensuring there is continuity in care was also used to inform this recommendation (see evidence review E).</p></div><div id="niceng227er4.s1.1.8.2.5"><h5>Regular visits to hospitals by IMHA services</h5><p>Statement 26 covered the need for regular visits to hospital wards by IMHA services, particularly to identify people who would be unable to instruct them and could potentially miss out on services. Health practitioners should be making referrals in the case of non-instructed advocacy; however, in the committee’s experience, this does not routinely happen. Therefore, the committee agreed that having a regular presence of IMHAs on hospital wards is important to help ensure that people are not missing out on their statutory right to advocacy. Further, the committee agreed that advocates having a regular presence on wards could have an important safeguarding effect, in addition to improving access, as it will give them a comprehensive view of people’s circumstances and living conditions on the ward. The committee agreed this recommendation was particularly important in light of difficulties accessing services or meeting with individuals face-to-face during the COVID-19 pandemic, as described above.</p></div><div id="niceng227er4.s1.1.8.2.6"><h5>Offering services to all eligible people</h5><p>Statement 39 originally covered access to IMHA services being improved by an opt-out system. This was amended in response to comments from the committee to focus on offering services to all eligible people, as opposed to using an opt-out system. However, in light of the expert testimony described in evidence review F, which recommended careful implementation of an opt-out system for advocacy in particular contexts, the committee agreed it was important that everyone who is eligible meets with an advocate and is offered the service. The expert testimony stated that this was an important measure for overcoming barriers to access arising from lack of awareness or understanding and negative attitudes about advocacy. The committee agreed, based on their experience, that referrals are not always made when they should be and that offering advocacy on an opt-out basis has been an effective way of ensuring access to advocacy for those with a statutory entitlement in areas where this has been implemented. The committee agreed it was important that an IMHA is offered to eligible people at the earliest opportunity. In the committees’ experience referrals are frequently made too late, which does not give people enough time to arrange advocacy support or meet with their advocates ahead of key meetings or events, resulting in them being unable to fully and effectively participate in decision making. The committee agreed that is was also important to repeat the offer of an IMHA, as in some circumstances people might be too unwell at the point advocacy is initially offered or their circumstances can change, both of which can both lead to people changing their minds about advocacy if they initially declined. However, repeatedly offering an IMHA needs to be done within the context of a regular presence on the ward where the offer of an IMHA can come up conversationally and a person is not being pressurised with repeated offers and information.</p></div><div id="niceng227er4.s1.1.8.2.7"><h5>Raising awareness of services user groups</h5><p>Statement 42 highlighted that access to IMHA could be improved by raising awareness of service user groups and supporting peer promotion of services. The committee agreed to amend this statement to focus on raising awareness of services user groups and supporting peer and self-advocacy as it is not within the remit of NICE guidelines to ask peers to promote advocacy services. However, in the committee’s experience, people may prefer to seek advocacy from a peer rather than a professional as they may feel that they are better understood by, or more trusting of, people with similar experiences to them. This was also supported by the expert testimony described in evidence review F. Further, self-advocacy has the benefit of developing skills and part of the advocacy ethos is to support independence and, by extension, self-advocacy. The committee also agreed that the use of less formal types of advocacy allows for consideration of wider issues that would not be within the remit of a professional advocate’s role.</p></div><div id="niceng227er4.s1.1.8.2.8"><h5>Ensuring services are being taken up by people with greatest needs</h5><p>Statement 1 covered advocacy organisations promoting advocacy services and proactively offering support to people who may want to use advocacy services. The committee agreed to reword this statement as advocates cannot be asked to promote themselves, but instead advocacy organisations should have plans as to how to ensure that their services are taken up by people with the greatest need, who may not be able to ask for them. In the committee’s experience this is not happening consistently and people might miss out on the support they are entitled to. Having this plan and acting on it would ensure these people do not miss out on this support.</p></div><div id="niceng227er4.s1.1.8.2.9"><h5>Making information available in a variety of locations</h5><p>Having made recommendations based on the statements presented as well as the expert testimony, the committee agreed there remained key areas which would benefit from recommendations to ultimately improve access. For instance, they discussed that difficulties in locating information about advocacy services are widely perceived to be a barrier to accessing support. They agreed that this could be addressed by advocacy providers making information available in a variety of different locations online. In the committee’s experience people who have previously used advocacy services have reported that they would like other people to be aware of advocacy services. Therefore, ensuring that information is available in multiple places could help to ensure accessibility, improve awareness of advocacy services, and potentially improve equality of access by making it easier to get information to seldom heard groups.</p></div><div id="niceng227er4.s1.1.8.2.10"><h5>Arranging advocacy where the person themselves in unable to do so</h5><p>The committee also agreed it would be crucial to address the challenge for people unable to access advocacy despite being entitled to do so. They discussed that people who are unable to ask for an advocate often miss out on advocacy services so to address this they recommended that health and social care practitioners arrange advocacy where the person themselves is unable to ask for an advocate. In the committee’s experience this should be happening consistently; however, health and social care professionals frequently do not make this referral.</p></div><div id="niceng227er4.s1.1.8.2.11"><h5>The use of digital platforms</h5><p>Statement 9 covered advocacy providers considering using digital platforms when it is genuinely effective. The committee agreed that this statement needed to be strengthened to ensure are actually used, not just considered, when they work and are necessary or preferred by the person. As outlined above, sometimes meeting remotely will be necessary, for example if advocates are unable to access a ward and, based on the committee’s experience, some people may prefer to meet with their advocate remotely. Despite the benefits of remote communication the committee also agreed it should only be used if it is likely to be as effective as meeting people in person so that the quality of the service is not compromised. Meeting in person should always be prioritised if this is needed in order to be effective or to ensure privacy. The committee agreed that this recommendation was more relevant in the enabling and supporting effective advocacy and therefore decided to move this recommendation to the area of enabling and supporting effective advocacy.</p></div><div id="niceng227er4.s1.1.8.2.12"><h5>Sufficient time to build relationships and trust</h5><p>Statement 49 highlighted that a lack of time can act as a barrier to advocacy services supporting people living with learning disabilities. Although they felt the statement lacked clarity the committee agreed about the importance of advocacy organisations giving people with learning disabilities (or other needs) the time required to build up relationships and trust. They agreed this was the key aspect to the statement and it is where they wanted to focus their recommendation. In the committee’s experience effective advocacy is only possible if sufficient time is taken to build relationships and trust with people, otherwise people may be unlikely to share information and what is important to them with their advocate. The committee also agreed that the amount of time it can take to build a trusting relationship with someone can vary greatly based on individual’s needs, communication styles, and personalities. Therefore, the committee did not think it was appropriate to limit the recommendation to people living with learning disabilities, as this is just one example of a group where additional time may be needed to build effective relationships. The committee agreed that this recommendation was about how enable effective advocacy and therefore decided to move this recommendation under the area of enabling and supporting effective advocacy (see evidence review E).</p></div><div id="niceng227er4.s1.1.8.2.13"><h5>Variety of advocacy models to meet the different advocacy needs</h5><p>Statement 51 highlighted that the lack of appropriate advocacy for people with complex needs acts as a barrier to supporting people living with learning disabilities. The committee agreed this was an important point as it illustrates that people have different advocacy needs, which can be best met by offering a variety of advocacy models. However they also agreed this would apply to all people who may benefit from advocacy, not just people living with learning disabilities. The expert witness testimony (see evidence review F) also highlighted the importance of investing in community based advocacy and a wider range of advocacy types to support the delivery of culturally appropriate advocacy. People are most comfortable with advocates to whom they can relate and have faith in and this tends to lead to more effective advocacy. According to the expert witness testimony, people from racialized communities and those with lived experiences are less represented in mainstream and statutory advocacy services compared with community and voluntary sector organisations. The committee also agreed that peer advocacy and family advocacy should be added to the recommendation as examples of different types of advocacy services that could be made available as, in the committee’s experience, these less formal types of advocacy can often be overlooked. The committee agreed that this recommendation was more about planning and commissioning advocacy and therefore decided to move this recommendation under the area of planning and commissioning (see evidence review H).</p></div><div id="niceng227er4.s1.1.8.2.14"><h5>Providing training to enhance knowledge of advocacy role</h5><p>The existing recommendation from the NICE guideline on safeguarding adults in care homes [NG189] stated that all organisations involved in safeguarding should understand the role of advocacy in relation to safeguarding and think about the person’s needs and know when to refer people. Further details about the committee’s decisions to adopt or adapt existing NICE recommendations in the area of improving access to advocacy are given in <a href="#niceng227er4.appf">appendix F</a>. The existing recommendation relates to statement 1 in training other practitioners (see evidence review J) about providing training to all agencies working with advocacy services (including safeguarding adult board members) to enhance knowledge about advocacy role and function. The committee agreed to use the existing recommendation to inform recommendation 1.10.3 in training practitioners (see evidence review J).</p></div><div id="niceng227er4.s1.1.8.2.15"><h5>Statements that were not used to inform new recommendations</h5><p>There were a number of statements carried forward to committee discussions that were not used to inform recommendations. Statement 17, which covered the requirement of local and national analysis to examine the extent to which the duty to refer for independent advocacy support is supposed to come into play in safeguarding situations, was not used to inform a recommendation as the committee agreed this would require legal reform which is outside of the scope of NICE guidelines. Similarly, statement 52 was not used to inform a recommendation as the nature of commissioning of health and social care as a whole is outside the scope of NICE guidelines. Statement 34 was not used to inform a recommendation as it outside of the scope of NICE guidelines to ask advocates to promote themselves. Furthermore, the committee agreed that recommendations in the section on information about effective advocacy (see evidence review C) would help ensure people are aware of the services available. Statements 43 and 46 were not used to inform recommendations as it is not within the scope of NICE guidelines to make recommendations about funding or staffing levels. However, the committee agreed that the issues they covered should be addressed by recommendation 1.8.1 about basing commissioning of advocacy services on local needs, in the section on planning and commissioning (see evidence review H). Statement 20, which suggested that advocacy providers should support social workers to make appropriate referrals by responding to feedback about ease of referring, was not used to inform a recommendation as the committee agreed this is likely to already be happening as part of good practice. Statements 11, 12, 15 and 21 were not used to inform recommendations as they did not provide enough detail to inform what action should be taken to improve access. However, the committee agreed that recommendations throughout this section would help to address the general messages made in these statements. Statement 38 was not used to inform a recommendation, as the committee agreed that there was a duty on commissioners to ensure that services are non-discriminatory. The committee acknowledged that equality analysis may be one way of addressing this, but that the requirement to be non-discriminatory is not specific to advocacy and would apply to all health and social care services. Furthermore, the committee were not aware that this duty is being ignored for advocacy services so agreed that the recommendation is not needed.</p><p>A large number of statements were not used to inform recommendations as the issues they addressed were already covered by other recommendations. Statements 3, 19, and 24 were not used to inform recommendations as ensuring practitioners understand who is entitled to advocacy and when and how to request advocacy is already covered by recommendation 1.10.1 in training for other practitioners (see evidence review J). Statements 14 and 47 are covered by recommendation 1.2.1 (see evidence review B) about ensuring that advocacy services are available to everyone who needs it. Statement 16 is also covered by the same recommendation, as well as recommendation 1.6.1 in the section on effective advocacy (see evidence review F) about making efforts to reach under-represented and underserved communities. Statement 18 highlighted that the lack of understanding about advocacy contributes to people not always receiving advocacy support in the context of safeguarding. This was not used to inform a recommendation because the committee agreed this would be addressed by recommendation 1.5.15 in the section on enabling and supporting effective advocacy (see evidence review E), recommendations 1.11.11 and 1.11.12 in monitoring services and collecting data (see evidence review K), 1.10.3 in training and skills for practitioners (see evidence review J), and 1.9.2 in training, skills, and support for advocates (see evidence review I). Statements 27 and 29 were not used to inform recommendations as the issue of using interpreters is covered by recommendations 1.5.2 and 1.5.7 in the section on enabling and supporting effective advocacy (see evidence review E), 1.3.4 in information about effective advocacy (see evidence review C) and 1.6.11 in effective advocacy (see evidence review F). Statement 28 is covered by recommendation 1.4.8 about IMHAs having regular visits to wards. Statement 41 is covered in the section on planning and commissioning (see evidence review H) and by recommendation 1.7.10 about advocacy providers working in partnership with other organisations to ensure culturally appropriate advocacy. Statement 23 was not used to inform a recommendation as the issues are covered in the section on training and skills for practitioners (see evidence review J) by recommendation 1.10.1 about training on when and how to request advocacy and in the section on information about effective advocacy (see evidence review C) by recommendation 1.3.3 about how to access independent advocacy. Statement 4 was not used to inform a recommendation as the concept of ensuring face-to-face meetings are made available was covered in the section on effective advocacy (see evidence review F) by recommendation 1.6.1. Statement 10 is covered in effective advocacy (see evidence review F) by recommendation 1.6.1 about delivering face-to-face advocacy. Statement 45 is covered in training and skills and support for advocates (see evidence review I) by recommendation 1.9.1 about supporting a wide range of needs and impairments. Statement 2 was not used to inform recommendations as the principle of not having universal restrictions and regular visits to wards is covered by other recommendations in this section (1.4.3 and 1.4.8 respectively), as described above. Statement 40 was not used to inform recommendations as the concept of making all information available in a variety of formats is covered in the section on information about effective advocacy (see evidence review C) by recommendation 1.3.4. Statements 30 and 36 were not used as the basis for a recommendation because they do not provide a clear action on how to ensure equality of access; however, the committee agreed that this was a core concept made throughout the recommendations in this section of improving access. Furthermore, equality of access should be improved through recommendations in other sections of this guideline, such as the section on enabling and supporting effective advocacy in recommendation 1.5.2 about using interpreters (see evidence review E) and in the section on effective advocacy with recommendation 1.6.1 about making efforts to reach under-represented and disadvantaged populations (see evidence review F). Statement 37 was not used to make a recommendation because needs assessments are covered in the section on planning and commissioning (see evidence review H) by recommendation 1.8.1 about basing the commissioning of advocacy services on an assessment of local need, building on the Joint Strategic Needs Assessment. Statement 6 was not used to inform a recommendation as the statement itself does not indicate what action needs be taken; however, the committee agreed that the actions are covered in the section on training and skills for practitioners (see evidence review J) by recommendation 1.10.1.</p></div><div id="niceng227er4.s1.1.8.2.16"><h5>Existing recommendations not used in this review</h5><p>There were two existing NICE recommendations that the committee neither adopted nor adapted for the section on improving access to advocacy. The reasons behind their decision making are given in <a href="#niceng227er4.appf">appendix F</a>.</p></div></div></div><div id="niceng227er4.s1.1.9"><h4>Cost effectiveness and resource use</h4><p>During the COVID-19 pandemic many of the initial meetings between an advocate and individuals using the service changed to remote meetings either conducted by telephone or using videoconferencing software. Whilst in-person meetings were the norm before there is concern that for some, such meetings might now be standard practice given it is associated with cost savings through reduced travel costs and advocates time. Moving from these remote meetings back to in-person will be associated with an increase in resource use although it is unlikely to be greater than pre-pandemic. In person meetings may also increase the uptake of advocacy again increasing costs. The committee highlighted that there would be likely cost savings in the long run through greater uptake of advocacy and improvement in the quality of interactions leading to identifying problems earlier, avoiding costly medical interventions such as unplanned admissions to hospital and preventing replication of or inappropriate referrals.</p><p>The committee highlighted that whilst in-person meetings were optimal there were situations where remote meetings using digital platforms would still be effective and preferred by the individual. Remote meetings are likely to be less expensive but if the added convenience increases uptake those cost savings will be reduced. There were also a number of recommendations to improve awareness and access to advocacy which would increase the total number of people receiving advocacy. These are compliant with statutory duties for the majority of this group.</p><p>The prevention of blanket restrictions on where advocates could visit should not increase resource use beyond those discussed above in regard to in-person meetings recommencing. Most places where advocates would visit would not significantly increase travel or time above other venues. Whilst extra time may be required in visiting prisons to clear security protocols, this population will only represent a small percentage of visits. Again allowing in-person visits may lead to long term cost savings similar to those discussed previously.</p><p>Providing a simple process to access to advocacy services will require some resource but this will likely be a shift of existing resources to a fewer number of access points. Cost savings should also be realised through economies of scale of having fewer access points and through a reduction in repeated or inappropriate referrals caused by an overcomplicated process.</p><p>The committee agreed that providing continuity of access could have some upfront costs associated with getting multi-skilled advocates where these are not currently used, but this should be offset in part through more effective use of resources.</p><p>There will likely be an increase in resource use from regular visitations to hospital wards by IMHA services. Whilst health practitioners should be making referrals in the instance of non-instructed advocacy in many places this does not happen. Whilst it is likely to increase costs there are likely to be savings through improved safeguarding practices and through advocates obtaining a better understanding of peoples’ needs. This should allow for better management of needs improving quality of life and preventing costly unplanned hospitalisations.</p><p>Making access to IMHA opt-out rather than opt-in will increase the number of meetings between advocates and people using their service, although providing a IMHA to eligible people is a legal requirement. The increase will therefore come from a greater number of people being aware of their right to access IMHAs and through barriers being significantly simplified to access them. This is likely to increase access to those most in need of IMHA services who may have otherwise had difficulty opting-in. Although there is likely to be a significant resource impact to this recommendation in the short term it will lead to improved access to advocacy services by overcoming barriers arising from lack of awareness or understanding and negative attitudes. Opt-out should also significantly speed up referral allowing for more time to prepare for meetings improving their effectiveness and ensuring that views can be expressed effectively. This is likely to reduce costs through more appropriate decision making and preventing waste on inappropriate or sub-optimal health care and also through preventing the need to repeat meetings or reducing their length through better preparation.</p></div><div id="niceng227er4.s1.1.10"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.4.1 to 1.4.2, 1.4.4 to 1.4.10, 1.4.12, 1.5.5, 1.5.10, 1.8.12, and 1.10.3. Other evidence supporting these recommendations can be found in the evidence reviews on enabling and supporting (see evidence review E), effective advocacy (see evidence review F), and training practitioners (see evidence review J).</p></div></div><div id="niceng227er4.s1.1.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="niceng227er4.s1.1.rl.r1.1"><h4>Existing NICE guidelines</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref1"><p id="p-114">National Institute for Health and Care Excellence 2019</p>National Institute for Health and Care Excellence (2019). Cerebral palsy in adults (NICE Guideline 119). Available at: <a href="https://www.nice.org.uk/guidance/ng119/resources/cerebral-palsy-in-adults-pdf-66141606816709" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/ng119/resources<wbr style="display:inline-block"></wbr>​/cerebral-palsy-in-adults-pdf-66141606816709</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/31241877" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31241877</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref2"><p id="p-115">National Institute for Health and Care Excellence 2021</p>National Institute for Health and Care Excellence (2021). Safeguarding adults in care homes (NICE Guideline 189). Available at: <a href="https://www.nice.org.uk/guidance/ng189/resources/safeguarding-adults-in-care-homes-pdf-66142030079941" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/ng189/resources<wbr style="display:inline-block"></wbr>​/safeguarding-adults-in-care-homes-pdf-66142030079941</a></div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref3"><p id="p-116">National Institute for Health and Care Excellence 2014</p>National Institute for Health and Care Excellence (2014). Domestic violence and abuse: multi-agency working (Public Health Guideline 50). Available at: <a href="https://www.nice.org.uk/guidance/ph50/resources/domestic-violence-and-abuse-multiagency-working-pdf-1996411687621" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/ph50/resources<wbr style="display:inline-block"></wbr>​/domestic-violence-and-abuse-multiagency-working-pdf-1996411687621</a></div></p></li></ul></div><div id="niceng227er4.s1.1.rl.r1.2"><h4>Formal consensus</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref4"><p id="p-117">Chatfield 2017</p>Chatfield, D., Lee, S., Cowley, J., Kitzinger, C., Kitzinger, J., Menon, D. (2018). Is there a broader role for independent mental capacity advocates in critical care? An exploratory study. Nursing in Critical Care, 23(2), 82–87. [<a href="https://pubmed.ncbi.nlm.nih.gov/28247553" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28247553</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref5"><p id="p-118">Harflett 2015</p>Harflett, N., Turner, S., Bown, H., National Development Team for Inclusion (2015). The impact of personalisation on the lives of the most isolated people with learning disabilities. A review of the evidence. Available at: <a href="https://www.ndti.org.uk/assets/files/Isolation_and_personalisation_evidence_review_final_02_06_15.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/Isolation<wbr style="display:inline-block"></wbr>​_and_personalisation<wbr style="display:inline-block"></wbr>​_evidence_review_final_02_06_15<wbr style="display:inline-block"></wbr>​.pdf</a> [Accessed 06/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref6"><p id="p-119">Lawson 2017</p>Lawson, J. (2017). Making Safeguarding Personal. What might ‘good’ look like for advocacy?
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Local Government Association. Available at: <a href="https://www.local.gov.uk/sites/default/files/documents/25.30%20-%20Chip_MSP%20Advocacy_WEB_2.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.local.gov<wbr style="display:inline-block"></wbr>​.uk/sites/default/files/documents/25<wbr style="display:inline-block"></wbr>​.30<wbr style="display:inline-block"></wbr>​%20-%20Chip_MSP%20Advocacy_WEB_2.pdf</a> [Accessed 07/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref7"><p id="p-120">Lawson 2020</p>Lawson, J., Petty, G. (2020). Strengthening the role of advocacy in Making Safeguarding Personal, Local Government Association. Available at: <a href="https://www.local.gov.uk/sites/default/files/documents/25.167%20Strengthening%20the%20role%20of%20advocacy%20in%20MSP_04.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.local.gov<wbr style="display:inline-block"></wbr>​.uk/sites/default/files/documents/25<wbr style="display:inline-block"></wbr>​.167<wbr style="display:inline-block"></wbr>​%20Strengthening%20the<wbr style="display:inline-block"></wbr>​%20role%20of%20advocacy<wbr style="display:inline-block"></wbr>​%20in%20MSP_04.pdf</a> [Accessed 07/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref8"><p id="p-121">Mercer 2020</p>Mercer, K., Petty, G. (2020). Scoping Exercise Report – An overview of advocacy delivery in relation to Personal Health Budgets and other health funded support. Available at: <a href="https://www.ndti.org.uk/assets/files/Advocacy-Health-Funded-Support-Report-pdf.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/Advocacy-Health-Funded-Support-Report-pdf<wbr style="display:inline-block"></wbr>​.pdf</a> [Accessed 07/05/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref9"><p id="p-122">National Development Team for Inclusion 2012</p>National Development Team for Inclusion (2012). Reasonably Adjusted? Mental Health Services and Support for People with Autism and People with Learning Disabilities. Available at: <a href="https://www.ndti.org.uk/assets/files/Reasonably-adjusted_2020-12-30-150637.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/Reasonably-adjusted<wbr style="display:inline-block"></wbr>​_2020-12-30-150637.pdf</a> [Accessed 06/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref10"><p id="p-123">National Development Team for Inclusion 2016a</p>National Development Team for Inclusion (2016a). Advocacy Outcomes Framework: Measuring the impact of independent advocacy. Available at: <a href="https://www.ndti.org.uk/assets/files/Advocacy_framework.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/Advocacy_framework.pdf</a> [Accessed 06/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref11"><p id="p-124">National Development Team for Inclusion 2020a</p>National Development Team for Inclusion (2020). Valuing voices: Protecting rights through the pandemic and beyond. Available at: <a href="https://www.ndti.org.uk/assets/files/Valuing_voices_-_Protection_rights_through_the_pandemic_and_beyond_Oct_2020.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/Valuing<wbr style="display:inline-block"></wbr>​_voices_-_Protection<wbr style="display:inline-block"></wbr>​_rights_through_the<wbr style="display:inline-block"></wbr>​_pandemic_and_beyond_Oct_2020.pdf</a> [Accessed 07/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref12"><p id="p-125">National Development Team for Inclusion 2020b</p>National Development Team for Inclusion (2020), Valuing voices in Wales: Protecting rights through the pandemic and beyond. Available at: <a href="https://www.dewiscil.org.uk/news/valuing-voices-in-wales-report" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.dewiscil<wbr style="display:inline-block"></wbr>​.org.uk/news/valuing-voices-in-wales-report</a> [Accessed 07/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref13"><p id="p-126">Newbigging 2011</p>Newbigging, K., McKeown, M., French
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B. (2011). Mental health advocacy and African and Caribbean men: Good practice principles and organizational models for delivery. Health Expectations, 16(1), 80–104. [<a href="/pmc/articles/PMC5060645/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5060645</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21645185" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21645185</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref14"><p id="p-127">Newbigging 2012</p>Newbigging, K., Ridley, J., McKeown, M., Machin, K., Poursanidou, D., Able, L., et al. (2012). The Right to Be Heard: Review of the Quality of Independent mental Health Advocate (IMHA) Services in England, University of Central Lancashire. Available at: <a href="https://www.firah.org/upload/notices3/2012/uclan.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.firah.org<wbr style="display:inline-block"></wbr>​/upload/notices3/2012/uclan.pdf</a> [Accessed 13/05/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref15"><p id="p-128">Roberts 2012</p>Roberts, H., Turner, S., Baines, S., Hatton, C. (2012). Advocacy by and for adults with learning disabilities in England, Improving Health and Lives: Learning Disabilities Observatory. Available at: <a href="https://www.ndti.org.uk/assets/files/IHAL_2012-03_Advocacy.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/IHAL_2012-03_Advocacy<wbr style="display:inline-block"></wbr>​.pdf</a> [Accessed 06/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref16"><p id="p-129">SERIO 2021</p>SERIO (2021). The Veterans’ Advocacy People: Final Evaluation Report and Social Return on Investment Analysis, The Advocacy People. Available at: <a href="https://www.vfrhub.com/wp-content/uploads/2021/01/898ed6_d72d832632234777aa1b5b68e8c314e6.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.vfrhub.com<wbr style="display:inline-block"></wbr>​/wp-content/uploads<wbr style="display:inline-block"></wbr>​/2021/01/898ed6_d72d832632234777aa1b5b68e8c314e6.pdf</a> [Accessed 06/04/2021]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng227er4.s1.1.ref17"><p id="p-130">Turner 2012</p>Turner, S. (2012). Advocacy by and for adults with learning disabilities in England: Evidence into practice report no.5, Improving Health and Lives: Learning Disabilities Observatory. Available at: <a href="https://www.ndti.org.uk/assets/files/IHAL-ev-_2012-01.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/IHAL-ev-_2012-01.pdf</a> [Accessed 06/04/2021]</div></p></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng227er4.appa"><h3>Appendix A. Study selection for formal consensus process</h3><p id="niceng227er4.appa.et1"><a href="/books/NBK588853/bin/niceng227er4-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for scope area: Improving access to advocacy (including addressing barriers)</a><span class="small"> (PDF, 118K)</span></p></div><div id="niceng227er4.appb"><h3>Appendix B. Evidence tables</h3><p id="niceng227er4.appb.et1"><a href="/books/NBK588853/bin/niceng227er4-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for scope area: Improving access to advocacy</a><span class="small"> (PDF, 447K)</span></p></div><div id="niceng227er4.appc"><h3>Appendix C. Quality Assessment</h3><p id="niceng227er4.appc.et1"><a href="/books/NBK588853/bin/niceng227er4-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Quality assessment tables for scope area: Improving access to advocacy</a><span class="small"> (PDF, 270K)</span></p></div><div id="niceng227er4.appd"><h3>Appendix D. Excluded studies</h3><div id="niceng227er4.appd.s1"><h4>Excluded studies for scope area: Improving access to advocacy</h4><div id="niceng227er4.appd.s1.1"><h5>Formal consensus (documents identified by the call for evidence and the guideline committee)</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng227er4appdtab1"><a href="/books/NBK588853/table/niceng227er4.appd.tab1/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng227er4appdtab1" rid-ob="figobniceng227er4appdtab1"><img class="small-thumb" src="/books/NBK588853/table/niceng227er4.appd.tab1/?report=thumb" src-large="/books/NBK588853/table/niceng227er4.appd.tab1/?report=previmg" alt="Table 8. Excluded studies and reasons for their exclusion." /></a><div class="icnblk_cntnt"><h4 id="niceng227er4.appd.tab1"><a href="/books/NBK588853/table/niceng227er4.appd.tab1/?report=objectonly" target="object" rid-ob="figobniceng227er4appdtab1">Table 8</a></h4><p class="float-caption no_bottom_margin">Excluded studies and reasons for their exclusion. </p></div></div></div><div id="niceng227er4.app4.s1.2"><h5>Excluded economic studies</h5><p>No economic evidence was considered for this scope area.</p></div></div></div><div id="niceng227er4.appe"><h3>Appendix E. Research recommendations – full details</h3><div id="niceng227er4.appe.s1"><h4>Research recommendations for scope area: Improving access to advocacy</h4><p>No research recommendations were made for this scope area.</p></div></div><div id="niceng227er4.appf"><h3>Appendix F. Existing NICE recommendations</h3><p id="niceng227er4.appf.et1"><a href="/books/NBK588853/bin/niceng227er4-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (188K)</span></p></div><div id="niceng227er4.appg"><h3>Appendix G. Formal consensus</h3><p id="niceng227er4.appg.et1"><a href="/books/NBK588853/bin/niceng227er4-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Additional information related to scope area: Improving access to advocacy</a><span class="small"> (PDF, 215K)</span></p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.4.1 to 1.4.2, 1.4.4 to 1.4.10, 1.4.12, 1.5.5, 1.5.10, 1.8.12 and 1.10.3 in the NICE guideline</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK588853</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36745723" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36745723</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng227er4tab1"><div id="niceng227er4.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the inclusion criteria</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588853/table/niceng227er4.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng227er4.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng227er4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country</th><td headers="hd_b_niceng227er4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">UK</td></tr><tr><th id="hd_b_niceng227er4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Geographical level</th><td headers="hd_b_niceng227er4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>National*</p>
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<p>*For policy or guidance documents, this means, the policies and recommendations apply nationally. For original research, this means the studies have been conducted in the national policy and practice context of our scope, i.e., the English health and social care system</p>
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</td></tr><tr><th id="hd_b_niceng227er4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication date</th><td headers="hd_b_niceng227er4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2011 onwards</td></tr><tr><th id="hd_b_niceng227er4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng227er4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Primary qualitative or quantitative studies (including unpublished research), excluding case-studies</p>
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<p>Systematic reviews of qualitative or quantitative studies, excluding case-studies</p>
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<p>Guidelines or policy documents that are based on qualitative or quantitative evidence, excluding case-studies</p>
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</td></tr><tr><th id="hd_b_niceng227er4.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Topic areas</th><td headers="hd_b_niceng227er4.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Improving access to advocacy (including addressing barriers)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng227er4tab2"><div id="niceng227er4.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of documents included in the formal consensus process</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588853/table/niceng227er4.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng227er4.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Document</th><th id="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Evidence base</th></tr></thead><tbody><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng227er4.s1.1.ref4" rid="niceng227er4.s1.1.ref4">Chatfield 2017</a>
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</p>
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<p>Exploratory qualitative study</p>
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<p>England & Wales</p>
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</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Critical care unit clinicians, relatives of critical care patients, and IMCAs</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 interviews across 2 NHS sites and a survey of IMCA services. Reporting some knowledge of the MCA across both study sites, but that training on MCA was unsatisfactory, with confusion about the role of IMCAs and when they should become involved. Overall, suggestion that broader involvement of IMCAs on a regular basis within critical care could be useful</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng227er4.s1.1.ref5" rid="niceng227er4.s1.1.ref5">Harflett 2015</a>
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</p>
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<p>Narrative review</p>
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<p>England</p>
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</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Most isolated people with learning disabilities</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Literature review</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng227er4.s1.1.ref6" rid="niceng227er4.s1.1.ref6">Lawson 2017</a>
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</p>
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<p>Report</p>
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<p>England</p>
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</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Those who have duties to commission and arrange advocacy services for safeguarding adults</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Report drawing on existing literature (including statutory guidance and core principles for safeguarding) to set out what needs to be done and what needs to be addressed to make safeguarding personal</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng227er4.s1.1.ref7" rid="niceng227er4.s1.1.ref7">Lawson 2020</a>
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</p>
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<p>Briefing</p>
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<p>England</p>
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</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Those who have duties to commission and arrange advocacy services for safeguarding adults</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Briefing generated by a series of conversations with 28 advocates from 18 advocacy providers across England, covering 33 local authority areas</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng227er4.s1.1.ref8" rid="niceng227er4.s1.1.ref8">Mercer 2020</a>
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</p>
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<p>Scoping review</p>
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<p>England</p>
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</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Independent advocacy services commissioned to provide advocacy to people accessing support/service through:
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<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>i)</dt><dd><p class="no_top_margin">s117 aftercare (under the Mental Health Act)</p></dd></dl><dl class="bkr_refwrap"><dt>ii)</dt><dd><p class="no_top_margin">NHS Continuing Healthcare (adults)</p></dd></dl><dl class="bkr_refwrap"><dt>iii)</dt><dd><p class="no_top_margin">Children and Young People’s Continuing Care</p></dd></dl><dl class="bkr_refwrap"><dt>iv)</dt><dd><p class="no_top_margin">Personal Health Budgets</p></dd></dl><dl class="bkr_refwrap"><dt>v)</dt><dd><p class="no_top_margin">Personal Wheelchair Budgets</p></dd></dl></dl></td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-systematic scoping exercise including data from: Freedom of information requests to identify what services were commissioned, by whom and to which groups; advocacy survey for advocates to identify what advocacy providers are delivering; semi-structured telephone interviews with Independent Advocacy providers; review of legislation and guidance to identify current provision and identify gaps</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng227er4.s1.1.ref9" rid="niceng227er4.s1.1.ref9">NDTi 2012</a>
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</p>
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<p>Report</p>
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<p>England</p>
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</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with learning disabilities and people with autism</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review with content analysis, call for evidence and meetings with experts by experience, family carers and professionals</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>NDTi 2016</p>
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<p>Framework</p>
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<p>England</p>
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</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Providers and commissioners of independent advocacy</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Literature review (no details reported) and consultation with two self-advocacy groups</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng227er4.s1.1.ref11" rid="niceng227er4.s1.1.ref11">NDTi 2020a</a>
|
|
</p>
|
|
<p>Report on survey findings</p>
|
|
<p>England & Wales</p>
|
|
</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Advocates (across multiple areas of statutory and nonstatutory advocacy)</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Survey of 435 advocates (with expertise across multiple areas of statutory and non-statutory advocacy) reporting data on accessibility and quality of advocacy during the pandemic and the impact on people who are entitled to advocacy; provides recommendations for government, local authorities, and care providers</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng227er4.s1.1.ref12" rid="niceng227er4.s1.1.ref12">NDTi 2020b</a>
|
|
</p>
|
|
<p>Report on survey findings</p>
|
|
<p>Wales</p>
|
|
</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Advocates (across multiple areas of statutory and non-statutory advocacy)</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Survey of 72 advocates (with expertise across multiple areas of statutory and non-statutory advocacy) reporting data on accessibility and quality of advocacy during the pandemic and the impact on people who are entitled to advocacy; provides recommendations for government, local authorities, and care providers</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng227er4.s1.1.ref13" rid="niceng227er4.s1.1.ref13">Newbigging 2011</a>
|
|
</p>
|
|
<p>Systematic literature review and national survey</p>
|
|
<p>UK (England, Wales, and Northern Ireland)</p>
|
|
</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">African and Caribbean men using mental health services</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic literature review, a national survey on the provision of advocacy (n=391 providers of mental health advocacy services), focus groups with African and Caribbean men (n=25), and case studies (22 people including 7 service users, 6 commissioners, 4 mental health service providers and 5 experts in the field)</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng227er4.s1.1.ref12" rid="niceng227er4.s1.1.ref12">Newbigging 2012</a>
|
|
</p>
|
|
<p>Research report</p>
|
|
<p>England</p>
|
|
</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People detained under the amended Mental Health Act 1983, who were eligible for support from IMHA services, including people with and without capacity and children under the age of 16</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multiple methods (including literature review, 11 focus groups, shadow visits with IMHAs, expert panel review) to obtain information on IMHA services to develop draft quality indicators for IMHA services. Data from 8 case studies (NHS Trust areas) to understand experiences of qualifying service users and the commissioning and delivery of IMHA services and their relationship with mental health services</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng227er4.s1.1.ref15" rid="niceng227er4.s1.1.ref15">Roberts 2012</a>
|
|
</p>
|
|
<p>Survey</p>
|
|
<p>England</p>
|
|
</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with learning disabilities</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 surveys (responses from 78 local authority commissioners and 88 advocacy providers) and 3 case studies; provides information on, for example, funding and also discusses gaps in advocacy provision and barriers to accessing services</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng227er4.s1.1.ref16" rid="niceng227er4.s1.1.ref16">SERIO 2021</a>
|
|
</p>
|
|
<p>Service evaluation</p>
|
|
<p>England</p>
|
|
</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Veterans and their families</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Report of an independent three-year evaluation of The Veterans’ Advocacy People, a service targeted at veterans, and their families from each of the service arms, which aims to provide open and flexible advocacy support. Includes qualitative interviews</td></tr><tr><td headers="hd_h_niceng227er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng227er4.s1.1.ref17" rid="niceng227er4.s1.1.ref17">Turner 2012</a>
|
|
</p>
|
|
<p>Brief report</p>
|
|
<p>England</p>
|
|
</td><td headers="hd_h_niceng227er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with learning disabilities</td><td headers="hd_h_niceng227er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 surveys (responses from 78 local authority commissioners and 88 advocacy providers) and 3 case studies (no detailed methods reported); provides advice and suggestions on actions for commissioners and advocacy groups to provide robust evidence on the effectiveness and reach of advocacy services</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">IMCA: Independent Mental Capacity Advocate; IMHA: Independent Mental Health Advocate; LGA: Local Government Association; MCA: Mental Capacity Act; NDTi: National Development Team for Inclusion; NHS: National Health Service; s117: section 117</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng227er4appdtab1"><div id="niceng227er4.appd.tab1" class="table"><h3><span class="label">Table 8</span><span class="title">Excluded studies and reasons for their exclusion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK588853/table/niceng227er4.appd.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng227er4.appd.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for Exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bauer, B., Wistow, G., Dixon, J., Knapp, M. (2013). Investing in Advocacy Interventions for Parents with Learning Disabilities: What is the Economic Argument? Personal Social Services Research Unit. Available at: <a href="http://eprints.lse.ac.uk/51114/1/Investing%20in%20advocay.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://eprints<wbr style="display:inline-block"></wbr>​.lse.ac<wbr style="display:inline-block"></wbr>​.uk/51114/1/Investing%20in%20advocay<wbr style="display:inline-block"></wbr>​.pdf</a> [Accessed 16/02/2022]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Davies, L., Townsley, R., Ward, L., Marriott
|
|
A. (2009). A framework for research on costs and benefits of independent advocacy, Office for Disability Issues. Available at <a href="https://www.bristol.ac.uk/media-library/sites/sps/migrated/documents/odiframework.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.bristol.ac<wbr style="display:inline-block"></wbr>​.uk/media-library/sites<wbr style="display:inline-block"></wbr>​/sps/migrated/documents<wbr style="display:inline-block"></wbr>​/odiframework.pdf</a> [Accessed 16/02/2022]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
EY (2017). Society’s return on investment (SROI) in older people’s cancer advocacy services. Available at: <a href="https://opaal.org.uk/?s=Society%27s+return+on+investment+%28SROI%29+in+older+people%E2%80%99s+cancer+advocacy+services" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://opaal<wbr style="display:inline-block"></wbr>​.org.uk<wbr style="display:inline-block"></wbr>​/?s=Society%27s+return+on+investment+<wbr style="display:inline-block"></wbr>​%28SROI<wbr style="display:inline-block"></wbr>​%29+in+older+people<wbr style="display:inline-block"></wbr>​%E2%80%99s+cancer+advocacy+services</a> [Accessed 16/02/2022]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Feeney, M., Evers, C., Agpalo, D., Cone, L., Fleisher, J., Schroeder, K. (2020). Utilizing patient advocates in Parkinson’s disease: A proposed framework for patient engagement and the modern metrics that can determine its success. Health Expectations, 23, 722–730. [<a href="/pmc/articles/PMC7495075/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7495075</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32363785" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32363785</span></a>]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-UK based (International)</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Healthwatch (2015). Independent Complaints Advocacy: Standards to support the commissioning, delivery and monitoring of the service. Available at: <a href="https://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/healthwatch_advocacy_standards_10022015.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.healthwatch<wbr style="display:inline-block"></wbr>​.co.uk/sites/healthwatch<wbr style="display:inline-block"></wbr>​.co.uk/files/healthwatch<wbr style="display:inline-block"></wbr>​_advocacy_standards_10022015<wbr style="display:inline-block"></wbr>​.pdf</a> [Accessed 16/02/2022]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kilinç, S.
|
|
Erdem, H., Healer, R., Cole, J. (2020). Finding meaning and purpose: a framework for the self-management of neurological conditions. Disability and Rehabilitation, 44(2), 219–230. [<a href="https://pubmed.ncbi.nlm.nih.gov/32406762" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32406762</span></a>]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Macadam, A., Watts, R., Greig, R. (2013). The Impact of Advocacy for People who Use Social Care Services, NIHR School for Social Care Research Scoping Review. Available at: <a href="https://www.ndti.org.uk/assets/files/SSCR-scoping-review_SR007.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/SSCR-scoping-review<wbr style="display:inline-block"></wbr>​_SR007.pdf</a> [Accessed 06/04/2021]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No key findings or recommendations relevant to Improving access to advocacy (including addressing barriers)</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
National Development Team for Inclusion (2014b). Office for Disabilities Issues Access to Advocacy Project: Summary Findings Minister’s Briefing Note. Unpublished.
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No key findings or recommendations relevant to Improving access to advocacy (including addressing barriers)</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
National Development Team for Inclusion (2014c). Office for Disabilities Issues Access to Advocacy Project: Executive Summary. Unpublished.
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No key findings or recommendations relevant to Improving access to advocacy (including addressing barriers)</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
National Development Team for Inclusion (2014). The impact of advocacy for people who use social care services: a review of the evidence, NDTi Insights. Available at: <a href="https://www.ndti.org.uk/assets/files/Insights_19_Impact_of_Advocacy_FINAL.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/Insights<wbr style="display:inline-block"></wbr>​_19_Impact_of_Advocacy_FINAL.pdf</a> [Accessed 11/02/2022]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No key findings or recommendations relevant to any scope area</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
National Development Team for Inclusion (2016b). Advocacy Outcomes Toolkit: An accompanying guide to the advocacy outcomes framework. Available at: <a href="https://www.ndti.org.uk/assets/files/Advocacy_Outcomes_Toolkit.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/Advocacy<wbr style="display:inline-block"></wbr>​_Outcomes_Toolkit.pdf</a> [Accessed 06/04/2021]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No key findings or recommendations relevant to Improving access to advocacy (including addressing barriers)</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
National Development Team for Inclusion. (2018). The Advocacy Charter (Poster). Available at: <a href="https://www.ndti.org.uk/assets/files/Advocacy-Charter-A3.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/Advocacy-Charter-A3.pdf</a> [Accessed 16/02/2022]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
National Development Team for Inclusion. (2018). The Easy Read Advocacy Charter (Poster). Available at: <a href="https://www.ndti.org.uk/assets/files/The-Advocacy-Charter-Easy-Read.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ndti.org<wbr style="display:inline-block"></wbr>​.uk/assets/files/The-Advocacy-Charter-Easy-Read.pdf</a> [Accessed 16/02/2022]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
National Development Team for Inclusion. (2018). Advocacy QPM: Assessment Workbook. Available at: <a href="https://qualityadvocacy.org.uk/wp-content/uploads/2021/12/QPM-Assessment-Workbook_V4_V1.3_Dec-2021.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https:<wbr style="display:inline-block"></wbr>​//qualityadvocacy<wbr style="display:inline-block"></wbr>​.org.uk/wp-content<wbr style="display:inline-block"></wbr>​/uploads/2021/12/QPM-Assessment-Workbook_V4_V1<wbr style="display:inline-block"></wbr>​.3_Dec-2021.pdf</a> [Accessed 16/02/2022]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
National Development Team for Inclusion, Empowerment Matters (2014). Advocacy QPM: Advocacy Code of Practice, revised edition, 2014. Available at <a href="https://qualityadvocacy.org.uk/wp-content/uploads/2018/05/Code-of-Practice-1.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https:<wbr style="display:inline-block"></wbr>​//qualityadvocacy<wbr style="display:inline-block"></wbr>​.org.uk/wp-content<wbr style="display:inline-block"></wbr>​/uploads/2018/05/Code-of-Practice-1.pdf</a> [Accessed 25/11/2021]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Newbigging, K., K., Ridley, J., McKeown, M., Machin, K., Poursanidou, D., et al. (2012). The Right to Be Heard: Review of the quality of Independent Mental Health Advocate (IMHA) Services in England, Summary Report [<a href="https://pubmed.ncbi.nlm.nih.gov/25475401" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25475401</span></a>]
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No key findings or recommendations relevant to Improving access to advocacy (including addressing barriers)</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Newbigging, K., K., Ridley, J., McKeown, M., Machin, K., Poursanidou, D., et al. (2015). Independent Mental Health Advocacy – The Right to Be Heard: Context, Values and Good Practice
|
|
</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on book/book chapter.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
Older People’s Advocacy Alliance (2014). Every Step of the Way. 13 stories illustrating the difference independent advocacy support makes to older people affected by cancer. available at: <a href="https://opaal.org.uk/app/uploads/2015/09/Advocacy-Stories.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://opaal<wbr style="display:inline-block"></wbr>​.org.uk<wbr style="display:inline-block"></wbr>​/app/uploads/2015/09/Advocacy-Stories<wbr style="display:inline-block"></wbr>​.pdf</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Older People’s Advocacy Alliance (2016). Facing Cancer Together. Demonstrating the power of independent advocacy. Available at: <a href="https://opaal.org.uk/app/uploads/2016/12/Facing-Cancer-Together.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://opaal<wbr style="display:inline-block"></wbr>​.org.uk<wbr style="display:inline-block"></wbr>​/app/uploads/2016/12<wbr style="display:inline-block"></wbr>​/Facing-Cancer-Together.pdf</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Older People’s Advocacy Alliance (2017). Time: Our Gift to You – why cancer advocacy volunteers support their peers. Available at: <a href="https://opaal.org.uk/app/uploads/2017/02/Time-our-gift-to-you.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://opaal<wbr style="display:inline-block"></wbr>​.org.uk<wbr style="display:inline-block"></wbr>​/app/uploads/2017/02<wbr style="display:inline-block"></wbr>​/Time-our-gift-to-you.pdf</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Ridley, J., Newbigging, K., Street, C. (2018). Mental health advocacy outcomes from service user perspectives, Mental Health Review Journal, Vol. 23(4), 280–292.
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No key findings or recommendations relevant to Improving access to advocacy (including addressing barriers)</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence, University of Central Lancashire (2015). At a glance 68: Understanding Independent Mental Health Advocacy (IMHA) for people who use services. Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/resources-for-users/understanding/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/resources-for-users<wbr style="display:inline-block"></wbr>​/understanding/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence, University of Central Lancashire (2015). At a glance 68: Understanding Independent Mental Health Advocacy (IMHA) for people who use services, easy read version. Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/resources-for-users/understanding/easy-read/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/resources-for-users<wbr style="display:inline-block"></wbr>​/understanding<wbr style="display:inline-block"></wbr>​/easy-read/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence, University of Central Lancashire (2014). At a glance 67: Understanding Independent Mental Health Advocacy (IMHA) for mental health staff. Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/resources-for-staff/understanding/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/resources-for-staff<wbr style="display:inline-block"></wbr>​/understanding/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence and University of Central Lancashire (2015). Flowchart for Open Access IMHA. Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/resources-for-staff/improving-access/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/resources-for-staff<wbr style="display:inline-block"></wbr>​/improving-access/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence, University of Central Lancashire (2015). Improving access to Independent Mental Health Advocacy for providers of mental health services. Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/resources-for-staff/improving-access/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/resources-for-staff<wbr style="display:inline-block"></wbr>​/improving-access/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence, University of Central Lancashire (2015). Improving equality of access to Independent Mental Health Advocacy (IMHA): a briefing for providers. Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/improving-equality-of-access/briefing/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/improving-equality-of-access/briefing/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence and University of Central Lancashire (2015). Improving equality of access to Independent Mental Health Advocacy (IMHA): a report for providers. Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/improving-equality-of-access/report/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/improving-equality-of-access/report/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence, University of Central Lancashire (2015). Commissioning Independent Mental Health Advocacy (IMHA) services in England: 10 top tips for commissioners. <a href="https://www.scie.org.uk/independent-mental-health-advocacy/measuring-effectiveness-and-commissioning/10-top-tips.asp" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/measuring-effectiveness-and-commissioning/10-top-tips.asp</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence, University of Central Lancashire (2015). What does a good IMHA service look like? (Self-assessment tool) Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/measuring-effectiveness-and-commissioning/what-good-imha-service-looks-like/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/measuring-effectiveness-and-commissioning<wbr style="display:inline-block"></wbr>​/what-good-imha-service-looks-like/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Social Care Institute for Excellence, University of Central Lancashire (2015). Making a difference: measuring the impact of Independent Mental Health Advocacy (IMHA). Available at: <a href="https://www.scie.org.uk/independent-mental-health-advocacy/measuring-effectiveness-and-commissioning/impact/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.scie.org<wbr style="display:inline-block"></wbr>​.uk/independent-mental-health-advocacy<wbr style="display:inline-block"></wbr>​/measuring-effectiveness-and-commissioning/impact/</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Strong, S. (2012). User-led organisation leadership of support planning and brokerage. The International Journal of Leadership in Public Services, 8(2), 83–89.
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Taylor & Francis Production Disability and Rehabilitation (IDRE). My Life Tool (self-management tool): <a href="http://www.mylifetool.co.uk" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>​.mylifetool.co.uk</a>
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Teeside University (2015/2016). UTREG Online Module Specification: Advocacy - Evolution, Equality and Equity. Unpublished.
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Townsley, R., Marriott, A., Ward, L. (2009). Access to independent advocacy: an evidence review, Office for Disability Issues. Available at: <a href="http://www.bristol.ac.uk/media-library/sites/sps/migrated/documents/iar-exec-summary-standard.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.bristol.ac<wbr style="display:inline-block"></wbr>​.uk/media-library/sites<wbr style="display:inline-block"></wbr>​/sps/migrated/documents<wbr style="display:inline-block"></wbr>​/iar-exec-summary-standard.pdf</a> [Accessed 16/02/2022]
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not published in the last 10 years</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Turner, S. & Giraud-Saunders, A. (2014). Personal health budgets: Including people with learning disabilities
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication is based on case-studies.</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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VoiceAbility (2021). Preventing over-medication. STOMP top tips for advocates: How you can help to stop the over-medication of people with a learning disability, autism or both
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr><tr><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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VoiceAbility (2021). STOMP and STAMP: Stopping the over medication of children, young people and adults with a learning disability, autism or both.
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</td><td headers="hd_h_niceng227er4.appd.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Publication has no evidence base</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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