Theory and Practice of Multi-Agency Partnership - Essay Example

Order 113547 Theory and Practice of Multi Agency Partnership Aphasia-An Identified Regeneration Programme in Leeds involving multi-agency partnership operation: The medium of communication in humans is through conversation for sharing the spectrum of social interactions. Communicative handicaps in conversation known as Aphasia play a major role in losing established relationships and social interactions. Nearly 300 people in Leeds every year are detected as having Aphasia, and among them, a lot have long-term intricate needs. Usually, Speech and Language Therapy -- SLT is not able to provide the funds to assist this group of population on a long-term basis. Therefore, multi-agency group treatment for people with Aphasia was undertaken in Leeds in a non-health setting. A number of actions were applied to examine conversation, perceptions of the injury and well-being. (An evaluation of the effectiveness of a Multi-agency partnership provision of groups for people with Aphasia) The outcomes point out that, in a large number of conversations, a marked relapse to pre-morbid levels of interaction was noticed. The outcome on well-being is less apparent. Present SLT encourages dealing with the total communication and associated psychological needs of the person with Aphasia. Pound et al reminds us about the comprehensive feature of Aphasia, affecting an intricate social being that needs flexible, integrated way of treatment. Multi-agency groups offers the benefits of such an approach and at the same time provide encounters in the behavior, responses and language of other people crucial during social participations. Collected evidence is also available which points out that group treatment can be increasingly effective in bettering communicative and linguistic performance for some people having Aphasia. Team effort was undertaken on a pilot basis in 1999 based on the work of Kagan & Gailey in 1993. The facts from the pilot studies establish strongly that inputs from expert from social services background would play a part in participant outcomes. After this recommendation, a partnership with Leeds SLT -- East Leeds PCT, rendering a service throughout the city Leeds Metropolitan University or LMU, City of Leeds Social Services and the Modernisation Team Disability was built up to supply custom made groups. The Modernisation Team Disability is a joint health services and local authority body enabling multi-agency working aimed at working for the disabled people to help in including and promoting independence within Leeds. The objective of the groups was to offer support in application of communication, accept one's changed self and to overcome obstacles to social participation. Location within an education environment, rather than in health environment, sustains these objectives. Assessment of the results consisted of examination of various conversation styles, extent of communication experience, views of impairment and proof of an alteration in confidence levels of members within the groups. (An evaluation of the effectiveness of a Multi-agency partnership provision of groups for people with Aphasia) The methodology applied was that the SLTs referred the subjects to one of the three groups. The first one is Conversation Group with subjects having moderate aphasia, a Communication Skills Group with high level of aphasia and a Client and Career group that consisted of clients with acute aphasia and their regular conversation partners. 14 subjects with cases of long-term aphasia were allocated to the groups. Pre-group, post group and a follow up -- FU measurements in 3 months were taken up. These measurements are classified into 3 groups. The first one being measurements of well being applying the "The Hospital Anxiety and Depression Scale" -- HAD with 14 items inclusive of feeling 'tense or wound up' and 'feeling of panic' and VASES i.e. the 'Visual Analogue of Self Esteem Scale' consisting of 'confidence' and 'optimism'. Measurement of linguistic performance, applying 'Conversational Analysis Profile for People with Aphasia' part A -- CAPPA A and measurement of social inclusion and changes from pre-morbid conversation styles applying CAPPA B. CAPPA B which is an aphasia-friendly service satisfaction survey was also built up to examine reported modifications in communication, confidence, and inclusion. Particularly tailor made information, research and keeping record of consent forms guaranteed informed consent from the aphasic group participants. The outcomes of the tests were that measures of well being exhibited small change. The HAD scales revealed a 2% reduction in anxiety and depression and VASES revealed an increase of less than 3% in self-esteem. Measurements of linguistic performance -- CAPPA revealed differences between the two parts. Small changes were noticed in the perceptions of disability, which have been explained as the frequency of a problem's happening like struggling to recollect the correct word and handicap as measured by CAPPA. An analysis of the problem displayed that it is the perceptions of conversations which displayed a bigger change as measured by CAPPA B. Taking a summary view, subjects reported that following their trauma, impairment was reported in more than 80% of their conversation experiences which indicates conversation opportunities for instance the number of people spoken to and styles like the ease in initiating conversations. Following the treatment, the subjects complained that less than 30% of the conversations were impaired. After the completion of the satisfaction survey, 79% of the subjects reported improvements in communication and overall levels of confidence when measured, though, by the VASES sub-tests of 'being understood' and 'confidence' the quantum of change was observed to be very small at 10% and 8% respectively. (An evaluation of the effectiveness of a Multi-agency partnership provision of groups for people with Aphasia) Factors responsible for bringing about Multi-Agency partnership: It has been reported that Aphasia normally happens following a stroke. The intensity of damage among many is so intense that carrying any type of communication becomes minimal. Aphasia as a disorder appears to be poorly perceived, comparatively unrecognized, mainly due to the fact that its presence is not widely felt and people with Aphasia go unnoticed. The experience of those having intense communication problems has never been recorded previously. This is partly due to the non-availability of methodological problems. (Social exclusion of people with marked communication impairment following stroke) A study conducted by Susie Parr, Sally Byng, Colin Barnes and Geof Mercer revealed the following (i) People having severe Aphasia had has little access to jobs, educational, training or scope to enjoy leisure activities. A lot of them received a wide range of statutory and voluntary care services for a long-term. Health, social and residential care workers lacked training or information regarding aphasia and were unaware regarding the manner in which to support fragile communications. (ii) Health and social care services sometimes were unsuccessful in addressing vital problems, like employment or financial matters, and small connection and communication were available among the various agencies. (iii) People having Aphasia were often excluded from the advantages of health, social care, residential and nursing services due to the fact that information and instructions were not accessible; the activities unsuitable or unachievable, and constant breakdown in communication took place during interactions. In case of these people, services became immensely difficult to reach. (iv) Service providers, family and friends might have deliberately not included people having severe Aphasia through applying idiosyncratic, unmonitored communication strategies. People having Aphasia were discussed, patronized, bullied and given directions. (v) Especially in residential and nursing care environments, people having acute Aphasia were in peril of losing their identity since the employees often knew scanty little regarding them and didn't have knowledge regarding how to find out. (vi) Keeping and maintaining friendships and social contacts was very difficult on the part of people having severe Aphasia, resulting in loneliness and boredom. Relatives also narrated experiencing identical restrictions. (vii) People having serious levels of aphasia typically applied little choice and control in their routine lives. (viii) The researchers made an inference that social exclusion happens, though not unavoidable, experience for people with Aphasia. Training and support for communication are indispensable for careers and service providers. (Social exclusion of people with marked communication impairment following stroke) The Research round-up section of the British Aphasiology Society Newsletter published in its Autumn 2005 edition came up with an insight regarding the manner in which to explore aphasia-friendly written formats. It has been observed that written material is often inaccessible for people having Aphasia. The study goes on to explore the manner in which various adaptations of written materials is able to increase understanding among people having Aphasia. The particular study also targeted to examine whether every single feature of aphasia-friendly formatting which means simplified vocabulary and syntax, enlarged printing, more white space and pictures used independently would result in more comprehension as compared to control paragraphs. The other objectives remained to compare the impact of Aphasia-friendly formatting with the effect that every single adaptation, and to examine whether the effects of Aphasia-friendly formats were connected to Aphasia severity. (Research Round Up - Exploring Aphasia-friendly written formats) The candidates having mild to moderate severe aphasia (N=9) read a continuous series of 90 paragraphs and chose the best word or phrase from a choice of four to complete each paragraph. After the analysis, the study revealed that people having Aphasia understood appreciably more Aphasia-friendly paragraphs weighed against control paragraphs. Moreover, they even understood considerably more paragraphs with each of the adaptations such as easy vocabulary and syntax, large print, and increased white space. Even though people having Aphasia are likely to understand more paragraphs having pictures added compared to control paragraphs, it was observed that this difference was not crucial. No major correlation between the acuteness of Aphasia and the impact of Aphasia friendly formatting was revealed. The particular study is in favor of the idea that Aphasia friendly formats augment the reading comprehension of people having Aphasia, even though it suggests that adding pictures, especially Clip Art pictures may not drastically improve upon the reading comprehension of the people having Aphasia. (Research Round Up - Exploring Aphasia-friendly written formats) Aphasia is an impairment of the spoken language, comprehension of speech and reading & writing. The problems people usually encounter undergo a change over a period of time and cover the communication disorder and its effect on life participation and well being. A good instance of multi-agency partnership involvement in this direction is the Leeds Communication Group. It developed among a University, an NHS speech and language therapy service, a social service, and a modernization group in order to extend support for people experiencing the long-term impacts of Aphasia. Research to assess the provision and scope for student placement experience are also integrated within the partnership. Monetary provision by the then Leeds Health Authority and the partner agencies for a two-year time frame in the first instance has made the funds available since September 2001. (Partners in Care: Multi-agency partnerships) The provision is established at the University level which gives a central city location that is accessible having a community focus in an educated instead of a health environment. The Personal Care Assistants support the participants so as to gain access to the University facilities and arrangements for their transport to and from the venue are extended where needed. The provision gives a comprehensive, relevant and accessible provision meant for people having Aphasia, which would not be otherwise possible to obtain. The University setting gives practical situations meant for participants so as to find out problems and practice the skills found out by groups. In the opinion of Alison Ross, Head of Speech and Language Therapy, Faculty of Health and Environment, the development builds up an additional student placement with scope for shared learning and support. It equips a lot of speech and language therapy students with initial experience of people with Aphasia, current and innovative practice, and working with people from different backgrounds. The assessment of the provision plays a part in the development of practice and provision for people having Aphasia. (Partners in Care: Multi-agency partnerships) Critical assessment of the possible tensions and benefits of multi-agency partnership in dealing Aphasia: Occupational Therapists -- O.T.s, physiotherapists, and speech language therapists -- SLTs undertake the assessment and treatment in order to lessen injury, disability and handicap. Occupational therapists engaged by the NHS trusts and social services department; work with the patients so as to lessen physical and mental disabilities. Their normal approach is to evaluate and reduce disability and handicap. For instance, while working with older people, they assess a patient's potential to perform things, for instance, activities of daily living -- ADLs. Thereafter they work with a patient's present physical injuries, motivating them to enhance their skills through practice, and impart them new skills that permit them to accomplish tasks despite their physical injuries for instance filling a kettle by standing the kettle inside the sink instead of holding it. (The Way to Go Home - Rehabilitation and remedial services for older people: The roles of Therapists) O.T.s are able to assess the need for specialist disability equipment or adaptations, such that the patient's domestic environment minimizes the threat of accidents and enables the patients to perform to the extent possible for themselves. The overwhelming majority of social services OT work remains in this area. In case of hospital patients, NHS engaged O.T.s put their effort in this area. In case of hospital patients, NHS engaged O.T.s normally assess equipment requirements for discharge, with SSD O.T.s assuming responsibility in case of major adaptations, even though working arrangements differ among locations. The equipment supplied ranges from tap grips to stair lifts to level-access showers. It is imperative on the part of hospitals to establish procedures for discharge. (The Way to Go Home - Rehabilitation and remedial services for older people: The roles of Therapists) O.T.s particularly in acute trusts in case where throughput remains high, is greatly involved in 'safe discharge assessments' in which patients considered to be at peril are checked for their capability to return home prior to discharge. This check covers assessment of ADLs and mobility and transfers and so on and might also cover a home visit, in which the OT escorts a patient home maybe with a social worker or other professional. This is done to assess the patient's capability to deal with, and the requirement for equipment and adaptations. O.T.s, in keeping with their initial assessment of a patient, will normally carry out tests to examine cognitive function for instance memory tests or the ability to solve problems as also physical disability tests. In the case of certain areas where no input from clinical psychologists exists, this might be the complete range of psychological assessment. Physiotherapists engaged by the NHS trusts and directly by the GPs work with patients so as to lessen injuries associated with mobility and motor function. After a detailed examination is done, which will contain details of the impairment, along with the talks regarding the patient's goals, a management care plan must be worked out. Several physical treatments might be applied which are directed to lower impairment and to augment function and capability. An important part of the intervention will be to enhance confidence of the patient and application of Self Help strategies. Involvement of formal and informal careers must also be there in the care plan to strengthen the therapy and maximize potential. (The Way to Go Home - Rehabilitation and remedial services for older people: The roles of Therapists) A continual assessment of the progress of the patient will be undertaken and the care plan customized as suitable. The patient and the care givers must be associated in this right across the treatment programme. Preventive methods must be taught to make sure the optimum mobility and motor function and assist in coming to terms with unforeseen incidents. Speech and Language Therapists -- SLTs work with the client covering all ages in order to improve their language and communication skills. These might consist of problems triggered by delay in speaking the language in the case of children or incoherent language in the case of adults who have suffered a stroke. SLTs work with those people having reduced clarity of speech caused due to the damage to nerves and muscles of the voice, tongue, lips and facial area. They even have a role to play in the case of evaluation and management of problems encountered while swallowing, particularly after recovering from a stroke i.e. dysphagia. SLTs carry out their functions in a wide spectrum of environments, inclusive of hospitals and community teams and in an educational context with children. In the realm of stroke rehabilitation, SLTs work in close connection with their physiotherapists and OT colleagues as part of the multidisciplinary group in order to provide a functional approach, including facilitation, strategies and re-education to maximize the chances of recovery. The outcome of a stroke can be severe, as it might result in considerable impairment to the language centres of the brain that can result in variety of problems. For example, some people have normal hearing, but have serious problems while understanding the meaning of particular words. Since Aphasia is a language problem, reading and writing might be affected in similar manners. Early evaluation is required so that supportive strategies for communication are applied. A major role for the SLT is advising careers and other professionals to establish the optimum communication with aphasic people. (The Way to Go Home - Rehabilitation and remedial services for older people: The roles of Therapists) References Partners in Care: Multi-agency partnerships. Retrieved from http://bookshop.universitiesuk.ac.uk/downloads/partnersincare.pdf Accessed 22 February, 2006 Research Round up - Exploring Aphasia-friendly written formats. British Aphasiology Society Newsletter. 2005. Autumn. Retrieved from http://www.bas.org.uk/newsletters%20and%20announcements/21.09.05.pdf Accessed 22 February, 2006 Social exclusion of people with marked communication impairment following stroke. 2004. August. Retrieved from http://www.jrf.org.uk/knowledge/findings/socialcare/814.asp Accessed 22 February, 2006 The Way to Go Home - Rehabilitation and remedial services for older people: The roles of Therapists. Retrieved from http://www.audit-commission.gov.uk/Products/NATIONAL-REPORT/40CDDD97-4563-47A9-B8F7-D4BC9AA1E44E/WayToGoHome.pdf Accessed 22 February, 2006 Winslow, Isabel; Ross, Alison. An evaluation of the effectiveness of a Multi-agency partnership provision of groups for people with Aphasia. Retrieved from http://www.cplol.org/cplol2003/EN/Full_text_EN/Session8_22_Winslow.htm Accessed 22 February, 2006 Read More