The effectiveness of Dental Health Support Workers at linking families with primary care dental practices: a population-wide data linkage cohort study.

BACKGROUND: Link workers (lay health workers, health support workers) based in the community provide additional support to individuals and families to facilitate engagement with primary care and other services and resources. This additional support aims to tackle the wider socio-economic determinants of health that lead to inequalities. To date, there is no clear evidence of the effectiveness of these programmes. This study evaluates the effectiveness of Dental Health Support Workers (DHSW) at linking targeted families with young children to primary care dental practices. The DHSW role is one component of Childsmile, the national oral health improvement programme in Scotland. METHODS: A quasi-experimental approach captured the natural variation in the rollout of the DHSW intervention across Scotland in a cohort of children born between 2010 and 2013. Survival analysis explored "time to attendance" at primary care dental practice. Cox's regression models compared attendance rates and time until first attendance between those families who received support from the DHSW and those who did not. RESULTS: The cohort consisted of 35236 children. Thirty-three percent of the cohort (n = 11495) were considered to require additional support from a DHSW. Of these, 44% (5087) received that support. These families were more likely to attend a dental practice (Hazard Ratio [95% Confidence Interval] =1.87 [1.8 to 1.9]) and, on average, did so 9 months earlier (median time until first attendance: 8.8 months versus 17.8 months), compared to families not receiving additional support. CONCLUSIONS: Link workers (DHSW) within the Childsmile programme are effective at linking targeted children to primary care dental services and, most notably, at a younger age for prevention. This is the first study of its kind to evaluate the effectiveness of link-worker programmes using a robust quasi-experimental design on three, population-wide, linked datasets. These results will inform future health programmes which aim to improve health and reduce inequalities by reaching and supporting families from more disadvantaged backgrounds.

The clinical impact of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and neuropsychological intervention in routine ALS care.

Objectives. The Edinburgh Cognitive and Behavioral ALS Screen (ECAS) is a brief multi-domain assessment designed for people with Amyotrophic Lateral Sclerosis (ALS). This study evaluated the clinical impact of using the ECAS on ALS patients, carers and healthcare professionals. A secondary aim was to evaluate the clinical impact of neuropsychological intervention. Methods. A survey of current screening practices in ALS services across the UK was undertaken. In addition comparative case studies, in seven ALS care contexts, was qualitatively explored through interviews with patients, carers and healthcare professionals. Results. 22/34 health care services responded to the survey. 95% screen patients for cognitive and behavioral changes and all used the ECAS. Thematic analysis indicated that the ECAS: raises awareness about cognitive and behavioral change between patients, carers and healthcare professionals; validates and/or reassures; identifies changes, aids understanding of the patients' presentation and informs clinical decision-making. The latter includes suitability of interventions, adaptations by the multidisciplinary team, discussions about end-of-life care, referral on to other services, and identifying carers' support needs. A number of indirect economic benefits were described. Clinical neuropsychological intervention was reported to help the multidisciplinary team manage the care particularly of complex cases, the effects on daily life, and stress of patients, carers and families. Conclusions. The ECAS has been widely implemented across ALS health care teams in the UK. Screening for cognitive/behavioral deficits and neuropsychological intervention has a positive impact on patients, carers and healthcare professionals and improves the quality of routine clinical care.

How lay health workers tailor in effective health behaviour change interventions: a protocol for a systematic review.

BACKGROUND: Lay health workers (LHWs) are utilised as a channel of delivery in many health interventions. While they have no formal professional training related to their role, they utilise their connections with the target group or community in order to reach individuals who would not normally readily engage with health services. Lay health worker programmes are often based on psychological theories of behaviour change that point to 'tailoring to individuals' needs or characteristics' as key to success. Although lay health workers have been shown to be effective in many contexts, there is, as yet, little clarity when it comes to how LHWs assess individuals' needs in order to tailor their interventions. This study aims to develop a better understanding of the effective implementation of tailoring in lay health worker interventions by appraising evidence and synthesising studies that report evaluations of tailored interventions. METHOD: Health and psychology electronic databases (EMBASE, CINAHL, MEDLINE and PsycINFO) will be searched. Reference lists of included studies will also be searched. For articles that are deemed to be potentially relevant, we will employ a 'cluster searching' technique in order to identify all published papers related to a relevant intervention. Cluster searching will be undertaken in an effort to maximise the breadth and depth of description of the intervention. Quantitative studies will be assessed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project, ON, Canada. Qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Sythesising the data will enable the development of a taxonomy of strategies for the criteria used for individual assessment of recipients' needs and the ways in which messages or actions are tailored to these individual criteria by LHWs. DISCUSSION: This systematic review focuses specifically on how health promotion and support is individually tailored in effective programmes by LHWs. This study will be of value to those involved in the design and implementation of interventions that utilise a LHW. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015030071.