Michele Abendstern

Towards integrated community mental health teams for older people in England: progress and new insights

To investigate progress in joint working within community mental health teams for older people (CMHTsOP) against a range of national standards, and to consider team characteristics that may hinder or facilitate integrated practice.

Reliability of needs assessments in the community care of older people: impact of the single assessment process in England

BACKGROUND The single assessment process (SAP) for older people, introduced in England across health and social care agencies from April 2004, aimed at improving assessment processes. We examined the impact of this policy in terms of the reliability of needs identification within statutory social services assessments. METHODS An observational study compared the accuracy of needs identification in samples of older people before and after SAP introduction. Participants, at risk of entering care homes, were interviewed using standardized measures. Needs elicited from interviews were compared with those from statutory social services assessments to ascertain the reliability of needs identification at both times. Inter-rater reliabilities were calculated using the kappa (k) statistic. A Chi-squared statistic tested the equality of kappa values pre- and post-SAP. RESULTS Most needs were identified more reliably after SAP introduction (range adjusted k = 0.05-0.58) than before (range adjusted k = -0.09 to 0.28), this being statistically significant for 9 out of 15 needs. Depression, and associated apathy, was an exception. CONCLUSION Statutory social services assessments better captured need following the introduction of the SAP. However, the extent to which these findings can be attributed to SAP introduction is limited by the introduction of multiple policy initiatives throughout the study period.

Developing multidisciplinary assessment - exploring the evidence from a social care perspective

This paper provides an initial evaluation of the impact of the Single Assessment Process (SAP) in England upon practice regarding multidisciplinary assessment.

Standards of care in home care services: a comparison of generic and specialist services for older people with dementia.

Current policy in England emphasises both the importance of caring for highly dependent older people for as long as possible in their own homes, and the development of specialist care services for people with dementia. However, the differences between specialist and generic home care services for people with dementia are poorly understood. This cross-sectional postal survey describes the standards of home care services for people with dementia in the North West of England, and investigates the differences in quality standards between specialist and generic home care services. Forty-six percent of identified services provided information on a range of quality indicators. Most services provided only a few of the indicators utilized by the study, and there was little evidence of services adopting national minimum standards. Few differences were found between the two service types, although generic services appeared to offer a greater degree of flexibility than specialist services. These results help to inform the understanding of home care service mix and provision, and the uptake of national minimum standards. They provide key material for shaping the future provision of home care for older people with dementia.

All things to all people? The provision of outreach by Community Mental Health Teams for Older People in England: Findings from a national survey

The objective of this study is to identify the extent of outreach activity community mental health teams (CMHTs) for older people provide to mainstream services in light of the recommendations of the National Dementia Strategy. In particular, to determine the range of settings in receipt of support; to specify the form of this activity; to identify the professionals involved; and to explore the factors associated with the provision of such support.

Variations in structures, processes and outcomes of community mental health teams for older people: a systematic review of the literature.

Objectives: In the UK and elsewhere, specialist community mental health teams (CMHTs) are central to the provision of comprehensive services for older people with mental ill health. Recent guidance documents suggest a core set of attributes that such teams should encompass. This article reports on a systematic literature review undertaken to collate existing evidence regarding the structures and processes of CMHTs for older people and to evaluate evidence linking approaches to effectiveness. Method: Relevant publications were identified via systematic searches, both electronic and manual. Searches were limited to the UK for descriptions of organisation and practice but included international literature where comparisons between different CMHT arrangements were evaluated. Empirical, peer-reviewed studies from 1989 onward were included, extended to non peer-reviewed nationally or regionally representative reports, published after 1998, for the descriptive element. Results: Forty-five studies met inclusion criteria of which seven provided comparative outcome data. All but one were UK based. The most robust evidence related to research conducted in exemplar teams. Limited evidence was found regarding the effectiveness of many of the core attributes recommended in policy directives although their presence was reported in much of the literature. Conclusions: The contrast between presentation and evaluation of attributes is stark. Whilst some gaps can be filled from related fields, further research is required that moves beyond description to evaluation of the impact of team design on service user outcomes in order to inform future policy directives and practice guidance. A framework for an evidence-based model of CMHTs for older people is provided.

An evaluation of the use of self-assessment for the provision of community equipment and adaptations in English local authorities.

Introduction: The Government plans to transform adult social care in England. Future services will place more emphasis on prevention and enablement, and promoting personalisation and choice. Self-assessment is one possible facilitator of this agenda. However, little is known about its utility in social care. This evaluation examined how eight local authorities employed self-assessment in the provision of community equipment and adaptations, and explored the implications for service delivery. Method: A multiple case study was employed, using a mixed methods approach. This drew on internal documents, management interviews, and service user and administrative records. Findings: Self-assessment was primarily used to facilitate service access. Although the authorities differed in the way in which they operationalised self-assessment, professional staff were almost always involved. The differences between people receiving self and traditional assessments were modest, but the people undertaking self-assessments in preventative services formed a particularly healthy subgroup. There was little consensus about the items suitable for provision through self-assessment. Conclusion: The concept of self-assessment was variously interpreted and not all its possible uses were explored. Nevertheless, the evaluation suggested that self-assessment can facilitate access to community equipment and adaptations and has the potential to extend the population traditionally served by social care services, thereby addressing the preventative agenda.

Quality in long-term care homes for people with dementia: An assessment of specialist provision

There has been debate for some years as to whether the best model of care for people with dementia emphasises specialist facilities or integrated service provision. Although the United Kingdom National Service Framework for Older People recommended that local authority social services departments encourage the development of specialist residential care for people with dementia, uncertainty continues as to the benefits of particular care regimes, partly because research evidence is limited. This paper examines a large number of ‘performance measures’ from long-term care facilities in North West England that have residents with dementia. Of the 287 in the survey, 56 per cent described themselves as specialist services for elderly people with mental ill-health problems (known familiarly as ‘EMI homes’). It was envisaged that EMI homes would score higher than non-EMI homes on several measures of service quality for people with dementia that were developed from research evidence and policy documents. The analysis, however, found that EMI homes performed better than non-EMI homes on only a few measures. While both home types achieved good results on some standards, on others both performed poorly. Overall, EMI and non-EMI homes offered a similar service.

Comprehensive assessment of older people with complex care needs: the multi-disciplinarity of the Single Assessment Process in England

ABSTRACT The quality of assessment of older people with health and social care needs has for some time been a concern of policy makers, practitioners, older people and carers in the United Kingdom and internationally. This article seeks to address a key aspect of these concerns, namely whether sufficient expertise is deployed when, as a basis for a care plan and service allocation, an older persons eligibility for local authority adult social-care services requires a comprehensive needs assessment of their usually complex and multiple problems. Is an adequate range of professionals engaged, and is a multi-disciplinary approach applied? The Single Assessment Process (SAP) was introduced in England in 2004 to promote a multi-disciplinary model of service delivery. After its introduction, a survey in 2005–06 was conducted to establish the prevalence and patterns of comprehensive assessment practice across England. The reported arrangements for multi-disciplinary working among local authority areas in England were categorised and reviewed. The findings suggest, first, that the provision of comprehensive assessments of older people that require the expertise of multiple professionals is limited, except where the possibility arose of placement in a care-home-with-nursing, and second that by and large a systematic multi-disciplinary approach was absent. Policy initiatives to address the difficulties in assessment need to be more prescriptive if they are to produce the intended outcomes.

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England

To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission.