Let’s get bothered about self management!

Let’s get bothered about self management! louise.gibson@alliance-scotland.org.uk from Health and Social Care Alliance Scotland (the ALLIANCE)

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With Scotland’s aging population comes the challenge of living with multiple conditions. People living with multiple conditions are more likely to be admitted to hospital, more likely to be prescribed drugs and have a poorer quality of life. Self management is key to improving outcomes for individuals with multiple conditions – allowing people to live their lives better by being more informed, prepared for everyday challenges and better supported when they need it.

What is self management?

Self management is based on a ‘strengths’ or ‘assets’ based approach. It means working collaboratively with people’s strengths so that together you find the best outcomes and the way to move forwards.

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How can Allied Health Practitioners engage in self management?

Allied Health Practitioners (AHPs) can take a shared approach to setting goals and problem solving and can take account of peoples inherent ability for self-healing whilst recognising people with long term conditions as experts in their own life circumstances. Through meaningful conversations, AHPs can encourage self confidence and support people to have more control of their conditions and lives.

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Self management makes a difference

Research shows that supporting self management improves:

  • self care behaviours
  • quality of life
  • clinical outcomes
  • patterns of healthcare use

When people are supported to look after themselves:

  • they feel better
  • enjoy life more
  • have less need to visit their doctor or hospital.

By practising self management, AHPs can relieve some of the pressure placed on health providers and help relieve the 70% expenditure which long term conditions are estimated to consume from health and social care resources.  

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The figure above shows the journey of a person living their life with a long term condition. The green line depicts the fluctuations associated with managing a long term condition, while the red stripes indicate the episodic consultations from health and social care practitioners. While people themselves are the principle contributors to their health and wellbeing, there are opportunities for AHPs to positively assist with this journey.

 

What supports self management

  • Gaun Yersel: The Self Management Strategy for Long Term Conditions in Scotland (2008)
  • Mental Health Strategy for Scotland 2012-1015
  • A Route Map to the 2020 Vision for Health and Social Care (2013)
  • House of care:

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When to endorse self management.

Now, Now, Now! Supporting self management is essential to the sustainability of delivering quality healthcare services across Scotland. A national acknowledgement of the importance of the individual being at the centre of their health and social care makes it an essential time to embrace an asset based, self management approach.

My Condition, My Terms, My Life

The Health and Social Care Alliance Scotland (the ALLIANCE) has launched the My Condition, My Terms, My Life campaign to share the message that living with a long term condition does not stop you being in charge of your own life. The campaign aims to:

  • help improve public understanding of what self management means for people living with long term conditions, and
  • encourage people living with long term conditions, and the people who support them to adopt a self management approach

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The ALLIANCE would welcome collaborating with any AHPs promoting self-management who are looking for advice, support, guidance and materials in their work.

All enquires to louise.gibson@alliance-scotland.org.uk or call 0141 404 0231.

 

For Allied Health Professional information related to Long Term Conditions please contact heather.hall@alliance-scotland.org.uk.

Should OTs be taking a tablet?

Should OTs be taking a tablet? Use of touch screen apps in early dev. By Melanie Ross Specialist OT, Keycomm AAC service, Edinburgh

Adapted from original in OT news with permission and thanks -Paediatric OT and portable touch screens in early development – Should OTs be taking a tablet? 

One of the common goals for Lothian’s Communication Technology service (Keycomm), and the Paediatric OT service at the Sick Children’s hospital in Edinburgh is to provide support for young children with complex disabilities to learn and develop through play. In Keycomm, I work predominantly with the under fives, or those at a very early developmental level, using technology and adapted or switch accessible toys to support access to play. I am increasingly aware how many children have regular access to touch screen devices.

ipad mum and toddler

At home they may relax with youtube clips on Mum’s ipad; While waiting for an appointment, they watch or listen to music on Dad’s iphone; and almost every nursery/school has access to touch screen tablets, ipads or smart boards. Apple sold 3 million ipads in 3 days in 2012 and sales have continued to soar. There are a vast array of apps tailored for children, both with and without disabilities and many specifically geared to the interests and learning styles of children with conditions such as Autism Spectrum Disorders and Down Syndrome.

There is an ongoing debate at many levels about the impact of “screen time” on the youngest learners. In October 2013, the American Academy of Paediatrics’ position statement, based on analysis of existing research, re-asserted that television and similar entertainment media should be avoided for children under 2. Key researchers like D Christakis (2009) support this with convincing arguments, concerned about the way in which television in particular is experienced as a passive, isolated activity for so many children. However, there is also support for the argument that video, television and touch screens (in particular) have potential for learning. There is admittedly little robust research in this area, but some studies have concluded that because the interaction required from the user of a touch screen device may enhance the potential for learning and may counteract at least some of the concerns around passive viewing e.g with a standard television. Stephenson and Limbrick (2013) have published a meta-analysis of studies with (mostly older) individuals with learning disabilities which may be of interest to readers.

ipad toddler tongue out

There is little or no substitute for interpersonal play. However, we must accept that touch screens are part of everyday experience for even the youngest children. In my experience, considered use, facilitated by an adult play partner and requiring response and interaction from the child, has little potential for harm, and strong possibility for good. Certainly, OT’s in our paediatric service and no doubt many others are embracing it, as we always do, with our analytic and pragmatic, solution focus.

Asking the question “how can this tool help to achieve our goals?”

For learners at early developmental stages, touch screen “Apps” have advantages. The high contrast, movement rich, audio-visual mix seems to promote attention and concentration in children who are otherwise hard to engage. Apps certainly suit visual learners, including those with Autistic Spectrum disorder and the huge variety of free or almost free apps increases the chances of finding something that really captures the special interests of the child. Apps can reward simply making a sound (e.g. apps like “furry friend”, sock puppets, Speak up*). For those who, perhaps with postural support, can control a reach or touch with even 2-3 fingers together on the screen there are visual and auditory rewards (apps like Electra*, imeba*, play piano and magic piano) and for children with the motor control to touch a target area, repeat a touch, swipe and drag a whole world of possibilities for learning and play are available. This seems particularly pertinent for those children whose access to a wider world of experience is restricted by illness or physical fragility.

There are of course drawbacks – touching over a larger surface area or “swiping” can unintentionally close the app or activate unwanted functions. However, guided access and other accessibility settings on ipads and iphones can help reduce these problems. An array of robust cases and screen protectors are now available too, thus avoiding very expensive accidents! The conclusion I have reached is that when the right apps are offered to any child they provide immediate and consistent feedback in a variety of forms (sound, colour, visual movement, etc), and are often very motivating, because, as one parent put it “they are just built to be great fun.”

(*from Sensory App House),

Through discussion with many parents, educators, speech therapists and other OTs. I have compiled a list of apps for developing early interaction and touch screen skills. This is available on Keycomm’s website at www.keycomm.weebly.com and is very much an evolving document with hyperlinks to (as far as possible) free apps. To promote goal centred use of apps, they are arranged in an approximately developmental sequence, starting with those that seem most effective at developing attention, then those for children who show desire to interact with the screen by making a sound or touching. Later apps encourage more precise touch, repeated touch, swiping and dragging. Currently the list also includes apps which develop skills for early writing/hand control and some fine motor skill apps for more advanced learners, but these may be re-located in their own advice sheets soon.

With such a multitude of apps available, including supporting daily living, social and behaviour skills, personal organisation, communication, etc, finding the right one for individual learning needs and preferences can seem a daunting task. Many apps seem to be marketed for a target audience, e.g. “for children with autism” but may be inappropriate for the age and stage of a particular child with that condition. It can be hard to find quality sources of unbiased, professionally qualified, pragmatic advice. I and colleagues have found Ian Bean to be an excellent UK authority on applying apps for early learners in special education. His website http://www.ianbean.co.uk/ has links to his facebook and twitter accounts which are very regularly updated with new ideas for apps, as well as lots of other ideas for using ICT with children with additional needs. In the US, Kate Ahern manages a very active blog at www.teachinglearnerswithmultipleneeds.blogspot.com/ ‎. This has links to so many other useful sources I feel obliged to give the warning to only open it when you have at least an hour to spare!!

Touch screen technologies are here (and there and everywhere!) to stay. I would love to inspire interest and an ongoing discussion about how we as a profession access and harness their potential across our diverse areas of practice.

REFERENCES

Christakis, D (2009) The effects of infant media usage: what do we know and what should we learn? Acta PaediatricaVolume 98, Issue 1, pages 8–16, January

American Academy of Pediatrics (2013) “Media and children”

Apple Press Info. (2012). Apple sells three million iPads in three days. http://www.apple.com/pr/library/2012/11/05Apple-Sells-Three-Million-iPads-in-Three-Days.html. Accessed 14 February 2014.

Stephenson J • Limbrick L (2013) A Review of the Use of Touch-Screen Mobile Devices by People with Developmental Disabilities J Autism Dev Disord, July 2013

2nd Chance to View: AHP leadership in the fight against obesity

ahpscot:

With the consultation period for the “Scientific consultation: draft SACN Carbohydrates and Health report – June 2014″ now open (http://bit.ly/1lYw4BC) and the launch of Public Health England’s discussion paper “Sugar reduction: responding to the challenge.” we thought we’d give a little more food for thought by giving you a second chance to view a blog from earlier this year. Please feel free to comment and join the discussion.

Originally posted on AHPScot Blog --->AHPs Sharing Information:

AHP leadership in the fight against obesity 

Linda Hindle, Chair of DOM UK [Dietitians in Obesity Management]

@hindlelinda

The obesity epidemic is a societal problem which will only be solved by simultaneous action at many levels and by a wide range of partners.  AHPs are rising to this challenge but we need to do more and faster if we are to tackle this ‘ever-growing’ problem.  Not surprisingly, dietitians, with their focus on food, are at the forefront of the fight against the nation’s obesity epidemic.   DOM UK is a specialist group of the British Dietetic Association dedicated to supporting health professionals to prevent and treat obesity.  Members of DOM UK are leading multi-agency strategies to tackle adult and childhood obesity, providing expert specialist input to bariatric surgery teams, informing national guidance and policies, supporting the provision of clear evidence based information to the public plus a range of local innovative…

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2nd Chance to View – Celebrating the launch of the ‘Personal Footcare Guidance and Resources – A Video Blog

Launch of the Personal Footcare Guidance and Resources

The Personal Footcare Guidance and resources were launched in September 2013.  Delegates were asked two questions about the guidance

  1. What is the best thing about the guidance
  2. What is your take home message from the launch

Here is what they had to say……

http://youtu.be/WSbjwVls72g

With thanks to

  • Jenny Ackland, National AHP Lead for Personal Footcare 
  • John McConway, Podiatry Manager, NHS Ayrshire & Arran
  • Karen Utting from the Society of Podiatrists and Chiropodists
  • Tracy MacInnes, AHP Officer, Scottish Government
  • Allister Kelly, Podiatry Manager, NHS Dumfries & Galloway
  • Pauline Johnston, Practice Development Podiatrist, NHS Greater Glasgow & Clyde
  •  Jacqui Lunday-Johnstone, Chief Health Professions Officer, Scottish Government
*[You can contact Jenny via email @ jenny.ackland@ggc.scot.nhs.uk]

Fully detailed information and resources to share and use can be found on the new footcare guidance web site http://www.lookafteryourfeet.info Click here to be redirected to it. 

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Cancer Prevention – Putting Evidence into Practice

By Prof Annie S. Anderson BSc PhD RD FRCP (Edin)
Professor of Public Health Nutrition,
Centre for Public Health Nutrition Research
Centre for Research into Cancer Prevention and Screening
a.s.anderson@dundee.ac.uk
@thescpn @anniescotta

It is almWCD_UK_Infographic_Finalost 7 years since the World Cancer Research Fund produced their comprehensive review on Food, Nutrition, Physical activity and the prevention of cancer, and about a month since the last update (ovarian cancer) was published. The totality of evidence shows that around 43% of breast and 47% of bowel cancer can be prevented and yet these messages remain largely unacted. After tobacco use, excess body weight is the biggest modifiable risk factor but obesity and its association with breast cancer remains the major elephant in the room. I do wonder why we spend so much on research if this cannot be translated into practice and policy.

Everyone has such fab excuses…. its fate, its in the genes, it’s what you ate as a child that counts, its alcohol bingeing as a teenager, Uncle johhny is still alive at 90 despite no green ever passing his lips.

Despite a burgeoning evidence base on the importance of weight management in cancer survivors, both in terms of cancer outcomes, management of treatment side effects and well being the nutritional focus is dominated by malnutrition. Last week, our colorectal clinical nurse specialists sought reassurance that the obese patients shouldn’t really be encouraged to consume creamy drinks, pies and pastries, highlighting a local patient guide that implied otherwise.

More disappointing is talking to clinicians, where a set of reasons for not talking about diet and obesity including “the evidence doesn’t come from randomised control trials” (neither does smoking evidence!), not enough time, not trained, personally overweight, don’t want to spoil professional relationships, talking about obesity is ineffective…… and for more just see our paper on colorectal clinicians (Anderson et al, Colorectal Dis 2013, 15(8) 949-57).
We have conquered so much in terms of treatments and length of survival we really are overdue the focus on quality of years, the well being associated with weight management, the refreshing effect of a brisk walk, the taste of fresh fruit but major advocacy efforts are needed!

SCPNThe Scottish Cancer Prevention Network (SCPN) was established 4 years ago to engage a range of stakeholders to work together to promote cancer risk reduction behaviours relevant for primary prevention and for cancer patients. SCPN gets funded through the Scottish Cancer Foundation and has grown a lot in these years, from a core of 80 people to over 800 signing up for our newsletter with cascades out to around 24,000 (including 4 health boards who flag the issues to all NHS staff). Patients are starting to say it is a duty of care to be informed about evidence on cancer prevention for them as survivors and for their families. The tide is starting to turn. Our annual conference has been a sell out for the last two years as the cancer charities get behind the idea that prevention must be a feature of their work and even CRUK have finally decided to invest in cancer prevention research. The health promoting health service initiative is a perfect opportunity to promote healthy lifestyle. One day we might even see some universal work around obesity with approaches that remove guilt and stigma and really flag opportunities for reducing cancer risk (as well as diabetes and cardiovascular disease).

NewsletterResearch (and teaching) are my key missions from my University overlords but in reality writing another paper to be read by 20 or so people versus a newsletter article that reaches thousands seems to me a better route to helping to change ways of life. It would be fab if more dietitians could be involved (sign-up for the newsletter by e-mailing scpn@dundee.ac.uk, follow on twitter @thescpn or e-mail us if you want to submit some content) and show professional solidarity for cancer risk reduction!

Do AHPs find it hard to swallow?

Joyce Thompson
Dietetic Consultant in Public Health Nutrition
NHS Tayside
Joycethompson@nhs.net

I can appreciate that you may well be thinking you are about to read something on dysphagia which is undoubtedly a very important clinical issue. But no that’s not today’s topic. Instead I want to draw your attention to an increasing irony which stems from the highly successful food and drinks industry. Whilst the industry seemingly counts on people’s ignorance to actively push waistline-busting, high fat, high sugar and nutrient poor drinks and snacks on them, what is getting harder to swallow is our own ‘do as I say not as I do’ approach!
But before you raise your hackles and fast forward to the ‘reply’ button (and please do because I really want to know what you think) let me expand on this seemingly contentious statement and centre on the fact that the majority of registered AHPs work for public sector organisations.

It remains shocking but not necessarily newsworthy anymore that the majority of the UK population is overweight or obese – six out of ten of us by the way – and the prevalence of nutrition-related disease such as cardiovascular disease, type 2 diabetes, and some cancers, remains high and potentially preventable. But being able to make appropriate lifestyle choices (I am talking about what we eat and drink and, how active or sedentary we choose to be), is definitely not easy in today’s obesogenic environment. And whilst we may quibble about whether or not the NHS is the best place to tackle obesity, what is certain is that solutions to the problem must go beyond blaming the individuals struggling with this condition. So in this blog I am focusing on the AHP work place.

Joyce Picture2We know that the work place has great potential as a setting for improving the health of the population. For many AHPs the work place is an NHS setting such as a hospital. In the context of retail facilities within the NHS, there is a great opportunity to influence the behaviours of staff, patients and the public because of the ease of constant access to a large number of people, many of whom already suffer from overweight or obesity and long term nutrition-related diseases or, are at risk for such adverse health effects. This can be positive or negative. Unfortunately the current business model appears to be the latter. It is aimed at achieving maximum profit and the reality is that we see an excess of undesirable high fat, high sugar items which are heavily marketed to vulnerable patients, visitors and staff. I fear that there are many examples throughout the UK to illustrate the point where fast food, coffee shop and confectionery chain outlets are located on NHS premises, along with their aggressive sales tactics pushing less healthy products down our throats. But perhaps there are also examples to the contrary where healthier choices are actively marketed and high fat, high sugar items are not marketed. Please let me know either way. Are there other business models that might be operating? Are there examples of good practice in retailing and specifically examples of what happens in other countries? Is there a social enterprise retail model that might be an exemplar for use in the NHS? Has anyone made a case about vulnerability and excess diet-related health in more disadvantaged grJoyce Picture3oups in NHS premises? And on a wider lens how can the synergies between nutritional adequacy, environmental sustainability and economic goals balance within this context?
And what about our own professional practice within the work place? It is widely recognised that our health and social care systems are unsustainable without radical transformation and that we must work more upstream to prevent problems arising rather than concentrating solely on trying to fix them. Linda Hindle, Lead AHP at Public Health England said that AHPs ‘must take every opportunity to create the environment, conditions, information and support to help individuals and communities change their behaviour to enjoy better health and wellbeing’. Yup – as registered healthcare professionals, AHPs can help achieve this transformation! But there is no silver bullet solution and it’s a combination of actions that are needed. For example AHPs can make every patient contact count by being able to:

  • Raise the issue of lifestyle.
  • Share some practical key messages about food, nutrition and physical activity.
  • Sign post to different support services such as weight management and physical activity opportunities.

Plus, we’ve all heard the old adage ‘do as I say and not as I do’. AHPs are often viewed by the general public as role models for health and promoting healthy lifestyles should play a key role in our own professional practice ………but we don’t always practice what we preach do we? For example have a think about the following suggestions:

  • Meetings and hospitalities – include fruit and not just biscuits (better still do without the biscuits!)
  • Working lunches – arrange for ‘healthier options’ such as pulse based soups, sandwiches with low fat fillings and fruit, and avoid the fatty sausage rolls and ‘deep fried’ nibbles.
  • Conferences & training sessions – ask for the above (there is usually a dietary needs box which you can use) and provide feedback on the food and drinks provision (positive or otherwise) on the evaluation.
  • Celebrations and gifts for teams – a fruit basket is much better that than tins of chocolate sweeties!

Joyce Picture1What more can AHPs do to change the reality under our work place noses of, an excess of undesirable high fat, high sugar items being heavily marketed, promoted and/or offered to vulnerable patients, visitors and staff? Answers on a postcard please.