winterbourne pbs amanda & alison

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Network Name WINTERBOURNE There Must be Another Way……. B ut W hat I s I t Lancaster & Preston Community LD Teams

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Page 1: Winterbourne PBS Amanda & Alison

Network Name

WINTERBOURNE

There Must

be

Another Way…….But What Is It ?

Lancaster & Preston Community LD Teams

Page 2: Winterbourne PBS Amanda & Alison

Network Name

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

Page 3: Winterbourne PBS Amanda & Alison

Network Name

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

Page 4: Winterbourne PBS Amanda & Alison

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Exercise

When you hear the words

“Winterbourne View”

what does it mean to you?

Lancaster & Preston Community LD Teams

Page 5: Winterbourne PBS Amanda & Alison

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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

Page 6: Winterbourne PBS Amanda & Alison

Network Name

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

Page 7: Winterbourne PBS Amanda & Alison

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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

Page 8: Winterbourne PBS Amanda & Alison

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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.

Page 9: Winterbourne PBS Amanda & Alison

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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

Page 10: Winterbourne PBS Amanda & Alison

Network Name

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

Page 11: Winterbourne PBS Amanda & Alison

Network Name

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

Page 12: Winterbourne PBS Amanda & Alison

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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

Page 13: Winterbourne PBS Amanda & Alison

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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

Page 14: Winterbourne PBS Amanda & Alison

Network Name

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

Page 15: Winterbourne PBS Amanda & Alison

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This

“Person”

could save

your life

Please Don’t Discriminate

Lancaster Community LD TeamLancaster & Preston Community LD Teams

Page 16: Winterbourne PBS Amanda & Alison

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To reduce the potential for Challenging

Behaviour what needs to be in the care plan?

GROUP EXERCISE

Lancaster & Preston Community LD Teams

Page 17: Winterbourne PBS Amanda & Alison

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Gold Standard Care Plan

Lancaster Community LD Team

PBS / PI Plan

FAMILY / FRIENDS

Communication

Competent Staff Teams

Is this the WAY????

Or have we forgotten something???

Lancaster & Preston Community LD Teams

Page 18: Winterbourne PBS Amanda & Alison

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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

Lancaster & Preston Community LD Teams

Page 19: Winterbourne PBS Amanda & Alison

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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

Page 20: Winterbourne PBS Amanda & Alison

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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

Page 21: Winterbourne PBS Amanda & Alison

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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

Page 22: Winterbourne PBS Amanda & Alison

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Any questions?

Lancaster Community LD TeamLancaster & Preston Community LD Teams