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Community rehab

How two community services are making tentative steps to normality

As pandemic restrictions lift, brain injury services are starting to come back out of hibernation. Jessica Brown speaks to two Headway groups across the country to see how they’re resuming support offline.

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In Portsmouth, the local Headway has had a difficult time in recent months. Two service users have died from Covid-19, and another has been sectioned and taken to a secure facility after their mental health took a downturn.

There’s been a huge spike in mental health problems, and a few service users, who wouldn’t have done so under normal circumstances, have got in trouble with the police.

Most service users are gradually building their contact with the outside world again, with Headway’s help.

When lockdown began in March, service manager Deborah Robinson decided the best course of action was to identify the most vulnerable users and make sure she and her team maintained regular contact with them. The next challenge was gradually exposing them to more contact as restrictions began to ease.

“We regard it as a graduation – first is phone contact, then sitting in the garden with them, then inviting them on a walk once they’ve got confident enough to come out of their homes with us, then eventually we’ll suggest they come to a session with the group,” she says.

“Some people are too frail or anxious, so they won’t come out,” she says, “So we’ll have to carry on popping in to see them.”

This approach has proven particularly helpful in some ways, Robinson says. Before the virus, staff members hoped service users would speak up in sessions when they had a problem, but visiting people at home has allowed staff and volunteers to pick up on issues faster and get to know them better.

“One staff member met a service user in his garden, and noticed that the recycling bin was overflowing with alcohol. We knew he’d been a drinker in the past, so the staff member talked to him about his drinking, teasing information out,” Robinson says.

“He said he was drinking a lot, so we’ve been able to put in place goals to help him cut down on his drinking and put him in touch with AA, as well as various other things to help with a problem that reared its head in lockdown.”

Employees and volunteers, she adds, are also getting better at texting group members and touching base.

“It’s a mix of phoning people regularly and picking up the ones where there are issues. We’re getting more adept at that because it wasn’t something we did, and we’ve also picked up almost everyone’s carers because we’ve been talking to them to hear their concerns, too.”

Forty miles west in Salisbury, Headway arranged Zoom groups every week, but recognised that this option wasn’t suited to everyone.

“We were conscious to get actual face-to-face contact again, so as the guidelines have changed, we’ve thought about how we can work with that,” says Sarah Allen, service manager.

In recent weeks, online groups have continued, but staff members have started arranging small group meet-ups in various locations, including the outdoor café at Salisbury Museum, which Allen says provided a good learning opportunity.

One of Robinson’s major concerns in Portsmouth is how service users will react when they see other people not wearing masks or standing too close, and are told they have to adhere to guidelines themselves.

Allen, however, hopes meeting up in public places will help service users slowly accustom to these new ways of life.

“Some people coming to the groups haven’t been outside during the pandemic because all their activities have stopped, so it’s really important to model social distancing and hygiene behaviours,” Allen says.

“Somewhere like an outdoor café has been really useful because it’s about giving group members social contact in a setting where they can see people all around them modelling social distancing, staff wearing face masks and putting on hand sanitiser,” she says. “Then, when group members do go out and about more, it’ll be more familiar for them.”

In recent weeks, groups in Salisbury have also met up in a park, where they were able to socially distance.

Allen says coming out of lockdown and resuming services has been a learning curve for her, and she is realising that it’s sometimes more beneficial to have smaller groups than the maximum allowed by government guidelines. 

She knows she will have to continue to adapt in unknown ways as government guidelines change.

But the future remains uncertain. Headway Salisbury doesn’t have its own centre, so rents community rooms to host sessions instead – and none have reopened yet. Allen plans on continuing outdoor activities for as long as possible, but is uncertain of what will happen as temperatures cool.

“Going into autumn and winter poses a new challenge,” she says. “I’m not sure how we’re going to meet if the government guidelines if the maximum number of people who can meet indoors stays the same,” she says.

Meanwhile in Portsmouth, premises have been locked up for the duration of lockdown. Robinson has seen an increase in demand for services, so as things resume back to pre-Covid 19, she says here’s a lot of thinking to be done about how the service is going to expand to accommodate increased need. She anticipates the service will need to expand by a third.

Both Portsmouth and Salisbury Headway services adapted quickly when the lockdown came in March. Adapting back to how things were before looks like it will be a longer, more difficult path – but while Allen and Robinson have faced slightly different challenges over the last few months, there’s no doubt they’ve both found silver linings in the challenges thrown at them so far.

Community rehab

Mental health NHS Trust extends roll out of Perfect Ward

Barnet, Enfield and Haringey mental health NHS Trust (BEH) plan to extend the Perfect Ward system to 12 community teams

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Three members of NHS staff walking down a corridoor in uniform using the Perfect Ward system

Barnet, Enfield and Haringey mental health NHS Trust (BEH) is extending the rollout of Perfect Ward to 12 community teams.

This will include the organisation’s health services in Enfield where the majority of the Trust’s 128,000 patients receive care at home or at local clinics.

BEH is a provider of integrated mental health services to a population of 1.2 million. They introduced Perfect Ward’s quality improvement digital technology to transform the way quality and is measured across the large organisation. Since it was introduced, over 300 staff in 45 teams rely on the system to conduct 13 quality audits on mobile devices.

The latest implementation took four months with 12 of the 20 community teams going live with Perfect Ward in November 2020.

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To assist the rollout to the community teams, the Trust enlisted the support of the IT department to install Perfect Ward on mobile devices and introduced training before the launch date. Staff were shown how the technology could simplify their life and encouraged to get involved in the design process. Any initial reluctance to engage was quickly dissipated and inspection rates are at 100 per cent.

Using the system, BEH’s community team can conduct their own audits and reconfigure the content and questions to match their own requirements. They can also receive instant feedback allowing them to react immediately to the results and track their performance in real-time. The efficiency of the Perfect Ward app vastly reduces the number of hours spent auditing staff giving them more time to spend with patients.

The exterior of BEH hospitals where the Perfect Ward system is being extended

Caroline Sweeney, deputy director of nursing and quality governance at BEH Mental Health NHS Trust, commented: “This latest development is part of our overall plan to integrate mental and physical health services to provide a better, more holistic level of care.  An ambitious goal like this requires an equally sophisticated tool to bring together our patient safety incident, auditing and patient experience survey results all in one place.

“Perfect Ward has already proved its worth in supporting Good Governance, combining consistent processes with a cohesive view of all quality activities in a single solution, the basis of a robust QI framework that guarantees continuous improvements in patient care.”

Alan Birch, chief commercial officer at Perfect Ward, added: “Our highly customisable technology combines intuitiveness with flexible configurability to transform the way organisations like BEH effectively measure quality across their large, complex and diverse organisations.

“At a glance, both clinical and non-clinical staff in all kinds of healthcare settings are able to flag up issues and monitor performance to boost staff morale and drive meaningful quality improvements simply using their smartphones or mobile devices.

“What is more, our technology is widely recognised as a valuable strategic tool.  With access to dynamic data, NHS Trusts such as BEH are empowered to contribute to national programmes including the Mental Health Act or meet the unique challenges of a global pandemic amid a rapidly changing healthcare landscape.”

Read more: Osteoarthritis: breaking the cycle

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Brain injury

Community rehab programme saved by brain injury charity

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A vocational rehabilitation programme in the North East aimed at getting those living with a brain injury back into working life has been resurrected by a community charity.

Headway Tyneside worked closely with the NHS and fellow charities, Headway County Durham and Headway Darlington & District, to ensure the programme could continue following last year’s closure of Newcastle-based providers, Momentum Skills.

‘Headway to Work’ is the newly-branded service which will support around 14 people per year living in Durham and Darlington. Each participant will be individually assessed by therapists to gain an understanding of their difficulties, enabling the team to offer personalised support throughout the programme.

The training focuses on improving self-management skills such as self-care, goal setting, productivity, sleep and fatigue management, as well as technical skills such as IT and literacy. The final phase of the programme will involve voluntary placements for participants to ensure they feel comfortable, confident and have the relevant vocational skills before seeking paid employment.

In the future, the group hopes to deliver the ‘Headway to Work’ programme across more parts of the North East, within Gateshead, Newcastle, South and North Tyneside.

Alistair McDonald, chairman at Headway Tyneside, explains: “We all know how incredibly difficult the past 18 months have been. Those with disabilities or long-term health conditions have been especially vulnerable. The Momentum programme was well received and helped lots of individuals with a brain injury plan a route into employment, education or training and it’s fantastic that we can continue to deliver this type of service.

“The service will now be delivered closer to where participants live rather than having to travel to Tyneside. Less travel and being in a more familiar place should help people feel less fatigued and provide an opportunity to socialise and development friendships with other learners local to them.

“Currently, we have around 10 staff, including Julie Meighan our clinical service development manager, who will oversee training sessions run by a neuropsychologist and job coach. Julie worked as a specialist brain injury occupational therapist for many years so has the clinical knowledge and experience this programme needs.

“Our fantastic team of committed volunteers will support the delivery of this vital work to those who want to prepare for a return to work or plan a route into employment, training or education.”

Headway Tyneside is an independent charity providing support services to brain injury survivors and their families. In recent years, the board of trustees has developed a strategy to grow the scale and scope of services to provide more diverse and specialist services to their members.

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Brain injury

Supporting professionals to understand suicidal risk

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Understanding suicidal risk and supporting professionals to deal with such a hugely difficult topic is to be tackled in an event being held next week. 

Life-changing brain, spinal cord and complex injuries can be significant factors in increasing this risk, as a result of the huge spectrum of difficult emotions a person faces in dealing with their new reality. 

And for the professionals dealing with clients going through such trauma, suicidal thoughts and acts can cause great distress to them and it can be difficult to know how to react and what action to take. 

Through the ‘Understanding Suicidal Risk – A Guide for Professionals’ event, held by Sphere Memory and Rehabilitation Team, advice and guidance will be offered to empower those working in complex injury to deal with such situations. 

The webinar, held on Thursday, July 1 from 10.30am to 11.30am, will be delivered by consultant psychologist Dr Clare West, and is raising money for SameYou – the charity founded by Game of Thrones actor Emilia Clarke after surviving two brain haemorrhages, to give a voice to fellow brain injury survivors and to deliver better holistic rehabilitation care. 

Dr Katherine Dawson, director and consultant clinical neuropsychologist at Sphere, says that while the issue of suicidal risk has gained more prominence during the pandemic, for professionals working with brain and spinal cord injury patients and those individuals who have experienced trauma, the issue is ever-present. 

“It is a timeless issue, which can cause anxiety for those around the individuals regarding management and intervention. Furthermore, often individuals really struggle to even voice how they feel and the enormity of suicidality can often silence individuals which then worsens hopelessness,” says Dr Dawson. 

“If someone does share their suicidal thoughts and feelings, in response people often don’t know how to move forward with that.

“During the pandemic, the loneliness and isolation has increased, and very early into lockdown quite a lot of my clients went into crisis as their support network, which provides a lot containment, wasn’t there anymore – while Zoom serves a purpose, it’s not the same as in real life. 

“People hear ‘suicide’ and can panic. There is understandable fear associated with it, and often those around the individual may inadvertently respond in quite a reactive way, wanting to try and fix the issue. We recognise that this can cause significant distress and anxiety and it can be hard to know what to do in the face of suicidal risk.

“Hopelessness is the most immediate risk factor for suicide so instilling hope is essential. The assessments we will consider in the webinar outline how to assess the different levels of risk including looking out for red flags, primary drivers and secondary drivers. 

“We focus on how to complete a suicide interview collaboratively, leading to a clear plan of risk escalation and services to involve at specific times. 

“Through putting the spotlight on a suicide intervention management plan, we can look at this in a thoughtful and containing way, reducing the risk of reactivity and decreasing anxiety. 

“We’ve heard directly from a lot of case managers that risk and managing risk is something they are concerned about, so we hope this event will help them with what is a very difficult topic.”  

Sphere are asking for a suggested £20 donation to SameYou to attend the event. To register, visit here

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