We are the PITSS —- Paediatric Imaging Tayside Study Sessions (PITSS)
This weeks AHP CYP Blog has been written by John Temple, Specialist Radiographer @NHSTayside and tells the story of the establishment of PITSS
This weeks AHP CYP Blog has been written by John Temple, Specialist Radiographer @NHSTayside and tells the story of the establishment of PITSS
I am a Band 6 Occupational Therapist (OT), working for The Highland Council as part of their Health and Social Care Children’s Service. Based in Fort William with a geographical patch covering Lochaber, Skye and Lochalsh. I have been an OT for 21 years, and a children’s OT for 18 of those years. I’ve worked in Highland for the last seven.
Our OT team is based and managed from Inverness where the majority of the Children’s OTs are located. After almost seven years as a lone practitioner I was joined by a Band 5 OT last October – at last I have someone to share the highs and lows of the OT world in our locality.
We are based out of Fort William Health Centre – which opened in 2007. A fantastic local facility from which to deliver our service with co-location with other therapy and health colleagues.
The world of the Children’s OT has changed a lot since I started with a real drive these days to improve the skills of those around the child including parents, carers, and school staff.To give a flavour of what I do I’d like to share my week: Continue reading
This week’s blog has been written by Jenna Reid, Clinical Specialist Physiotherapist RHSC, Edinburgh and the Chair of the MSN National AHP and Psychology group working with Children and Young People with Cancer. Continue reading
Gillian Boag & Beth Brewster , NHS Tayside
We are both Speech and Language Therapists [SLTs] working in an early year’s capacity in Dundee city. In April 2013 we embraced the opportunity to work as Early Years Collaborative Coordinators for AHP groups across Tayside for six months to raise the awareness of AHPs in Tayside of the Early Years Collaborative (EYC) and to increase their involvement.
What is the Early Years Collaborative?
The EYC is the driving force behind empowering and supporting agencies from health, education, social work and voluntary sector to work in partnership to make Scotland the best place in the world to grow up in. It aims to accelerate the progress services make towards meeting the objectives of the Early Years Framework, that is, shifting our focus to deliver early, preventative intervention in a way that can be sustained, to deliver better outcomes and reduce inequalities for Scotland’s most vulnerable youngsters . There are 4 workstreams within the EYC each with their own stretch aims.
What did we achieve?
We learned there was mixed awareness across each of the AHP groups. We also found that there was a willingness from therapists to invest in the EYC to carve out and develop an early and preventative role within services. However a particular challenge was repeatedly raised
How could the time needed to build relationships and to test new ways of working be found?
We hope we have been able to inspire and motivate staff to identify
What they can do differently working with other agencies to promote early health promotion messages and deliver early intervention.
We feel that during our six months we were able to raise the profile of the EYC and what its aspirations mean for AHP services across Tayside.
We also collated information on tests of change being carried out by AHP colleagues across Tayside and shared this information with managers and staff in each of the localities and below are some examples of these
Colleagues in Perth city occupational therapy worked collaboratively with nursery staff to provide a programme called ‘Jungle Journey’ with the aim of increasing the number of nurseries in the area including fine and gross motor groups as part of the nursery day. The therapists initially ran the groups alongside staff and then provided advice and information for the staff to continue running the groups alone. Activities included those to improve hand-eye co-ordination, pencil control and finger isolation along with ideas for improving ball skills and check lists for dressing skills.
In Dundee the physiotherapy team have been involved in a project called ‘Tummy Time’. The team had found they had increasing numbers of children referred with low muscle tone and it was felt this was due to lack of time spent by babies from six months of age playing on the floor. The first cycle involved one child and her parents being encouraged to use floor play for crawling and high kneeling. Within three months the child was more accepting of floor play, was moving more and pulling to stand and began to walk unaided within six months of starting the project. Tummy Time has now been used successfully with groups of parents and other agencies involved in working with parents of young children have been advised on the importance of promoting exploratory floor play.
Communication & Language
An Angus SLT has been joining a Health Visiting colleague when she has been carrying out the 27-30 month screening assessment. This has highlighted a need to change the question format for parents in order to gain appropriate and sufficient information to make a decision as to whether a referral to the speech and language therapy service is required.
Dundee SLTs have been collaborating with the adult learning team, One Parent Families Scotland, educational psychologists, midwives, health visitors and others to deliver programmes to groups to promote early play and communication skills targeting families in more vulnerable areas of the city.
What we learned
During our six months as early years co-ordinators we learned that there is a lot of enthusiasm across a broad spectrum of agencies to work with others to ensure Scotland is the best place to grow up in. A significant part of our learning was about the variety and number of groups working with families across Tayside.
We also learnt about Improvement Methodology e.g. making small tests of change and scaling this up to work with larger numbers of children and their families. An important lesson was that there is as much to learn from a failed test of change as there is from a successful one.
Planning and evaluating tests of change through PDSA‘s was useful and we are now more confident about using PDSA’s. More recently we have been introduced to run charts as a way of collecting data and recording our work.
The importance of attachment as a human requirement to meet and overcome challenges and difficulties in life is the highest ranking factor we have learned about during our time as early years coordinators. This is now being raised as one the main areas to focus on within workstreams. We are now aware that people who have had more than four traumas in their childhood are likely to have health and social problems in later life although those with strong attachment fare better. We look forward to continuing to work with others to improve this vital process.
Four weeks of blogging on @AHPScotBlog relating to Children & Young People’s AHPs
Back in October I wrote my first blog for @AHPScot about milestones and this month sees another milestone; a month devoted to finding out more about AHPs working with children and young people. When I was initially asked to take the lead on this I thought I would struggle with topics but once I started thinking I could have carried on for several more months!! I won’t but I will revisit this opportunity later in the year.
As an AHP working with children and young people you could find yourself working anywhere; acute hospitals (children’s and adults!), nurseries or schools, out-patient clinics, homes, young offenders institutions the list could go on. Equally interventions can vary considerably from direct working one:one with a child and their family, to providing training for education staff to enable a group of children to develop the necessary skills to succeed at school and in life, to preventing unnecessary hospital admission.Therefore this month I have asked a range of AHPs working in a variety of different areas to contribute to give an overview of the work they do.
The first blog in the series – out on Monday- has been written by Gillian Boag and Beth Brewster, SLTs and Early Years Collaborative Co-ordinators who will share their achievements and learning from their roles.
The other blogs will share the experience of being an AHP working with children in a remote and rural health board, AHPs working with children with cancer and also from an award winning paediatric radiography team.
However to get you started I want to share this profile of Zoe Johnstone who is a community respiratory physiotherapist who leads the rapid response service which has reduced hospital stays for children with complex needs ; Rapid Response via @csp
Finally I want give a huge thanks to all the AHPs who have contributed this #AHPCYPTakeover and I hope that this gives you a flavour of some of the innovative and exciting roles within child health. There are many more potential child health bloggers out there so watch this space!
I have always had a keen interest in horse riding being fortunate enough to have my own pony as a child. My pony was aptly named “Wee Joker” and lived up to his name by regularly inventing new strategies to get me out of the saddle!
Following one particular occasion where Joker had decided he needed some respite I recall regaining consciousness whilst being transported in the back of an ambulance from one community hospital to another. Next to me was a very noisy wire rack, as I reached out to ask “what is that?” The ambulance man kindly advised that these were my “wet plate x-rays”.
Looking back on Wee Jokers antics I now appreciate what that scamp of a pony has done for me. If it weren’t for the various visits to the local Radiographer during my teenage years to examine the extent of my injuries I would never have decided to become a Diagnostic Radiographer.
Becoming a Diagnostic Radiographer at this point in time has afforded the opportunity to become a part of the evolution from wet film processors where we followed a maze system to get into the dark room to the implementation of automatic processors, film loaders and then the introduction of tele-radiography, CR, DR, PACS, II , CT, MR, U/S. As Radiographers we seem to have had an endless list of acronyms for the various modalities we have had to master. The advance of technology has been relentless as has the pace and scope of change.
Qualifying as a sonographer and developing as an advanced practice Radiographer challenged me and my colleagues not only to keep pace with technological advances but also with the advancement of Professional Practice. Whilst professional boundaries were being broken and professional territory being invaded with assistant practitioner roles and advanced practice Diagnostic Radiographer roles being introduced and taking on roles historically the territory of Consultant Radiologists change within the Radiography profession has been relentless.
I am pleased to say that it has not been change for change sake, whilst LEAN and the Toyota Production System were evolving Radiology was applying these commonsense approaches to QI driven largely by the creativity and tenacity of Radiographers to support their medical colleagues to deliver the high quality imaging systems we are all witness to today. My current ambition is to see similar application of advances in technology applied to support the evolution of the remainder of the AHP professions. The geography of the Highlands is beautiful and a privilege to be a regular part of as we deliver services. It is also one of the biggest obstacles to the delivery of healthcare locally; embracing technology to help us deliver transformational change will mean more rapid access to services by facilitating more effective use of clinical time.
Service users need to be facilitated to easily access our services; we need to redesign pathways which support individuals being placed on a natural course to and through the most appropriate professions and services.
To do this we need to have the confidence to try out new ideas through small scale tests of change, learning from what works and what doesn’t work in a safe and controlled way. The pathway from where we are now to where we aim to get to is unclear. We can currently see the next horizon but until we get there we will not see the potential for what lies beyond. We need to have confidence to follow incremental small steps to complete our journey and to value all views and opinions as collectively they all shape the pathway to that new horizon and what lies beyond.
When I came into Radiography as a student the idea that we would be able to transport digital images around the nation at the touch of a button was incomprehensible. The pathway from where we were on entering the profession to where we are now has been realised through incremental steps. It is important that we allow the journey to take place but it is also important that we continue to make the journey and that we do that together with our service users.
I wonder where we will have arrived in another 30 years? That is impossible to predict but is worthy of some creative thought as the future is ours to shape!
Over the Christmas holiday period I spent a lot of time and a considerable amount of money taking my accident prone dog, Jess to the vet. First with back pain and secondly for surgery on a very badly cut paw. Both times the overly anxious owners phoned for an urgent appointment. Both times an immediate intervention was offered. The process got me thinking about what would have happened to a human member of my family and just how urgent their back pain would have been managed by their local AHP service – particularly as it was Christmas Eve and Hogmanay! Obviously the urgency of an NHS appointment decided by who can pay the most cannot happen. So how can AHP appointments be classified as urgent or not and can public and clinicians agree? Continue reading
Written by Cecilia Thompson and Juliet McBean, NHS Grampian HealthWorks team,
on behalf of the AHP Associate Director Susan Carr and Dr Linda Leighton-Beck Head of Social Inclusion Public Health, NHS Grampian.
In NHS Grampian, a virtual AHP HealthWorks Team was created with members coming together from a number of the professions of the AHP family. This group formed an alliance with Public Health to deliver the Governments ‘Scottish Offer’ agenda. This has brought a powerful synergy to the task of embedding routine enquiry about a persons work status in clinical practice, effectively asking ‘the work question’.
Addressing health inequalities by supporting people to overcome existing health barriers, addressing readiness to participate in health promoting behaviours, and realising the potential for self management of health-related issues are essential components in healthcare.
The NHS Grampian HealthWorks approach is to identify key patient pathways, and draw specifically on the AHP skillset to harness staff capability. Essentially this means AHPs acting as catalysts for transformational change in population health, because the consequence of worklessness is profound, long standing and can prolong intergenerational health inequality.
To embed this agenda, AHPS formatted pre and post questionnaires, to scope the confidence and competence of staff to ask patients about their work status. In addition AHPs delivered face to face training, adapted to reflect the needs of different clinical groupings. A local Z-card was produced as an effective signposting resource to enable staff to support patients in beginning to address their own employability needs. A clinical practice video demonstrating the ‘work’ question being asked was produced and stills from this are shown here within the blog.
NHS Grampian aspires to be a caring, listening and improving organization. Our AHP/Public Health approach to support staff to address ‘the work question’ demonstrates that universal services can be effectively engaged in delivering improved outcomes, with a lot of key people doing at least a little to effect change.
“Working in partnership to change lives” states that for more than 20 years Macmillan Cancer Support have invested in Cancer Information and Support Services (CISS). It explains that Macmillan do this because research suggests good information and support can improve not only the healthcare experience, but it can also make a real difference to quality of life, which may in itself lead to faster recovery, earlier discharge from hospital and a reduced use of statutory services. Good information and support can also improve a person’s mental and physical health, enable them to manage their finances more adequately and support them to cope better with their diagnosis. Which leads us to ask the question: do you provide enough of the right kind of information and support to those affected by cancer?
At the start of #CancerTalk week we showcase the development of one Macmillan Cancer Information Support Service; as with more than 170 Macmillan supported services throughout the UK it is likely there is a service near you, and perhaps by investing in local partnerships and working together you could change the lives of those affected by cancer.
In partnership with Macmillan Cancer Support, local authorities and other voluntary sector organisations, NHS Ayrshire and Arran are developing a network of Cancer Information and Support Services. The vision of this innovative Information and Support service is to build community capacity through a shared partnership approach and provide information and support for people affected by cancer throughout Ayrshire and Arran.
In 2010 a significant consultation process established the information and support needs of local patients, carers, voluntary support groups and professionals. Scoping results and a detailed gap analysis showed that although a large number of varied resources were previously available to people affected by cancer, many patients and family members found it difficult to access appropriate support. This highlighted a continuing need for:
Consultation also revealed that libraries were seen as the hub of the community and as such they provided a valuable way of offering information to everyone. As a result a handful of local libraries were developed into service hubs.
Finally, research showed that first-hand knowledge and experiences of cancer could add value to information and support services, and so a group of volunteers were recruited and trained to help deliver the new services.
The main needs of people affected by cancer
Progress to date
Macmillan Cancer Information and Support Services are now available throughout Ayrshire with two library services (Saltcoats and Cumnock) launched between 2011- 2012 and another Boots partnership (Ayr) launched in September 2013. This later service is the first Boots Macmillan Information and Support Service in the UK and it has proved extremely successful and led to the developments of additional services such as look good feel better events, awareness sessions for pharmacy staff and increased promotion in other high street stores. A further service is planned to open in March 2014 in Boots in Irvine which will increase the support available to those in North Ayrshire.
Since 2011 these services have dealt with over 1200 enquiries and many people who have been struggling to find the appropriate help have been assisted in finding the information and support they require. The extent of the information and support provided has varied from a simple leaflet or a chat in one of the hubs, to spending time with individuals and their families when they needed support to come to terms with a cancer diagnosis.
“For us, the Macmillan service was a springboard to other sources of support. We got much more than we expected out of it and got advice from Macmillan Money Matters, and access to complementary therapies from Ayrshire Cancer Support. We started out going in for advice but we’ve made friends with the volunteers and other people like ourselves.”
“As the spouse of the person diagnosed with cancer, it has helped me understand and cope. It has provided me with advice, reassurance and hope. I have been able to express my feelings in a confidential, relaxed atmosphere.”
In short the service offers:
*via Ayrshire Cancer Support
Service access and processes
Whilst the number of support services available to people affected by cancer have grown, with rehabilitation courses, health and well-being events, palliative care services and interventions such as counselling, complementary therapies and financial advice being provided by various voluntary organisations and NHS healthboards, it should be remembered that some people do not require this level of support and many find that a chat with a volunteer in an information area can meet their needs.
”One of the things that I like about it is the volunteers. They are company, there’s always somebody there that understands what you’ve been through and what you’re going through. They’re always that cheery and willing to listen to whatever I want to talk about. It’s the only place I know of that does this.”
Locally a referral policy has been developed with the involvement of key stakeholders and levels of intervention agreed. Four levels of intervention ensures the appropriate and standardised handling of cases and onward referral when necessary. Cases labelled level 1-2 are handled by volunteers, and levels 3-4 are referred to project staff for further assessment (completion of a full holistic needs assessment) which helps to create a care plan.
Assessing and managing psychosocial needs has been seen as an essential component of care planning for people affected by cancer (Jacobson 2009). Psychosocial Health Care needs assessment are not seen to increase the burden on patients and have many possible benefits regarding communication and ensuring access to appropriate interventions (Howell et. al. 2009).
Model of Service
The non-clinical environment and the use of volunteers benefits the service as together they provides people affected by cancer with a familiar space, and the time and place to identify, express, prioritise and discuss the concerns that reflect the whole life impact of a diagnosis. This process is tailored and personalised and ultimately it is this which helps those affected by cancer cope with the physical, emotional and social aspects of the diagnosis.
Volunteers are not a cost free option or a replacement for paid staff as they require training and supervision; however they are central to the community approach which builds capacity and helps people affected by cancer manage their illness. Volunteer Champions, who recruit, train and support new volunteers, further sustain services.
Recruiting, training and supporting Volunteer Champions to take on responsibility for managing future service volunteers will be a key element in sustaining the service when Macmillan funding ends. Macmillan will sustain these roles providing access to a Macmillan volunteer co-ordinator providing on-going education and support essential to their role development.
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 programmes designed to change behaviours and improve the obesogenic environment.
However, this work is set against a backdrop of the commercial profits associated with promoting consumption of unhealthy foods and then promoting participation in unhealthy diets: a money making vicious circle with the ultimate outcome of poor health.
So how can we show leadership and achieve change in this environment? Two excellent examples include:
The British Dietetic Association’s annual round up of the Top 5 Worst Celebrity Diets to Avoid in 2014 This is always a popular media story and provides a national platform to promote good old healthy eating as the best way to control weight.
DOM UKs partnership with the Children’s Food Campaign to run Junk Free Checkouts Campaign launched last September, the aim of the campaign is to encourage retailers to stop positioning junk food at the checkout where we know it increases opportunistic purchases and increases pester power from children. The excellent media coverage has already seen results with some supermarkets pledging to change practice. We need to keep the pressure on though so please support the campaign by giving out checkout test cards to your local retailer (pass or fail) or sending off a letter to the supermarket HQ to let them know your thoughts on this issue. The campaign website makes it easy for you to support the campaign.
Of course dietitians are not the only AHPs leading the fight against obesity, physiotherapists and occupational therapists are increasingly involved in this agenda. We all need to do more otherwise our health services will be crippled by the cost of treating the complications of obesity.
3 things we can all do in 2014 include: