Folau I Lagi-Ma is an innovative project which integrates occupational therapy and peer support into Mangere Health Centre, a primary care practice in Counties Manukau, to deliver better care for people living with long-term conditions.
The project helps to bridge the gap in primary care in Counties Manukau for a holistic service to support people who experience both physical and mental health symptoms. It is particularly important for Mangere Health Centre because the practice serves a high-needs population with a large number of people who have long-term conditions.
Counties Manukau Health occupational therapists, a peer support specialist, a community mental health service manager and representatives from Mangere Health Centre led the project. They were supported by a Ko Awatea project manager and improvement advisor as part of the Manaaki Hauora – Supporting Wellness campaign, which was launched in 2015 to provide self-management support for people living with long-term conditions.
The aim of Folau I Lagi-Ma was to work with 45 people with long-term conditions by December 2016 to improve their overall EUROHIS-QOL (quality of life) score by four points. EUROHIS-QOL measures quality of life across eight domains, such as satisfaction with health, energy level, finances and satisfaction with living conditions.
The project team created a change package aligned around three primary areas of focus: activated service users, activated general practitioners (GPs) and self-management. Change ideas were developed and tested for each one using the Model for Improvement.
To activate service users, the Folau I Lagi-Ma team developed an initial interview process. The process starts with a screening phone call by a peer support specialist, who introduces the Folau I Lagi-Ma service and makes an appointment for a face-to-face meeting at a venue of the patient’s choice. The peer support specialist contacts the patient with a reminder the day before the appointment. During the appointment, the occupational therapist (OT) and peer support specialist gather information and work with the patient to set health goals.
“Working towards health and occupational goals identified by the patient encourages them to engage because we can offer interventions that are meaningful to the patient,” says Fionna Sutherland, team manager of The Cottage Community Mental Health Centre and Regional Dual Disability Service, who is part of the Folau I Lagi-Ma team.
An intervention plan is developed after the initial interview to help the patient achieve their goals. Folau I Lagi-Ma offers between three and ten sessions with an OT or a peer support specialist, depending on patient goals and needs. The sessions may be held at the patient’s home, at the clinic or at a third location in the community.
To activate general practitioners, the project team created an easy referral pathway and worked to improve understanding of the Folau I Lagi-Ma service. The team developed a referral form, held monthly multidisciplinary meetings with representatives of stakeholder services, and dedicated time to be present at Mangere Health Centre to liaise with GPs and practice nurses. A nurse manager at the centre acted as a champion to encourage practice nurses to make referrals and to promote Folau I Lagi-Ma at the centre’s nurses’ forum.
To support self-management, the Folau I Lagi-Ma OT and peer support specialist worked together to provide a holistic model of care. Occupational therapists can support self-management by teaching patients new ways of doing things, adapting the physical environment, developing the patient’s ability to participate in the occupations that are important to them, and by helping the patient to develop new skills, access the support available in the community and develop a healthier lifestyle, says Ms Sutherland.
She says that peer support in Folau I Lagi-Ma compliments this by forging a bond of understanding and empathy based on shared experiences. “Peer support helps people to understand and apply five recovery concepts that motivate people to take control of their health and wellbeing: hope, personal responsibility, education, self-advocacy and support.”
For patients who have physical health conditions that impact on their ability to engage in daily activities, the Folau I Lagi-Ma team work with a specialist physical OT.
“We provide a holistic occupational therapy intervention from both mental and physical health perspectives,” says Ms Sutherland.
Using the EUROHIS-QOL 8-item index, the Folau I Lagi-Ma team collected pre- and post-intervention scores to measure the outcome of their interventions on patient quality of life. On average, patients experienced an increase of 7.8 points in their EUROHIS-QOL score, almost double the target, indicating a better quality of life after participating in Folau I Lagi-Ma.