Reablement and Occupational Therapy in Gloucestershire Margot Mason

Reablement and Occupational Therapy in Gloucestershire Margot Mason Professional Team Lead, Occupational Therapy, Stroud & Gloucester Locality.

Presentation outline • Integrated Adult Health & Social Care. • Overview. • Our Journey. • Challenges & benefits.

Measuring Outcomes April 2013 -March 2014: • number of people entering Reablement: 557 • 86. 6% of these were over 65 years old • 43. 8% of these did not need ongoing care We are to gather more detail: • % partially reabled • % needing less/same/more ongoing care • reasons for not completing

Quality Outcomes • Right levels of care: Indicative budget calculation before & after reablement used as a measure of the outcome/ benefit. Initial results showed a 48% reduction in indicative budget following reablement (although it should be noted that the sample size was very small). • Canadian Occupational Performance Measure: Occupational Therapists use the COPM, showing significant improvement in Service User satisfaction and performance of their identified Occupational Performance Issues. • Experience: Countywide Service User Reablement satisfaction survey rolled out. Positive results.

Identifying Reablement cases • Countywide telephone ‘Helpdesk’. • Local referral centre: New referrals screened by an Occupational Therapist, Physiotherapist and Reablement co-ordinator. • Initial assessment by Therapist or Senior Reablement Worker. • Use of robust Goal Planning. • Regular Evaluation.

Added Value of Occupational Therapy • The COT Position Statement discusses our use of evidence informed practice, person centred working, thorough assessment and outcome measurement. • Literature review & Benchmarking. • We use the Canadian Model of Occupational Performance & outcome measure. • Work within Integrated Community Teams for the benefit of Service Users.

Occupational Therapy skills • New Integrated Community Teams (ICTs) in place. • Social Care, Intermediate Care & Community Hospital backgrounds. • All extending core skills. • Supervision, CPD sessions, work-shadowing. • Use of delegation to Reablement staff.

Our journey • Literature review completed to inform practice. • Competency framework for Reablement staff developed. • Range of training developed. • Reablement goal plan re-designed. • Team working & Communication. • Need for countywide model of Reablement.

Assessment • High-quality assessment before re-ablement started was said to be essential in helping re-ablement teams to set up appropriate support arrangements. • Ongoing assessment during the period of reablement was also important to enable the team to identify new targets as people’s abilities improved. Rabiee & Glendinning 2011

Communication • Regular communication is extremely important and key to the whole process; • So, understanding each others roles; • Discussion with the service user & family to monitor progress and timescales; • And liaison between Reablement workers, Nurses, Therapists & Co-ordinators to regularly review and progress goals with the service user.

Work completed to date • Development and implementation of a comprehensive Reablement competency framework. • Delivery of an extensive training programme to support the framework. • Development of Team Working Workshop and Workbook. • Development of Therapy screening and first assessment. • Development of outcome based performance measures as part of the scorecard.

Barriers & Challenges • Reablement staff change of role, hours & rotas. • Widening role of Occupational Therapy staff. • Service demands. • New referral screening & assessment-By whom? • Need to increase Assessment skills and Clinical support of Senior Reablement Workers. • Need to further embed Team working, Vision and true Integrated working.

Leadership • • South West Clinical Network Benchmarking Leadership Group, Work streams identified: Development of alternative reablement pathway and pilot. Workforce Development of outcome measures. Increasing contact time. Review domiciliary care in lieu of reablement.

Summary • Reablement is embedded in the Integrated Community Teams. • Continue to develop Occupational Therapy at the forefront of Reablement. • Positive impact on External Care budget spend. • Any Questions?

References • Boniface et al. 2013. The effectiveness of local authority social services’ occupational therapy for older people in Great Britain: a critical literature review. British Journal of Occupational Therapy. 76(12) 538 -547 • COT Position statement 2010 Reablement: The added value of occupational therapists. www. cot. org. uk • Rabiee P. and Glendinning C. (2011) ‘Organisation and delivery of home care re-ablement: what makes a difference? ’, Health and Social Care in the Community, vol 19, no 5, pp 495– 503.

Contact details Margot Mason Professional Team Lead, Occupational Therapy. Stroud & Gloucester Locality margot. mason@glos-care. nhs. uk 01452 427661