NIHR CLAHRC Community e-newsletter – Supporting vulnerable adults.
CLAHRC East Midlands: Major stroke care improvement in the East Midlands drive could boost recovery
The care people receive after a stroke is being reviewed as part of a major drive to improve standards thanks to CLAHRC East Midlands.
The Research to Implement EVidence Based In-Hospital Stroke Rehabilitation (REVIHR) study is reviewing the impact of the first-ever nationwide stroke audit by examining the delivery of rehabilitation for the condition in four units in the region.
The aim of the study is to help improve methods by which stroke units can monitor and improve the quality of therapy they provide.
If successful, the findings could be rolled out nationally so care is consistent across the rest of the country.
The Sentinel Stroke National Audit Programme (SSNAP) was introduced in 2014 to improve the quality of stroke care by auditing services against evidence-based standards, and national and local benchmarks.
CLAHRC East Midlands: Supporting older people in the East Midlands to self-manage their health needs
A CLAHRC East Midlands study is supporting older people’s resilience through an assessment of needs and outcomes, focusing on care and services provided by the third sector.
Charities, community organisations and social enterprises play an important role in addressing lifestyle health factors, but currently they are not coordinated with other parts of the system such as the NHS.
The Supporting Older People’s Resilience through Assessment of Needs and Outcomes (SOPRANO) study is establishing whether an assessment process may lead to better decision-making and signposting for support and care from third sector or other integrated services. Ultimately, the project is looking to enable people to self-manage their health needs and maintain independence in the community.
Older people across the East Midlands will be asked their opinions on the services available. The organisations providing the support and those commissioning services will also be consulted.
CLAHRC East Midlands: Commissioning guide to come out of East Midlands falls study
A CLAHRC East Midlands initiative is looking to reduce the number of falls among older people in parts of the East Midlands by supporting commissioners.
Older people falling over leads to four million hospital bed days in England each year, costing the NHS £2 billion. The Falls Management Exercise programme (FaME) is easing pressure on the health service and leading to less personal trauma by reducing episodes by 26 per cent.
FaME is a 24-week long exercise programme that works by improving the strength and balance of older people. It is recommended by health watchdog NICE but has not been implemented widely yet across the UK.
The PhISICAL study is looking at the implementation of FaME into routine practice in Leicestershire, Rutland and Derby, which represent both rural and urban locations, to understand the factors behind the success or failure of such a programme.
Findings from this project will then be used to develop a commissioning toolkit for Clinical Commissioning Groups and local authorities to inform the planning and commissioning of falls prevention programmes, with resources and promotional materials.
CLAHRC East of England: Community teams for adults with learning disabilities in the East of England
Specialist community teams for adults with learning disabilities (CTLDs) have an important role, not just in preventing placement breakdown, but also in improving the quality of life of adults with learning disabilities (LD) and their families and other care-providers.
As part of an on-going programme of research, funded by CLAHRC East of England (Farrington et al., 2015; Clare et al. 2017), interviews with CTLD members and their team managers are taking place across the Eastern Region to establish (i) the organisation, structure and membership of different teams; (ii) the type of person with LD for whom they accept referrals; (iii) the kinds of specialist needs they seek to address.
Data collection is not yet complete but preliminary analysis suggests that, while there is wide variation in their organisation and membership, virtually all CTLDs share a commitment to (i) adults with severe LDs and syndromes associated with LDs (eg Down’s Syndrome); (ii) the assessment and treatment of mental health and/or behavioural needs.
CLAHRC EoE are not yet able to make recommendations but it is anticipated that the findings will inform regional and national bodies (particularly NHS England) responsible for the development of services that promote the well-being of people with LDs.
For more information, please contact; Isabel Clare email@example.com
Link to Farrington et al. (2015)
Link to Clare et al. (2017):
CLAHRC East of England: Beyond dysphagia: mealtime support needs for people with learning disabilities
Mealtimes are risky for many people with learning disabilities. As part of a study, funded by the NIHR’s RfPB programme and supported recently by CLAHRC East of England (Ball et al., 2012), the need for support was examined among a sample of 69 adults, aged 16-79 years, with mild to profound learning disabilities (LDs), identified from a prevalence study.
The type and level of support needed by the group varied greatly but, for almost half (49%; n = 69), it had increased over time. Reasons for needing support included difficulties getting food into the body (82%), primarily through dysphagia, but also risky eating and drinking behaviours (50%) and slow eating or food refusal (44%).
The presence of additional disability or illness (dementia, visual impairment) contributed to the support needs of almost two-thirds (65%) of the group; more surprisingly, for more than half (52%), their need reflected psychological or behavioural issues.
The findings highlight the need for a multi-disciplinary approach to mealtime interventions, paying attention to psychological and environmental, as well as physical, issues. They also signal the daily difficulties faced by families and other care-givers and their crucial role in managing the health risks associated with eating and drinking difficulties among people with learning disabilities.
Link to Ball et al
Contact: Marcus Redley at firstname.lastname@example.org
CLAHRC Greater Manchester: Supporting Stroke Survivors Living in a Care Home Setting
Following on from their earlier work supporting and exploring the implementation of six month reviews for stroke survivors living in the community, the CLAHRC Greater Manchester stroke team has been working in collaboration with stroke services across six Clinical Commissioning Groups (CCG) areas to look at the delivery of post-stroke reviews for care home residents.
As part of that work, the existing Greater Manchester Stroke Assessment Tool (GM-SAT) was modified for use with this patient population, and its feasibility, usefulness and acceptability has recently been explored through an evaluation study. This study has involved 74 stroke survivors, and the results are due to be published later this year.
CLAHRC Greater Manchester: Supporting Vulnerable Groups at Risk of AKI
Some patient groups are at a greater risk of developing Acute Kidney Injury (AKI) and at CLAHRC Greater Manchester they have been working with a number of partners to target the most vulnerable groups. This includes trying to prevent cases in those at higher risk due to being on certain medicines through the Salford Clinical Commissioning (CCG) Sick Day Guidance project; improving care for patients whilst acutely unwell in secondary care, through the MAKIT Better project; and enhancing management of post-AKI patients once discharged back into primary care, through the Bury Post-AKI project.
In addition to supporting implementation of these interventions, CLAHRC Greater Manchester’s Kidney Health programme team has also been conducting in-depth qualitative, quantitative and health economic evaluations to better understand the processes of implementation, and attempt to capture any potential improvements in patient care and cost-benefits.
CLAHRC North Thames: The impact of co-located welfare advice in General Practice settings
Locating welfare advice in GP surgeries aims to support people whose health is affecting or affected by social circumstances. Recent GP surveys report increasing demand for supporting patient social needs, and poorer patient health linked to increased financial hardship and welfare reform.
Previous evaluations of co-located advice services have been methodologically limited, thus effectiveness has not been established. Without this continued funding of such services is further compromised.
CLAHRC North Thames carried out a methodologically robust mixed methods evaluation in two London boroughs to examine whether and how co-located advice services can support patients and GP practices.
We find quantitative evidence for improved mental health and well-being and reduced financial strain; furthermore, advice recipients received £15 per £1 of funder investment. Qualitative findings illustrate how co-located advice could reduce GP pressures, and identifies key enablers and barriers affecting whether or not this happens.
CLAHRC North Thames: Encouraging timely help-seeking for dementia in Black African and Caribbean families
A CLAHRC North Thames project focuses on improving the care of Black African and Caribbean people with memory problems – an early warning sign for dementia. Black African and Caribbean elders develop dementia earlier, and seek help later than their White peers – a delay that can greatly affect access to treatment, care and support, and reduce the independence of dementia patients prematurely.
Extensive engagement work within this community – focus groups and interviews – helped us find out the perceptions and beliefs that influence people’s decisions to seek – or not to seek – help from their GP when memory problems first arise. This informed the co-design of a “Getting help for forgetfulness“ leaflet with patients and carers to encourage timely help-seeking for memory problems among Black elders.
NHS, community and voluntary organisations, and charities can order free printed copies from email@example.com
CLAHRC North West Coast: Development and effectiveness of maternity staff training to reduce trauma experienced by socioeconomically disadvantaged women during childbirth.
Women’s experience of childbirth is integral to help nurture and build competent, confident and independent mothers. As a multi-racial, multi-cultural society, maternity professionals are increasingly required to provide maternity services to women from diverse backgrounds. Unfortunately, provision in maternity education is lacking resources and knowledge to support maternity professionals to deliver an equitable service. This is a unique study that will identify feasible, meaningful and psychosocial key components identified and expressed by women and health care professionals to underpin a training programme for maternity staff.
A qualitative methodology will be adopted in this project to explore the lived experiences of a traumatic/distressing birth for vulnerable/disadvantaged women. This will be done by undertaking 10-20 semi structured interviews. The interviews aim to explore the interactions between these women and health care professionals to identify key areas for consideration in care delivery. Interviews with health care professionals who deliver care to vulnerable/disadvantaged women will be sought following interviews with women. This will help further identify areas of care delivery for exploration informed by the findings from the interviews with women. Engagement and consultation with PPI will be used at all stages to help inform the research.
Interviews with both women and health care professionals will help design and develop a tailored educational programme that draws on implementation, education and change theories to address maternity professional’s behaviours, attitudes, beliefs and practices in caring for vulnerable/disadvantaged women. The outcome of this study will be of benefit to childbearing women, policy makers, health care professionals and commissioners through the design of training informed by empirical data and theoretical insight.
CLAHRC North West Coast: A systematic review of barriers and enablers to South Asian women’s attendance for asymptomatic screening of breast and cervical cancers
The purpose of this review is to collate information on all of the studies that have been conducted to date on South Asian women and asymptomatic screening for female cancers. This will allow us to synthesize the literature on cultural and individual beliefs and attitudes and their effects on individual women’s screening attendance and willingness to consult health professionals for cancer symptoms.
This synthesis will provide broad directions as to how to intervene with South Asian communities generally, and a more narrow focus on factors unique to constituent communities that make up Bangladeshi, Pakistani, Indian and Sri Lankan populations.
This will inform interventions directed toward early detection of female cancers in South Asian women from hard to reach communities. Such interventions could improve cancer mortality and morbidity outcomes in this group and help to reduce health inequalities.
CLAHRC Northwest London: Supporting vulnerable adults
The overall aim has been to improve the care experience, as well as the long-term well-being of alcohol dependent patients. Training and education of triage nurses and doctors has been paramount because they are the first point of contact with them. Refferal to specialist hospital based staff can offer detox and psychological treatment for dependency related moods and behaviours, which this can make all the difference to the outcome for the patient and the efficacy of clinicians.
PenCLAHRC: Study investigates the essentials of nursing care
The success of a vulnerable patient’s care can stand or fall based on the quality and effectiveness of the nursing they receive. A research team supported by NIHR PenCLAHRC are developing and testing nursing methods around activity such as communication, help with eating and drinking, mobilisation, help with going to the toilet and being clean and comfortable.
Using the ‘amalgamation of marginal gains’ (a method employed in sports such as cycling), nurses will be helped to make a number of small improvements over a wide range of areas with the accumulation of improvements resulting in benefit to patients in terms of experience and recovery. More here.
PenCLAHRC: Preventing falls in people with Parkinson’s disease
PDSAFE is a personalised physiotherapy treatment designed to manage problems with movement and stability in people with Parkinson’s disease. While there is evidence to suggest that physiotherapy is beneficial to reducing falls in general, there is a gap in the evidence in relation to falls and Parkinson’s disease.
Supported by NIHR PenCLAHRC, a research team is investigating whether or not PDSAFE means fewer falls for those with Parkinson’s disease after six months and a year of the treatment. There is more on the PDSAFE project here, and links to related publications here and here.
PenCLAHRC: Moral narratives, mental distress and prescribing
A multi-disciplinary research team supported by NIHR PenCLAHRC is investigating the role that moral narratives play in an individual’s motivation to seek medical help for mental distress, and in the delivery of healthcare and prescribing.
The research team is examining how and why the ability to cope with poverty-related problems has become regarded or treated as psychologically abnormal. They are also examining the impact of the high level of antidepressant prescription in low-income communities in the South West, and good healthcare practices for, and potential care alternatives to, responding to mental distress in vulnerable communities. More here.
CLAHRC West: Reducing drug use in female street sex workers: a feasibility study
Most female street sex workers in the UK are affected by the use of illegal drugs, such as heroin and crack cocaine. For most of these women, drug use reinforces their dependency on sex work and adds to their health and social problems. The need to finance their drug use, and often that of a partner, underpins their involvement in sex work. Drug intoxication also means they are less able to protect themselves whilst working.
Street sex workers who are drug-dependent find using treatment services difficult and when they do, typically don’t benefit as much as other drug users.
Managing problem drug use amongst sex workers is complex. They can experience stigma from other drug service users. This prevents them from discussing their sex work, a major factor in their drug use, in treatment groups. There is also evidence that many drug-using street sex workers are affected by post-traumatic stress disorder (PTSD). They are unlikely to benefit from other treatment unless this is addressed.
With our partners, have developed a plan to improve the results of drug treatment for these women, by organising NHS and voluntary sector services to work together. This new approach involves creating a stigma-free environment for street sex workers to discuss their work in treatment groups, as well as addressing trauma.
Find out more on the CLAHRC West website.
CLAHRC West Midlands: Evaluation and impact on older person’s assessment and liaison services in Birmingham
The older persons’ assessment and liaison (OPAL) team, based at the Queen Elizabeth Hospital in Birmingham, conduct comprehensive geriatric assessments in elderly patients within the emergency department (ED) and clinical decisions unit (CDU), with the aim of enabling the safe and early discharge of older people. The clinical lead of the OPAL team approached CLAHRC West Midlands requesting for a formal evaluation of the service. However, prior to the evaluation a better understanding of the OPAL service was needed.
A qualitative study was conducted among members of the OPAL team as well as those working closely with OPAL. Sixteen staff members were invited; of whom 11 (68.8%) consented to take part in the qualitative study. Interviews were with a range of participants: OPAL doctors, OPAL nurses and therapists, management and external staff members from ED/CDU. The average length of interview was 65 minutes, and ranged between 30 minutes to approximately 2 hours.
Using the framework analysis approach to analyse the data we found that participants felt that the service had positively evolved and expanded over the recent years. It appeared that OPAL was seen as two distinct parts (OPAL medics and OPAL therapy) within one service. The service was also seen to have a number of roles, where at times OPAL was not always the main focus. Patients were sourced using a variety of methods; however methods seemed to vary between OPAL staff.
The patient eligibility criteria for the service were unclear and inconsistent, with some staff using subjective methods to assess eligibility (i.e. the assessment of frailty). Additionally, it appeared there were a number of factors which affected the OPAL review, leading to variations in patient assessments between team members – possibly impacting on outcomes such as patient length of stay or discharge destination. Participants however, did not mention any issues related to unsafe clinical practice or incorrect working methods.
This qualitative study revealed a number of inconsistencies within the OPAL processes. As a result OPAL have been recommended to standardise their working methods prior to the evaluation of the service, particularly the processes related to patient sourcing, assessment of patient eligibility and the OPAL assessment/review.
For further information please contact Kiran Rai (firstname.lastname@example.org).
CLAHRC West Midlands: Supporting young adolescents and young people’s mental health
The CLAHRC WM Youth Mental Health Theme is led by Prof. Max Birchwood from the University of Warwick. The research team focuses on early intervention for youth mental health, with the aim of developing strategies to enable better help-seeking, improved care pathways, the identification of early warning signs of mental health problems and the design and development of targeted interventions for vulnerable young people.
The team have recently examined the risk factors associated with the development of Eating Disorders (EDs) in young people (The SchoolSpace Study). This 2-year study worked with young people in schools, aged 13/14 years and explored prevalence and the likely predictors of new disordered eating behaviour over the course of 24-months, using an online survey. A total of 758 young people completed the online study measures at least once during the 24-month period and data was collected on their levels of depression and anxiety, self-esteem, body-esteem, difficulties with emotional regulation, dieting behaviour and adherence to food rules. Preliminary findings show that the key predictors of young people who went on to transition from no ED to ED during the survey period were the presence of restraint, shape, weight and eating concerns, dieting behaviour and difficulties with emotional regulation prior to transition.
Building on the SchoolSpace study, and the work conducted in FEP, the research team is now planning to develop and pilot interventions to reduce the duration of untreated eating disorders (DUED). These will include schools based detection strategies and a stepped care programme for use in a variety of healthcare settings. These will be co-produced with young people, teachers, GPs and mental health workers.
For further information please contact Charlotte Connor (email@example.com) (Research Lead – CLAHRC-WM Youth Mental Health).
CLAHRC Yorkshire and Humber: Exploring the impact of inhaled illicit drug use on respiratory health
Illicit polydrug inhalation, high rates of tobacco smoking and significant psycho-social barriers to healthcare may put illicit opiate users at risk of early onset chronic obstructive pulmonary disease and poor asthma control and outcomes. The NIHR CLAHRC YH Mental Health and Comorbidities theme is undertaking a series of linked research projects, in collaboration with the Sheffield Addiction Recovery Research Panel Patient and Public Involvement group and Drug and Alcohol services in South Yorkshire to understand how services can respond to this need.
The findings of Lung Health of Opiate Users (LHOp1) a pilot study to screen for respiratory health problems in a substance misuse clinic with embedded patient and public involvement are available in the BMJ Open here and for information on this and subsequent work please contact firstname.lastname@example.org or email@example.com.
CLAHRC Yorkshire and Humber: Sexual Health in Mental Health Services
Sexual health is an important yet often neglected aspect of care for people who use mental health services. They are more likely to experience sexual and physical abuse and exploitation; more likely to have HIV and other sexually transmitted infections; and more unintended pregnancy that people in the general population. Mental health practitioners say they avoid this topic for fear of embarrassing the person and causing upset.
Prof Liz Hughes (University of Huddersfield) leads a sexual health theme within the Mental Health and Co-Morbidities Theme of NIHR CLAHRC YH. The RESPECT study (NIHR funded) aims to develop and test a sexual health promotion intervention for people in community mental health services. In addition to the RESPECT study, Samantha Gascoyne (University of York) is undertaking a CLAHRC funded PhD examining sexual risk behavior and tools for assessment of this in people with serious mental illness.