Co-design Principles Research Articles

From discovering to delivering: A critical reflection on eco-feedback, application design, and participatory research in the United Kingdom

The area of Eco-Feedback has received significant attention in recent years. Whilst there have been increasing calls to move ‘beyond feedback’ and consider the wider social, organisational and cultural context that feedback sits within, the involvement of community members in the design process of eco-feedback applications, known as co-design, has been limited. This study addresses that research gap through working collaboratively with community members to develop an accessible eco-feedback interface. First, we conducted an online survey questionnaire with 151 respondents with distinct socio-economic characteristics and environmental knowledge to get insights into their preferences about different aspects of the eco-feedback interface. Secondly, based on the survey findings, 20 community members living in Nottingham, UK, worked collaboratively to develop interface design proposals. Finally, the design of the eco-feedback interface was finalised based on the community interface prototypes and suggestions. The developed interface contains multiple information panels with options for expanding to gain deeper levels of information and a community space allowing for community interactions and sharing of information and actions. This research sheds new light on the challenges of utilising co-design principles to build eco-feedback interfaces. Specifically, we highlight the potential for interactions between community members during the design stages to allow for the generation of innovative ideas (e.g. Integration of third-party applications) moving the interface beyond feedback leading to greater adoption and energy savings.

A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study.

BackgroundPromotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology.ObjectiveThis study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds.MethodsA total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires.ResultsFor the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology.ConclusionsIncorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial.

View From the Canoe: Co-Designing Research Pacific Style.

In 2016, Rose Lamont and Tana Fishman were the first patient-clinician dyad from outside North America to attend the North American Primary Care Research Group (NAPCRG) Patient and Clinician Engagement Program workshop. They returned to New Zealand inspired and formed the Pacific People's Health Advisory Group and a Pacific practice-based research network (PBRN). They are guided by the principles of co-design, and the Samoan research framework fa'afaletui, which emphasizes a collective approach and importance of reciprocity and relationships. Their collective inquiry aims to reduce health inequalities experienced by Pacific people in South Auckland. Their community group members and PBRN are generating research questions being answered by university-based graduate students. When they embarked, they knew not the direction in which they headed. With guidance, their community members and clinicians have led the way. By giving everyone a say in where they are going and how they get there, they are modeling what they wish to achieve-an egalitarian approach which decreases disparities for Pacific people.

Health service engagement with consumers and community in Australia for issue

Purpose The purpose of this paper is to provide an overview of consumer and community engagement in health service planning, quality improvement and programme evaluation in Australia, and key components and importance of a strong suite of tools for achieving effective outcomes. Design/methodology/approach This paper is a non-systematic review of Australian national, state and territory websites in relation to policy commitment to consumer engagement, best practice framework for consumer engagement and recent project example. Findings Consumer engagement is a recognised component of the Australian health system. It is reflected in the national and state health policy and is a mandatory requirement of hospital accreditation. The application of co-design principles is gaining increasing popularity in health service planning and programme evaluation. Co-design is an important enabler of patient/community-centred service planning and evaluation; however, on its own it may lead to poorer outcomes. Co-design must occur within a broader systemic framework. Practical implications The research identifies a conceptual framework, approaches and tools of value to health service management and planners. Originality/value Consumer and community engagements are critical to the development of consumer-centric services. However, this should complement and add value to, not divert attention away from established principles of service planning, continuous quality improvement and programme evaluation. To do so may result in poorer quality health and well-being outcomes, reduced efficiency and ultimately reduced consumer and community satisfaction with services. This paper examines consumer and community engagement within the broader planning and quality improvement framework and practical implications for keeping planning, research and evaluation on track.

Case study of a method of development of a selection process for community health workers in sub-Saharan Africa

BackgroundChoosing who should be recruited as a community health worker (CHW) is an important task, for their future performance partly depends on their ability to learn the required knowledge and skills, and their personal attributes. Developing a fair and effective selection process for CHWs is a challenging task, and reports of attempts to do so are rare. This paper describes a five-stage process of development and initial testing of a CHW selection process in two CHW programmes, one in Malawi and one in Ghana, highlighting the lessons learned at each stage and offering recommendations to other CHW programme providers seeking to develop their own selection processes.Case presentationThe five stages of selection process development were as follows: (1) review an existing selection process, (2) conduct a job analysis, (3) elicit stakeholder opinions, (4) co-design the selection process and (5) test the selection process. Good practice in selection process development from the human resource literature and the principles of co-design were considered throughout. Validity, reliability, fairness, acceptability and feasibility—the determinants of selection process utility—were considered as appropriate during stages 1 to 4 and used to guide the testing in stage 5. The selection methods used by each local team were a written test and a short interview.ConclusionsWorking with stakeholders, including CHWs, helped to ensure the acceptability of the selection processes developed. Expectations of intensiveness—in particular the number of interviewers—needed to be managed as resources for selection are limited, and CHWs reported that any form of interview may be stressful. Testing highlighted the importance of piloting with CHWs to ensure clarity of wording of questions, interviewer training to maximise inter-rater reliability and the provision of guidance to applicants in advance of any selection events. Trade-offs between the different components of selection process utility are also likely to be required. Further refinements and evaluation of predictive validity (i.e. a sixth stage of development) would be recommended before roll-out.

Implementing an outreach headspace mental health service to increase access for disadvantaged and rural youth in Southern Tasmania.

Barriers, including distance and lack of transport, make it difficult for young people to access mental health services such as headspace. A collaborative mental health outreach service initiative with outcome measures assessed at baseline and after 2years. The service was designed and implemented by headspace Hobart and Pulse Youth Health Service based in Glenorchy, Tasmania, Australia. Number of rural and socio-economically disadvantaged young people accessing the outreach service. Wait time to see a mental health clinician. Organisational leadership and adoption of co-design principles. Staff and youth from both services were engaged in planning and implementation. Regular service reviews were undertaken by representatives from both organisations. Numbers of young people from rural and socio-economically disadvantaged areas accessing the service increased. Wait times to see a mental health clinician were reduced by a minimum 10 working days. Staff engagement was vital in supporting and promoting the new outreach service. The risk of diluting the headspace model fidelity was ameliorated by collaborating with an existing, complimentary youth health service. The success of the service has resulted in four more outreach sites. Although administration resources are stretched, the outreach model offers an opportunity to increase access to youth-friendly mental health services for young people from disadvantaged and rural areas of Southern Tasmania.

Formative Evaluation of the Central Coast Integrated Care Program (CCICP), NSW Australia

Introduction:Integrated care has been posited as an important strategy for overcoming service fragmentation problems and achieving the Quadruple Aim of health care. This paper describes the Central Coast Integrative Care Program (CCICP) a complex, multi-component intervention addressing 3 target populations and more than 40 sub-projects of different scale, priority and maturity. Details are provided of the implementation including activities undertaken for each target population, in the context of the Central Coast Local Health District (CCLHD) strategies and priorities. Key lessons are drawn from the formative evaluation.Methods:A mixed methods approach to the formative evaluation was taken. Key stakeholders, professional staff with an in-depth knowledge of the program, were invited to complete surveys (n = 27) and semi-structured interviews (n = 23). The evaluation employed co-design principles with dialogue between CCICP partners and researchers throughout the process and sought to achieve a shared understanding of the dynamic context of the program, and the barriers and enablers for the various interventions.Key lessons and conclusion:Seven interdependent key lessons have been identified. These distil down to the setting of clear objectives aligning with all the goals of partners, developing strong relationships, leadership at multiple levels and communication and the building of a common language.

Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda.

Health system planners in low- and middle-income countries (LMIC) of the Asia-Pacific region seeking to reorient primary health care (PHC) systems to achieve universal health coverage may be hindered by lack of knowledge of what works in their setting. With limited resources for research available, it is important to identify evidence-based strategies for reorganising PHC delivery, determine where relevant evidence gaps exist and prioritise these for future study. This paper describes an approach for doing this using the best available evidence combined with consultation to establish evidence priorities. We first reviewed PHC organisational interventions in Asia-Pacific LMICs and ascertained evidence gaps. The largest gaps related to interventions to promote access to essential medicines, patient management tools, effective health promotion strategies and service planning and accountability. Evidence from Pacific Island countries was particularly scant. We then engaged an expert panel of 22 PHC stakeholders from seven Asia-Pacific LMICs in a Delphi exercise to identify priority questions for future research. Research priorities were: (1) identifying effective PHC service delivery models for chronic diseases; (2) devising sustainable models of disease integration; (3) optimising task shifting; (4) understanding barriers to care continuity; (5) projecting future PHC needs; and (6) designing appropriate PHC service packages. Notably, stakeholder-determined priorities reflected large, context-dependent system issues, while evidence gaps centred on discrete interventions. Future research on the organisation of PHC services in Asia-Pacific LMICs should incorporate codesign principles to engage researchers and national PHC system stakeholders, and innovative methods that build on existing evidence and account for system complexity.

Digital health benefits evaluation frameworks: building the evidence to support Australia's National Digital Health Strategy.

Digital health benefits evaluation frameworks: building the evidence to support Australia's National Digital Health Strategy.

Prototyping open digital tools for urban commoning

ABSTRACT The paper will discuss an experimental co-design approach to the development of a digital toolkit prototype and a resulting set of co-design principles, which are put forward as a way of infrastructuring future design of digital tools for urban commoning. Focus is placed on the case study of a commoning hub in a Parisian suburb where the toolkit was co-designed through a series of prototyping workshops, carried out with hub users and addressing key hub needs. The prototyping process explored possibilities for re-appropriating and re-framing existing digital technologies as open toolkits, which can be further re-purposed by users, here and beyond, after the design of an initial toolkit prototype.

Getting back to life after stroke: co-designing a peer-led coaching intervention to enable stroke survivors to rebuild a meaningful life after stroke

Purpose: Rebuilding one’s life after stroke is a key priority persistently identified by patients yet professionally led interventions have little impact. This co-design study constructs and tests a novel peer-led coaching intervention to improve post-stroke leisure and general social participation.Methods: This study followed the principles of co-design by actively engaging and harnessing the knowledge of stroke survivors in order to develop and test a peer-lead coaching intervention. Phase 1 assessed function, mood, and involvement in leisure and social activities 6 months following stroke (n = 79). Phase 2 involved semi-structured, in-depth interviews with 18 stroke survivors, and 10 family carers to explore experiences related to social and leisure participation. Phase 3 tested the co-designed peer-led coaching intervention. Data collected also included co-design feedback sessions and a training workshop with selected peer coaches and in addition, interviews with stroke survivors and their peer coaches at two time-points: following the training program (n = 5) and delivery of the intervention (n = 2).Results: A peer-coaching intervention was successfully co-designed and tested combining the use of lay knowledge sociocognitive and self-regulatory theories with principles of transformational leadership theory. Both peers and stroke survivors reported having benefited at a personal level.Conclusions: This study reports on an innovative community-based and peer-led intervention and its results have generated new evidence on how stroke survivors engage with and respond to peer coaching support. It further provides a theoretical platform for designing and implementing peer interventions. Hence, these results have the potential to inform the development of future peer coaching intervention not only for stroke rehabilitation but also for a wide range of chronic conditions.Implications for rehabilitationThe results of this co-design study, if replicated and extended, provide a theoretical framework to guide rehabilitation professionals about the optimal timing of peer-coaching interventions and contextual factors that need to be taken into account.Applying transformational leadership theory principles to the training of peers may prove useful at the time of the implementation of a coaching intervention.Peer-led coaching interventions, which are community-based and tailored to stroke survivors at the time of discharge, may help support re-engagement in social and leisure activities.

Preliminary codesign and testing of a feedback tool to improve the quality of peer appraiser documentation for medical revalidation

ABSTRACTMedical appraisal and associated revalidation are mandatory for doctors in the United Kingdom. However, the quality of appraisal documentation, which informs the revalidation process on a doctor’s fitness-to-practise, is known to be variable. This preliminary study aimed to develop and test a formative educational tool that could be used, as part of routine appraiser training in the general practice setting, to review and provide evidence and feedback on the quality of documentation completion. A mixed-methods study was undertaken based on codesign principles, which elicited the views and opinions of medical appraisers, appraisal leads and medical managers on the content of an educational tool designed to reduce variation in appraisal paperwork completion. The study team created a 24-item educational tool covering six domains of the appraisal process. Domains included ‘reflection on practice’, ‘knowledge, skills and performance’ and ‘quality and safety’. The tool was piloted amongst appraisers and received positive feedback. This study contributes practical knowledge to help reduce variation in appraisal documentation. The tool can be used to streamline the completion of appraisal documentation by appraisers. It may provide a level of quality assurance and contribute to providing fair, objective and measurable grounds for revalidation.

Co-design of eHealth Interventions With Children and Young People.

Co-design, defined as collective creativity across the entire design process, can lead to the development of interventions that are more engaging, satisfying, and useful to potential users. However, using this methodology within the research arena requires a shift from traditional practice. Co-design of eHealth interventions with children and young people has additional challenges. This review summarizes the applied core principles of co-design and recommends techniques for undertaking co-design with children and young people. Three examples of co-design during the development of eHealth interventions (Starship Rescue, a computer game for treating anxiety in children with long-term physical conditions, a self-monitoring app for use during treatment of depression in young people, and HABITS, the development of an emotional health and substance use app, and eHealth platform for young people) are provided to illustrate the value and challenges of this contemporary process.

Welcoming Feedback: Using Family Experience to Design a Pediatric Weight Management Program.

Objective:To describe an approach using principles of experience-based codesign (EBCD) and quality improvement (QI) to integrate family experience into the development of a pediatric weight management program.Methods:Clinic development occurred in 3 plan, do, study, act (PDSA) cycles that were driven by family experience data. During these cycles, families were engaged in feedback sessions that informed program development. Staff reflected on feedback and designed and tested changes that would improve service delivery.Results:The first PDSA cycle resulted in the fundamental program parameters and a formalized patient engagement strategy. The second cycle focused on pilot programming, and feedback was used to develop the structured group program. During the third cycle, feedback sessions were embedded into the structured group programs. Program changes included focusing on health rather than weight-based outcomes, adjusting the timing of program offerings, increasing experiential learning opportunities, and providing more opportunities for peer support.Conclusions:Both EBCD and QI methodologies informed the process of family engagement and program development. This pragmatic approach might be useful for the development of other family-centered pediatric programs.

Is Australia ready for Accountable Care? - academic, policy and service provider perspectives

Background : Healthcare organisations are increasingly adapting their delivery system models to focus on total populations and move away from volume-driven, fee-for-service models. One key example of this change internationally is with the establishment of Accountable Care Organizations (ACOs) where provider groups are held accountable for the total costs and quality of care for a defined population. In this workshop we will offer an academic, policy and service provider perspective on the applicability of ACO models of care for Australia. Aims and objectives : The objective of the workshop is to critically appraise international ACO models and to understand the cultural, policy and implementation considerations that need to be considered if such models are to be considered in Australia. Format : The workshop will be delivered in four parts. Part 1: The findings from an evidence synthesis of accountable care models will be presented. We will highlight what is known about the structures, capabilities and outcomes of these models and highlight exemplar models that are most relevant to the Australian health system. Part 2: The Australian and NSW policy environment will be reviewed. Several initiatives at both federal and state levels are currently underway with the aim of moving the health system toward population-based care delivery models. These will be reviewed and their relevance to ACOs will be discussed. Part 3: The implementation considerations of population-based health care delivery models will be discussed from a service provider perspective. The North Coast Primary Health Network and the the Northern New South Wales Local Health District are implementing several projects exploring locally driven strategies to address care fragmentation. Examples include projects to enhance consumer health literacy and self-management, support for patients at high risk of hospitalisation during winter and the 'reverse ambulance' program. Such strategies feature strong consumer and community engagement using co-design principles, pooled funding and commissioning of services, and establishing critical infrastructure to enhance sustainability. Part 4: In the final part we will engage workshop participants to: (1) critically appraise the information presented; (2) identify the models and model components of ACOs that are most relevant to Australia; (3) understand what policy reforms are needed to enable these models; and (4) identify potential risks and unintended consequences of their implementation. Target audience : We encourage a diverse audience of consumers, service providers (from primary through to tertiary care), managers, and funders to bring their unique perspectives to this workshop. Learnings : Health systems around the world are exploring innovative funding and care delivery models to improve health and performance outcomes. This workshop will make an important contribution to the dialogue on health system reform in Australia.

Gaining NHS ethical approval from the perspective of a biomedical engineering team

Gaining ethical approval to conduct collaborative research in the NHS is transitioning. The process of gaining ethical approval from a Research Ethics Committee was viewed as cumbersome within the UK. This viewpoint fuelled continuous improvement of the approval system, most recently implemented by the Health Research Authority. This paper documents an 8-month process of gaining ethical approval, under Proportionate Review, to recruit NHS patients, by an academic biomedical engineering laboratory. Within the field of prosthetic healthcare technology, the multidisciplinary laboratory adopted co-design principles to establish an effective relationship with clinicians to collaboratively gain approval. The challenges and recommendations of acquiring such approval are presented in this paper, including time commitment, project management, strategic networks and stakeholder engagement. The authors believe that academic biomedical engineering research is ideally situated to collaborate with the healthcare sector. By forging a collaborative approach, biomedical engineering can lead in the translation of technology from early stage research to clinical adoption. This vision will be facilitated by gaining an understanding of the NHS ethical approval process. The paper provides insight to this regard, with the aim of informing academic, research management and healthcare domains of this transitioning field of work.

Adapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol.

(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18–29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more.

Learning from the locals: how can co-design support malaria education in a post-colonial environment?

ABSTRACTDesigning for social good framed within an ethical practice has a long tradition informed by the democratic philosophy of John Dewey, but more recently it has been acknowledged that co-design can embody cultural respect and empathy through an expressed purpose. Using the principles of co-design, a northern European university took a small group of graphic design students to Mozambique to participate in a practice-led research project with local youth groups. The focus was on promoting malaria awareness and preventative education in an area of Africa where the disease is endemic despite large interventions from NGOs. This study examines the iterative process of the co-design project and how it responded to the challenges of a post-colonial environment to deliver a method of communication that was valid and participatory. When people engage in a co-design process, they also engage in ethics, in a process with embedded ethical, reflective and social qualities based on lived knowledge. If design-based social change is going to be effective and sustainable, it must be rooted in empowerment, and not solely dependent on the designer. Applied through this ethical and democratic approach, co-design could provide an engaging new strategy to solve some of the world's greatest social problems.

Integrated mental healthcare in Australia: rural pact and city partnership

The responsibility for Australian health services is shared between public and private sectors and three levels of governments. Service planning is difficult ; shifting of blame and costs endemic. It produces fine plans that are not matched by performance and the Federal Government is currently responding to a national review of the effectiveness and efficiency of health services completed in 2015. Health services in Australia chiefly focus on two of the four aims of health systems: individual patient care and provider efficiency. The failure to address population health and workforce issues results in a distorted and expensive system which largely fails to address prevention, early intervention or the use of low-intensity solutions. There are some signs of progress in the development of Primary Health Networks, charged with regional planning for mental health and suicide prevention services for defined populations, but many are just finding their feet. This paper will examine two partnerships. The Integrated Mental Health pact (IMHpact), as in agreement, has addressed this challenge for the rural Mid-North Coast (NSW) population by setting up an independent co-operative of public and NGO sector organisations with responsibilities to the community, not to any single organizational member in order to ensure its stability, sustainability and effectiveness. The Sydney Inner-city Urban Partnership for Health and Wellbeing (UP) addresses the needs of a vulnerable inner-city population with serious and persistent metal illnesses that are often combined with coexisting conditions and social adversities. The network combines a rich combination of clinicians, providers and sponsors from all sectors as it attempts to reframe service provision within a context where resources and incentives are poorly aligned with desired outcomes. Both models of care have been in development for about three years and adopt a place-based approach to care which attempts to shift attention from provider to beneficiary and to use principles of co-design to provide better care. The paper will present contrasting rural and urban research evidence to better understand the development of the partnerships and highlight the lessons learnt.

ADMISSION 2 DISCHARGE TOGETHER (A2D) - improving the hospital journey for people with an intellectual disability

Introduction : People with intellectual disability (ID) living in supported accommodation have complex health needs and poorer health outcomes. Their average age of death is 25 years younger than the general population*. Clinicians and support workers report challenges in caring for this population in hospital because of “inadequate information, not understanding the person’s wants and needs, and challenges in communication with the person and their carers”. Practice change : The development and implementation of the A2D Folder promotes carer and hospital engagement to provide safe clinical care. The training of hospital staff raises disability awareness and challenges staff attitudes to people with disability. Aim & theory of change : Co-design and capacity building principles: • Underpin the development and implementation of a simple and cost-effective solution to optimise transfer of information between group homes and hospital. • Assist health and disability staff with knowledge and strategies to meet the needs of persons with an ID in the hospital setting. • Increase the integration of care and smooth transition in and out of hospital for residents of supported accommodation. Targeted population and stakeholders: • 128 residents of government funded group homes in the catchment of three hospitals • Disability carers • Hospital staff Timeline : Two years (18 months currently) Highlights: • Development of the A2D Folder and staff education packages • Completed A2D Folders for 128 residents • Trained 560 medical, nursing and allied health staff • Formative evaluation shows a positive effect on attitudes • High demand for broader implementation and training • Health district innovation award nomination Sustainability: • Hospital culture shift with local champions propagating new clinical attitudes and skills • Development of a web-based A2D Toolkit including training resources, train-the trainer packages and a film clip Transferability: • Several other local health districts in NSW and 5 non-government service providers have implemented the A2D folder and training package • Families providing care in their own homes are requesting an A2D Folder Conclusions: • The project has demonstrated that an equal partnership model using co-design principles can enhance outcomes for residents in supported accommodation. • Targeted rights based training can change staff culture and attitudes. • Preliminary analysis of 55 admissions since the start of the project show a reduction in duplication of services, length of stay and in readmissions. Discussion: • Co-creating a normative vision for an optimal admission to discharge journey for a person with ID facilitates the functional integration of interagency services. • Case example of nursing staff using the Top 5 to decrease client anxiety by singing a favourite song rather than using physical restraint. Lessons learned: • Simple strategies can have significant outcomes • Patient stories are a powerful tool to change staff and organisational culture across agencies • Integration of care between acute health and community based disability services is possible when working in true partnership with a shared vision. * 2015 NSW Ombudsman’s Report of Reviewable Deaths in 2012 and 2013; Volume 2: Deaths of people with disability in residential care.