Why a service directory is a critical component of a compassionate community project.

In this blog, we will look at why a service directory is a critical component of a compassionate community project. We will cover

·     What is a service directory

·     How is it kept alive

·     How it can be used in clinical practice

·     How it can be used across organisational boundaries, including all 4 cogs of the new essentials

What is a service directory?

One of the key principles of community development is mapping the resources that are already available in the community. As Cormac Russell https://www.nurturedevelopment.org(@CormacRussell) repeatedly states ‘Start with what is strong and not what is wrong’. Communities already have significant existing resource. Mapping consists of going out into the community and making links to these resources. This is turn leads to building a directory of all of the diverse resources which can be made available to the public on a website. A great example of this can be found on the Health Connections Mendip website https://healthconnectionsmendip.org/mendip-directory/

A service directory is a living, breathing document which gathers together all that is going and available as community resource. The more that is on there, the more resource there is. It includes groups ranging from choirs to disease specific groups such as Parkinson’s Disease, services such as Citizens Advice Bureau, and anything else that might be considered relevant to help connect people together in the community. 

How is the service directory kept alive?

There are three key principles in keeping a service directory alive. 

The first principle is that the service directory has to be kept updated. The easiest way of doing this is that the community development workers are the people who do the updating. The system they have in place at Health Connections Mendip works well. There is always someone in the office to answer the phone. If someone in the community rings in to say that a group has changed in any way, one of the Health Connectors immediately changes the information on the Mendip Directory. This means that the directory is easy to alter. It also means that there are no intermediaries when trying to change it. There is no need for a ticket that goes in a queue which has to be completed by an IT department, perhaps happening 3 weeks later. If the directory is not up to date, the danger is that when somebody uses the information on there and it is inaccurate or out of date, then it will put people off using it. 

It is important to consider who does the updating. If this is done by someone who does not use the directory, it stands a chance of being yet another irritating administration task that gets put on the list and is done at the end of the day, or gets put off until another day. Accuracy and immediacy is likely to be improved if the person who does the updating is someone who uses it regularly.

The second key principle is that the service directory has to be designed so that it is easy for everyone to use. If the first thing you see is a sign-in page, this will put people off. Busy clinicians will not sign in if there are extra steps needed to access the directory. They already use multiple systems requiring sign in. Asking for more just discourages them. The design process must therefore include testing the directory with the people who use it. This should be done through face to face communication, getting feedback on design through testing cycles. Design has to make it as easy to use as possible, for public and professionals alike.

The third key principle is that the information about what is going on in the community must be local. If somebody opens up a service directory and sees groups that are going on miles away, they will not be interested and will not bother to scroll through lots of irrelevant information. I do not recommend using a search function to find what is happening locally. Again, this involves an extra step which puts people off using it. If you have a look at the Mendip Directory, you will see that you can find what you are looking for by scrolling through the headings. This is quick and easy. You are more likely to navigate your way through the multiple groups and services by browsing rather than searching. In addition, if you search and you do not find what you want, then you have to go back and do another search. This is a sure fired way of irritating busy people.

How the service directory can be used in clinical practice

A service directory plays a central role in linking community development with clinical care. 

A way of thinking about how this happens is to consider the impact of having easy access to the enormous variety of different things that are going on in communities. A service directory may have many hundreds of individual items on it. For example, in Frome there are over 400. When a community resource mapping took place in Penwith in Cornwall, there were over 700. Having this huge community resource at hand, it is possible to greatly expand the nature of discussions that clinicians will have with patients. If a clinician has nothing available and at hand when someone mentions that they are homeless, they are unlikely to progress with such a conversation and will shut it down. Alternatively, if a click of a button gives them a wide variety of options, there is something to discuss. See https://healthconnectionsmendip.org/category/housing/as an example of how this information might change the nature of a conversation about homelessness. A small point here – not being able to help people who are in need in a way that is meaningful to them is one of the most difficult and stressful situations a clinician may find themselves in. Seeing suffering without being able to help can make clinicians feel powerless.

Keeping the service directory open, ready to use, is the key to bringing its use into clinical practice when seeing a patient. If a clinician knows that they have a huge social resource at their fingertips, it becomes much safer to talk about a wider variety of problems. Clinicians who do this as a matter of routine find that the nature of their clinical conversations change. If someone is suffering from anxiety, loneliness or wants to lose weight, something useful is at hand. As the clinicians get used to the variety of resources on the service directory, they become more confidant in finding out what matters most to the patient. This can be very different from a discussion about the medical condition which seems to be the problem. If someone is suicidal from loneliness, they are not even remotely interested in what is happening with their diabetes. Addressing the loneliness is therefore much more important than thinking about their HBA1c levels. 

How a service directory can be used across organisational boundaries, including all 4 cogs of the new essentials

The big plus about having a service directory open to both public and professionals, is that it can be used in any setting.  We have described how this can be done by clinicians above. It is important to remember that this can be done by clinicians in hospital as well as in primary care. Making use of community resource in a busy Accident and Emergency Department can save time and give clinicians options that might avert an admission to hospital. Likewise, when considering what might be needed to help someone get home from hospital, linking to community resource can be extremely helpful. It might include befriending services for lonely people or volunteer transport to help people get home. Community peer support bereavement groups are something that can be really valuable to relatives who suffer a bereavement of their loved on during a hospital admission. They may not need specialist bereavement support but still want to find ways of accessing help. The use of the service directory is therefore relevant to communities and clinicians across all settings. 

Summary

 A service directory plays a central role in linking community resource to clinical practice in the wide variety of clinical settings. As we discussed in another blog, unless taking a compassionate community approach is something that changes clinical practice, face to face with patients and families, it will remain remote and distant for clinicians. In the previous blog I briefly discussed how it can be used in clinical practice and have used this blog to expand further how this can be done. In addition, I have discussed how the service directory is the repository for the huge range of support already available to communities and clinicians.