A joint initiative between Gateshead Council and Gateshead PCT looking at overcoming barriers which prevent people engaging in meaningful activities. The group focuses on the well elderly in warden controlled accommodation and is held on these premises. The group looks at the link between activity and wellbeing by using goal setting graded for individual needs to enable them to overcome their barriers in order to be fit and active.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Our aim is to work with older people on the cusp of frailty to increase their engagement in meaningful activity and social interaction. We focus on those people that find it difficult to engage in activity due to a range of issues e.g. anxiety, low mood, low self esteem or reduced mobility. The group is a twelve week programme and aims to equip people with skills and strategies to enable them to independently engage in activity post the group. Thus resulting in a positive impact on health and wellbeing. The group is led by it's members and focuses on peer support and shared learning. Between them members of the group have a wealth of experience and expertise. The facilitator's role is to enable participants to recognise this and develop their confidence so that they can share this with the group and learn from each other as they are the experts. By working jointly with the council it was felt that resources and knowledge of local facilities could be shared so that engagement in the local community could be fostered and social exclusion reduced. We first identified how occupational therapists could contribute to the implementation of the NICE public health guidelines and gaps in service provision. By working with the local authority we were not only able to identify gaps in our own service provision when addressing the NICE public health guidelines, but also gaps in the local authority's provision. Therefore ensuring that services were not duplicated across organisations or needs left unmet. We then carried out a literature review of how other trusts were addressing this and looking at initiatives that had been set up in the past. This enabled us to identify and learn from what had gone well and what had been the challenges for other people. Thus enabling us to shape our group differently. This led us to the conclusion that it was best to set up the group in sheltered accommodation. Therefore we had to identify an appropriate sheltered accommodation with a warden who was positive about implementing the programme. After this we identified and recruited group members. The length of the group's duration was identified and paperwork and outcome measures were decided upon. 1:1 sessions were carried out with all group members prior to the sessions beginning, to identify individual goals. Objectives of what group members needed to cover in order to achieve their aims were identified both on their 1:1 session and in the group sessions. This was to give the group members ownership of the sessions and to help them identify their own barriers to engaging in activity so that these could be addressed. Facilitators also had to be identified. The approach that was taken with the group was an Occupational Therapy approach. However the joint working with the local authority gave us the opportunity to share this approach with staff from the local authority. Therefore a local authority employed health worker as well as occupational therapy staff were identified to facilitate the group.
Before undertaking this initiative, Occupational Therapy Services for Older People were focused around secondary care, this was due to historical funding arrangements, and with developments elsewhere, such as intermediate care, the case load of patients seen were becoming increasingly frail and complex. It was evident also that within other services, referral to OT was mainly indicated for people with ongoing medical problems. Although we did not complete a base line audit, we were confident that through our networks, there was no availability for people to access OT as a preventative strategy to maintaining health and well being for older people, i.e. people would usually be unwell with decreased function before they would be referred to OT. We became aware of the Lifestyle Matters research and how this had influenced the development of the NICE Public Health Guidance on Mental wellbeing and older people. We recognised that our resources were focused on dealing with health problems and that there was an opportunity to work to implement the NICE guidance to use OT as a preventative intervention. We participated in a local stakeholder event looking at promoting independence for older people. During this event, people with similar ideas or interests were grouped together to create plans and initiatives to take those ideas forward, and develop services for older people across the locality. Through this event we also recognised that our knowledge of the local community and its resources was limited, and when an opportunity arose to work in partnership with the local authority it seemed the circumstances were right to develop a Lifestyle Matters Group, in the hope that the work would evaluate positively and that we could use this as evidence to support the long term sustainability of the service.
When examining other trusts initiatives it was identified that they had difficulty recruiting members and getting them to attend a venue. We therefore decided to carry out the group in sheltered accommodation as this would eliminate the difficulty of access to a venue. We hypothesised that as the group members would all be neighbours, relationships would have already been established and peer support could more easily be offered. In practice group members established relationships also presented challenges as these were not always positive ones. It was found that at the beginning of the sessions pre-existing dynamics were very negative and instead of encouraging each other they actively discouraged each other. Therefore time had to be spent on re-establishing group rapport and group inclusion. This was done by first of all getting the group to create a name for themselves. This encouraged a sense of group ownership and group cohesion. We then spent time on sharing information about each other in a different context so people could get to know each other in a different light. Participants were recruited by doing a mail shot for all residents advertising the group and we attended residents coffee mornings to meet them. We attended two coffee mornings so that people interested could encourage others to attend once they had found out more. We then carried out one to one sessions with people that were interested in joining. These sessions were used to explore individual goals and their barriers to achieving these. The duration of the group was 12 weeks. We felt that it was important to have a definite finishing point so that reliance on the group to meet individual goals was not fostered. Instead group members had to look further afield into the local community to meet their goals and need for social inclusion. The only costs that had to be taken into consideration were staff time and expenses of refreshments and taxis for trips out as the venue was free.
Progress of the group was revaluated weekly by the facilitators meeting following the group to discuss group members progress, and how sessions needed to be regraded to meet their needs. The facilitators could also use this time to reflect on their own performance as facilitators so learning could be consolidated for those that were using this approach for the first time. Group members were encouraged to identify and celebrate their own achievements within the group by sharing their goals with the group and then reporting back their progress. This process of sharing goals reinforced their commitment to achieve them and pulled the group together by identifying that they all had barriers to overcome. The group was evaluated by looking at the group members achievements and the completion of their goals. Longer term goals were also set and will be evaluated through follow up one to one session. These follow up appointments are essential to evaluate the lasting effects of the group. Quantitative data was attempted to be gathered however the group members found it difficult to grasp the tools used to gather this. Therefore concentration was placed on the qualitative data gathered through individual feedback and achievements. The literature demonstrates evidence that activity has a positive and beneficial effect on wellbeing. Therefore by implementing this approach with people who are on the cusp of frailty the evidence shows that this should reduce their amount of hospital and GP visits thus having a long term saving on health care resources.
This was the first time that these facilitators had worked together and they came from different professional backgrounds. Therefore they were unfamiliar with each other's approaches. This learning was done within the sessions resulting in facilitators not working as cohesively as they could with each other at the beginning. Therefore time should have been spent prior to setting up the group to gain an understanding of each others approach and explaining the process of grading activity and goal setting. As this type of group had not been held in warden controlled accommodation before we made assumptions about the level participants would be at the beginning of the programme. These assumptions led us to the conclusion that the programme could be carried out in 12 weeks. However it took longer for the group members to move through the programme than we had envisaged. In light of this we are extending the length of the duration of the next programme to 14 weeks. We carried out a trip to a local age concern centre which had several different groups and activities running. This got people thinking about what they wanted to achieve and moved on the goal setting process. We had wanted to carry out this visit earlier in the programme however it was postponed due to weather and the groups at age concern slowing down for Christmas. It would have assisted the goal setting process if this visit was carried out earlier. As Christmas was in the middle of the programme we had to have a two week break. This impacted on the momentum of the group.
Clinical Specialist Occupational Therapist
Is the example industry-sponsored in any way?