Interagency training to support the liaison and diversion agenda

Background In England and Wales there are an unacceptably large number of people in prison or in contact with the criminal justice system who have mental health issues. Integrated and effective interagency collaboration is required between the criminal justice system and mental health services to ensure early diagnosis, treatment, appropriate sentencing or diversion of these individuals from the criminal justice systems into mental health services. Liaison and diversion schemes are proposed as a means to integrated service provision through positioning mental health professionals within the criminal justice system. These schemes were recommended by the Bradley Report (2009) to be rolled out for all police custody suites and courts by 2014 in a National Diversion Programme. Working within these schemes, at the interface of the criminal justice system and mental health services, has its challenges (Hean et al., 2009) and the workforce from both systems must be prepared to address these. This was recognised by Bradley when he recommended that: “where appropriate, training should be undertaken jointly with other services to encourage shared understanding and partnership working. Development of training should take place in conjunction with local liaison and diversion services (p111; Bradley, 2009). The form this joint training should take is as yet unexplored. We have proposed elsewhere that joint training should equip different agencies and professionals with the skills and knowledge required to collaborate effectively, and not only focus on mental health awareness courses for those in police, prison and courts services (Hean et al. 2011). The criminal justice system and mental health services need to come together to learn about, from, and with each other in interagency training. Aim We present in this report our vision of what this joint interagency training between the criminal justice and mental health services should contain, how it may be delivered and its potential benefits. We explore the receptiveness of professionals from the criminal justice and mental health services to interagency training and explore their perceptions of the challenges to interagency working between the two systems. We focus particularly on one particular dimension: an interagency crossing boundary workshop and its theoretical underpinnings. We explore professionals’ expectations of this type of intervention as well as their perceptions of the knowledge and skills required to deliver the emerging liaison and diversion agenda in general and the content and delivery of interagency training in the future. These findings are synthesized into a series of recommendations and a model of interagency training that will prepare professionals in both agencies to respond to the liaison and diversion agenda more effectively and work collaboratively in the interest of the mentally ill offender. Method A crossing boundary workshop (Engeström, 2001) was delivered in December 2011 to a sample of 52 professionals from a range of non-health professionals associated with criminal justice system (probation, police and courts) and professionals from the mental health system or health domain (learning disability, substance misuse and mental health services). The receptiveness of criminal justice system and mental health service professionals to interagency training was assessed through the Readiness for Interprofessional Learning Scale (Reid et al., 2005) administered to respondents before the workshop. Perceptions of the challenges facing interagency working and the expectations of the workshop were explored through interactive exercises. Professionals from both agencies participated in a series of 6 parallel focus groups to discuss how to prepare the workforce to respond effectively to the liaison/diversion agenda and the constraints they worked under in terms of commissioning, delivering and attending this training. Findings Professionals from both the mental health and criminal justice systems need to build empathic relationships with staff from other agencies. They stressed the importance of actual face-to-face contact between professionals from different agencies to achieve this and saw interagency relationships as being built through increased knowledge of other agencies and the orchestrating of formal facilitated contact between them. They were strongly in favour of interagency training and its contribution to enhanced collaborative competence across the workforce and, in the long term, improved offender mental health. They believed interagency training would develop in the workforce a greater knowledge of other agencies and help them understand other professionals’ roles and responsibilities. They believed interagency training should occur pre-qualification, through into continued professional development and contain a variety of interagency training experiences. Professionals from both systems shared a high level of person centredness in their approach to their practice and stressed the importance of training being grounded and delivered in a real world environment. Participants acknowledged that training opportunities are under threat due to financial and time limitations and that joint commissioning, shared resources and economies of scale must be considered. Recommendations • A training package should be developed to prepare professionals both from the mental health and criminal justice system for the liaison and diversion agenda and integrated service provision. This training must offer a strong interagency component aimed at developing interagency collaboration skills and interagency knowledge. A four-stage training model is proposed in this report. This incorporates pre-registration or undergraduate training for trainee professionals in the mental health services and criminal justice system, general awareness training, interagency training for continuing professional development and the development of interagency reflective practice opportunities. This model may be supplemented by a variety of on-line resources, some of which are described. • These interagency training models should be developed in partnership between universities and local facilitators from within the criminal justice system and mental health services to provide both the theoretical and evidence based rigour associated with developing collaborative practice curricula alongside the real world contextual knowledge required of these programmes. • In the long term, interagency training should be delivered in practice by practitioners to ensure the continued validity and sustainability of these programmes. Training should be sensitive to changes in the workforce due to turnover and the pressures of organisational change. • In times of economic constraint, training should be well targeted at staff and organisations essential to the liaison and diversion agenda. • An interagency commissioning approach will be required to deliver the training package outlined to support the liaison and diversion agenda, and especially if there is to be joint training and sharing of resources

Designing a New Model for Clinical Education: An Innovative Approach.

To keep pace with the ever-changing health care delivery system, it is important to transform the way future nurses are educated, both in classroom and in clinical settings, to care for people along the life and care continuum, not only in acute-care settings. The purpose of this article is to describe a new approach to educating baccalaureate nursing students using immersion practicums that expose students to population health, transitions of care, care coordination, and the multiple roles a nurse engages in along the continuum. The curriculum includes 5 immersions, each with a specific life and care continuum focus to develop anticipatory thinkers

Enhancing Care Transitions for Older People through Interprofessional Simulation: A Mixed Method Evaluation

Introduction: The educational needs of the health and social care workforce for delivering effective integrated care are important. This paper reports on the development, pilot and evaluation of an interprofessional simulation course, which aimed to support integrated care models for care transitions for older people from hospital to home. Theory and methods: The course development was informed by a literature review and a scoping exercise with the health and social care workforce. The course ran six times and was attended by health and social care professionals from hospital and community (n=49). The evaluation aimed to elicit staff perceptions of their learning about care transfers of older people and to explore application of learning into practice and perceived outcomes. The study used a sequential mixed method design with questionnaires completed pre (n=44) and post (n=47) course and interviews (n=9) 2-5 months later. Results:Participants evaluated interprofessional simulation as a successful strategy. Post-course, participants identified learning points and at the interviews, similar themes with examples of application in practice were: Understanding individual needs and empathy; Communicating with patients and families; Interprofessional working; Working across settings to achieve effective care transitions. Conclusions and discussion:An interprofessional simulation course successfully brought together health and social care professionals across settings to develop integrated care skills and improve care transitions for older people with complex needs from hospital to home

Curriculum renewal for interprofessional education in health

In this preface we comment on four matters that we think bode well for the future of interprofessional education in Australia. First, there is a growing articulation, nationally and globally, as to the importance of interprofessional education and its contribution to the development of interprofessional and collaborative health practices. These practices are increasingly recognised as central to delivering effective, efficient, safe and sustainable health services. Second, there is a rapidly growing interest and institutional engagement with interprofessional education as part of pre-registration health professional education. This has changed substantially in recent years. Whilst beyond the scope of our current studies, the need for similar developments in continuing professional development (CPD) for health professionals was a consistent topic in our stakeholder consultations. Third, we observe what might be termed a threshold effect occurring in the area of interprofessional education. Projects that address matters relating to IPE are now far more numerous, visible and discussed in terms of their aggregate outcomes. The impact of this momentum is visible across the higher education sector. Finally, we believe that effective collaboration is a critical mediating process through which the rich resources of disciplinary knowledge and capability are joined to add value to existing health service provision. We trust the conceptual and practical contributions and resources presented and discussed in this report contribute to these developments.Office of Learning and Teaching Australi

A virtual practice community for student learning and staff development in health and social work inter-professional education. Mini-project evaluation report.

Interprofessional education (IPE) has been widely advocated and developed as a means to encourage effective collaboration in order to improve public sector services. An IPE curriculum was introduced at Bournemouth University from 2005 for all nursing branches, midwifery, occupational therapy, physiotherapy, operating department practice and social work students (n=600). Challenges of this ambitious and large scale project included facilitating meaningful interprofessional learning while balancing structural complexities of professional body requirements and the logistics of large student numbers and multi-site teaching. A web-based simulated community was created, known as Wessex Bay, as a learning resource to facilitate interprofessional learning around case scenarios. An evaluation of student and staff experiences of IPE over two years, focusing principally on the use of technology in the education process was implemented. Student and staff data were collected via e-surveys, focus groups and open-ended questionnaires with additional feedback from external reviewers specifically on Wessex Bay. Qualitative data were subjected to thematic analysis. Whilst the findings are not claimed to be representative, they provide a rich insight into student and staff experiences of technology enhanced learning in IPE. The richness and complexity of data has led to a number of project outcomes with wide-ranging implications for interprofessional education. This research has led to the identification of three major territories of praxis in which individuals, both students and tutors, are operating in IPE, namely professional differences and identity, curriculum design and learning and teaching strategies, and technology enhanced learning. For the purposes of this report, we will discuss the findings related to student and staff experiences of technology enhanced learning in IPE. The evaluation of the findings highlighted three issues; the level of student and staff knowledge and skill in using learning technologies impacted significantly on learning; there was a need to capitalise on the use of web-based learning resources by increasing interactivity within the scenarios; and finally student and staff experiences of the learning resources was enhanced by a positive learning culture to facilitate creative use of materials. All project aims and objectives were met, and whilst more focused staff and student development in using learning technology is required, a culture of working interprofessionally among students and academic staff has begun to develop, leading to the sharing of ideas about content and learning processes. Recommendations resulting from the project include the introduction of assessed development of student and staff learning technology skills; development of more interactive web-based learning embedded within the case scenarios; and streamlining of the scenarios to provide fewer, but more developed, cases

A Virtual Practice Community for Student Learning and Staff Development in Health and Social Work Inter-Professional Education; Changing Practice Through Collaboration

This Mini Project has been funded by the Health Sciences and Practice Subject Centre of the Higher Education Academy Available on-line at HEA website: http://www.health.heacademy.ac.uk/publications/miniproject/scammell08.pd

Inter-professional education and primary care : EFPC position paper

Inter-professional education (IPE) can support professionals in developing their ability to work collaboratively. This position paper from the European Forum for Primary Care considers the design and implementation of IPE within primary care. This paper is based on workshops and is an evidence review of good practice. Enablers of IPE programmes are involving patients in the design and delivery, providing a holistic focus, focussing on practical actions, deploying multi-modal learning formats and activities, including more than two professions, evaluating formative and summative aspects, and encouraging team-based working. Guidance for the successful implementation of IPE is set out with examples from qualifying and continuing professional development programmes

Perspectives of Healthcare Practitioners: An Exploration of Interprofessional Communication Using Electronic Medical Records

Contemporary state-of-the-art healthcare facilities are incorporating technology into their building design to improve communication and patient care. However, technological innovations may also have unintended consequences. This study seeks to better understand how technology influences interprofessional communication within a hospital setting based in the United States. Nine focus groups were conducted including a range of healthcare professions. The focus groups explored practitioners’ experiences working on two floors of a newly designed hospital and included questions about the ways in which technology shaped communication with other healthcare professionals. All focus groups were recorded, transcribed, and coded to identify themes. Participant responses focused on the electronic medical record, and while some benefits of the electronic medical record were discussed, participants indicated use of the electronic medical record has resulted in a reduction of in-person communication. Different charting approaches resulted in barriers to communication between specialties and reduced confidence that other practitioners had received one’s notes. Limitations in technology—including limited computer availability, documentation complexity, and sluggish sign-in processes—also were identified as barriers to effective and timely communication between practitioners. Given the ways in which technology shapes interprofessional communication, future research should explore how to create standardised electronic medical record use across professions at the optimal level to support communication and patient care

A framework for understanding outcomes of integrated care programs for the hospitalised elderly

__Abstract__ __Introduction__: Integrated care has emerged as a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. Therefore, we developed a framework to identify the underlying mechanisms of integrated care delivery. We should understand how they operate and interact, so that integrated care programmes can enhance the quality of care and eventually patient outcomes. Theory and methods: Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. A review of integrated care components brings to light a distinction between the cognitive and behavioural components of interprofessional collaboration. __Results__: Effective integrated care programmes combine the interactin