27 Jun 2012

03. Therapeutic liaison worker

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TLC from the TLWs

Introduction

The role of ‘Therapeutic Liaison Worker’ (TLW) was originally created on Ashby Ward at the Bradgate Mental Health Unit in Leicester by Nic Higham,  a Healthcare Support Worker. (Happily for Star Wards, Nic now works with us!) The unit recognised the need for a role on acute wards to help create, enhance and promote a therapeutic environment and to also seek to embed this ethos within the ward environment. LPT mental health wards mostly have limited occupational therapy input (in terms of ward-based activities), so this is an approach to address the lack of meaningful and therapeutic activity utilising existing ward staff members.

Nic sees the role of the TLW as a facilitator in motivating and encouraging patients and staff to engage in constructive and purposeful daily activities whilst on the ward, supporting patients with exploring ways of coping and recovering whilst promoting autonomy and independence.

After a successful pilot on Ashby ward in 2010, other wards at LPT caught the TLW bug and have since worked to establish the same role. There’s now 7 TLWs working across the wards who provide an extensive therapeutic programme, liaising with colleagues like OTs and clinical psychologists to provide a more complete package of care. These activities range from community meetings and recovery groups, to baking cakes with patients and organising and celebrating special events like National Book Day.  The activities are purposeful, provide structure, aim to counteract boredom and frustration and increase motivation.

TLWs are supernumery and are completely out of the staffing numbers which means they have plenty of time each day to spend with patients without interruption. TLW staff members can commit to spending time with patients whether group work or one-to-ones and escorts.

What’s great about this role is that it came from front-line staff. It just goes to show that grassroots initiatives can grow and flourish into something quite remarkable. Actually, Nic felt he was speaking up for the people who use the wards when he approached the unit’s General Manager to present his proposal. Nic was delighted to get complete support and commitment from senior management who have fully embraced this work. The TLW role is now being included in new care strategies and pathways within the Trust, which is notably significant.

Another amazing achievement is that the role has been banded a level higher than HCAs, which helps acknowledge and support this new work. At LPT, the TLW role is seen as a new career pathway for unqualified staff. Most of the staff undertaking this role are well established HCAs who really value patient contact and the provision of meaningful activity.

It is felt that the TLW role improves communication with other wards, teams and services, which again reinforces a more comprehensive package of care. As part of the role, the TLWs act as a link to other services, one of these is the pharmacy department who are now running a weekly medication education group (which was inspired by Star Wards) on the wards.

The Therapeutic Liaison Worker role also includes liaising with the nursing team and bringing together a core of staff that co-facilitate the ward-based groups.  These new enhancements empower both the service users and staff. The ward teams very much embraced these changes which are making the wards more healing and therapeutic places to recover. The TLW role has ignited an interest in therapeutic activity from other staff contributing towards their professional development.

Along with significant increases in patient groups, resources (eg self-help leaflets) and influence, the wards now have dedicated volunteers who work alongside the TLWs providing  activities like regular complementary therapy sessions. Again, the Liaison Worker role provides a point of contact and support for these highly appreciated volunteers.

Typical activities:

  • Medication Education group
  • Relaxation
  • Art and craft
  • Recovery group
  • Games
  • Escorted walks
  • Trips to the hospital coffee shop
  • Trips (to parks, museums, cinema, bowling, galleries etc)
  • Problem-solving group
  • Coffee morning
  • Community meetings
  • Personal recovery plans
  • Mental health information, self-help guides and resourcesWii
  • Movies nights
  • Special meals
  • Baking and cooking
  • Charity fundraising
  • Pamper group
  • Current affairs group
  • Bingo
  • Discussion groups

A little note from Marion

The role of Therapeutic Liaison Co-ordinator was geniusly created for healthcare assistants by Nic Higham of Leicestershire Partnership Trust (LPT), himself a healthcare support worker. I was fortunate to meet some TLWs when I visited Bradgate Mental Health Unit, and could see how effective this role is, in enhancing HCA’s role, status, focus, motivation and therapeutic impact. It’s an astute mix of, broadly, co-ordinating patient activities and, alongside the ward manager, liaising with MDT colleagues.
This is what Nic says:
“The role really was a direct product of Star Wards. It came about through conversations with colleagues about how I could be realised to focus solely on implementing the ideas set out in Star Wards publications, and coordinating and supporting other staff getting involved. I thought that’d be a fantastic job and really beneficial for patients on the ward. So I spent time putting together some ideas with the help of colleagues and some key staff from therapy services (plus a heap of support from senior staff, commitment, passion and experience and simply listening to what patients wanted) and the TLW role was the result. I think the role embodies the philosophy and captures the heart of Star Wards and makes all the good stuff it describes tangible on the wards here.”

Ward examples

  • The TLW organises and facilitates special events on the ward like: National Women’s’ Day, pancake day, Comic Relief, Children in Need, World Book Day, Breast Cancer Awareness, etc.
  • The role has reduced the pressure on the staff and increased patient morale.
  • Staff on the ward regularly approach TLWs asking, for example to do a coffee morning when new students come into the ward to work, so they could be introduced to patients informally. This has had positive impact on the ward.
  • The TLWs have made positive impact on both patients and the MDT. It has definitely increased morale within the staff team and patients. It has been positive in terms of activities reducing the level of pressure on the staff, who at times have been dealing with challenging patients.
  • Happier and calmer place to work. Ward has more positive atmosphere.
  • Gives staff more time with patients as TLWs offer their activities and support to patients who can, at times, demand staff time and leave them with nothing else to do but create problems. Having activities minimises incidents on the ward.
  • The TLWs staff work hard to engage with patients who present as ‘unsettled’ and have had good outcomes, every patient is always included and often patients carry on the work they have started throughout the day eg an art project which keeps them focused.
  • The TLW has created a therapeutic culture on the ward which has impacted positively on outcomes for patients. Particularly in engagement and observing patients in ‘natural’ environments. The TLW role has benefited the ward greatly.
  • Patients have a calmer, more positive ward experience leading to enhanced outcomes.
  • Having the staff and the time to engage patients in ward-based activities (time and staff are protected and supernumery) makes a huge difference and address patients levels of boredom and gives them structure, especially as many of our patients are unable to leave the ward due to being ward-based.
  • A member of staff each shift asks about therapeutic activities.
  • When commenting on this new role, patients stress the importance of ‘quality time’ and how a little tender-loving-care goes a long way. This can take the form of providing space for groups of patients to talk and relate to each other, playing on the Wii together, or going on ward outings.
  • A good range of self-help handouts and leaflets have now been put together which patients are able to take away with them when they leave hospital. It is hoped that these resources will teach patients healthy ways to cope post discharge. The TLW role provides a member of staff with the capacity to research, create and source these resources.
  • “Getting creative and being inspired by the patients I work with has helped me to create activity sessions that patients love to come along to again and again. Often the most simple of ideas can turn in to a session that everyone can be involved in and everyone can enjoy – including staff!” (Health Care Support Worker)

 

Patient Examples

  • Taking part in ward activities really helped me. It reduced my feelings of isolation and it was fun too!
  • I felt like I had no choice over anything so every day on the ward I was given the task of planning an activity for everyone – now I am ward activity co-ordinator! I’ve missed my life calling!!

Snippets

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