JoAdams 1;.IS article examines the provision and funding of home adaptations for people with physical disabilities. Part 1 looks at the following components of home adaptations: the Implementation of local housing and social legislation; the effect housing tenure has on the ease of obtaining adaptations; and the Involvement of a variety of agencies In the adaptation process.The findings are based on questionnaires and Informal Interviews of local authority housing departments, community occupational therapists and Disabled Facilities Grant applicants. The article concludes that people with disabilities receive an adaptation service which is skewed according to housing tenure and affected by the variation In local Interpretation and Implementation of social legislation. Rg.1. Row chart of a grant enquiry. Reproduced from Bumphrey 'Community Practice' 1995 with kind permission of the publisher, Prentice Hall/Harvester Wheatsheaf, Hemel Hempstead.

This article examines the provision and funding of home adaptations for people with physical disabilities. Part 1 concluded that people with disabilities receive an adaptation service that Is skewed according to housing tenure and local policy implementation. Part 2 examines the response of one county's social services department and its senior grade occupational therapists in the assessment and allocation of a home adaptation service across housing tenure and across the county. It investigates, first, the role of community occupational therapists in assessing home adaptations across that county and, secondly, the shortcomings in the Disabled Facilities Grant system as documented by service users. Recommendations are made for Improving the adaptation service across housing tenure for people with disabilities.

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BackgroundThere is an association between clinical teams engaging with research and improvement in the delivery of health services1. Randomised controlled trials (RCTs) provide strong evidence to influence practice in musculoskeletal services. For occupational therapists (OTs) and physiotherapists (PTs) implementing RCTs is not yet commonplace. As part of a multi-centred clinical effectiveness and efficacy RCT of splints for thumb base osteoarthritis (OTTER II Trial) we established an education training programme to support clinical therapists deliver the trial across 15 UK hospitals.ObjectivesTo evaluate the content of trial training to educate and support OTTER II Trial clinicians in undertaking clinical research roles.MethodsTwo trial training days were run in the North and South of England. Therapists provided details of their clinical trial experience. They were asked to identify one area in which they felt confident and one in which they were not confident in participating in a RCT. These perceived facilitators and barriers were summarised using descriptive statistics and content analysis.ResultsThirty five clinicians (20 OTs,15 PTs) attended a training day, 13 (37%) had no previous experience with clinical trials; 19 (54%) had been involved with at least one previous clinical trial. Clinicians considered they were already confident in; delivering the trial standardised assessment and treatment to patients n=21 (60%); trusting the OTTER II trial team and their own hospital research departments to support their research role n=11 (31%); understanding the trial protocol and what needed to be delivered n=6 (17%) and, being convinced that the trial asked a relevant question 3 (9%). Areas in which clinicians considered they did not have confidence included; the logistics and time management of delivering a RCT in their own hospital n=18 (51%); the associated trial paperwork to be completed n=8 (23%); NHS computer access/wifi access for randomisation procedure n=7 (20%); recruiting participants to time and target n=6 (17%) and staff capacity to deliver a RCT in the NHS alongside clinical commitments n=5 (14%).ConclusionsWell documented trial protocols and support from a trusted research team and local hospital research departments were identified as key areas that help clinicians become confident to engage with a national clinical RCT. Clinicians are less confident about managing the practical logistics, staff time and trial paperwork involved in delivering a national RCT. Clinicians identify that they possess core clinical assessment and treatment skills that already equip them to recruit and treat patients as part of a national trial. The logistics of delivering a trial requires ongoing negotiation and support from clinical service managers and the clinical trial teams to ensure clinicians are supported to deliver the RCT to time and target.References Boaz et al 2015 BMJ Open 5:e009415 doi:10.1136/bmjopen-2015-009415. AcknowledgementsThe OTTER II Trial is funded by Arthritis Research UK (Grant Ref number 21019)....

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