Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
2. www.england.nhs.uk
LTC Framework
Commitment
to Carers
Frailty
Health Ageing
Guide
Fire Service as
an asset
Care Homes
Quick Guides
Care & Support
Planning
Navigating Health
& Social Care
Self Care
Ambitions for
End of Life Care
Our Declaration
Delivery Models
Planning for Change:
• Capitated Budget
• Contracting
• Simulation Modelling
Patient and
Service
Selection
Planning for Change:
Workforce
Whole Population
Analysis;
Understanding your
population
LTC Dashboard LTC Toolkit
4. www.england.nhs.uk
7
Using behavioural
change to open
minds
#A4PCC – Action for Person-
Centred Care
Person
with long
term
condition
o Make a declaration at
www.engage.england.nhs.uk/survey/ltc
-declaration
o Tell your teams about our work
o Encourage them to make a declaration
o Ask them to feed back thoughts and
ideas
o Use our hashtag – #A4PCC – when
you see work that is relevant to
person-centred care for people with
LTCs
o Let us know of any events, activities or
social media opportunities that we can
join forces with you
6. Frailty: building understanding, empathy and
the skills to support self-care
31st March 2016
Dr Dawn Moody
An opportunity to learn about some innovative
approaches to making the health and care
workforce ‘fit for frailty’.
@Fusion48net
@Moody_D_K
#frailty
7. www.frailtytoolkit.org 7
What are the aims of the session?
• To explore the Frailty Fulcrum as a tool for holistic assessment
and management of frailty
• To hear how Virtual Reality is being used to build empathy for
older people living with frailty
• To learn about the impact of a county-wide, multi-agency, multi-
professional training and toolkit for care professionals working
with older people
7
8. www.frailtytoolkit.org 8
What we are going to cover
• The importance of supported self-care for people with frailty
• An introduction to the Frailty Fulcrum
• FrailSIM - a Virtual Reality experience to build empathy
• Integrated training & person centred case studies
• The Frailty Toolkit App.
9. www.frailtytoolkit.org 9
What is ‘Frailty’?
A state of
reduced
resilience and
increased
vulnerability
A state which minor
events can trigger
disproportionate
adverse outcomes
in health, wellbeing
or functional ability
Related to, but
distinct from,
ageing,
comorbidity
and disability
Delivering safe, effective & consistent care to people with frailty is the greatest
challenge facing the NHS in 2016 and beyond.
10. www.frailtytoolkit.org 10
What is self-care?
Regulatory Preventative
Reactive Restorative
Self-care
Recovery &
rehabilitation
Health & well-
being
Daily Living
Diagnosing &
dealing with
symptoms
11. www.frailtytoolkit.org 11
Supported self-care
What’s required:
1. Engaged, informed individuals
and carers.
2. Professionals who recognise the
central role of the person in their
own care and are committed to
partnership working.
3. Care systems and services that
are organised in ways that enable
individuals, carers and
professionals to work together.
‘Supported Self-care’ is the process of assisting people to manage
their own care in a way that helps to improve their quality and
experience of life.
13. www.frailtytoolkit.org 13
Ten components of care for older people
13
Shift to prevention and pro-
active care:
1. Age well and stay well
2. Live well with one or more
LTC
3. Support for complex co-
morbidities / frailty
15. www.frailtytoolkit.org 15
What we are going to cover
• The importance of supported self-care for people with frailty
• An introduction to the Frailty Fulcrum
• FrailSIM - a Virtual Reality experience to build empathy
• Integrated training & person centred case studies
• The Frailty Toolkit App.
17. www.frailtytoolkit.org 17
What we are going to cover
• The importance of supported self-care for people with frailty
• An introduction to the Frailty Fulcrum
• FrailSIM - a Virtual Reality experience to build empathy
• Integrated training & person centred case studies
• The Frailty Toolkit App.
19. www.frailtytoolkit.org 19
The role of simulation in training
o Simulation Based Medical Education is believed to be
superior to the traditional style from the viewpoint of
the active and adult learning theories
o Generally used to simulate patient / person for
practitioner to practice on e.g., mannequins, role play,
actors
o Simulation suits allow practitioners to experience some
aspects of an individual’s situation e.g., Age Simulation,
Obesity simulation
o Suits tend to be difficult to scale up and easily change
the environment
20. www.frailtytoolkit.org 20
The basic idea for FrailSIM
1. Create a virtual living space, building in clues
about the person’s situation and interest
3. Develop a scenario that gives the
user simple tasks to do to
experience life as “Victor”
2. Develop an avatar that can have different
levels of frailty-related impairments
21. www.frailtytoolkit.org 21
The learning goals
1. “Virtually” walk in the shoes of an older person with frailty to
increase understanding of their situation and help develop greater
empathy
2. Promote observational skills
and develop greater awareness
of clues in the environment
about an individual and their
situation.
3. Deploy novel assistive technology to support
training goals and thereby mirror one of the skills
for supported self-care
22. www.frailtytoolkit.org 22
Key facts from FrailSIM to date (1)
320+ individuals
40+ roles
50+ organisations
93%
of participants rated it ‘good’ or
‘excellent’ in terms of helpfulness in
building empathy / walking in the
shoes of an older person with frailty
Poor, 2 Fair, 5 Neutral, 17 Good, 106
Excellent,
192
Helpfulness in building empathy /
walking in shoes of an older person with
frailty
23. www.frailtytoolkit.org 23
Key facts from FrailSIM to date (2)
Nursing, 115
Allied Health
Professional,
51Care
Worker, 32
Social
Worker, 28
Health Care
Assistant,
22
Support
Worker, 15
Other, 57
Mix of staff groups par cipa ng in FrailSIM
14.6
Average number of years
participant had worked in the
health & care sector
27%
Of participants rated themselves
as 5 out of 5 for familiarity and
comfort using smart phones
What words would you use to describe the
VR experience to a colleague?
85% of participants were female
24. www.frailtytoolkit.org 24
What we are going to cover
• The importance of supported self-care for people with frailty
• An introduction to the Frailty Fulcrum
• FrailSIM - a Virtual Reality experience to build empathy
• Integrated training & person centred case studies
• The Frailty Toolkit App.
26. www.frailtytoolkit.org 26
Mid Notts Transformation
Programme (inc. PACS
vanguard)
Open to all…
26
Domiciliary
Care providers
Care Homes
Primary & Urgent Care
Community & Mental
Health services
Acute services
Nottingham University
Hospitals
Sherwood Forest
Hospitals
City Care
County Health
Partnerships
226 Practices
85 Nursing
Homes
131 Residential
Homes
100 Provider
“locations”
South Notts
Transformation
Programme
Health Education England
Skills for Care
Nottinghamshire
Healthcare
East Midlands
Ambulance Service
Age UK
British Red Cross
Nottinghamshire Care
Homes Association
Nottingham Community &
Voluntary Service
Carers Trust
Dentistry, Pharmacy,
Optometry
OOHs Providers
Fire & Rescue Service
Housing Associations
27. www.frailtytoolkit.org 27
Multi-agency, multi-professional to support
person along journey of care
Open to all
Table planning to ensure
multi-agency MDTs on the day
Lots of interaction through
doing work together
Quiz as Ice breaker
Sharing cases through
Fulcrum exercise
Help & hinder: roles within
the wider system (and shared
frustrations)
Home and hospital-based
case scenarios
Time and space for
networking over lunch and at
breaks
28. www.frailtytoolkit.org 28
Putting the older person with frailty at the
centre of the training
Case introduced through
VR simulation
Care planning exercise
starts with video using
actors for Vic & Kath plus
memorabilia
Victor’s story
“Voice of” cards available for both stories plus
additional input from facilitators
Case introduced through
hospital-based MDT role-
play
Care planning exercise
starts with video using
relatives’ voice over of
Nirmala & Baldev’s story
Nirmala & Baldev’s story
29. www.frailtytoolkit.org 29
Outline of the day
Outline Timings Session
0915 - 0930 Overview of the day
0930 - 0950 Team quiz: Concepts & Consequences of Frailty
0950 - 1100 Understanding frailty
1100 - 1115 Break
1115 - 1230 Frailty & Supported self-care
1230 - 1245 Introducing the Frailty Toolkit App: Learning Zone & Enabling Zone
1245 - 1330 Lunch
1330 - 1345 Overview of the afternoon’s programme
1345 - 1515 Supported self-care along journeys of frailty - Case-based scenarios, Part 1
1515 - 1530 Break
1530 - 1615 Supported self-care along journeys of frailty - Case-based scenarios, Part 2
1615 - 1635 Presentation of supported self-care plans
1635 - 1650 Introducing the Frailty Toolkit App: Development Zone & Feedback
1650 - 1700 Recap of the day and close
30. www.frailtytoolkit.org 30
Evaluation of outcomes of training
6.0
8.3
Pre-event - cohort 3 month - cohort
Confidence in suppor ng
older people with frailty to
self-care (out of 10)
+37%
92%
of participants rated the
training ‘very effective’ or
‘effective’
1
On a scale of 1 - 10 how well do you
think you have achieved your goals
from the training?
10
7.8
31. www.frailtytoolkit.org 31
Three biggest challenges for training
programme
Reaching 700+ primary
care and social care
providers!
Trust in Special Measures
unable to release staff
for training
32. www.frailtytoolkit.org 32
Development of shorter training modules
• 2 hour sessions
• …. 1. Raising awareness
of frailty and
supported self-care
2. Case-based multi-
agency, multi-
professional team
experience
33. www.frailtytoolkit.org 33
What we are going to cover
• The importance of supported self-care for people with frailty
• An introduction to the Frailty Fulcrum
• FrailSIM - a Virtual Reality experience to build empathy
• Integrated training & person centred case studies
• The Frailty Toolkit App.
34. www.frailtytoolkit.org 34
Toolkit as an App: basic functionality
34
‘Web-based application’ that is platform agnostic:
works on Apple or Android devices, desktop or laptop
Basic log in functionality set up as part of registration
process for training event
Consistent ‘look and feel for ease of usability
Clear structure of drop down and expandable menus
and sub-menus, lists and features
Search function and ‘tagged’ content for ease of
navigation
Access to videos without leaving application
Links to external content available
Localisation of content in key menus (e.g., directory of
services / resources)
Highly scalable for increased numbers of users
37. www.frailtytoolkit.org 37
What is available now?
1. Home: Welcome page, latest additions
2. My profile: Change profile, log out, bookmarks
3. Concepts & consequences: Contextual reports and
background information
4. Learning Zone: A range of modules covering frailty and
supported self-care theory & principles
5. Enabling Zone: Supported self-care planning templates
6. Development Zone: Additional training & education
resources
7. Case studies: 3 examples of person centred care to bring
the theory to life plus a service innovation
8. Directory of resources: Links to helplines, support and
assistive technology relevant to clients and their families
9. About the Toolkit: Background to the development and
contacts
38. Frailty: building understanding, empathy and
the skills to support self-care
Dr Dawn Moody
dawn@fusion48.net
An opportunity to learn about some innovative
approaches to making the health and care
workforce ‘fit for frailty’.
@Fusion48net
@Moody_D_K
#frailty
Notas do Editor
Jane to lead
Jane to lead
Jane to lead
DM:
Firstly the reach and mix of participants:
300+ health and care professionals from more than 20 organisations
Multi-professional with over 40 different roles across all major staff groups
Secondly ‘hot feedback’ on the day of training
92% of participants rated the training “very effective” or “effective”
Around 90% of participants were “likely” or “very likely” to download, recommend or share the Toolkit and Training
Round-table networking and multi-agency working were the “best things about the events”
Length of intensity of the day was an issue for a small proportion of participants, especially at venues with less space and natural light
DM:
Firstly the reach and mix of participants:
300+ health and care professionals from more than 20 organisations
Multi-professional with over 40 different roles across all major staff groups
Secondly ‘hot feedback’ on the day of training
92% of participants rated the training “very effective” or “effective”
Around 90% of participants were “likely” or “very likely” to download, recommend or share the Toolkit and Training
Round-table networking and multi-agency working were the “best things about the events”
Length of intensity of the day was an issue for a small proportion of participants, especially at venues with less space and natural light
Jane to lead
Thirdly:
3 month follow up survey.
In the pre-event work people were asked to rate themselves on a 10 point scale. 3 months later to rate themselves on the same scale.
Across all 6 areas, respondents reported higher levels of confidence and understanding at the 3- month point.
Understanding of frailty and self care and confidence in supporting people with frailty to self care.
Also in understanding n roles of other people and organisations, in confidence in sign posting people to most appropriate services and in working with families and carers.
Also mention the comments
The final dimension of the evaluation is the data analytics of the toolkit usage, which is currently a work in progress but shows interesting early results.
DM
Needless to say there have also been some challenges.
Awareness of training – ambitious project with tight timescales and reaching out to 700 + primary and social care providers to raise awareness significant challenge.
Access to training – frontline staff, both in fragmented community services and also in big providers e.g. in special measures
Access to toolkit - technology challenges – out of date technology restricting access – IE8 well out of date and unsupported but still browser of choice in many organisations!
An innovative and interactive 2-hour session designed to build understanding and empathy for older people with frailty.
Using the ‘real life’ case-based scenarios, a practical experience of working in a multi-agency, multi-professional environment to support older people living with frailty to self-care.