The development of the rehabilitation community transition support team as a response to COVID-19

Background/aims The rehabilitation community transition support team was created as a response to the COVID-19 pandemic, resulting in faster discharges from the inpatient rehabilitation service. The aim of this evaluation was to explore the perspectives of staff and patients on their experience of the rehabilitation community transition support team. Methods Staff and patients in the new team were interviewed using semi-structured interviews. The data were analysed using thematic analysis. Results Staff interviews generated seven main themes: positive staff experiences; defining the ‘team’; mode of working; link role for the team; technology; relationships with patients; and support from colleagues. The patient analysis generated five themes: positive experiences of the rehabilitation community transition support team; relationship with rehabilitation community transition support team worker; mode of working; handling the hurdles of discharge; and defining the ‘team’. There were crossovers of staff and patient themes, particularly surrounding around face-to-face visits, defining the team and relationships. Patients indicated that contact with the community team helped them to overcome both practical and emotional hurdles of discharge. Conclusions The presence of a team supporting the transition from hospital to a community setting may be helpful for people who have been discharged.

Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol

IntroductionThe postdischarge suicide risk among psychiatric patients is significantly higher than it is among patients with other diseases and general population. The brief contact interventions (BCIs) are recommended to decrease suicide risk in areas with limited mental health service resources like China. This study aims to develop a postdischarge suicide intervention strategy based on BCIs and evaluate its implementability under the implementation outcome framework.Methods and analysisThis study will invite psychiatric patients and family members, clinical and community mental health service providers as the community team to develop a postdischarge suicide intervention strategy. The study will recruit 312 patients with psychotic symptoms and 312 patients with major depressive disorder discharged from Shenzhen Kangning Hospital (SKH) in a Sequential Multiple Assignment Randomised Trial. Participants will be initially randomised into two intervention groups to receive BCIs monthly and weekly, and they will be rerandomised into three intervention groups to receive BCIs monthly, biweekly and weekly at 3 months after discharge according to the change of their suicide risk. Follow-ups are scheduled at 1, 3, 6 and 12 months after discharge. With the intention-to-treat approach, generalised estimating equation and survival analysis will be applied. This study will also collect qualitative and quantitative information on implementation and service outcomes from the community team.Ethics/disseminationThis study has received ethical approval from the Ethics Committee Review Board of SKH. All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations. A project report will be submitted to the National Natural Science Foundation of China as the concluding report of this funded project, and to the mental health authorities in the Shenzhen to refine and apply evidence-based and pragmatic interventions into health systems for postdischarge suicide prevention.Trial registration numberNCT04907669.

The Development of a Community-based COVID-19 Public Health Intervention in Rural Ghana

Background: The Promoting Action on Research Implementation in Health Services (PARIHS) framework was utilized to design an evidence-based practice, Cocoa360’s COVID Preparedness & Outbreak Prevention Plan (CoCoPOPP), for rural communities in Ghana. Through participatory academic-community team discussion, interactive dissemination, systematic review of evidence about community-based interventions during Ebola, HIV/AIDS, and Influenza outbreaks and effective engagement with local and national stakeholders, CoCoPOPP was developed to be consistent with the PARIHS framework. Methods: Applying the three core elements of the PARIHS framework (evidence, context, and facilitation), the designers developed orientation, logistic needs and planning, and social mobilization. Components of CoCoPOPP also included participant recruitment and training, communication, research, monitoring & evaluation plan, execution, technical assistance, and facilitation. Results: This intervention achieved three (3) main aims: (1) meet a pressing health need during the COVID-19 pandemic in local underserved settings, (2) ensure that the strategy is informed by high-quality evidence from similar interventions in past outbreaks, and (3) evaluate and learn from research on interventions to garner data. Beyond the impact on health outcomes and healthcare services utilization, CoCoPOPP sought to garner data for organizational use and to share insights on pandemic management and control with the Ghanaian government and the broader global health community. Conclusion: The use of evidence-based public health framework, PARIHS, renders CoCoPOPP a replicable community-based model that can be implemented in other rural communities in Ghana and other Sub-Saharan African counties with similar cultural settings.

Social Capital as a Mediator in the Link between Women’s Participation in Team Sports and Health-Related Outcomes

The role of social capital in the association between team sports and health-related outcomes has not been well established in the literature. The purpose of this study was to explore whether social capital components (social support, trust, and social involvement) mediate the association between team sports and health-related outcomes (self-reported health, psychosomatic symptoms, and depressive symptoms). In a cross-sectional research design, we obtained data from 759 participants in the Mamanet Cachibol League, a community team sports model for women in Israel, as well as a comparison group of 308 women who did not participate in any team sports. Team captains were sent a link with an online questionnaire, which were then delivered to team members via text message. Using three parallel mediation models, we found that social support mediated the association between team sports and self-reported health, psychosomatic symptoms, and depressive symptoms. Trust mediated the association between team sports and both psychosomatic symptoms and depressive symptoms. Social involvement was not found to be a mediator in the association between team sports and any of the health-related outcomes. Our findings reveal the important role of social capital, specifically social support and trust, in promoting the health of women who participate in team sports.

Pharmacist-led sedative-hypnotic deprescribing in team-based primary care practice

Background: Sedative-hypnotic (SH) medications are often used to treat chronic insomnia, with potentially serious long-term side effects. The objective of this study is to evaluate an interprofessional SH deprescribing program within a community team-based, primary care practice, with or without cognitive behavioural therapy for insomnia (CBT-I). Methods: Retrospective chart review for patients referred to the team pharmacist for SH deprescribing from February 2016 to June 2019. Results: A total of 121 patients were referred for SH deprescribing, with 111 (92%) patients who attempted deprescribing (average age 69, range 29-97 years) and 22 patients who also received CBT-I. Overall, 36 patients (32%) achieved complete abstinence, and another 36 patients (32%) reduced their dosage by ≥50%. For the 36 patients who achieved complete abstinence, 26 (72%) patients remained abstinent at 6 months (9 patients resumed using SH and 1 patient was lost to follow-up). The proportion of patients achieving complete abstinence or reduced dosage of ≥50% (successful tapering) was higher with CBT-I than without CBT-I but did not reach statistical significance (77% vs 62%, p = 0.22). There were also no statistically significant differences detected in the success between those who took a benzodiazepine and those who took a Z-drug (67% vs 61%, p = 0.55) or for those who took SH daily and those who took them intermittently (67% vs 44%, p = 0.09). Conclusion: Almost two-thirds of patients participating in our pharmacist-led program were able to stop or taper their SH medications by ≥50%. The role of CBT-I in SH deprescribing remains to be further elucidated. Can Pharm J (Ott) 2021;154:xx-xx.

Abstract : stomp in HPFT

AimsAnalyse the pattern of psychotropic drug use and deprescribing (in the context of STOMP) in people with Intellectual disability and Challenging behaviour in Hertfordshire community team(s) during 2016-17. STOMP stands for Stopping Over Medication in People with Learning Disability, Autism or both.BackgroundPublic Health England in 2015 estimated that on an average day in England, between 30,000 and 35,000 adults with a learning disability, autism or both were taking prescribed psychotropics without appropriate clinical indications . HPFT signed up to the STOMP pledge in 2017 to actively review psychotropic prescribing in line with NICE guidance alongside patients, carers and professional partnerships. This audit provides the outcomes of applying the STOMP Pledge to clinical practice.MethodData collection for the current audit occurred over Q1-5 in 2016–2017. All patients with Intellectual Disabilities on psychotropic medication were reviewed in psychiatric clinics. Awareness was raised about STOMP in teams. A semi-structured tool was developed based on the Self assessment framework published by the ID faculty RCPsych and prospective data were collected after each outpatient visit.Result347 patients were prescribed psychotropic medication and reviewed quarterly between 2016-2017. 96 patients were prescribed antipsychotics for challenging behaviour. Other prescribed medications included mood stabilisers, anticonvulsants, anti-depressants and benzodiazepines. Common antipsychotics used: Risperidone (63), Aripiprazole (14), Quetiapine (9), Olanzapine (4); Chlorpromazine (2). Four patients were maintained on two antipsychotics in varying combinations. The data collection tool noted that alternatives to medication were tried in 32 cases. Deprescribing occurred in 41 casesConclusionThis study represents an attempt to capture the impact of the STOMP principles in a clinical sample. Various alternatives to medications were pursued in the sample such as positive behaviour support, sensory integration, psychological therapies, social support. Younger adults (under 30 years) represented the largest proportion of cases where medication was increased. Adults over 30 years represented the largest proportion of cases where a STOMP reduction occurred. This may reflect the individual factors at play. Younger people with ID and /or Autism are more likely to experience changes in support and structure at transition, whilst older adults may have more physical comorbidities that may influence this decision.zcvv

Improving remote prescribing in a CAMHS community team during the COVID-19 pandemic

AimsPrior to the COVID-19 pandemic, prescriptions were usually collected by patients/families in person from the CAMHS community team base. Due to social distancing measures introduced during the pandemic, face-to-face contact between staff and patients had to be minimised. This led to an increase in remote prescribing, including from home. Feedback from team doctors was that the process of following the Remote Prescribing Protocol (RPP) was taking up a significant portion of their day, preventing them from doing other clinical work.Our aim was to reduce the time taken to complete a remote prescription to pre-pandemic levels (under 15 minutes).MethodWe used PDSA methodology in this QI project: 1)Plan: Survey sent out to team duty doctors to identify the most time-consuming steps in RPP which could be safely delegated to administrative staff2)Do: Email sent requesting administrative staff clarify several details with patients/families when they request a prescription. This included the names and doses of medication, how many days they had left, where they wanted the prescription sent to (home/pharmacy) and the relevant address. If the patient usually received their repeat prescription from their GP, they were re-directed to their GP3)Study: Following the intervention above, team doctors recorded how long it took to complete a remote prescriptionResultThe average time taken to complete a prescription fell from 31 minutes (pre-intervention) to 22 minutes (post-intervention). The range of time taken also dropped from 10-241 minutes (pre-intervention) to 0-46 minutes (post-intervention). The medications taking above the average time to complete were more likely to be non-controlled drugs rather than controlled drugs (which one may typically think would be more time-consuming to write out).ConclusionWhilst we have successfully reduced the time for remote prescribing, we have not reached the target of reducing it down to less than 15 minutes (pre-pandemic timings). As part of the next PDSA cycle, we have carried out a survey to ask what barriers remain. Checking patient's notes and recent prescriptions can still be inefficient. We propose introducing an intervention whereby this can also be safety delegated to administrative staff e.g. including a copy of the most recent prescription in the request.In the future, we will continue to improve the RPP with further PDSA cycles and carry out an audit on the system on a regular basis to ensure standards are met.

Simple Suppers – Gone Online (SS-Go): Feasibility of a Family Meals Program Transitioned From In-Person to Online in the COVID-19 Pandemic

Objectives Adapt and pilot Simple Suppers (SS)—a site-based 8-week family meals program for Head Start (HS) families offered in fall, winter, and spring—to an online platform using a community-based participatory approach, in response to COVID-19. Methods Researchers collaborated with community partners and HS families to adapt the core components (caregiver education; child education; family meal) of SS to an online format. Feasibility outcomes (demand: response rate, attendance, retention; acceptability: satisfaction; implementation: fidelity, cost; limited effectiveness: diet, weight status) were measured: pre, post, or throughout programming via count, survey, focus group, or direct measure. Baseline demographic data were also collected. Results The research-community team came to consensus on: a) utilizing e-methods families were accustomed to in local HS programs and elementary schools (Google Classroom; Zoom; YouTube videos) for the educational components; b) enhancing the educational components with a supplemental program-specific weekly magazine (“SS Digest”); c) creating a weekly meal kit delivery for the family meal component (“SS Chef's Crate”); and d) adding an additional week to programming (8 to 9) to orient families to the new online format. 13 of 40 families enrolled in HS participated in the fall session of SS-GO programming (32.5% response rate) and mean (SD) weekly attendance was 4.0 (0.86). 11 of the 13 families engaged in the research, and 10 of 11 completed pre- and post-test data collection (91% retention). Survey and focus group data revealed high levels of satisfaction for SS-GO. Weekly lessons were delivered as intended 92.8% of the time, and Chef's Crates were received by families 100% of the time. Mean (SD) food cost of programming was $212.33 (66.06) or $16.33 per family. Limited effectiveness data are forthcoming. Baseline mean (SD) caregiver age was 32.5 (9.32) years (n = 11), 100% (n = 11) female, 72.7% (n = 11) Black, mean (SD) BMI 36.3 (9.31), 36.4% (n = 4) low income, and 36.4% (n = 11) had low or very low food insecurity. Mean (SD) child age was 3.45 (0.69) (n = 11), 45.5% (n = 5) were female, and had a mean (SD) BMI z-score 0.63 (0.76) (n = 11). Conclusions SS-GO demonstrates feasibility utilizing a community-based participatory approach. Data will guide future iterations of the program—in COVID-19 and after. Funding Sources USDA NIFA CYFAR

Reviewing suitability of Essex Partnership University Foundation NHS Trust out of area locked rehab placements

AimsTo look at 14 EPUT out of area patient profiles, map their journey to the current locked rehab placements -To review the appropriateness of placement of 14 patients through reviewing whether the care provided is achieving the rehabilitation goals.To look at patients’ needs and whether the local alternatives can provide the careBackgroundRehabilitation services aim to help complex General Adult Mental health patients reintegrate in the community by promoting independent living skills. Some complex mental health patient's care needs mandate a specialist rehabilitation services. Currently there has been a nationwide shortage of local rehabilitation services. This resulted in placing complex needs patients out of area in locked rehabilitation hospitals and miles away from their local community connections. Families and local community team providers travel miles to keep in contact with their complex need persons. The NHS five year plan includes minimizing the current out of area placements and for local services to work together as per CQC recommendations to work together and bring those individuals closer to home.MethodWe designed a tool and examined the electronic records for all 14 out of area placed patient profiles, mapping their clinical journey and reviewing whether the care provided is achieving the rehabilitation goals.Result(N = 14), Patient profiles: 78.5% had residual symptoms (Psychotic symptoms 85%). Patient's Illness profile; treatment resistant with residual symptoms in 71.4% and 7% had comorbid illicit substance misuse, other illness profiles 21.4%. History of alcohol and illicit drug misuse was present in 78.5% and 45% of them were using illicit substances more than 5 years. .patients’ risk profile revealed 86.7% had history of non-compliance. Attempted suicide 21.4% has attempted suicide at list once in which 1/3 of them had more than one attempt. 64.3% Had positive history of offending behavior. All patients in the sample had history of violence 85.7% had risk of vulnerability and self-neglect, 28.5% has history of carrying weapons, 35.7 had a previous Custodial sentence. Average Duration of illness average 16.7 years, average distance from home was 149 miles though clozapine was considered in 92.8% only 35.7% of sample was on clozapine, and the other 64.3% were on combinations. Only 35.7% were on depot.ConclusionThere is a need for expert input for advice regarding complex Management of residual symptoms and rehabilitation needs in the community. Health and social care joint working is needed.