Projects we’ve funded 2016

Developing enhanced data capture for Greenwich on the MOVE

PI: Claire Higgins, Greenwich MOVE Team, Oxleas NHS Foundation Trust
Email: MOVE@oxleas.nhs.uk

The MOVE partnership (Movement Opportunities Via Education) is a UK based charity working with local authorities, schools and organisations to improve the mobility skills of children/Young people (C/YP) and adults who have disabilities and/or complex needs, in order to achieve maximum movement skills. MOVE is an activity based programme which uses the combined knowledge of family, education and therapy to help build opportunities for movement practice in to daily life.

The Greenwich MOVE programme has operated as a permanent team since 2013. It is an innovative, integrated service funded by the Royal Borough of Greenwich and co-ordinated via the Oxleas Children’s Physiotherapy team. This partnership has resulted in MOVE being offered to children based directly on their individual need, rather than determined by the setting they attend and has enabled mainstream education settings to adopt the MOVE programme, which has not been previously achieved. Greenwich MOVE has been introduced to 25 educational settings within the borough, has 116 children on the caseload and has trained 221 staff to date. The work carried out in Greenwich has been instrumental in developing the core national programme over recent time. 

Children and Young People (C&YP) on the Greenwich MOVE programme are assessed against a mobility framework that captures their ability in 16 movement domains (progressing from standing to walking).  This is commonly known as ‘Page 19’ data. Having reached a stage in the programme where there is a significant cohort of longitudinal Page 19 data the team has recognised that the information it provides does not meet the requirements of a robust outcome tool.   This makes it difficult to accurately capture and convey the model objectively in the context of definitive outcomes and proposed future developments.

This project aims to evaluate the existing Greenwich MOVE programme, summarise the work to date and arrive at a revised, comprehensive data capture model that will demonstrate robust outcomes for children, carers and education staff across the borough. It is then the intention to promote the new direction, ethos and framework as a best practice inter-agency model of working.

Designing and validating a user-led, dedicated evaluation tool to assess the impact of music therapy in children with autism spectrum disorders (ASD): a multi-agency approach

PI: Dr Christina Malamateniou, Department of Family Care & Mental Health, University of Greenwich
Co-Applicants: Mr Luke Annesley, Music Therapist, Oxleas NHS Foundation Trust; Dr Stella Tsermentseli, Department of Psychology, University of Greenwich; Mrs Angie Campbell, Department of Family Care and Mental Health, University of Greenwich
Email: C.Malamateniou@greenwich.ac.uk

There are currently many different diagnostic tools for autism spectrum disorders (ASD) at different ages. Early diagnosis and early therapeutic intervention in ASD can make a difference between a happy and fulfilling life and one where ASD people are struggling to deal with everyday tasks and make sense of the world. Different holistic therapeutic approaches for ASD have recently emerged, with Music Therapy holding great promise in improving outcomes of ASD children and adult populations and directly addressing the communication, emotional and behavioural challenges associated with it. However, as these therapeutic approaches have just started to build their evidence base, which often relies on isolated case studies, there are currently many key areas, that remain vastly unexplored. In particular, there are no customised evaluation tools to systematically assess and monitor the impact of music therapy, to

  1. help therapists and parents/carers evaluate children’s progress
  2. allow them to make informed decisions and modify, if required, therapeutic schemes
  3. help NHS Trusts provide cost-effective treatment schemes in the community and ultimately
  4. improve the patient experience and offer customised, patient-centred care.

The idea of this project is to provide the pilot data to create a user-led, dedicated, comprehensive yet practical for everyday use evaluation tool, to assess the effect of music therapy on children with ASD and monitor their progress against some meaningful and relevant outcomes. These outcomes will relate to communication, social/emotional, motor, sensory/perceptual and behavioural development to address all the different areas which may be affected by ASD and where potential improvement with the help of music therapy could be observed, as highlighted by the relevant literature.

This project builds on current expertise in Oxleas and the University of Greenwich and introduces a new clinical-academic partnership with active user involvement and with strong potential for future work in this field. It will also help design a much needed dedicated evaluation tool of music therapy in children with ASD, using robust research methodology, multi-agency support and user feedback at all stages to improve the experience of the patients.

Implementing Outcome Measurement in a Dementia-Focused and Person-Centred Care Home Service

PI: Liz Kenny, Bromley Older People’s Mental Health, Oxleas NHS Foundation Trust
Co-Applicant: Sheila Bishop, Jane Foong, Bromley Older People’s Mental Health, Oxleas NHS Foundation Trust
Email: elizabeth.kenny@oxleas.nhs.uk

The aim of this project is to evaluate the use of a set of established outcome measurements alongside an advisory and educational intervention for care staff supporting people living with dementia in a care home setting. It will involve people with dementia, their relatives and carers, including paid carers, in the process of evaluation. A key principle of the project is valuing and validating experience which will directly inform improvements in service provision. This principle is at the centre of person-centred approach to dementia care, drawing on a large and established body of evidence. The project also builds on existing partnerships between cross-sector stakeholder organisations (secondary mental health care service and care home sector) and can develop links with the University of Greenwich upon dissemination. The service evaluation will draw upon existing service provision arrangements with care homes in the local area. The project is focused on identifying suitable outcomes which will in turn improve the delivery of the service.

The main objectives of the project are to:

  1. Explore the current literature on the use of outcome scales within person-centred dementia care literature; review work of dementia focused services across NHS trusts to identify outcome measures currently used in clinical practice.
  2. Pilot the use of a selection of outcome scales, designed to measure positive outcomes for people living with dementia, in a care home setting.
  3. Ask key stakeholders to evaluate their experience of using the outcome scales.

The findings of the study will inform future planning and delivery of the Care Home Project service in Bromley.

Exploring visualization of personhood on pin boards within care homes specialising in dementia care

PI: Marianne Markowski, University of Greenwich
Co-Applicant: Sunita Sahu, Consultant Psychiatrist, Oxleas NHS Foundation Trust; Julie Cooper, Department of Adult Nursing & Paramedic Science, University of Greenwich
Email: A.M.Markowski@gre.ac.uk

In the UK dementia affects every sixth person over 80 years of age and every third person over the age of 95 years (Age UK 2016). Care homes increasingly specialise in dementia care to ensure a nurturing environment for their residents. Person-centred care and knowing the individual resident, with his/her history and preferences, is key to delivering high quality care and avoiding unnecessary distressed reactions and behaviours by the resident (such as wandering, restlessness and screaming). Involving a person affected by dementia in activities through ownership and choice, is in line with the NICE (2006) guidelines for person centred care, which values the unique personality of the person and calls for relationship-centred care (see for example Brookers VIPS model (Brookers, 2007, Brookers & Latham 2016).

This explorative research will create personhood boards with service users to establish the benefits of introducing the co-creation of personhood pin boards into residents’ rooms to support engagement in person-centred care. Not all care staff have the time to fully engage with the details of their resident’s life, particularly when they have just started in their role or have changed location. The pin board aims to support the process of getting to know the resident’s personhood by offering visuals prompts for meaningful interaction.

The project will also develop dynamic relationships between actors of different sectors through consistent involvement of a steering group including members from the private, NHS and charity sectors, and people that are directly affected by the dementia journey.

Ultimately the project intends to improve patient experience and maximise multi-agency working, as well as improve family members’ experience through involvement in the activity and seeing a tangible outcome. The steering group serves as a starting point for a forum on sharing research, information on service improvement, and provides evaluation after each research phase.

Evaluating the effectiveness of integrating physical health in mental health services and the service user experience

PI: Mariam Aligawesa, Nursing Directorate, Oxleas NHS Foundation Trust
Co-Applicant: Sulan Gingell, Quality & Governance, Oxleas NHS Foundation Trust
Email: mariam.aligawesa@oxleas.nhs.uk

There is now a considerable body of research highlighting significantly poorer physical health outcomes for patients with serious mental illness (SMI).  Striking figures show that patients die on average 20 years earlier than the general population due to preventable physical health problems due to a combination of factors including lifestyle choices, difficulty accessing mainstream physical health services and side effects from anti-psychotic medication.

Oxleas developed a physical health and wellbeing policy in 2015 which set out clear standards and expectations for staff in terms of responsibilities for physical health and wellbeing monitoring and interventions.  The Department of Health recently launched a policy on the role of mental health nurses in improving physical health in mental health (May 2016). Whilst the CQUIN scheme has helped to increase awareness of cardio-metabolic risk factors and improve documentation of screening and interventions in Oxleas, the service user perspective around this important issue has yet to be fully understood. 

This project aims to explore how service users in the Early Intervention Team view their physical health and their experiences of support for their physical health needs in Oxleas.  This will be a service user led project, with Greenwich ResearchNet coordinating much of the evaluation, in consultation with the Greenwich Early Intervention Team and Trust physical health and wellbeing lead facilitator. It is hoped that by having a greater insight into service user perspectives, Oxleas can better support their physical health needs in a more effective and meaningful way.