Section 3 Support for change: making it happen
National, regional and local support from AHPs and a number of key stakeholders is required to enhance the capacity and capability of AHPs in mental health to deliver the recommendations in this action plan. This support is described below.
AHPs need to understand workforce and workload methodologies and use them to demonstrate their impact and maximise their potential. They should be able to articulate the difference they make to a wide range of service user pathways, ensuring best value and highest quality care. The Six steps to introducing a structured approach to workforce planning resource (24) can be used to support AHP services to develop and deliver evidence-based workforce plans.
The Scottish Government scoping exercise to identify workforce characteristics mentioned previously will contribute specific mental health-related data to inform workforce planning for the future.
The Scottish Government, in partnership with NES, is scoping the four Scottish universities who educate AHPs to review pre-registration AHP curricula for evidence of mental health fieldwork and academic learning requirements across mental health specialties (children, adolescents, adults and older adults). This will be completed by autumn 2010, with recommendations to follow.
AHPs have a professional responsibility to pursue ongoing learning activity to retain their capacity to practise safely, effectively and legally within their evolving scope of practice.
AHPs in mental health must continue to access regular profession-specific supervision in individual or facilitated-group settings, and are expected to:
- receive clinical supervision from a trained clinical supervisor within protected time
- be trained as clinical supervisors
- evaluate the effectiveness and impact of the supervision provided.
Work-based learning opportunities are being supported through the AHP practice education facilitation programme supported by NES. 5In addition, The Ten Essential Shared Capabilities ( ESCs) should be integral to training, induction and ongoing learning of all AHP professionals and support staff (see Box 2).
BOX 2 The Ten Essential Shared Capabilities
The Ten Essential Shared Capabilities ( ESCs) (25) set out shared capabilities that all staff working in mental health services should achieve as best practice. The principles have been supported by AHPs in Scotland and have been adopted by the College of Occupational Therapists ( COT) and the Chartered Society of Physiotherapy ( CSP) as their underpinning values. They are now beginning to integrate them into their accreditation and re-accreditation processes.
What is not yet clear is the training infrastructure required to support service change and developing AHP roles in mental health. A range of CPD opportunities enabling AHPs to deliver effective treatment interventions need to be available: these should focus on profession-specific specialist fields, recovery and ESC training, self-management, psychological therapies and vocational rehabilitation.
The Scottish Government, in partnership with NES, will review NHS boards' current and future workforce education priorities for AHPs in mental health to ensure synergy with the proposed service delivery changes. Recommendations will be produced by autumn 2010.
First graduate post
It is essential that there is support for all newly qualified AHPs who specialise in mental health, ensuring engagement with Flying Start NHS, 6 supervision and rotation opportunities. This will also have a positive impact on recruitment and retention of staff.
AHPs of all grades need leadership skills to meet the service change agenda. A range of leadership programmes are available in NHSScotland for AHPs in mental health, and AHP leaders and practitioners should engage with these programmes.
Leadership is critical for effective change. Effective leaders motivate staff to perform optimally, enable team working and collaboration and contribute to overall organisational effectiveness. The development of this action plan now offers the opportunity for NHS boards and AHP directors to review their current clinical leadership structures for AHPs in mental health to complement existing board leadership structures.
The Scottish Government will establish a national AHP mental health clinical leaders' group.
NHS boards and AHP directors should identify an AHP mental health lead, developing a sustainable clinical leadership function that reflects proposed service delivery changes.
" If I hadn't started coming to see the speech therapist, I reckon I'd just have stayed the same or worse. Coming to my sessions gets me out of the house and interacting [and] I feel better when I leave, too. Talking with her makes it easier to talk to others [and] it's made it easier to communicate with the other professionals I see. "
Service user : Experience of speech and language therapy
Evidence-based practice and research
The development process for this action plan identified many excellent practice-based and evidence-based clinical examples which will be developed as a supportive resource. The AHP community needs to share and disseminate this good practice through online sources such as www.enablinghealth.scot.nhs.ukand professional journals and web resources (see Appendix 3).
The newly formed clinical leaders' group mentioned above will set up a community of practice in the Self-management and Rehabilitation Managed Knowledge Network ( MKN), which connects groups, communities of practice and interested individuals committed to sharing knowledge resources and expertise specific to mental health.
Practice based on best evidence
The Health Professions Council ( HPC) expects all AHPs to base their interventions on the best available evidence, which calls for AHPs to review relevant research and implement accordingly. Time and support must be available to ensure AHPs can reflect on their practice to deliver services based on best evidence.
Outcomes and impact
The challenge for all services in mental health is to develop a culture in which data are used to inform improvement work. There is a need within mental health services to improve the quality of, and use of, information to drive service improvement.
AHPs need to measure the outcomes and impact of their interventions using standardised assessments and measures. The Mental Health Collaborative, 7 Integrated Care Pathways in Mental Health 8 and the National Benchmarking Project (26) allow AHPs access to improvement methodologies and techniques to deliver change and should be utilised to support AHPs during this period of transition.
AHPs also need to evidence improvements in the quality of the service they deliver by demonstrating improvement in outcomes. They should use patient-reported outcome measures ( PROMs) to monitor the patient experience; these should be evaluated and integrated into current practice and service delivery. AHPs often use PROMs as an underpinning to their assessment process (the Model of Human Occupation Screening Tool ( MOHOST) 9 and the Canadian Occupational Performance Measure ( COPM), 10 for instance). These are also often repeated on exit from the service but are seldom aggregated to produce outcome data regarding service impact.
AHPs should use information gathered while providing AHP interventions to evaluate the service user experience, enhance the evidence base and improve services using patient-reported outcome measures and standardised assessments.
AHPs have a growing international research base reflecting a mixture of quantitative and qualitative research activity.
Consultant AHPs have a strong influence on the research agenda for mental health AHP practice, with four new AHP consultant posts having been created in Scotland. These posts will influence the research agenda for dementia care and forensic care and will be integrated into the Scottish Government National Impact Framework to evaluate the impact of the consultant role.
There are nevertheless gaps in the practice and research agendas. Practice and research need to be linked, with AHP practice being evaluated through quantitative and qualitative research methods to build practice-based evidence and evidence-based practice.
The Scottish Government will work with the AHP research community to explore how best to develop further research opportunities in AHP mental health practice to contribute to the development of clinical guidelines andThe healthcare quality strategy for NHSScotland (2).
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