Building Health Partnerships

Building Health Partnerships

Reimagining Care Closer to Home @SocialEnt_UK @IVAR_UK #BHPselfcare Welcome Katie Coleman & Helen Garforth @SocialEnt_UK @IVAR_UK #BHPselfcare Design tangible actions or projects to develop the CHIN model that will: Aims for today: Support people to self-care

Connect social prescribing and community initiatives across North London Re-imagine how the system could work best for patients and residents Establish the roles local voluntary sector organisations, commissioners and others can play Where are we at? Focus on four areas:

@SocialEnt_UK @IVAR_UK #BHPselfcare 1. A common Outcomes Framework for social prescribing across NL 2. Expert patient programmes in each Borough 3. A social prescribing link role in each CHIN and a mechanism for connecting togheter 4. A central person/ organisation/ system to make opportunities/ services/ providers visible How we got here?

@SocialEnt_UK @IVAR_UK #BHPselfcare Research and conversations about whats happening in NL around self care Core group formed Partnership Session 1 in Sept Volunteers coming together to take forward ideas and bring them today What helps us feel good and look after our health? What helps us recover and stay well? Relationships, social networks, family, friends depend on us and support us

Holidays, travel Hobbies Work Success Exercise Having fun social activities Walking, fresh air, pets Feeling better on the journey Seeing others doing the same me time @SocialEnt_UK @IVAR_UK #BHPselfcare Self-belief doing things we love and enjoy Giving back, sharing Nature, outdoors Shopping Eating, healthy eating Belonging

Socialising, interaction Relaxing, time/prioritisation what gets in the way? Time pressures Stress Family Work Life Perfectionism Drugs and alcohol Children

@SocialEnt_UK @IVAR_UK #BHPselfcare Services that dont meet needs Over thinking Fast food Lack of information/confusion London life traffic, hectic life Technology, phones 24/7, social media Too much socialising Conflicting public health messages fads, one size fits all Local priorities Looking at how the new Care and Health Integration Networks (CHINS) can make the most of whats working well such as social

prescribing, expert patient programmes etc, and discuss how we can all collaborate to support better health and wellbeing: Exploring what self-care means in North London, and how it is supported Sharing stories of what is working well and whats not , and what might Working together to prioritise and plan for further action and further sessions Developing action plans that will make a difference when it comes to looking after ourselves in North London- both quick wins and longer term changes in the system @SocialEnt_UK @IVAR_UK #BHPselfcare Examples of whats already happening in North London? @SocialEnt_UK @IVAR_UK #BHPselfcare

4 possible areas for joint action Access to Information, building awareness (of social prescribing??) Compiling resources and information in a database/platform. Carry out communications and engagement activities to raise awareness. Workforce development Actions Review whats already been done Explore potential for sharing the platform Research/consultation on what people want to know Carry out a cost benefit analysis/create a business case Involve CVS

Actions @SocialEnt_UK @IVAR_UK #BHPselfcare Carry out training with the whole workforce drawing on the skills and knowledge of the voluntary sector. Create an online database. Change contracts. Mapping of training and services Engage the workforce Develop an memorandum of understanding with GPs and other services Collect feedback from service users and the workforce 4 possible areas for joint action System-wide coordination

EPP in place across NCL Build knowledge and understanding of social prescribing. Make sure opportunities are consistently available and known (i.e. on the same platform). Ensure all GPs have a link worker. Support volunteers and use codesign Make sure EEP is in place in every CCG to reduce usage of hospital services for patients with long-term conditions Actions: Actions: Share data, good practice, outcomes measures Business case for export PAT

programme Create a business case Standard specifications for Care Nav and LAC etc Standardised protocol operational framework Share vision statement @SocialEnt_UK @IVAR_UK #BHPselfcare Recap our focus reimagining the system arriving at tangible projects @SocialEnt_UK @IVAR_UK

#BHPselfcare 1. A common Outcomes Framework for social prescribing across NL 2. Expert patient programmes in each Borough 3. A social prescribing link role in each CHIN and a mechanism for connecting together 4. A central person/ organisation/ system to make opportunities/ services/ providers visible What well do today @SocialEnt_UK

@IVAR_UK #BHPselfcare 1. Whats happening elsewhere in BHP 2. Some definitions SP, CHIN 3. Inspiration what works well around NL? 4. Re-imagining roles within the system 5. Action planning 6. Interrogating plans 7. Next steps Whats happenin g elsewhere ? @SocialEnt_UK @IVAR_UK

#BHPselfcare Herefordshire and Worcestershire - Think Carer BNSSG - A Good Life in Old Age Greater Manchester - Borough of Rochdale, Building & Connecting Communities North East STPs - Keeping Well in Communities

Humber, Coast and Vale - What makes us feel good our health in our hands Mid and South Essex Breathing well: pathways for respiratory health Hampshire and the Isle of Wight - Pathway to engagement & co-production: mental health crisis care Presentations Establishin g definitions :

@SocialEnt_UK @IVAR_UK #BHPselfcare Working definition of social prescribing in London Jason Tong and Claire Davidson Social prescribing practically from a VCSE perspective Andy Murphy (Age UK Islington) What is CHIN and how do they work? Katie Coleman Social prescribing

and self-care models and definitions Claire Davidson and Jason Tong @SocialEnt_UK @IVAR_UK #BHPselfcare Definition of Self-Management for Long Term Conditions The individuals ability to manage the symptoms, treatment, physical and psychological consequences and lifestyle changes inherent in living with a long-term condition. DH 2005 Knowledge, Skills, Confidence Medical management, Role management, and Emotional management Social Prescribing Definition:

New relationship/model of care Self-referral Statutory or community services Patient/Person Traditional practice in health settings - Signposting Healthcare Staff Patient/Person Statutory or community services New Model of Care in health settings Social Prescribing Healthcare Staff

Link worker Patient/Person Statutory or community services Social Prescriptions: Statutory and Community Assets Hierarchy of needs Contribution to the community e.g. Volunteering, befriending Physical, artistic, horticultural and relaxation activities, support groups, lunch club Education and training of skills e.g. IT training, CV, counselling E.g. Housing, finance/benefit, food bank, employment

Example of a whole system selfcare and social prescribing model Single point of access for signposting and social prescribing A local team will triage and signpost patient to statutory and/or community assets or referral to social prescribing service Social prescribing link worker meet with patient and coproduce a plan of social prescription and refer and support patients to statutory and/or community

assets What does social prescribing look like practically from a VCSE perspective? Andy Murphy AgeUK Islington @SocialEnt_UK @IVAR_UK #BHPselfcare Social Prescribing WHAT DOES IT LOOK LIKE PRACTICALLY FROM A VCSE PERSPECTIVE? Age UK Islington In OUR View Practically Social Prescribing is a means, not an end in itself Practically Social Prescribing exists on a continuum from Information to Navigation/Link Work Practically Social Prescribing has to fit within a wider range of Wellbeing service inputs and processes Practically Social Prescribing is like other forms of Prescribing You want to prescribe the right thing in the right dose in the right way

as part of a wider treatment being mindful of interactions minimising negative side effects avoiding dependency assuming the person can take them ... assuming the person will take them And then you want to Check its working Review and increase/decrease/change/stop as needed . towards some goal.. Doing {prevention] Properly Conceptual Model Goal/Value Proposition for Social Prescribing within Wellbeing +v e ivi d

ua l Acute +v e Ch an ge f or in d WHATS GOING ON Primary Care

Ch an ge f or in d ivi du al NEG (Theres got to be a reason for buying it) Social Care

POS WELLBEING POS COPING ABILITY NEG Age UK Islington Whats Going On and How Coping Matrix (Situation Gauging) Year of Care Model Practical Model - Operationalising (internally and externally) (Theres got to be a way of organising it, managing it and measuring it) Situation Situation

Highly negative 0 1 2 3 Highly Positive 4 5 Statutory Service All Ages All Stages Self managing Managing Nil ability confident 0 1

Self 2 3 4 5 Escalation Navigation Enablemen t Advice Information Carers Hub +v e

fo ri n l Ch a di n vid g ua e (Common goal for individual and system) ONE Age UK Activities Situation

Situation Highly negative 0 1 2 3 Highly Positive 4 5 supported Self Managing Self managing Managing Nil ability confident 0 1

continuing contact Self 2 3 Case work nee 4 ded? Early/Self identification nce Activities Attenda 5

Wellbeing Screening o Targeted o Regular Wellbeing Promotion o Get Help Keeping Active o Get Together Comms Model Visualising it for People and Practitioners (Theres got to be a way of explaining it) Practical Model Delivery Process Route to Team > Gauge/Co Produce Plan > Coproduce Delivery > Gauge Outcome and Impact > Set Follow On> Quality Assure (Theres got to be a way of delivering consistently )

Opening Stages Route to Team > Gauge/Co Produce Plan > Coproduce Delivery > Gauge Outcome and Impact > Set Follow On (Theres got to be a way of working outwith the service user/ patient- what to prescribe, and how it will be delivered) Tracking Inputs Why? Opening Service Activity & Inputs Closing (Theres got to be a way of working out what works )

Workforce Set the Actions for Plan Set field to Yes when Actions are set as part of Finalising the Service to Deliver Set the Actions Completed field to Yes when Actions are completed as part of Check Outcomes/Impact/Quality stage (Theres got to be a way of aligning your staff and volunteers on the way.) Workforce & Directories (Theres got to be a way of ensuring consistent/ correct prescribing even by less experienced staff and volunteers.)

Sustaining Outcomes Targeted Preventio n Input Follow up/ follow on set based on GAUGED future self managing capabilities Common Outcome Framework and Wellbeing Gauge across services. (Theres got to be a way of gauging follow up/follow on, stepup/ down progress towards overall goals, and what works at population and sub group levels - so you can do more of it ) Wellbeing in 1 Over Time

ONE Age UK supported 2017 Self Managing (Theres got to be a way of tracking and responding to trends for an individual over time, integrating with the rest of the system and continually improving ...) continuing contact 2020 Wellbeing Screening Wellbeing

Promotion Keeping Active o Get Together 2027 < < < < < < < < --------------------------------------------------------------------------------------------- Case Records ONE Age UK What is CHIN and how do they currently work? Katie Coleman @SocialEnt_UK @IVAR_UK #BHPselfcare

Care Closer to Home Integrated Network (CHIN) Team CHIN OUTCOMES CHIN TEAM Pharmacist working across the practices within the CHIN. Working with registers, proactively reviewing patients. Specific service lines working in primary care, alongside the CHIN practice teams to improve population health outcomes. Community Services staff (Specialist nurses, Physio etc.)

Practice based pharmacist Acute (specialist advice and guidance) Consultant/ specialist advice and guidance to GPs/ other CHIN staff in managing patients in primary care and avoiding unnecessary referrals. STP, CCG, CHIN QOF + targets: CHIN shared registers with templates to deliver QOF + Shared management/ input to delivery of targets annually Contracts aligned

5 x General Practice team (GPs, PNs, HCAs) & QIST Voluntary Sector link worker/ navigator Voluntary sector care navigator linked to CHIN and able to proactively social prescribe. Mental Health Social Care Social care linked to CHIN to support and link to local authority support for proactive support. Mental Health input in to the team via a link

worker or primary care mental health support through clinics within the CHI. Proactive population support. Group feedback & reflection: @SocialEnt_UK @IVAR_UK #BHPselfcare What is the most exciting aspect of this emerging model from your perspective? What are the things that worry you?

Local case studies to inspire: @SocialEnt_UK @IVAR_UK #BHPselfcare Presentations Bridge Renewal Trust, Haringey Geoffrey Ocen Age UK Islington Andy Murphy Expert Patient Programme, working within the CHIN Claire Davidson

Bridge Renewal Trust, Haringey Geoffrey Ocen @SocialEnt_UK @IVAR_UK #BHPselfcare Re-imagining Care Closer to Home 2nd Partnership Session CHINS and Social Prescribing in Haringey A Voluntary and Community Sector (VCS) Perspective 7 December 2017 Prepared by Geoffrey Ocen Chief Executive Bridge Renewal Trust Content About The Bridge Renewal Trust CHINs in Haringey whats happening? Social Prescribing in Haringey whats happening?

Way forward and how the VCS can work collaboratively to deliver CHINs and Social Prescribing services in Haringey About The Bridge Renewal Trust Our mission: To deliver practical ways that people can live healthier, long and fulfilling lives thus playing our part in working towards reducing health inequalities and building stronger communities. Haringey Councils Strategic Partner for the Voluntary and Community Sector supporting capacity building, fundraising, partnership development, volunteering, VCS forums and networking. Haringey CCGs partnership engagement provider (with Public Voice) promoting engagement, public meetings, co-production and raising awareness. CHINs whats happening? We have been working with Haringey CCG and GPs to develop closer working relationship with Haringey VCS organisations to ensure effective co-production of CHIN services across Haringey. 3 x CHIN design workshops attended by Haringey CCG, GPs, Partners over April June 2017 including VCS CHIN meetings.

CHIN business cases developed and approved for: West Haringey (frail and older people in care homes) Central Haringey (frail and older people) East Haringey (North and South)(Diabetes and Hypertension) Approval for 4 x Care Navigators and VCS participation in governance Social Prescribing in Haringey whats happening? Social Prescribing is being developed as a VCS-led service in partnership with Haringey Public Health, CCG, CHINs and other partners. Proposed model, in support of Haringeys Community Wellbeing Framework has the following components: Asset mapping of all community and voluntary sector initiatives; Co-ordination role to link residents to opportunities and have asset based conversation that will identify their opportunities;

Training of all frontline staff on asset based/strength based approach in health and care; A range of interventions in the community for social prescribing / community involvement. Online asset map Established Local Area Co-ordination (LAC) in two most deprived wards. Developing CHIN links and applied for funding from Department of Health SP partnership workforce development/ alignment VCS capacity building Local Area Coordination Mental Health services VCS services to

reduce falls for older people (e.g. exercise) GPs Voluntary and Community Sector orgs Acute hospitals and Social Care CHIN Care Navigators Referral to Link Workers aligned with CHINs VCS services to

support people with diabetes (EPP) VCS services to support people with mental health problems (ats on prescription) Online directory of VCS services East Haringey (North and South) Diabetes and Hypertension Engaging and educating BMEs (specifically AfroCarribbean, Turkish and Asian) in managing their conditions including translators in specific clinics. Identifying and working with non-compliant patients to improve their self-management and health outcomes. Central Haringey Home Visiting Service for older people, and GP Gym exercise classes. Improved care plans and appropriate interventions.

Care navigation and development of new VCS opportunities. West Haringey Older people living in residential care homes and extra care housing schemes. Integrated model of care which enables residents to be healthier and have a better quality of life, and more positive experience of care. Care navigation and development of new VCS opportunities. Way forward and how the VCS can work collaboratively to deliver CHINs and Social Prescribing services 1. 2. 3. Ongoing mapping to identify existing and develop new VCS services to meet CHIN and emerging priorities. Identifying and providing support to VCS to maximise engagement and service provision including: True partnership governance and co-production

Funding - particularly for small grassroot VCS organisations; how CCG and other commissioners can make it easier for small groups to compete. Infrastructure support and training eg. asset mapping, social prescribing, safeguarding, volunteering / time credits Co-location, co-ordination and processes closer working, link workers/care navigators, referral pathways, information governance etc Business case development - outcome measurements and demonstration of value for money. Thank you Age UK Islington Andy Murphy @SocialEnt_UK @IVAR_UK

#BHPselfcare Age UK Islington Inspiration (and some Perspiration) Whats Inspired our Journey with Wellbeing Services, Social Prescribing, CHINs, Personalised Care and Prevention Doing {prevention] Properly +v e ivi d ua

l Acute +v e Ch an ge f or in d WHATS GOING ON Primary Care Ch

an ge f or in d ivi du al NEG Inspiration Wellbeing as an integral part of the whole system Social Care POS

WELLBEING POS COPING ABILITY NEG Age UK Islington Whats Going On and How Coping Matrix (Situation Gauging) Year of Care Model Inspiration you dont have to do EVERYTHING Activity Information Outreach Targeted Outreach

Group Activities 1-2-1 Support Episodes Follow Up Continuing & Follow Support Through Focus Information distributed through multiple channels Information to particular sub groups with call to action

Case Finding Maintained regular connections Case Work (including advice) Monitoring and acting on risk to sustained Screening and regular contact programmes Value Stream Focus o o

o o o o o o o Measures Informed & Prepared Individuals o Early (self) Identification

Self Action o o Early Identification Self Action Signposted Identification Signposting Follow through Action o Early identification Peer support (knowledge)

Informed & Prepared Individuals Identified at risk individuals Informed & Prepared Individuals Situations/issues stabilised Connected to Sources of Support Connected to sources of support Connected to networks of support Connected to

sources of support Support initiated Change Problem resolution Know what to do Know what to do Will do it Know where to get help Will get it Sustained problem resolution

Support set up Informed and Prepared Individuals Sustained change Know where to get help Know what to do Problem resolved Know where to get help Unlikely to reoccur Are getting it

Will get it Troublesho oting Know what to do Will do it VCS Providers and Prevention Value Stream choose where you operate! o Early identification Signposted Maintained stability Case work requirement reduced Inspiration - Weve chosen to focuse on the Connector role and Wellbeing

Inspiration Person centred as the basis of organisation and service transformation Inspiration service and IT alignment for generating insight and intel on what matters Inspiration analysing service input related to what types and level of outcomes Inspiration proactively tracking changing attendance patterns for prescribed to services Whats Hot Whats Not ..for whom? Inspiration platforms to engage volunteers safely, productively, consistently and at scale Inspiration new technology decision support tools to find whats relevant to people Step 1 SEARCH & SELECT Searchbar will autofill with case title but you can

overwrite it Common Outcome Framework and Wellbeing Gauge across services. Targeted Preventio n Input Follow up/ follow on set based on GAUGED future self managing capabilities Inspiration using technology for prediction and . prescription Inspiration the continued integration/expansion of Social Prescribing and Wellbeing

This model visualises extending at both ends, incorporating current programmes for extending navigation into CHINs and IPC, and, potentially, Multiple Needs programme + new/developing approaches to embedding/extending navigator type roles into selected community providers/programmes. Design criteria: Needs to operate as single system, with single, simple point of referral/connection via Health Professionals/existing integrated care networks, with outcomes and signal/indicators captured using a common framework New Models of I&A New Models of Navigation Care Coordination extend / systematise Community Assets/Services Navigation One Age UK Wellbeing in 1 Information

extend / systematise social prescribing Objective Stability/Prevention within Care Plan User/Patient characteristics < Prevention within System > Prevention within Population High Intensity, Multiple Needs, Regular change/fluctuations

e.g. LTCs at varying levels of self management, Less complex MH problems, Low confidence or capabilities Early stages frailty. Life change awareness. Moderately activated. Signals/Triggers Easy to see>Immediate >presenting>crisis> re-referral/repeat referral/A&E Harder to see> extract from Service Requests/Activity/Contact pattern changes (lack of contact/engagement as well as increased contact), health checks Hidden> First time contact with VCSE/ Scale/frequency of activity Low volume (individuals) high volume 1-21 (case work and coordination)

Higher volume (individuals) Low volume (direct case work) Higher volume (proactive contacting) Very high volume (individuals), low volume/no case work, V high volume proactive contacting << User cohort objectives, characteristics, system requirements re signals/triggers for preventative intervention, scale and nature of activity >> Inspiration the continued expansion of population and person centred approaches CHINs Care Closer to Home Integrated Networks Population approach to managing health, Focused on prevention this pilot project is about working proactively to identify patients who could benefit from intervention

New AUKI team New models of Navigation tied in IPC Integrated Personal Commissioning Islington is a pilot site for this national programme a new approach to care planning aiming to; improve social & health care integration and better support people with complex needs. A cohort of Adults - with long term physical condition, social care need and mental health condition will be offered personalised care and support planning to support use of a personal budget Expert Patient Programme Claire Davidson @SocialEnt_UK

@IVAR_UK #BHPselfcare Expert Patients Programme Claire Davidson Lead Self-Management Support and Behaviour Change Expert Patients Programme Adults or carers (18+) with any long-term health condition e.g. chronic pain; multiple conditions; mild-moderate mental health problems who live, or have GP, in Islington or Haringey 6 week course, 2.5 hours per week 2 trained lay tutors who have health conditions Turkish, Bengali, Somali Common Challenges living with a health condition

Physical difficulties Psychological/emotional Reduced quality of life Isolation Loss of confidence Changed expectations Cant do what used to do Cant work / reduced work

Financial impact Changes relationships Fear of future Impact of treatment/medicine Adapt life around it Constantly changes Symptom Cycle EPP Toolbox Self-Management Tool Box Patients Journey Outcomes PAM Whittington Health 2015-17: average increases in Patient Activation of 11 points. Meaningful increase. EPP use of care services % GP consultations

7% Outpatient visits 10% A&E attendances 16% National Primary Care Research and Development Centre. The National Evaluation of the Pilot Phase of the Expert Patients Programme Final Report. December 2006 Those with less confidence to manage their LTC and coping poorly benefit more from EPP. Predicting who will benefit from an EPP self-management course (Reeves, Kennedy et al) BJGP vol 58, Nr 548, March 2008, pp. 198-203 Feedback I now have improved health, take less medication & feel a lot better. The feeling that I was alone has gone. It completely changes your mindset on everything.

I am now motivated to embrace the goal setting exercises as an integral part of my lifestyle." CHINS - Working Together - Deliver programmes in community venues across the borough - Work closely with third sector e.g. AgeUK - CHINs help us promote EPP, ensure local people know about programmes available close to them - Patients can access any course in their borough according to convenience e.g. time & venue - Ensure self-management continues to be integrated Split into 5 groups: 1. Voluntary and community sector What can we learn from what we

have heard?: 2. Commissioning and procurement people 3. Acute and community NHS/ health providers 4. Patients and the public 5. Others Discuss What we currently bring to the system? What can we re-imagine contributing that would shift the system to a better future? What do we need to avoid or watch out for? @SocialEnt_UK @IVAR_UK #BHPselfcare Break! @SocialEnt_UK @IVAR_UK

#BHPselfcare #HIOWcrisiscare Four groups Action planning @SocialEnt_UK @IVAR_UK #BHPselfcare 1. Common Outcomes Framework 2. Expert patient programmes

3. Social prescribing link role 4. make opportunities/ services/ providers visible Agree and write on flipchart Action planning @SocialEnt_UK @IVAR_UK #BHPselfcare 1. Outcomes what do we want to happen? 2. Targets (make it tangible!)

Quick Win and Longer Term target 3. Drivers what will move this forward and influence change? 4. Actions what will you do to make this happen? House of Care checklist: What does this mean for @SocialEnt_UK @IVAR_UK #BHPselfcare Commissioners, procurement, evaluation Engaged, informed individuals and carers

Organisational and clinical processes Health and care professionals (incl VCSE) working in partnership Brief feedback: Feedback from groups and agree plans What you are trying to achieve? How does it simplify the system or make it better? Whats your key steps? Discuss together: Is it tangible and do-able? What do we need to do to get buyin? @SocialEnt_UK

@IVAR_UK #BHPselfcare What next? Write up notes IVAR/SEUK Core group lead on each and discuss taking forward coordinated by Core group telecon catch- up 21st Dec, 11 am Next steps Core Group call 12th Jan, 9 am to check progress Meeting with Commissioners 1st Feb 9.3011.30 put forward ideas and get buy-in Action to take plans forward Final Partnership meeting 23rd March to assess progress, talk about impact, share learning, plan legacy @SocialEnt_UK

@IVAR_UK #BHPselfcare Thank you!

Recently Viewed Presentations

  • Table 1-1: Summary of Four Phases of Cyberethics

    Table 1-1: Summary of Four Phases of Cyberethics

    Cyber-Ethics Assignment PRE-OUTLINE This assignment is designed to help you prepare to write a well-formed, OUTLINE for a 5-paragraph (intro, 3 body points, conclusion) essay. List THREE (3) arguing points for the claim below.
  • Enhanced Assessment Grant

    Enhanced Assessment Grant

    Previous KY post-test surveys indicated students using a text reader were re-reading test items more often than when they tested on paper with an adult oral accommodation * * Finding: Study Shows Online students more likely to use text reader...
  • Parts of a Flower -

    Parts of a Flower -

    The pistil has three main parts: a sticky stigma on top to catch pollen and a style, a tube that leads to the third part, the ovary. The egg cells develop in the ovary. After fertilization, the ovary grows to...
  • Internet Searching -

    Internet Searching -

    Internet Searching. Create their listings automatically. They "crawl" or "spider" the weband then index what it finds to build the search base. Web page changes can be dynamically caught by this type of engine. Good when you have a specific...
  • Defined as a violently rotating column of air

    Defined as a violently rotating column of air

    Occur in many parts of the world ... Outdoors: Lie down in a depression, ditch or culvert. Cover your head with your arms. (3) In a vehicle or mobile home: In a vehicle or mobile home is probably ...
  • Nörofi̇zyoloji̇k Yaklaşim

    Nörofi̇zyoloji̇k Yaklaşim

    Lower extremity. Upper extremity. General Medical. History. of . Neurological. Approaches. PNF: Diagonal and sipiral thought of active and passive patterns have emerged and developed over time. Stretching effect and resistant work are important. Brunstrom
  • CDC Presentation

    CDC Presentation

    In areas with high mosquito densities: use mosquito repellents. wear clothing that minimizes skin exposure. Do not allow standing water to accumulate around your home. Be aware of warnings issued by state and local health departments. * Citations, references, and...
  • Lesson one: Understanding the Issue

    Lesson one: Understanding the Issue

    Touch on each misconceptions: ... One-third (34%) of clients of homelessness services have experienced family violence. The majority of these (66%) were female and one quarter (26%) were under the age of 14. Over 400,000 women experienced violence during pregnancy.