16 minute read
WIDENING ACCESS
Extending Askham’s renowned rehab into the community
Through the creation of an outpatient service, Askham Rehab is offering its life-changing therapy and neuro-rehab support to non-residents for the first time. NR Times learns more
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As a renowned neuro-rehabilitation provider, delivering life-changing outcomes to residents through its person-centred approach, Askham Rehab is now launching an outpatient service to extend access to its sector-leading expertise and resources to the wider community. Askham Rehab has become known for the strength of its work in neuro-rehab, supporting people from around the country - who come to the Cambridgeshire centre through its reputation and capability - to rebuild their lives after illness or injury and return home to their families. Its provision for residents includes robotics - with five pieces of equipment bought during COVID-19 lockdown to enable their rehab to progress and even increase - and a hydrotherapy pool, which, alongside the work of the therapy team, are seen as being key in Askham delivering the outcomes it does. But now, for the first time, its resources are also available to those living in the area around its site in Doddington, with people able to visit for their full array of therapies, delivered by Askham’s on-site multi-disciplinary team, and then return to their own home afterwards.
And to help deliver its new outpatient service, Askham is adding further to its team, with a number of new therapists set to help meet the strong demand. The move into outpatient work comes at a particularly significant time as the world continues to recover from the COVID-19 lockdowns, during which many people relying on neuro-rehab in the community saw their support paused or withdrawn and progress lost. For Aliyyah-Begum Nasser, director of Askham Rehab - which, as part of Askham Village Community, has been a central part of local life for over 30 years - the fact support can be offered more widely is hugely important. “We have had many enquiries over the years about outpatient work, to which we’ve always had to say no, but now we will be able to welcome those who need us to come in and access our therapy and neuro-rehab support,” she says. “This will be very positive for the individual, but I think it will also be of great benefit to our residents as part of their group therapy sessions, where we allow residents to mix with outpatients in a safe way. The social interaction will be really important. “One of our core values is community, and we are committed to ensuring people can integrate from all walks of life - but more recently, we have experienced distance, separation and isolation. “From my perspective as a director and non-clinician, I’m always amazed when I see people arriving at Askham and coming out of the other side in a better place, supported by the work of our amazing therapy team. It is great to have the opportunity to offer this to even more people now. “Now we are really excited to be able to push forward with our outpatient plans and to bring people in to create even more of a community.” The timing of the outpatient service, while planned for many years, comes at a point where resources are significantly under pressure trying to meet the COVID-19 backlog - so access to Askham’s resources is particularly timely. “I suspect that during COVID, many people have not been able to get the access to neuro-rehab they need, and may have gone backwards in their ability levels and independence,” says Aliyyah. “So we hope that by opening up Askham, we can help to regain some of the lost time and progress and really make a difference. “This has been planned since pre-COVID, but when that hit, our priority was the residents who lived at Askham and keeping them safe - it was not the time to launch a new service, or to increase the risk by anyone new coming into Askham, as much as we wanted to extend our support to those people who we knew were missing out. “We have watched the guidance change and evolve, while maintaining appropriate safety measures, and we felt now is the time to launch. We can work safely while managing distancing, cleaning and other safety measures, and being able to offer the levels of service we pride ourselves on. “It’s very exciting that we can share the expertise and resources we have and extend that to another group of people, particularly during such an important time in neurorehab provision.” For over a decade, Askham has built its dedicated neuro-rehab provision, supported by significant capability and resources to support residents’ progress. The addition of the robotic equipment during the pandemic - financed by a £50,000 grant from the Cambridge Mayoral Authority and match-funded by the directors at Askham - added further to the therapies already delivered at Askham, introducing the enormous potential of robotic rehab tech into its portfolio. The robotics are believed to be the only resources of their kind in the East of England, combining with the hydrotherapy pool to deliver a sought-after neuro-rehab offering. Access to such a comprehensive offering is something Aliyyah believes will help outpatients, like residents, to achieve strong progress. “We have continued to invest in our therapy services and we are now a place where you can come for all your therapies, be that to see your speech and language therapist, occupational therapist, or to use the gym or the hydrotherapy pool,” she says. “Therapists of course can and do communicate between sites, but to have everything on one site makes that communication much more in-depth and valuable. “Rehab is our bread and butter, we are very proud of the outcomes our residents achieve. I am confident our outpatients will see strong progress too and for our support to have a tangible impact. “While they won’t have the 24/7 holistic rehab our residents receive, they will certainly get the same very focused, person-centred rehab that is tailored to their needs and supports them to meet their rehab goals.” Recruitment is also underway to support Askham’s plans for its outpatient service, to help meet the growing levels of demand from the local community. “We want to be able to support as many people as we can, while continuing to provide the quality of service Askham is known for and prides itself on,” says Aliyyah. “We are proactively recruiting specialist therapists, but we also train up care staff internally into rehab assistants, who then work in areas including physio and occupational therapy. “Working in rehab is such a great opportunity - to be part of someone’s journey which, for the most part, is about progression and improvement and to support them in that is a privilege, and a totally different experience and type of interaction to working in traditional care. “We are looking to bring in a number of new people and are always keen to hear from anyone who would like to be part of what we do.”
Asking the questions that matter for patients:
When empirical research is conducted in partnership with those involved in clinical practice, with both parties sharing knowledge, experience and contributing to a truly collaborative programme of work, then there is greater potential to make a positive difference to the lives of patients. As part of Elysium Healthcare’s commitment to share best practice and facilitate collaboration, Dr Claire Williams, Associate Professor in the School of Psychology at Swansea University, was appointed Honorary Senior Research Fellow with Elysium and now plays a vital role in encouraging collaboration to improve outcomes for patients. With research interests in neurobehavioural disability, emotional processing and regulation, and how individuals with brain injury are evaluated within the criminal justice system, Dr Williams has developed specialist tools for use in brain injury research, assessment and rehabilitation, including the ‘St Andrew’s – Swansea Neurobehavioural Outcome Scale’ (SASNOS). Available in seven languages and used on an international scale in at least 18 countries, the SASNOS provides health professionals with a unique basis for treatment planning and evaluation, allowing rapid identification of rehabilitative goals and detection of meaningful change. Put simply, SASNOS is helping services to achieve better outcomes for their patients than would otherwise have been the case. In this EveryExpert article, we discuss the benefits of collaboration with Dr Williams, and why gathering feedback and asking research questions that matter to patients and clinical practice is so important.
Hi Claire, thanks for joining us today. Let's start by talking about your role as Honorary Senior Research Fellow with Elysium Healthcare. Can you tell us a bit more about the role and what it entails?
A big focus of my role is to work collaboratively with health professionals within Elysium Healthcare and to support the integration of research into clinical care. The goal of this collaboration is to drive evidence-based improvements in treatment and care options. A key part of that is to develop, design, undertake, and to advance research. So that means to identify research questions, develop the appropriate methods to undertake research, contribute to the analysis, interpretation, and evaluation of clinical research, and to also produce high quality impact research outputs, which can then be disseminated amongst the clinical team, but also to wider clinical and academic communities. It's also about creating opportunities to co-facilitate and contribute to education, training and continuing professional development as well. All of these opportunities are used to share best practice and to share advancements in the field. And that is the fantastic thing about a really collaborative approach - when people from diverse areas with different perspectives, skills and levels of expertise come together - there is real potential to improve treatment and care outcomes. You can evaluate existing approaches, develop new interventions or new strategies, and it’s an environment where you can learn from one another.
Could you give an example of how that works or what that looks like?
A good example of this collaborative approach is the annual conference run by Swansea University and Elysium Healthcare, which brings together leading experts in acquired brain injury to present the latest innovations in clinical practice and delivery. We typically have a real mix of presenters, delegates and exhibitors, who are all involved in the care and support of individuals with brain injury and/ or or are part of research teams. And, as I’ve mentioned, there are so many benefits to that type of learning environment.
It sounds like a fascinating event, can you say a bit more about why it benefits people to participate or hear about the latest research?
Often an advancement in a very specific area of neurological support will be used in isolation initially, in the area that it specifically relates to. But that advancement may have value or potential to be used in other areas. However, without sharing research across specialities, or across different treatment areas and teams, we won’t know what is possible. It's not about reinventing the wheel as such, but rather it’s about sharing the knowledge and seeing how that can be applied to improve outcomes for patients. In this way, we make much more efficient use of research and knowledge to support patients. So, the more people who participate in and share research, and also hear about research and newly developed approaches, the more potential benefits there are.
So ultimately the biggest benefit is for the patient, the person receiving the care that the research informs?
Exactly, and it might be easier to give a tangible example here. I’ve worked in collaboration with Professor Nick Alderman, Clinical Director, Neurobehavioural Rehabilitation Services & Head of Psychology at Elysium Neurological Services, in the development of specialist tools for helping clinicians on the ground to assess and measure, what I would say is perhaps often the less measurable but more disabling aspects of acquired brain injury. “We know that neurobehavioural disability arising from acquired brain injury presents a major obstacle to psychosocial recovery, is associated with reduced quality of life, acts as a barrier to recovery, and contributes to poor engagement in rehabilitation. However, feedback from medical and health professionals on the ground was that there was a lack of reliable and sensitive assessment tools to help detect and monitor change in symptoms of neurobehavioural disability. So, by being able to collaborate with and receive feedback from health professionals, we understood that there was a significant gap in clinical practice – a gap that we could seek to address via a programme of research work. This is an example of when collaboration and feedback shapes research, and from this, we went on to develop the SASNOS – a tool that we have continued to collaboratively refine and evaluate since its creation. It benefits patients because those less measurable but more disabling aspects are being identified and being detected, and from there you can then better inform treatment and rehabilitation plans. You can then monitor progress throughout a patient’s journey, and you can also adjust plans in light of progress made.
How do you collect feedback from therapists and clinicians?
Traditionally you might get feedback from colleagues on the ground or perhaps a passer-by happens to mention it at a conference. However, we’ve taken quite a proactive approach to gathering feedback. We’ve always maintained a registered list of users of the SASNOS tool, and we routinely contact them to ask them for their feedback in a more structured way, such as via online questionnaires and feedback surveys. We ask them what's working, or if there is anything that's not working or could be improved. We ask them to let us know what they would like to see in a new development, or what needs are met? Or are there any unmet needs? How are you currently using it and for what purposes and in what contexts? We gather their feedback and suggestions on tweaks we can make and to inform further developments of the tool. In a nutshell, we proactively gather feedback to ensure the tool is meeting needs on the ground and is supporting patient care.
Do you have a specific example of how feedback has influenced the development of the SASNOS?
Yes, there are a few. One example is that we received feedback concerning the tools ability to monitor change over time, and that instigated a programme of work for us where we examined the responsiveness of SASNOS - its ability to detect change during rehabilitation and when change has occurred. As other examples, clinicians have asked whether a self and patient-rated version of SASNOS could be developed, and we responded to this need. Others asked whether there were plans to make the tool available in other languages, and it’s now available in seven. Basically, feedback is important, and it has really helped shape and develop the tool and our research.
Have you found an open response from the people you’ve contacted? Do they want to be involved in the feedback process?
Yes. In general, we’ve always had a really good response to any of the feedback type surveys that we’ve run, and our collaborative research more generally. And I think that ultimately, well - what makes a difference, is that they can see there’s a potential value to their work. It's something they use, they're engaged with it, and it is relevant to them and how they support those with brain injury. So they're already really invested in these types of topics. And again, that's why you have to collaborate, because otherwise you’re conducting research in a silo almost. It might be excellent research, but you’re not getting it to the people who could use it or need it.
So what you’re saying is that research must be relevant to those providing care, to improve the outcome for the patient?
Yes, absolutely. As a researcher you need to identify the key issues and the priority areas, and those that have potential to have the biggest and most positive impact on care and the patient. You need to make sure that any research that you conduct is geared towards making a difference on the ground and then in turn, it will hopefully benefit patients and care pathways. And this comes back to why we actually collaborate in the first place - to really address questions which matter on the ground. So as a researcher, collaboration helps you to identify questions that matter, or gaps in clinical practice that could be addressed. So actually, that's an example of where there's no point in being in a silo as a researcher, because it may well turn out not to be as useful as it could have been if you had worked collaboratively with others and those who may benefit from it.
And that’s something that always shapes how you work?
Yes absolutely, and I believe this approach must be front and centre of research, right from the very start when you are contemplating your research questions. This has become ingrained in me - with the type of researcher that I want to be. You have to ask the questions that matter to patients and their treatment. So whenever I am thinking about a new project, the key question I always ask myself is why. Why is this important, and why might it be of benefit? Again, and it goes back to the fact that in terms of my research in this area, I am motivated by the want and the desire to make a difference to those who have been affected by acquired brain injury. It's always at the forefront of my mind - yes you can ask really interesting questions and advance knowledge, but there needs to be some tangible way that it could potentially have an impact on individuals or society or a service. It needs to be translatable to make a difference.
And have you ever encountered any obstacles with this approach?
There are sometimes tensions, of course. As researchers we might become interested in an empirical research question or a particular line of investigation, but then it isn’t immediately relevant to clinicians because it doesn't help them with a presenting problem that they have right then, or they can’t quite see how it would translate. But sometimes the empirical research does come first as we have to understand something more before we can look at how it can be applied practically. So it is not always in a straight forward order - there are ebbs and flows about what takes priority, and again - that’s why collaboration is so vital and why we should always ask - why does it matter?
So in one way you can’t have one without the other – the empirical research can inform practice and practice can also inform research?
Yes, it’s a bidirectional relationship for sure, and by working together you end up with much more profitable research questions to begin with and much more advanced programmes of work, where you know you're asking a sensible question or you’re trying to address a problem in a sensible and meaningful way. Indeed, as a clinically applied researcher rather than clinician, I absolutely need to have that clinical partnership to help link my empirical research with practice.” But equally it works in reverse, and it’s not uncommon for services and health professionals to want to evaluate the effectiveness of something they’re doing. However, they might not necessarily have the research expertise or perhaps the time or infrastructure to do that. So that's where researchers come in and where it's mutually beneficial – working together achieves so much more.
Get the latest insights, blogs and news from Elysium Neurological over on their EveryExpert thought leadership hub: www.elysiumhealthcare.co.uk/neurological/ every-expert
