Co-creating rehabilitation: Findings from a pilot and implications for wider public service reform

As part of a large pan-European project on co-creating public services we supported the design of a programme in England that attempted to operationalise research on desistance, through a model of co-created, strengths-based working. We then evaluated its implementation and impact. The programme was implemented in a Community Rehabilitation Company. It was delivered in the context of rapid organisational change, often in response to rapidly changing external events and a turbulent policy environment. These factors impeded implementation. An impact evaluation did not identify a statistically significant difference in re-offending rates between the intervention group and a comparator group. However, in-depth qualitative evaluation identified positive examples of co-production and co-creation, with individual case managers and service users supportive and noting positive change. Taken as a whole our findings suggest that a co-created, strengths-based model of probation case management is promising but needs to be accompanied by wider systems change if it is to be embedded successfully.

Expanding Arizona’s Dementia Capable System

Currently, 5.8 million US adults live with Alzheimer’s disease (ADRD); the number is expected to double by 2050. Arizona will experience the greatest percent increase in ADRD by 2025. This project targeted three underserved groups in order to expand Arizona’s dementia capable system: people living alone with ADRD; people with Down Syndrome or another intellectual/developmental disability (DS/IDD) aging with ADRD and their family caregivers; and people with ADRD and their caregivers in the Latino community. This presentation describes the development and delivery of the project’s educational workshops, case management services, and evidence-based programs. Over 2,220 participants have participated in workshops to date with the largest percentage being case managers, care coordinators, and discharge planners. Evaluations have been extremely positive with 86.1% being “very likely” to recommend the project to others. The presentation concludes with findings and lessons learned regarding the delivery of the project’s evidence-based programs and case management services.

Impact of iN2L Tablets on Loneliness and Well-Being: Findings of an Innovative Industry-AAA Program

Area Agency on Aging (AAA) senior and adult day centers closed due to COVID-19, causing many older adults to lose an important source of connection and engagement, leading to social isolation. To combat negative consequences, iN2L and a Florida AAA partnered on an innovative program providing iN2L tablets to AAA-supported older adults to use at home. The tablets have a simple interface, content specifically designed for older adults (e.g., games; music; movies), and video call capability. Participants included 51 independent older adults (mean age 77) and 39 family caregivers (mean age 59) of people with dementia. Participants completed phone surveys with AAA case managers at baseline and 3 months, including UCLA Loneliness Scale (3 item) and questions about their tablet experiences. Findings show positive trends for loneliness and well-being in both groups. At 3 months, lonely participants decreased from baseline by 25% for independent older adults and 18% for family caregivers. Over 80% of independent older adults agreed the tablet engages them in meaningful activities, provides daily enjoyment, and helps with relaxation. For family caregivers, 79% agreed the tablet is another tool in their caregiver toolkit and about 70% agreed the tablet adds daily enjoyment, helps with relaxation, and provides engagement in meaningful activities for their family member. Approximately 50% of caregivers felt happier, less stressed, and less irritable since using the tablets. This work has implications for the utility of technology in promoting engagement and connection, alleviating negative effects of social isolation, and the effectiveness of industry-AAA partnerships.

Participatory Research With Older Workers in a Pandemic: Innovations and Lessons Learned

In the spring of 2020, and as the implications of the COVID-19 pandemic became increasingly dire, in-person studies halted throughout the world. This included our planned study to examine the role of the Senior Community Service Employment Program (SCSEP)—the sole federal workforce training program for low-income older adults—in influencing participant financial, physical, and mental well-being. While our original plans were to hold a series of in-person workshops with SCSEP participants and case managers using a form of participatory research called community-based system dynamics (CBSD), we paused the launch of our study to determine the safest path forward. This presentation will describe how we responded as well as innovations and implications for future research with harder to reach populations. First, we met with the Massachusetts state SCSEP director to assess the feasibility of moving our sessions online with this particular population. After determining that virtual and telephone sessions would both be needed to increase accessibility, we identified virtual whiteboard software rigorous enough to utilize CBSD-specific activities, user-friendly enough for populations less familiar with virtual environments, and with security features that would be approved by our university, as well as discussed what types of activities to conduct on the telephone for such a visual research method. Our CBSD study was one of the first to utilize virtual and telephone formats in the history of this method, and our results indicate that it is possible—and sometimes beneficial—to move in-person participatory methods to these environments to increase inclusion and efficiency.

Findings from Community Workshops Designed to Help Expand Arizona's Dementia Capable System

Among the 5.8 million people living with Alzheimer’s disease (AD), there are three vulnerable groups where community partners can join efforts to serve the community more comprehensively. These include (a) people living alone with Alzheimer’s disease and other related dementias (ADRD) who may or may not have a family caregiver, (b) people with Down Syndrome or another intellectual or developmental disability aging with ADRD and their family caregivers, and (c) people with ADRD and their family caregivers in the Latino community. Dementia capable systems are designed to address the needs and concerns of all individuals, families, and communities impacted by ADRD. The project develops and expands ADRD programs and services across Arizona through educational workshops, case management services, and evidence-based programs. Workshops (N=67) were provided to a variety of professionals and community members ranging from promotores/CHW’s (community health workers) and case managers to family caregivers and people living with dementia (N=2,272). Workshops successfully attracted a substantial proportion of Hispanic or Latino/a participants (63%) and women (84.5%). Perception of benefit ratings were overwhelmingly positive with over 90% of participants agreeing or strongly agreeing that: the workshops met expectations; they were willing to attend other programs by us; and they learned something they could use. Moreover, based on their workshop experience, they felt more confident that they could help these three underserved populations. Overall, workshops were clearly acceptable to participants and feasible to deliver. In addition, they contributed to an increased awareness in ADRD related to the project’s three target groups.

Comparative Perspectives on Geriatrics-Surgery Co-Management Program by Specialty and Staff Role

Co-management programs between geriatrics and surgical specialties have gained popularity in the last few years. Little is known about how these programs are perceived across surgical specialties and staff roles. We conducted a mixed methods study to assess perspectives on a geriatrics-surgery co-management program (GSCP) at a hospital where geriatricians co-manage patients 65 or older admitted to Orthopedic Trauma, General Trauma, and Neurosurgery. We used semi-structured interviews (n=13) and online surveys (n=45) to explore program value, facilitators, use, understanding, and impact by specialty and staff roles (physicians, advanced practice providers, nurses, case managers, social workers). Interview transcripts were analyzed using qualitative thematic analysis, and survey data were analyzed using Kruskal-Wallis, ANOVA, and Fisher’s exact tests. Interviews revealed three themes: 1) GSCP is valued because of geriatricians’ expertise in older adults, relationship with patients and families, and skill in addressing social determinants of health; 2) GSCP facilitators include consistent availability of geriatricians, clear communication, and collaboration via shared data-driven goals; and 3) GSCP use varies by surgical specialty and role depending on expertise and patient complexity. Survey data analysis affirmed interview themes and showed significant differences (p-values<0.05) between perspectives of surgical specialties and roles on GSCP use, understanding, impact, and which specialty should manage specific clinical issues. Findings suggest that while there are similarities across surgical specialties and roles regarding the value of, and facilitators for, a GSCP, specialties and roles differ in use, understanding, and perceived program impact on care. These findings suggest strategies for optimizing this intervention across groups.

Case Managers’ Perceptions About Synchronous Telerehabilitation versus Clinic-based Physical Therapy Services for People with Spinal Cord Injury

People with spinal cord injury (SCI) require extensive rehabilitation to maximize independence and quality of life. Much of this treatment occurs on an outpatient basis through telerehabilitation or clinic-based services. Synchronous telerehabilitation has become increasingly common in recent years, but many professionals remain reluctant to suggest it when clinic-based services are available. This survey study explored case managers’ perceptions regarding advantages and disadvantages of synchronous telerehabilitation versus clinic-based physical therapy services for people with SCI. Respondents were 89 case managers responsible for service provision coordination. Results showed a significant preference for clinic-based rather than telerehabilitation physical therapy services. Relative experience with the two service delivery models significantly affected perceptions. Only facilitating travel convenience differed significantly as a reason for recommending one service delivery method over the other. The incongruity between perceptions about synchronous telerehabilitation and existing literature about its cost, convenience, and efficacy suggests a need for additional education.

A Community-Based System Dynamics Study of the Senior Community Service Employment Program

The Senior Community Service Employment Program (SCSEP), the only federal workforce-training program that targets older adults, engages people aged 55 years and older with incomes at or below 125% of the federal poverty level with multiple barriers to employment. This study examined SCSEP’s role in participant financial, physical, and mental well-being. To do so, we held five sessions (four virtual, one telephone) over a combined nine hours in August and September 2020 using a form of participatory research called community-based system dynamics with 15 Massachusetts SCSEP participants and case managers. Through structured activities, respondents identified how program, policy, and organizational factors influence and are influenced by participant well-being (e.g., SCSEP participation results in less social isolation, decreased isolation subsequently increases desire to participate) as well as program and policy recommendations to strengthen the program (e.g., reconsider benchmarks of success). These findings highlight the benefits and potential of this long-running program.

Using Voice and Touchscreen Technology to Protect Vulnerable Clients in Residential Care Facilities

Due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum for long term care facilities to restrict visitation by all nonessential personnel, including guardianship case managers. To enhance caseworker access to their guardianship clients, an eastern seaboard state agency distributed Amazon Echo Show devices to clients in long term care facilities. These touchscreen and voice-activated devices have both video and audio capabilities. This study reports the results of the first phase of a comprehensive evaluation, pilot testing the devices via a group of “superuser” case managers to understand the potential challenges and benefits of using these devices. Sixteen case managers participated in two virtual focus groups before and after the installation of an Echo device with one of their guardianship clients. Participants were asked to discuss experiences in accessing clients and client engagement before and after device installation. The focus groups were audio-recorded and transcribed verbatim and two researchers independently identified themes using open and axial coding. Major themes identified included: challenges to device installation and use, strategies to overcome challenges, benefits to using Echo devices, and ethical concerns. These findings suggest that touchscreen or voice-activated devices with video capability can assist case managers in protecting vulnerable clients and ensuring their well-being when in-person access is restricted. Additionally, the devices can be used to enable isolated residents to connect to the outside world, including family, friends, and case managers through technology. Strategies for replication of this innovative program will be discussed.