CMHTs for older people: team managers’ views surveyed

Healthcare professionals' experiences of using a biopsychosocial approach to understand behavioural and psychological symptoms of dementia: A qualitative interview study

BACKGROUND

Biopsychosocial approaches to understanding behavioural and psychological (otherwise known as "non-cognitive" or "neuropsychiatric") symptoms of dementia tend to be conducted by specialist psychology professionals. To increase service users' access to these approaches, healthcare professionals from nursing and allied health disciplines are being trained to use them. However, little is known about healthcare professionals' experiences of implementing biopsychosocial approaches in everyday practice.

OBJECTIVES

To explore nursing and allied healthcare professionals' views of using the "Newcastle Model," which is a biopsychosocial approach to understanding behavioural and psychological symptoms of dementia.

METHOD

Thirteen community mental healthcare professionals from nursing, social work and occupational therapy backgrounds were interviewed about their views and experiences of using the Newcastle Model to understand and work with behavioural and psychological symptoms of dementia. Data were analysed using thematic analysis.

RESULTS

Five themes were identified. The first theme reflected the perceived positive value of taking a more psychosocial approach to understanding behavioural and psychological symptoms of dementia. The second theme reported participants' expressions of low confidence in using the approach, as well as their reported difficulties in prioritising it. The third theme highlighted the perceived time-consuming nature of the approach, and the adaptations that some staff made to increase its practicality. The fourth theme highlighted the importance of working in collaboration with those who provided direct care and support to the person with dementia. The final theme reflected participants' positive view of the effectiveness of the approach for delivering person-centred care CONCLUSION: Community healthcare professionals valued the integration of a biopsychosocial approach into their practice, although identified key implementation barriers.

IMPLICATIONS FOR PRACTICE

Formalising this approach within professional role descriptions; increasing collaborative working within multidisciplinary teams; and increasing carers' psychological understanding of dementia, are key ways in which this biopsychosocial approach could be implemented more effectively.

Multi-agency working and implications for care managers

Purpose

To examine the association between multi-agency working and psychosocial characteristics of work, practitioner time-use and job satisfaction.

Design/methodology/approach

A comparison of practitioners working in multi-agency (health and social care) and single-agency (social care only) teams, using data from the 2008 evaluation of Individual Budgets pilots in England. Participants worked in care manager roles supporting adult social care service users, and comprised social workers and a smaller number of health professionals. Data was collected using a self-completed questionnaire.

Findings

Data were returned from 249 respondents (a 29 per cent response rate), with two-thirds working in single-agency teams. No significant differences were found between team type and job satisfaction. Respondents in multi-agency teams reported greater decision autonomy but poorer supervisory support than those in single-agency teams. The latter finding was robust to further exploration using regression to control for confounding factors.

Research limitations/implications

These data were not specifically collected for the study and response rates were relatively low due to organisational upheaval at the time of data collection, which may affect interpretation.

Practical implications

Government policy is dedicated to extending integrated forms of working, including multi-agency teamwork. This research suggests that such structures need careful planning for them to work effectively, with particular attention to supervision arrangements.

Originality/value

This research gives a systematic and objective exploration of the relationship between job characteristics, time-use and satisfaction of practitioners in single as compared to multi-agency teams.