Transcript Objective 1 - Communication Matters

National AAC
Dissemination
Seminar
London & South East
Monday 22nd April 2013
Prince Philip House, London
Funded by
The future of
A A C S E R V I C E S
In England
a framework for equitable and
effective commissioning
The findings of the DfE funded
AAC Grants 2012 - 2013
B A C K G R O U N D
DfE AAC Grants
Purpose of the DfE AAC Grants
To assist organisations’ transition to new commissioning
arrangements.
Applications invited from organisations in March 2012.
Project ran from April 2012 to 31 March 2013
Outcome of the project is a report intended to inform the
commissioning of the recommended ‘hub and spoke’ model
of AAC services.
B A C K G R O U N D
DfE AAC Grants
DfE AAC
Grant Regions
B A C K G R O U N D
DfE AAC Grants
North
Ace Centre
Barnsley AT Service
CandLE Ltd
B A C K G R O U N D
DfE AAC Grants
Midlands & East
ACT Birmingham
B A C K G R O U N D
DfE AAC Grants
Royal Hospital for Neuro-disability
Great Ormond Street Hospital
UCL
ACS – CLCH Trust
CENMAC
London
B A C K G R O U N D
DfE AAC Grants
Bristol Communication Aid Service
Kent CAT
Chailey Heritage
Dame Hannah Rogers trust
South
B A C K G R O U N D
The Objectives
DfE AAC Grants
1. Stakeholder involvement ALL Regions
Involving all stakeholders – patients, families, staff, commissioners
2. Mapping ALL Regions
Mapping existing services
3. Guidelines North
Writing good practice guidelines for AAC provision
4. AAC Care Pathway North
Planning the AAC Care Pathway
5. Database London
Developing specifications for data recording for AAC provision
6. Procurement Midlands & East
Developing processes for managing and procuring equipment
7. Remote assessment South
Determining how technology could help assess and support remotely
8. Training/learning London
Scoping current learning provision for AAC
O B J E C T I V E
O N E
Stakeholder engagement
All regions
O B J E C T I V E O N E
Stakeholder engagement
First meeting
identified
stakeholders.
O B J E C T I V E O N E
Stakeholder engagement
Where possible materials have been
adapted to make them accessible with
symbolisation and Easy Read.
Thanks to Widgit for
supporting the project with
Widgit Literacy Symbol.
O B J E C T I V E O N E
Stakeholder engagement
Expression of interest
A database was developed
so that people could be
further consulted on
objectives of specific
interest to them.
O B J E C T I V E O N E
Stakeholder engagement
Survey
A survey of AAC
users was developed
by the Midlands &
East Region with over
80 responses by the
end of the project.
O B J E C T I V E
T W O
Service mapping
Data collection by all regions
Collation and analysis by
Simon Judge and Sheffield University
O B J E C T I V E T W O
Mapping
Audit & mapping tool
Designed to map services providing
AAC at a local level
Developed from CM – Research
Matters project work
Referenced against the CM service
standards
Inclusion criteria, procedure and
definitions key.
O B J E C T I V E T W O
Mapping
Coverage
263 services mapped
70 further services identified
308 further catchment
services identified
Whilst we can not say that the
gaps in coverage are
definitely gaps, we can say
they are more likely to be.
O B J E C T I V E T W O
Mapping
What does a typical service look like?
Components
Information/ad…
Creation of low…
Identification…
Training for…
Ongoing…
Training for…
Follow up AAC…
Equipment…
Assessment for…
Training for…
Loan trial of…
Equipment…
Recycling of…
Equipment…
Long term…
Repair of…
Maintenance…
Positioning and…
Replacement of…
Research and…
Equipment…
Custom…
0
100
200
300
O B J E C T I V E T W O
Mapping
What does a typical service look like?
O B J E C T I V E T W O
Mapping
Variation by region and sector
O B J E C T I V E T W O
Mapping
Variation by region and sector
O B J E C T I V E T W O
Mapping
Prevalence
O B J E C T I V E T W O
Mapping
Summary & Implications
Caveats: Initial analysis of data.
Health bias to provision but significant provision in other
sectors.
Variation across regions and sectors
Significant demand for AAC services.
Information to promote equitable provision and to manage
local networks.
Explore the data yourself:
communicationmatters.org.uk/dfe-aac-project/objective-2
O B J E C T I V E
T H R E E
Good practice guidelines
North Region
Andrea McGuinness
O B J E C T I V E T H R E E
Good practice guidelines
Consultation findings
Lots of documentation out there
People using the service need to know their service is a good
quality
Commissioners know the service is equitable with the rest of
country
Those involved in service delivery need to have consistent
standards to work to and have supportive resources to do this
Roles need to be defined for hub and spoke service
Short!!
O B J E C T I V E T H R E E
Good practice guidelines
Purpose and audience
Provide structure
Team
Assessment protocols
Give information
Definitions
Background information
Measurement tool
Efficacy of the service, outcome measurement
Who to monitor
Individuals using AT, professionals, families, others...
O B J E C T I V E T H R E E
Good practice guidelines
How does it look?
Short document outlining roles / responsibilities
Supporting documentation
Glossary
CM National standards
CM outcome measurements
AAC competencies in development
O B J E C T I V E
F O U R
National AAC Care pathway
North Region
Anna Reeves
O B J E C T I V E F O U R
AAC care pathway
A brief history
Significant lobbying over many years as technology has
evolved and the number of children and adults who need
AAC has increased
Bercow Review acknowledged “that there was no consistent
or equitable system (locally, regionally or nationally) for
ensuring that those who need communication aids receive
them”
Former Communication Champion developed a
comprehensive business case for the ‘Hub and Spoke’ model
for AAC provision
O B J E C T I V E F O U R
AAC care pathway
A changing policy landscape
Health and Social Care Act and Children and Families Bill
In September 2012, specialised AAC services were
included within a list of services to be commissioned
directly by the NHS Commissioning Board
This necessitated the challenge to define who is eligible to
access specialised AAC services and what services should
also be provided by local commissioning arrangements
O B J E C T I V E F O U R
AAC care pathway
Specialised AAC commissioning
Severe physical disability especially of the upper limbs.
Additional sensory impairment to the communication impairment.
In need of specialist switch access, which may need to be bespoke.
In need of a device that integrates spoken and written communication, as well
as environment control.
Able to understand the purpose of a communication aid.
Developed beyond cause and effect understanding.
Multiple disabilities which in combination impact on the individual’s ability to
communicate.
Communication technology needs beyond the competence of the local AAC
service.
Experience of using low tech AAC which is insufficient to enable them to realise
their communicative potential.
O B J E C T I V E F O U R
AAC care pathway
Local AAC commissioning
No/mild physical disability.
Communication technology needs within the competence of the
local AAC workforce.
Co-morbid conditions that do not impact on the individuals’
communication disability.
Minimal upper limb impairment.
Language commensurate with cognitive skills.
Preverbal communication skills.
Not achieved cause and effect understanding.
O B J E C T I V E F O U R
AAC care pathway
O B J E C T I V E
F I V E
Database specification
London Region
Gary Derwent
O B J E C T I V E F I V E
Database
Current picture
There is currently no consistent method of collecting, managing and
analysing data relating to the provision and use of AAC in England.
Information gathered by Sheffield University as part of the Communication
Matters : Research Matters project showed a wide range of methods of data
collection regarding AAC assessment and provision. 92 AAC services
throughout England were asked “Which database system do you use to
record your data?”
25.0%
21.7%
15.0%
10.8%
10.8%
6.5%
5.4%
4.3%
Named a specific clinical database such as Rio, Lorenzo or SystmOne.
Listed only standard office databases or spreadsheets (Access / Excel).
Did not answer or provided unclassifiable answers.
Indicated a probable major database using generic initials (ie PAS / CRS).
Specified a combination of a major database and local desktop databases.
Listed a local or custom database without stating how it was implemented.
Stated that they used paper systems only.
Named a specific education database such as B-Squared or DataBridge.
O B J E C T I V E F I V E
Database
Changing aims
To identify potential users of data who will benefit from accessing data on
AAC provision.
To identify the requirements of each of these potential users of data.
To identify broad categories of data that would need to be managed.
To identify permissions for each user type to view each category of data at
either an individual identified level or anonymous aggregated level.
To propose potential data items, data types and coding systems within each
data category.
To identify members of the AAC community at all levels who would be
interested in continuing to provide feedback beyond the DfE project, should
the NHS wish to utilise this.
O B J E C T I V E F I V E
Database
Potential data users
Table 1A. Potential users of data by role
1. Service user and family
1.1 Service user
Child service user , Adult service user
1.2 Parent / guardian / next of kin
Parent / guardian of child, Next of kin of adult
2. Organisations with contact with the service user
2.1 AAC Hub Staff
Hub clinical staff, Hub technical support staff, Hub admin staff, Hub management
2.2 AAC Spoke Staff
Spoke clinical staff, Spoke technical support staff, Spoke admin staff, Spoke management
2.3 Local NHS community team
Local team clinical staff, Local team technical support staff, Local team admin staff, Local team management
2.4 School
School SENCO, School technical support staff, School admin staff, School Head / Management
2.5 GP surgery
GP, GP admin staff
2.6 Environmental controls service
EC service clinical staff, EC service technical support staff, EC service admin staff, EC service management
2.7 Wheelchair service
Wch service clinical staff, Wch service tech support staff, Wch service admin staff, Wch service management
2.8 Local authority social services
2.8.1 Local authority social worker
3. Commissioning and other statutory services without client contact
3.1 Area Team (AT)
Area Team commissioner, Area Team Admin staff
3.2 Clinical Commiss. Group (CCG)
CCG commissioner, CCG Admin staff
3.3 Local authority education dept
Local authority education management, Local authority education admin staff
4. Equipment suppliers
Equipment supplier staff
5. Research organisations
Researcher
O B J E C T I V E F I V E
Database
#
1
Data group name
Identifier
Description
A unique identifier for the service user. NHS Number.
2
3
4
5
Service user name
Demographic data
Service user contact details
Family / Next of Kin contact details
Service user’s name.
Users demographic data.
Address, telephone, email.
Address, telephone, email.
6
7
Other services contact details
Diagnosis details
Contact information for all involved parties
Primary diagnosis resulting in communication needs and any relevant secondary diagnoses
8
Referral to Spoke
Information provided to the spoke when referral received.
9
Referral to Hub
Information provided to the hub when referral received from spoke.
10
Remote connection details
Fields to record details of video-conferencing and remote support facilities for the service user.
11
Contact log / progress notes
Fields to track day to day interactions.
12
Goals / aims / targets
Fields to record the goals of intervention.
13
14
Assessment / review information
Assessment / review conclusions
Information generated by the assessment (at spoke or hub level).
Recommendations made by the assessment (at spoke or hub level).
15
Workload planning / task management
Fields to record tasks required (at spoke or hub level)
16
Loan episode details
Fields to record a loan of assessment equipment to a service user.
17
Loan episode conclusions
Fields to analyse outcome of a loan episode.
18
Equipment issue
Fields to record the issuing of the service user’s own equipment.
19
Equipment return
Fields to record the return of the service user’s own equipment with reasons.
20
Current AAC device / technique
The AAC device or technique the service user is currently using.
21
History of AAC devices / techniques used
List of previous techniques and equipment used.
22
Other related equipment
List of other equipment used, such as environmental controls and wheelchairs.
23
24
Clinical Outcomes
Service user satisfaction data
Formal outcome measures & other data with a function in measuring outcomes (TOMs, GAS etc)
Results of user satisfaction surveys and questionnaires.
25
Contracting outcomes
Contracting outcomes, eg CQUINS.
26
Tariff details
O B J E C T I V E
S I X
Procurement
Midlands & East Region
Clive Thursfield
O B J E C T I V E S I X
Procurement
Procurement, maintenance, recycling
Activity within the AAC field has been focused on where and how
aid funding can be achieved.
Little room for broader considerations such as “what is the
most cost effective way of procuring AAC equipment” and
“how can we make best use of this, often, very expensive
equipment”.
The establishment of AAC as a National Commissioning Board
Specialist Service affords us an opportunity to devise a new
system which is defined by:
O B J E C T I V E S I X
Procurement
A new system which
is defined by:
Equipment is made available to
assessing professionals when
and where they need it
Minimum administration needed
to obtain equipment
Minimum administrative and
logistical costs
Maximum use of equipment
(minimum redundancy)
Maximum use of equipment
(optimised technical maintenance)
Maximum purchasing power
Sustainability for suppliers
Optimising innovation
O B J E C T I V E S I X
Procurement
Equipment is made available to
assessing professionals when
and where they need it
Minimum administration needed
to obtain equipment
Minimum administrative and
logistical costs
Maximum use of equipment
(minimum redundancy)
Maximum use of equipment
(optimised technical maintenance)
Three ‘models’ considered
rental agreements
outright purchase:
1. A single national
procurement centre
2. A sub set of specialist
centres procure on behalf
of all specialist centres
Maximum purchasing power
Sustainability for suppliers
Optimising innovation
3. All specialist centres
procure for their own
needs
O B J E C T I V E S I X
Procurement
Recommendations
A National Framework Agreement which includes all AAC equipment
including ancillaries and supporting equipment should be established
via the OJEU process which will meet Public Procurement and NHS
Standing Financial Instructions.
On behalf of the NCB it would be led by the NHS Supply Chain who will
represent and coordinate with the AAC Specialist Services.
This National Framework will be an opportunity for negotiations on best
value for money and for suppliers to properly represent the totality of
their product/service.
O B J E C T I V E S I X
Procurement
Recommendations (cont’d)
Procurement should be the responsibility of each Specialist Service which
is defined by the NCB and the AAC Specialist Service Specification,
operating with and within the National Framework Agreement.
Each Specialist Service should have a technical capacity to enable it to
ensure that the AAC equipment in their catchment area is maintained to
optimise its use and avoid unnecessary redundancy.
The technical maintenance of the equipment will be a combination of ‘inhouse’ capacity and liaison and collaboration with suppliers to ensure the
most cost effective approach. Similarly, the technical capacity will ensure
that uncommitted equipment is made ready for recycling.
O B J E C T I V E S I X
Procurement
Recommendations (cont’d)
A national data source should be provided and a network between the
Specialist Centres be established to promote and facilitate recycling of
equipment on as wide a basis as possible but should only apply to
equipment where recycling costs are less than the equipment cost. The
costs of recycling should be built into Specialist Services contract costs.
O B J E C T I V E
S E V E N
Remote Access & video
conferencing
South Region
Judith De Ste Croix
O B J E C T I V E S E V E N
Remote access and video conferencing
Updated literature review
Surveys were undertaken to determine current AAC remote
access technology use
An information pack was created to standardise trial
methodology and provide information for those involved.
Remote access and videoconferencing trials were carried
out with professionals and service users.
Remote access and Video conferencing products were
evaluated and a evaluation tool was developed.
O B J E C T I V E S E V E N
Remote access and video conferencing
Literature review
20 published papers were included
Selection of clients
Remote service delivery not appropriate in all circumstances or for all clients.
More robust evidence needed
Technology
Hardware/software
Network
Client acceptance
Generally good in all the studies.
Professional acceptance
Tended to be more sceptical.
Training
Lack of comprehensive training in this area.
Information governance and data security
A number of issues outlined that need to be considered
Costs
Cost of installing and setting up a service
Increased demand for services.
Long term costs of delivery may be less than cost of establishing services. No definitive data re
this.
O B J E C T I V E S E V E N
Remote access and video conferencing
Survey
The questionnaire collected quantitative data and identified:
suitable technology for evaluation
best practice models
barriers, limitations and problems experienced
current pathways, standards and documentation used
potential participants
current costings
80 professionals and 8 service users responded
O B J E C T I V E S E V E N
Remote access and video conferencing
Information pack
information sheets were provided to include:
•
•
•
•
•
•
•
•
An introduction to videoconferencing and remote access
How to prepare for sessions
How a session would take place
What would be expected of the AAC user
Videoconferencing etiquette and how it differs from face to face
communication
Advantages of remote sessions
Consent forms
Guides to the specific software packages being used with set-up
instructions
Also questionnaires were designed and used to collect quality and cost data to
inform the outcomes of the project.
O B J E C T I V E S E V E N
Remote access and video conferencing
Trials
A total of 14 trials were carried out.
Aims
•
•
•
•
•
Identify suitable technology to carry out sessions
Identify and assess suitable services and users for sessions
Assess professional and service user acceptance of remote service delivery
Identify barriers, limitations and solutions for remote service delivery
Assess cost comparisons of remote sessions and face to face appointments
Outcomes
•
•
•
•
•
Supported trials and showed that remote service delivery successful for:
Training
Review appointments
Appointments for those with in-tact cognitive skills
Appointments for those who struggle in new environments and/or with unfamiliar people
O B J E C T I V E S E V E N
Remote access and video conferencing
Costs: video conferencing
Video conferencing clinical trial
savings
Video conferencing trial
percentage savings
O B J E C T I V E S E V E N
Remote access and video conferencing
Costs: remote access
O B J E C T I V E S E V E N
Remote access and video conferencing
Evaluation tool
An online tool was developed to ensure consistency and objectivity in analysis and
comparison of system features when selecting remote access software
Scoring system was applied to easily identify suitable products based on user
requirements.
Criteria for analysis based on
The project specification
Product features required for successful AAC interventions
Clinical governance influence
Security requirements
The tool is divided into 5 sections.
Product features
Security requirements
Ease of use
Network requirements
Costing tool
The score is determined by requirements selected as Essential or desirable and if
the feature is available on that system.
O B J E C T I V E
E I G H T
Training & Learning
London Region
Mike Clarke
O B J E C T I V E E I G H T
Training and learning
Training Provision
1. To investigate regional variation in availability of
training to professionals supporting people using AAC in
England
2. To examine the amount and type of training currently
provided, and priorities for future training
O B J E C T I V E E I G H T
Training and learning
Regional variation in availability of training
Number of services providing training
Number of services not providing training
60
50
40
30
20
10
0
East
Midlands
n=187
East of
England
London
North North WestSouth East
East,
Coast
North
Cumbria
and
districts of
North
Yorkshire
South
West
Thames
West
Yorkshire
Valley and Midlands and the
Wessex
Humber
O B J E C T I V E E I G H T
Training and learning
Professionals receiving training
Other
Doctors
Commissioners
Psychologists
Social workers
Clinical technicians
Managers
Physiotherapists
Nurses
Occupational therapists
Care assistants
Teachers
Teaching assistants
Speech and language therapists
0
n=107
10
20
30
40
50
60
70
O B J E C T I V E E I G H T
Training and learning
Subject areas in which training is delivered
Use of specific AAC products,
systems and technology
31%
38%
Introducing/awareness raising
of AAC products, systems and
technology
Language development and
learning through AAC
Cognition and language
12%
8%
11%
n=84
Other (representing 11 different
subject areas)
O B J E C T I V E E I G H T
Training and learning
Levels at which training is provided
Use of specific AAC products,
systems and technology
Introducing/awareness raising of
AAC products, systems and
technology
Foundation
Intermediate
Language development and
learning through AAC
Advanced
Cognition and Language
0%
n=72
20%
40%
60%
80% 100%
National AAC
Dissemination
Seminar
London & South East
Monday 22nd April 2013
Prince Philip House, London
Funded by