MENTAL HEALTH FEATURE
The group was offered to patients who were at the latter stage of the occupational therapy pathway and were likely to be in the process of discharge planning . No exclusion criteria were agreed for the group , however consideration was given by the occupational therapists to each member ’ s ability to engage with the peer support element of the group .
Developed over a four-month period , the group was the result of careful co-production between the occupational therapists and the patients . Patients were asked to complete questionnaires and discuss with their occupational therapist what aspects of community living they lacked confidence in and what skills and knowledge would help them feel more prepared .
Core themes were then identified based on this feedback , and eventually six topics emerged that provided the structure of the group , with each package personalised to meet group members ’ needs : food and shopping ; money management ; health and safety in the home ; DIY and home maintenance ; keeping well in the community ; and creating links in the community .
The group was piloted as a seven-week course : an introductory session , followed by one topic covered per week . It was decided to run it for this length of time , rather than the recommended 12 weeks , due to the typical timeline of patient discharge within the service .
A key aim of the group was to create a social environment within which group members would feel empowered to share their feelings and experiences , which would be conducive towards creating an environment that would encourage and allow for peer support .
The group dynamics were therefore carefully considered during selection of group members , and group expectations were identified and agreed upon by participants .
Members were supported by the authors to share their anxieties and hopes about moving on from hospital , in order to enable peer support and promote normalisation .
The physical environment of the classroom was selected as a location , as it was private and familiar to the group members , but was adapted to create a comfortable and relaxed atmosphere .
The resources available within the physical environment were also a key consideration and a variety of activities were used within each session to meet the learning needs of all group members . This included discussion-based tasks , worksheets , case studies and practical tasks .
Group members were able to create their own Moving On resource pack , which consisted of all the content from each session . Participants were encouraged to refer to this resource pack once discharged and share this with friends , family members or care teams who may be supporting them in their Moving On journey .
One service user , David *, enrolled on the group as he was soon to be discharged to his own flat . David attended all the sessions and showed high levels of motivation in engaging with the group .
The group facilitated David to share his previous experience of living in the community and provide support and advice to his peers . Not only did this provide David with a role within the group , but it also enabled him to reflect on choices he had made in the past and consider what he would like to do differently in the future .
The main successes of the group were the peer support element , the topics covered within the group and level of engagement from the participants . This was reflected in the positive feedback received from individuals .
Group members were asked to complete post-group evaluation forms and they considered the group to be ‘ helpful ,’ ‘ relevant to their needs ’ and ‘ motivational ’. One patient commented : ‘ The Moving On group helped me to familiarise myself with the things I need to think about in relation to Moving On and discharge ’.
One challenge encountered was patient attendance , which was occasionally impacted on by external factors such as appointments , however this was effectively managed through one-to-one catch up sessions .
The outcome measure used at the conclusion of the group was a non-standardised self-assessment of change , where group members were asked to reflect on how their knowledge , skills or attitudes had changed within five key areas .
However , no baseline outcome measure had been obtained by participants prior to the session , which hindered the facilitator ’ s ability to accurately and objectively judge the overall success of the group .
During reflection after the group , the authors identified that a standardised outcome measure would improve the ability to evidence the effectiveness and value of the Moving On group and will be instigated in future .
A second reflection was that the focus on occupation was lost within some sessions , due to the amount of content and information that was being disseminated . In order to address this , the content of each session has since been streamlined and occupation has been prioritised as the key focus within every session .
The package has now been adapted to address the changes that were identified during the reflection and evaluation process , and the need for the group is currently reviewed on a monthly basis .
The Moving On group has been presented at the Cygnet Occupational Therapy conference and the package has been shared among Cygnet occupational therapists . The group will continue to evolve to ensure that it is effectively meeting patients ’ unique needs and will remain an established intervention that supports patients in their journey from hospital to living a more independent life in the community .
Reference
National Institute for Health and Care Excellence ( 2017 ) Transition between inpatient mental health settings and community or care home settings . Available at : www . nice . org . uk / guidance / qs159 / resources / transitionbetween-inpatient-mental-health-settings-and-community-or-carehome-settings-pdf-75545548372933 [ accessed 6 October 2021 ].
Clodagh O ’ Farrell , head occupational therapist , and Fiona Batty , occupational therapist , Cygnet Oaks , Cygnet Health Care , email : ClodaghO ’ Farrell @ cygnethealth . co . uk . * Name has been changed
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