Learning Disabilities Managed Care Network Severe Challenging Behaviour Working Group

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group
Study/Training Day Care Pathways 15th March 2005
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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Membership of group
• Nursing (In-patient community)
• S.A.L.T.
• Psychiatry
• O.T.
• Local Authority Day Services
• Psychology
• Project Manager
• Commissioner

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Main issues considered in working group
• Type of network
• What is Severe Challenging Behaviour?
• Identification of current position in
  Network/Needs assessment
• In-patient services
• Community supports
• Care pathways/Protocols
• Training Issues
• Good practice Service Development

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Type of Network
• Peer support rather than specialist service
• Were stuck role
• Formalising the informal
• Development of services to prevent out of area
  services
• Emphasis on community reintegration

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• What is severe challenging behaviour?
• culturally abnormal behaviour(s) of such an
  intensity, frequency or duration that the
  physical safety of the person or others is likely
  to be placed in serious jeopardy, or behaviour
  which is likely to seriously limit use of, or
  result in the person being denied access to,
  ordinary community facilities. (Emerson, 1995)

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Definition in Business Case for development of
  Managed Care Network
• People who have very severe challenging
  behaviour which cannot be safely assessed and
  treated within existing local arrangements for
  people with a learning disability.

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Initially considered Exclusion Criteria
• No learning disability present
• Individual meets criteria for Autism MCN
• People who have Autistic Spectrum Disorder
  associated with severe mental illness or severe
  challenging behaviour and who require an autism
  specific service
• Individual meets criteria for Forensic MCN
• People with a mild/moderate learning disability
  who offend or whose behaviour would be regarded
  as offending behaviour if they were in contact
  with the criminal justice system

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Identified a range of possible Inclusion
  Criteria
• Piloted in Lochview Lothian CBT
• Revised questionnaire developed (exclusion
  criteria dropped)
• Circulated to specialist health services in 4
  health board areas
• Responses requested for end of month

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• This person has shown challenging behaviour which
  has caused significant injury or extreme distress
  to themselves or others in the past year.
• This person has shown challenging behaviour which
  is placing themselves or others at real risk of
  significant injury or extreme distress as
  defined above and it is only by good fortune
  that such injury has not already occurred.
• This persons challenging behaviour is putting
  their current community placement at imminent
  risk of breakdown, despite the best efforts of
  local services.

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• This person is currently detained under the
  Mental Health (Scotland) Act for their own
  protection, or for the protection of others, as a
  consequence of their challenging behaviour.
• This person is currently placed on a Guardianship
  Order for their own protection, or the protection
  of others, as a consequence of their challenging
  behaviour.
• This person is currently placed in Out of Area
  services as a consequence of the challenge they
  present to services.

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• This person is in continuing NHS care as a
  consequence of their challenging behaviour.
• This persons challenging behaviour is associated
  with extremely high use of medication (regularly
  or as required).
• This persons challenging behaviour is managed by
  the regular use of physical or mechanical
  restraint (e.g. arm splints).
• This persons discharge from NHS care is delayed
  as a consequence of the challenge their behaviour
  presents.

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• This persons challenging behaviour is managed by
  extremely intrusive staff management approaches
  (e.g. seclusion, constant observation, one to one
  supervision etc.).
• This person is currently (or is at significant
  risk of being) excluded from day services as a
  consequence of their challenging behaviour.
• This person shows severe challenging behaviour
  which cannot be safely assessed and treated
  within existing local arrangements for people
  with a learning disability which has not been
  covered by the categories above.

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group
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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group
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Number or responses to each criteria from all
areas
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Q.1 This person has shown challenging behaviour
which has caused significant injury or extreme
distress to themselves or others in the past
year.
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Q.2 This person has shown challenging behaviour
which is placing themselves or others at real
risk of significant injury or extreme distress
as defined above and it is only by good fortune
that such injury has not already occurred.
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Q.3 This persons challenging behaviour is
putting their current community placement at
imminent risk of breakdown, despite the best
efforts of local services.
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Q.4 This person is currently detained under the
Mental Health (Scotland) Act for their own
protection, or for the protection of others, as a
consequence of their challenging behaviour.
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Q.5 This person is currently placed on a
Guardianship Order for their own protection, or
the protection of others, as a consequence of
their challenging behaviour.
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Q.6 This person is currently placed in Out of
Area services as a consequence of the challenge
they present to services.
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Q.7 This person is in continuing NHS care as a
consequence of their challenging behaviour.
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Q.8 This persons challenging behaviour is
associated with extremely high use of medication
(regularly or as required).
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Q.9 This persons challenging behaviour is
managed by the regular use of physical or
mechanical restraint (e.g. arm splints).
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Q.10 This persons discharge from NHS care is
delayed as a consequence of the challenge their
behaviour presents.
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Q.11 This persons challenging behaviour is
managed by extremely intrusive staff management
approaches (e.g. seclusion, constant observation,
one to one supervision etc.).
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Q.12 This person is currently (or is at
significant risk of being) excluded from day
services as a consequence of their challenging
behaviour.
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Q.13 This person shows severe challenging
behaviour which cannot be safely assessed and
treated within existing local arrangements for
people with a learning disability which has not
been covered by the categories above.
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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group
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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group
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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group
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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Identification of current resources within
  network
• staffing
• resources
• community provision
• potential contributors to Network

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• In-patient services
• Sub-group established to consider implications
  for Lochview
• possibility of making 4 regional beds available
  for use instead of out of area placements
• alternative in-patient service arrangements
• Sharing expertise between units
• Alternative service models

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Community Supports
• Were stuck
• Transition models
• Outreach services
• Expert links

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Care Pathways/Protocols
• How do assessment/treatment services operate in
  practice?
• Evidence based/Clinical Governance friendly
• Routes in and out of MCN beds
• Routes to access MCN supports
• Specificity of MCN contributions

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Training Issues
• Clear potential for joint training initiatives
• Extended skill base available to provide
  training
• Sharing of expertise
• Economies of scale
• Staff development opportunities

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Good Practice Service Development
• User involvement
• Sharing best practice
• Sharing problems
• Potential to share workload on service
  improvement and quality improvement processes
  (e.g. QIS Indicators)

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Purpose of today
• To further develop relationships between
  services
• To use initial focus on in-patient services as a
  springboard to improve community systems
• To consider the benefits of a care pathway
  approach (and the costs)
• To use the Lothian experience to stimulate our
  thinking and to reflect on our own systems
• To consider what might be applicable on an MCN
  basis (and/or what could be improved locally)

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Structure of the day
• Introduction to the Care Pathways principles
• A guided tour of the Lothian Pathway (warts and
  all)
• The Lothian Pathway in practice - case
  studies
• Area Workshops

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Learning Disabilities Managed Care NetworkSevere
Challenging Behaviour Working Group

• Questions for workshop sessions
• What are we doing now?
• What works well?
• What could be better?
• What bits of CP are we doing now?
• What do we do thats not on the Lothian CP and
  needs to be added?
• How much of the CP would it be useful for us to
  adopt?
• How will we take it forward?
• What help and support will we require?