Community Rehabilitation Teams Research Articles

Exploring staff experiences of remote working in a new community rehabilitation team

Background/Aims Health services required significant adaptation during the COVID-19 pandemic. The remote community enhanced rehabilitation team was created during the pandemic in response to faster discharges. This service evaluation aimed to explore staff experiences of remote working when implementing this new community rehabilitation team. Methods Six members of the community enhanced rehabilitation team, including nursing and psychology staff, completed qualitative semi-structured interviews about staff experiences. The interviews explored experiences of delivering clinical care, providing and receiving team support and personal impacts of remote working. Data were analysed using thematic analysis via a critical-realist approach. Results Thematic analysis from the interview transcripts revealed five main themes: anxiety related to remote working practices during a global pandemic, work–life balance, developing relationships, limits to remote working and working towards a hybrid model. Conclusions Challenges and benefits of remote working were identified along with some mitigations. Moving forward, a hybrid working model would likely benefit both service users and staff.

Community rehabilitation for people with severe and enduring mental health difficulties: a description and evaluation of a new community enhanced rehabilitation team

Background/Aims The community enhanced rehabilitation team was implemented in 2021 as part of the NHS Long Term Plan. This evaluation assesses whether the team is meeting its aims and objectives.. Methods Qualitative and quantitative methods were used to assess the team's progress. This included semi-structured interviews with service users, staff questionnaires and a review of data collected as part of routine clinical care.. Results Findings showed 117 interventions had been provided via the community enhanced rehabilitation team since May 2021. Service user anxiety had reduced following intervention, and service users were less likely to be re-hospitalised if they were under the community enhanced rehabilitation team compared to other teams. Conclusions The community enhanced rehabilitation team is meeting its aims and objectives, suggesting this is an effective model for community rehabilitation teams. Implications for practice Community enhanced rehabilitation teams can be created using this model as an example.

The Role of a Specialist Community Rehabilitation Team (Mental Health Intensive Support Team) in Reducing Referrals for Out-of-Area Placements

AimsPatients may be referred for out-of-area (OOA) placements for a variety of reasons, including a lack of local service provision to meet the requirements of patients with complex or longer-term needs. OOA placements can lead to patients experiencing social isolation from family and friends, as well as disjointed access to local services. In addition, placements can be costly in comparison with locally provided services. Mental health Intensive Support Team (MhIST) is a specialist community rehabilitation service within Cheshire and Wirral Partnership NHS Foundation Trust which was established in June 2021. Although the team does not have specific diagnostic inclusion criteria, patients referred will typically have a high level of complexity in addition to severe, treatment refractory symptoms and impaired social, interpersonal and occupational functioning.MethodsWe analysed routinely collected data to explore two methods by which MhIST is reducing referrals for OOA placements including i) direct diversion of patients who would otherwise have been referred for OOA placements to the community with MhIST support, and ii) facilitating discharge from local high dependency inpatient rehabilitation services in order to improve patient flow, which in turn additionally enables repatriation from pre-existing OOA placements.ResultsWe identified a cohort of 33 patients who had been supported by MhIST for ≥3 months. This cohort includes seven patients who would otherwise have been referred for an OOA placement. Further analysis for this group showed that initial referrals to MhIST were received from community mental health teams (CMHT) (n=1), acute inpatient wards (n=4) and high dependency inpatient rehabilitation services (n=2). Two patients (29%) were discharged to supported accommodation, and five (71%) were discharged to independent accommodation. Within the wider patient cohort identified (n=33), 66% of patients are living independently in the community.In total, 13 patients have been discharged from high dependency inpatient rehabilitation services to MhIST during the review period.ConclusionMhIST uses a multi-disciplinary model which offers an intensive level of support and a high frequency of interventions. The team includes support workers, nurses, doctors, occupational therapists, psychologists and social workers, and in addition links with other community services involved in housing, employment and social projects. A bespoke and flexible approach allows complex needs to be addressed within local services, and here we highlight the role of MhIST in reducing referrals to OOA placements.

The Impact of COVID-19 on Physical Health Monitoring of Community Rehabilitation Team Patients in NHS Borders

AimsPeople with schizophrenia have a life expectancy that is 10–20 years shorter than the general population. The high incidence of metabolic syndrome, cardiovascular disease and diabetes mellitus in this patient group are thought to be major – and potentially modifiable – factors contributing to this premature mortality. Therefore, annual monitoring of physical health parameters is recommended by organisations including the Scottish Intercollegiate Guidelines Network (SIGN). The SIGN guideline on schizophrenia advises that the following parameters are checked annually for patients with schizophrenia who are on anti-psychotics: ECG, blood glucose, lipid profile, prolactin, BMI/weight, smoking status and blood pressure. Traditionally, this monitoring is overseen in the community by general practitioners. This audit aimed to capture how the COVID-19 pandemic impacted on the annual physical health monitoring of patients under the care of NHS Borders Community Rehabilitation Team.MethodsA retrospective audit was performed by reviewing notes of the 100 patients on the NHS Borders Community Rehabilitation team caseload. Notes from the years of 2019, 2020 and 2021 of all 100 patients on the caseload were reviewed, for documentation of the following seven parameters as recommended by SIGN: ECG, blood glucose, lipid profile, prolactin, BMI/weight, smoking status and blood pressure. Results were then entered manually into a secure spreadsheet. Permission for this audit was granted by NHS Borders.ResultsInitial results for the parameters of: ECG, blood glucose, lipid profile and prolactin levels demonstrate that routine monitoring of all four domains has decreased since the start of the COVID-19 pandemic. In 2019 the following numbers of patients had monitoring in these domains: ECG 56 (56%); blood glucose 84 (84%); lipid profile 74 (74%) and prolactin levels 62 (62%).During 2020, the number of patients having monitoring in all four domains fell: ECG 31 (31%); blood glucose (72%); lipid profile 64 (64%) and prolactin levels 48 (48%). During 2021, monitoring levels remained low: ECG 30 (30%); blood glucose 71 (71%); lipid profile 62 (62%) and prolactin levels 43 (43%).Data collection for the parameters of blood pressure, BMI/weight and smoking status is ongoing.ConclusionInitial results indicate that the COVID-19 pandemic has negatively impacted on the routine physical health monitoring of patients under the care of the community rehabilitation team in NHS Borders. These results imply opportunities to treat and prevent conditions such as diabetes mellitus and hypercholesterolemia are being missed, further perpetuating an existing health inequality for patients with severe and enduring mental illness.

“Life, Interrupted”: A Patient Experience Encompassing the Journey From Hospital to the Community, With Support From the Mental Health Intensive Support Team (MhIST)

AimsWe present outcomes of a newly developed Community Rehabilitation team (MhIST) using the context of Jen's personal story. Jen is a 31-year-old student and freelance journalist. This story encompasses her journey from inpatient rehabilitation services to the community, completed with support from MhIST.Methods“For nearly four years, I was sectioned under the Mental Health Act as an inpatient in hospital. As I had been denied my fundamental liberties for so long, the prospect of leaving hospital for good and enjoying total freedom was both exhilarating and terrifying. How would I fare in the community, living on my own? Would I be lonely? Would I relapse? Would I survive?”Upon leaving hospital, I immediately received intensive support from MhIST. They were the bridge between the gulf that was hospital and the community. Since leaving hospital, I have been relishing my freedom. I enjoy meeting up with my friends after so long apart. I have volunteered at The Storyhouse, a local arts venue. The Spider Project – a non-clinical community mental health service in Chester - has also provided me with fulfilling activities from yoga to creative writing. The MHIST team have not only kept me well but, most importantly, helped me thrive. Leaving hospital has been an adventure. It has been a joy to regain my independence and freedom. To live rather than to exist. Life is amazing. Long may it continue.”ResultsMhIST provides an intensive rehabilitation and recovery service, delivering bespoke packages of care to individuals. This is achieved using key working and a shared team approach, outcome focused goal-based interventions, weekly reflective/formulation meetings, and a focus on social rehabilitation. Patients referred to MhIST will have a high level of complexity plus severe, treatment refractory symptoms, with impaired social, interpersonal and occupational function and high support needs. They may have co-occurring mental health conditions including substance misuse or neurodevelopmental disorders.MhIST is a new service and has been active for around 6 months. The first 10 patients referred have been from acute wards (3), community mental health teams (1), and inpatient rehabilitation wards (6). 60% of patients are currently housed in independent accommodation.ConclusionJen's story narrates the experience she encountered during transition from inpatient rehabilitation services to the community. This was completed with support from MhIST, a new community rehabilitation service which provides an intensive rehabilitation and recovery service.

Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

IntroductionA growing evidence base demonstrates the effectiveness of supported self-management in stroke for stroke survivors and their families. However, there is significant variation in its implementation in community stroke care...

Provision of training for accommodation providers in the London Borough of Hackney – results of a scoping exercise and educational session pilot

AimsTo understand the level of training given to staff in providers of accommodation in the London Borough of Hackney across mental and physical health.MethodThe Urgent and Emergency Care Collaborative (Health Education England) put out a call for funding bids around a number of workforce priority areas. This included upskilling care home staff to reduce admissions. We considered care home staff as those working across supported living schemes, housing with care, residential and nursing homes. Some of these settings exclusively support people with mental health needs.We obtained a list of accommodation providers across the borough via the Local Authority. As a Community Rehabilitation team we work closely with many of the providers. We also co-facilitate the Hackney Mental Health Supported Accommodation panel and review all funded placements annually. We made contact via email and phonecall and arranged face to face meetings with 11 providers. We asked a standard set of questions about the organisation and training provision. We also asked them to identify gaps in training.ResultThe level of training provided to staff varies vastly across different settings. There was a predominance of e-learning for some providers. Most staff in mental health settings are support worker level which limits the level of training offered/received.Providers varied greatly in size of project and management structure and this directly impacts on access to training, often as a result of cost.Providers were able to identify training gaps and were keen to have additional training.Some common themes emerged – dual diagnosis, psychosis, medication – and some setting specific themes – dementia.Based on the gaps identified we provided training sessions to a total of ~40 staff across a number of settings. Content included mental health awareness, crisis signposting and medicines management. All sessions were well received with pre and post-training questionnaires demonstrating an improvement in knowledge and confidence.ConclusionThere is potential for knowledge sharing across accommodation settings and for stronger links between accommodation providers and healthcare providers. We plan to explore the possibility of quantitative data on the number of Emergency Department presentations from accommodation settings locally.

Facilitators and \u201cdeal breakers\u201d: a mixed methods study investigating implementation of the Goal setting and action planning (G-AP) framework in community rehabilitation teams

BackgroundHigh quality goal setting in stroke rehabilitation is vital, but challenging to deliver. The G-AP framework (including staff training and a stroke survivor held G-AP record) guides patient centred goal setting with stroke survivors in community rehabilitation teams. We found G-AP was acceptable, feasible to deliver and clinically useful in one team. The aim of this study was to conduct a mixed methods investigation of G-AP implementation in diverse community teams prior to a large-scale evaluation.MethodsWe approached Scottish community rehabilitation teams to take part. Following training, G-AP was delivered to stroke survivors within participating teams for 6 months. We investigated staff experiences of G-AP training and its implementation using focus groups and a training questionnaire. We investigated fidelity of G-AP delivery through case note review. Focus group data were analysed using a Framework approach; identified themes were mapped into Normalisation Process Theory constructs. Questionnaire and case note data were analysed descriptively.ResultsWe recruited three teams comprising 55 rehabilitation staff. Almost all staff (93%, 51/55) participated in G-AP training; of those, 80% (n = 41/51) completed the training questionnaire. Training was rated as ‘good’ or ‘very good’ by almost all staff (92%, n = 37/41). G-AP was broadly implemented as intended in two teams. Implementation facilitators included - G-AP ‘made sense’; repetitive use of G-AP in practice; flexible G-AP delivery and positive staff appraisals of G-AP impact. G-AP failed to gain traction in the third team. Implementation barriers included - delays between G-AP training and implementation; limited leadership engagement; a poor ‘fit’ between G-AP and the team organisational structure and simultaneous delivery of other goal setting methods. Staff recommended (i) development of training to include implementation planning; (ii) ongoing local implementation review and tailoring, and (iii) development of electronic and aphasia friendly G-AP records.ConclusionsThe interaction between G-AP and the practice setting is critical to implementation success or failure. Whilst facilitators support implementation success, barriers can collectively act as implementation “deal breakers”. Local G-AP implementation efforts should be planned, monitored and tailored. These insights can inform implementation of other complex interventions in community rehabilitation settings.

The community rehabilitation response to COVID-19: innovative service delivery in community rehabilitation teams

International Journal of Therapy and RehabilitationVol. 27, No. 8 EditorialThe community rehabilitation response to COVID-19: innovative service delivery in community rehabilitation teamsNicole Lavin, Elizabeth FarrarNicole LavinCorresponding author: Nicole Lavin; E-mail Address: [email protected]University of Bradford, Bradford, UKSearch for more papers by this author, Elizabeth FarrarLiz Farrar Physiotherapy, Halifax, UKSearch for more papers by this authorNicole Lavin; Elizabeth FarrarPublished Online:1 Sep 2020https://doi.org/10.12968/ijtr.2020.0096AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Attend Anywhere. Our work. 2020. https://www.attendanywhere.com/our-work.html (accessed 17 August 2020) Google ScholarChartered Society of Physiotherapy. Rehabilitation and COVID-19. CSP policy statement. 2020a. hhttps://tinyurl.com/y4gq4m44 (accessed 17 August 2020) Google ScholarChartered Society of Physiotherapy. Community rehabilitation: live well for longer. 2020b. https://tinyurl.com/y3sdzg3v (accessed 17 August 2020) Google ScholarDepartment of Health and Social Care. Equity and excellence: liberating the NHS. 2010. https://www.gov.uk/government/publications/liberating-the-nhs-white-paper (accessed 17 August 2020) Google ScholarDepartment of Health and Social Care. NHS Outcomes Framework. Domain 2: health-related quality of life for people with long-term conditions. 2017. https://tinyurl.com/y4g8f3hh (accessed 17 August 2020) Google ScholarGreenhalgh T, Wherton J, Shaw S, Morrison C. Video Consultations for Covid-19. BMJ. 2020;368:m998. https://doi.org/10.1136/bmj.m998 Crossref, Google ScholarJackson M, Jones D, Dyson J, Macleod U. Facilitated group work for people with long-term conditions: a systematic review of benefits from studies of group-work interventions. Br J Gen Pract. 2019;69(682):e363–e372. https://doi.org/10.3399/bjgp19X702233 Crossref, Google ScholarLahelle AF, Oberg GK, Normann B. Group Dynamics in a group-based, individualised physiotherapy intervention for people with multiple sclerosis: a qualitative study. Physiother Res Int. 2020;25(3):e1829. https://doi.org/10.1002/pri.1829 Crossref, Google ScholarNHS England. Universal personalised care: implementing the comprehensive model. 2019a. https://tinyurl.com/yxg6outw (accessed 17 August 2020) Google ScholarNHS England. The NHS Long Term Plan. 2019b. https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf (accessed 17 August 2020) Google ScholarNHS England. After-care needs of inpatients recovering from COVID-19. 2020. https://www.england.nhs.uk/coronavirus/publication/after-care-needs-of-inpatients-recovering-from-covid-19/ (accessed 17 August 2020) Google ScholarPhillips M, Turner-Stokes L, Wade D, Walton K. Rehabilitation in the wake of COVID-19 – a phoenix from the ashes. 2020. www.bsrm.org.uk/downloads/covid-19bsrmissue1-published-27-4-2020.pdf (accessed 17 August 2020) Google ScholarSchuster R, Sigl S, Berger T, Laireiter A. Patients' experiences of web- and mobile-assisted group therapy for depression and implications of the group setting: qualitative follow-up study. JMIR Ment Health 2018;5(3):e49. https://doi.org/10.2196/mental.9613 Crossref, Google ScholarScriven H, Doherty DP, Ward EC. Evaluation of a multisite telehealth group model for persistent pain management for rural/remote participants. Rural Remote Health. 2019;19(1):4710. https://doi.org/10.22605/RRH4710 Google Scholar FiguresReferencesRelatedDetailsCited byExploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators30 November 2021 | Health & Social Care in the Community, Vol. 30, No. 5Getting infected with SARS-CoV-2Massimiliano Polastri28 February 2022 | International Journal of Therapy and Rehabilitation, Vol. 29, No. 2 2 August 2020Volume 27Issue 8ISSN (online): 1759-779X Metrics History Published online 1 September 2020 Published in print 2 August 2020 Information© MA Healthcare LimitedPDF download

Predictors of successful move-on to more independent accommodation amongst users of the community mental health rehabilitation team: a prospective cohort study in inner London.

In England, community mental health rehabilitation teams play a major role in supporting people with complex mental health needs to progress from inpatient to community settings and from more to less supported accommodation. We aimed to conduct the first study to investigate longitudinal outcomes for users of a community rehabilitation team and identify service user characteristics associated with successful progress along the rehabilitation pathway. We used routinely collected clinical outcome data relating to all 193 users of a community rehabilitation team in inner London, transferred to the team between June 2013 and May 2018, with a cut-off data-collection date of 20th June 2019. We estimated the proportion who moved on to more independent accommodation successfully, with no breakdown in the placement. We conducted multivariable Cox proportional hazard regression to investigate associations between service user characteristics at transfer and successful move-on. Overall, 43/193 (23%) service users achieved successful move-on during a median follow-up of 51months (IQR 32-63). This was more likely for those who were residing in more highly supported accommodation (HR 3.90; 95% CI 2.01-7.54) and those who had better functioning (HR 1.04, 95% CI 1.02-1.06) at transfer, while those with a serious physical health condition were less likely to achieve successful move-on (HR 0.44, 95% CI 0.21-0.95). Most supported accommodation services aim to offer time-limited support, but most service users do not progress successfully to more independent accommodation within 4years. Investment in interventions that improve functioning and physical health may facilitate successful move-on.

Community rehabilitation teams and COVID-19: rehabilitation demand and innovation in delivery

The impact of the coronavirus on the NHS has been well publicised and the country has locked down to protect it. Acute hospital services needed additional resources and support leading up to the peak of the virus but, as the number of hospital admissions reduces, demand for community rehabilitation services will increase.

A 3 month prospective audit of physiotherapy referrals to a community rehabilitation team and trial of alternative triage process

A 3 month prospective audit of physiotherapy referrals to a community rehabilitation team and trial of alternative triage process

Investigating the Model of Community-Based Case Management in the New South Wales Brain Injury Rehabilitation Program: A Prospective Multicenter Study.

To investigate a model of community-based case management (CM). New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP). All clinicians (N = 72) providing CM within 14 BIRP community rehabilitation teams. A prospective, multicenter study. A purpose-designed survey. Participants from the 12 adult and 2 pediatric services (8 located in metropolitan areas, 6 in rural areas) completed a 3-part survey investigating their organizational context, clinical approach, and CM interventions. Between-groups analyses explored differences among individual services, as well as differences based on age (adult vs pediatric) and location (metropolitan vs rural). All services provided a direct service model of CM. The underlying principles were uniform across services (more direct than indirect service provision; with more client-related than administrative-related tasks; more holistic than service-led in defining client needs; with decision making equally directed by staff and clients; and undertaking a more comprehensive than minimalist range of tasks). CM interventions included the provision of individual support, family support, advocacy, and community development alongside assessment, monitoring, referral, and liaison tasks. There were little differences in practice based on age or location. The NSW BIRP has drawn upon the results to produce a model of service for CM.

Community Services Integration into General Practice “Health Care Homes”

For decades, healthcare providers have worked from separate organisations, with disconnected care and processes. General practice teams, District Nurses and Community Rehabilitation teams have worked with the same patients, but not so much with each other. In 2016, an Alliance initiative and District Health Board/Primary Health Organisation jointly funded project, introduced a “Health Care Home” model to General Practice teams in Wellington, New Zealand. Supporting integration of community services into general practice was included as part of a suite of mandated practice developments. Teams from both community nursing and allied health services were challenged to develop a new integrated model with general practice, based on desired outcomes and planned interventions. With change management support, these teams were assisted to implement their changes. Developments included practices having a named and known District Nurse and Allied Health person; re-introductions to each other’s capabilities and resources; improved contact processes; shared lists of patients; sharing skills; monthly Multi Disciplinary Team (MDT) meetings; joint proactive care management for risk modelled, complex people; use of shared care records; development of a joint care planning tool; and use of mobile technology. Outcomes of this project included improved relationships exampled by quotes from a GP, “MDTs are worth their weight in gold”, and from a community nurse “I have learnt so much about how general practice teams function, and they understand me more too”. Other health professionals and patients have joined the MDT meetings with remote attendance planned for in the future. Through this project, teams have understood the need to work differently. Developed local networks and alliances have helped improve efficiencies and proactive patient care. The future challenge is to sustain and enable further improvement and expansion of this successful model across the whole DHB.

Improving service user self-management: development and implementation of a strategy for the Richmond Response and Rehabilitation Team.

Community rapid response and rehabilitation teams are used to prevent avoidable hospital admissions for adults living with multiple long-term conditions and to support early hospital discharge by providing short-term intensive multidisciplinary support. Supporting self-management is an important service intervention if desired outcomes are to be achieved. A Care Quality Commission inspection of the Richmond Response and Rehabilitation Team in 2014 identified that self-management plans were not routinely developed with service users and reported this as requiring improvement. This quality improvement project aimed to develop and implement a self-management strategy for service users and for 90% of service users to have a personalised self-management plan within 3 months. The quality improvement intervention used the Plan-Do-Study-Act model comprising: (1) the development of a self-management plan, (2) staff education to support service users to self-manage using motivational interviewing techniques, (3) piloting the self-management plan with service users, (4) implementation of the self-management plan and (5) monthly audit and feedback. Evaluation involved an audit of the number and quality of self-management plans developed with service users and a survey of staff knowledge and confidence to support service users to self-manage. Following implementation of the intervention, the number of self-management plans developed in collaboration with service users increased from 0 to 187 over a 4-week period. Monthly audit data confirmed that this improvement has been sustained. Results indicated that staff knowledge and confidence improved after an education intervention. Quality improvement methods facilitated development and operationalisation of a self-management strategy by a community rapid response and rehabilitation team. The next phase of the project is to evaluate the impact of the self-management strategy on key service outcomes including self-efficacy, unplanned and emergency hospital admissions and early discharges.

Community teams, specialist fall services and emergency department implementing an integrated regional falls risk assessment and prevention pathway

Introduction: In 2008, the national strategy for the prevention of falls and fractures in Ireland was published. In 2009, a detailed mapping exercise in our region demonstrated the size of our problem showing 4,680 emergency department attendances locally for falls annually, 21,500 acute bed-days used after falls and falls-related local health cost of €31 million. We had elements of good practice but services for falls management were neither coordinated nor integrated. Practice change: We took a whole-system approach to the delivery of services for falls in older people. Since 2012 a multidisciplinary clinician group has worked with regional management to improve falls services. Our project has four main work streams: building community capacity for fall risk assessment; re-engineering specialist fall services to improve access; standardising continuing care falls assessment; and promoting healthy ageing to prevent falls. Aim: We aim to deliver 1,300 additional multifactorial fall risk assessment places yearly. Our objective was to implement an integrated pathway between emergency department, community services and specialist services for falls prevention. Targeted population: Our catchment population has ~300,000 people in mixed urban and rural settings. A large stakeholder workshop was held in July 2014. The change management process is coordinated through monthly steering group meetings along with weekly teleconferences with four project work-streams leads. Highlights: In 2015, a regional falls coordinator and an administrator were appointed. The continuing care work-stream has separate funding, allowing an experienced nurse support 17 community units for 12 months to implement a standardized approach to falls. Otherwise, all developments were within existing resources. A simplified referral pathway with a single point of access was established. Five new community-based falls risk assessment clinics using validated user-friendly assessment tool were formed. Mentoring by experienced staff is important to support each new community clinic. Pathways now exist linking the emergency department, geriatric medicine specialist services and the community falls services. A medical fall clinic and a multidisciplinary community rehabilitation team were integrated into a single specialist fall service and a weekly triage meeting started. The referral rate has doubled in the past six months with over 80 new cases now triaged monthly. By re-engineering the specialist service, we reduced the waiting times for medical appointments from over three months to two weeks. Conclusions & Discussion: By following a national strategy supported by detailed local data a change management approach has delivered a system-wide integrated falls service in our region. The success of this project has depended on securing buy in from key stakeholders. With complex interacting services having a single point of contact through the falls service coordinator has been essential. Clinicians and management building trust and working together over time was central to this project. A robust evaluation of “how” this change has been achieved is underway to ensure the learning is transferable to other areas. Lessons learned: Resilience is essential in such a large project Change of this scale requires top down support for a bottom up approach Ongoing ownership by those involved in service delivery is important

6 Brain injury rehabilitation: audit of a neuropsychiatry liaison service

<h3>Objective</h3> Since 2013, rehabilitation after brain injury has been coordinated in Cheshire and Merseyside through a rehabilitation network. The network consists of four rehabilitation units: a Level One hyper-acute ward and complex rehabilitation unit within the Walton Centre and two Level Two spoke rehabilitation units within Liverpool and St Helens, in addition to a Community Rehabilitation Team. An inpatient Liaison Neuropsychiatry service consisting of a Consultant Neuropsychiatrist and a Clinical Nurse Specialist cover the units. <h3>Method</h3> Electronic patient records were searched for information pertaining to Neuropsychiatry reviews undertaken on patients in the rehabilitation units. Data were collected on the number of reviews, diagnoses, previous psychiatric history, number of injuries due to suicide attempts, capacity assessments performed and number of subsequent referrals to Community Mental Health Teams (CMHT). <h3>Results</h3> Over a twelve month period, a total of 174 patients were reviewed by the Neuropsychiatry Liaison Service. 29.9% (52) of those patients had a past psychiatric history and indeed 4 of them had sustained their brain injury due to a suicide attempt. The patients were reviewed an average of 5 times during their stay on the rehabilitation unit. Capacity assessments were performed on 20 patients. The most common diagnoses seen were adjustment reaction, depression, delirium and anxiety. Of the patients reviewed, 11.5% (20) were subsequently referred on to CMHT. <h3>Conclusion</h3> This study shows the importance of Neuropsychiatry provision within Inpatient Rehabilitation units and the high level of psychiatric conditions within patients who suffer an acquired brain injury.

A behavior change program to increase outings delivered during therapy to stroke survivors by community rehabilitation teams: The Out-and-About trial.

Australian guidelines recommend that outdoor mobility be addressed to increase participation after stroke. To investigate the efficacy of the Out-and-About program at increasing outings delivered during therapy by community teams, and outings taken by stroke survivors in real life. Cluster-randomized trial involving 22 community teams providing stroke rehabilitation. Experimental teams received the Out-and-About program (a behavior change program comprising a training workshop with barrier identification and booster session, printed educational materials, audit, and feedback). Control teams received printed clinical guidelines only. The primary outcome was the percentage of stroke survivors receiving four or more outings during therapy. Secondary outcomes included the number of outings received by stroke survivors during therapy and undertaken in real life. At 12 months after implementation of the behavior change program, 9% of audited experimental group stroke survivors received four or more outings during therapy compared with 5% in the control group (adjusted risk difference 4%, 95% CI - 9 to 17, p = 0.54). They received 1.1 (SD 0.9) outings during therapy compared with 0.6 (SD 1.0) in the control group (adjusted mean difference 0.5, 95% CI - 0.4 to 1.4; p = 0.26). After six months of rehabilitation, observed experimental group stroke survivors took 9.0 (SD 3.0) outings per week in real life compared with 7.4 (SD 4.0) in the control group (adjusted mean difference 0.5, 95% CI - 1.8 to 2.8; p = 0.63). The Out-and-About program did not change team or stroke survivor behavior.

Sexuality after stroke: an exploration of current professional approaches, barriers to providing support and future directions

ABSTRACTPurpose Sexual difficulties post-stroke are common, yet frequently neglected within rehabilitation. This study aimed to explore the process by which healthcare professionals approach and work with the topic of sexuality within stroke rehabilitation. Method Ten participants were recruited from 5 community and inpatient multi-disciplinary stroke rehabilitation teams. Semi-structured interviews were carried out and data were analysed using grounded theory methodology. Results The authors developed a theoretical model of how professionals engage with sexual concerns. Professionals’ own personal level of comfort with the topic of sexuality interacted with a series of barriers to limit opportunities for engagement. These barriers included factors relating to the context and workplace environment of stroke rehabilitation, professionals’ perceptions that they did not have adequate skills in this area and unhelpful attitudes towards stroke survivors and sexuality. Although the majority of participants rarely engaged with sexual issues, they adopted both direct and indirect strategies for engaging with their service users’ sexual concerns. Concerns were usually addressed through the provision of information and supportive conversations. Conclusions The findings suggest that sexuality is not a legitimised topic within stroke rehabilitation, and current work practises limit professionals’ abilities to address service-users’ concerns. Implications for developing effective training and staff support are discussed.Implications for rehabilitationProfessionals working within stroke rehabilitation rarely directly bring up sexuality with patients, but an indirect method of approaching the topic is more common.Addressing sexual concerns often does not require expertise.Training should show professionals how to use transferable knowledge to address sexual issues and also enhance communication skills.Sexuality should be incorporated within local stroke policy and procedures, to support professionals in addressing the concerns of their patients and motivate them to act.

Mechanisms to enhance the effectiveness of allied health and social care assistants in community-based rehabilitation services: a qualitative study.

This research aims to describe the factors associated with successful employment of allied health and social care assistants in community-based rehabilitation services (CBRS) in England. The research involved the thematic analysis of interviews and focus groups with 153 professionally qualified and assistant staff from 11 older people's interdisciplinary community rehabilitation teams. Data were collected between November 2006 and December 2008. Assistants were perceived as a focal point for care delivery and conduits for enabling a service to achieve goals within interdisciplinary team structures. Nine mechanisms were identified that promoted the successful employment of assistants: (i)Multidisciplinary team input into assistant training and support; (ii)Ensuring the timely assessment of clients by qualified staff; (iii)Establishing clear communication structures between qualified andassistant staff; (iv) Co-location of teams to promote communication and skill sharing; (v) Removing barriers that prevent staff working totheir full scope of practice; (vi) Facilitating role flexibility of assistants,while upholding the principles of reablement; (vii) Allowing sufficient time for client-staff interaction; (viii) Ensuring an appropriate ratio of assistant to qualified staff to enable sufficient training and supervision of assistants; and (ix) Appropriately, resourcing the role fortraining and reimbursement to reflect responsibility. We conclude thatupholding these mechanisms may help to optimise the efficiency andproductivity of assistant and professionally qualified staff in CBRS.