Transcript Vision Rehabilitation Services: Increasing the evidence base

Parvaneh Rabiee, Kate Baxter,
Gillian Parker and Sylvia Bernard
RNIB Research Day 2014: Rehabilitation and social care
RNIB, 105 Judd Street, London
20 October 2014
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Background and the rationale for the project
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Aims and methods
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The key findings
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Conclusions
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Implications for policy and practice
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A rise in the number of people living longer with
long-term conditions
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Sight loss is most prevalent among older people
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Increasing pressure on health and social care
services
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Preventive and rehabilitation services are a high
policy priority for all care settings
 Reduce the number of people entering the
care system
 Reduce needs for on-going support
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Growing interest in rehabilitation not a new idea:
 1997: The Audit Commission
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2000 onwards: Significant investment in
intermediate care and reablement services
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2010: DH guidance on eligibility criteria for adult
social care - endorsed by:
 UK Vision Strategy Advisory Group 2013
 Vision 2020 UK 2013
 ADASS guidance 2013
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2013: RNIB - ‘Facing Blindness Alone’ campaign
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2014: Recent DH Care Act guidance
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Much of the existing research has focused on
low vision services – not clear
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What community-based rehab services are
currently doing to support people with VI
What impact they have on people with VI
What a model of ‘good practice’ might look like
The study funded by Thomas Pocklington
Trust is the first step towards a future full
evaluation study of vision rehabilitation
services
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To provide an overview of the evidence base
for community-based vision rehab
interventions:
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People aged 18 and over
Rehab interventions funded by LAs in England
The study involved 4 main research elements:
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A review of literature
Scoping workshops with people with VI and key
professionals
A national survey
Case studies
No secure evidence around effectiveness, costs and
different models of community-based vision rehab
services – however some strong messages for:
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The potential for vision rehab to have a positive
impact on daily activities and depression
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High prevalence of depression in people with VI and
increased need for emotional support
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Vision rehab interventions mostly target
physical/functional rather than social and emotional
issues
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The cost effectiveness of group-based selfmanagement programmes
All LAs (152)
Survey respondents
(87)
0%
In-house
Combination
Social enterprise
None
20%
40%
60%
80%
100%
Contracted out
Joint health/social care
Other
Not known
Specialist sensory impairment
Specialist vision impairment
Multi-disciplinary/other
Generic adult social care
Specialist physical & sensory
0%
20%
Contracted out
40%
In-house
60%
80%
Generic social worker
Specialist in vision impairment
Specialist in sensory impairment
Occupational therapist
Other (not vision specialist)
0%
20%
Contracted out
40%
In-house
60%
80%
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60% screened by professional with
specialist vision rehab skills
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95% assessed by professional with
specialist vision rehab skills
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25% required FACS assessments
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66% reported a waiting list
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Average waiting time 8-10 weeks
Measured impact
Standard tools
0%
Contracted out
50%
In-house
100%
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Survey data on budgets poorly reported
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Annual budgets £13,000 to £800,000
 Average budget £221,000
 Annual caseloads 16 to 2000
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Additional data from three case studies
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Annual budgets £238,000 to £336,000
Annual caseloads 282 to 3322
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Who provides the service
 A and B: LA in-house
 C: Contracted out service
Team delivering vision rehab
 A: Sensory Needs
 B and C: Visual Impairment
Manager specialism
 A: Social Work
 B and C: Visual Impairment
Current waiting time:
 A: up to 6 months
 B: up to 2 months
 C: up to 1 month
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35-40% of time spent on admin duties – travelling time
varied
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Differences in the way services operated
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Sites A & B restricted activities to one-to-one
intervention - Site C offered a range of group-based
activities
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Only one site (C) measured outcome using an
evaluation tool
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Limited staff training & networking opportunities - more
opportunities in site C
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Access to specialist knowledge and skills
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Early access to vision rehab interventions
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Concerns about the loss of specialist input within
the team
Late referrals risk care needs intensifying and
clients losing motivation
A tendency among health professionals to see
vision rehab as the last resort
The characteristics of people who use vision
rehab services
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A long gap between diagnosis and referral - in
particular those with degenerative conditions
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Rehab goals tailored around individual needs
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Support could continue as long as needed But...
Waiting
list to get additional training - Site B
Time constraints - Site C
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Progress monitored informally & no follow-up
contacts
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Boosted confidence, improved independence.
Increased motivation
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People felt safer
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Greatest benefits related to mobility training,
independent living skills and supply of aids, adaptation
and equipment.
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Group-based activities offer great opportunities to
socialise and learn from peers’ experiences
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Positive impacts on families
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Information not always forthcoming and timely
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Concerns about future needs
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Help often offered when it is too late/when
people ‘have to have it’
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Emotional needs not met effectively
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Social activities most often geared towards
older people
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Staff with specialist knowledge and skills
High quality assessment
Personalised support
Offering a wide range of support
Flexibility to adapt to users’ abilities
Timely intervention
Shared vision among all relevant health and
social care staff
Regular follow-up visits
Easy access to information
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Potential for vision rehab to have a positive impact on
the quality of life for people with VI
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A wide variation of vision rehab provision – measuring
outcomes not a common practice
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Restricting access on the basis of FACS assessment
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Negative impacts of financial cuts
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Lack of recognition of specialist vision rehab skills
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Group-based activities effective but limited
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Main focus is on the physical aspects of life
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All LAs should follow the recommended practice
on FACS eligibility criteria – timely intervention
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Raising the profile of specialist vision rehabilitation
skills
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Safeguarding specialist assessments
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Taking account of individual priorities
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Improved staff training and networking
opportunities
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Greater focus on group-based activities