BIRT outcome report - superabile.it · The Supervision Rating Scale is an indicator of the level of...

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BIRT outcome report 2011

Transcript of BIRT outcome report - superabile.it · The Supervision Rating Scale is an indicator of the level of...

BIRT outcome report2011

“�We�believe�that�using�an�outcome�measurement�system�is�an�essential�practice�allowing�service�users�and�other�stakeholders�to�evaluate�our�services�and�allowing�us�to�improve�our�services�year�by�year.”Professor Michael Oddy, Director of Clinical Services, BIRT

Our�third�Outcome�Report�offers�critical�information�to�service�users�and�other�stakeholders,�such�as�family�members�and�commissioners,�about�the�changes�they�may�expect�during�and�following�rehabilitation.�We�use�the�outcome�measures�to�improve�our�services�and�for�scientific�research�on�brain�injury�rehabilitation.�As�can�be�seen�from�this�report�all�information�is�in�an�anonymised�form.

Each�year�we�evaluate�the�usefulness�of�our�measures;�in�2011�we�added�new�measures�appropriate�for�our�current�service�users.�Our�aim�is�to�find�measurement�tools�that�are�sensitive�to�the�changes�our�service�users�wish�to�achieve�and�help�support�the�decision�making�process�when�choosing�a�brain�injury�service�provider.

The�measures�we�have�chosen�are�widely�used,�standardised�instruments�with�good�psychometric�properties.�Feedback�from�stakeholders�about�the�usefulness�of�this�report�is�welcomed�and�should�be�forwarded�to�[email protected]

Outcomes at a glance ●● We�served�396�adults�with�acquired�brain�injury�in�2011

●● We�admitted�178�new�service�users�to�our�rehabilitation�and�community�services

●● We�discharged�183�service�users�from�our�services

●● 72% of�service�users�moved�to�an�environment�with�less�supervision�and�at�less�cost�in�most�cases

●● The�average�length�of�stay�was�6.6�months�in�assessment�and�rehabilitation�services�and�6.5�months�in�challenging�behaviour�services.�

●● 88%�of�service�users�required�full�time�care�on�admission,�yet�only�42%�required�full�time�care�on�discharge

●● By�6�month�follow�up�this�had�reduced�further�so�that�only�30%�required�full�time�care

●● 65%�of�service�users�had�no�productive�activity�on�admission,�yet�only�29%�had�no�productive�activity�on�discharge.�

●● Our�challenging�behaviour�services�achieved�an�average�reduction�of�47%�on�the�BIRT�Aggression�Rating�Scale�(BARS)�at�discharge�

The�Supervision�Rating�Scale�is�an�indicator�of�the�level�of�support�that�service�users�require.�Our�data�shows�that�over�50%�of�service�users�were�rated�as�independent�or�needing�part�time�supervision�at�discharge�compared�with�only�11%�at�admission.�At�follow�up�88%�of�service�users�were�independent�or�required�only�part�time�supervision.�

One�of�the�goals�of�rehabilitation�is�to�improve�service�users’�quality�of�life�by�increasing�the�productive�activity�they�engage�in.�Our�results�show�that�at�discharge�there�was�a�50%�reduction�in�the�number�of�service�users�who�had�no�productive�activity.�

Increasing independence and engagement in activity

0

20

40

60

80

100

0% 12% 44% 11% 44% 44% 89% 44% 12%Pe

rcen

tage

of s

ervi

ce u

sers

Level of supervision

Independent Part time Full time

Admission

Discharge

Follow up

Occupational activity on dischargeOccupational activity on admission

Supervision Rating Scale – assessment and rehabilitation services

Community Disposition Rating Scale – Occupation

2%0%5% 9% 14% 5% 4% 4% 30% 30% 7% 7% 54% 32%

Perc

enta

ge o

f ser

vice

use

rs

Level of support

Indepen

dent

Intermitt

ent

Wee

kly

Every

few day

s

Up to 11

hours

12-19

hours

20-24

hours0

10

20

30

40

50

60

Admission

Discharge

Care and Needs Scale

The�Care�and�Needs�Scale�measures�the�extent�and�frequency�of�care�and�support�needs.�Scores�range�from�very�low�indicating�independence�to�very�high�indicating�a�greater�level�of�support�need.�Compared�to�admission,�on�discharge�three�times�as�many�services�users�required�care�or�support�every�few�days�or�less.

12%Education,�training�or�employment

1%Independenthomemaker

1%Independenthomemaker

1%Education,�training�

or�employment

32%No�productive�activity

9%Volunteer

34%Recreational��

or�day��activity

46%Recreational�or�day�activity

64%No�productive�activity

BIRT outcome report2011

EQ-5D Health Rating Questionnaire All service users

At�6�months�after�discharge�from�BIRT�services,�service�users�are�asked�to�identify�levels�of�difficulty�in�five�areas;�anxiety/depression,�mobility,�pain/discomfort,�self-care�and�usual�activities.�In�all�of�these�areas,�the�number�of�extreme�problems�was�very�low�and�overall�56%�of�service�users�reported�‘no�problems’

0

5

10

15

20

6%

57% 40% 3% 75% 22% 3% 47% 43% 10% 53% 38% 8% 38% 47% 15%

22% 39% 11% 50% 44% 83% 28% 17%

18.44 9.84

Mea

n BA

RS s

core

Perc

enta

ge o

f ser

vice

use

rsPe

rcen

tage

of s

ervi

ce u

sers

Type of Accommodation

Admission

Independentwith family

Supported living Residential Unit

EQ-5D Category

Mobility

Self c

are

Usual

activ

ities

Pain/d

iscomfo

rt

Anxiety/

depres

sion

Discharge

Admission

Discharge

Follow up

No problems

Some problems

Extreme problems

0

20

40

60

80

100

0

10

20

30

40

50

60

70

80

Reducing aggression Our�main�measure�of�challenging�behaviour�is�the�BIRT�Aggression�Rating�Scale�(BARS).�For�the�service�users�in�our�challenging�behaviour�services�there�was�a�47%�average�reduction�in�their�BARS�score�at�discharge.�

Moving on from BIRTCommunity Disposition Rating Scale – AccommodationAssessment and Rehabilitation

BIRT�services�aim�to�help�service�users�become�more�independent,�enabling�them�to�live�with�less�supervision.�Therefore,�the�type�of�accommodation�a�service�user�requires�on�admission�to�our�services�and�following�discharge�is�rated.�The�data�show�that�83%�of�our�service�users�were�admitted�from�residential�care�with�very�few�living�independently.�At�discharge,�however,�72%�of�service�users�were�living�independently�or�in�supported�living,�and�this�figure�increased�to�83%�at�follow�up.�

0

5

10

15

20

6%

57% 40% 3% 75% 22% 3% 47% 43% 10% 53% 38% 8% 38% 47% 15%

22% 39% 11% 50% 44% 83% 28% 17%

18.44 9.84

Mea

n BA

RS s

core

Perc

enta

ge o

f ser

vice

use

rsPe

rcen

tage

of s

ervi

ce u

sers

Type of Accommodation

Admission

Independentwith family

Supported living Residential Unit

EQ-5D Category

Mobility

Self c

are

Usual

activ

ities

Pain/d

iscomfo

rt

Anxiety/

depres

sion

Discharge

Admission

Discharge

Follow up

No problems

Some problems

Extreme problems

0

20

40

60

80

100

0

10

20

30

40

50

60

70

80

0

5

10

15

20

6%

57% 40% 3% 75% 22% 3% 47% 43% 10% 53% 38% 8% 38% 47% 15%

22% 39% 11% 50% 44% 83% 28% 17%

18.44 9.84

Mea

n BA

RS s

core

Perc

enta

ge o

f ser

vice

use

rsPe

rcen

tage

of s

ervi

ce u

sers

Type of Accommodation

Admission

Independentwith family

Supported living Residential Unit

EQ-5D Category

Mobility

Self c

are

Usual

activ

ities

Pain/d

iscomfo

rt

Anxiety/

depres

sion

Discharge

Admission

Discharge

Follow up

No problems

Some problems

Extreme problems

0

20

40

60

80

100

0

10

20

30

40

50

60

70

80

Assessment and rehabilitation

Challenging behaviour

In�August�2010,�Meg�Elliot,�a�26�year�old,�recent�English�literature�graduate�was�pursing�her�love�of�climbing,�working�as�an�activity�instructor�for�a�local�climbing�centre�in�Snowdonia.

On�one�of�her�days�off�from�the�centre,�during�an�excursion,�Meg�suffered�a�terrible�fall�from�an�almost�vertical�cliff�face�at�30ft.�Meg�had�broken�her�back,�her�neck,�her�left�shoulder,�her�left�ribs,�punctured�a�lung�and�received�a�brain�injury�from�hitting�her�head�on�the�rock.�

Meg�was�stabilised�at�Bangor�Hospital�and�then�transferred�to�Liverpool�intensive�care�where�she�remained�for�4�months�in�total.�

Meg�transferred�to�TEM�House�in�Milton�Keynes.�With�help�and�support�from�

the�excellent�multi�disciplinary�team,�Meg�made�rapid�progress�with�her�rehabilitation.��Occupational�therapy,�physiotherapy,�speech�and�language�therapy�and�clinical�psychology�make�up�the�team�at�TEM.��As�part�of�her�intensive�rehabilitation�programme�Meg�was�encouraged�to�start�writing�again�and�has�written�the�TEM�House�newsletter.

In�over�a�year�at�TEM�house�Meg�made�such�rapid�progress�that�she�was�able�to�move�to�a�community�house�in�Northampton�run�as�a�part�of�BIRT’s�continuum�of�care,�living�independently�but�with�support�available�to�her�as�and�when�she�needed�it.�Meg�has�now�been�supported�to�find�a�flat�in�the�community�and�is�moving�out�to�live�on�her�own.��

Who uses our services?

Age of service users – assessment and rehabilitation

Age of service users – challenging behaviour

Gender of service users –assessment and rehabilitation

Gender of service users –challenging behaviour

Cause of injury – assessment and rehabilitation

Cause of injury – assessment challenging behaviour

Time since injury – assessment and rehabilitation

Time since injury – challenging behaviour

‘I�am�settled�into�my�room�and�my�new�lifestyle�and�I’m�pleased�to�say�that�I�love�it.�Moreover,�I’m�moving�onto�my�next�step�of�living�independently�in�my�own�house.’

32%>50�yrs

35%>50�yrs

26%40-49�yrs

24%40-49�yrs

24%18-29�yrs

22%18-29�yrs

26%Female

13%Female

74%Male

87%Male

65%0-1�yr

54%0-1�yr

19%1-3�yrs

21%1-3�yrs

10%4-10yrs

16%4-10yrs

6%>10yrs

9%>10yrs

56%TBI

56%TBI

24%CVA

24%CVA

9% Hypoxia

9%Hypoxia

6%Infection

6% Infection

2%Neoplasm

3%Other

3% Other

18%30-39yrs

18%30-39yrs

BIRT outcome report2011

Stakeholder satisfactionOne�of�the�ways�BIRT�monitors�quality�is�by�using�satisfaction�surveys�which�address�different�aspects�of�our�service.��We�ask�our�stakeholders�to�complete�questionnaires�at�service�user�discharge�or�at�least�annually.��The�feedback�we�receive�is�used�to�plan,�develop�and�improve�our�services,�both�at�individual�centres�and�Trust-wide.��We’d�like�to�thank�everyone�who�took�the�time�to�complete�our�questionnaires.�Feedback�is�vital�for�us�to�ensure�we�maintain�our�high�standards�and�improve�wherever�we�can.�

Level of satisfaction %0 20 40 60 80 10010 30 50 70 90

Would recommend BIRT to others

Overall satisfaction

Social/leisure activities

Appearance of centre

Support of familiesCourtesy of sta�

Consideration of concerns/goals

Organisation/information at case confs

Benefits of rehab programme

Admission process

Satisfaction ratings Commissioners and referrers97%�of�commissioners�and�referrers�said�they�would�recommend�BIRT�to�others�and�91%�were�“more�than�satisfied”�or�“satisfied”�with�BIRT�services�overall.��Respondents�particularly�commented�on�the�professionalism�of�staff,�the�effectiveness�of�communication�and�the�flexibility�of�the�approach�used�from�referral�through�to�discharge.

Family members of our service users said:

“�BIRT�has�given�us�our�son�back.��When�he�arrived�his�behaviour�was�extremely�difficult�to�manage�&�discharge�home�would�not�have�been�possible.��The�staff�deserve�medals.”

“�BIRT�gave�us�peace�of�mind�at�a�time�when�it�was�much�needed�for�the�whole�family.”

“�The�staff�are�wonderful�and�nothing�is�too�much�trouble.��They�always�have�time�to�listen�and�give�you�their�full�attention.”

Our commissioners said:

“�A�very�professional,�well�organised�service�which�I�would�highly�recommend.”

“�Case�reviews�are�well�structured�and�informative�to�enable�discharge�planning�to�commence.”

“�I�am�pleased�that�BIRT�provides�opportunities�for�service�users�to�progress�with�rehabilitation�into�supported�living�environments.”

Families95%�of�families�would�recommend�BIRT�to�others,�and�92%�of�families�were�“more�than�satisfied”�or�“satisfied”�with�BIRT�services�overall.��Families�expressed�appreciation�about�how�well�service�users�were�involved�in�choosing�their�programme�and�activities,�and�how�well�they�were�kept�informed.�They�also�commented�on�the�caring�and�positive�attitude�of�the�staff�working�with�their�family�members.

Level of satisfaction %

Overall satisfaction

Would recommend BIRT to others

Skill and training of sta�

Prompt response to referral

E�ectiveness of rehab plan

How to rehad plan put in practice

Informative & organised meetings

Timeliness of assessment report

Appearance of centre

Cleanliness of centre

Courtesy of sta�

0 20 40 60 80 10010 30 50 70 90

Commissioner and referrer satisfaction 2011

Family satisfaction 2011

Service users85%�of�BIRT�service�users�reported�that�they�were�“more�than�happy”�or�“happy”�with�BIRT�services�overall.��Several�commented�on�the�helpfulness�of�staff�and�how�they�were�supported�to�make�choices�about�their�activities�and�leisure�interests.��The�high�levels�of�satisfaction�reported�by�service�users�demonstrate�that�our�efforts�to�make�the�rehabilitation�experience�as�tolerable�and�beneficial�as�possible�are�successful.

Level of satisfaction %

Overall satisfaction

Choices o�ered

Treated with dignity

Privacy respected

Treated as individual

Complaints taken seriously

Standard of accommodation

Standard of food

Cleanliness of service

Well treated by sta�

Happy with rehab programme

0 20 40 60 80 10010 30 50 70 90

The people who used our services said:

“�I�am�treated�with�dignity�by�the�staff.”

“�I�am�happy�with�all�the�help�given�to�me�by�staff.”

“�I�like�the�food!”

“�Thank�you�to�everyone�for�all�that�they�have�done�for�me.”

We�collect�information�about�why�people�who�have�been�assessed�as�suitable�for�our�services�are�not�subsequently�admitted.�After�identifying�barriers�we�find�solutions�which�support�our�partners�and�increase�access�to�our�services.

Our�latest�study�showed�that�the�most�common�reason�why�people�were�not�admitted�was�linked�to�finances�(36%�of�cases),�usually�associated�with�the�constraints�placed�upon�PCTs�and�local�authorities�budgets.�To�work�with�commissioners�and�increase�access�to�our�services�BIRT�developed�a�new�range�of�flexible�rehabilitation�options,�launched�late�2011.�These�follow�our�internationally�recognised�neurobehavioural�approach�yet�with�a�different�delivery�model,�all�designed�to�offer�maximum�choice.��Accompanying�this�are�several�financial�incentives,�giving�value�for�money�options�in�our�specialist�services.�To�find�out�more�about�these�options�visit�www.birt.co.uk�or�contact�your�nearest�service.�

Service user satisfaction 2011

Improving access to BIRT’s services

BIRT outcome report2011

90% of�service�users�felt��they’d�been�treated��as�individuals

72% of�service�users�moved�on�to�live�independently�or�in�supported�living�accommodation

36% agreed�that�their�life��was�close�to�their�ideal�(at�follow�up)

68% felt�a�sense�of�accomplishment�in�completing�their�rehabilitation�and�overcoming�some�of�their�difficulties�(at�follow�up)

75% had�no�problems�with�self�care�(at�follow�up)

68% were�engaged�in�productive�activity��at�discharge�

The�Disabilities�TrustFirst�Floor,�32�Market�Place,�Burgess�Hill,�West�Sussex,�RH15�9NPTel:�01444�239123��Fax:�01444�244978��Email:�[email protected]

The�Disabilities�Trust�is�a�company�limited�by�guarantee�incorporated�in�England�and�Wales�under�2334589�and�registered�as�a�charity�in�England�and�Wales�under�800797�and�in�Scotland�under�SC038972.�Registered�office�as�shown.

www.birt.co.uk

Key facts

For more information please contact: BIRT, 60 Queen Street, Normanton, Wakefield WF6 2BU Tel: 01924 896 100 Fax: 01924 899264 Email: [email protected]

BIRT outcome report2011