Embedding Outcomes in Homecare Re-ablement for Older People in North Lanarkshire

本项目旨在调查在家庭护理再适应的背景下实施证据的潜力和最有效的方法（正式的研究，从业者的智慧以及用户和护理人员的观点）。虽然有一些尝试更广泛地考虑家庭护理的结果（Sawyer, 2005），但进展仍然不完整。还需要在重新调整服务方面取得成果，这在整个英国正在推广（CSED, 2007）。重新调整已被确认为地方当局节省了大量开支；然而，重新调整的初始成本似乎抵消了长期节省（PSSRU, 2010）。在资源减少和人口老龄化的背景下，在再适应中嵌入结果方法可能有助于提供有效的家庭护理服务。结果方法的新证据表明，它们既以人为本，又能使人受益，无需额外资源即可实施（Miller, 2010）。来自再适应的证据在很大程度上是积极的，表明家庭护理再适应可以减少委托的家庭护理时间，并通过提高服务使用者的技能和独立生活的能力，为他们提供持续的好处（麦金泰尔和斯图尔特，2011）。然而，（Slasburg, 2009）表明，为所有人建立一种重新适应的文化，而不是为某些人提供特定的服务，将确保所有人而不是少数精心挑选的服务用户受益。该项目将建立在苏格兰已建立的知识交流倡议“谈话要点”（苏格兰政府，2009年）的基础上。它将直接与合作伙伴地方当局北拉纳克郡议会合作，调查如何将基于结果的评估方法嵌入两个家庭护理重新调整团队中。该项目将使结果和重新调整的现有证据能够在北拉纳克郡的当前实践中得到映射，这一迭代过程将促进知识交流。将为地方当局编写指南和相关工具，并为更广泛的传播和培训目的编写数字故事。预计这一知识交流过程的关键信息将适用于其他家庭护理服务，他们正在努力将结果嵌入英国和国际上的重新调整。此外，如果获得资金，这个项目将是探索重新调整方法的第一步，这种方法将在社委会和签约的私营机构的家庭护理服务中推行。项目的关键阶段总结如下。第一阶段将从文献中建立与结果和重新调整相关的关键信息。此外，将对地方当局和其他提供者内的少数战略工作人员进行面谈，以确定目前做法的基线。第二阶段将通过焦点小组测试第一阶段确定的关键信息与北拉纳克郡两个重新调整团队的从业者和管理人员的相关性和适用性。第三阶段将通过专家组综合来自研究的信息，实践经验和实施的潜在挑战，包括；包括Partnership4Change在内的相关从业人员、研究人员和外部顾问。第四阶段-将制定最佳实践模式的详细指导，包括确保结果嵌入北拉纳克郡重新调整模型的相关工具。第五阶段-通过第二个焦点小组传播指导和工具，以考虑来自从业者的任何挑战和关注。第六阶段-第二次专家组会议，最终确定在北拉纳克郡开发的模型。该活动的进一步产出将是详细的传播指导第七阶段-在北拉纳克郡实施模型第八阶段-通过IRISS在苏格兰传播项目成果。

This project aims to investigate the potential for and most effective means of implementing evidence (formal research studies, practitioner wisdom and user and carer perspectives) about outcomes in the context of home care re-ablement. While there has been some attempt to consider outcomes in homecare more broadly (Sawyer, 2005), progress remains patchy. There is also a need to develop outcomes in re-ablement services, which are being promoted throughout the U.K (CSED, 2007). Re-ablement has been recognized as achieving significant savings for local authorities; however initial costs of re-ablement appear to negate long-term savings (PSSRU, 2010). Embedding an outcomes approach within re-ablement may assist in providing effective home care services within a context of diminishing resources and an ageing population.Emerging evidence of outcomes approaches show that they are both person-centred and enabling and can be implemented without additional resources (Miller, 2010). Evidence from re-ablement is largely positive, suggesting that home care re-ablement can reduce commissioned hours of home care, and offer sustained benefits to service users by increasing their skills and ability to live independently, (MacIntyre and Stewart, 2011). However, (Slasburg, 2009) suggests that establishing a re-ablement culture for all rather than a specific service for some will ensure benefits to all rather than to a small minority of hand picked service users. This project will build on an established knowledge exchange initiative in Scotland, Talking Points (Scottish Government, 2009). It will work directly with a partner local authority, North Lanarkshire Council, to investigate how an outcomes-based approach to assessment has been embedded within two home care re-ablement teams. The project will enable existing evidence on both outcomes and re-ablement to be mapped across current practice in North Lanarkshire and this iterative process will facilitate knowledge exchange. Guidance and associated tools will be produced for the local authority as well as digital stories for broader dissemination and training purposes. It is expected that the key messages from this knowledge exchange process will have applicability for other home care services who are working to embed outcomes in re-ablement across the U.K. and internationally. In addition, if funding is secured, this project will be the first stage in the development of the exploration of a re-ablement approach being introduced throughout home care services both within the council and in the contracted private sector services. Key stages of the project are summarised below.Stage 1 will establish key messages from the literature as they relate to outcomes and re-ablement. In addition a small number of strategic staff within the local authority and other providers will be interviewed to establish a baseline for current practice.Stage 2 will test out via focus groups the relevance and applicability of the key messages identified in stage 1 with practitioners and managers across two re-ablement teams in North LanarkshireStage 3 will synthesise the messages from research, the practice experience and potential challenges to implementation via an Expert Group comprising; relevant practitioners, researchers and external advisors including Partnership4Change. Stage 4 - Detailed guidance on the optimum model of practice, including relevant tools to ensure outcomes are embedded in the re-ablement model in North Lanarkshire will be produced.Stage 5 - guidance and tools disseminated via a 2nd focus group to consider any challenges concerns from the practitioners.Stage 6 - second Expert Group meeting to finalise the model to be developed within North Lanarkshire. A further output of this event will be detailed guidance for disseminationStage 7 - implement model across North LanarkshireStage 8 - dissemination of project outcomes across Scotland via IRISS.