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Occupational therapists in community mental health teams for older people in England: findings from a five-year research programme
- Authors:
- ABENDSTERN Michele, et al
- Journal article citation:
- British Journal of Occupational Therapy, 80(1), 2017, pp.20-29.
- Publisher:
- Sage
Introduction: This English study is the first to focus on the contribution of occupational therapists to the work of community mental health teams for older people. Method: A mixed methods study comprising: a national survey of community mental health team managers; caseload audit; qualitative interviews; and a practitioner survey provided information on team membership and functions, user characteristics, accounts of occupational therapists’ roles and experiences, and work characteristics. Findings: Occupational therapists worked mainly with people with dementia and were involved in both generic and specialist tasks, with the latter focusing largely on maintaining functionality. They had found ways to balance their roles for the benefit of the team without loss of professional identity. Some differences of opinion between clinical leads and occupational therapists were reported. Stress levels among occupational therapists were similar to those of professional colleagues. Conclusion: Some findings contrast with earlier studies of community mental health teams for working-age adults, offering new insights into the nature of the occupational therapists’ experiences. To ensure that occupational therapists in these settings are able to contribute effectively, a shared understanding of their role is required between them and their clinical leads. (Publisher abstract)
Social workers as members of community mental health teams for older people: what is the added value?
- Authors:
- ABENDSTERN Michele, et al
- Journal article citation:
- British Journal of Social Work, 46(1), 2016, pp.63-80.
- Publisher:
- Oxford University Press
Social workers have worked with older people with mental ill health in multidisciplinary teams for many years. Research regarding their contribution is nevertheless sparse. This article addresses this gap. Qualitative data from semi-structured staff interviews were drawn from a multiple case study of community mental health teams (CMHTs) for older people, some with and others without social worker members. Interviews included questions about team roles and the impact of the presence or absence of social workers on team functioning. A grounded theory approach was adopted to analyse the data, enabling issues of importance to interviewees to emerge. Non-social work CMHT staff were found to place a high value on social worker team membership due to their specific skills, knowledge and values, and with regard to communication pathways. Social workers and other team members' views were found to differ regarding whether social workers within CMHTs should operate as generalists or specialists. The findings suggest the need for formal structures extending beyond the co-location of multidisciplinary staff; appropriate and sufficient supervision for social work team members; and the development of more workable and direct referral systems between CMHTs and social services adult social work teams. (Publisher abstract)
Care coordination for older people in England: Does context shape approach?
- Authors:
- ABENDSTERN Michele, et al
- Journal article citation:
- Journal of Social Work, 19(4), 2019, pp.427-449.
- Publisher:
- Sage
Summary: Policy and practice developments in adult social care in England and elsewhere recognise the increasing role of the non-statutory sector. Care coordination services are central to the delivery of tailored support. This qualitative study focuses on support for older people and reports an analysis of 13 non-statutory sector services providing care coordination, grouped into four service types. Semi-structured interviews explored the influence of service context on the nature of practice. Findings: Particular elements of care coordination (e.g. assessment) were found to be shaped by the specific aims and purpose of each service type, such as extent to which they had a commissioning or provider role and the nature of their target group. Aspects of a range of case and care management approaches were in use throughout the sample, varying in relation to the distinct features of the service type. A set of overarching standards was found to be relevant to all services considered. Non-statutory sector services were found to provide innovative support which both complemented and sometimes substituted for the statutory sector. Applications: Findings point to the continued importance of social work values and methods to the work of non-statutory sector services providing care coordination and to current limitations in relation to what the sector can provide. These are issues which employers and service commissioners need to address to ensure that non-statutory sector services have the capacity and standards of practice to meet the demands made of them. Further areas of research are identified. (Edited publisher abstract)
Care coordination for adults and older people: the role and contribution of the non-statutory sector
- Authors:
- ABENDSTERN Michele, et al
- Journal article citation:
- Journal of Integrated Care, 24(5/6), 2016, pp.271-281.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide new insights into the contribution and experiences of non-statutory sector (voluntary) services delivering care coordination. Design/methodology/approach: This qualitative study, based on face-to-face semi-structured interviews with 17 managers from a range of non-statutory sector services, used thematic data analysis supported by a framework approach. Findings: Four themes emerged: commissioning arrangements undermined non-statutory sector development; working relationships between statutory and non-statutory services required time and energy to navigate and sustain; the establishment of a niche role in the larger network of provision; and tensions relating to future developments. The non-statutory sector was found to provide a mix of services, including specialist provision targeting specific communities that complemented or substituted for those provided by the state. Managers wanted their services to be recognised by the statutory sector as equal partners in the delivery of care coordination and were also keen to retain their independence. Practical implications: Findings provide information for service commissioners and managers from statutory and non-statutory sectors indicating a complex set of experiences and views regarding the role of the latter. This is particularly salient in a political landscape which has increasing expectations of their involvement in the provision of care coordination. Originality/value: This study considers the work of the non-statutory sector in the delivery of care coordination to adults and older people, an area under-reported to date. It suggests that there are opportunities available for these services to become embedded within a wider social care system and to excel by retaining or developing specialist roles and services. (Publisher abstract)
CMHTs for older people: team managers’ views surveyed
- Authors:
- ABENDSTERN Michele, et al
- Journal article citation:
- Journal of Integrated Care, 22(5/6), 2014, pp.209-219.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to identify features of community mental health teams (CMHTs) for older people valued by their managers, and those they would most like to change. Design/methodology/approach: Content analysis was used to analyse “free text” responses to open questions from a national survey about CMHTs’ organisational structures and processes. Responses were sorted into statements which were categorised into content areas and higher level dimensions. Findings: Free text information was provided by 376 teams (an 88 per cent response rate). Eight higher level dimensions were identified. One related specifically to integration with social care services, whilst several more included material about other aspects of intra-team integration (e.g. documentation and location). The largest proportion of statements related to staffing and teamwork. Statements about inter-personal and inter-professional issues were largely positive, whilst statements about resources, bureaucracy and integration with social care services typically detailed desired changes. Practical implications: Four key issues emerged comprising a high level of support from managers to develop integrated practices; a need to define the focus of CMHTs for older people and to be fully resourced; and the importance of a nurturing and supportive team environment. Originality/value: The methodology provides a bridge between qualitative and quantitative research, exploring the volume of statements on particular topics and their meaning. (Publisher abstract)
The pursuit of integration in the assessment of older people with health and social care needs
- Authors:
- ABENDSTERN Michele, et al
- Journal article citation:
- British Journal of Social Work, 41(3), April 2011, pp.467-485.
- Publisher:
- Oxford University Press
Health and social care services for older people are mediated and delivered through multiple and complex linkages between a range of organisations. The Single Assessment Process (SAP) policy initiative was introduced in 2004 in order to provide a more standardised and integrated assessment process across these organisations. One aim is to ensure that assessment information is shared between appropriate professionals and agencies. This article considers the extent to which the SAP has implemented this integrated approach at a local level. Data on processes and practices associated with integrated assessment were derived from a national survey conducted in 2006 completed by 122 SAP lead officers. The indicators of integration that are investigated include: the existence of protocols and agreements between agencies; linkage between assessment settings and processes; joint training programmes; information sharing systems; and the nature of professional involvement. The findings suggest that some aspects of the policy have been taken up more than others. Whilst there is commitment to an integrated approach, this has been hampered by disjointed information sharing initiatives and by lack of involvement from some sectors. In particular, the limited availability or use of information technology systems to support the implementation of the SAP has hindered effective information sharing between professionals.
Levels of integration and specialisation within professional community teams for people with dementia
- Author:
- ABENDSTERN Michele
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(1), January 2006, pp.77-85.
- Publisher:
- Wiley
This study considered the nature of current practice among multi-disciplinary and single discipline health and social care teams providing a service to people with dementia and compare the quality of service offered. A postal survey of professional community teams in North West England, providing services to people with dementia was conducted. Responses were analysed according to a number of standards measuring service quality, developed from research and policy documents. A response rate of 59% yielded a final sample of 52 teams. Multi-disciplinary teams scored more highly than single discipline teams on many of the measures used. Single discipline teams achieved a higher score on just one measure, culturally sensitive services. Generally teams were found to provide a more integrated, targeted and person-centred service, as measured in this study, compared with earlier findings. Teams performed less well on measures of flexibility and culturally sensitive provision. The findings indicate some potential gains from integration, and highlight the level of work still needed to achieve it. The authors call for further research to build on the structural and process measures used in this research in order that the costs and outcomes consequent upon these practices can be measured.