Conwy Falls Programme
Falls are the most common cause of serious injury in older people and the most frequent reason for hospital attendance. Our Welsh Government Survey showed that fear of falling is a significant factor in reducing physical activity and participation in society amongst adults. We feel that falling does not have to be an inevitable part of growing older and our Falls Prevention team work with people over the age of 65 to help reduce the risk of slips, trips and falls.
The team is made up of four specialist officers, co-located within Conwy’s Information, Advice and Assistance (IAA) section with other related teams. They screen all new referrals, carry out home-based assessments, identify the individual’s risk factors and make recommendations. This could include signposting to appropriate agencies/services, advising on hazards within the home environment or suggesting exercises to build resilience.
The team work with partners in Health, the Fire Service and voluntary agencies to raise awareness and provide information in the community. Up to the end of 2017 25% of care homes had received training on the fall risk assessments tool, all pharmacies in Conwy had been provided with leaflets, and valuable links were established with charities and support groups.
We work closely with our health colleagues to ensure speedy discharges. The rate of delayed transfers of care – people not able to leave hospital because there is no support available for them at home – is 0.33 % – per 1,000 population aged 75 or over.
A lady was referred to the falls service after suffering a fall and having frequent ‘near misses’. She was also at risk of a dislocation if she performed certain movements. Her mobility was significantly reduced and she was at high risk of further falls.
The Falls Officer discussed her situation thoroughly with her and they agreed that a referral to PSI (Postural Stability Instruction) classes would be beneficial. During the telephone review some weeks later, the lady informed her that she was thoroughly enjoying the classes and said there was a good rapport in the group, adding that the sessions had highlighted definite limb/muscle strengths and weaknesses. She also expressed an interest in free swimming sessions in order to practice her hydrotherapy exercises for her right hip. In fact, her overall health has improved so much that she was considering a holiday with her partner which was something that she had not been able to do for a number of years. She also said that she was recommending the service to her friends who have fallen, providing them with the SPOA number so they can request an assessment from the team.
Conwy Family Centres
We are developing Family Centres across Conwy, to provide community-based and accessible support, available earlier for families, and open to all families. We already have a Family Centre in Llanrwst, which serves the rural community. Based on experience from this centre, and research with families and service providers, we have developed this model to be developed across the county, with a total of five Family Centres.
Each Family Centre will have a core team of Family Support Workers, who will get to know the local communities and build relationships with other people and groups working with families in the area. There will be other services delivered out of the Family Centres, such as domestic abuse and family counselling, making sure that families can access the support that they need at an earlier point. We will be working together to make sure that we support the whole family effectively. We will be using volunteers and giving communities the opportunity to get involved. The Family Centres will run activities and provide all kinds of things to meet the communities’ needs. For example:
- Support, information and advice for families of all ages
- Parenting classes and groups
- Baby and toddler sessions
- Support for young people
- Cook and eat sessions
- Drop ins
An important part of this project is community engagement and involvement. A Parents Advisory Group meets monthly to get involved with the project development. We have also consulted with families, children and young people in the areas where we are developing. This will help us to understand and respond to what families need in each community.
The East of the county is the first area to see a new Family Centre developing. We are refurbishing a wing of a building next door to Emrys Ap Iwan Foundation School, and this will be open in the summer of 2018. We have been running some pilot activities in the East area, to help us learn about what works well and what families need in the East area. We have created a video to tell people about it.
We’ve received great feedback!
When I first came here I didn’t feel I was meeting the boys’ needs at all, I felt like the most useless parent on the planet…… we have definitely made progress and things were really positive.
As soon as [Team Around the Family] got in touch with me I felt like there was someone there that actually listened to my needs, and because they are so complex, so many. It was amazing because a lot of people had gone “oh we don’t really deal with that”, whereas….there is somebody there that knew and that could do it all for you as well.
Because it can give unhappy parents a chance to bring family together again…it keeps families connected.
Year 10 boy
We’re going to be looking at the central area Family Centre (Colwyn Bay and surrounding communities). We are considering possible locations at the moment, and we are consulting with families. We will be considering the lessons learnt from the pilot project in Abergele and working to implement these in the centre when it’s open and take account of the messages in our further developments.
How well are we supporting our children?
- 78% of children seen by a registered dentist within 3 months of becoming looked after (PMC30)
- 100% of children looked after were registered with a GP within 10 working days of the start of their placement (as at 31 March, PMC31)
Working to Improve Mental Health
We have been working with our Health colleagues through a series of meetings to create an Integrated Mental Health support model for Looked after Children. We are also streamlining a Continuing Care Multi Agency model to support the Strategic Multi Agency Panel process. This will help us get a better understanding of the needs of children and plan more effectively to meet those needs. The aims are to provide early intervention to prevent escalation, have more targeted support for Foster Carers and Adopters and improved placement stability. This will be launched at the end of June. The priority for next year will be to ascertain how effective the model is.
We are working together with Health colleagues to develop specific training around self-harm for foster carers, to help them support the children in their care and maintain these placements. The training will be rolled out in the summer.
The Prevention and Early Intervention Community Service aims to manage the ‘front-door’ of mental health services very differently and offer a robust, effective and evidenced-based alternative to a ‘medical model’ of Secondary Care i.e. working with people with mental health issues and/or experiencing distress due to a social crisis in order to foster and maintain their personal resilience and mental, social and psychological wellness. Social Workers will work flexibly and creatively to meet the needs of service users; to address causes of crisis and loss of mental wellbeing, e.g. housing, welfare, financial inclusion, social isolation, employment. They will undertake the Integrated Assessment process, offering information, advice and/or assistance according to the desired personal outcomes identified from a ‘What Matters’ conversation. Anyone who is identified as requiring a medical service and assessment under the Mental Health Measure will be referred to the Community Mental Health Team. However, as the volume of cases being passed to the CMHT will be lower, a more efficient and effective service will be provided for those service users who require specialist medical intervention.
Learning 4 Recovery
The ‘Learning 4 Recovery and Wellbeing’ brochure is specifically aimed at people who use mental health services or care for someone who does. It will be produced quarterly and will be available as a printed brochure and online. It was put together by Conwy’s People’s Partnership group for Mental Health and Emotional Wellbeing, and has been a collaboration between statutory and third sector organisations.
Courses are themed so that people can find sessions that are relevant to them, whether they are starting to understand their mental health issues, are looking to gain life skills, wanting to find ways to become socially active, or want to find work or volunteering opportunities.
Supporting people to live well with dementia
The Dementia Map developed by Health, Social Care and third sector professionals (see below) will be used to facilitate conversations with people diagnosed with dementia, and their carers. The aim is that the map will support people to understand their dementia journey and help them plan for what may be ahead as their dementia journey progresses. Services for people diagnosed with early onset dementia have been identified by the group as a gap in current service provision, and this will be the focus of the group for the year ahead.
Discussions with Health colleagues have also resumed in relation to potential joint commissioning of respite provision in a Nursing facility, as the provision of respite care is also a recognised gap in current service provision. We will be working with BCUHB and the third sector on innovative new proposals which will be linked to the prevention agenda, aimed at providing effective support for people with dementia and their families/carers to maintain their independence, thus reducing the likelihood of hospital admissions and delaying the need for residential or nursing care. This will also alleviate the pressure on the independent sector providers. It is envisaged that any new service proposals will support us to deliver on the priority actions identified in the Dementia Action Plan for Wales 2018-2022.
The Dementia Map
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