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RING

Summary

Description

Operational Information

Evaluation

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Summary

The "Ring project" was publicly funded by the European Commission through the Lifelong Learning Programme 2007-2013, Leonardo Da Vinci, Transfer of Innovation, and set up by the local Government of Turin, which coordinated the project, together with some Italian and international stakeholders, such as social services, local health authorities, lifelong learning and training policies offices and others. The service’s budget was approximately €340,000, of which €96,000 was allocated for its implementation and the dissemination of results.

The Ring project used three tools to train informal and migrant carers of older people with dementia in order to raise the quality of care and decrease health and social costs. At the beginning of 2014 approximately 1,300 training packages were distributed. Even though the project is no longer running, its coordinator is using the kits in training courses for carers organised by the Training School of Continuing Education (SFEP) of the Department of the Relationship with Health Authorities of the Turin Social Services.

The service has had a positive impact on end users, as it improved their skills and also on national Health System, saving human and financial resources in the long term.

Description
refers to the target users, kind of service provided, ICTs typologies and devices used

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RING
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Italy, Spain, Romania, Turkey
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01-11-2008
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01-11-2011
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  • To reduce the level of stress and anxiety experienced by carers and care recipients;
  • To increase the skills of informal carers;
  • To improve the skills of social and health care trainers;
  • To facilitate the social integration of migrant care workers;
  • To update the European partners on these issues.

Informal carers are often left alone and/or struggle with a heavy care burden. The initiative aimed to fill this gap by means of specific training, disseminating information both about the disease, as well as the competences of carers (informal and formal) and health and social care services. The project also intended to be a reference for good practice in home care, as an alternative to residential services (Alzheimer centers, nursing homes, etc.), for the Italian NHS.

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Millions of Europeans suffer from dementia, which is one of the greatest problems of public health and welfare systems and requires appropriate support. Formal and informal carers experience high levels of emotional and psychological stress, which puts them at risk of becoming second patients. The diverse background (gender, age, social background) of informal carers highlighted a need to train them to adequately manage dementia sufferers.

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No Care Recipients
Yes Informal carers
Yes Paid assistants
Yes Formal carers

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The main beneficiaries were:

Direct:

-Informal carers (family, friends or neighbours) of people with dementia.

-Paid assistants: care assistants who are privately hired by care recipients or their households (including migrant care workers) of people with dementia.

Indirect:

-doctors, psychologists and trainers within social or health sectors and care providers.

-Other target groups: informal carers of disabled people, mental patients, or people with chronic diseases.

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No Independent Living
Yes Information and learning for carers
Yes Personal Support and Social Integration for carer
No Care coordination

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Training of carers using the following tools:

  1. GAM, which was a psycho-educational programme of 6 modules to teach carers relational strategies to improve their emotional wellbeing (the Matia Gerontologico Institute - Ingema (ES);
  2. “Guidelines for Carers", which was a guide for carers on the different forms of dementia, its course, practical advice and support at the end of the patient's life (Sospiro Fondation-Hospital Institute (IT);
  3. a DVD with highlights from many films that support the training of carers (Maderna Center (IT).

The training package was also address to carers of disabled people, mental health patients, or people with chronic diseases. The training was possible both face-to-face with experts and through a dedicated website.

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An internet connection for the e-learning platform and a DVD player.

Operational Information
refers to the type of funding, budget, sustainability and organisations involved

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Public only
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Public research funding: local, regional, national, European and international funds for research, development and implementation of innovative initiatives
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European and international funds for research, development and implementation of innovative initiatives (Lifelong Learning Programme 2007-2013 Leonardo Da Vinci - Transfer of Innovation).

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Other: please specify
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Not applicable

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Not applicable

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The service was free, with no co-payment.

As highlighted in the Opportunities section of the SWOT analysis, the service was useful and appreciated. Moreover, it created a strong partnership between the local and regional, health and social services. Both of these aspects gave the project a good chance to increase its target users and financing. According to its promoters, the service structured and improved the quality of care and therefore was able to act as a reference for best practice, to be replicated and adapted, with low cost, to other areas of the local social and health system. After the pilot phase, the Local Health Authority TO1 (ASL Turin 1) believed the "Ring Kit" could also be adapted to any carer of a patient with disabilities and the Local Health Authority TO2 (ASL Turin 2) offered to extend the kit to family members and acquaintances. Thus, the future sustainability looked promising.

The innovative aspect of the initiative was its combination and adaptation of three teaching and methodological tools ("Ring Kit") to improve training skills. As those tools were provided by partners from various geographical areas an increase in the number of users was expected.

The financial sustainability of the project seemed guaranteed by the integration of the project in the health and social services in the Turin area, as well as in partner countries, with dedicated resources for its operation. In addition, the creation of an e-learning platform could have helped limit the need for sustainability resources. Given the importance of the results obtained, and their recognition at the community level, all partners agreed to apply to new EU projects.

The sustainability plan foresaw the following specific actions:

• identify the human relationship needs of carers;

• combine the Ring Kit training tools;

• adapt and test the Ring Kit at the national and European levels;

• validate and systematize the Ring Kit;

• monitor and assess the final results.

These actions were intended to increase the applicability of the training package to other fields, such as carers for disabled people, for mentally ill patients, or for people with chronic diseases

A large multidisciplinary partnership, coordinated by the Project manager, was to operate through national and European meetings, workshops and online contacts. The participation of stakeholders, trainers, and various social bodies would have facilitated the impact evaluation, the sustainability of the training, and the health of carers, thus reducing costs at the meso- and the macro levels and potentially creating opportunities to obtain further financing.

The sustainability plan recognised that the Ring project needed to collect information regarding experiences, to analyse formative needs and to suggest educational material and “good practices”. To realise this, all project partners focused on the following sustainability promotional strategies:

• awareness of the project identity and of its outputs;

• analysis of the current socio-cultural context;

• analysis of resources and existing constraints;

• analysis of tools and instruments;

• set priorities by project members, target users and stakeholders;

• analysis of critical factors in project development;

• analysis of strengths and weaknesses;

• hypotheses of future scenarios and perspectives;

• verification of needed changes.

The sustainability plan aimed to ensure that the initiative had an important impact and that the planned actions were aligned with real needs. Such criteria were fundamental for a positive comparison and interchange among the actors of the different learning paths to enrich the project and to gain potential new users and additional financing.

(the Department of the Relationship with Health Authorities of the Turin Social Services and at http://www.comune.torino.it/pass/php/4/ring_en.php?pag=45855)

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€ 50,000 - 500,000
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€ 50,000 - 500,000
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340,000€ for setting up the initiative and 96,000 € for implementing it.

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Yes Authorities
Yes Private Care Sector
Yes Health and Social Care Systems
No Third Sector
No Private Companies

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  1. Authorities (national, regional and local): European Commission, City of Turin; Istanbul Metropolitan Municipality.
  2. Health and Social Care Systems: Local Piedmont Health Authorities-ASL Turin 1 and ASL Turin 2.
  3. Private care sector: Sospiro Fondation-Hospital Institute; Maderna Center; Igema Foundation-San Sebastian.
  4. Educational sector: University of Turin; Catholic University of Sacro Cuore-Rome, University of Transilvania-Brasov.

Briefly the partners were:

  • TURIN

Social Services and Relations with Local Health Authorities - Health Office

Contact: Cristiana Bianchi +39 011 4425146 cristiana.bianchi@comune.torino.it

  • SOSPIRO FOUNDATION - HOSPITAL INSTITUTE

Contact: Luca Acito +39 0372 620243 luca.acito@fondazionesospiro.it

  • MADERNA CENTER Contact: Anna Maria Melloni +39 0323 934663 annamariamelloni@centromaderna.it

  • The UNIVERSITY OF TURIN Education and Pedagogy Sciences Department

Contact: Cecilia Marchisio +39 011 6703187 cecilia.marchisio@unito.it

  • CATHOLIC UNIVERSITY OF SACRO CUORE - ROME

Faculty of Medicine Contact: Flavia Caretta +39 06 30154916 flavia_caretta@rm.unicatt.it

  • LOCAL HEALTH AUTHORITY - ASL TO1 Elderlies Long Care Department Contact: Daniela Leotta +39 011 70952503 daniela.leotta@aslto1.it

  • LOCAL HEALTH AUTHORITY - ASL TO2

Elderly Department Contact: Nicoletta Nicoletti +39 011 4393762 nicoletta.nicoletti@libero.it

  • The UNIVERSITY OF TRANSILVANIA - BRASOV (RO)

Faculty of Medicine Contact: Liliana Rogozea +004 0721510223 r_liliana@unitbv.ro

  • ISTANBUL METROPOLITAN MUNICIPALITY (TR) Contact: Kubra Bayraktar +90 2124551980 kubra.bayraktar@ibb.gov.tr

  • INGEMA FOUNDATION - SAN SEBASTIAN (ES)

Instituto Gerontologico Matia ContactRif. Igone Etxeberria +34 943224643 igone.etxeberria@ingema.es

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Not applicable
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Yes Informal Carers
Yes Health Professionals
Yes Social Care Professionals
Yes Privately-Hired Care Assistants (inc. Migrant Care Workers)
No Volunteers

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Experts with a multidisciplinary education provided individual training and managed the e-learning platform. University professors, psychologists, educationalists, geriatricians, neurologists, trainers, volunteers

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Not involved

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1,001 - 5,000
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Even though the project ended in 2011, the kit is available and usable for training. As of the start of 2014, 1,300 kits were provided and about 70,000 people had been reached through the website, training courses and dissemination events.

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The communication strategy used social marketing to facilitate communication of the disseminated practices, experiences, information and problems from the project participants to a wider target group. The aims of the communication plan were:

A. to share with the partnership the whole communication process.

B. to convey the contents of the project and to circulate best practices

The communication strategy assured shared and coherent actions with following organisation:

- Description of the action;

- Objectives of the action;

- Target of the action.

The communication plan was delivered by the Department of the Relationship with Health Authorities of the Turin Social Services , which coordinated the project.

(Comune di Torino, Divisione Servizi Sociali, 2011)

Evaluation
refers to the impact of the service on end-users, care organisations and authorities

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The service seemed to have a positive impact on the quality of life of:

- Informal carers by improving their social life and health through reconciling care and work.

- Paid assistants by improving their social life and health.

- Older people by indirectly improving their health and social relationships through better quality of care.

Other benefits are:

  • Increased acceptability of the ICT as a potential medium of support by formal and informal carers;
  • Qualification and professionalisation of informal carers’;
  • Care recipients and informal carers’ awareness of each other’s mood (Ring Project Consortium, 2011)
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The service seemed to have a positive impact on:

- Private organisations that provide care by helping to save on costs and optimise resources through training of informal and formal carers to increase their effectiveness and efficiency. Therefore they can partially relieve those organisations of their care burden (Ring Project Consortium, 2011)

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The service seemed to have a positive impact on public authorities, the NHS and social care services by helping to reduce home caring and hospitalisation and training informal and formal carers. These latter are better supported and able to optimise financial and human resources sharing some activities with public care (Ring Project Consortium, 2011)

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Strengths:

  1. Decreased stress and anxiety of informal carers;
  2. Increased care competence and knowledge of older people with dementia of informal and formal carers (similarly for carers of people with disabilities);
  3. Different levels of appreciation between formal and informal carers towards various parts of the Kit, thus confirming its flexibility and adaptability;
  4. Training formal carers to relate to informal carers;
  5. The Ring kit was usable.
  6. Coordinated inclusion, in the local social and health system, of specific services to support carers;
  7. Consortium members’ satisfaction with the results regarding the number of people involved and the training quality.

Weaknesses:

  1. There were difficulties to involve informal carers in the training;
  2. The training videos should have been more suitable for informal carers;
  3. Required to have trainers with multi-professional skills (psychological, health, social);
  4. There was a brief period of experimentation;
  5. Informal carers had difficulty accessing the training, which required accommodating both care recipients and carers;
  6. The small print of the “Guidelines for caregivers” made it difficult to read.

Opportunities:

  1. For 48% of formal carers, the most useful tool of the “Ring Kit” was the DVD, which concerned the care relationship with people with dementia, disabilities or psychiatric problems. For informal carers, GAM was found to be more useful. Therefore both groups were satisfied with one service, which indicated that the number of users could have increased;
  2. The initiative showed the importance of a flexible and modular support. This was exemplified by the "Ring Kit", which integrated experiences and tools by various stakeholders, from different countries, to usefully address the needs of carers of older people with dementia;
  3. The project demonstrated the essential role of evaluation and assessment to improve training methods and its contents.

Threats:

  1. The e-learning platform was more useful for experts, such as teachers, while GAM and DVD users may have abandoned using these tools if not given enough instruction (Ring Project Consortium, 2011)
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The consortium was composed of a diverse, multi-disciplinary national and European partnership, with the participation of professors, psychologists, educationalists, geriatricians, neurologists, trainers, from three Italian regions (Lombardia, Piedmont, Lazio) and two other EU countries (Spain, Romania) and a potential EU country (Turkey). Moreover, the direct involvement of stakeholders and committees of care recipients allowed the assessment of the impact and sustainability of training and promoted self-help care groups.

The initiative was transferred to all partner countries. The whole consortium disseminated the Kit to local authorities, health and social authorities, volunteer associations and cooperatives. All partners added the Ring Project link to their official website and were committed to translating the “Ring Kit” into the language for a wider European dissemination online. There was a good opportunity to extend the initiative locally in Turin and widely in Piedmont. Due to the validation of the "Ring Kit", it could have been applied to other parts of Italy, although this would have required decisions by local and regional institutions and stakeholders. (The e-learning platform was created for this purpose.) Therefore there were good chances to increase the local coverage.

To develop the scalability and transferability of the service, Turin managed the “VELA” Project, for migrant care assistants, and promoted the “LAPIS Project. This latter project, which comprised training for the promotion of healthy ageing (LDV–VetPro), was aimed at a wider local and national partnership. A network of European partners on carer training was generated from these initiatives.

The final results of this project were:

- creation of the Ring Kit;

- expansion of care recipients composed of the disabled, the mentally ill and the chronically ill.

More Information
includes contacts, publications and accompanying documents

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References:

Ring Project Consortium (2011), Final Report of WP4, validation of results, validation of Kit Ring, available at http://www.comune.torino.it/pass/php/4/documenti/ring/WP4_Phase%20Report.pdf

Publications:

Department of the Relationship with Health Authorities of the Turin Social Services (2011), Transfer RING Supports for Carers, http://www.comune.torino.it/pass/php/4/ring_en.php?pag=45857

Etxeberria I., Zamora G., Bianchi C., Marchisio C., Rogozea L., Camcı Y.(2010), Psychological needs perception and stress, depression, insomnia and medical problems in caregivers, Transforming Care 2010.

Per M. (2010), Alzheimer: il “kit Ring” aiuta i caregiver, Il Sole24ore, 7 giugno 2010.

Rivoiro C. & Marchisio C., Alzheimer: come assistere chi assiste, Il Sole24ore, 12 ottobre 2010.

Rivoiro C. (2010), XVII ISA World Congress of Sociology – Sociology on the Move – 11-17 July 2010, Gothenburg, Sweden.

Zamora, G., Etxeberria, I. Galdona, N. Urdaneta, E. Yanguas, JJ. Bianchi, C. Marchisio, C. and

Resources:

Ring Project website http://www.comune.torino.it/pass/php/4/ring.php

Mr Cabodi A.-Ring Project Manager, case study’s update via telephone and e-mail, January 2014.

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Address:

the Department of Relations with Health Authorities

Social Services and Health Office

via C.I.Giulio 22 - 10122 Turin

Telephone: 0039 0114425146

For information:

project e-mail: ring@comune.torino.it