Kirkhill Resource Centre' Involving older people in service integration an action research project

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Kirkhill Resource Centre. Involving older people
in service integration an action research
project

• Joan Healey, Vicky Klymczuk,
• Margaretta Johnson
• 2006

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Kirkhill

• Residential, day hospital and day care services
  combined
• Brooklees day hospital moved to the site in 2003
  -integration of health and social service
  provision for older people with mental health
  needs

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The project - aims

• Involve people in exploring their experience of
  working in and using the services at Kirkhill,
  post structural integration
• Involving all stakeholders in developing service
  towards being more service-user led

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(No Transcript)
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• 'Action research...seeks to bring together action
  and reflection, theory and practice, in
  participation with others, in the pursuit of
  practical solutions to issues of pressing concern
  to people.' Reason P, Bradbury H ( 2001) p.1
• 'Although action research invariably permits the
  use of a wide range of methods to bring about
  desirable changes, group processes are central
  because of their potential in engaging
  participants in research.' Chiu LF (2003) p.166

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First round groups
KIRKLEES 3
KIRKHILL 3
BROOKLEES 8
STAFF 8
STAFF 7
STAFF 7
CARERS 6
INTERVIEW 1
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Focus group topics

• people's experience of using / working in the
  service
• how integration had impacted
• what people liked or disliked about current
  service
• how much people felt involved in what happened
• how much choice people had
• how working processes effected involvement
• wish lists
• (each groups worded appropriately)

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What people said -integration..

• Staff -'I think one of the difficulties for us
  since we came over to SCT is that we are
  basically employed by Social Services and
  question mark seconded to health. We've got the
  badges but we've had nothing else. We're still
  working to Social Service guidelines.' Staff
  group 1

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• 'I think there is some divide but it's not as bad
  as it used to be. It's got better....like for
  example if the buzzer goes, anybody answers the
  buzzer. It could be one of my clients but I might
  be busy and someone could come and say your
  client wants you....' Staff group2

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Integration cont.

• Staff lack of knowledge about others roles
• -desire to share expertise across all services
• - positive learning experiences of working
  together
• - positive outcomes for service users being
  together
• -desire for seamless service between day
  hospital, day centre and respite services
• Service users and carers lack of knowledge
  about other parts of the service and how they
  related to one another

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What people said - service user involvement -
staff

• Involvement residential meetings, community
  meetings, consultations, information BUT lack of
  ownership and control
• '..Possibly.... but it's also people of that age
  don't like to rock the boat so to speak do they?
  they don't want to complain because they might
  think they'll get chucked out or something so
  it's easier just to keep quiet.' Staff group2

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Involvement cont...- service users.

• (asked by interviewer what stops people from
  having their say)
• 'Shyness' ( laughter)
• 'Yeah because you feel as though probably they
  know best...because they have more experience,
  we're only visiting aren't we? They do that every
  day' ( Service user group1)
• '

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• '..yeah but I think the majority of people seem
  to think that... when they're paid, not the staff
  don't, but with patients, we shouldn't be
  involved you know, we..... the staff might....'
• 'That's right. It's no good, I mean, like you
  say, we sit back and say nothing don't we.'
• 'But like A says, what we'd like to do, well I
  would like a say in it. I would like a say in
  it.' ( Service user group2)

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Involvement service users

• 'I mean when we were kids at Christmas we used to
  get an orange and apple'
• They've got a room full of toys now ..everything
  they can buy..'
• 'We didn't mind if we had the house and furniture
  slowly but nowadays they want it all in one
  go'(Service user group1)
• 'We're a nation of non-complainers aren't we? we
  just let things go over the top of us. We'd get a
  lot more things if we did complain..' (Service
  user group2)

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What people said -service users perceptions of
day services..

• valued it as prevented them from having to go
  into residential care
• benefit from the company, the staff
• and the activity
• did not have much information about what they
  were coming to before referred to day services
• lack of choice and control about days

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Activity and empowerment -autonomy v. risk
management

• Pivotal role of meaningful activity in why they
  were there, what they wanted to do and what staff
  wanted to do BUT barriers and problems
• Risk management hampering staff and service users

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Activity barriers-

• Staff
• ' You get more tasks to do per day than time to
  spend with the residents.'
• You need time on your task sheet to actually
  spend with clients' ( Staff group 1)

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Barriers to involving people in activity

• 'You can spend all your time filling paper work
  in and risk assessments etc. when you could be
  spending time sat talking or doing things with
  clients...you'd have more quality time' ( Staff
  group3)

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Risk management and disempowerment .

• Service users-
• 'Sometimes you're made to feel that you're about
  two years old, that you can't do these
  things...there's something up with you...so you
  can't do it because you're getting on.' (Service
  user group2)

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Risk management and disempowerment

• Staff (discussing how people could be more
  independent)
• 'I mean we've got a shower on there that they
  would be actively able to use themselves...
• 'Because they are not incapable..'
• 'But it's just the risk that's in the way' (
  Staff group 1)

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What people said-role of carers

• Complexities from all three groups
• how much to be involved how much to leave to
  staff ( from carers) (involvement v.
  interfering)
• burdening carers ( from staff and service users)

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Second round groups
Service users 8
Staff 8
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Second round groups

• service users
• flexibility to accommodate more individual choice
• integrated activity across three services
• look at when activity happens, balance between
  therapeutic and social activity

• staff
• need to make integration work
• reviewing processes for consulting / involving
  service users
• importance of impact of risk assessment
  procedures

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Where the action is

• 2 half day training session for all staff on
  group work and activity
• monthly meeting for staff from all services
• newsletter
• activity 'champion'
• information sheet for new service users
• final workshop service users involved in
  planning and running groups
• explore volunteers from ex-service users
• new activities staff thinking out of the box
  about what constitutes activity

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POPPIE

• Involvement in POPPIE
• visit from Slovenia and to Asti
• service user from Kirkhill involved in
  teleconference with older people from other
  European projects

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Drawbacks

• limited project time and finance
• loss of participant researcher
• small numbers
• resources staff recruitment
• ''...change is problematic and although action
  research lends itself well to the discovery of
  solutions, its success should not be judged
  solely in terms of the size of change achieved or
  the immediate implementation of solutions. '
  Meyer J (2000) p 179 - 180

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Learning points

• Action research stakeholder ownership
• Partnerships between university and practice
  service development
• Desperate need to re-look at risk management it
  is disempowering and exacerbating mental health
  issues institutionalised ageism
• Staff roles within 'care' settings
• Expert patient initiatives to work against
  internalised ageism

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References

• Reason P, Bradbury H (2001) Handbook of action
  research Participative inquiry and
  practice. Sage London
• Chiu,LF (2003)Transformational potential of focus
  group practice in participatory action research.
  Action research 1 (2)165-183
• Meyer J (2000) Using qualitative methods in
  health related action research. British Medical
  Journal. 320 178- 81