The MoRE project: Models of reablement evaluation: a mixed methods evaluation of a complex intervention

SPRU research team

• Fiona Aspinal 
• Bryony Beresford (Principal Investigator)
• Gillian Parker
• Rachel Mann
• Parvaneh Rabiee

External collaborators

• , Centre for Health Economics, University of York
• Helen Weatherly, Centre for Health Economics, University of York
• Mona Kanaan, Department of Health Sciences, University of York
• Alison Laver-Fawcett, Research Centre for Occupational & Mental Health, York St John University
• Gerald Pilkington, Gerald Pilkington Associates

Background

Reablement is a relatively new approach to supporting people to regain (or maintain) independence and resume the activities which make up their daily lives. The reason for referring an individual to a reablement service can be conceived as falling into one of two broad categories:

• to support an individual to return home (RH) from hospital or other in-patient care setting following an acute episode
• to support an individual to remain at home (RAH), with minimum demands on home-care/community services, where there is evidence of declining independence or ability to cope with everyday living.

It is a short, time-limited intervention. The typical population of people receiving reablement are: those who have suffered an acute illness/event (e.g. a fall), who have a long-term condition, and/or are growing frail.

Government has invested substantially in this approach with the aim of reducing costs/demands on acute health care and social care. A national evaluation of reablement services in 2010, primarily focusing on older people who had suffered an acute event, found that reablement can make a positive difference to people’s lives.

The rapid expansion of reablement services has led to a range of service models and differences between services in terms of their functions. Research is needed to find out:

• whether the type of service model affects users’ outcomes;
• what other factors (e.g. age, co-morbidities, reason for referral, user engagement, carer involvement) affect how effective and cost-effective these different service models are;
• users’ and carers’ experiences of reablement.
• how reablement services are responding to the needs of users with more complex or ‘atypical’ needs, for example, those with dementia or younger adults.

This comprehensive study addresses these questions and will generate evidence to support commissioners and practitioners as they make decisions about the organisation, delivery and development of reablement services. It comprises three work packages (WP) extending over 34 months.

Aims

This research aims to establish:

• the characteristics of generic and specialist reablement services in England
• the impact different models of reablement have on service-level and service user outcomes
• the impact different models of reablement have on different groups of service users
• the indicative costs for the health and social care system of different models of reablement
• how the local context influences the ability of reablement services to achieve their goals
• what specialist practice & services exist and how it/they developed for individuals with complex needs or ‘atypical’ populations who would benefit from reablement.

Methods

Work package 1: Mapping and modelling reablement services

A national survey of providers of reablement services will establish the type, range and nature of services available across England and generate a typology of reablement services. The typology will be used to identify four service models (or service types) for evaluation. Findings from this work package (WP) will be disseminated as interim findings in month 16 of the project.

Work package 2: Evaluation of generic reablement models

A quantitative evaluation of the effectiveness of the different service models will examine short and longer-term service-level and individual-level outcomes, and compare outcomes between models to understand the effects of reablement and the impact of service and user characteristics and other factors on effectiveness.
 
A process evaluation, comprising interviews with professionals, service users and carers, will develop an understanding of the immediate and wider context in which reablement models exist. It will also investigate the different effects reablement can have and how, and why, these effects vary between recipients and different services/sites.
 
The economic evaluation will use data collected in WP1 and across WP2 to compare the costs and consequences of different reablement models in comparable populations.

Work package 3: Description of specialist reablement services/practice approaches

This focuses on specialist provision that has developed to reable people with more complex needs and/or ‘atypical’ populations. It will provide evidence on:

• current practice and service models
• what has been learnt about meeting the reablement needs of those with specialist needs
• differences between generic and specialist reablement
• the costs associated with specialist provision.

The survey (WP1) will be used to identify exemplars of specialist services and practices. Managers and practitioners will be interviewed. Data will be compared with process evaluation data from WP2.

Policy and practice aims

This research aims to provide new evidence on different models of reablement services. This information will inform NHS and social care managers, commissioners and their partner organisations about the most effective and cost-effective approaches for providing reablement services for their populations.

Additional information