Service Integration

Assistive technology (AT) services are often described as 'fragmentary' in delivery. This describes a lack of joined up working and communication between:

• different AT services working in health, social care, education, employment, transport and leisure;
• community services working at neighbourhood level and specialist AT services working at a regional level;
• mainstream and AT services;
• service providers at different stages in the care pathway (for example, when AT is delivered following assessment, service is often terminated so that follow up and review is left to be picked up by other services)

FAST is working to address this lack of integration.

Work to address the lack of service integration

One way FAST aims to do this is to establish a core of good practice across AT sectors and to raise awareness within separate professions, disciplines and provider organisations of the common base of knowledge and practice. An example of this is development of workforce strategies which will be relevant across sectors and disciplines.

Work carried out by FAST to map standards indicated a low level of communication between community and specialist services embedded in service standards with only one identified care pathway negotiation. Included in the recommendations of the Forum's report on Service Standards was that:

• any future service standards should be developed in a way that is coherent across sectors and documents should explicitly address interagency working
• AT service provider organisations should consider whether a care pathway approach would be appropriate for their regional and local services and, if so, act to secure the necessary funding, resources and local participation.
• service commissioners should consider whether investment in the development of care pathways would gain service efficiencies

The care pathway negotiation which was identified has been developed by the West Midlands Rehabilitation Centre. Though there are limits to how directly care pathway documentation can be adapted to other services, due to the specific nature of the local agreement, the learning which arises from these projects indicates that, given sufficient funding and the championship of a committed centre, a care pathway negotiation can be a powerful tool for remodelling services and setting standards for any local AT service. The pathway agreement can be downloaded from the Centre's website.

Through work to develop National Occupational Standards in AT, FAST have drafted a framework of elements required from an effective AT service. This will enable the development of a commissioning framework, and greater clarity on the required scope of AT services. The elements are proposed as:

Elements of an effective AT service

• Raise awareness of services
  Raise awareness of the potential of AT
  Identify potential service users.
• Information provision and management
  Make available information about the service
  Support information seeking about AT services.
• Assessment
  Communicate effectively using a range of methods in relation to sensory, physical and cognitive needs
  Assess the impact of a range of functional impairments on the individual's lifestyle/ preferred way of life
  Assess the individual's preferences and choices
  Assess the needs and abilities of the individual to participate in desired activities
  Assess the impact of social and environmental factors on function and on the potential use of AT
  Assess the impact on the service user/ carer relationship of impairment, use of AT, changing social roles and transitions
• Clinical Reasoning/ Decision Making
  Identify creative solutions acceptable to client and relevant funder or service provision organisation(s) - AT, non-AT and hybrid
  Identify the degree of risk involved in using/ not using AT and agree a risk management strategy acceptable to the client and the funder/ provider organisation(s)
  Support clients to decide on a course of action/ develop a care plan
• Assess and advise on the optimal funding route acceptable to the client (and funder) to access AT
• Implement and review care plans with individuals
  Establish information management and communication systems
  Make and respond to referrals to/from external agencies
  Independently represent and advocate with and on behalf of users of AT
• Procure AT and AT services for individuals
  Sell / supply AT
• Deliver/ fit/ set up/ install AT 
  Deliver AT
  Install, set up, or fit AT
• Training/ remote support
  Train the individual and/or carers in the use of AT
  Support remote communication with the individual
• Maintenance and emergency response
  Manage equipment in a storage/ retail environment
  Maintain, repair and return equipment
  Provide emergency response to replace/repair AT
  Clean/ recycle/ dispose of AT
• Design and Manufacture AT
  Prepare specification for existing AT, modification, adaption
  Read and extract information from specifications
  Carry out design (and manufacture) of custom made AT
  Carry out design and manufacture of commercial AT
  Generate and evaluate ideas for novel AT
  Design novel AT
  Commercially exploit novel designs for AT
• Sustain the use of AT (in a range of environments and over transition periods)
  Modify/ customise/ adjust AT in response to changing needs and wishes, tasks and environmental factors
  Implement a programme using AT to increase an individual's capacity to perform desired activities.
  Act on a range of social and environmental barriers which impact on functional ability and the use of AT
  Provide support to enable an individual, their carer/ family members to manage change, adapt to disability and to the use of AT
• Review AT provision
  Identify emerging/ changing needs and potential problems.
  Evaluate the impact of any AT intervention 
• Manage a service which provides AT to clients
  Manage staff responsible for using AT to provide care for an individual (including directly employed personal assistants, care workers, etc) 
  Market service to commissioners
  Evaluate cost/benefit (up-front and life-time costs and benefits)
  Purchase/ procure AT (contractual arrangements)
  Equipment Evaluation
• Research and policy
  Conduct and participate in research and service development
  Create and influence policy 

(Version: Oct 2006)

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