Abida Malik - University of Leeds Kath Broscombe, Trudy Korner – Sure Start Barkerend, Bradford. The Efficiency and Appropriateness of Physiotherapy Home Visiting Programme

2 Barkerend Population Strengths and problems of the area Access

3 Why Physiotherapy? Consultation Need Recognition

4 Who are we- skills? Skills recruitment –Physiotherapists –Physio assistants

5 What Do We Do Aims of service Objectives How the service has developed

6 How the Service has developed? Numbers Activities

7 What Findings? In House Evaluation DNA in SS vs. Mainstream

8 Need for further insight? Commissioning of work to external evaluators University of Leeds

9 What did we plan to do? To investigate the factors responsible for affecting the efficiency of Physiotherapy Home Service

10 How achieved - 1? Gaining insight of various perspectives –Service Users - Users of physiotherapy HVS –Service Providers Physiotherapists –Sure Start –Mainstream Physiotherapy Assistants Consultant Paediatrician

11 How achieved - 2? LREC Permission Evidence for the need to do this piece of research – Protocol Background Aims Methodology

12 How achieved - 3? LREC Permission Qualitative Research Users of physiotherapy Home Visiting Scheme –Focus group More mobile and empowered participants –One-to-one interviews Hard to reach and less empowered

13 How achieved - 4? Audio taping with consent of the group members Transcription Thematic analysis dissemination

14 Findings

15 Challenges in Service Provision ? Perceptional Lack of empowerment Competing priorities –Child care –Elderly relatives Publicity Cultural Linguistic

16 Looks after the needs of my son and other children similar to him. It provides a chance for mothers to get together and the children to get together and for mothers who are not allowed out or can not come out. organizes playgroups, activities through Womenzone, physiotherapy service and play in the home. What does Sure Start do? - Parents’ views?

17 Sure start is better as they are more homely, friendly and down-to-earth Sure start is more convenient as I do not have to carry nappies and bottles with me. I prefer Home service because of child care responsibility for a younger daughter who is 9 month old And the benefits of physiotherapy Home Service - Parents’ views?

18 More frequent service No cancellation More play groups for special needs Speech therapy Home visiting Scheme …. What else do they need?

19 …. I think the benefit is actually in the locality. They can walk there (Sure Start service), they don’t have to get the bus, don’t have to get a taxi which is often a barrier to coming here (CDC)….. Health providers’ views? locality base

20 …. we (mainstream) are not very flexible, we only work on certain days, therefore, people do not have much choice. We are not actually here 5-days a week. I believe with Sure Start they are given a choice of morning or afternoon session and also a choice about specific time but we can’t do that. … Health providers’ views? Flexibility

21 … I feel that the push is towards the community so we need to meet people where they are. … Health providers’ views? Clients’ Need based approach … There are some cultural barriers as well and reaching out to them makes the service much more acceptable.

22 … I think if they can get support very early on then it helps to have a more positive attitude towards the child and the intervention. The whole family is better equipped to deal with the problem and this has a better long-term effect. It also makes them realise that the Physios are not from another planet. … Health providers’ views? Whole family approach

23 … Well it depends on the parents. They have to understand the reasons for coming to us. If they understand and have their own concerns, they will make every effort to attend otherwise there are excuses such as illness or the car broke down … Health providers’ views? Tackling Gaps in Concept

24 …. Everything revolves around appointment model, you have appointment with your doctor, Physio bla bla bla…. But now everything is changed it is the professionals who go and see them and therefore they want us to go to them a lot more than we ever used to……… … Health providers’ views? Alternative approach!!! …. When I went to visit them at home they had no idea that I was supposed to be going to them. Perhaps it is better that they should feel the need for the treatment. So that when they have an appointment they can bring the child to the clinic.

25 Physio Assistants’ Role …. I actually see my role as being exactly the same as the physiotherapists. we do exactly the same, we work together going on home visits, ……comforting the parents, just being there for the parents and listening to them if they need support, emotional support.

26 …. And Why Is It a Strength for the Service? …. Seeing them in their own environment is seeing how they are like at home. Probably when they come out of their own home they tend not to be themselves……You can see more of their natural progression. … …. they take us as friends whereas if they go into hospital they think it is a professional thing, its all strict. they say that they feel cold when they go into the hospital even though they are getting good help from the hospital and they are really happy with it, but they don’t feel as relaxed as they do with me going to the house and doing the exercises with the child.

27 Conclusions User Needs Lack of confidence Competing priorities Lack of diary keeping skills Granny phenomenon Physiotherapy a new concept Language need Getting the message across SS strengths User friendly approach Home based service, flexible Reminders! Family orientated approach Appeasing fears Appropriate health education Use of Physio assistants from within the community Better publicity! More physio assistants – trained and appropriately rewarded

28 Recommendations -1 Further recruitment of Physiotherapy assistants Nationally recognised training + better rewards to improve recruitment Health promotion according to the linguistic & cultural needs of the users Patient support and empowerment programmes

29 Recommendations - 2 Service provision beyond 4 years of age Appropriate cultural awareness training for health professionals Extension of the home based service to include other programmes Extension of Sure Start ethos into mainstream provision

30 Where next? Dissemination with the view of promoting changes in service delivery at: –Local –Regional –National arena

31 Acknowledgements This project is funded by Bradford Council’s Sure Start Regional Fund We are grateful to all the participants who agreed to accommodate us in their busy schedule. We are also indebted to our colleagues Professor Sonia Williams, Ms Julia Csikar, Judith Saunders and Kal Nawaz for their advice and support.