PROFILING HEALTH IMPROVEMENT INTERVENTIONS UNDERTAKEN IN RESIDENTIAL CARE HOMES IN SCOTLAND

1
PROFILING HEALTH IMPROVEMENT INTERVENTIONS
UNDERTAKEN IN RESIDENTIAL CARE HOMES IN SCOTLAND

• Presentation of Results

2
Overview

• Research indicates looked after children (LAC)
  represent vulnerable group in society which
  experiences various health inequalities.
• NHS Health Scotland commissioned Dudleston
  Harkins Social Research Ltd to profile current
  health improvement initiatives taking place
  within residential care homes for LAC in
  Scotland.

3
Background (1)

• Literature highlights vulnerability of LAC,
  particularly in relation to health issues.
• Children can face number of adverse life
  circumstances prior to entering care.
• Within the care system they can experience
• frequent placement moves
• disrupted access to education and health care
  services and
• limited opportunities to engage trusted sources
  of information and support.
• Thus, their health status along with existing
  health inequalities are seen as priority issues.

4
Background (2)

• Current policy in Scotland contains a clear
  commitment to address the relatively poor health
  outcomes for LAC.
• Include adopting new, holistic approaches to
  addressing health outcomes (as outlined in
  Getting it Right for Every Child).
• General shift towards a more outcome-focused
  approach - principles designed to achieve no
  discernible difference between outcomes for LAC
  and peers not in the care system.
• Changing approaches to health promotion
  initiatives reflect current policy climate in
  terms of addressing health outcomes for LAC.

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Scope of research

• Small-scale study undertaken between January and
  September 2008.
• Profiling exercise of health improvement
  interventions undertaken in residential care
  homes rather than critical analysis of underlying
  contributory factors relating to current issues
  and practices.
• Parameters and scale of study limited due to the
  time and resources available postal survey of
  all residential care homes in Scotland and case
  study research of 8 residential care homes.
• Acknowledged that wider study involving
  participants from a greater range of sectors and
  linked settings, including children and young
  people, would have further enriched the data.

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Aims

• Identify and profile health improvement
  initiatives within residential care homes for
  LAC
• Profile the role of residential care home staff
  in terms of the health improvement initiatives
• Highlight any training needs required which can
  assist residential care home staff to contribute
  more effectively to these initiatives and
• Highlight instances of partnership working.

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Terms applied to research

• Health - a state of complete physical, mental
  and social well-being and not merely the absence
  of illness, disease or infirmity.
• Health Improvement - the theory and practice of
  promoting the health of populations by
  influencing lifestyle and socio-economic,
  physical and cultural environments through
  methods of health promotion.
• Health Improvement Interventions - relate to any
  purposely planned activity designed to improve
  the health of children living in the residential
  care home, whether carried out by health staff,
  care home staff or others.

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Methodology

• Postal survey - 3 main health-related themes
  health and health services health improvement
  interventions and training and support.
• Survey sent to all (144) local authority-run
  residential care homes for children and young
  people registered in Scotland.
• 72 completed questionnaires received - 50
  response rate.
• Qualitative case study research in 8 areas across
  Scotland
• 52 individuals took part in in-depth qualitative
  interview or focus group.
• Interviewed range of individuals care home
  managers, depute managers, care home staff,
  LAC/LAAC nurses, CAMHS, sexual health projects,
  mental health projects, social work, young
  womens project, counselling project.

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Postal survey results (1)

• To identify health needs of LAC
• formal assessments by a GP (72) or a LAC/LAAC
  Nurse (67).
• majority (over 90) reported using observation
  and discussion between care home staff and the
  child.
• informal discussions between the child and
  LAC/LAAC nurse (61).
• Thus, although formal assessments used to
  identify the health needs of LAC care home staff
  played a key role through observation and
  building trusting relationships with LAC in their
  care.

10
Postal survey results (1)

• Although relatively high priority given to health
  within care homes - significant number viewed
  health of LAC as either average, poor or very
  poor.
• Health improvement interventions undertaken in
  almost all care homes (over 90)
• Lead responsibility
• Care home staff for a wide range of health
  improvement interventions.
• LAC/LAAC nurses more of a lead role regarding
  sexual health (30) and smoking (28).
• Voluntary organisations more of a lead on drugs
  and substance misuse (26).

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Postal survey results (1)

• Care home staff supported external partners in
  delivering health improvement interventions
  through
• encouraging young people to take forward advice
  provided by external agencies (24),
• supporting LAC to attend appointments (15), and
• encouraging them to access external services
  (10).
• Training
• Mental health most commonly undertaken (31)
  followed by training on drug and alcohol issues
  (24).
• Training delivered through external voluntary
  agencies (21), SIRCC (13), and LAC/LAAC nurses
  (8).
• Mental health seen as most useful training in
  supporting the care home staff to undertake
  health improvement initiatives (28) as well as
  addressing general health issues (19).

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Case Study Research Defining and prioritising
health

• Generally, care home staff adhere to wide,
  holistic view of health.
• Care homes appeared to reflect positive ethos
  regarding health and health improvement but
  extent to which health promotion prioritised
  differed
• some care home staff reported that health dealt
  with reactively rather than proactively, often
  due to competing day-to-day priorities.
• The Care Commission and National Care Standards
  incentive for care homes in addressing health
  improvement.

13
Case Study Research Identifying health need

• Health needs of LAC identified through both
  formal and informal methods.
• Comprehensive health needs assessment regarded as
  useful tool.
• Attempts by some LAC/LAAC nurses to make it more
  comfortable process as recognised that can be
  stressful and intrusive for young people.
• Important role of care home staff in assessing
  health of LAC
• informal discussions and observation, and
• responding, or raising relevant issues when child
  or young person feels ready.
• Key/link worker system - LAC allocated member of
  staff within care home who liaised with relevant
  health professionals and external agencies on
  their behalf and supported them to attend
  external health and other appointments.

14
Case Study Research - Lead responsibility for
health improvement

• Complex issue lack of consensus and clarity as
  to who should take lead responsibility.
• Overall, health of LAC seen to be responsibility
  of everyone involved in their care.
• Care home staff, external agencies and health
  professionals take lead responsibility with
  different topics/areas of health improvement -
  often depended upon the level of specialist
  knowledge required.
• Many felt care home staff should take the lead in
  identifying health needs and in maintaining the
  day to day well being of looked after children
  acting as parent.

15
Case Study Research Delivering Health
Improvement Interventions (1)

• Range of activity undertaken in care homes by
  different individuals.
• Although group work interventions undertaken in
  care homes by external agencies and LAC/LAAC
  nurses to some extent - significant proportion
  undertaken by care home staff using more informal
  methods.
• Care home staff reported
• acting as positive role models
• encouraging them to adopt healthier behaviours
  and lifestyles
• encouraging attendance at health appointments,
  and taking up health promotion information and
  advice
• trying to keep young people active and
  participating in activities
• using harm-reduction approach.

16
Case Study Research Delivering Health
Improvement Interventions (2)

• Health professionals and external agencies
  deliver health improvement interventions
  requiring more specialist knowledge and skills.
• Health improvement taken seriously in the care
  homes - also strong feeling that care home should
  be viewed primarily as the young persons home.
• Many respondents not favourable to group work
  sessions undertaken in the care home.
• Nature of health promotion intervention needs to
  be suitably tailored towards a home environment.

17
Case Study Research Multi agency partnership
working (1)

• All care homes worked in partnership to varying
  degrees with a range of external agencies -
  recognised importance of working in this way.
• Many instances of effective partnership working.
• Dual role of many external agencies viewed as
  good facilitator of partnership working.
• Informal networking between care home staff and
  external agencies.

18
Case Study Research Multi agency partnership
working (2)

• Success of partnerships reliant on
• effective communication
• pro-active action from care home staff and
  external agencies to increased their awareness of
  services available.
• Awareness of contribution of different
  approaches, and value of staff applying them.
• Importance that all individuals involved in care
  of young person communicate and work together in
  order to provide the best care possible.

19
Case Study Research Multi agency partnership
working (3)

• LAC/LAAC nurse service viewed as crucial and
  pivotal in areas where it existed.
• Areas where added particular value
• informally liaising with care homes
• leading the process of identifying health needs
  of LAC with stakeholder partners
• arranging and delivering health improvement
  interventions
• delivering and arranging training sessions on
  topics requested by care home staff and
• supplying information.

20
Case Study Research Accessing external
health-related services

• Generally, not too many problems accessing
  services, other than some problems accessing
  certain mental health services.
• Particular concerns
• time taken by mental health services to respond
  to referrals
• lack of understanding of the needs of LAC among
  external agencies
• communication
• reliance on informal relationships in response to
  established procedures
• lack of recognition that care home staff not
  trained to deal with complex mental health
  issues.
• Specialist mental health training for staff
  viewed as a priority.

21
Case Study Research Key challenges (1)

• Key reported challenges included
• nature of the care homes - chaotic environment
  and peer pressure issues
• challenging role of care home staff in terms of
  managing day to day behaviour
• limited resources
• already established attitudes and behaviours of
  LAC, particularly regarding smoking and healthy
  eating
• stigma associated with LAC
• challenges in providing home-like environment
  within legislation, policy and procedures
  associated with managing care homes for LAC.
• Care home staff should be given recognition for
  the crucial role they play in identifying health
  needs and supporting the delivery of health
  improvement interventions.

22
Case Study Research Key challenges (2)

• Factors which may support a more health-promoting
  establishment include
• smaller care homes with fewer residents
• placements made according to need
• promoting a safe, stable and homely environment
  for LAC to live in
• reducing the risk of unwanted peer pressure and
  bullying within the care home and
• addressing the stigma of LAC within the wider
  community.

23
Case Study Research Getting it Right and Doing
It Better (1)

• Interventions - more effective if tailored to
  needs of the individual, age appropriate, and
  delivered in fun ways.
• Those involved in delivering interventions
• LAC/LAAC nurses and external agencies -
  importance of relationship building, promotion of
  services, and establishing informal
  relationships.
• Care home in which interventions delivered -
  need for the care home to provide a stable
  environment for young people.

24
Case Study Research Getting it Right and Doing
It Better (2)

• Many of suggested improvements echo findings
  throughout research
• greater investment needed in services (especially
  mental health)
• more effective partnership working between care
  homes and external agencies may lead to improved
  outcomes for LAC
• care home staff require training in specific
  health issues so they are equipped to address a
  wide range of health issues relating to LAC and
  refer to specialist support when required.
• Further suggestions included changing the size of
  care homes, and involving LAC in initiatives.

25
Case Study Research Staff skills and training
needs (1)

• Care home staff attended a range of training
  courses - often driven by the health needs of
  LAC.
• Training ensured care home staff equipped to deal
  with salient health issues.
• Although care home staff very knowledgeable in
  some areas, they (and their managers and external
  agency partners) acknowledged that some issues
  were out with their ability or knowledge
  (particularly in relation to mental health).

26
Case Study Research Staff skills and training
needs (2)

• Generally felt that more training and new
  knowledge was beneficial
• would support care home staff in identifying
  relevant health needs
• referring to specialist support from LAC/LAAC
  nurses and/or appropriate external agencies.
• Generally, care home staff confident in their
  abilities
• likening their skills and knowledge levels to
  that of a parent
• care home managers also spoke highly of care home
  staff.
• Reported barriers to training included resource
  issues, staff cover, and lack of sharing of
  information between care home staff.

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Conclusions

• Research highlights positive work undertaken in
  care homes for children and young people to
  improve the health of LAC.
• Highlights pivotal role of care home staff and
  LAC/LAAC nurses in relation to the health of LAC.
  
• However, key challenges such as issues with
  mental health services and greater training and
  investment in care home staff need to be
  addressed if the complex health needs of LAC are
  to be improved.