specialist psi exercise module implementation making it work and making it sustainable different...
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Specialist PSI Exercise
Module
Implementation
Making it work
and making it sustainable
Different models, but similar principles
Specialist PSI Exercise
Module
IDEALLY - An Integrated
Falls and Fracture Prevention Service
• multi-professionalMedical and Nursing staff, Therapists, Social Workers, Exercise Professionals
• multi- agencyLocal health authority, Social services. Local authority , Leisure Services, Sports
Development Service, Voluntary sector
• co-ordinated
Working to agreed protocols, Working to agreed pathways, Utilising agreed communication pathways
• and integrated serviceUsing a regular mechanism of meeting to agree strategy and review progress
towards objectives
Specialist PSI Exercise
Module
What should a service consider?
Aims of Service• To provide a seamless service across all
agencies• To promote personal responsibility for healthy
active ageing• To pro actively identify those at risk of falls and
osteoporosis• To ensure appropriate assessment and
interventions for those at risk
Specialist PSI Exercise
Module
3-tiered inter agency assessment process:-
3. Specialist falls assessment
2. Determine risk factors
1. To identify a falls problem
Specialist PSI Exercise
Module
Getting falls and fractures on the map
• ? Trigger questions on falls and fractures in– A & E– GPs– Single Assessment process?
• Educating others– Pharmacy, Opticians, Chiropodists, Day Centres– etc
Specialist PSI Exercise
Module
Exercise Continuum 3 components:-
1. Community exercise opportunities that offer varied and progressive programme
2. Specific falls prevention (and injuries from falls) rehab class and
3. home based exercise programme
Specialist PSI Exercise
Module
How?• Clinical Exercise Specialists creating links between health
and leisure
• Nationally validated courses:- CBE, OEP, PSI available to all professional groups
• Additional ‘top up’ training to develop skills and standards of practice across all areas
• ‘Code of practice’ – agreed minimum standards for all instructors in both health and leisure
• List of approved classes (monitored and evaluated on a regular basis)
Specialist PSI Exercise
Module
Community Exercise Programme
Aim: to ensure that all older adults have
easy access to a regular, safe and effective
local exercise class
• community
• sheltered housing complex
• day centre
• residential home
Specialist PSI Exercise
Module
Home based exercise programme
OTAGO
Chair Based Exercise Class
(Community based)
Exercise Referral Scheme
12 weeks
PSI/Rehab based exercise group
12 weeks
Community based classes for older people
OTAGO exercise classes
(Community based)
Falls AssessmentIdentification of a falls problem and screening to determine risk factors
Cambridgeshire Falls Prevention EXERCISE PATHWAY
Motivation Screening Pathway
Specialist PSI Exercise
Module
Transport issues……Funding issues
• Link in with other services – Exercise Referral– Mental Health priorities– Social Care funding– Leisure Services
• Consider self funding after initial period?– Often more valued and attendance better!
• Consider ‘buddying’ shemes to aid travel– Going with people on the bus– Providing a lift– Bring along family (and their car!)
Specialist PSI Exercise
Module
Challenges for future• Keeping falls and osteoporosis on agenda
(different priorities across primary and secondary care and community)
• financial constraints - demonstrating cost effectiveness
• ongoing organisational changes
• staff - rapid turnover - low morale
Specialist PSI Exercise
Module
Conclusions
• Falls and Fracture Prevention Services have come a long way in past 6 years.
• In order to ensure ongoing funding locally, we must convince commissioners of cost effectiveness in terms of:-
- preventing falls related injuries.
- maintaining independence and improved QOL for those at risk of falls and fractures (eg. Evaluation!)
Be clear about the specific needs of this group of people (Not all exercise is the same!)