Download - Winterbourne PBS Amanda & Alison
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WINTERBOURNE
There Must
be
Another Way…….But What Is It ?
Lancaster & Preston Community LD Teams
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Who We AreWe are Amanda Tiley and Alison Riley.
We are Community Learning Disability Nurses based in Preston and Lancaster respectively.
We work with people who challenge services and may be subject to being sectioned under the
Mental Health Act.We liaise with all members of the multidisciplinary
team, including police, solicitors, social workers, commissioners, psychiatrists etc.
Lancaster & Preston Community LD Teams
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Aims of the Workshop
To raise awareness of Positive Behavioural Supports.
To work collaboratively in a multi-professional forum in order to develop strategies to minimise the risk of abuse of vulnerable adults.
To generate action plans to put into practice within the workplace.
Lancaster & Preston Community LD Teams
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Exercise
When you hear the words
“Winterbourne View”
what does it mean to you?
Lancaster & Preston Community LD Teams
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These are some of the thoughts my colleagues and I felt…..
• Safeguarding• Restraint• Abuse• Lack of care• Sadness• Despair• Evil
• Torture
• Guidance
• Lack of supervision
• Anger
• Threat
Lancaster & Preston Community LD Teams
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Winterbourne View Review Concordat or Agreement Programme of Action
• After the Panorama Programme was aired, an inquiry took place identifying what went wrong and why.
• Recommendations were made – not only to front line staff and service providers but also to community teams, commissioners, social workers, housing and CQC.
Lancaster & Preston Community LD Teams
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Simon Tovey was at Winterbourne view because the care home he’d lived in for 16 years needed extra staff to cope with his behaviour.They asked the council for an extra £600 a week.
The council and other agencies decided he needed assessing and
moved him out of area.
Assessment was supposed to take 6 months, but Simon was away for
3 years.
He ended up at Winterbourne View.
Lancaster & Preston Community LD Teams
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Winterbourne One Year On
It costs £1,400 a week less than it did for him to stay at Winterbourne View.
His mother, Ann Earley says:
‘All this could have been resolved in his current home. He need never have had those three years of hell.”
Lancaster & Preston Community LD Teams
Since the inquiry, Simon has moved back to the care home near his family
that he did not want to leave in the first place.
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Working with people who challenge services when distressed may cause
risk of serious harm, not only to the person themselves, but members of
the public and staff teams supporting them. Physical intervention,
restrictive practices and the use of the Mental Health Act have historically
been used to reduce the risk of harm, sometimes disproportionately.
When developing care plans for these people, we have to consider risk,
duty of care and proportionate responses.
What led us to Winterbourne and
the Mental Health Act as an
answer?
Lancaster & Preston Community LD Teams
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So what is the other way?
• Today we will be discussing: positive behavioural supports, legislation and guidance around the protection of vulnerable adults.
• As a group we will be working together to look at ways forward to avoid the possibility of these scenes occurring again.
Lancaster Community LD TeamLancaster & Preston Community LD Teams
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As a group
• What can we change?• Keeping it Local - are the Mental Health Act
and Out of Area Placements the only way to support people who challenge the service?
• Leadership - who is in charge?• Accountability - what is the line of
accountability? Supervision, training, support, burn out, competency?
Lancaster & Preston Community LD Teams
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Associated Legislation
• CARE IN THE COMMUNITY ACT (1990)OUTLINED - PLANS FOR HOSPITAL TO COMMUNITY TRANSFER
• THE HUMAN RIGHTS ACT (1998)• THE CARE STANDARDS ACT (2000) -RECOGNISED ABUSE IN CARE HOMES
LEADING TO CSCI INSPECTIONS• THE CARE STANDARDS ACT (2000) - RECOGNISED ABUSE IN CARE HOMES
LEADING TO CSCI INSPECTIONS• MENTAL CAPACITY ACT (2005) – AND DOLS PUTS BEST INTERESTS IN STATUTE
LAW• SAFEGUARDING VULNERABLE GROUPS ACT 2006• MENTAL CAPACITY CODE OF CONDUCT(2007) - PROVIDES FRAMEWORK TO
DETERMINE MENTAL CAPACITY• THE EQUALITY ACT 2010 PREVENTS DISCRIMINATION AGAINST A PERSON
BECAUSE OF PROTECTED CHARACTERISTICS• WINTERBOURNE ENQUIRY 2012
Lancaster & Preston Community LD Teams
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What is positive behaviour support?
• Positive Behavioural support approaches have become established as the
preferred approach when working with people with learning disabilities who
exhibit behaviours described as challenging.
• The strengths and successes of positive behavioural support approaches
provide the reason for the increasing support for their use. They are
fundamentally rooted in person centred values, aiming to enhance
community presence, increasing personal skills and competence and
placing emphasis on respect for the individual being supported. They also
use quality of life improvements for the person, both as an intervention and
as an outcome measure.
(BILD)
Lancaster Community LD TeamLancaster & Preston Community LD Teams
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Staff responses to behaviours that challenge services.
As reported at previous sessions of PBS for managers training.
They are attention seeking
It’s a slippery slope, what if it gets out of control
They know exactly what they are doing
They are doing it to wind us up
They have already had (biscuit/brew…..)
You are giving in to them
I don’t get paid enough to be attacked at work
Why do people respond in this way?
Lancaster Community LD TeamLancaster & Preston Community LD Teams
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This
“Person”
could save
your life
Please Don’t Discriminate
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To reduce the potential for Challenging
Behaviour what needs to be in the care plan?
GROUP EXERCISE
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Gold Standard Care Plan
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PBS / PI Plan
FAMILY / FRIENDS
Communication
Competent Staff Teams
Is this the WAY????
Or have we forgotten something???
Lancaster & Preston Community LD Teams
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What is involved in a PBS Plan?• Personal Information• Health Action Plan• Person Centred Plan• Mental Capacity Assessment/Consent• Communication Passport• Person Centred Risk Assessment• High Density of Preferred Activities
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• Functional Assessment (including Support Plan)
• Sensory Assessment
• Medication
• Primary and Secondary Prevention Strategies
• Reinforcement Inventory
• Motivational Assessment
What is involved in a PBS Plan?
Lancaster & Preston Community LD Teams
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Risk Assessments• Human rights joint risk assessment and
management plan (hr-jramp)• How can we develop person centred risk
assessments that keep people safe and happy (as opposed to safe and unhappy or happy and unsafe)
• How can we work together for a solution
Lancaster & Preston Community LD Teams
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What do we need in order to improve?
• More community based enhanced services- environments tailored to individual
needs.• More specialised skilled services to deal with
these behaviours.• Using the Mental Capacity Act as opposed to
the Mental Health Act as a legal framework.• Meaningful life.• Keep it local.
Lancaster & Preston Community LD Teams
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Any questions?
Lancaster Community LD TeamLancaster & Preston Community LD Teams