Good practice in social care for disabled adults and older people with severe and complex needs: evidence from a scoping review

Abstract

What is known about this topic• The population of people with severe and complex needs is growing.• Support for these groups comes from a wide range of organisations and is often criticised for being uncoordinated.• The preferred policy in the UK is to issue personal budgets to enable service users to purchase their own support. What this paper adds• There is little evaluation evidence about the costs or outcomes of 'good practice' approaches to UK social care for people with severe and complex needs.• Some promising evidence was identified, indicating the effectiveness of a young adults' multidisciplinary specialist team; intensive case management of people with severe dementia; specialist (psycho-geriatric inpatient) social work; and multidisciplinary training for mental health professionals. AbstractThis article reports findings from a scoping review of the literature on good practice in social care for disabled adults and older people with severe and complex needs. Scoping reviews differ from systematic reviews, in that they aim to rapidly map relevant literature across an area of interest. This review formed part of a larger study to identify social care service models with characteristics desired by people with severe and complex needs and scope the evidence of effectiveness. Systematic database searches were conducted for literature published between January 1997 and February 2011 on good practice in UK social care services for three exemplar groups: young adults with life-limiting conditions; adults who had suffered a brain injury or spinal injury and had severe or complex needs; and older people with dementia and complex needs. Five thousand and ninety-eight potentially relevant records were identified through electronic searching and 51 by hand. Eighty-six papers were selected for inclusion, from which 29 studies of specific services were identified. However, only four of these evaluated a service model against a comparison group and only six reported any evidence of costs. Thirty-five papers advocated person-centred support for people with complex needs, but no well-supported evaluation evidence was found in favour of any particular approach to delivering this. The strongest evaluation evidence indicated the effectiveness of a multidisciplinary specialist team for young adults; intensive case management for older people with advanced dementia; a specialist social worker with a budget for domiciliary care working with psycho-geriatric inpatients; and interprofessional training for community mental health professionals. The dearth of robust evaluation evidence identified through this review points to an urgent need for more rigorous evaluation of models of social care for disabled adults and older people with severe and complex needs.

Nurse-led navigation to provide early palliative care in rural areas: a pilot study

“…With broad knowledge of the resources available in the community, and of the existing social connections, she was able to mobilize support in an integrated way. An approach that uses caring connections to facilitate access to community supports has strong evidentiary support [17, 18] and the individualized nature of the intervention illustrates best practices for this population [9, 40], particularly as it pertains to end-of life communication [41]. The nurse navigator ‘s long history of working as a nurse within this community, and participant’s relational continuity with one nurse, were important factors in implementation.…”

“…A palliative approach has been used to describe ideal care for this population [6–8]. However, little evidence exists on how to realize this ideal [9]. A palliative approach is defined as palliative care that is adapted to non-specialist contexts, chronic disease conditions, and provided early in the palliative trajectory with the intent to ease the transition between chronic disease management and end-of-life care [10].…”

Good practice in social care: the views of people with severe and complex needs and those who support them

“…Other strands of the research included a literature review (Gridley et al . ) and identification of case examples of services with the desired characteristics (Gridley et al . ).…”

“…This paper reports findings from the first stage of the research: a qualitative study of the views of people with complex needs (from the three exemplar groups listed above), family carers, and staff and volunteers from user-led and specialist organisations working with them (hereafter referred to as 'members of specialist organisations'). Other strands of the research included a literature review (Gridley et al 2013) and identification of case examples of services with the desired characteristics (Gridley et al 2012). The study was approved by the Social Care Research Ethics Committee for England.…”

Models of adult safeguarding in England: A review of the literature

“…Interest in the comparative merits of specialist and generic approaches to the organisation of social work and social care services is long-standing and was the subject of Stevenson's (1981) seminal study of social services departments. More recently attention has turned to the comparative effectiveness of social work specialisms in England around long-term conditions (Gridley, Brooks & Glendinning, 2013), transitions (Clarke, Sloper, Moran, Cusworth, Franklin & Beecham, 2011) and mental health (Wilberforce, Harrington, Brand, Tucker, Abendstern & Challis, 2011). In parallel there have been other forces at work to integrate disparate specialisms, most notably the creation of generic adult social work teams in England covering previously separate areas of practice (Samuel, 2011;Stanley, 1999).…”