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Article
Publication date: 20 August 2018

Ursula Turner

The purpose of this paper is to describe how, as part of a national initiative led by NHS England and key partners, it is transforming lives by helping people with a learning…

Abstract

Purpose

The purpose of this paper is to describe how, as part of a national initiative led by NHS England and key partners, it is transforming lives by helping people with a learning disability, autism or both to live more independent and better quality lives in their own home rather than spending many years in hospital unnecessarily.

Design/methodology/approach

The methodology applied was to capture the real experience of a person with a learning disability, autism or both who successfully moved from long-term hospital care to home. This was achieved through developing a narrative story by capturing their experiences in their own words and the words of the individual’s support team who made this life changing event possible.

Findings

This story shows how with the right planning and support, people with a learning disability can live in their own homes, gain their independence and be supported to take risks.

Originality/value

This is an original case study that has not been published previously and has been written for the sole purpose of this journal.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 1
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 2 July 2018

Jo Whaley, Di Domenico and Jane Alltimes

This purpose of this paper is to examine the role of engagement and empowerment in “Transforming Care”, for people with a learning disability. The aim is to shift the balance of…

1060

Abstract

Purpose

This purpose of this paper is to examine the role of engagement and empowerment in “Transforming Care”, for people with a learning disability. The aim is to shift the balance of power so that people are able to live ordinary lives in the community, in the home they choose, close to people they love. It shares ideas to support people to take control over their own lives and to influence the system, so that it works with people, rather than “doing to” people.

Design/methodology/approach

The paper examines barriers and enablers to people having their rights as citizens. So that people have as much choice and control as they are comfortable with to live an ordinary life (bearing in mind any legal restrictions). The paper includes people’s involvement in system/service redesign. It critiques traditional views of looking at language, participation and power. The authors have used the language throughout which people have told us they prefer as a descriptor.

Findings

The authors present a framework for looking at the power of, and around, people with a learning disability who have mental health issues or have displayed behaviour that can challenge services.

Originality/value

This paper offers advice on how to address power imbalances at individual level and at organisational/system level. It looks at the language we use, the information we share and how we work with experts by experience to ensure we can transform care and support and enable people to live ordinary lives as citizens.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 1
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 2 October 2017

Elaine James, Chris Hatton and Mark Brown

The purpose of this paper is to analyse rates of inpatient admissions for people with learning disabilities in England and to identify factors associated with higher rates of…

Abstract

Purpose

The purpose of this paper is to analyse rates of inpatient admissions for people with learning disabilities in England and to identify factors associated with higher rates of inpatient admission.

Design/methodology/approach

Secondary analysis of data submitted as part of the Transforming Care programme in England.

Findings

2,510 people with learning disabilities in England were inpatients on 31st March 2016. Findings indicate that people with learning disabilities are at risk of higher rate of inpatient admission than can be explained by prevalence within the general population; this risk may be associated with areas where there are higher numbers of inpatient settings which provide assessment and treatment for people with learning disabilities.

Research limitations/implications

Variability in the quality of the data submitted by commissioners across the 48 Transforming Care Plan areas mean that greater attention needs to be paid to determining the validity of the common reporting method. This would improve the quality of data and insight from any future analysis.

Practical implications

The study’s findings are consistent with the hypothesis that geographical variations in the risk of people with learning disabilities being admitted to inpatient services are not consistent with variations in prevalence rates for learning disability. The findings support the hypothesis that building alternatives to inpatient units should impact positively on the numbers of learning disabled people who are able to live independent lives.

Originality/value

This is the first study which examines the data which commissioners in England have reported to NHS England on the experience of people with learning disabilities who are admitted as inpatients and to report on the possible factors which result in higher rates of inpatient admission.

Details

Tizard Learning Disability Review, vol. 22 no. 4
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 3 October 2016

Lawrence A. Patterson and Samuel Berry

The purpose of this paper is to explore experiences of team culture, structure and function of an intensive support service (ISS) within the context of the recent service guidance…

Abstract

Purpose

The purpose of this paper is to explore experiences of team culture, structure and function of an intensive support service (ISS) within the context of the recent service guidance “Building the Right Support” (NHS England, Local Government Association and Association of Directors of Adult Social Services, 2015). Reflections on the Hampshire and Southampton ISS set up in 2010 are discussed with a view to informing a debate about frameworks for ISS services nationally.

Design/methodology/approach

A reflective piece, drawing on experience and case examples.

Findings

This paper describes that a key function of an ISS is making individuals safe and this is significantly assisted by using shared team formulation, which can enable information and perspectives to be shared between and within teams as rapidly as possible. Further, a case is made for recognising the importance of inter-disciplinary practice, as the Southampton and Hampshire ISS has removed the “old fashioned” demarcations that led to individuals seeing a “procession” of different professionals from different disciplines. This relates to team structure, but importantly is about a culture of holding a shared identity based on positive behavioural support values, rather than a traditional uni-disciplinary perspective.

Practical implications

ISS models are being proposed by NHS England and this paper suggests some important practical aspects.

Originality/value

Limited literature exists examining the team culture within ISSs, which contributes to desired outcomes for service users. This paper opens a debate about structural and functional aspects of service delivery in this service model.

Details

Tizard Learning Disability Review, vol. 21 no. 4
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 4 October 2019

Anna Leonie Wark

Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive environment…

Abstract

Purpose

Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive environment. On these bases there is a growing emphasis on the requirement for local authorities to develop appropriate services for people who are currently in a hospital setting. The purpose of this paper is to examine the literature addressing factors influencing the provision of effective community-based forensic services.

Design/methodology/approach

The six articles were analysed separately using the evaluation tool – Currency, Relevance, Authority, Accuracy, Purpose. The six articles used divergent sample groups and employed both qualitative and quantitative methods to collate data. The articles shared a purpose of examining forensic community service provision with an aim to improve services.

Findings

There were three themes that emerged consistently across the literature these included: balancing risk management vs individual autonomy; multi-disciplinary and multi-agency working; service improvement. There is a growing emphasis on the need to replace long-term hospital placements with specialist, community provision, employing least restrictive methods and positive responses to crisis situations. In this climate, it is crucial that multi-disciplinary agencies from local authority, health and the charitable and private sector continue to work collaboratively on the integration of service provision in order to bring about the development of effective and responsive community services.

Research limitations/implications

Research limited to peer reviewed and published research papers focusing on the subject of community forensic services with publications specifically made within the time frame of the Transforming Care Agenda.

Practical implications

This paper looks to examine the practical solutions to providing effective community forensic services for a person with an intellectual disability and makes recommendations for research into improving service specific training for support staff.

Social implications

Following the Winterbourne View Hospital scandal (BBC One, 2011) instigations were made to make legislative change under the Transforming Care Agenda. Despite a renewed conviction in the rights of people to be a part of their local community without segregation or discrimination, professionals in the field continue to report a failure to reduce numbers of people in long stay hospitals and secure settings. With commissioning under pressure to make these intentions a reality it is a really good time to reflect on practice and evaluate service models to establish the factors that bring about positive outcomes for individuals enabling inclusion within community settings.

Originality/value

This review will focus on the literature evidencing positive intervention and outcome focussed methods of supporting people with a forensic history in the community. This is an entirely original piece of work analysing peer reviewed and published research.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 10 no. 3
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 11 September 2017

John L. Taylor, Susan Breckon, Christopher Rosenbrier and Polly Cocker

Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning…

Abstract

Purpose

Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however, there is little guidance available to help those working with detained patients with ID and offending histories to consider how to affect safe and effective discharges. The paper aims to discuss these issues.

Design/methodology/approach

In this paper, the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought.

Findings

Initial outcome data provide support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support.

Practical implications

People with ID are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission.

Originality/value

This is the first attempt to describe and evaluate a discharge planning intervention for detained offenders with ID. The intervention described appears to be a promising approach but further evaluation across a range of service settings is required.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 8 no. 3
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 27 November 2020

Ashok Roy, Peter Baker and Sue Carmichael

Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of…

Abstract

Purpose

Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”.

Design/methodology/approach

This paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges.

Findings

It is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again.

Originality/value

Standards in relation to care pathways are presented.

Details

Tizard Learning Disability Review, vol. 25 no. 3
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 11 November 2020

Louise D. Denne, Nick J. Gore, J. Carl Hughes, Sandy Toogood, Edwin Jones and Freddy Jackson Brown

There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that…

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Abstract

Purpose

There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation.

Design/methodology/approach

This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built.

Findings

This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process.

Originality/value

In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed.

Details

Tizard Learning Disability Review, vol. 25 no. 3
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 22 July 2019

Karin Fuchs and Peggy Ravoux

The purpose of this paper is to present the service model and evaluation of Southwark Enhanced Intervention Service (EIS). EIS is an intensive community service for adults with…

Abstract

Purpose

The purpose of this paper is to present the service model and evaluation of Southwark Enhanced Intervention Service (EIS). EIS is an intensive community service for adults with intellectual disabilities whose behaviours challenge in the context of the Transforming Care agenda.

Design/methodology/approach

The service model is described and the following evaluation data over four years are presented: key performance indicators, descriptive data, clinical outcomes, financial outcomes and qualitative feedback on users’ experience.

Findings

The EIS has demonstrated good outcomes for a small number of adults with complex needs by supporting them at crisis point locally and preventing hospital admission or a move to a restrictive environment out of area. EIS has also supported the successful transition back to area of a small number of adults with complex needs. The evaluation has shown improvements in behaviour, wellbeing and quality of life as well as demonstrating financial savings. Families’ and providers’ qualitative feedback indicates that the service has been highly valued and in particular the access to timely multidisciplinary coordination of input.

Originality/value

The service was developed around the same time as the start of the Transforming Care agenda. It presents findings of a four-year evaluation at a time when there is limited evaluation of such service models focusing on the Transforming Care aims. The paper presents significant findings in support of guidance and recommendations published more recently as well as reflections on components of effective service delivery.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 3/4
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 4 July 2016

Sanjib Kumar Ghosh and Eddie Chaplin

A consultant forensic psychiatrist and an individual with autism under his care discuss their experiences of working with autism in secure care. Dr Ghosh is a Consultant Forensic…

226

Abstract

Purpose

A consultant forensic psychiatrist and an individual with autism under his care discuss their experiences of working with autism in secure care. Dr Ghosh is a Consultant Forensic Psychiatrist who analyses some of the practice issues and concerns for clinicians working with people with autism in secure care. He includes comments on the issues raised by one individual with autism (who has consented to sharing his thoughts) in secure care based on his experiences. This is particularly relevant given the recent publication of Building the Right Support, which offers national guidance to develop community services and close inpatient facilities for people with a learning disability and/or autism who display challenging behaviour, including those with a mental health condition. The paper aims to discuss these issues.

Design/methodology/approach

X is an autistic patient on a medium secure unit. His viewpoint, together with his then inpatient consultant psychiatrist ' s view, is given.

Findings

There are multiple issues for patients and staff to consider when on a secure unit. The approach to take is focusing on holistic management.

Originality/value

This paper starts with the patient perspective of his experiences with autism in the community and in hospital. This provides a framework for the paper to demonstrate how theoretical knowledge and holistic, patient-centred management can be applied to address the issues raised for an autistic patient who has spent a number of years as an inpatient on a medium secure unit. It shows how such plans can directly involve the patient and be adapted to suit the patient ' s self-identified needs and wishes. It also looks at the challenges longer-term inpatients with autism face in their rehabilitative journey from the patient and clinician perspectives.

Details

Advances in Autism, vol. 2 no. 3
Type: Research Article
ISSN: 2056-3868

Keywords

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