BIRT outcome report 2011
“ We believe that using an outcome measurement system is an essential practice allowing service users and other stakeholders to evaluate our services and allowing us to improve our services year by year.” Professor Michael Oddy, Director of Clinical Services, BIRT
Our third Outcome Report offers critical information to service users and other stakeholders, such as family members and commissioners, about the changes they may expect during and following rehabilitation. We use the outcome measures to improve our services and for scientific research on brain injury rehabilitation. As can be seen from this report all information is in an anonymised form. Each year we evaluate the usefulness of our measures; in 2011 we added new measures appropriate for our current service users. Our aim is to find measurement tools that are sensitive to the changes our service users wish to achieve and help support the decision making process when choosing a brain injury service provider. The measures we have chosen are widely used, standardised instruments with good psychometric properties. Feedback from stakeholders about the usefulness of this report is welcomed and should be forwarded to director@birt.co.uk
Outcomes at a glance ●●
We served 396 adults with acquired brain injury in 2011
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We admitted 178 new service users to our rehabilitation and community services
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We discharged 183 service users from our services
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72% of service users moved to an environment with less supervision and at less cost in most cases
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The average length of stay was 6.6 months in assessment and rehabilitation services and 6.5 months in challenging behaviour services.
88% of service users required full time care on admission, yet only 42% required full time care on discharge
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By 6 month follow up this had reduced further so that only 30% required full time care
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65% of service users had no productive activity on admission, yet only 29% had no productive activity on discharge.
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Our challenging behaviour services achieved an average reduction of 47% on the BIRT Aggression Rating Scale (BARS) at discharge
BIRT outcome report 2011
Increasing independence and engagement in activity Supervision Rating Scale – assessment and rehabilitation services 100
Percentage of service users
The Supervision Rating Scale is an indicator of the level of support that service users require. Our data shows that over 50% of service users were rated as independent or needing part time supervision at discharge compared with only 11% at admission. At follow up 88% of service users were independent or required only part time supervision.
Admission
80
Discharge Follow up
60
40
20
0%
0
12% 44%
11% 44% 44%
89% 44% 12%
Part time
Full time
Independent
Level of supervision
Community Disposition Rating Scale – Occupation Occupational activity on admission
Occupational activity on discharge 1% Education, training or employment 1% Independent homemaker
12% Education, training or employment
9% Volunteer
32% No productive activity
34% Recreational or day activity 64% No productive activity
46% Recreational or day activity
One of the goals of rehabilitation is to improve service users’ quality of life by increasing the productive activity they engage in. Our results show that at discharge there was a 50% reduction in the number of service users who had no productive activity.
Care and Needs Scale 60
50
Admission Discharge
40
30
20
10
Level of support
ho ur s
54% 32%
20 -2 4
ho ur s
7% 7%
12 -19
to Up
fe w
da ys
30% 30%
11 ho ur s
4% 4%
kly
5%
Ev er y
rm
itt
t te In
de pe nd en
2%
W ee
0% 14%
en t
5% 9%
0
In
Percentage of service users
The Care and Needs Scale measures the extent and frequency of care and support needs. Scores range from very low indicating independence to very high indicating a greater level of support need. Compared to admission, on discharge three times as many services users required care or support every few days or less.
1% Independent homemaker
10 15 10
1055
05 0
0
Discharge
Follow Followup up
Admission
60 60 80
Discharge Follow up
40 40 60
20 20 40
0 80 80
6% 6%
22% 39% 22% 39%
6%
22% 39%
Independent Independent with family with family
Independent with family
11% 11%
Supported living Supported living
Supported living
Residential Unit Residential Unit
Residential Unit
Type of Accommodation No problems No problems Some problems Some problems Extreme problems Extreme problems No problems
Some problems Extreme problems
75% 22% 3%
47% 43% 10%
75% 22% 3%
47% 43% 10%
Se Se lf lf c ca ar re e
57% 40% 3%
83% 28% 17% 83% 28% 17%
Type of Accommodation Type11% of Accommodation 50% 44% 83% 28% 17%
70 70
80 60 60 70 50 50 60 40 40 50 30 30 40 20 20 30 10 10 57% 40% 3% 20 0 57% 40% 3% 0 10
50% 44% 50% 44%
75% 22% 3%
0
53% 38% 8%
53% 38% 8%
38% 47% 15%
38% 47% 15%
Us Us ua ual l a ac ac ct ti tiv ivi vit iti tie ie es s s Pa Pai in n/ /d di sc isc sco om om m fo fo for rt rt t A An nx xie ie ty ty/d /d e pr ep pr es re ess sio ss io io n n n
0 20 0
y
At 6 months after discharge from BIRT services, service users are asked to identify levels of difficulty in five areas; anxiety/ depression, mobility, pain/discomfort, self-care and usual activities. In all of these areas, the number of extreme problems was very low and overall 56% of service users reported ‘no problems’
Admission
ilit
All service users
9.84
M M ob ob ilit ilit y y
EQ-5D Health Rating Questionnaire
18.44
Discharge Discharge
ob
BIRT services aim to help service users become more independent, enabling them to live with less supervision. Therefore, the type of accommodation a service user requires on admission to our services and following discharge is rated. The data show that 83% of our service users were admitted from residential care with very few living independently. At discharge, however, 72% of service users were living independently or in supported living, and this figure increased to 83% at follow up.
Discharge Discharge
80 100
M
Assessment and Rehabilitation
Admission Admission
Admission Admission
Percentage Percentage ofservice service users users Percentage of serviceof users
Community Disposition Rating Scale – Accommodation
9.84 9.84
100
Percentage ofusers service users Percentage of service users Percentage of service
Moving on from BIRT
18.44 18.44
ca re
Our main measure of challenging behaviour is the BIRT Aggression Rating Scale (BARS). For the service users in our challenging behaviour services there was a 47% average reduction in their BARS score at discharge.
15 20 15
Se lf
Reducing aggression
Mean BARSscore score Mean Mean BARS scoreBARS
20
47% 43% 10%
53% 38% 8%
EQ-5D Category EQ-5D Category
38% 47% 15%
BIRT outcome report
Who uses our services?
2011
Assessment and rehabilitation Age of service users – assessment and rehabilitation
32% >50 yrs
24% 18-29 yrs
Gender of service users – assessment and rehabilitation
2%Neoplasm 3% Other 6% Infection
26% Female
Time since injury – assessment and rehabilitation 6% 10% >10yrs 4-10yrs
9% Hypoxia 74% Male
18% 30-39yrs
26% 40-49 yrs
Cause of injury – assessment and rehabilitation
24% CVA
56% TBI
19% 1-3 yrs
65% 0-1 yr
Challenging behaviour Age of service users – challenging behaviour
35% >50 yrs
22% 18-29 yrs
Gender of service users – challenging behaviour
3% 6% Other Infection
13% Female
18% 30-39yrs
Cause of injury – assessment challenging behaviour
24% CVA
24% 40-49 yrs
‘I am settled into my room and my new lifestyle and I’m pleased to say that I love it. Moreover, I’m moving onto my next step of living independently in my own house.’ In August 2010, Meg Elliot, a 26 year old, recent English literature graduate was pursing her love of climbing, working as an activity instructor for a local climbing centre in Snowdonia. On one of her days off from the centre, during an excursion, Meg suffered a terrible fall from an almost vertical cliff face at 30ft. Meg had broken her back, her neck, her left shoulder, her left ribs, punctured a lung and received a brain injury from hitting her head on the rock. Meg was stabilised at Bangor Hospital and then transferred to Liverpool intensive care where she remained for 4 months in total. Meg transferred to TEM House in Milton Keynes. With help and support from
9% >10yrs
9% Hypoxia 87% Male
the excellent multi disciplinary team, Meg made rapid progress with her rehabilitation. Occupational therapy, physiotherapy, speech and language therapy and clinical psychology make up the team at TEM. As part of her intensive rehabilitation programme Meg was encouraged to start writing again and has written the TEM House newsletter. In over a year at TEM house Meg made such rapid progress that she was able to move to a community house in Northampton run as a part of BIRT’s continuum of care, living independently but with support available to her as and when she needed it. Meg has now been supported to find a flat in the community and is moving out to live on her own.
Time since injury – challenging behaviour
16% 4-10yrs 56% TBI
21% 1-3 yrs
54% 0-1 yr
Satisfaction ratings Stakeholder satisfaction
Commissioners and referrers
One of the ways BIRT monitors quality is by using satisfaction surveys which address different aspects of our service. We ask our stakeholders to complete questionnaires at service user discharge or at least annually. The feedback we receive is used to plan, develop and improve our services, both at individual centres and Trust-wide. We’d like to thank everyone who took the time to complete our questionnaires. Feedback is vital for us to ensure we maintain our high standards and improve wherever we can.
97% of commissioners and referrers said they would recommend BIRT to others and 91% were “more than satisfied” or “satisfied” with BIRT services overall. Respondents particularly commented on the professionalism of staff, the effectiveness of communication and the flexibility of the approach used from referral through to discharge.
Our commissioners said:
Commissioner and referrer satisfaction 2011
“ A very professional, well organised service which I would highly recommend.”
Overall satisfaction Would recommend BIRT to others Skill and training of staff Prompt response to referral
“ Case reviews are well structured and informative to enable discharge planning to commence.”
Effectiveness of rehab plan How to rehad plan put in practice Informative & organised meetings Timeliness of assessment report Appearance of centre Cleanliness of centre Courtesy of staff 0
10
20
30
40
50
60
70
80
90
100
Level of satisfaction %
“ I am pleased that BIRT provides opportunities for service users to progress with rehabilitation into supported living environments.”
Families 95% of families would recommend BIRT to others, and 92% of families were “more than satisfied” or “satisfied” with BIRT services overall. Families expressed appreciation about how well service users were involved in choosing their programme and activities, and how well they were kept informed. They also commented on the caring and positive attitude of the staff working with their family members.
Family satisfaction 2011 Would recommend BIRT to others Overall satisfaction Social/leisure activities
Family members of our service users said:
“ BIRT has given us our son back. When he arrived his behaviour was extremely difficult to manage & discharge home would not have been possible. The staff deserve medals.” “ BIRT gave us peace of mind at a time when it was much needed for the whole family.”
Appearance of centre Support of families Courtesy of staff Consideration of concerns/goals Organisation/information at case confs Benefits of rehab programme Admission process 0
10
20
30
40
50
60
70
Level of satisfaction %
80
90
100
“ The staff are wonderful and nothing is too much trouble. They always have time to listen and give you their full attention.”
BIRT outcome report 2011
Service users 85% of BIRT service users reported that they were “more than happy” or “happy” with BIRT services overall. Several commented on the helpfulness of staff and how they were supported to make choices about their activities and leisure interests. The high levels of satisfaction reported by service users demonstrate that our efforts to make the rehabilitation experience as tolerable and beneficial as possible are successful.
The people who used our services said:
Service user satisfaction 2011 Overall satisfaction
“ I am treated with dignity by the staff.”
Choices offered Treated with dignity Privacy respected Treated as individual
“ I am happy with all the help given to me by staff.”
Complaints taken seriously Standard of accommodation Standard of food
“ I like the food!”
Cleanliness of service Well treated by staff Happy with rehab programme 0
10
20
30
40
50
60
70
80
Level of satisfaction %
Improving access to BIRT’s services We collect information about why people who have been assessed as suitable for our services are not subsequently admitted. After identifying barriers we find solutions which support our partners and increase access to our services. Our latest study showed that the most common reason why people were not admitted was linked to finances (36% of cases), usually associated with the constraints placed upon PCTs and local authorities budgets. To work with commissioners and increase access to our services BIRT developed a new range of flexible rehabilitation options, launched late 2011. These follow our internationally recognised neurobehavioural approach yet with a different delivery model, all designed to offer maximum choice. Accompanying this are several financial incentives, giving value for money options in our specialist services. To find out more about these options visit www.birt.co.uk or contact your nearest service.
90
100
“ Thank you to everyone for all that they have done for me.”
BIRT outcome report 2011
Key facts
90%
72%
68%
68%
75%
36%
of service users felt they’d been treated as individuals
felt a sense of accomplishment in completing their rehabilitation and overcoming some of their difficulties (at follow up)
of service users moved on to live independently or in supported living accommodation
had no problems with self care (at follow up)
The Disabilities Trust First Floor, 32 Market Place, Burgess Hill, West Sussex, RH15 9NP Tel: 01444 239123 Fax: 01444 244978 Email: info@thedtgroup.org The Disabilities Trust is a company limited by guarantee incorporated in England and Wales under 2334589 and registered as a charity in England and Wales under 800797 and in Scotland under SC038972. Registered office as shown.
www.birt.co.uk
were engaged in productive activity at discharge
agreed that their life was close to their ideal (at follow up)
For more information please contact: BIRT, 60 Queen Street, Normanton, Wakefield WF6 2BU Tel: 01924 896 100 Fax: 01924 899264 Email: director@birt.co.uk