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Outcomes of reablement and their measurement: findings from an evaluation of English reablement services
- Authors:
- BERESFORD Bryony, et al
- Journal article citation:
- Health and Social Care in the Community, 27(6), 2019, pp.1438-1450.
- Publisher:
- Wiley
Reablement – or restorative care – is a central feature of many western governments’ approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority – to develop an evidence base on models of delivery – is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare‐ and social care–related quality of life, functioning, mental health and resource use (service costs, informal carer time, out‐of‐pocket costs). In contrast with the majority of other studies, self‐report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow‐up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self‐report outcome and resource use measures in evaluations of reablement. (Edited publisher abstract)
Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation
- Authors:
- BERESFORD Bryony, et al
- Journal article citation:
- Health and Social Care Delivery Research, 7(16), 2019, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
BACKGROUND: Reablement is an intensive, time-limited intervention for people at risk of needing social care or an increased intensity of care. Differing from home care, it seeks to restore functioning and self-care skills. In England, it is a core element of intermediate care. The existing evidence base is limited. OBJECTIVES: To describe reablement services in England and develop a service model typology; to conduct a mixed-methods comparative evaluation of service models investigating outcomes, factors that have an impact on outcomes, costs and cost-effectiveness, and user and practitioner experiences; and to investigate specialist reablement services/practices for people with dementia. METHODS: Work package (WP) 1, which took place in 2015, surveyed reablement services in England. Data were collected on organisational characteristics, service delivery and practice, and service costs and caseload. WP2 was an observational study of three reablement services, each representing a different service model. Data were collected on health (EuroQol-5 Dimensions, five-level version) and social care related (Adult Social Care Outcomes Toolkit – self-completed) quality of life, practitioner (Barthel Index of Activities of Daily Living) and self-reported (Nottingham Extended Activities of Daily Living scale) functioning, individual and service characteristics, and resource use. They were collected on entry into reablement (n = 186), at discharge (n = 128) and, for those reaching the point on the study timeline, at 6 months post discharge (n = 64). Interviews with staff and service users explored experiences of delivering or receiving reablement and its perceived impacts. In WP3, staff in eight reablement services were interviewed to investigate their experiences of reabling people with dementia. RESULTS: A total of 201 services in 139 local authorities took part in the survey. Services varied in their organisational base, their relationship with other intermediate care services, their use of outsourced providers, their skill mix and the scope of their reablement input. These characteristics influenced aspects of service delivery and practice. The average cost per case was £1728. Lower than expected sample sizes meant that a comparison of service models in WP2 was not possible. The findings are preliminary. At discharge (T1), significant improvements in mean score on outcome measures, except self-reported functioning, were observed. Further improvements were observed at 6 months post discharge (T2), but these were significant for self-reported functioning only. There was some evidence that individual (e.g. engagement, mental health) and service (e.g. service structure) characteristics were associated with outcomes and resource use at T1. Staff’s views on factors affecting outcomes typically aligned with, or offered possible explanations for, these associations. However, it was not possible to establish the significance of these findings in terms of practice or commissioning decisions. Service users expressed satisfaction with reablement and identified two core impacts: regained independence and, during reablement, companionship. Staff participating in WP3 believed that people with dementia can benefit from reablement, but objectives may differ and expectations for regained independence may be inappropriate. Furthermore, staff believed that flexibility in practice (e.g. duration of home visits) should be incorporated into delivery models and adequate provision made for specialist training of staff. CONCLUSIONS: The study contributes to our understanding of reablement, and what the impacts are on outcomes and costs. Staff believe that reablement can be appropriate for people with dementia. Findings will be of interest to commissioners and service managers. Future research should further investigate the factors that have an impact on outcomes, and reabling people with dementia. (Edited publisher abstract)
Transition to adult services and adulthood for young people with autistic spectrum conditions: summary
- Authors:
- BERESFORD Bryony, et al
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2013
- Pagination:
- 4p.
- Place of publication:
- York
Many people with autistic spectrum conditions (ASC) are not realising their full potential in adulthood. Access to transition support and appropriate services within the adult sector are key issues. There have been concerns that young adults with a diagnosis of autism but with no learning difficulties (i.e. those with 'high functioning autism' (HFA) or Asperger's syndrome (AS)), whilst not eligible for support from adult social care, do have significant support needs. The aim of this study was to explore the ways in which young adults with HFA or AS are supported over the transition period. This mixed-method study was located in 5 research sites. It sought the views of young adults with HFA and AS, their parents, and practitioners, ranging from strategic/managerial to front line staff. Qualitative and quantitative data, including data on costs, was collected. This research summary reports on the findings and implications of this study. The findings cover the following areas: the transition pathways and planning for leaving school; experiences of further education; planning for leaving college; the lack of post-education options; experiences of employment for young people and young adults with HFA and AS; support for young adults with HFA and AS; moving from the family home and independent living; and the role of parents.
Transition to adult services and adulthood for young people with autistic spectrum conditions: final report
- Authors:
- BERESFORD Bryony, et al
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2013
- Pagination:
- 210p.
- Place of publication:
- York
Many people with autistic spectrum conditions (ASC) are not realising their full potential in adulthood. Access to transition support and appropriate services within the adult sector are key issues. There have been concerns that young adults with a diagnosis of autism but with no learning difficulties (i.e. those with 'high functioning autism' (HFA) or Asperger's syndrome (AS)), whilst not eligible for support from adult social care, do have significant support needs. The aim of this study was to explore the ways in which young adults with HFA or AS are supported over the transition period. This mixed-method study was located in 5 research sites. It sought the views of young adults with HFA and AS, their parents, and practitioners, ranging from strategic/managerial to front line staff. Qualitative and quantitative data, including data on costs, was collected. Each chapter of this report describes the findings and conclusions of the various issues covered by the research. Implications of these findings are structured around the following topics: transition planning, strategies and processes; the move from further education; continuity of mental health support at a time of change; and services and support for young adults.
Managing behaviour and sleep problems in disabled children: an investigation into the effectiveness and costs of parent-training interventions: summary report
- Authors:
- BERESFORD Bryony, et al
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2010
- Pagination:
- 39p.
- Place of publication:
- York
Disabled children, and particularly those with learning disabilities or autistic spectrum conditions (ASC), are more likely to have problems with their sleep or behaviour than non-disabled children. This summary report provides an overview of the second element of a project on behavioural interventions for parents of disabled children regarding their child’s sleep or day-time behaviour. A suite of investigations explored the effectiveness, costs, and user and practitioner experiences of 4 behaviour management interventions and 4 sleep management interventions for parents of disabled children. These best practice interventions were selected following a national, voluntary, mapping exercise of practitioners working in health, education, and voluntary sector. For each intervention, a controlled trial design was used to investigate the effectiveness of the programme looking at both child and parent outcomes. The purpose of this summary report is to provide an overview of the rationale and aims of the project, the interventions, methodology and the key findings. It concludes by drawing out key implications for practice. Some headline evidence on effectiveness is also provided, however, differences across the interventions with regards participant variables and outcomes mean that comparisons between interventions should not be undertaken.
Managing behaviour and sleep problems in disabled children: an investigation into the effectiveness and costs of parent-training interventions
- Authors:
- BERESFORD Bryony, et al
- Publisher:
- Great Britain. Department for Education
- Publication year:
- 2011
- Pagination:
- 302p.
- Place of publication:
- London
Sleep problems are common among all children but more common among disabled children, especially those with learning disabilities. For these children sleep problems appear to be very persistent, and are not likely to disappear without intervention. Behaviour problems are also more common among disabled children than among their nondisabled peers, with studies finding rates of behaviour problems to be three to four times higher compared to non-disabled peers. Such behaviours can be difficult to manage, anti-social, distressing, and/or interfere with family routines and activities. Current evidence suggests that access to early/preventive interventions which help parents better manage the behaviours they find difficult or problematic may be an important factor in improving outcomes for disabled children and their families. This report: evaluated the effectiveness of four different parent-training interventions for parents of disabled children with sleep problems; identified the costs of these interventions and explored their cost effectiveness; explored the factors which hindered or support the effectiveness of these interventions; described parents' experiences of receiving these interventions; and described professionals' experiences of delivering these interventions.
Technical report for SCIE research review on access, acceptability and outcomes of services/interventions to support parents with mental health problems and their families
- Authors:
- BERESFORD Bryony, et al
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2008
- Pagination:
- 251p., bibliog.
- Place of publication:
- York
The review concerns access to, acceptability and impact of services/interventions to support parents with mental health problems, their children and families. It will show what is known about access to and acceptability of services and interventions available to support parents, children and families and how these influence outcomes
Appendices to: technical report for SCIE research review on access, acceptability and outcomes of services/interventions to support parents with mental health problems and their families
- Authors:
- BERESFORD Bryony, et al
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2008
- Pagination:
- 87p.
- Place of publication:
- York
The report concerns access to, acceptability and impact of services/interventions to support parents with mental health problems, their children and families. It will show what is known about access to and acceptability of services and interventions available to support parents, children and families and how these influence outcomes.
An evaluation of specialist mental health services for deaf children and young people
- Authors:
- BERESFORD Bryony, et al
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2008
- Pagination:
- 123p.
- Place of publication:
- York
Deaf children are at increased risk for mental health difficulties compared with their hearing peers. Access to high quality, effective mental health services is a key standard of the Children's National Service Framework. There is evidence, however, that deaf children are not accessing mental health support and that generic CAMHS do not have the necessary skills or expertise, such as being able to meet a child's communication needs, and being knowledgeable about deafness and the relationship between mental health and deafness. The first specialist mental health service for deaf children was established in London in 1991. In 2004, two further services (in the West Midlands and York) were funded to extend access. An innovative aspect of this network was the use of teleconferencing (known as the telelink) to facilitate case management and supervision between services, and to allow, where appropriate, children referred to the West Midlands and York services the opportunity to work with a clinical psychologist based in the London service who was fluent in British Sign Language (BSL). Data collected by the research project, supplemented by information collected routinely by the clinics, were used to evaluate the services.
Desired outcomes for children and adolescents with autistic spectrum disorders
- Authors:
- BERESFORD Bryony, et al
- Journal article citation:
- Children and Society, 21(1), January 2007, pp.4-16.
- Publisher:
- Wiley
Within children's services, frameworks for assessing outcomes have been developed in the absence of consultation with children with autistic spectrum disorders and their parents. The research reported here worked with parents, other key adults and children with autistic spectrum disorders to identify desired outcomes. It found similarities with non-autistic children in terms of the broad types of outcomes desired. However, the presence of autism meant either new or different sorts of outcomes were reported. Implications in terms of the ways outcomes for autistic children are defined and measured, and the role of services in achieving outcomes is discussed.