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A model of service delivery and best use of Occupational Therapy staff within a community falls prevention service. F.Neil 1 , M.Anderson 2 , D.A. Skelton 1 , C. Ballinger 3 1 HealthQwest, School of Health, Glasgow Caledonian University,
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A model of service delivery and best use of Occupational Therapy staff within a community falls prevention service.
F.Neil1, M.Anderson2, D.A. Skelton1, C. Ballinger3
1HealthQwest, School of Health, Glasgow Caledonian University,
2Greater Glasgow and Clyde NHS Community Falls Prevention Team,
3 NIHR Research Design Service South Central/School of Medicine University of Southampton, UK
Falls and consequent injury are common amongst older people. Greater Glasgow and Clyde (GGC) in Scotland, has a population of 184,000 people aged >=65 years. In 2008, within GGC, 4240 people aged >=65 years were admitted into Hospital following a fall. About 65% of these admissions were due to falls in people’s own homes. There was a mean hospital stay of 23.3 days. 88 people died and 1953 suffered a hip fracture as a result of their fall.
In 2006, local health and social care services in (GGC), Scotland, introduced a Community Falls Prevention Programme (CFPP) . The CFPP was based on evidence and supported by National policy . The CFPP patient pathway sees an average of 221 clients/month (2008 data). Occupational therapy (OT) is a key component of this evidence-based falls service [2,3].
Figure 1: Referrals on to services following home visit by OTSW
Through competency based training, regular support and supervision, the OT enables the OTSW to undertake the effective screening of all new fallers referred to the CFPP. The role of the OTSW in turn, enables the OT to be more efficient with their time. The OT can target those most in need of interventions to maintain, restore and /or improve functional abilities, health and well being and prevent further falls. The OTSW also support the OT in the delivery of group educational sessions to empower the client to make changes to attitude, behaviour and lifestyle to prevent or manage further falls.
To describe the patient pathway for the CFPP and the key role of OTs and OT Support Workers (OTSW) in maintaining quality and effectiveness of the fall risk assessment and intervention process.
The role of the OTSW includes:
In 2008, the CFPP won an award for ‘Clinical Effectiveness’ from NHS Quality Improvement Scotland. In 2009, the CFPP reached the final of the Allied Health Professionals and Health Services Awards for ‘Promoting Health and Wellbeing in hard-to-reach Communities’.
The CFPP accepts both self and health referral. The patients is triaged via a telephone call. If their need is urgent, referral is made directly to the appropriate service e.g. Medical Falls Clinic. Where appropriate for CFPP, the patient is offered an appointment for a home visit, by an OTSW, within 5 working days. Approximately 55% of referrals receive a home visit.
The OTSW has a specific competency based qualification [4,5] and has received specialised knowledge and skills training by an OT. The OTSW is further supported by regular supervision meetings to maintain quality care. The OT intervenes where the need has been identified in the Action Plan. Interventions are based on a comprehensive assessment to explore reduced confidence, fear of falling, loss of independence since their fall, risk behaviours and hazards. The Westmead Home Safety Assessment  is the main tool used to identify and guide intervention on environmental hazards.
The CFPP currently employs 3 full time (FT) Senior OTs, 5 FT OTSWs, a mix of Physiotherapy staff and 3 FT administrative staff.
The collaborative working of OT and OTSW, as demonstrated in the CFPP service pathway, ensures efficient use of resources and skills whilst providing an effective and quality service to the older person who has suffered a fall.
Contribution to Occupational Practice
The CFPP provides a model of efficient use of skills mix of OT staff, both qualified and support, to provide an efficient and effective service for the prevention of falls in community dwelling
 Clemson L, et al. Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials. J Aging Health.2008;20:954-71.
 NICE 21 Falls Guideline. Falls: the assessment and prevention of falls in older people. National Institute of Clinical Evidence, London. 2004.
 http://www.cardonald.ac.uk/courses/show/9/ Higher National Certificate.
 Clemson L, Cumming RG, Roland M. Case-control study of hazards in the home and risk of falls and hip fractures. Age Ageing. 1996;25:97-101.
 AHP Best Use of Resource policy doc?
Contact: Fiona Neil, School of Health, Glasgow Caledonian University: firstname.lastname@example.org