Community Link Working (CLW) in Argyll and Bute
Argyll and Bute Council · 14 August 2024
Back to Oban Lorn & the Isles Area Community Planning Group — 14 August 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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in Argyll and Bute What do Community Link Workers do in Argyll & Bute? Community Link Working (CLW) The CLW service works directly with patients to enhance their wellbeing, with the aim of addressing the wider determinants of health, tackling financial exclusion and focusing on populations from the most deprived areas, helping them access services and connect with third sector providers. establish effective pathways for improved service access; foster professional links with public health services; collaborate closely with GP practices; work to raise awareness of social prescribing; identify & address gaps in community provision. follow a person-centred social prescribing approach; CLWs focus on addressing the underlying causes & stressors that negatively impact the health & wellbeing of the individual; Referrals & case management occur through integration of GP Vision systems using Elemental software for social prescribing. (Practices using EMIS systems can access Elemental via a web-based process.) Ways to access Argyll & Bute’s CLW Service Self referral OR be referred by any member of the primary care team (GP, nurse, pharmacist, dentist, or optician). 14 of 32 GP practices involved 3.6 WTE Community Link Workers 975 referrals 84% engagement rate *Data Dec 2021 to Mar 2024 Argyll & Bute’s CLW Contract Dec 2021 to Dec 2024* Find out more at: www.nhshighland.scot.nhs.uk/health-and-wellbeing/social-prescribing Pg 1/4 Watch our video https://www.youtube.com/watch?v=FzTAdEAh6_4
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Strategic selection of GP Practices based upon the Scottish Index of Multiple Deprivation (SIMD) deciles. Focusing on areas of higher socioeconomic deprivation (living within decile 5 and under). Community Link Working (CLW) in Argyll and Bute (Continued) Argyll & Bute’s CLW model Argyll and Bute HSCP has contracted the independent provider ‘We Are With You’ to deliver the CLW service for the region. CLW Service based within GP practices. CLWs work directly with patients to navigate & engage with wider community services, fostering a person-centred approach. Service includes diverse approaches to assess individuals’ health & wellbeing needs, collaborate on a customised plan to encourage self-management, and provide guidance to access relevant community services Face-to-face or telephone sessions Motivational interviewing to assess individuals’ needs MAP (Motivation, Action & Prompts) health behaviour change model to structure behavioural change consultations Plan of action designed with the individual based on outcomes of above sessions, with patients referred to appropriate community services, third sector organisations, & financial support services, etc. No. of sessions tailored to individual need mins.60 Avg. session length: CLWs work collaboratively to create a customised plan to support clients with their underlying issues & client circumstances. As CLWs engage with clients they often uncover a complex web of interconnected problems & challenges through holistic assessment. CLWs play a pivotal role in connecting clients to appropriate services, through signposting & providing support to reduce any barriers in reaching out to them. Pg 2/4 Aligns with overarching goal of addressing health disparities & catering to individuals facing complex socioeconomic challenges.
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*Data listed for Apr 2023 to Mar 2024 Housing & essential needs Bereavement Substance misuse Long-term condition management Employment & training Relationship breakdown Pain management Family support CarerWeight management Learning disability Disability Sleep support Physical activity 52% Mental health & wellbeing 18% Loneliness & isolation 15% Financial advice 13% Stress management Social prescriptions per quarter 180-250 Reasons for referrals & social prescriptions* Community Link Working (CLW) in Argyll and Bute (Continued) The outcome of the service is evaluated for each patient using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). The survey is administered at the initial session, and again at the conclusion of the final session. 90% of those who completed the SWEMWBS experienced a positive change in their health & wellbeing A high level of change was found across all respondents, with a change of: +5.08 The Results (A change of between 1 to 3 points on the SWEMWBS scale meets the threshold for statistically significant change.) Note: Where clients attend only 1-2 sessions, it is too short a timescale to measure change on the SWEMWBS. Also, some do not attend their final session, meaning they do not complete an exit SWEMWBS. The above results are based upon the 58% of clients who have left the CLW service having completed an initial and exit SWEMWBS survey. *Shah, N., Cader, M., Andrews, W. P. et al., Responsiveness of the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS): evaluation a clinical sample. Health Qual Life Outcomes 16, 239 (2018). https://doi.org/10.1186/s12955-018-1060-2 Pg 3/4 points on the SWEMWBS scale
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Find out more at: www.nhshighland.scot.nhs.uk/health-and-wellbeing/social-prescribing Community Link Working (CLW) in Argyll and Bute (Continued) Client Feedback ‘The Links Worker was my lifeline.’ ‘I have Dr X to thank for the best referral any doctor has given me. The CLW allowed me to talk, get upset, and be non- judgemental. I’d never have thought 4 months ago I’d have improved so much.’ ‘If it wasn’t for the [service], I wouldn’t be on this journey to better myself and move on from the past [..] that has been haunting me for years .’ ‘I felt that pills on their own were not the answer to my problems.’ ‘It has certainly helped me through a very dark time in my life.’ ‘Definitely feel that having the link worker support me and help me find the correct resources has made a huge difference and achieved so much. I am very grateful for the time, effort and compassion that was shown to me and I feel like a lot of people would really benefit from the same experience I had.’ ‘I felt I had an ally navigating lots of things I could not have done alone. An invaluable resource. Dignified [..]. I felt listened to & understood regarding my difficulties, as they are hidden ones.’ ‘I was feeling frustrated by answers of others’ to my housing problems, but [the CLW] instilled a confidence I thought I’d lost & was concise & professional in handling the housing issues I had.’ GP Practice Feedback Practices find the CLW service ‘invaluable’ & ‘very helpful’. ‘CLW ’X’ is worth their weight in gold. [...] We don’t want to lose this service.’ They also value the flexibility of the service e.g. being able to do house visits. ‘The Link Worker has an excellent knowledge of services available to patients dealing with social problems, taking work off GPs & other practice staff.’ Recognised some challenges with embedding the service as it was strange having a member of staff present who wasn’t employed by the practice, but this has now largely been overcome. ‘I am really pleased with the availability of the Live Well WIth Pain group.’ The ability for anyone in the practice to refer is valued, as is the option to self-refer. Also, the referral process is easy. Practices reported the service was ‘a good service’, ‘well established’ & ‘vital’. Perceptions of integration varied between areas and integration was a challenge when CLWs worked remotely from more rural practices. CLW Feedback However, overall, feedback was very positive from CLWs who felt welcomed in practices and enjoying being able to make a difference as part of the practice team. Pg 4/4