The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) is a brief multi-domain assessment designed for people with Amyotrophic Lateral Sclerosis (ALS). This study evaluated the clinical impact of using the ECAS on ALS patients, carers and healthcare professionals. A secondary aim was to evaluate the clinical impact of neuropsychological intervention. Methods: A survey of current screening practices in ALS services across the UK was undertaken. In addition comparative case studies, in seven ALS care contexts, was qualitatively explored through interviews with patients, carers and healthcare professionals. Results: 22/34 health care services responded to the survey. 95% screen patients for cognitive and behavioural changes and all used the ECAS. Thematic analysis indicated that the ECAS: raises awareness about cognitive and behavioural change between patients, carers and healthcare professionals; validates and/or reassures; identifies changes, aids understanding of the patients' presentation and informs clinical decision-making. The latter includes suitability of interventions, adaptations by the multidisciplinary team, discussions about end-of-life care, referral on to other services, and identifying carers' support needs. A number of indirect economic benefits were described. Clinical neuropsychological intervention was reported to help the multidisciplinary team manage the care particularly of complex cases, the effects on daily life, and stress of patients, carers and families. Conclusions: The ECAS has been widely implemented across ALS health care teams in the UK. Screening for cognitive/behavioural deficits and neuropsychological intervention has a positive impact on patients, carers and healthcare professionals and improves the quality of routine clinical care.

BackgroundLink workers (lay health workers, health support workers) based in the community provide additional support to individuals and families to facilitate engagement with primary care and other services and resources. This additional support aims to tackle the wider socio-economic determinants of health that lead to inequalities. To date, there is no clear evidence of the effectiveness of these programmes. This study evaluates the effectiveness of Dental Health Support Workers (DHSW) at linking targeted families with young children to primary care dental practices. The DHSW role is one component of Childsmile, the national oral health improvement programme in Scotland.MethodsA quasi-experimental approach captured the natural variation in the rollout of the DHSW intervention across Scotland in a cohort of children born between 2010 and 2013. Survival analysis explored “time to attendance” at primary care dental practice. Cox’s regression models compared attendance rates and time until first attendance between those families who received support from the DHSW and those who did not.ResultsThe cohort consisted of 35236 children. Thirty-three percent of the cohort (n = 11495) were considered to require additional support from a DHSW. Of these, 44% (5087) received that support. These families were more likely to attend a dental practice (Hazard Ratio [95% Confidence Interval] =1.87 [1.8 to 1.9]) and, on average, did so 9 months earlier (median time until first attendance: 8.8 months versus 17.8 months), compared to families not receiving additional support.ConclusionsLink workers (DHSW) within the Childsmile programme are effective at linking targeted children to primary care dental services and, most notably, at a younger age for prevention. This is the first study of its kind to evaluate the effectiveness of link-worker programmes using a robust quasi-experimental design on three, population-wide, linked datasets. These results will inform future health programmes which aim to improve health and reduce inequalities by reaching and supporting families from more disadvantaged backgrounds.

BackgroundLay health workers (LHWs) are utilised as a channel of delivery in many health interventions. While they have no formal professional training related to their role, they utilise their connections with the target group or community in order to reach individuals who would not normally readily engage with health services. Lay health worker programmes are often based on psychological theories of behaviour change that point to ‘tailoring to individuals’ needs or characteristics’ as key to success. Although lay health workers have been shown to be effective in many contexts, there is, as yet, little clarity when it comes to how LHWs assess individuals’ needs in order to tailor their interventions. This study aims to develop a better understanding of the effective implementation of tailoring in lay health worker interventions by appraising evidence and synthesising studies that report evaluations of tailored interventions.MethodHealth and psychology electronic databases (EMBASE, CINAHL, MEDLINE and PsycINFO) will be searched. Reference lists of included studies will also be searched. For articles that are deemed to be potentially relevant, we will employ a ‘cluster searching’ technique in order to identify all published papers related to a relevant intervention. Cluster searching will be undertaken in an effort to maximise the breadth and depth of description of the intervention. Quantitative studies will be assessed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project, ON, Canada. Qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Sythesising the data will enable the development of a taxonomy of strategies for the criteria used for individual assessment of recipients’ needs and the ways in which messages or actions are tailored to these individual criteria by LHWs.DiscussionThis systematic review focuses specifically on how health promotion and support is individually tailored in effective programmes by LHWs. This study will be of value to those involved in the design and implementation of interventions that utilise a LHW.Systematic review registrationPROSPERO CRD42015030071Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0271-z) contains supplementary material, which is available to authorized users.

TITLE Factors influencing the implementation of cognitive and behavioural screening in Motor NeuroneDisease. ABSTRACT (100-150 words)Changes in cognition and behaviour occur in approximately 50% of people with Amyotrophic Lateral Sclerosis (ALS), the most common form of Motor Neurone Disease (MND). The aim of this study was to explore current factors influencing the implementation of cognitive and behavioural screening in MND care in the UK. Semi-structured interviews with healthcare professionals working in a range of settings were conducted and data were analysed thematically. In most of the settings included, a pathway to screening and neuropsychological intervention had not yet been established. Factors identified as barriers included: limited number of staff trained to administer screen, limited time available during outpatient clinic hours, and limited or no links with neuropsychological services.Screening was implemented routinely in one setting where there was support from a clinical neuropsychologist working within the MDT. Support from neuropsychological services was suggested to be necessary for interpretation of screening results and advice on intervention. KEYWORDSMotor Neurone Disease; Amyotrophic Lateral Sclerosis; cognition; behaviour; screening KEY POINTS 1. Cognitive and behavioural screening is an important component in the assessment and management of people with ALS/MND and is recommended in National Institute for Health and Care Excellence guidelines. 2.Although healthcare professionals are aware of screening tools and have a positive attitude to screening, it is not currently implemented routinely in all settings.