CLAHRC-NDL Engage Edition 2 - Autumn 2010

CLAHRC Associates

We now have almost 500 associates, join them and keep up to date on CLAHRC-NDL’s news and events: • Updates about your area of interest• Training and development opportunities • Networking opportunities • Information about conferences, lectures and

seminars

Register to become an associate at: www.clahrc-ndl.nihr.ac.uk/associates

Welcome

This bumper issue of Engage includes details of the first CLAHRC-NDL conference on ‘ImprovingHealthcare – the role of CLAHRC-NDL’. An introduction to the event is on pages 21-23, and a video of proceedings will be available on our website.

In this newsletter we also present some of the theory behind communities of practice and how these are developing in the region around four CLAHRC-NDL themes: Stroke Rehabilitation, Adult Mental Health, Primary Care, and Children and Young People.

Each of these research themes provides an update on its work here, as do the two cross-cutting themes: Implementation, and Engagement, Synthesis and Dissemination (EnSyD).

We hope that this overview of the CLAHRC in Nottinghamshire, Derbyshire and Lincolnshire will leadyoutofindoutmorebycontactingtheindividualsnamed for further information, and by logging on to our website: www.clahrc-ndl.nihr.ac.uk

Our mission:

“To undertake high quality, applied research and related education in order to enable a ‘step change’ in the way research is delivered and services are designed. We foster ‘knowledge exchange’ that improves the quality and effectiveness of health and social care delivery across the north East Midlands.”

What is the CLAHRC?

The Collaboration for Leadership in Applied Health Research and Care (CLAHRC) brings together the University of Nottingham and local health and social care providers in Nottinghamshire, Derbyshire and Lincolnshire (NDL) to conduct applied research that will have a direct impact on health and social care practice.

It is jointly funded by its partner members and the National Institute for Health Research (NIHR), and is one of nine across England.

CLAHRC-NDL Bi-Annual Newsletter Edition 2 - 2010

engage

Contents INTRODUCTION3 Director’s Comments

CHILDREN AND YOUNG PEOPLE4 Mental health in schools 5 Behaviouralrewards‘worklikemedication’

MENTAL HEALTH 6 Employment study launch7 Chronic mood disorder, Readiness for treatment in personality disorder

PRIMARY CARE 8 Impact of injuries, Regular attendance, Making an impact nationally9 Welcome to new staff, Supporting lifestyle change in South Asians, Call for help from mothers in Derby

STROKE REHABILITATION 10 Early Supported Discharge, HOVIS study11 Return to work, Upper limb rehabilitation

Dates for your diary

ENGAGEMENT 12 Systematic reviews, Priorities for research on children’s health 13 What is synthesis?, CLAHRC-NDL PhD studentship

IMPLEMENTATION 14 CLAHRC model, Exploring early interventions15 Development series, Open Access publications

16 FEATURE: COMMUNITIES OF PRACTICE

OUTPUTS: SYSTEMATIC REVIEWS18 Sickness absence due to pregnancy- related ill health19 Physical health care monitoring for people with serious mental illness

CLAHRC PROFILES20 Dr Anne Thomson and Trevor Jones

21 CONFERENCE SPEAKERS’ PROFILES

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Forthcoming development series events in 2010:

29 September: Lunchtime learning – Qualitative Analysis

21 - 22 October: University of Nottingham Institute for Enterprise and Innovation (UNIEI) Innovation Course

1 - 3 November: NVivo Data Analysis software training

Further details on these and other CLAHRC events can be found on our website: www.clahrc-ndl.nihr.ac.uk/news-and-events

www.clahrc-ndl.nihr.ac.uk 3

Introduction“Welcome to the second edition of Engage. We have made tremendous progress with CLAHRC - our projects have gone through academic, commissioner, service user/carer, and ethics reviews, with many now recruiting patients. Seeing results truly highlights that CLAHRC-NDL is continuously moving forward. Thanks to everyone for their contribution so far!

Recent political changes are at the forefront of issues, drawing attention to the current need to deliver both productivity and quality gains through CLAHRC-NDL. Indeed, our first CLAHRC-NDL conference on 21stSeptember 2010 at Trent Vineyard will focus on such matters.

CLAHRC-NDL was funded at a time when we anticipated new services would be commissioned based upon evidence produced by our applied research activity. Things have undoubtedly changed. CLAHRC-NDL will have to deliver value to partners in new ways so that the NHS can

deliverefficiencygainssafely.Newevidence-basedservicesmaybecommissionedbuttheeconomiccase for this will need to be strong. CLAHRC-NDL evidence may also be used to benchmark whether existingservicesshouldcontinue.Thisrepresentsnewterritoryforusall,butitreflectsoneofthekeydimensions of CLAHRC-NDL – the need to respond swiftly to the changing face of health and social care through innovative thinking.

Finally, to end on a very positive note, I was delighted to see continued support for CLAHRCs highlighted in the recent July White Paper (see below). On this basis, I remain hopeful that the CLAHRC will be re-financedfrom2013onwardsaswasoriginallyanticipated.

Professor Graeme CurrieDirector of CLAHRC-NDL, Professor of Public Services Management, University of Nottingham Business School

Extract from Equity and Excellence

The Government is committed to the promotion and conduct of research as a core NHS role. Research is vital in providing the new knowledge needed to improve health outcomes and reduce inequalities.Researchisevenmoreimportantwhenresourcesareunderpressure–itidentifiesnewways of preventing, diagnosing and treating disease. It is essential if we are to increase the quality and productivity of the NHS, and to support growth in the economy. A thriving life sciences industry is critical to the ability of the NHS to deliver world-class health outcomes. The Department will continue to promote the role of Biomedical Research Centres and Units, Academic Health Science Centres and Collaborations for Leadership in Applied Health Research and Care, to develop research and to unlock synergies between research, education and patient care. (Equity and Excellence: Liberating the NHS 3.16)

Promoting and educating schools on mental health

Over the past year, CLAHRC staff have been working on a secondary school-based study in three mixed-sex comprehensive schools in Nottingham and Nottinghamshire. It aims to prevent depression in adolescents considered to be at high risk of developing this condition.

The study, “PROMoting Mental health In Schools through Education” (PROMISE), is a randomised controlled trial involving over 5000 young people aged between 12 and 16 years across Nottingham and Nottinghamshire, Bath, Bristol, Swindon and Wiltshire. Eachpupilcompleteda‘Mood&Feelings’questionnaireatthreepoints-atthestartofthestudy,aftersix months, and again after 12 months. Pupils could be at risk, for example, if they reported feeling unhappy, restless, lonely or cried a lot.

The interventions have taken place over nine weeks at a whole-class level in Personal Social and Health Education (PSHE) lessons. The study examines the effectiveness of a school-based cognitive behaviour therapy (CBT) programme, versus two other programmes; PSHE delivered by people external to the school and usual (school-delivered) PSHE. The study is led by the University of Bath together with the University of Nottingham and NottinghamshireHealthcare NHS Trust, and is run in collaboration with academic colleagues at the University of Bristoland the Peninsula Medical School in Exeter. It is funded by the NIHR Health Technology Assessment (HTA) panel.

Children and Young PeopleThe Children and Young People’s Theme focuses primarily on child and adolescent mental health and issues of public health and service development. Early intervention, disruptive behaviour problems and obesity are key targets within the theme. Each of the projects includes an implementation arm to identify the barriers and drivers that may prevent or help the uptake of research in practice.

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Children and Young People

Activity in different parts of the brain was monitored using an electroencephalogram (EEG). The team found that the incentives helped the children perform better at the game andhadtheeffectof‘normalising’brainactivity,although not to the same extent as the child’s normal dose of Ritalin.

Professor Chris Hollis, who led the research, said that the findings might mean childrenwith ADHD could eventually take lower doses of drugs while maintaining control of their behaviour:

“Although medication and behaviour therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their effect on the brain. Both help normalise similar components of brain function and improve performance.”

But he also warned that teachers and parents may struggle to give instant rewards:

”We know that children with ADHD respond disproportionately less well to delayed rewards - this could mean that in the ‘real world’ of the classroom or home, the neural effects of behavioural approaches using reinforcement and rewards may be less effective.”

To find outmore about this research pleasevisit www.midas-adhd.org.uk or contact: [email protected]

Research led by CLAHRC’s Professor Chris Hollis has found that children with attention-deficit disorders respond to on-the-spot rewards in the same way as they do to medication.

A team at the University of Nottingham measured brain activity as children played a computer game, offering extra points for less impulsivebehaviour.Theirfindings,publishedin Biological Psychiatry, could eventually mean lower doses of drugs such as Ritalin would be needed in severe cases.

It isbelievedthatuptofiveper cent of children in the UK have some form of attention-deficithyperactivitydisorder(ADHD). This can lead to behavioural problems and can affect a child’s academic and social progress.

In severe cases, stimulant drugs can be given, such as Ritalin, which acts on parts of the brain associated with attention and behaviour. In addition, parentsareoftenaskedtotrytoinfluencetheirchild’s actions directly by rewarding positive behaviour and making sure there are negative consequences if a child behaves badly. Unlike in non-ADHD children, these incentives and disincentives only work well if delivered on the spot, as opposed to later in the day or week.

In order to look at the effects of this “behaviour therapy” in a child’s brain, the Nottingham team devised a computer game in which children hadto‘catch’aliensofacertaincolour,whileavoiding aliens of a different colour. The game was designed to test the children’s ability to ‘applythebrakes’ontheirbehaviour.

Behavioural rewards ‘work like medication’ for ADHD

Mental Health

‘The partnership between the Involvement Centre and CLAHRC-NDL is an exciting opportunity to help service users develop new skills and knowledge.’ Paul Sanguinazzi, Head of Involvement at Nottinghamshire NHS Trust

Justine Schneider, Principal Investigator on the study, also spoke of the strong support CLAHRC has received from Nottinghamshire NHS Trust. Julie Swann, from the Employment Connections Service wrapped up the launch by describing the advice and guidance which Employment Specialists will provide to service users, as well as the need for ongoing support once service users have found employment.

If you are a user of mental health services in Nottingham city and would like further information about joining the study contact [email protected]

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Employment study launch

Our Individual Placement Support (IPS) study was launched on 7th June at the Involvement Centre within Duncan Macmillan House.

This pilot study is taking place in the city of Nottingham and aims to assist people with mentalhealthdifficultiestofindemployment.

IPS consists of intensive, individualised support,benefitsadviceandarapidjobsearch,followed by placement in paid employment, and time unlimited in-work support for both the employee and employer.

The launch event saw Catherine Pope, Diffusion Fellow for the study, speaking about principles of recovery. Eric Wodke, IPS Development Manager, emphasised that the IPS approach represents the distillation of best practice, and is a proven method for helping service users back into work, and Athfah Akhtar answered questions about the research.

Research projects have been selected in the Mental Health theme to be service-facing; that is they seek to improve standard clinical care in relation to best practice standards or to enhance usual care through innovation.

Eric Wodke, IPS Development Manager

The IPS study team


Readiness for treatment in personality disorder

This study aims to map existing Personality Disorder services in the region, devise and pilot an intervention toenhanceengagement,andfinally todisseminate thisalongwithpotentialmeasures,interventions and guidelines.

Principal Investigator, Professor Kevin Howells, describes the concept of ‘readiness for treatment’as “the presence of characteristics (states or dispositions) within either the client or the therapeutic situation, which are likely to promote engagement in therapy and which are likely to enhance therapeutic change”.

In a presentation to CLAHRC staff and Diffusion Fellows, he outlined a range of readiness factors and certain ‘indicesof engagement’, suchas the ‘therapeutic alliance’, pointing to the implicationsalso for CLAHRC studies: to promote success and prevent drop-out from research, it is important toestablish working relationships between researchers and study participants, just as between clinicians and patients.

Chronic mood disorder trial

Depression is a common problem and the Increasing Access to Psychological Therapies (IAPT) services have been set up to offer cognitive behaviour therapy which is often successful. However, should it fail or the disorder recur, rapid access to specialist treatment is important.

Nineteen participants have been taking part in a randomised controlled trial of a specialist depression team, receiving either standard care, or enhanced specialist care. Service users have already made a number of recommendations to services. These include:

• The formation of long-term support groups after psychological treatment has ended and developing service-user-led treatments

• Initiating a conference on coordinating services for depression• Changes to local policy, so that IAPT service users can now receive a secondary care mental health

assessment.

Can you help?

The Mental Health Team have designed an interview to establish what helps treatment engagement for peoplewithapersonalitydisorder,andexplorewhatmakesengagementmoredifficult.Wearecurrentlylooking for 100 service users and 55 clinicians across Nottinghamshire, Derbyshire and Lincolnshire.

If you would like to know more about the interviews, or if you are interested in being interviewed, please contact: [email protected]

Primary Care

Understanding regular attendance in primary care

This project aims to determine whether a nurse based cognitive behaviour therapy intervention for regular attenders in primary care with depression, anxiety or medically unexplained symptoms is more cost effective than usual treatment.

With the help of a large GP practice in Bassetlaw, the team havealready identifiedapproximately690patientswhoattendedthe practice on at least 40 occasions in the last two years and who may have problems with depression, anxiety or medically unexplained symptoms. Over the two year period in question these consultations have cost in the region of £600,000. Some saving in these consultations and costs would free much more access to care for other patients, and would reduce the costs of primary care.

The team have been given the go-ahead to move forward with this important research which aims to have a deeper understanding of patients who attend their GP practice frequently, the nature of their underlying problems, reasons for consulting so much, and what other services they are in contact with. Thiswillultimatelyassistinfinding,andimproving,waysofmeetingtheirneeds.

The patients in the study account for around 28,000 contacts with the practice in the last two years and our next step is to interview some of these patients and offer a talking therapy treatment to a selected fewtoassessthebenefitsforpatients,andthecost-effectivenessforthepractice.

The Primary Care research projects highlighted on these pages reveal some of the new and innovative approaches being undertaken in this area.

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Impact of Injuries study

The Impact of Injuries study attempts to address the lack of information on psychological problems following injury and the extent to which patients’ needs are being met. The project comprises two linked studies which take complementary approaches to understanding levels of need and how best to designservicestoprovideappropriatepsychologicaltreatmentsforthesepatients.Thefindingsfromthese studies will help the NHS develop services to help injured people make a better recovery.

We are delighted to report that recruitment of participants to the study is now under way at four emergency departments in England including the Queen’s Medical Centre in Nottingham, and three others in Bristol, Leicester and Surrey. The project is well on the way towards achieving its target of 680participants-Junesawtheteammoveonestepclosertofindingoutmoreabouttheeffectsofaccidental injury on people’s lives and how to help them make a better recovery.

Making a national impact on pre-conception care

ThePre-conceptioncareteamarealreadystartingtohaveinfluenceonanationalstage.DiffusionFellow Nadeem Qureshi has persuaded the Quality and Outcomes Framework panel to consider including preconception healthcare assessment as part of the reward and incentive programme for all GP surgeries in England.


Welcome to new staff

We are delighted to welcome three new Diffusion Fellows, Andrew Bartholomew, Steve Regel and Julie Clarkson.

Healthier lifestyles - the South Asian way

Do you have a particular interest in or experience of helping to support lifestyle change in people from South Asia? Then you may be able to contribute to our research by getting involved in one of our focus groups.

We would particularly like to hear the views of community-based professionals in Nottingham and Derby with hands-on experience of supporting lifestyle change in South Asians – for example, you may be a community worker or an exercise faciliator.

Mothers and mothers-to-be in Derby

We are looking for women of child-bearing age to be involved in a focus group about a ques-tionnaire we have designed for use in GP sur-geries.

If you are a woman who belongs to a parent-and-toddler group, faith centre, or another com-munity-based group in Nottingham or Derby City Centre, and are interested in being involved, please contact us (details below). We are par-ticularly interested in the views of women from Pakistani, Indian and Caribbean communities.

Tofindoutmoreabouteitheroftheseitems,pleasecontact:[email protected] or call 0115 8231438.

Can you help with our studies?

Julie Clarkson is an Occupational Therapist, currently team leader on Burns, Plastics and Orthopaedics at Nottingham University Hospital. Julie has worked at the city hospital campus for 24 years, with most of this time spent working on Medical Surgical and Oncology in- and outpatients. Julie joined CLAHRC-NDL as a Diffusion Fellow in February 2010 and will be working with the Impact of Injuries team researching how to address the needs of accidental injury patients.

Steve Regel is Principal Psychotherapist/Co-director of the Centre for Trauma, Resilience and Growth, Nottinghamshire Healthcare NHS Trust. He is also Special Lecturer in the School of Sociology and Social Policy, University of Nottingham and a Senior Fellow of the Institute of Mental Health, Nottingham. He is a Diffusion Fellow for the Impact of Injuries study within the theme.

Andrew Bartholomew is a General Practitioner in the North West of Derbyshire and has been a partner in the same Practice for 25 years. Andrew has joined CLAHRC-NDL as the Diffusion Fellow for the Pre-conceptionCarestudy.Hewillbeworkingtoovercomethedifficultiesthatexistingettingresearchevidence to lead to changes in practice, and consequently to improvements in clinical effectiveness and care.

Stroke Rehabilitation

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Early Supported Discharge (ESD) study

Rebecca Fisher and Marion Walker (Principal Investigators), Kay Gaynor (Diffusion Fellow) and Micky Kerr (Senior Research Fellow) have carried out an ESD consensus activity with ESD trialists that contributed to the 2005 Cochrane systematic review on ESD (Langhorne 2005). The aim of the activity was to reach consensus on key aspects of an effective ESD service and clarify messages from the research literature to make them more accessible to commissioners and service providers. Results from the ESD consensus activity have been disseminated in a short report to the Stroke Improvement Programme (www.improvement.nhs.uk/stroke) and are currently being written up for publication.

The ESD consensus document summarises key elements of an ESD service and promotes the implementation of evidence-based ESD services in local regions. It has been used to inform a collaborative initiative between CLAHRC-NDL and the East Midlands Cardiac and Stroke Network to developanevidence-basedESDservicespecification forthe East Midlands. Continuing research will evaluate health and cost benefits when ESD services are implementedinto local areas. For more information, please contact:[email protected]

Our Stroke Rehabilitation theme aims to increase the capacity of the stroke rehabilitation community to engagewithandapplyresearchfindings. Indoingthis,wehopetoproducean improvement in thedelivery of care and evidence-based rehabilitation services for all stroke survivors.

Home Visits After Stroke (HOVIS) study

Great news for the HOVIS team as the trial opened for recruitment in Derby on the 12th July. In addition, the team have completed the pilot interviews for the qualitative arm of the study and are ready to begin the main interviews shortly. To date there has been a great response from senior occupational therapists working in stroke care, who have volunteered to participate in telephone interviews.

Two of the team, Karen and Phillip, will also be presenting a poster at the College of Occupational Therapists Specialist Section for Neurological Practice conference in September, where they will be encouraging occupational therapists to participate in the national questionnaire, planned for 2011, on home visits for patients who have had a stroke.


Stroke RehabilitationReturn to work

TheReturntoWorkteamhavenowbeengrantedethicalandR&Dapprovaland,withresearchpassportsin place, a schedule of interviews is planned with people who commission, deliver or receive vocational rehabilitation services from the Department of Work and Pensions, health, social care, independent and voluntary sectors. The purpose of these interviews is to understand the local contextual factors which may limit the success of new services intended to meet the vocational needs of stroke survivors and to identify barriers and drivers to their implementation.

The teamhasalsobeenworking closelywithan ‘ExpertPanel’, including serviceusers, providersand commissioners with expertise in stroke and vocational rehabilitation, to develop and validate the proposedstroke-specificvocationalrehabilitationinterventionthatwillbedeliveredinthefeasibilitytrial(recruitment to which is now underway!) and which will ensure meaningful outcomes are measured. The team will be asking for their help at various stages of the project with prioritising theory areas for theliteraturereviewandininterpretinganddisseminatingthefindings.

Upper limb rehabilitation

TheUpperlimbrehabilitationprojecthasseenasignificantround of developments of the virtual glove and games system that will ultimately be implemented to deliver upper limbrehabilitation.Thishasledtorefinementsinthevirtualglove making it lighter and easier to wear, and also to the development of a set of three usable games. The updated system was tested in two workshops at Nottingham City HospitalandMansfieldCommunityHospitalinJunewhereservice providers and service users were able to try out the system. As well as receiving positive encouragement, the team were able to gain insightful comments and constructivefeedbackaboutfurtherrefinementstoimproveusability and engagement with the games. The team are now working towards these new changes and hope to repeat the workshops for final feedback on the systembefore implementation.

The team has also engaged in various dissemination activities for the project. In August, Penny Standen (Principal Investigator) attended the Eighth International Conference on Disability, Virtual Reality and Associated Technologies (ICDVRAT) held in Chile to deliver a paper on the project. Previous to this, Louise Connell (Research Therapist) attended The Physiotherapy Acquired Brain Injury Network Day in June and delivered a talk to an audience of physiotherapists who were very positive in their feedback about the merits of the project. Louise also presented a project poster at The Society for Research in Rehabilitation Summer Meeting 2010.

About systematic reviews

Health inequalities are a major theme in commissioning plans across the country. The programme of work of the Engagement, Synthesis and Dissemination theme (EnSyD) includes two systematic reviews designed to increase our knowledge about health inequalities in relation to access to health care.

Systematic reviews of the research literature are an essential starting point for any new research as they identify relevant research, and highlight well-designed studies, as well as evaluating the quality of those studies, in order to draw general conclusions.

The reviews cover two topics:

1) Access to care for people who are recovering from a stroke: Approximately 30,000 papers were initiallyidentifiedforscreening.Completionofthetitlescreeninghasreducedtheseto2,000.Thesepapers will be obtained and scrutinised to enable us to summarise the research evidence concerning what promotes and what prevents fair access to health care following a stroke.

2)Access to care forAttentionDeficit HyperactivityDisorder in children: Understanding themainbarriers to equal treatment means being better placed to tackle or prevent them. This literature search initiallyidentifiedmorethan20,000papers,andaninitialscopingreviewisexpectedsoon.

The reviews support CLAHRC’s current research and dissemination and they also indicate potential areas for future research bids, as well as informing commissioners about the most effective approaches to increase access to care.

Tofindoutmorecontact:[email protected]

Engagement

Research priorities for children and young people

Researchers from the Implementation and Engagement teams have responded to a request from NHS Nottinghamshire County to help identify the key research priority areas related to health and social care for children and young people in the NDL area.

Nicola Wright and Sarah Pass designed a Delphi survey to consult a wide range of people about areas needing research to inform decision-making. A Delphi survey is a method used to derive agreement onspecificquestionsfromanumberofexperts,usuallyaboutatopicthatisnotwell-researched.Thesurvey was circulated to over 40 individuals in the region. Flexibility and sustainability funding will be used to address the most pressing needs.

Tofindoutmorecontact:[email protected] or [email protected]

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FOCUS: What is ‘synthesis’?

Synthesis strives to find common ground between research themes, identify overlapping areas ofinterest and generate added value from CLAHRC-NDL research by building on these.

As the second year of CLAHRC-NDL’s activities is being completed, the middle stage of the EnSyD theme’s programme of work is particularly topical. Two themes of pressing importance to taxpayers andhealthplannerswereidentifiedtoguideoursynthesisactivities:occupationaloutcomesandhealthinequalities in terms of access to care.

Louise Thomson leads the cross-cutting synthesis on occupational outcomes.ShehasidentifiedthreeCLAHRC-NDLstudiesthatidentifyemployment as an outcome, and is investigating what implications their collective work may have for employment and health. Louise will also be collating information on a range of employment outcome measures used in applied healthcare research and reviewing their utility. Initial discussions are under way to develop future research into the psychological factors affecting return-to-work, such as motivationandconfidence.

Nicola Wright is leading the access to care (health inequalities) synthesis. The importance of access to care has been highlighted by the recent Marmot Review, so this synthesis will help to position CLAHRC-NDL’simplementationofresearchfindingsinrelationtopreventionofinequalityandtothepromotion of equal access. Improving access to services has been highlighted as a core theme to numerous CLAHRC studies across the four clinical themes.

A health economic analysis of the impact of CLAHRC-NDL in relation to occupational outcomes and access to care is also planned. This stream of work is already generating cross-cutting issues that could lead to future research proposals. Any research or implementation questions that relate to theCLAHRC as a whole, rather than to a specific research project, may be addressed [email protected] or [email protected]

CLAHRC-NDL PhD studentship

Kezia Scales recently won a CLAHRC-NDL PhD studentship in the EnSyD theme. Herresearchfocusesonknowledgetransferamongnon-qualifiednursingstaffat the frontlines of health and social care.

Thisdoctoralprojectwillinvestigateknowledgetransferamongstnon-qualifiednursing staff working in dementia care, exploring how such workers receive, understand, engage with, and implement research evidence as well investigating how they impart the knowledge they have gained.

Ultimately,theprojectwillcontributetoourunderstandingofhowtosuccessfullyequipnon-qualifiedstaff, who stand at the forefront of care but often in the shadows of healthcare research, with the skills and attributes to provide high quality direct care for people with cognitive impairment across a range of settings.

Engagement

360° vision

The implementation team has been working on a 3D model of some of the challenges that we face in getting research into practice.

The model developed from frustrated discussions aboutthedifficultyofsharingperceptionsacrossboundaries. What is experienced as a problem on one side of the boundary (or picket fence in the model) may be seen as of no consequence on the other side. So we began to play with visual representations as a means of expressing what members of the implementation team have been findingacrossCLAHRC.

Themodelhashadtwooutings.Atthefirst,alearningeventforall9CLAHRCs,itsparkeddiscussionabouthowotherCLAHRCsaresolvingsimilarproblems.WewereheartenedtofindthatNDLisnottheonlyCLAHRCtofindthatcommunicationcanbedifficult.HuwDavies,outgoingDirectorofKnowledgeMobilisation&Capacity Building for theServiceDelivery andOrganisation section of theNationalInstitute for Health Research, added some new and enlightening components related to how he sees fundingstreamsmayinfluencerelationships.

At the second outing, the CLAHRC Knowledge Exchange event, further additions were made. We benefittedfromDiffusionsFellowstellingusoftheirexperiencesandamendingthemodeltodemonstratehow those experiences are having an impact on the progress of their work.

Thisisaworkinprogress.Popintotheofficeandaddyourcommentsorsuggestions.Wehope,likeWallace and Grommit, that by October 2013 we will have a happy ending.

Implementation

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Keep it simple

Ratherthanseparateprogrammestosupportfamilies,whatisneededisaunifiedapproach,accordingto the results of a CLAHRC evaluation of three of the City Council’s Early Intervention programmes: the Family Nurse Partnership, the Mentoring Scheme and Stronger Families.

Findings from the research were fed back to members of the Early Intervention Programme and interested parties through an interactive workshop run by Graeme Currie and Sarah Pass. Consequently, the City Council has asked for recommendations about how children and adult mental health services might be merged, to stop individuals falling through the gaps.

The CLAHRC Implementation Theme has been collaborating with Nottingham City’s Early Intervention Programme, which is supported by One Nottingham and the Local Strategic Partnership. The Early Intervention Programme is led by the City Council to provide innovative and accessible services for families in greatest need.


ImplementationDevelopment series

A dynamic programme of workshops, seminars and other networking opportunities is planned for the rest of 2010 including:

• Local events which bring together researchers and commissioner• Skill sharing in engagement and networking • Informal lunchtime learning sessions on research methods; and formal training in health

economics and statistics

For more information please visit our website: www.clahrc-ndl.nihr.ac.uk

We are currently planning more events for 2011 . If you have any suggestions regarding this please contact: [email protected]

Open Access publications

In 1998, the US Department of Veteran Affairs launched the Quality Enhancement Research Initiative (QUERI).To quote two QUERI authors: “The QUERI Series offers clinical researchers, implementation scientists, health systems, and health research funders from around the globe a unique window into the both the practice and science of implementation or knowledge translation (KT) in the VA. By describing successes and challenges as well as setbacks and disappointments, the QUERI Series is all the more useful”.

Thegeneral lessons fromQUERI,aswell as topic-specific insights,haveagreatdeal tooffer theCLAHRC programme. A collection of papers can be found on our website: www.clahrc-ndl.nihr.ac.uk/publications/open-access

Communities of Practice in CLAHRC-NDL

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How do they work?

CoPs can be face-to-face, but they can also be virtual. They may involve large or small groups, and they may change in membership and aims over time. The essential ingredients appear to be;

• enthusiasmforatopic• opportunitiestocommunicateaboutthiscommoninterest• someadministrativesupporttokeeppeopleintouchwitheachother• enoughleadershiporinitiativetogivethegroupsomeimpact.

What are Communities of Practice?

Communities of Practice (CoPs) are groups or networks of people who have a shared interest in a particularfield.Theirpurpose is toshare information,adviceand insightsbetweenmembersof thenetwork. They promote communication and so seek to improve health care and speed up innovation.

We have adopted a clear model to promote engagement and knowledge transfer in CLAHRC-NDL around our research themes. Research has shown that professional networks, local exchanges of knowledge, and the advice and support of peers or local opinion leaders is more likely to lead to changesinpracticethanclinicalguidelinesorhigh-qualityscientificevidence.


Communities of Practice in CLAHRC-NDL

Who can be in a Community of Practice?

Anyone who has an interest or experience in the particular area of practice can become a member of a community of practice. They could be a practitioner, researcher, service manager, commissioner, service-user/carer, or someone working in voluntary organisations and the Third Sector. Members of a community of practice must self-select themselves to join.

How are Communities of Practice formed?

Communities of practice can take time to build and need effort to be sustained - but over-managing doesn’t help either! It seems that the most effective approach is to build communities through the natural networks and relationships between clinicians and practitioners, which do not require formal management structures.

However, two key areas in which we can support their development are:

• Ensuringtherightpeopleare brought together

• Providinganinfrastructureto support that network

What we are doing at CLAHRC-NDL

At CLAHRC-NDL we are starting to develop CoPs through the following actions, many of which are undertaken by our Diffusion Fellows:

• identifying and making links with existing networks of practitioners and other stakeholders• identifying and making links with local opinion leaders and champions• encouraging people to sign up as Associates to receive research updates, newsletters, invitations

to conferences, seminars and other events• organisingnetworkingeventsaroundspecifictopicsofmutualinterest.

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Systematic ReviewsSickness absence due to pregnancy-related ill health

To improve our knowledge about the extent andspecificcausesofpregnancy-relatedabsence, the Engagement, Synthesis and Dissemination Theme, working with the Primary Care Theme, will be conducting a systematic review in this area.

In the UK, around 50% of the workforce is made up of women (ONS, 2008). Of these 13.6 million workers, it is likely that a sizeable proportion will become pregnant whilst in employment.

There are a number of health problems that can occur during pregnancy that could impact on a woman’s ability to work. These commonly include morning sickness, back pain, pre-eclampsia and miscarriage.

In addition, there are certain risk factors (such as obesity, smoking, and having poorly managed diabetes) that increase the likelihood of pregnancy-related complications, which in turn lead to absence.

The review will assess the available evidence to answer the following questions:

1. What is the extent of pregnancy-related absence in the UK?

2. What types of pregnancy-related ill-health cause women to be absent from work?

3. What is the role of ongoing health conditions (e.g. obesity, diabetes) in pregnancy-related absence?


Systematic ReviewsLimited evidence to support health monitoring policy

Issues for clinical practice

People with long-standing serious mental illnesses often have poor dental hygiene. With the erosion of teeth comes erosion of quality of life. In recent years there has been an increasing focus on improving the physical (and oral) health of people with serious mental illness. Current guidance suggests that mental health professionals should give advice and monitor the physical health of people with serious mental illness. Therehasbeenasignificantfinancialinvestmentoverrecentyearstoprovide this.

A review of the evidence

On the dental project we set out to identify current relevant local physical health policies in Nottingham-shire, Derbyshire and Lincolnshire (Tosh et al 2010a). We have conducted three systematic reviews ofhigh-gradeevidenceoneffectsofrelevantpolicyoradvice.Thefirstisfocusedonanyrandomisedtrials of general physical healthcare monitoring for people with serious mental illness (Tosh et al 2010b) and the second focuses on any general physical health care advice for people with serious mental ill-ness(Toshetal2010c).Athirdreviewfocusesonthespecificoralhealthcaremonitoringoradviceforpeople with serious mental illnesses (Khokhar et al 2010).

We did not identify any randomised trials which assessed the effec-tiveness of physical health monitoring in people with serious mental illness. However, there is some evidence that general physical healthcare advice can improve health-related quality of life. The same study showed that general physical healthcare advice can improve the uptake of health services for people with serious mental illness. Finally we found that there is some evidence that motivational interviewing + education and education alone can improve short-term oral health behavior of people with serious mental illness.

Implications for service providers and future research

Mental health workers have a responsibility to improve the physical healthcare of people with serious mental illness and there is a raft of policies and guidance to help them achieve this. These policy docu-ments are often written with the best of intentions. However, often they fail to achieve their objective because they are written to appease a diverse range of clinical practice and opinion. This is further compounded by the fact that policy-makers are unable to apply much in the way of evidence-based rules or accepted standards at the point of policy creation. By conducting three systematic reviews we have started to unravel some of the evidence in this area. It is vitally important that further studies and trials of health-promoting interventions are undertaken to underpin polices with robust evidence.

For more information contact: [email protected]

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CLAHRC ProfilesDr Anne Thompson (Diffusion Fellow)

DrAnneThompsonisaConsultantChild&AdolescentPsychiatristworkinginLincolnshire Partnership Foundation NHS Trust.

Anne trained in Newcastle upon Tyne and Nottingham, and was a Clinical Lecturer at the University of Nottingham before taking up her consultant post in 1997. Anne maintains an interest in research, which informs clinical practice. She co-founded a research group for CAMHS colleagues within her Trust, which has successfully promoted research and audit activity. She has published on a varietyofclinicaltopics-mostofherrecentpublicationshavebeeninthefieldof ADHD, including an invited commentary for the BMJ on the NICE Clinical Guideline 72 on ADHD (2008).

“Being a Diffusion Fellow provides me with an opportunity to influence research to deliver new information about patient care which will meet key NHS priorities. The NHS will be changing in the next few years to reflect the Equity and Excellence agenda. Quality of patient care and meaningful treatment outcomes will become paramount.

The CLAHRC-NDL MOSAIC project with which I am very pleased to be involved is ideally placed to deliver cutting edge information to inform high quality practice in the management of severe ADHD”.

Trevor Jones (Service Users & Carers Reference Group / POPULOS Panel)

Trevor Jones is a CLAHRC-NDL service user representative based in Nottingham. His major experience of local healthcare services followed a road accident in 2004, when he suffered serious brain injury.

Over the following year Trevor required help from a number of services, ranging fromearly intensivehospital care, throughphysiotherapyandfinallyoccupational therapy during phased re-entry to employment. Trevor has also accessed healthcare services during other periods, including including care of a son with Cystic Fibrosis and recently during recovery after fracturing his pelvis and arm. Trevor’s interest in healthcare research began while acting as patient representative for a local study into return to work following traumatic brain injury. Early retirement has since allowed time to become active within CLAHRC-NDL.

“Being an Associate and a member of the Reference Group and POPULOS panel of service users, provides me with an opportunity to work with others to ensure that patients’ views are fully represented within all research conducted by CLAHRC-NDL. I strongly believe in the value of research into which services bring real benefit to patients and carers, then using the findings to influence service provision in the NHS.”

Trevoralsodirectlyworkswiththe‘ImpactofInjuries’studywithintheprimarycaretheme,wherehepresents the patient perspective.


CLAHRC Profiles Conference SpeakersProfessor Mike CookeCLAHRC-NDL Chair and Chief Executive, Nottinghamshire Healthcare NHS Trust

Mike is an experienced Chief Executive who joined Nottinghamshire Healthcare NHS Trust in June 2007, having worked in Trusts and NHS organisations around the country.

He has experience working at Regional level and has a real understanding of the Acute Hospital, Mental Health and Primary Care sectors. With an exceptional track record of developments in the NHS and local public sector, he led South Staffordshire NHSFoundationTrust tobeoneof thefirstMentalHealthstyleFTs,helped theacquisition of Shropshire Services, and the Award for NHS Foundation Trust of the Year 2006/07.

Mike is now a Special Professor in Healthcare Innovation and Learning at Nottingham University Business School and was recently runner up in the NHS Leader of the Year 2009. He is on the National Institute for Health Research Advisory Board and Chairs the local Nottinghamshire, Derbyshire and

Professor Graeme CurrieDirector of CLAHRC-NDL, Professor of Public Services Management at Nottingham University Business School

Graeme’s NHS research interests are: translation of innovation into practice, leadership, knowledge management, re-engineering of professional roles and relationships, network forms of organising and management education. His PhD focused on the strategic role of middle managers in the NHS.

Prior to CLAHRC-NDL, Graeme was a Non-Executive Director at Nottinghamshire Healthcare NHS Trust. In a previous life, Graeme has been an organisation developmentadvisorintheNHSandworkedforRoverCarsasapersonnelofficer.

Professor Louise FitzgeraldVisiting Professor, Manchester Business School

Louise currently holds an appointment as Visiting Professor at Manchester Business School, and Emeritus Professor, De Montfort University. Her previous career spans management posts in the private sector and academic posts at Salford, Warwick, City and De Montfort Universities.

Her main research focus is the implementation of organisational change in complex organisations. Her recent projects have focussed on the management of networks in health care; E.B.H.C. and innovation diffusion among clinicians and knowledge utilization by clinical managers in leading service changes.

Muir Gray entered the Public Health Service from a career in academic surgery in 1972 as a local authority employee in the County Borough of Oxford. During the years that have passed he has had over twenty structural reorganisations of the health service and the Public Health Service, and has been involved with every type of health service from smoking cessation to environmental protection, from antenatal counselling to end-of-life care.

Among the jobs he has held have been a Consultant in Public Health for the Oxfordshire Health Authority, the Regional Director of Public Health for the Oxford Region, the founding Programme Director of the National Screening Committee,

theDirectoroftheNationalLibraryforHealth,andtheChiefKnowledgeOfficerfortheNHS.

MuiriscurrentlyaConsultantinPublicHealthintheNHS,workingtoensurethattheresearchinfluencespractice, as well as Director of the Oxford Centre for Healthcare Transformation, a company which uses podcasting and other Web 2.0 technology to help those who pay for and manage healthcare create systems and change the culture of the organisations in which they work. As founding Director of thecharity‘KnowledgeIntoAction’,heisalsoleadingtheNationalCampaignforWalkingandtheCampaign for Greener Healthcare.

In 1998 Muir was awarded the CBE, and was knighted in 2007 for services to the NHS.

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Conference Speakers

Professor Marion WalkerProfessor in Stroke Rehabilitation and Stroke Rehabilitation Theme Lead

Marion is an Occupational Therapist by background and has played a leading role in developing a research culture within her profession.

Marion is past president of the Society for Rehabilitation Research - the UK’s only multidisciplinary rehabilitation research group - and was Chairman of the UK Stroke Forum from 2006-2008. She is also Associate Director (Rehabilitation Lead) of the UK Stroke Research Network and a Trustee of the Stroke Association.

Her trial involvement includes service evaluations of stroke patients not admitted to hospital, multi-disciplinary stroke teams, intermediate care, early supported

discharge, daycentre care for young stroke patients and therapy provision in nursing homes. She also evaluatesspecificcomponentsofstroketherapyincludingleisure,outdoormobilityandbehaviouralapproaches in patients with aphasia and depression.

Sir Muir Gray CBE, MDConsultant in Public Health, Director of Oxford Centre forHealthcare Transformation


Conference Speakers

In addition to his work within CLAHRC, Joe leads the HTA-commissioned ECLIPSE trial. The Eclipse trial is a clinical research unit based at the University of Birmingham which investigates the causes and best treatment for a wide range of diseases.

Joe has been an inner-city GP for 20 years, currently working in central Derby. He leads a national programme to support new genetic assessment and screening by health professionals, using haemoglobin disorders as a model. His teaching and research seek to enhance care in ethnically diverse and disadvantaged contexts and in applied genetics.

Joe has published widely; notably his BMA award-winning Primary Care in Urban Disadvantaged Communities (Radcliffe, 2004); Interactive health professional training such as PROCEED: Professionals responding to cancer and diversity (Cancer Research UK, 2005), Valuing Diversity (2nd ed, RCGP, 2006); and most recently e-learning on health inequalities, language barriers and cross-cultural communication for the new national GP curriculum (e-GP, RCGP, 2010).

Professor Joe KaiProfessor of Primary Care at the University of Nottingham, Primary Care Theme Lead

Professor Marilyn JamesProfessor of the Economics of Health and Social Policy

Marilyn came to Nottingham to join the CLAHRC with considerable experience in applied economic evaluation. She has been economics advisor to the Department of Health’s National Screening Committee’s Antenatal Sub Group and advises the NationalDiabeticRetinopathyNetwork‘FourNationsGroup’.

Marilyn has worked in the NHS, as well as academia and the private sector, and is currently a health economics reviewer for a number of government bodies and research councils, including the HTA College of Experts, the SDO and the MRC.

Her current research focuses on the practical application of economic evaluation inanumberofresearchsettingsandshehaspublishedandpresentedwidelythefieldofclinicalandeconomic evaluation as well as applying health economics to policy issues.

NIHR CLAHRC Nottinghamshire, Derbyshire and Lincolnshire Sir Colin Campbell BuildingUniversity of NottinghamInnovation ParkTriumph RoadNottingham NG7 2TU

Tel: 0115 823 1253Fax: 0115 823 1289 Email: [email protected]

www.clahrc-ndl.nihr.ac.uk

This document can be made available in large print and other formats including translations upon request.

Documents

CLAHRC-NDL Engage Edition 2 - Autumn 2010