Allied health, non-government organisation and university partnerships building an evidence base for a consumer peer-led education program in youth mental health

Ms Cate Bourke1, Dr Primrose Lentin2, Ms Kate Higgins3, Ms Mia Thiedeman-Brown1, Mr Matt Boyd2, Mr Justin McKenzie3, Ms Evie  Thomas1, Ms Samantha Buis1

1Mental Health Program, Eastern Health, East Ringwood, Australia, 2Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University., Frankston, Australia, 3Wellways, Fairfield, Australia

 

Aim:

To describe the development of a successful partnership between a child and youth mental health service, a mental health community service and a university, that enabled evaluation of a consumer peer-led youth mental health program.

Method:

Using principles of project development as well as key discipline and consumer related models, the background, rationale and processes that underpinned the partnership development will be analysed.  Key learnings regarding the building of the partnership, including policy, organisational, consumer and allied health influences will be presented as well as outcomes including benefits to consumers, staff, organisations and student practice.

Results:

Change in mental health policy and practice from a medical model to a recovery based model means that new approaches are required to guide and evaluate practice. Services report finding the time and resources to develop these approaches is a challenge.  Allied health professionals have a range of collaborative partnership skills and working in partnership has helped address this challenge. Keeping consumers central to the partnership has led to a culture of innovation and trialing of new consumer-led practices, this has helped drive an agenda for research that is relevant to consumers.

Significance of the findings to allied health:

To provide effective and responsive services to consumers an ability to establish interagency collaborations and meaningful partnerships is needed. Within this paper, the ways in which the allied health workforce can develop, establish, maintain and evaluate these innovative approaches and partnerships are discussed.

“Brain Waves”; a stroke education program in community rehabilitation

Ms Ricci Presser1

1Monash Health, Melbourne, Australia

 

The Brain Waves team were recently named as a finalist in the Stroke Care Champion category of the Stroke Foundation 2016 Stroke Awards. Stroke Foundation Chief Executive Officer Sharon McGowan said “the Brain Waves program were an outstanding team who demonstrated exceptional commitment to improving the lives of stroke survivors, their families and carers”.

Aim: To meet the National Stroke Foundation guidelines for consumer education through the development and delivery of an evidence-based, consumer driven, interdisciplinary education program for stroke survivors and their carers.

Method: The Community Rehabilitation Neurology Special Interest Group formed an interdisciplinary working party to develop the stroke education program. Information from benchmarking, literature review and consumer surveys were combined to develop the Brain Waves stroke education program.

Results: The Brain Waves stroke education program was piloted at 3 Monash Health Community Rehabilitation sites in 2015. Consumer feedback was collected after each of the education sessions, along with an overall evaluation following program completion in 2015. This information informed changes for the 2016 program. Staff and client feedback will be re-evaluated in December 2016 and changes will be made accordingly. (Specific results available on request).

Significance of the findings to allied health: We feel the Brain Waves program is unique as we engaged our consumers and asked them what they wanted. The group dynamic promotes social connectedness which we know is very important with this population.

Collaborating with consumers to enhance the communication skills of health professionals working in aged care and rehabilitation

Ms Ruth Townsend1, Ms Emma Burns1

1Austin Health, Kew, Australia

Aim: To implement a training program for allied health and nursing staff that enhances communication skills and includes opportunity to use learnt strategies and skills in face-to-face communication practice with people with communication disability.

For the past five years, speech pathologists at Austin Health have been providing the Aphasia Institute’s “Supported Conversation for Adults with Aphasia” one day training program to Latrobe University speech pathology students. The program is co-facilitated by people with aphasia who engage in conversation practice with participants to enable practical application of skills and strategies taught within the program.

Currently no regular staff training opportunities in this area exist for allied health staff working within aged care and rehabilitation at austin Health.

Methods: A series of training days (4 training days) were arranged in November 2016 and February 2017 for nursing and allied health staff to attend. Attendance of allied health staff was coordinated by the allied health clinical education lead. The Nursing Clinical Education leads recruited nursing staff. 20 staff attended each session (evenly spilt between allied health and nursing). 5 PWA (people with aphasia) co-facilitated at each training day.

Results: Staff completed pre training questionnaires via survey monkey which included evaluating pre training knowledge and skill base and a requirement to identify an example of communication breakdown experienced within the workplace with patients with communication disability and a personal development goal. Staff completed a paper based questionnaire immediately post training which included questions pertaining to how knowledge acquisition would impact on clinical practice, including specific actions relating to pre training example (utilising Austin Health’s TOTR teaching on the run professional development framework). Further evaluation via a Survey Monkey questionnaire one month post training was sent via email to staff participants.

Findings: to follow

Significance to allied health: to follow

“Dining with Friends” An enjoyable mealtime experience for patients in hospital: Aimed at promoting socialisation and increasing meal enjoyment

Ms Natalie  Lim1, Ms Chantelle Hutchinson1

1Werribee Mercy Hospital, Werribee, Australia

Aim:

– To decrease isolation and promote socialisation.

– To promote opportunities to address therapy goals related to feeding.

– To promote multi-sensory stimulation (i.e sights, sounds, tastes).

– To promote oral intake and meal enjoyment by facilitating shared meals and mimicking a normal mealtime experience.

– To support meaningful activity associated with eating/drinking.

Method:

25 patients on the GEM/Rehab ward attended the Dining With Friends (DWF) group which was held once each week for a trial period over 5 weeks. From this group 14 patients completed a pre and post DWF survey. Patients with significant cognitive impairments were excluded from completing the surveys however were not excluded from attending the group.

The surveys were used to obtain quantitative data and measure areas such as: times where patients are more sociable, the impact of eating with others on appetite, overall enjoyment of their meals during their hospital stay, etc. Qualitative data was also gathered through informal conversation and a comments section on the survey.

Results:

– Before DWF only two patients identified lunch time as a time where they are more sociable however after DWF seven patients did.

– 93% of patients stated they would attend DWF again

– Average rating for the enjoyment of DWF was 3.75 out of 4

– Before DWF 10% of patients indicated they would prefer to eat with other people however after dining with friends this increased to 50%

Significance of the findings to allied health:

Results indicate many patients would prefer to eat with others therefore this should be considered on inpatient wards.

Helping carers care: Supporting informal carers now and in the future

Ms Amy Heath1

1La Trobe University, Melbourne, Australia

 

This quantitative and qualitative study, with the support of Carers Victoria and the Palliative Care Unit of La Trobe University, sought to quantify and qualify the stresses and challenges that the role of informal caring has upon someone managing an ageing person. Research in the area of care-giving is substantial in Australia thanks to pioneers such as Drs Noel and Cynthia Schultz, but service provision and the ongoing use of services amongst the ageing and their carers is an area of constant struggle. The knowledge about carers is vital for ensuring that not only are those requiring care receive it in a timely and appropriate manner, but that their carers are also supported in order to allow them to care in a positive and meaningful way.

 

The increasing ageing population in Australia ensures that informal carers will be sought after, with more and more family member becoming carers, possibly on multiple occasions throughout their life. Supporting these people, allowing them to access the resources and support they need in times of difficulty is crucial – and not judging them on their performance in this time of need is even more important.

 

The overall results of this research will be presented which will help to enlighten health professionals in the geriatric and palliative care fields about how to reach out to these carers, to use their untapped expertise they possess so as to support the ageing, knowing that they too, as health professionals, might also need such a carer in the future.

An evaluation of whether discharge plans meet patients’ requirements: A survey

Ms Kate Roberts1, Ms Rachel Dempsey2, Ms Amanda Wurfel3, Dr Kathy Stiller1

1Central Adelaide Local Health Network, Adelaide, Australia

2Hampstead Rehabilitation Centre, Adelaide, Australia

3St Margaret’s Rehabilitation Hospital, Adelaide, Australia

 

Aim: The provision of discharge plans that meet the requirements of individual patients’ needs are an essential component of rehabilitation, with allied health a vital component of rehabilitation. There is little research investigating the effectiveness of discharge planning in this setting. The aim of this quality improvement activity was to survey patients to investigate whether discharge plans met their requirements, identify factors predicting the success of discharge planning and investigate whether the perceptions of patients and a family member/carer regarding the success of discharge planning were in agreement.

Method: Forty patients discharged home from units within two rehabilitation hospitals were recruited. Patient surveys, undertaken via interviews, were conducted to determine participants’ satisfaction with their discharge planning: one pre-discharge and the other 1-2 months post-discharge.

Results: Overall, discharge plans, in which allied health staff played a pivotal role, were successfully developed and implemented. Most items that were listed on participants’ discharge plans were provided, required and met participants’ requirements. The success of discharge planning did not appear to be influenced by factors including age, gender, length of stay, primary diagnosis, functional scores or home address. Participants and a family member/carer had a high level of agreement regarding the success of discharge planning.

Significance of the findings to allied health: Allied health staff play a pivotal role in discharge planning in the rehabilitation setting. The discharge plans of participants involved in this quality improvement activity accurately identified patients’ needs, and the actions identified were provided and met the requirements of participants.

Patient centred multidisciplinary case conferences

Mrs Nicole Jones1, Mr Brett Walters1

1GV Health, Shepparton, Australia

Aim: To improve patient centred goal setting in case conference on the subacute ward and improve patient centred communication through clearer definition of the patient liaison role.

Method: As part of an Allied Health Redesign Project, best practice for a multidisciplinary team (MDT) case conference was benchmarked. A patient questionnaire was conducted to ascertain patient views and awareness of goal setting, case conference and progress updates during their stay on the ward. New case conference documents were trialled and implemented with specific focus on goal setting. A standard work practice for the subacute liaison role was created along with an initial contact sticker with prepopulated questions. Evaluation included repeating the patient questionnaire and seeking feedback from staff in response to the changes.

Results: Preliminary results show from 17 patients surveyed before intervention, only one (5.9%) was aware of having a liaison assigned, four (24%) had been asked what goals they wanted to achieve and were involved in setting goals and two (12%) were aware of case conferences. Eleven patients (65%) didn’t feel they were part of the discharge decision making process, of which 82% would have liked to be included. These results highlighted MDT case conference gaps, which shaped changes implemented. Post intervention results will be available at project completion.

Significance of the findings to allied health: As a result of the redesign project there is emerging evidence of improved teamwork and communication along with an enhanced Allied Health profile in the subacute ward.

 

Patients’ perceptions of weekend allied health influence on quality

Dr Lisa O’brien1, Mr Mitchell Sarkies1, Dr Kelly-Ann Bowles1, Ms Romi Haas1, Professor Terry Haines1

1Monash University, Melbourne, Australia

Aim: It is unclear whether acute hospital patients whose wards have weekend allied health services have different perceptions regarding the quality of care received compared to those without. The aim of this study was to determine whether there are differences in perceptions of service quality between patients on wards with/without weekend allied health service, and whether patient comments at discharge are related to overall satisfaction scores, ratings of how much they were helped, or the appropriateness of their length of stay.

Method: 606 randomly selected patients on day of planned discharge from acute medical and surgical wards of two public hospitals completed the Victorian Patient Satisfaction Monitor survey, consisting of four items relating to service quality dimensions. Qualitative comments were categorised using content analysis. Ordered logistic regression was used to identify relationships between comment codes and scaled responses for overall satisfaction and perception of how much the patient was helped by this admission.

Results: Categories of comments were similarly distributed for both groups. Comments relating to staff in general were positively related to overall satisfaction and perception of length of stay appropriateness. Comments regarding staff (and doctors specifically) were positively related to patient ratings of how much they thought they were helped, however those regarding other patients were negatively related.

Significance of findings to allied health: Findings emphasise the importance of creating strong relationships between patients and hospital practitioners.  This was reflected in trust in practitioners’ technical knowledge and skill. Patients value hospital staff who are courteous, sensitive and kind when dealing with patients.

 

Patient and family engagement in goal setting in brain injury

Ms Jacinta Sadler1

1Caulfield Abi Unit, Alfred Health, Caulfield, Australia

Authors: J.Sadler, E.O’Shannessy, L.Jolliffe, K.Roberts, J.Morarty & N.A.Lannin

Aim:

Patient and family directed goal setting is an important component of rehabilitation models of care. This study aimed to understand strategies that health professionals use to facilitate patient and family engagement in goal setting.

Method:

A qualitative phenomenological study was conducted using a convenience sample in a metropolitan brain injury rehabilitation inpatient unit. Goal setting interviews were recorded and transcribed verbatim then analysed thematically. Interviews included a cross section of patients’, family members’ and health professionals and were conducted at various time-points in the patient journey between April and June 2015.

Results:

Inpatients (n=21) and family members (n=13) participated in the study, the majority of inpatients had sustained a traumatic brain injury (81%) and were male (62%). Consenting health professionals were from a range of disciplines (SW, OT, SP, PT, medicine).  Themes explored during interviewing highlighted key strategies and skills that facilitated successful engagement in goal setting, including investing time in developing the therapeutic relationship, breaking down goals, guiding rather than leading, displaying empathy and explaining the goal setting process in simple terms.  Therapists’ confidence, experience and skill levels were identified as key factors that impacted on goal setting success.

Significance of the findings to allied health:

While often considered an innate skill, results suggest that allied health clinicians need additional skill development to engage inpatients and their families in rehabilitation goal setting. Identifying health professionals’ within your organisation who have expert skills and involving them as key goal-setters is expected to improve the experience of patients’ and families.

What about the caregivers?

Dr Kimberley Haines1, Associate Professor  Sue  Berney2, Dr  Stephen  Warrillow2, Professor  Linda Denehy3

1Western Health, Melbourne, Australia, 2Austin Health, Melbourne, Australia, 3The University of Melbourne, Melbourne, Australia

Aim: To investigate the prevalence and short-term trajectory of psychological morbidity in informal caregivers of the critically ill.

Methods: Multi-site, prospective observational study of caregivers of patients mechanically ventilated >48 hours. Outcomes measures collected at intensive care unit (ICU) admission, hospital discharge, two-month follow-up: Depression (Center for Epidemiological Studies – Depression), Anxiety (Hospital Anxiety and Depression Scale), Mastery (Pearlin’s Mastery Scale); HRQoL (Short-Form 36 v2 – SF36v2), PTSD (Impact of Events Scale – two-months only). Preliminary results are presented descriptively for n = 40.

Results: Caregivers were mainly female, spouses, mean age of 54 ± 15, and no pre-existing psychology. Caregiver psychological morbidity was highest during ICU and decreased over time. During ICU, 63% experienced clinically significant symptoms of depression, reducing to 30% at hospital discharge and 15% at two-months. Forty-eight percent experienced clinically significant symptoms of anxiety during ICU, reducing to 15% by follow-up. The highest proportion (38%) of caregivers experienced low self-mastery scores at hospital discharge.

HRQoL mental health was most affected with mean SF-36v2 mental component summary scores of 44 ± 13, 40 ± 16, 48 ± 10 over time. At two-months, 33% of caregivers experienced clinically significant PTSD symptoms.

Conclusions: We provide for the first time comprehensive psychosocial trajectory data among non-bereaved caregivers. Psychosocial morbidity was greatest during ICU and decreased over time, although more than a third of informal caregivers experience PTSD at two-month follow-up.

Significance of findings to Allied Health: These data are important as caregiver well-being may impact patient recovery. These results indicate when caregivers are most at risk, informing clinical care and future interventional studies.

12