1. I MPLEMENTING P SYCHOSOCIAL I NTERVENTIONS IN P RACTICE : P OSITIVES, P ITFALLS AND P RACTICAL T IPS Jill Pendleton & Sarah Butchard MSNAP Special Interest Day 8 th July 2016

2. AIMS To consider the practical application of psychosocial interventions in the real world To explore the complexities and difficulties of delivering a range of psychosocial interventions To outline some of the benefits of delivering a range of psychosocial interventions To consider the place of service user involvement in developing services.

3. B ACKGROUND Over the last few years Mersey Care Foundation Trust has made a commitment to: Increase the provision of psychosocial intervention to people living with dementia Ensure the quality of the interventions offered Ensure equity of services provided Increase service user and carer involvement in service development

4. H ISTORICAL D IFFICULTIES Predominance of medical model Limited staff ‘trained’ to deliver psychosocial interventions Postcode lottery Belief amongst professionals that people living with dementia cannot usefully contribute to service development As services started to develop problems with meeting demand

5. S O HOW TO ADDRESS THESE PROBLEMS ?

6. W IDER CONTEXT Increasing dementia diagnosis rates If there is early diagnosis need something to offer Evidence that providing support at an early stage helps with long term coping Alzheimer’s Society/ DAA call for post diagnostic support

7. F IRST ….I NCREASING THE OFFER Documents that point to the psychosocial interventions that should be offered: BPS papers MSNAP standards NICE guidelines

8. P SYCHOSOCIAL I NTERVENTIONS O FFERED Post Diagnostic Support Group x6 per weekCognitive Stimulation Therapy x2 per weekMaintenance CST x1 per weekMonthly Memory Group x1 per monthEverton in the Community x1 per monthSURF x1 per monthPhysiotherapy groups x2 per weekTime limited projects

9. T HEN …E NSURE EQUAL ACCESS TO SERVICES

11. Identified Gateway in Clinical Network C LINICAL N ETWORK FOR D EMENTIA : R EFERRAL FOR D IAGNOSIS P ROCESS Mersey Care RLUH Walton Centre Aintree HT Liverpool Community Health GP Acute Admission/ Other Stage 2: Diagnosis Referral Source Stage 3: Post Diagnosis Support Post Diagnostic Support Referral across Network Agreed outcomes measures On diagnosis referral to Stage 1: Pre - Diagnosis Referral < 6 week Wait

12. G REAT TO BE ABLE TO MAKE SUCH A COMPREHENSIVE OFFER BUT IT CAN LEAVE YOU FEELING ………….

13. A ND FINDING YOURSELF ………

14. P OTENTIAL S OLUTIONS Increase number of staff trained (and willing) to deliver the interventions Ensure that psychosocial interventions are considered an integrated and important element of the service. Build psychosocial interventions into service specification Multi Agency working

15. E NSURING Q UALITY Increasing capacity means that more people are needed to deliver interventions. Need to ensure quality Developed competencies to deliver specific interventions: Multi professional Capture the key knowledge and skills Acknowledge the complex nature of delivering psychosocial interventions Link into the areas covered in PACE Build into Service Specification

16. W ORKING IN P ARTNERSHIP WITH O THER O RGANISATIONS

17. EVALUATION Often difficult to evaluate some aspects of psychosocial interventions as idiosyncratic Large scale studies often give no positive results Does this mean that they aren’t useful?

18. S PECIFIC PROJECTS The service also encourages people to be involved in one off or linked projects: Innovate dementia Human Rights and dementia Reflections Film making App development

19. M EANINGFUL I NVOLVEMENT OF PEOPLE LIVING WITH DEMENTIA An unintentional but very welcome consequence of increasing psychosocial interventions has been increased service user involvement in service development. Meaningful involvement vs tokenistic involvement

20. C O -P RODUCTION RATHER THAN C ONSULTATION

21. C OMPLEXITIES But with increased service user involvement comes some complexities: People’s changing abilities People becoming overwhelmed Other people expecting you to ‘magic up’ people with dementia Potential exploitation versus autonomy

23. F UTURE C HALLENGES Meeting the needs of people living with more advanced dementia Meeting the specific needs of younger people with dementia Increasing demand and pressure on services Ensuring adequate evidence for psychosocial interventions

25. T HANK Y OU !! If you have any questions please feel free to get in touch Sarah.butchard@merseycare.nhs.uk Jill.Pendleton@merseycare.nhs.uk