Home Based Memory Rehabilitation our Improvement Journey Emma

Home Based Memory Rehabilitation our Improvement Journey Emma Coutts and Alison Mc. Kean Email: emma. coutts@nhs. net and alison. groat@nhs. net Twitter: @Emma. AHPDem and @Ali. AHPDem NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Outline • Improvement journey within Dumfries & Galloway • Scotland’s Dementia Strategy and the Allied Health Professionals • National Improvement journey • Video – views of people living with dementia NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Area for Improvement Access to Mental Health OT Service earlier on in a person’s Dementia journey NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Model for Improvement NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Improvement Approach (Focus on Dementia) NHS Dumfries and Galloway Mental Health Occupational Therapy Service

National Drivers (Understand) • Scotland’s National Dementia Strategy (2013 -2016): Commitment to improving post diagnostic support • AHP National Delivery Plan, Action 2. 6 “AHP directors and AHP leads in local authorities, working in partnership with Alzheimer Scotland will work to ensure the multisectoral delivery of early intervention and post-diagnostic support for people with dementia and their families and carers in line with the national commitment” NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Local Drivers (Understand) NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Home Based Memory Rehabilitation(HBMR) (Understand & Design) • Evidence based Occupational Therapy early intervention in dementia (College of Occupational Therapy www. COT. org. uk) • Developed & RCT completed by Mary Mc. Grath, specialist occupational therapist, Belfast (Mc. Grath and Passmore 2009) • Established contact with Mary. . . . NHS Dumfries and Galloway Mental Health Occupational Therapy Service

HBMR (Understand & Design) HBMR based on Cognitive Rehabilitation theory and techniques Key is to compensate for memory difficulties via: 1)Environmental Adaptation 2)Use of external memory aids Use of internal memory strategies HBMR - delivered over 4 (minimum) and up to 6 sessions The structured format of the HBMR programme creates • Structure and Repetition: encouraging new learned behaviours in early stages of dementia • Habits and Routines: more likely to be remembered and can be relied on as/when memory difficulties progress NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Design & Implement - Identified two areas for small pilot with participant numbers agreed - OT Project Team established - Agreed referral criteria and assessment tools - Stakeholder Engagement: 1. SBAR to OMG 2. Potential referrers NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Implement • Able to identify both our ‘early adopters’ and ‘laggards’ Early Adopters Laggards Individuals who are keen to try out new ideas, but in a careful way (Rogers’ innovation Traditional individuals who favour old models of working. Can be resistant to change and critical of new ideas (Roger’s adoption curve) innovation adoption curve) Dementia Link Worker -encouragement given for referrals to continue to be made -feedback given re HBMR progress with clients Community Mental Health Nursing Team -presentations within CMHNT meetings -OT presence at CMHNT meetings -joint visits -feedback re outcome of HBMR NHS Dumfries and Galloway Mental Health Occupational Therapy Service

NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Implement & Evaluate - Developed an HBMR ‘database’ to record all outcome measurement data - Assessment battery completed at initial assessment and subsequent HBMR reviews - in order to determine the impact of HBMR and to evidence this intervention - Qualitative data also gathered “Without data you’re just another person with an opinion” Deming NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Evaluate NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Evaluate • Gathering Data - Qualitative – Emotional Touchpoints • carried out with both client and caregiver elpful h s e i g strate e h t d n “I fi ng for i k o o l th the i w p …I am l e g to h n i h t e these m d n so u o f its – I wd) p ( ” blank b d e p ies hel g e t a r t s ng that i t r o f m with t’s co i n i k n g i n h i t “I as com w e n have o o t d o some o was g t i , ontact c e c i d l u o adv that I c e n o r had e o p l e som h ed any d e giver) e e n r I a c if ( ions. ” t s e u q any NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Evaluate • Positive results obtained overall • Demonstrate people with dementia have ability to learn new strategies/skills with support from the occupational therapist/OT technician • Demonstrate that over time people can retain and continue to utilise these skills • Decreased number of reported everyday memory problems NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Evaluate - Completed formal evaluation, shared this, successful case for additional resource - Won National Dementia Award - Got carried away! NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Embed/Sustain/Spread locally • • • Rolled out within OT service across all localities. Reviewed pilot project assessment pack Professional resources People’s feedback (person centred) Set up peer supervision groups - ensure best and equitable practice across the service NHS Dumfries and Galloway Mental Health Occupational Therapy Service

D&G Roll Out (PDSA) • Initial findings suggested our referral rate was lower than expected: – Started to screen all memory clinic letters and identify those appropriate for HBMR. This was then communicated with CMHNT/psychiatry to help raise awareness of appropriate referrals – Based on data already gathered we were able to predict our: Actual Annual turnover (Pre HBMR Screening): 23 Estimated Annual Turnover (Post HBMR Screening): 144 NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Spread wider • Promotion - Feedback at National AHP Expert Group - Blogs for various forums both locally and nationally - HBMR poster created and shared (NHSScotland & Alzheimer Europe) - Presentations at events - Promotion within Alzheimer Scotland Dementia Awareness Week events NHS Dumfries and Galloway Mental Health Occupational Therapy Service

NHS Dumfries and Galloway Mental Health Occupational Therapy Service

“We will commission Alzheimer Scotland to produce an evidence based policy document outlining the contributions of AHP’s to ensuring implementation of the 8 -Pillar model” (Scotland’s Dementia Strategy, 2013 -2016). . “Connecting people, connecting support the Allied health professional offer to people with dementia in Scotland” (2017) Elaine Hunter, National AHP Consultant Alison Mc. Kean, AHP Project Lead PDS

Evidence for Action Evidence from research & evaluations • Distributed leadership : Extend Alzheimer Scotland AHP Dementia expert group • Continued role for strategic leadership : found increased understanding of what AHP can do, training future & current workforce, positive impacted on current AHP practice in targeted areas • Build on evaluation of impact of role and interventions, recording impact on people living with dementia Impact of the Allied Health Professional Dementia Consultants in Scotland? An Evaluation

Evidence for Action www. alzscot. org/AHP

Scoping of AHP contribution to post diagnostic support 2015 • Scoping work completed with Alzheimer Scotland Dementia Link Workers n=49 and AHPs n=147 • Background report and recommendations • Improvement work commenced October 2015 • All work available on Community of Practice http: //www. knowledge. scot. nhs. uk/ahpcommunity/ndpworkstreams/dementia. aspx

Scoping of AHP contribution to post diagnostic support 2015 5 Key Actions: 1. Clarity and consistency around the allied health professional role during the post diagnostic support period 2. Clear process and pathways for people living with dementia for timely access to the allied health professionals in the post diagnostic period 3. AHPs to develop their knowledge and understanding of post diagnostic support in dementia 4. Development of the evidence base for AHP led interventions during the post diagnostic support period 5. Development of partnership working and consultation between AHPs and Dementia Link Workers

OT Findings from national scoping exercise

OT Findings and Aspirations • OTs recognised that people with dementia were not receiving access to their Services at the right time • OTs reported they could be doing more in the area of Post Diagnostic Support in Dementia • OTs identified Home Based Memory Rehabilitation as intervention they would like to take forward as best practice

Partnership formed NHS Dumfries and Galloway Mental Health Occupational Therapy Service

How to share “best practice” across Scotland? NHS Dumfries and Galloway Mental Health Occupational Therapy Service

A National Rollout (Spread) September 2016 Assessments And 2017. . agreed : 11 areas signed up May 2016 October National 2016 Phase 1 Launch HBMR : 11 Event : 5 areas signed up Summer 2015 : OT’s across Scotland interested in HBMR NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Impact for People with dementia • Today, in NHS D&G, all people who are diagnosed with mild dementia are considered for HBMR • HBMR is offered as part of the post diagnostic support pathway • Equitable access to an evidence based intervention NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Wider Impact • Demonstrating impact of occupational therapy, promoting professional profile • Contributing to the evidence base • Consistency and access to evidence based interventions • Sharing practice across Scotland NHS Dumfries and Galloway Mental Health Occupational Therapy Service

Consistency of access across Scotland • Ambition is that people will have equitable access to this OT early intervention during the post diagnostic support period • #Oncefor. Scotland (and beyond? !) https: //dghealth. wordpress. com/2016/05/13/one-small-step-for-dumfries-and-gallowayone-giant-leap-for-scotland-by-wendy-chambers/ http: //www. knowledge. scot. nhs. uk/ahpcommunity/ndp-workstreams/dementia. aspx NHS Dumfries and Galloway Mental Health Occupational Therapy Service