time for action dave williams
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TRANSCRIPT
Time for Action…
• Dave Williams– Clinical Nurse Specialist Salford LD Team– Winterbourne View Joint Programme Board
member– Core Member of CB-NSG
Presentation Overview
• Update from Winterbourne View Joint Improvement Programme Board
• Information about CB-NSG• Actions
Winterbourne
“This isn't just about wicked staff, or weak management, but it is about the wrong model of care - people with challenging behaviour being shunted off for 'assessment and treatment' as a substitute for working away to set up the kind of services that would support them well in the long term”
Jim Mansell May 2011
Winterbourne View Joint Improvement Programme Board
• There are approx 3500 people placed in hospital placements of which 1200 are seen as “assessment and treatment units”
• Over 400 people have no identified LA or NHS commissioner
Timetable• June 2013
– Health and care commissioners, working with service providers, people who use services and families, will review the care of all people in learning disability or autism inpatient beds and agree a personal care plan for each individual based around their and their families’ needs and agreed outcomes.
– ThenHealth and care commissioners should put plans into action as soon as possible and all individuals should be receiving personalised care and support in appropriate community settings no later than 1 June 2014.
Winterbourne View Joint Improvement Programme Board
• Framework for individual care reviews of people with challenging behaviour currently in hospital placementsWill set out framework for current hospital placementsFuture documents will be published about joint plans
to assist with people returning to their local area
Also NCB will be publishing service specification guidance in April 2013
Question
What would it be like if we got it right?
Individuals and their families would have the right support, at the right time
and in the right place.
Rights and Values
1. People will be supported to exercise their human rights (which are the same as everyone else’s) to be healthy, full and valued members of their community with respect for their culture, ethnic origin, religion, age, gender and disability.
Rights and Values
2. All children who are at risk of presenting behavioural challenges have the right to have their needs identified at an early stage, leading to co-ordinated early intervention and support.
Rights and Values
3. All families have the right to be supported to maintain the physical and emotional wellbeing of the family unit.
Rights and Values
4. All individuals have the right to receive person centred support and services that are developed on the basis of a detailed understanding of their support needs including their communication needs. This will be individually-tailored, flexible, responsive to changes in individual circumstances and delivered in the most appropriate local situation.
Rights and Values
5. People have the right to the highest attainable standard of health and appropriate support to enable this.
Rights and Values
6. People have the same rights as everyone else to a family and social life, relationships, housing, education, employment and leisure.
Rights and Values
7. People have the right to supports and services that create capable environments for individuals which are developed on the principles of positive behavioural support and other evidence based approach and which draw from additional specialist input as needed. This will respond to all the needs of the individual.
Rights and Values
8. People have the right not to be hurt or damaged or humiliated in any way by interventions. Support and services must strive to achieve this.
Rights and Values
9. People have the right to receive support and care based on good and up to date evidence.
Actions from the charter
• Local authorities and the NHS will know how many children and adults live in their area and how many they have placed out of area. On the basis of information from person-centred plans all agencies will plan and deliver local support and services.
Actions from the charter
• Services will seek to reduce the use of physical intervention, seclusion, chemical and mechanical restraint with the clear aim of eliminating them for each individual.
Restrictive Practice AuditName
Mechanical Restraints including adaptations/additions to wheelchairs
Restrictive Physical intervention
Prn meds Covert meds
Locked doors /areas
Support Plans Guidelines
Date last Reviewed
Mindfulness-based approaches withfamily and paid carers
Dene Donalds
Presentation Overview
• What is mindfulness?
• Why is mindfulness relevant to family and paid carers working and living with people with challenging behaviour?
• Some outcomes from evaluations of mindfulness-based intervention with family and paid carers
What is Mindfulness?
Mindfulness is the practice of focussing attention in a non-judgemental, non-reactive way on the present moment and what is happening in an individual’s mind, body and the world around them.
Mindfulness forms the basis of mindfulness-based stress reduction and mindfulness-based cognitive therapy programmes and there is growing evidence of the benefits of mindfulness for managing a range of difficulties including stress, anxiety, depression, pain and disordered eating.
Chapman 2012
Mindfulness and “therapy”
• Mindfulness offers an alternative or an adjunct
to current therapies
• Instead of challenging an individual’s irrational
or negative thinking, mindfulness-based
approaches focus on the individual’s
relationship to thinking itself
• Transformative - changes the way we relate to
thoughts, feelings, emotions, and actions;
changes the way we engage with situations we find ourselves in.
Relevance to challenging behaviour
Positive associations of mindfulness with reduced parental and care staff distress [Lloyd & Hastings, 2008; MacDonald et al., 2010; Noone &Hastings, 2011]
Negative associations of avoidant coping with stress for parents and care staff [Hastings et al., 2005; Devereux et al., 2009]
Literature Search and Analysis of Mindfulness Based Approaches with people with learning disabilities families and paid carers[Chapman & Mitchell 2012]
Models suggest emotional reaction to challenging behaviour effects family and paid carer responses
Models
Conclusions from research and presentation
• Challenging behaviour is emotionally demanding
• Mindfulness based approaches with families and staff reduce stress support values and reduce the use of physical intervention
• Focus is on the family member and staff • Potential to enhance existing positive
approaches to Challenging Behaviour
