Home Based Memory Rehabilitation Programme

Transcription

1 Home Based Memory Rehabilitation Programme Towards a National Roll Out and Developing Evidence Base in Scotland Wendy Chambers and Alison McKean Dumf-uhb.OTreferrals-mentalhealth@nhs.net #OTHBMR NHS Dumfries and Galloway Mental Health Occupational Therapy Service

2 Outline 1. Scotland s Dementia Strategy and the Allied Health Professionals 2. Home Based Memory Rehabilitation 3. A National Scottish Rollout - a model for sharing best practice - developing an evidence base - consistency of access to services 4. Video views of people with dementia

3 Scotland s national context Approximately 90,000 people living with dementia in Scotland and this number is continuing to increase (Alzheimer Scotland, 2015) Scotland s National Dementia Strategy ( ): Commitment to improving post diagnostic support AHP National Delivery Plan, Action 2.6 AHP directors and AHP leads in local authorities, working in partnership with Alzheimer Scotland will work to ensure the multisectoral delivery of early intervention and post-diagnostic support for people with dementia and their families and carers in line with the national commitment

4 Review of evidence + National Scoping exercise with AHPs and Alzheimer Scotland Dementia Link Workers (2014) 5 Key Actions: 1. Clarity and consistency around the allied health professional role during the post diagnostic support period 2. Clear process and pathways for people living with dementia for timely access to the allied health professionals in the post diagnostic period 3. AHPs to develop their knowledge and understanding of post diagnostic support in dementia 4. Development of the evidence base for AHP led interventions during the post diagnostic support period 5. Development of partnership working and consultation between AHPs and Dementia Link Workers

5 OT Findings from national scoping exercise (2014)

6 OT Findings and Aspirations OTs recognised that people with dementia were not receiving access to their Services at the right time OTs reported they could be doing more in the area of Post Diagnostic Support in Dementia OTs identified Home Based Memory Rehabilitation as intervention they would like to take forward as best practice

7 Home Based Memory Rehabilitation (HBMR) Evidence based Occupational Therapy early intervention in dementia (College of Occupational Therapy Developed & RCT completed by Mary McGrath, specialist occupational therapist, Belfast (McGrath and Passmore 2009) 2013/15 Tested & HBMR resource pack created in Dumfries and Galloway, Scotland HBMR based on Cognitive Rehabilitation theory and techniques Key is to compensate for memory difficulties via: 1)Environmental Adaptation 2)Use of external memory aids 3)Use of internal memory strategies

8 HBMR Programme overview HBMR - delivered over 4 (minimum) and up to 6 sessions The structured format of the HBMR programme creates Structure and Repetition: encouraging new learned behaviours in early stages of dementia Habits and Routines: more likely to be remembered and can be relied on as/when memory difficulties progress Criteria for referral: Diagnosis of mild dementia (mild cognitive impairment- outwith scope of National Roll out Phase 1) Non age specific Insight / awareness of everyday memory difficulties : essential ACE III >60/100 MMSE >20/30 (guideline) Family/friend/carer support : preferable

9 HBMR Sessions Clinician's manual for HBMR and Tip Sheets for each session have been developed Session 1 Remember your priorities Session 2 Remember what people have told you Session 3 Remembering something you have to do Session 4 Remembering names, coping in social situations Session 5 Keeping your brain healthy Session 6 Remember your bearings Person centred Occupation focused Repetition and reinforcement Order Clinical reasoning

10 Dumfries and Galloway Outcomes at 1 year review 6 Number of Memory Strategies and Reported Everyday Memory Problems number strategies used Memory problems initial assessment post HBMR 3 month 1 year

11 HBMR Outcomes Summary Positive results obtained overall Demonstrate people with dementia have ability to learn new strategies/skills with support from the occupational therapist/ot technician Demonstrate that over time people can retain and continue to utilise these skills Decreased number of reported everyday memory problems

12 How to share best practice across Scotland?

13 A National Rollout Summer 2015 : OT s across Scotland interested in HBMR May 2016 National Launch Event : 5 areas signed up September 2016 Assessments agreed : 11 areas signed up October 2016 Phase 1 HBMR : 11 areas And

14 Sharing Best Practice Aim: To develop a model and framework for sharing best practice Ground up approach Led and driven by interested occupational therapists Nationally supported Academically supported

15 Developing an Evidence Base Demonstrating impact of occupational therapy, promoting professional profile, #ValueofOT Developing a robust evidence base for non pharmacological, AHP led interventions in dementia Assessment toolkit -agreed (September 2016) -robust -research ready

16 Logic model for HBMR evaluation strategy

17 Assessment battery * Plus a qualitative feedback tool to capture people s experiences and opinions eg Emotional Touchpoints (Bate and Robert 2007)

18 Consistency of access across Scotland Ambition is that people will have equitable access to this OT early intervention during the post diagnostic support period #OnceforScotland (and beyond?!)

19 References Bate. P & Robert. G (2007) Toward more user centric OD: Lessons from the field of experience based design and a case study. Journal of Applied Behavioural Science, 43 (31) Chambers W & Groat A (2015) Home based memory rehabilitation programme: an OT early intervention for dementia COT abstracts (session 21) College of Occupational Therapists Limited. OT Evidence: OTs help those with dementia and their carers Factsheet McGrath M and Passmore P (2009) Home-based memory rehabilitation programme for persons with mild dementia. Irish Journal of medical Science. 178 (Suppl 8), S330 Scottish Government (2013) Scotland s National Dementia Strategy, Scottish Government (2013) AHPs as agents of change in health and social care; The National Delivery Plan for the Allied Health Professions in Scotland,

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