Social prescribing

With the idea of recovery club, I found the project Source of support: social prescribing has something similar I can refer to. Therefore, I talked to expert in this project and it really helps me a lot.

Interview with social prescribing expert

Case study: Social prescribing – mental health support

GP, user — Link worker, user — user, community groups 

GP sees people who have mental health problem and he refers this to the link worker. The link worker talks to them for about half an hour to find out what is the problem, what would they like to do and then they refer them to classes in community link like walking groups, badminton classes, art therapy, cooking therapy, all the different community groups. These classes are for anybody, not especially for people who have mental problem.

In every house state in Dundee, usually there is a community centre running all kinds of different classes.

Generally, people in social prescribing are very socially isolated and they don’t go out. So the link worker in this project can help and support them to go out. After the first initial visit, they managed to go themselves.

The target user in this project don’t need medication.

About the motivation

They suffer from the depression. Evolving people in social prescribing is a difficult process. The link worker and the person who possibly runs the recovery club, it is more like to be a consultant service, a listening service to get them motivated. In fact, some people took a lot of moving to get them to involve. Because those people are so damaged.

Suggestion given on the stroke project 

Who would run the recovery club? Who would lead the special classes?

The leader will need to be someone with physiotherapy, because they will understand the needs. But someone also who has insights into the mental health problems for people have stroke. Because people with stroke understand that they need exercise for the ability issues, but the impact on their life and mental health problems is huge.

You can highlight the problem: don’t be socially isolated, don’t just sit in your house, come to recovery club.

The peer support maybe also very helpful.

About Online info

If you want to send them to gym, the gym should have the instructor who can understand the problem. It should be tailored especially for stroke survivors.

Online information could work, because 60 or 70 they should be online. It will tell them all about the recovery club and tell them where to go in the community centers.

Useful: Dundee healthy living initiative (website)

They do a lot of different kind of programs and that might be a way of linking to them so that you can start with your recovery club. Small fee to access to those classes. And this is Dundee wide.

Lack of links. That is the problem. Every body works in their little groups and nobody links.

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Interview with stroke survivor I

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This week I interviewed a male stroke survivor. In this interview, we mapped his experience of stroke treatment, including cure as well as rehabilitation. We talked about exercise. Also, I showed him several ideas I come up with and gained feedback. It was really nice talking to him, as I got lots of useful information, knew about user’s needs and found some problem in the current health care service.

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Stroke survivor used heart to show his likes to these ideas and flag to show the feasibility.

Key points quote/Highlights

“This is where I think the health care service breaks down. You go to a very protective environment in hospital with lots of people helping you. At the stage when you sent home, you are on your own. All the services, helps, supports stop. “

 “I got that service because I pushed.”

 “I think there should be some transition from lots of support to nothing. The supports could slowly withdraw.”

 “After 2-3 days when I back to home, I thought what can I do now? I am not gonna sit here for months.”

 “I did exercise for 4 months. I didn’t enjoy the exercise, I just wanted to be better and stronger. I stopped exercise but I carried on swimming, because I enjoy swimming.”

 “People that felt down or depressed, they were given psychologists to get help. I think that maybe more important than exercise.”

 “Getting the stroke survivor to the point of wanting to control and better their own life. Maybe the mental side is more important to get survivors to think ‘it’s me.’ 

Users’ needs 

These quotes highlight what the stroke survivor thought about his journey of stroke treatment and imply what the stroke survivor need as well. As designing a service, always remember to find the problems and explore users’ needs.

Interview record with Dr Jacqui Morris II

27/03/2013 with Jacqui Morris

Do you have a user group with which you are doing a research I can interview?
No, because I have finished my research. But there are people who will be very interested in speaking to you. I don’t think there will be ethical problems. Because the two gentlemen, they are part of the patient council, which in NHS they have commit that, they can give their opinions and experiences in healthcare system. They can take part in studies. It’s just a concertation. They are stroke survivors. I can contact them. But we have already had quite a lot of discussions with them about physical activities. But your ideas are different from ideas that I have.

Can I use the report you give as a reference?
If you say it is an unpublished dissertation.

Details confirm
Age range: 61-80 Average age: 67
Community dwelling = living in their own home in community

Who is the caregiver when a stroke survivor live alone?
Social services, home-care system, not in healthcare system, most funded by the city council. Depends on people’s need. Part of funded by the government. But they still have to pay.

Conditions of stroke survivors
When you are looking into designing a service, it maybe important to consider what if you want to look at a certain group of people. Who is most likely to benefit or who has the most need. There are varies conditions of the stroke survivors. Some of them can work and some of them can do nothing.
When we interviewed with stroke survivors, some of them have communication difficulty. We use pictures to show them, because we also want to catch the views of people who have communication difficulties as well. If we don’t do that, we just interviewed particular proportion of the stroke population and we don’t catch everybody thinks.

When stroke survivors get home, what is the role of physiotherapist in this stage?
Depends on their needs. Usually, physiotherapists will go to their home. They haven’t rehabilitation in their own home, so the physiotherapists will visit them once or twice a week. This is also physiotherapists’ work. They are called community rehabilitation teams. Usually is a short intervention, like 6 or 8 weeks. It is part of the rehabilitation.
You have a cure hospital, then you have rehabilitation hospital, then you have community rehabilitation. Their role is really to make sure that people are managing at home and to continue the therapy as long as they need it. They will decide what they need and then they will hand over the responsibility to the healthcare assistants or caregivers. They can guide them how to take care of the stroke survivors. Physiotherapists will come back again to see how it is getting on and decide if they need more therapy or not.
The system is organized to try to get people out of hospital quickly and the therapists in the community are there to make sure people recover as much as they can do, but in a different environment, in home.

Interview record with Dr Jacqui Morris I

28/02/2013 with Jacqui Morris

About Jacqui and the research she has done
She is a professional physiotherapist.
They have done a quilatated study about the reason why stroke survivors don’t continue the physical activities after they having completed the rehabilitation when they go back home.What the barriers are, what is easier for them, what they wanted for supporting.

Some information:
Caregivers are mostly partners.
Their treatment is about 2 month – 2 years. After it people take 6-7 years to do activities which is much more longer

Reasons about why they stop doing PA:
Exercise class set up in community by healthcare services are time limited
What do they need? What they really wanted? (physically and mentally)
They need a wide range of activities
Want to do things be outside. Do what they do previously
Transportation problem and accessibility 

The environment of healthcare services
Health services sometimes create dependence people are scared to do activities without health professionals but they still have sort of need of the community that’s why they want to do exercise in community. Healthcare system always focus on safety
Maybe people not the health professional with people who understand stroke who have been trained. Not nessearylily professional

This service maybe create ( Stroke survivors are living in a community setting) :
Something appealing to them
Outside the medical model ( when exercise class is over)
Enable them to feel that they are in a community again
About identity regain the identity who is able to engage in what they are before previous identity
Pathway to be an active person in the community
Enjoyable activities with others outside healthcare service
They will not do if it is not interesting

Different of patients’ thought health professionals’ thought
Health professionals think: activities of daily living get dressed cook go down stairs
Patients: socialize meet people do enjoyable things. Go back to they were

Focus on a particular group of stroke survivors ( target people )
Maybe you should think people that are less disabled
Focus on people are mobile
About belief that causes the stroke:
Those who think life style cause it are more likely to get motivation to do PA
Key issue: people who have strong belief will active anyway, others not