Community Services For Adults Research Articles

Contextual and individual barriers to providing practice leadership by frontline managers in community services for adults with intellectual disabilities: A qualitative study

AbstractBackgroundAs practice leaders, frontline managers observe staff working, provide feedback and use organisational structures to improve staff skills and focus on service‐user quality of life. This qualitative study explored the experiences and barriers for frontline managers providing practice leadership to staff in community services for adults with learning disabilities.MethodsAudio‐recorded data was collected during semi‐structured interviews with 14 frontline managers, transcribed and analysed using thematic analysis.FindingsThree themes emerged reflecting participants' experiences of barriers to their work as practice leaders, focusing on stable staff teams, ‘admin’ and paperwork, and developing staff, each with sub‐themes.ConclusionsResults reflect existing research and suggest new challenges relating to progress in personalisation. Frontline managers experience barriers to providing practice leadership due to contextual and individual factors described in the themes. Successful implementation of policy initiatives, for example, Transforming Care requires further research on the impact, development and provision of practice leadership for support staff. should recognise these factors influencing frontline managers and ensure suitable policies and training to support practice leadership.

P02 Novel pharmacy roles strengthen the multidisciplinary hospital infection team

Abstract Background Pharmacists have an essential role to play in the NHS Long Term Plan. Hospital pharmacy departments need to develop novel roles to strengthen teams and improve patient care. In September 2017, Mid Yorkshire Hospitals NHS Trust appointed a consultant antimicrobial pharmacist along with an administrative apprentice to strengthen pharmacy and infection leadership and support the delivery of the antimicrobial resistance national targets. From January 2018 to June 2020, the infection team worked with locums but no substantive consultant microbiologists. Objectives To describe the benefits of developing novel pharmacy roles to strengthen an infection multidisciplinary team Methods A shortage of consultant microbiologists provided opportunities to develop and enhance other infection roles. These included one year of funding from Pathology for a Band 6 Specialist Pharmacy Technician. The role was subsequently funded by the Adult Community Services team to support the home intravenous antibiotic service. Senior support was provided by the Pathology Group Manager, Head of Infection Prevention and Control and Director of Pharmacy. The apprenticeship levy supported a Level 4 Data analyst qualification to develop the pharmacy administrator role. Two other infection roles were developed: Advanced Clinical Practitioner and Trainee Clinical Scientist, both of which could not be sustained for lack of adequate consultant microbiologist resources for clinical supervision within the team. Results The Specialist Pharmacy Technician coordinates the home intravenous antibiotic service. Clinical responsibility remains with the discharging consultant medical officer. The antimicrobial pharmacy team led the introduction of antibiotic elastomeric pumps for home use, saving 2500 inpatient bed days. Patient and staff feedback on the novel pharmacy roles has been positive. Band 5 Pharmacy Data Analyst – Antimicrobials responsibilities include clinical trial participation, data collection and analysis including ward level working, reporting and coordination of the audit programme. The role has enabled contribution to national research studies, including Antibiotic Review Kit (ARK-Hospital) and Procalcitonin: Evaluation of Antibiotic Use in COVID-19 Hospitalised Patients (PEACH). Through a new strategy, consultant microbiologist workforce has progressively grown back to three full time equivalents and a 4th post advertised, enabling an increase in participation in ward rounds, multidisciplinary team meetings, antimicrobial stewardship, infection prevention & control, Director of Infection Prevention and Control role and leading NIHR research trials. The consultant pharmacist remains in post as a senior leader, and also has a Trust role as Director of Innovation. This change provided funding for an increase from Band 3 to Band 5 data analyst, promotion of a senior Band 7 pharmacist to a Band 8a advanced clinical pharmacist, and conversion of a part time Band 7 pharmacist to a full-time role. Discussion An innovative approach to development of pharmacy, data, nurse and scientist roles has strengthened the infection service in a regional hospital and community services Trust. Pharmacy-led team meetings are now routine in the Trust allowing for more efficient use of consultant microbiologist time. Conclusions Potential future roles are further administrative support, pharmacy assistant, clinical nurse specialist – antimicrobials, and antimicrobial pharmacy team leader.

A Quality Improvement Project to Evaluate Satisfaction With Alternatives to Face to Face Consultation in a Learning Disability Service

AimsCOVID-19 pandemic has had a great impact on all groups in society. People with intellectual disability (ID)/learning disability (LD) are especially vulnerable. As a result, restrictions were put in place to protect this group, including limiting face to face visits/consultations. Restrictions on usual activities of people with learning disability are likely to induce stress leading to an escalation in challenging behaviors. Regular assessments and follow-ups are essential to evaluate the patients and provide the best care, so virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultationsAim: Evaluation of the service provided during the COVID-19 pandemic including virtual clinics.MethodsA questionnaire was designed to evaluate the patients and their careers’ satisfaction with the virtual clinics, seeking their feedback about positives and limitations of the service and exploring their preferences for future clinical contact. Data were collected during May 2021. Different professions including (psychiatrists, psychologists, nurses, occupational therapists and speech and language therapists) in community services for adults with learning disabilities in Aneurin Bevan University Health Board have participated in the survey. The questionnaires were filled by service users, their carers or by the service provider.Numbers of DNA (Did not attend) across the whole service during May 2021 were compared to DNAs in May 2018, 2019 and 2020.Results140 surveys were completed. Patients and their carers were happy with many aspects of the service provided through the pandemic. It was reported that virtual clinics are an efficient way to meet with professional carers and families where there are difficulties bringing patients to clinics, however home visits were preferred for assessing patients.No noticeable change in DNA rates has been identified.ConclusionVirtual clinics have been well tolerated by patients and their carers during the pandemic and have provided an extremely efficient tool to overcome the restrictions which were imposed.Carers and patients expressed satisfaction with clinic appointments provided remotely.

Risk Factors for Excess Deaths Among Older Adults Without Confirmed COVID-19 During Lockdown: A Retrospective Cohort Study

Background: Besides deaths directly attributable to COVID-19, many excess deaths occurred during ‘lockdown’, the range of societal responses to the initial wave of the COVID-19 pandemic. Data regarding these excess deaths is sparse, but necessary in order to avoid them in future waves. We investigated what factors contributed to excess deaths of older patients during the initial 2020 lockdown beyond those attributable to confirmed COVID-19. We hypothesized that both physical diseases and mental disorders would contribute.Methods: We did a retrospective cohort study using data from the electronic clinical records from Cambridge and Peterborough NHS Foundation Trust (CPFT), UK (catchment area population ~ 0.86 million). Eligible patients were aged 65 years or over at baseline with at least 14 days’ follow-up, excluding patients diagnosed with confirmed or suspected SARS-CoV-2 infection. We defined a cohort exposed to COVID-19 lockdown comprising patients recorded in CPFT between March 23, 2020 and May 19, 2020, and compared their mortality with an cohort recorded in CPFT between January 13, 2020 and 10 March, 2020, unexposed to lockdown. We used Cox regression to estimate the association between risk factors and death. Controlled covariates included social demographic factors, smoking status, mental comorbidities, and physical comorbidities.Findings: In the two cohorts, 3,073 subjects were exposed to lockdown and 4,372 subjects were unexposed; the cohorts were followed up for an average of 74 days and 78 days, respectively. After controlling for confounding by sociodemographic factors, smoking status, mental comorbidities, and physical comorbidities, dementia patients suffered an additional 53% risk of death (HR = 1.53, 95% CI = 1.02-2.31), and patients with severe mental illness suffered an additional 123% risk of death (HR = 2.23, 95% CI = 1.42-3.49). No significant additional death risks were identified from physical comorbidities.Interpretation: During lockdown people with dementia or severe mental illness had a higher risk of excess death. This study suggests that such patients require additional support during a societal response to this and similar epidemics/pandemics. These data could inform future health service responses and policymaking to help prevent avoidable excess death during future outbreaks of similar infectious diseases.Funding Statement: SC’s, PBJ’s, and RNC’s research was supported by the Medical Research Council (grant MC_PC_17213 to RNC). PBJ is funded through the NIHR Applied Research Collaboration (ARC) East of England. This research was supported in part by the UK National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre. Declaration of Interests: SC, EFE, PQ, and JRL declare no conflict of interest with this work. PBJ is a scientific advisory board member for Janssen and Recordati. BRU is clinical director for older people’s and adult community services at CPFT. He is clinical director of the Windsor Unit at Fulbourn Hospital (CPFT), which delivers clinical trials in dementia/mild cognitive impairment for academic and commercial organisations without personal benefit, and is the clinical lead for dementia for the NIHR Clinical Research Network (CRN) in the East of England. His salary is part-funded by the NIHR CRN. He has been principal investigator on trials for Axovant, Lilly, and EIP Pharma; his institution has benefited from payment for research carried out but he has not personally received any money. His wife is the lead for mental health for Suffolk Clinical Commissioning Group. RNC consults for Campden Instruments Ltd and receives royalties from Cambridge University Press, Cambridge Enterprise, and Routledge.Ethics Approval Statement: NHS Research Ethics 17/EE/0442

A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study

ObjectivesTo investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID).DesignSingle-arm feasibility study conducted over a 6-month period.SettingSpecialist community ID teams in...

Transforming care: developing a community enhanced intervention service

PurposeThe purpose of this paper is to present the service model and evaluation of Southwark Enhanced Intervention Service (EIS). EIS is an intensive community service for adults with intellectual disabilities whose behaviours challenge in the context of the Transforming Care agenda.Design/methodology/approachThe service model is described and the following evaluation data over four years are presented: key performance indicators, descriptive data, clinical outcomes, financial outcomes and qualitative feedback on users’ experience.FindingsThe EIS has demonstrated good outcomes for a small number of adults with complex needs by supporting them at crisis point locally and preventing hospital admission or a move to a restrictive environment out of area. EIS has also supported the successful transition back to area of a small number of adults with complex needs. The evaluation has shown improvements in behaviour, wellbeing and quality of life as well as demonstrating financial savings. Families’ and providers’ qualitative feedback indicates that the service has been highly valued and in particular the access to timely multidisciplinary coordination of input.Originality/valueThe service was developed around the same time as the start of the Transforming Care agenda. It presents findings of a four-year evaluation at a time when there is limited evaluation of such service models focusing on the Transforming Care aims. The paper presents significant findings in support of guidance and recommendations published more recently as well as reflections on components of effective service delivery.

The use of anti-psychotic and other psychotropic medication in a specialist community service for adults with learning disabilities

PurposeThe purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.Design/methodology/approachAdult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.FindingsWhile a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.Research limitations/implicationsThere were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.Practical implicationsWhile recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.Originality/valueComplementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs.

How can we smooth the transition of care?

Practice NursingVol. 28, No. 12 EditorialHow can we smooth the transition of care?Debbie BrownDebbie BrownSearch for more papers by this authorDebbie BrownPublished Online:30 Nov 2017https://doi.org/10.12968/pnur.2017.28.12.513AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Queen's Nursing Institute. Transition from children's to adult community services learning resource. 2017. https://www.qni.org.uk/child_to_adult/index.html (accessed 14 November 2017) Google Scholar FiguresReferencesRelatedDetails 2 December 2017Volume 28Issue 12ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Published online 30 November 2017 Published in print 2 December 2017 Information© MA Healthcare LimitedPDF download

Does a bespoke intellectual disability (ID) epilepsy service reduce mortality? A 11 year study of sudden unexpected death in epilepsy (SUDEP) in Cornwall UK

AimEpilepsy is the second most common cause of premorbid mortality in the ID population. Rates of SUDEP are considered up to 9 times higher in the ID population. Cornwall UK (population 600.000 i.e. 1% of UK) runs a specialist ID epilepsy community service for adults with ID. It delivers reasonable adjustments and person centered care to this population. We measured how service outcomes on SUDEP compared to regional and national averages.MethodsData of all Cornwall epilepsy deaths 2004–2015 using the Cornwall Coroner's database and the Public Health Cornwall was reviewed systemically. We identified patients with and without ID.ResultsThere were 113 epilepsy deaths of which 57 were SUDEPs of which 3 were identified to have a clinical diagnosis of ID. In another 2 cases it was not evident if they had an ID or not. None of the 5 was known to the ID Epilepsy service. Mean and 95% confidence intervals were calculated using a binomial calculation, making no prior assumptions about the population distribution.ConclusionCornwall's specialist ID epilepsy service is a rarity in the UK. A recent study using the Leicestershire ID Register revealed 26 people with ID of the total deaths of 83 SUDEP. This contrasts greatly with Cornwall only 5.26% of SUDEP deaths had ID compared to 23.4% in Leicestershire and similarly when compared to neighboring Plymouth (population 300.000) which had 26% ID deaths in its SUDEPs between 2004–2012. It is possible that having an ID dedicated epilepsy service saves lives.

‘What vision?’: experiences of Team members in a community service for adults with intellectual disabilities

In the UK, the closure of 'long-stay' hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams have been neglected. Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management Team members of (1) their personal well-being; (2) the functioning of their team; and (3) the organisation's commitment to quality, and culture. Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care practitioners and care managers were very similar: (1) the MBI scores of more than half the respondents were 'of concern'; (2) similarly, almost four in ten respondents' scores on the Vision scale of the TCI were 'of concern'; (3) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (4) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical. The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the changes in legislation, policy and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose.

A survey of consultant psychiatrists in intellectual disability based in England

Purpose Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services. Design/methodology/approach The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets. Findings In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services. Research limitations/implications Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners. Originality/value This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID.

Establishing and evaluating an assertive outreach team

Emma Louise Douglass and Barbara Hurtado discuss the effectiveness of a community service for adults with learning disabilities and mental-health needs

Staff Perception of Aggressive Behaviour in Community Services for Adults with Intellectual Disabilities

Experiencing aggressive behaviour has been associated with increased stress and turnover among staff who support adults with intellectual disabilities. Incident perception is a strong predictor of psychological outcomes after trauma but has not been studied in this staff group. This study clustered exposure to aggression and endorsement of emotional difficulties among 386 community residential group home staff and evaluated the contribution of four behavioural topographies to staff-rated perceived severity. Staff exposure varied considerably. Perceived severity correlated with subjective emotional difficulties. High perceived severity was associated with daily exposure, aggression towards others causing injury, and property aggression causing injury or damage. Therefore, the role the staff plays, whether a witness or target, may impact their experience.

Only for Minor Offences: Community Service in the Netherlands

Community service for adults was introduced in the Netherlands in the first half of the 1980s as an alternative to custodial sentences. In 1989 it was accepted as a third formal sentence in the Penal Code for adults. Since that time the number of orders increased to 40.000 on a yearly basis. In general, the probation service has managed to deal successfully with this growth. It did have consequences, however for the involvement of the community and the degree of individualization and support. The initial object of decreasing imprisonment by offering an alternative has not been achieved. In terms of reducing recidivism, community service seems to be relatively successful, however.

What should community services provide for adults with psychosis and learning disabilities? A comparison of the views of service users, carers and professionals

Three separate focus groups were conducted to compare the views of service users, carers and specialist health professionals on community services for adults with psychosis and learning disabilities. Participants were asked which staff, treatments or interventions and methods of working or style of service organisation make a significant contribution to helping people with psychosis and learning disabilities. Although there were few direct contradictions or conflicts between the three groups, the priorities of service users, carers and professionals often differed. Development of community services for adults with psychosis and learning disabilities should incorporate the views of service users and their carers as well as clinicians.

Services in the community for adults with psychosis and intellectual disabilities: a Delphi consultation of professionals' views

There remains a severe lack of evidence on the effectiveness of community services for adults with psychosis and intellectual disabilities (ID). There has been little consensus even of what services should provide for this service user group. A consultation of multidisciplinary professionals was carried out by using a three-round Delphi exercise. Participants were recruited nationally. They rated their views on the importance of 139 items for the care of adults with psychosis and ID. These included 85 routine service components, 23 service user characteristics for those needing a more intensive service and 31 more intensive service components. Forty-nine out of 52 participants completed all three rounds of the Delphi consultation. Consensus of opinion (> or = 80% agreement as essential) was obtained on 18 of the routine service components, nine of the service user characteristics and five of the more intensive service components. The routine service components considered essential can be broadly considered under a need for a focused approach on the service user and their illness (e.g. monitoring of mental state) and the added need to work within the wider context of the service user with psychosis and ID (e.g. access to social, leisure or occupational activities). Five of the more intensive service components were considered to be essential (e.g. can react to a crisis that day). However, the routine service components considered essential already contained many components such as out-of-hours support and crisis plans also relevant to more intensive services. These findings can be used to develop further the evidence base for services in the community for this user group and to assist in the preparation of much needed service evaluation studies.

Respite care as a community care service: Factors associated with the effects on family carers of adults with intellectual disability in Taiwan

Background This study examines the effects and associated factors of respite care, which was legislated as a community service for adults with an intellectual disability (ID) in Taiwan in 1997.Method A total of 116 family carers who live with an adult with ID and have utilised the respite care program were surveyed using standardised measures.Results The results suggest that the most notable effects of respite care include improvement in the carers' social support and life satisfaction, and relief of psychological stress and overall burden of care. The factors associated with these effects include the way the participants have used the respite care and the users' individual characteristics.Conclusions How families used the respite care, whether the carers practised a religion, and where the families resided, were the most significant factors in determining the effectiveness of the respite. Suggestions are made for making access to information about the program more widely available, and for extending the availability and duration of the service.

Social Ecology of a Residential Special School for Young People with Challenging Behaviours: A Preliminary Report

Background Little is known about the social ecology of residential schools. This study examined staff/student interaction and student activity in a traditional residential unit and an ‘independent living unit’ (ILU) in a school for students with intellectual disabilities and challenging behaviour.Method Staff and student behaviours were observed for 23 students aged 8–16 years, five from the ILU and 18 from the traditional unit.Results Students received staff assistance to complete activity for under 6% and 1% of time, and were constructively engaged for under 50% and 20% of time, in the traditional unit and ILU respectively. Few differences were found between the units.Conclusions Despite higher staffing ratios, levels of staff assistance and attention and resident activity in the school resemble mean levels in comparable adult community services. Further research into outcomes in residential schools seems warranted.

Incorporating Adult Community Services in Students' Transition Planning

Despite the 15-year focus on transition planning, students with learning disabilities (LD) continue to experience less positive postschool outcomes than their peers without disabilities. Outcome data indicate that experiencing successful transitions from public schooling into the adult world seems to be a complex and elusive process. The 1997 amendments to the Individuals with Disabilities Act promote the development of interagency linkages between school personnel and community agencies in an effort to mobilize all available resources. In many cases, however, these linkages are not being made. This article provides information on available community agencies, the resources they offer, and ways school personnel might work with these agencies in an effort to enhance successful transitions for individuals with LD.

Evaluating clinical supervision in community homes and teams serving adults with learning disabilities.

Evaluating clinical supervision in community homes and teams serving adults with learning disabilities This paper provides a discussion of some of the professional and policy outcomes associated with implementing clinical supervision within a community service for adults with learning disabilities. It is based upon a small qualitative study whose aim was to examine how clinical supervision was operating, its strengths, its weaknesses and where improvements might be made. The study followed the introduction of clinical supervision 9 months earlier for nurses and carers employed in three community homes and one community multiprofessional team. The method consisted of direct observation of individual and group supervision and staff completing critical incident questionnaires, followed by semi-structured, audio-taped interviews with seven registered nurses and four community team members, including a social worker, psychologist and physiotherapist. Outcomes were expressed in two ways: in terms of the benefits of clinical supervision or of its ambivalence. The range of matters brought for discussion, or resolution, in supervision reflected some of the difficulties or dilemmas staff faced working in this area, for example promoting empowerment and assisting clients to make choices, and dealing with clients' challenging and inappropriate behaviours. As for the role of supervisor there was some evidence of nurses expressing apprehension or unpreparedness, also a perceived general concern over the relatively low status of clinical supervision, thought to be due to absence of visible management approval or failure to articulate properly the objective of supervision. A limitation of the study was its small subject sample although considerable data were gathered in each of the units through relatively long-term contact.