A ~OCT 2 5 19881This report contains a proposed comprehensive land use 0 planning process for Army installations, along with a broad review of the theories, techniques, and history of master planning in general and an analysis of Army master planning. It addresses the following questions: (1) What tools are available to implement land use planning? (2) How does (should) the Army master planning process work? (3) Which regulations affect Army master planning? (4) What type of comprehensive land use planning implementation process will meet Army installations' needs, given the findings from the previous three questions?Based on the findings from the questions, the report has three recommendations. 1.Create a standard installation land use planning process, incorporating recent revisions to Army Regulation (AR) 210-20, Master Planning for Army Installations, and replacing conflicting or obsolete standards with state-of-theart planning techniques.2. Assemble references from the many related ARs and guidance documents into one users' guide, to be used as a single reference for installation master planners and MACOM reviewers. An appendix includes a preliminary effort to list the applicable regulations. 3.At some future time, codify the related ARs into a subject-indexed code that reflects that standard land use planning process. This report contains a proposed comprehensive land use planning process for Army installations, along with a broad review of the theories, techniques, and history of master planning in general and an analysis of Army master planning. It addresses the following questions: (1) What tools are available to implement land use planning? (2) How does (should) the Army master planning process work? (3) Which regulations affect Army master planning? (4) What type of comprehensive land use planning implementation process will meet Army installations' needs, given the findings from the previous three questions? (Continued) Based on the findings from the questions, the report has three recommendations. 1.Create a standard installation land use planning process, incorporating recent revisions to Army Regulation (AR) 210-20, Master Planning for Army Installations, and replacing conflicting or obsolete standards with state-of-the-art planning techniques.2. Assemble references from the many related ARs and guidance documents into one users' guide, to be used as a single reference for installation master planners and MACOM reviewers.An appendix includes a preliminary effcrt t, '.4,zt the applicable regulations.3. At some future time, codify the related ARs into a subject-indexed code that reflects that standard land use planning process.

The role of assistant practitioner (AP) was defined around 14 years ago. It is widely regarded as an innovative role, with the ability to work semi-autonomously and across conventional health boundaries, and between both the health and social care sectors. APs are non-registered, so are not subject to regulation like nurses. Their accountability, however, comes through working to locally agreed and defined protocols. They are able to undertake a wide range of technical tasks and work with a high degree of autonomy within a specified care plan. The role is often cited as an effective means of helping the sector meet the productivity challenges that it is confronted with. APs are credited with being able to take on a wide range of tasks that are traditionally, but not necessarily, undertaken by registered professionals. It is a role which many are happy to treat as a destination in its own right, and which others view as a stepping stone to move up to registered roles. Our own research at Skills for Health has seen that APs have become more successful in some areas than others. And while the role has had some successes, there is a case for significant and ongoing action to improve not only training and development for support workers, but also to clarify and develop high-quality support worker roles, of which the AP is an important aspiration and legitimate channel.

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Background Care home residents are mainly inactive, leading to increased dependency and low mood. Although exercise classes may increase activity, a more sustainable model is to engage staff and residents in increasing routine activity. Objectives The objectives were to develop and preliminarily test strategies to enhance the routine physical activity of care home residents to improve their physical, psychological and social well-being through five overlapping workstreams. Design This trial had a mixed-methods research design to develop and test the feasibility of undertaking an evaluative study consisting of gaining an understanding of the opportunities for and barriers to enhancing physical activity in care homes (workstream 1); testing physical activity assessment instruments (workstream 2); developing an intervention through a process of intervention mapping (workstream 3); refining the provisional intervention in the care home setting and clarifying outcome measurement (workstream 4); and undertaking a cluster randomised feasibility trial of the intervention [introduced via three facilitated workshops at baseline (with physiotherapist input), 2 weeks (with artist input) and 2 months], with embedded process and health economic evaluations (workstream 5). Setting The trial was set in 12 residential care homes differing in size, location, ownership and provision in Yorkshire, UK. Participants The participants were elderly residents, carers, managers and staff of care homes. Intervention The intervention was MoveMore, designed for the whole home, to encourage and support the movement of residents in their daily routines. Main outcome measures The main outcome measures related to the feasibility and acceptability of implementing a full-scale trial in terms of recruitment and retention of care homes and residents, intervention delivery, completion and reporting of baseline data and outcomes (including hours of accelerometer wear, hours of sedentary behaviour and hours and type of physical activity), and safety and cost data (workstream 5). Results Workstream 1 – through a detailed understanding of life in a care home, a needs assessment was produced, and barriers to and facilitators of activity were identified. Key factors included ethos of care; organisation, management and delivery of care; use of space; and the residents’ daily routines. Workstream 2 – 22 (73.3%) out of 30 residents who wore a hip accelerometer had valid data (≥ 8 hours on ≥ 4 days of the week). Workstream 3 – practical mechanisms for increasing physical activity were developed, informed by an advisory group of stakeholders and outputs from workstreams 1 and 2, framed by the process of intervention mapping. Workstream 4 – action groups were convened in four care homes to refine the intervention, leading to further development of implementation strategies. The intervention, MoveMore, is a whole-home intervention involving engagement with a stakeholder group to implement a cyclical process of change to encourage and support the movement of residents in their daily routines. Workstream 5 – 12 care homes and 153 residents were recruited to the cluster randomised feasibility trial. Recruitment in the care homes varied (40–89%). Five care homes were randomised to the intervention and seven were randomised to usual care. Predetermined progression criteria were recruitment of care homes and residents (green); intervention delivery (amber); and data collection and follow-up – 52% of residents provided usable accelerometer data at 9 months (red), > 75% of residents had reported outcomes at 9 months (green, but self-reported resident outcomes were red), 26% loss of residents to follow-up at 9 months [just missing green criterion (no greater than 25%)] and safety concerns (green). Limitations Observations of residents’ movements were not conducted in private spaces. Working with care home residents to identify appropriate outcome measures was challenging. Take-up of the intervention was suboptimal in some sites. It was not possible to make a reliably informed decision on the most appropriate physical activity end point(s) for future use in a definitive trial. Conclusions A whole-home intervention was developed that was owned and delivered by staff and was informed by residents and staff. The feasibility of conducting a cluster randomised controlled trial was successfully tested: the target numbers of care homes and residents were recruited, demonstrating that it is possible to recruit care home residents to a cluster randomised trial, although this process was time-consuming and resource heavy. A large data set was collected, which provided a comprehensive picture of the environment, residents and staff in care homes. Extensive quantitative and qualitative work comprehensively explored a neglected area of health and social care research. Completion of ethnographic work in a range of settings enabled the production of an in-depth picture of life in care homes that will be helpful for other researchers considering organisational change in this setting. Future work The content and delivery of the intervention requires optimisation and the outcome measurement requires further refinement prior to undertaking a full trial evaluation. Consideration could be given to a recommended, simplified, core outcome set, which would facilitate data collection in this population. Trial registration Current Controlled Trials ISRCTN16076575. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grant for Applied Research programme and will be published in full in Programme Grant for Applied Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.