EP.TU.23Impact of a multi-disciplinary team teaching programme on understanding of roles and communication among the multi-disciplinary team

Background Multidisciplinary teamwork is a critical aspect of patient care. It has a well recognised impact on patient healthcare outcomes. Communication among the multidisciplinary team (MDT) is paramount for effective collaboration, joint care planning and co-ordinated assessments of patients. Aim To evaluate the impact of an MDT teaching programme on understanding of roles, and communication among the MDT. Methods A questionnaire was distributed among ward staff who rated their understanding of roles and experience of communication for 8 teams within the MDT. An MDT teaching programme was designed and ran weekly over 6 weeks, aimed at improving understanding of roles and communication among the MDT. Sessions were attended by various members of staff including junior doctors, occupational therapy, physiotherapy, junior and senior nursing staff, consultants, and ward clark. The questionnaire was repeated and results were compared. Results Understanding of MDT roles was rated 15-32% higher after the teaching programme. For MDT teams not involved in the teaching programme, understanding of roles was rated the same or lower than before the programme. Staff experience of communication among the MDT was rated higher by 18% after the teaching programme. Additionally, the teaching programme provided an opportunity for MDT members to organise weekly MDT-based activities aimed at improving patient healthcare outcomes. Conclusion In conclusion, MDT teaching programmes are an effective way of improving understanding of roles and communication among the MDT.

Addressing disruptions in childhood routine immunisation services during the COVID-19 pandemic: perspectives and lessons learned from Liberia, Nepal, and Senegal

The COVID-19 pandemic has inflicted multifaceted disruptions to routine immunisation from global to local levels, affecting every aspect of vaccine supply, access, and demand. Since March 2020, country programmes have implemented a range of strategies to either continue vaccination services during COVID-19 measures like 'lockdown' and/or resume services when risks of SARS-CoV-2 transmission could be appropriately mitigated. Through the Exemplars in Global Health partnership in Liberia, Nepal, and Senegal, we conducted interviews with immunisation programme managers and ministry of health leadership to better understand how they have addressed the myriad vaccination challenges posed by the ongoing pandemic. From establishing alternative modes of service delivery to combatting vaccine distrust and rumours via risk communication campaigns, many routine immunisation programmes have demonstrated how to adapt, resume, and/or maintain vital vaccination efforts during the COVID-19 crisis. Yet millions of children remain un- or under-vaccinated worldwide, and the same programmes striving to implement catch-up services for missed doses and postponed mass campaigns will also soon be tasked with COVID-19 vaccine deployment. As laid bare by the current pandemic, the world's gains against vaccine-preventable diseases are fragile: enshrined by a delicate global ecosystem of logistics, supply, and procurement, the success of routine immunisation ultimately rests upon dedicated programme staff, the resources and support available to them, and then the trust in and demand for vaccines by their recipients. Our collective lessons learned during COVID-19 offer insights in programme adaptation and resilience that, if prioritised, could strengthen equitable, sustainable vaccine delivery for all populations.

Explaining post-prison rehabilitation through music from the Good Lives Model perspective

Whereas many research studies have discussed the impact of music programmes in a prison setting, few studies have investigated the impact of music programmes that take place outside the prison and are intended for formerly incarcerated individuals. The current study aims to fill this void by examining the experience of formerly incarcerated individuals who participated in a group music programme intended to assist them on their journey towards rehabilitation. Five formerly incarcerated individuals who participated in the Sounding Out Programme (SOP), a group music programme funded by the Irene Taylor Trust in London, were interviewed for this research. In addition, three programme staff members were interviewed in order to gain further perspective on the process. Content analysis of the interviews indicated the emergence of four central themes: improved social bonding, a sense of hope and life purpose, a sense of achievement, and transformation. These findings are discussed in light of the Good Lives Model (GLM). Accordingly, the SOP assisted both formerly incarcerated individuals and programme staff members in attaining the following GLM primary goods in life: community, relatedness, knowledge, spirituality, excellence in work and play, excellence in agency, and creativity.

Testing ZELPH ['sɛlf] – a self-assessment instrument to surface intended and unintended outcomes of work-integrating pedagogies

PurposeThis paper's twofold purpose is, first, to present ZELPH ['sɛlf], a self-assessment instrument that enables those developing the pedagogy of work-integrating study programmes in higher education (HE) systematically to surface the intended and unintended outcomes of their programme's approach to integrating professional practice into an academic course. Secondly, the paper reports on a small pilot study with programme staff from five different HE institutions in various countries who tested ZELPH.Design/methodology/approachZELPH operationalises aspects of key theories on work-integrating learning pedagogy, and thereby enables a simplified depiction of the reality of combining classroom-based and worksite-based learning. Programme staff from Germany, the United Kingdom, France, South Africa and Taiwan applied the instrument to their respective work-integrating study programmes and evaluated its perceived value and feasibility.FindingsThe findings suggest that ZELPH offers value as a practical instrument, in particular to those less familiar with developing work-integrating learning pedagogy as well as to those keen to compare programmes across national, cultural and institutional contexts.Originality/valueZELPH contributes to addressing the lack of practically applicable instruments to support the design and international benchmarking of work-integrating learning pedagogy in HE.

Feasibility of Group Problem Management Plus (PM+) to improve mental health and functioning of adults in earthquake-affected communities in Nepal

Aims Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal. Methods In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8–8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC). Results We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5–3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm. Conclusion The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.

The entanglement of facts and values: An example from an agricultural project in Honduras

The entanglement of facts and values is shown in the context of an example from an evaluation of an agricultural project in Honduras. Instead of assuming that the evaluated project corresponded to what really mattered to the people (that it was ‘relevant’ for them), the evaluation team tried to find out what people valued most and incorporated this perspective in the assessment of the project. Thus, it became a value-focused evaluation in which the evaluation team undertook to identify the local people’s priorities, their key concerns, their values through conversation with them and the programme staff who were involved in the implementation. These conversations played a critical role in completing the evaluation.

Development and delivery of a clinical leadership programme for integrated community teams

Neighbourhood teams were formed throughout Worcestershire in early 2018, which led to a change in staff roles and responsibilities, as these are multidisciplinary community teams. It became apparent during the transition that many of the staff in band 6 roles required additional support and education to enable them to develop their knowledge and skills. Therefore, a clinical leadership programme was developed specifically for these staff. The programme followed the principles of the NHS Leadership Framework and consisted of six full-day training sessions. During the programme, staff identified issues within their team and developed a plan to address these issues over the following 6–12 months. The next two cohorts of the programme included staff from out-of-hours community nursing teams. The feedback from all delegates and managers was overwhelmingly positive, and delegates continue to implement their plans.

Observations of the first GameSense-branded responsible gambling centre in a US casino

Objective: To help mitigate potential gambling harm, responsible gambling information centres are launching across casino venues in North America. The launch of the first such centre in the USA provided an opportunity to achieve three goals: (1) document the centre’s reach among casino patrons, (2) generate a comprehensive description of services provided, and (3) explore the potential for a dose–response relationship between centre exposure and gambling beliefs and behaviour. Design: We documented services provided and surveyed consecutive centre visitors. Setting: We achieved these goals at the GameSense Info Center, located in the first Massachusetts casino. Method: Programme staff recorded their services via electronic checklist and administered one-page surveys to visitors with whom they discussed problem or responsible gambling. Results: Programme staff reported engaging directly with approximately 1% of daily patrons. About 70% of their interactions were casual. During conversations that did move beyond a casual nature, programme staff typically provided information about responsible gambling, consistent with patrons’ self-reported needs and concerns. Finally, among a sample of patrons who repeatedly engaged with programme staff at the most involved level ( N = 129), those with relatively little programme exposure were more likely to hold an accurate gambling belief but less likely to report having set time limits on their casino visits. Conclusion: We did not observe support for the notion that using an on-site information centre to teach patrons about important gambling concepts is associated with more responsible gambling behaviour.

Addressing occupational stress among health staff in non-government controlled Northern Syria: Supporting resilience in a dangerous workplace

Introduction: Syrian medical staff working in non-government controlled areas of Syria operate in situations that expose them to great personal danger, while they must often face the same challenges as the people they help. Supporting the wellbeing of these staff is crucial to the operation of health services for internally displaced Syrians given the large-scale destruction of healthcare infrastructure. Methods: Findings from a staffcare programme designed by a grassroots Syrian psychosocial organisation in Southern Turkey and implemented in a medical nongovernment organisation in Idlib in Northern Syria are presented. An iterative and collaborative process employed individual, team and organisational level consultation to identify occupational stresses within the workplace. A six-month programme involved group sessions across eight sites with 56 staff working in three primary health clinics, two mobile teams and one sexual and reproductive health clinic, serving eight internally displaced persons camps in Idlib. Results: Following the programme, staff reported significant reductions in role ambiguity, and improvements in the nature of their work, personal relationships with colleagues and superiors and physical conditions in the workplace. There were no significant differences in reported organisational structure or job satisfaction. Discussion: This evaluation of a grassroots programme, designed to address the expressed needs of displaced staff, suggests that reductions in daily living stresses can be achieved even in the context of ongoing crisis.

New York City’s window guard policy: four decades of success

BackgroundPreventing child falls from windows is easily accomplished by installing inexpensive window-limiting devices but window falls remain a common cause of child injuries. This article describes the history and evolution of the New York City (NYC) window guard rule,which requires building owners to install window guards in apartments housing children aged ≤10 years. The NYC window guard rule was the first directive of its kind in the USA when it was adopted in 1976, and it has led to a dramatic and long-lasting reduction in child window fall-related injuries and deaths.MethodsData about the history of the window guard rule were obtained by reviewing programmatic records, correspondence, legal decisions and the published literature. In addition, key informant interviews were conducted with programme staff.Results and DiscussionThis article describes each stage of policy development, starting with epidemiological studies defining the scope of the problem in the 1960s and pilot-testing of the window guard intervention. We describe the adoption, implementation and enforcement of the rule. In addition, we show how the rule was modified over time and document the rule’s impact on window fall incidence in NYC. We describe litigation that challenged the rule’s constitutionality and discuss the legal arguments used by opponents of the rule. Finally, we discuss criminal and tort liability as drivers of compliance and summarise lessons learnt.