1. Physical loss or disturbance of bodily function affecting mobility, sleep and energy;
2. Psychological upheaval affecting levels of pain, anxiety, depression, mood swings, loss of motivation & will;
3. Personal factors: loss of self-confidence & esteem, inability to exercise a sense of self, frustration of ambition, loss of independence & sense of purpose;
4. Biographical events: previous trauma, abuse, bereavement;
5. Social factors: isolation through loneliness, lack of friends, dysfunctional relationships;
6. Work-related and financial influences: job loss, debt and Benefits Agency problems;

The following aims are addressed:

• Clinical assessment, individual therapy and ongoing management to reduce the burden of symptoms, also monitoring and appropriate reduction of medication;
• Personal: to encourage principles of self-development, strengthen self-confidence & esteem, kindle motivation and will;
• Educational: to broaden outlook, improve language & communication skills, develop new interests;
• Social: to meet, work alongside and befriend others within and outside the project;
• Work-related: to develop and exercise new skills with an increasing sense of empowerment and responsibility, to move on to voluntary and part-time employment;
• Financial: to receive advice and representation for all benefit, housing and other eligible claims;

The pathway begins where the patient’s condition and concerns demand. The patient’s situation is frequently reassessed in order that interventions are appropriate and sufficiently challenging. Social, volunteering and fund-raising activities provided by KRT enable patients to take their recovery further. In the process they become the agent for change of others through their help and example, as well as sharing in the development of a young charity.

Challenges:

• Close co-working with health professionals responsible for the patient’s care;
• Co-working with ATOS & DWP to encourage attitudes which are realistic, fair and productive as far as returning to creative activity and work are concerned.
• Furthering more social and work-related opportunities.

1. IN THERAPY: The nature of our one-to-one therapeutic interventions is that they can engage the person, ‘warm’ them up (physically and psychologically), restore patterns of sleep and lift mood. They then begin to have some energy to play with and feel motivated to start facing their situation. Many patients feel that they are up against their problems alone and worth very little. They have given up thinking that they could have any impact on their condition or that they could change their adverse circumstances e.g. problems with relationships, benefits, finance & occupation. Through regular one-to-one therapy the chances of them attending and engaging are increased. If they can be ‘brought into play’ during the therapeutic period they have generally proven terribly keen to share and contribute in more social activities. Examples of individual involvement follow:
2. HELPING ONE ANOTHER: Knowing and having experienced what another person is suffering gives one understanding and often sympathy for the other facing similar difficulties. Moral support and a strong camaraderie can develop between individuals who discover they are facing the same trials.
3. FUNDRAISING: A number who have received help and felt the benefits have turned their hand to fundraising for us e.g. boot-fairs, stalls at fayres, cakes & craft sales
4. HELPING RUN EXISTING ASPECTS OF THE PROJECT: Our little choir was the idea of one our patients. It is led by one of our therapists. A patient who is a piano teacher has joined in by bringing music and doing some of the directing.
5. INITIATING NEW ASPECT OF THE PROJECT: When funding for a craft workshop leader ran out, new individuals appeared and decided they would run one between themselves, teach each other what they were able to do and sell the proceeds for the new charity.
6. JOINING THE RESEARCH TEAM: The National Institute for Health Research (NIHR) Patient Benefit Fund requires that patients help run the project under evaluation. Three patients have keenly volunteered to do this.
7. GIVING OF THIR OWN SKILLS: a solicitor who suffered a serious road accident understood the difficulties of completing benefits forms. He is now helping those that we have identified as needing help to do their forms more effectively.
8. REPRESENTING THE PROJECT: A group of 5 patients attended a public meeting called by Greenwich CCG to hear opinions of the their musculo-skeletal services which they had identified were in need of reform. They reported so positively about our little project that the CCG promptly visited and highlighted the benefits of Kairos at the first commissioning meeting of health professionals.
9. ACTIVITIES OUTSIDE: A Turkish Cypriot widow generously took it upon herself to re-decorate and help furnish the flat of a Somali single mother of 4 children.