Supporting People Programme Research Articles

Novel Multicomponent Digital Care Assistant and Support Program for People After Stroke or Transient Ischaemic Attack: A Pilot Feasibility Study.

Evidence is increasing for digital health programs targeting the secondary prevention of stroke. We aimed to determine the feasibility of the novel Care Assistant and support Program for people after Stroke (CAPS) or transient ischaemic attack (TIA) by combining person-centred goal setting and risk-factor monitoring through a web-based clinician portal, SMS messages, a mobile application (app), and a wearable device. We conducted a 12-week mixed-methods, open-label feasibility study. Participants (6 months-3 years after stroke or TIA, access to the internet via a smartphone/tablet) were recruited via the Australian Stroke Clinical Registry. Participants set one or two secondary prevention goals with a researcher and provided access and training in technology use. Feasibility outcomes included recruitment, retention, usability, acceptability, and satisfaction. Secondary outcomes included goal attainment, health outcomes, and program costs. Following 600 invitations, 58 responded, 34/36 (94%) eligible participants commenced the program (one withdrawal; 97% retention), and 10 were interviewed. Participants (27% female, 33% TIA) generally rated the usability of the mobile application as 'Good' to 'Excellent' (System Usability Scale). Most (94%) agreed the program helped with engagement in health self-monitoring. Overall, 52 goals were set, predominantly regarding exercise (21/52), which were the most frequently achieved (9/21). At 12 weeks, participants reported significant improvements (p < 0.05) in self-efficacy (Cohen's d = 0.40), cardiovascular health (d = 0.71), and the mental health domain of the PROMIS GH (d = 0.63). CAPS was acceptable, with good retention and engagement of participants. Evaluation of this program in a randomised controlled trial is warranted.

Feasibility and end-user perceptions of a novel digital care assistant and support program for people after stroke or transient ischemic attack (CAPS)

Abstract Background The Care Assistant and support Program for people after Stroke (CAPS) or transient ischaemic attack (TIA) is a clinician-led program designed to improve the secondary prevention of stroke. The program combines person-centred goal setting and risk-factor monitoring through a web-based clinician portal, SMS goal-aligned messages, a mobile application (app), and a wearable device. We aimed to determine the feasibility of CAPS among people living with stroke or TIA, and clinicians who would deliver the program in future. Methods Open label single group pre-posttest mixed-methods evaluation of the 12-week program. Eligible lived-experience participants were recruited through the Australian Stroke Clinical Registry. Eligibility: diagnosis of stroke or TIA in preceding 6 months - 3 years, ≥18 years old, smartphone/tablet ownership, living in the community. Following surveys and interviews of lived-experience participants, ten clinicians experienced in stroke care were invited to participate in focus groups to discuss the program. We used descriptive statistics to evaluate feasibility outcomes, i.e. participant perceptions of usability, acceptability and satisfaction, and clinician perceptions on program design and delivery. Results From 600 invitations, 34 eligible participants commenced the program (27% female, 33% TIA, median 1.7 years from index event; one withdrew). Usability of the CAPS app was rated as ‘Good’ to ‘Excellent’ (System Usability Scale), with moderate sustained usage by study conclusion (&amp;gt;60%). Participants frequently reviewed their health data within the app (average twice a day/participant over 12 weeks), and entered their health measurements an average 73 times/participant. The majority (≥90%) of participants thought the program fitted well into their daily lives or helped engage them in self-monitoring, with 76% indicating they would use the program, if publicly available. Clinician participants included three nurses, three allied health professionals, two neurologists, a stroke consultant, and a general practitioner (GP) in focus groups. Overall, eight had positive perceptions of the CAPS program. Three clinicians indicated the measurements collected in the app captured "vital information", and five saw the value of CAPS to improve secondary prevention. Recommended modifications to the program included tracking atrial fibrillation and blood cholesterol. Seven believed participants would receive the most benefit from the program if delivered within three months post-discharge. Six indicated that GP-led multidisciplinary care was the best model to deliver CAPS. Conclusions The CAPS program was feasible to deliver and acceptable to people living with stroke or TIA. Clinicians saw the value of CAPS for secondary prevention, with feedback prompting further focus groups with GPs to develop the potential model of care. Findings have informed the design of a Phase II randomised feasibility trial.

Impact evaluation of a new counselling and support programme for unemployed with multiple placement obstacles

AbstractWe analysed a new counselling and support programme for people with low employment prospects in Austria. The Austrian Public Employment Service introduced regional pilots to investigate whether a new counselling strategy could improve labour market outcomes for this group. Eligible unemployed individuals could opt for third‐party counselling and support, access a wide range of low‐threshold services, and focus on personal stability rather than job placement. The goal was to achieve similar or even better labour market outcomes at lower cost. By comparing pilot and control regions, we found that introducing the offer resulted in higher costs without improving labour market outcomes.

Supporting People Data Linking Programme: Linked data research into the impact of housing-related support on use of healthcare services

ObjectivesWith an annual budget of over £120 million, the Welsh Government Supporting People Programme provided housing-related support to help vulnerable people to avoid homelessness and live as independently as possible. The SPDLP aims to determine the impact of the programme on other public services I.e. healthcare.&#x0D; MethodsEstablish data sharing agreements and acquire data for 21 out of 22 Local Authorities. Link the acquired Wales-wide sample of Supporting People data with other routine health and administrative datasets in the SAIL Databank. Examine the impact on subsequent interactions with other services (i.e. health, social care, housing options and pre-16 education). Create control groups and identify subgroups of clients to better quantify the effects of the Supporting People intervention. Compare service utilisation groups of clients and non-clients to inform future provision of public services.&#x0D; ResultsWork to validate the SPDLP approach by applying the method from the earlier Supporting People Data Linking Feasibility Study (SPDLFS) to the most recent data has been completed. Results from this will be presented along with emerging findings related to repeat homelessness. The development of health economics approaches to evaluating the impact of the programme will also be presented.&#x0D; ConclusionFor most local authorities in Wales, we have developed a longitudinal linked dataset comprising details of people at risk of homelessness. This has successfully enabled statistical research and analysis to explore the wider impact of government programmes to address inequalities and answer research questions around homelessness.

From the United Kingdom to Australia-Adapting a Web-Based Self-management Education Program to Support the Management of Type 2 Diabetes: Tutorial.

Diabetes self-management education and support can improve outcomes in people with diabetes. Providing health interventions via digital modes of delivery can extend the reach of programs delivered through traditional means. The web-based version of the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (MyDESMOND) is a digital diabetes education and support program for people with type 2 diabetes. The program was originally developed in the United Kingdom and is evidence-based, grounded in behavioral theory, and designed through a rigorous process of intervention mapping. As such, MyDESMOND was considered an ideal candidate for adaptation to the Australian setting. Program content and the digital platform were modified to suit the local context to increase the likelihood that the revised version of MyDESMOND will deliver similar outcomes to the original program. The aim of this paper is to describe the systematic processes undertaken to adapt the digital MyDESMOND diabetes education and support program for people with type 2 diabetes to the Australian setting. The adaptation involved a multidisciplinary group with a diverse range of skills and expertise—a governance structure was established, a skilled project team was appointed, and stakeholder engagement was strategically planned. The adaptation of the program content included modifications to the clinical recommendations, the inclusion of local resources, practical changes, and revisions to optimize readability. A 2-stage independent review of the modified content was enacted. Digital adaptations were informed by relevant standards, local legislative requirements, and considerations of data sovereignty. The digital platform was extensively tested before deployment to the production setting. MyDESMOND is the first evidence-based digital diabetes education and support program for Australians with type 2 diabetes. This paper provides a road map for the adaptation of digital health interventions to new contexts.

Assessing the Health Outcomes of the Food Access Pilot Project: An Evaluation of a Medically Supportive Food Support Program for People Living with HIV in Rural California Counties

Food insecurity disproportionately affects rural communities and people living with HIV (PLHIV). The Food Access Pilot Project (FAPP) was a California state-funded program that provided home-delivered, medically supportive meals via online meal vendors to food-insecure PLHIV in three rural counties. We performed longitudinal, retrospective analyses of FAPP participant data (n = 158; 504 and 460 person-time observations for viral load and CD4 count, respectively) over 36 months from a Ryan White client management database. Pre-post analyses demonstrated increased prevalence of food security and CD4 ≥ 500 between baseline and 12 months. Population-averaged trends using generalized estimating equations adjusted for participant demographics demonstrated increased odds of viral suppression and CD4 ≥ 500, and increased CD4 count (cells/mm3) for every six months of program enrollment. Home-delivered, medically supportive meals may improve food security status, HIV viral suppression, and immune health for low-income PLHIV in rural settings.

PP391 Economic Analysis Of Treatment For Spinal Muscular Atrophy: A Scoping Review

IntroductionSpinal muscular atrophy (SMA) is a rare, life-threatening, and seriously debilitating neuromuscular disorder, which has a heavy burden on patients, caregivers and the health system. Technological advances have improved clinical effect, but have also increased the financial burden. There is limited information in the literature on the resource utilization and economic burden of SMA. Our research aims to summarize the current literature on resource use, cost and economic evaluations of treatments for SMA, to inform further research and policy decision making.MethodsDatabases, including PubMed, Embase, Cochrane Library and CRD Database, were searched from inception. Two reviewers undertook title and abstract screening followed by full-text screening, and any disagreement was resolved in consensus. Data extraction was conducted using a customized form. Included studies were summarized using narrative synthesis structured around general and economic characteristics. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to where applicable.ResultsWe reviewed 552 abstracts and included twenty-six from 2015 to 2019. Four-fifths were published in the United States and Europe. Five full economic evaluations and one budget impact analysis compared nusinersen with AVXS-101 or best supportive care, and the remaining evaluated the economic burden of SMA. The most common outcomes were healthcare resource utilization and direct medical costs, only a few studies evaluated direct non-medical costs or indirect cost.ConclusionsSMA patients have significant medical expenditures and high utilization of healthcare services, including nusinersen-treated patients. The results highlight the substantial burden of treatment for SMA, not only for patients but also for their caregivers. SMA represents a significant hidden cost that society should be made aware of, and that should be considered in the design, implementation and evaluation of support programs for people who suffer from this disease and their families, as well as in the economic evaluation of new treatments.

A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV

Persons living with HIV (PLWH) are living into old age with more complex care needs that non-PLWH. Promoting quality of life should include advance care planning (ACP) education, particularly among African Americans. We explored faith/spirituality-related correlates of interest in a future quality of life program among African American PLWH. Data were from the AFFIRM study. Participants were recruited from an HIV clinic and completed surveys, interviews, and focus groups. Quantitative analyses included Logistic regression. Qualitative data were coded using grounded theory. Nearly half of participants had less than a high school education (47.9%), and roughly 90% had heard of at least one ACP-related topic (86.6%; N = 315). Qualitative themes related to quality of life and faith/spirituality were: (1) Coping with life challenges; (2) Motivation to improve health for loved ones; and (3) Support programs for people with HIV (N = 39). Satisfaction with religion/spirituality was associated with greater interest in a future program (p < .05); discussing ACP before getting sick was associated with less interest (p < .05). Prioritizing skill-building and grounding in spirituality with input from faith leaders can reduce ACP inequities and improve health outcomes among African Americans.

Technology to support relational care for people who use drugs at home: Literature review and key informant content.

Canada's opioid crisis is a public health emergency that disproportionately affects people who use drugs alone at home, requiring the mobilization of health systems to implement timely, effective, and innovative programs. The purpose of this review is to provide a synthesis of recent literature relating to technology-enabled harm reduction strategies. The results of the literature review are corroborated with key informants, including family members of people who use drugs and policy-makers in the area of opioid use. Based on this, it is recommended that technology-enabled support programs for people who use drugs at home must deliver support at whatever point the person is along their drug use continuum, must transfer frontline relational skills, must be co-developed with community members and service providers, and must deliver predictable and reliable services that are safe from stigma.

Establishment of a National Homelessness Prevention Programme dataset to enable an anonymised longitudinal dynamic cohort based study

IntroductionWelsh Government invests over £120m annually in housing related support to help prevent and tackle homelessness under the ‘Supporting People Programme’.&#x0D; A 2016 data-linkage Feasibility Study indicated health-service utilisation reductions post-intervention, and led to a four year project to create a national, all-Wales dataset to provide robust statistical results.&#x0D; Objectives and ApproachEstablish data sharing agreements, acquire and import anonymised individual-level data into the SAIL Databank. Create a research ready dataset, designed to permit annual administrative data updates to form dynamic cohort and control groups.&#x0D; Create several control group methods: 1) Internal Programme Data; 2) Matched controls; 3) Healthcare-Utilisation Patterns; 4) External Data Sources.&#x0D; Link to routine health data, obtain and link to other public service data to gain a deeper understanding of the Programme; how it affects use of other public services, and whether it helps people live independently.&#x0D; Complete statistical analysis using a Generalised Linear Mixed Modelling approach.&#x0D; ResultsData sharing agreements, data acquisition and standardisation complete for nineteen of twenty-two Unitary Authorities in Wales. Temporal coverage varies by Unitary Authority (2003-2017). 2016 data measures: match rates &gt;85%; 57% female; lead reason for support (top 5) : ‘General’ 20%, ‘Mental Health’ 15%, ‘Older People’ 14%, ‘Domestic Abuse’ 9%, ‘Young People’ 7%.&#x0D; Various control group methods employed: 1) Internal ‘Programme’ Data – no support taken up; 2) Matched controls; 3) Healthcare-Utilisation Patterns – rejected due to sparse outcome data; 4) External Data Sources being further explored.&#x0D; Health data-linkage (emergency admissions, emergency department attendance and primary care events) complete. Ongoing discussions to obtain sample social care, and police call data during 2018.&#x0D; Statistical analysis underway with results planned to be published during the summer of 2018.&#x0D; Conclusion/ImplicationsDespite many challenges, creation of a national linked dataset for people at risk of homelessness is possible with collaborative working between central government, academic and local government bodies. This ‘Administrative Data Research Centre Wales’ project has created a rich research resource enabling statistical analysis to answer research questions around homelessness.

Creation and analysis of a ‘national’ homelessness prevention programme dataset – The Supporting People Data Linkage Study

BackgroundWelsh Government (WG) invests over £120m annually in housing related support to help prevent and tackle homelessness under the Supporting People (SP) Programme.&#x0D; A 2016 data-linkage Feasibility Study for two Local Authorities (LAs) indicated health-service utilisation reductions post-intervention, and led to a four-year ADRC-Wales project to create a national, all-Wales dataset to provide robust statistical results.&#x0D; ObjectivesEstablish data sharing agreements and acquire anonymised individual level data into the SAIL (Secure Anonymised Information Linkage) databank to create a national, all-Wales, longitudinal SP dataset.&#x0D; Create control groups and carry out statistical analysis to investigate how the Supporting People Programme may help service users and the effects on other public services.&#x0D; Methods (including data)Intervention data for Supporting People service users was collected from individual LAs and imported into the SAIL databank using a split file process to maintain anonymity.&#x0D; Anonymised service users data were linked at the individual level to demographic and health data records for in excess of 40,000 individuals, with outcome measures created based on emergency hospital admissions, accident and emergency visits and General Practice events.&#x0D; Several control group creation methods were examined: 1) Internal Intervention Programme Data; 2) Matched controls using the SAIL databank; 3) Healthcare-Utilisation Patterns; 4) External Data Sources (Housing Options and Substance Misuse datasets).&#x0D; FindingsData sharing agreements and data acquisition complete for nineteen of twenty-two LAs, discussions ongoing for remaining LAs.&#x0D; Health data-linkage complete, other public service data acquisition ongoing.&#x0D; Annual progress reports published, main statistical analysis underway and due for 2018 publication.&#x0D; ConclusionsWe discuss challenges and opportunities around acquiring multi-sourced administrative data, methods of creating meaningful control groups and planned statistical analysis.

First steps in demonstrating an impact on health service use of the Welsh Government Supporting People homelessness prevention programme using linked administrative data

ABSTRACT&#x0D; ObjectivesTo assess the feasibility of using linked administrative data to deliver a quantitative component to the evaluation of the national homelessness prevention programme in Wales, Supporting People. Specifically, to establish whether any impact of Supporting People on the use of health services could be demonstrated. Approach: Data on the Supporting People programme was acquired from two pathfinder Local Authorities in Wales and anonymously linked to the routine health records held in the SAIL Databank at Swansea University. Any bias in linking rates was examined and health events analysed for the period 12 months before and 12 months after the point when homelessness prevention support began (the ‘crisis point’). The study evaluated a range of possible control groups that could be created using administrative data and undertook some preliminary comparative analysis. ResultsThe results of the study are due to be published on 10th March 2016 so detailed results will be available for August. We will briefly explore the unique contribution of data linking to researching the hard-to-reach and/or vulnerable groups supported by the intervention (e.g. people with substance misuse problems, women experiencing domestic violence and people with a criminal offending history) and the challenges of delivering a quantitative evaluation using linked administrative data. Findings will be reported on linking rates including any potential areas where particular service groups were relatively less well represented. Patterns of the following health events will be reported around the ‘crisis point’: i) number of days when GP events occurred; ii) number of A&amp;E visits and iii) number of emergency hospital admissions. Interpretations are made of consistent patterns of health events across different service user subgroups. The GP diagnosis codes, GP prescribing codes, reasons for visiting A&amp;E and reasons for emergency hospital admissions that showed the greatest decrease after the intervention will be reported. A brief discussion will be presented of the suitability of different control groups and the findings of the preliminary comparative analysis. ConclusionsUsing primary research methods, demonstrating the impact of a homelessness prevention programme on outcomes like health service use represents an insuperable challenge. The use of data linking data delivers a challenging but potentially robust method to demonstrate impact and the feasibility study was able to take the first steps towards demonstrating improved health outcomes for individuals.

Comparison of the adaptive implementation and evaluation of the Meeting Centers Support Program for people with dementia and their family carers in Europe; study protocol of the MEETINGDEM project

BackgroundThe MEETINGDEM study aims to implement and evaluate an innovative, inclusive, approach to supporting community dwelling people with mild to moderate dementia and their family carers, called the Meeting Centers Support Program (MCSP), in three countries in the European Union (EU): Italy, Poland and United Kingdom. Demonstrated benefits of this person-centered approach, developed in The Netherlands, include high user satisfaction, reduced behavioral and mood problems, delayed admission to residential care, lower levels of caregiving-related stress, higher carer competence, and improved collaboration between care and welfare organizations.MethodsThe project will be carried out over a 36 month period. Project partners in the three countries will utilize, and adapt, strategies and tools developed in the Netherlands. In Phase One (month 1-18) activities will focus on establishing an initiative group of relevant organizations and user representatives in each country, exploring pathways to care and potential facilitators and barriers to implementing the program, and developing country specific implementation plans and materials. In Phase Two (month 19‑36) training will be provided to organizations and staff, after which the meeting centers will be established and evaluated for impact on behavior, mood and quality of life of people with dementia and carers, cost-effectiveness, changes in service use, user satisfaction and implementation process.DiscussionAn overall evaluation will draw together findings from the three countries to develop recommendations for successful implementation of MCSP across the EU. If the Meeting Centers approach can be widely implemented, this could lead to major improvements in dementia care across Europe and beyond.Trial registrationThe trial was retrospectively registered in May 2016: trial number: NTR5936.

NAVIGATING DRIVING CESSATION: DEVELOPING AN EDUCATION AND SUPPORT PROGRAM FOR PEOPLE WITH DEMENTIA

NAVIGATING DRIVING CESSATION: DEVELOPING AN EDUCATION AND SUPPORT PROGRAM FOR PEOPLE WITH DEMENTIA

A mentor-mentee support program for people with anorexia nervosa

Results During workshop discussions, participants (4 mentors and 5 mentees) defined the program, examined roles and responsibilities, partnerships, interaction, use of funds, conflict resolution and risk management. The workshop, conducted informally in a setting that simulated a home environment, reduced anxiety levels. Uncertainty evolved into an appreciation for the program, development of new relationships, learning that everyone had similar reservations yet reassurance that people were there to support and encourage recovery. Participants were positive and optimistic for the program’s trial. Conclusion PAR is an apt research method for actively engaging stakeholders in the development of a tailored program to support recovery.

Laughing Like Crazy Stand Up Comedy Peer Support Program for People with Mental Illness: Research Results

Laughing Like Crazy Stand Up Comedy Peer Support Program for People with Mental Illness: Research Results

A service evaluation of The Haven at Home as a support programme for breast cancer survivors

Aim of the service evaluationThe Haven at Home is a free outreach programme offered by The Haven breast cancer support centres, which consists of a DVD, audio CD and web-based psychosocial, emotional and physical support for people diagnosed with breast cancer. The aim of the service evaluation was to assess the suitability of The Haven at Home as a support programme for people with breast cancer in Yorkshire. MethodsTwo hundred and twenty The Haven at Home packs were sent out to ten breast cancer units in the Yorkshire and Humber region to be distributed to breast cancer patients unable to attend the Leeds Haven, and directly to 206 previous visitors to the Leeds Haven centre. Ten respondents were contacted for a 15–30min recorded telephone interview to explore their response in more detail. Transcripts of the recorded interviews underwent framework thematic analysis. ResultsSeventy three (17%) of potential recipients completed the feedback questionnaire. Overall, The Haven at Home programme was considered to be both very helpful (73%) and easy to understand (81%). Respondents (n=67) liked The Haven at Home for its positive effects (27%), usefulness at home (16%), offer of companionship (15%) and specific therapies (31%), and considered it well presented (11%). Despite difficulty in some cases navigating the DVD, 96% of respondents would recommend the programme to others with breast cancer. ConclusionsA sample of breast cancer patients living in Yorkshire found that The Haven at Home outreach programme provided them with appropriate support.

Home-based exercise and support programme for people with dementia and their caregivers: study protocol of a randomised controlled trial

BackgroundDementia affects the mood of people with dementia but also of their caregivers. In the coming years, the number of people with dementia will increase worldwide and most of them will continue to live in the community as long as possible. Home-based psychosocial interventions reducing the depressive symptoms of both people with dementia and their caregivers in their own home are highly needed.Methods/DesignThis manuscript describes the design of a Randomised Controlled Trial (RCT) of the effects of a home-based exercise and support programme for people with dementia and their caregivers. The aim is to randomly assign 156 dyads (caregiver and dementia diagnosed person) to an intervention group or a comparison group. The experimental group receives a home programme in which exercise and support for the people with dementia and their caregivers are combined and integrated. The comparison group receives a minimal intervention. Primary outcomes are physical health (people with dementia) and mood (people with dementia and caregivers). In addition, to get more insight in the working components of the intervention and the impact of the intervention on the relationship of the dyads a qualitative sub-study is carried out.DiscussionThis study aims to contribute to an evidence-based treatment to reduce depressive symptoms among people with dementia and their caregivers independently living in the community.Trial RegistrationThe study has been registered at the Netherlands National Trial Register (NTR), which is connected to the International Clinical Trials Registry Platform of the WHO. Trial number: NTR1802.

Standards for epidemiologic studies and surveillance of epilepsy

Worldwide, about 65 million people are estimated to have epilepsy. Epidemiologic studies are necessary to define the full public health burden of epilepsy; to set public health and health care priorities; to provide information needed for prevention, early detection, and treatment; to identify education and service needs; and to promote effective health care and support programs for people with epilepsy. However, different definitions and epidemiologic methods complicate the tasks of these studies and their interpretations and comparisons. The purpose of this document is to promote consistency in definitions and methods in an effort to enhance future population-based epidemiologic studies, facilitate comparison between populations, and encourage the collection of data useful for the promotion of public health. We discuss: (1) conceptual and operational definitions of epilepsy, (2) data resources and recommended data elements, and (3) methods and analyses appropriate for epidemiologic studies or the surveillance of epilepsy. Variations in these are considered, taking into account differing resource availability and needs among countries and differing purposes among studies.

Mental health and housing: developing a care and support pathway

This article describes the development of the Supported to Independent Living project (SIL), which is for the support and care for people with mental health needs in Oxfordshire to live as independently as possible in ordinary housing in the community. The project is a partnership between NHS Oxfordshire (Primary Care Trust), the Oxfordshire Supporting People programme and Oxfordshire County Council Social and Community Services.Although there was a very vigorous development of community living for people with longstanding mental health needs through the provision of group homes, particularly in Oxford City that started in 1963, there has not been an overall strategy for the development of mental health services for the County as a whole. The needs of a diverse, younger, often more mobile and potentially more challenging group of service users for housing with appropriate care and support have not been met.A joint strategy between the County Council and the Primary Care Trust (PCT) to meet these needs has therefore been developed that introduces a pathway of linked accommodation and support arrangements. These range from intensive support through to floating support in the community, and are intended to offer individuals a guided pathway away from specialist services to more mainstream provision. The services are based on the principles of recovery, personalisation and ordinary housing.As well as achieving significantly reconfigured services the strategy has to deliver savings to meet the cuts imposed on the Supporting People programme grant by Central Government.The project has involved the PCT and the County Council in close partnership working, and important and significant involvement of and engagement with service users and carers. A framework agreement has been agreed by all of the organisations involved. It sets out the roles and responsibilities of each and covers local government, the NHS, housing and support.