Case study -Milton Keynes Community Health & MacIntyre on Making it Real
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Presentation by representatives from Milton Keynes Local Authority and MacIntyre regarding “On Track Forensic Support model”. The model supports people with complex behaviour move back to the community. Staff give different views on what works. MacIntyre is a specialist service for people with learning disabilities or autism who have offended or are at risk of coming into contact with the criminal justice system.
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Case study -Milton Keynes Community Health & MacIntyre on Making it Real
- 1. Making It Real In Milton Keynes Milton Keynes Joint Learning Disability Team MacIntyre On Track Forensic Support Forensic Support
- 2. Amanda Griffiths Head of Joint Learning Disability Services Milton Keynes Council
- 3. Commissioning • Integration • Pooled budget/Section 75 • Collaboration • Infrastructure • Providers
- 5. MacIntyre Background MacIntyre Background • National charity set up in 1966, providing services for over 1,200 children, young people and adults. 2,100 staff, turnover £47.8m MacIntyres Mission • To be recommended and respected • Offering best choice, best value • Employing the best people in support of people with learning disabilities (http://bit.ly/Welcome-to-MacIntyre) What we do • Offer wide range of services that encourage increasing independence
- 6. Investors in People Champion, 2014 Appointed Investors in People Champion, and will now act as an ambassador for the Standard Winner, CareKnowledge Workforce Innovation Award, 2013 For MacIntyre’s ‘My Key’ self- assessment tool, aimed at reaching staff for whom traditional approaches to supervision, role modelling and teamwork are not easily arranged. Awarded Investors in People Gold, 2012 Recognising MacIntyre’s commitment to excellence and innovation in how we recruit, train and develop our staff Winner, 2012 Charity Awards - Disability For MacIntyre No Limits, an innovative project that provides education and support for young people with learning disabilities or autism Skills for Care 2010 prestigious ‘Winner of Winners’ Awarded the ‘Most Innovative Workforce Development’ accolade and prestigious ‘Winner of Winners’ Award from Skills for Care for our Great Interactions work MacIntyre’s approach has been recognised in recent years:
- 7. MacIntyre On Track Forensic Support (OTFS) Our model/methodology A specialist service for people with learning disabilities or autism who have offended or are at risk of coming into contact with the criminal justice system The On Track Forensic Support model is uncomplicated and was originally established in 2005
- 8. OTFS Key Features: • To support people with complex behaviour move back to community • Supported to live in own homes to live healthy, fulfilled lives • Support in person centred ways to learn new skills and live as independently as possible whilst monitoring risk to selves and others • Staff model and encourage respectful and positive relationships • People re connected to their community, families/friends • Achieve new skills and contribute to community life
- 10. Why does our On Track Model matter?
- 11. Without shared responsibility and MDT working:
- 12. On Track Forensic Support in practice: • Invested in specialist staff • Close partnerships • Risks scoped and managed through partnerships • Person & project specific MDTs established • Routine and specialist supported living support: MacIntyre staff • Clinical support and leadership: community health & social care teams • Sharing of assessment and support plans/processes • Change supported and measured : Life Star • Bespoke training of staff
- 13. How we apply our methodology to our work : • MacIntyre prepare the internal ground • Close working • Joint assessments/ transition work • Support plans • MDT approach, sharing challenges • Explore ways forward/available, together. • We work together to provide on going, flexible support
- 14. Kevin Williams Supported Living Manager Milton Keynes Joint Learning Disability Services
- 15. Multi - Disciplinary Working • Regular and inclusive communication • Regular update meetings • All professionals included – Joint Commissioning – Social Care Representatives – Winterbourne Lead (NHS) – Proposed Support Provider(s) – Proposed Housing Association(s) – Other Key Stakeholders
- 16. Housing Solutions • Team approach to design issues based on individual need • Work with Housing Provider as a key partner (ongoing) • Work through issues together (MDT) • Consider all options, share decision making
- 17. Supported Living • Preferred option for ALL new schemes in Milton Keynes • Unique challenges / solutions • Assistive Technology / Who can help with what? • Family members as key part of ongoing team
- 18. First Line Contingency • Community Support Intervention Team (CSiT) • Shared and evolving support plans • Person at centre of each decision • Use of each person’s name (not case number etc.)
- 19. Chris Ward Team Manager, CTALD Milton Keynes Council
- 20. Care Coordination • CPA – Fidelity to process • Early identification of suitable provider service • Face-to-face contact – Regular & with all stakeholders • Active involvement – From referral to transition and beyond • Collaborative planning – Selecting and utilising the most appropriate tools (MHA/PCP/Living Locally toolkit)
- 21. Recruitment & Induction MacIntyre On Track Specialist: Barrie Ellis Specialist Area Manager, MacIntyre
- 22. Recruitment and Induction • Recruitment – Open Day – New job roles, specific requirements in addition to usual characteristics – Recruitment specifically informed by MDT discussions of needs of people – Positive response rate – Different cohort of applicants – excellent but posed new challenges
- 23. Recruitment continued .. • Interviews involved On Track specialists and Adult Services managers, a combined approach • Tailored interviews accordingly; existing profiling approach with additional forensic elements • Challenges around keeping support roles distinct from more mainstream services, staff need firm understanding of this
- 24. Induction • Tailored, intensive and collaborative approach • Generalised support aspect, supplemented by specialist forensic elements delivered by On Track Forensic Support • Bespoke sessions based specifically around each person to be supported, in conjunction with our OT specialists and the forensic support teams for each person (including the Registered Clinician) • Utilisation of local MacIntyre expertise
- 25. Collaboration: • Wide range of multi-agency partners: – The commissioning team of course, which brings in the LDT, CSIT and the full range of health and social care support services – Clinical teams in current settings – Criminal Justice agencies (where/when appropriate) – Housing providers
- 26. Transition & collaborative working MacIntyre specialist: Joyce Hennis Lead Forensic Practitioner MacIntyre
- 27. Transition, • Living Locally and Getting to Know You, collaborating from the outset • Preparing someone to be ready for a supported living service, collaborating with them, their families/significant people, current providers • Enabling the person to gain trust in a new staff team, collaborating with the person, working with others to achieve this
- 28. Collaborative working with families • Working with families • Families are anxious about people returning to local area • Being introduced to peoples families by someone they know and trust • Clear communications • Families can see transition work as a way of spending more time with their relative and this needs to be managed sensitively
- 29. Our keys to a success outcome • Multi disciplinary approach • Relationships • Flexibility • Respecting others points of view and experience
Editor's Notes
- MacIntyre is an award winning National Charity
- MacIntyre’s On track Forensic support specialises in providing support for people who have offended or are at risk of offending. The level and nature of support depends on the person’s individual circumstances and needs. For each person we design a framework that enables the person to make positive choices, taking increasing control and responsibility for their life, significantly reducing the risks relating to offending. Increasingly we are providing intensive specialist support within our forensic service for those who are not connected to the CJS, who require a more tailored support service that fits will with our On Track methodology The On Track Forensic Support Model is simple and has the same core values and commitment to all people receiving support as the rest of Macintyre. It provides a specialist service building on the existing long standing bedrock of experience, competence and skills we already have within MacIntyre.
- Some of the THE KEY FEATURES OF OTFS We support people with complex behaviour to move home, back to their community. The people we support may otherwise be in hospitals or secure settings/assessment units People are supported to live in their own homes, with intensive support from specialist staff to encourage them to live healthy and fulfilled lives Our partnership approach ensures that each person is supported in person centred ways to learn new skills and live as independently as possibly whilst monitoring the risk they pose to themselves and the public Our On Track staff model respectful and positive relationships and we coach people in developing these types of relationships in their own lives As a result of this, the people we support become connected back to their community and re-establish and retain their important relationships with their families and friends And we aim to create opportunities for people to achieve new skills and contribute to community life and of course, this in turn enhances their self esteem, and motivates them to stay away from offending and challenging behaviour
- The On Track Model On Track methodology relies upon three main areas (with the person as a whole circle around all three areas): Social support Area – empowering and enabling, placing the person at the centre of their individual service Therapeutic Area– health, well being, mental and physical health Commissioners Area– risk management, boundaries, any combination of all aspects, linking health and social care and external agencies All three of these areas overlap and they are bought together through Multi Disciplinary working – joint working, shared decision making A multi disciplinary approach involves drawing appropriately from different disciplines to re define problems outside of the ‘usual’ boundaries and reach solutions on a new understanding of complex situations. It works. It’s a method commonly used within the NHS and other professions. (It has been identified as an essential part of the Recovery Model if any of you have worked with that (i.e. for many people the concept of recovery is about staying in control of their life, despite experiencing a (mental health) problem Putting this into action means focusing on care supporting recovery and upon the building resilience of the people being supported) This approach is why our On Track service is proving successful also supporting people in the community who are not associated with the Criminal Justice System. It is based on the medical model with MDT style working at it’s heart. The traditional working and expertise of MacIntyre provides the backbone of our service, the On Track element needs to be the heart of a forensic service – keeping the MDT beating, the flowing and sharing of decisions, ideas, expertise and resources Shared working, decision making and responsibility is fundamental to delivering a service that is both person centred and strengths based, encouraging transformation, self management, self control and personal responsibility, all within a social context. All working together supports personal growth in the presence of continuing symptoms and disabilities because the emphasis is on living a satisfying, hopeful and contributory life by supporting changing attitudes, values, feelings, goals, skills and roles – doing this together
- So why does our methodology within On Track Matter to us and the people we support? This matters because it gives us regular access to experts at the right time for the right support – it’s really that simple – simple but very difficult if this model is not in place. Our joint working brings these expert elements together via an agreed and managed protocol that minimises risks to the person, the public and professionals. This maximises the opportunity for the person we are supporting to live a good life.
- Sometimes commissioners and their teams, are under pressure to ‘close’ cases and hand them over to providers with no further contact or access to them or specialists. MacIntyre and Milton Keynes both believe that providing people requiring specialist forensic support with the access to the specialist resources they need to help them on their personal journey towards a better life is their right, just as it would be in any other service
- On Track In Practice We’ve invested in specialist staff for our forensic support service, including myself and a lead forensic practitioner We have a close partnership between us all, health and social care commissioners, our On Track service, and other community services. We work to keep this open and ongoing and use this partnership to ensure that any risks are managed in the community with agreement from all people about the level and scope of responsibility and accountability We establish a project multi-disciplinary team to develop joint approaches and share responsibility for the wellbeing of the people being supported with Clinical support and leadership coming from community health and social care teams, and routine and specialist supported living support, coming from MacIntyre staff recruited specifically for the job Individual Multi Disciplinary teams are established for each person requiring support and returning to the community MacIntyre’s especially developed External Referral Form and assessments, are used alongside MK’s own assessments to inform and develop management and support plans Change (both positive and non positive change) is supported and measured using Life Star, developed for people with learning disabilities We provide our staff with bespoke forensic and specialist training, where appropriate alongside specialist MacIntyre training to equip staff to balance risk and opportunity and provide them with appropriate qualifications
- We prepare the internal ground within MacIntyre We work closely with the Commissioners, the person we will be supporting and their families and professionals/others in their lives We start transition work following joint assessments We work with families, existing providers and prepare support plans All within an MDT approach, ironing out and sharing challenges as they appear along the way The MDT provides the opportunity to explore best ways forward/available. We work together to provide on going, flexible support
- Open Day: pulled in HR team, specialist On Track staff and forensic practitioners from established services in the North West. New job roles – review of job roles, person specifications and job descriptions, keen to ensure standard MacIntyre DNA and values, plus additional need for different emphasis, resilience and strong (different) boundaries. Recruitment informed by MDT – discussions to outline the needs of the person to be supported and recruitment tailored accordingly. This collaboration was important in getting the right skills mix, although because of the regularly changing landscape, it meant that there were pitfalls. We might start recruitment for one person with specific characteristics in mind, only for the person to suffer a setback or delay and so we would be using staff in a slightly different way. This isn’t a disaster, and as the team has developed and expanded we’re developing a broader mix so are more and more flexible as things progress. Positive response rate – much larger number of applicants, most of which were converted into job offers initially, although this effect waned into the second round of recruitment. Different cohort of applicants – as well as large numbers, the calibre was very high and not typical of the usual profile. Lots of graduates that had specifically sought out the role due an interest on forensics and/or psychology. This poses unusual but luxurious challenge of needing to balance the number of young, educated, and motivated people but with limited experience. Interestingly, all of the team so far have been external candidates – we would usually expect to see some internal applicants be successful, but on this occasion this was not the case.
- Combined interviews – forensic specialists alongside operational managers to ensure that we achieved that positive collaboration. Tailored interview questions – competency based, with additional forensic questions aimed at identifying appropriate character traits. Challenges re distinct roles – decision made to have the roles as equivalent to mainstream support roles but the differences are reinforced with the On Track diploma, as well as structural elements such as forensic supervision.
- Intensive collaboration: involving the joint commissioning team, who presented on the new team’s first day, Milton Keynes Council who trained us in RESPECT techniques (we would usually draw upon our own internal Team Teach resources, but MKC felt that RESPECT would be a more appropriate model in this delivery and so we adopted this approach to enable close collaborative working), MacIntyre specialists on topics such as autism, challenging behaviour, our Great Interactions communication approach and of course the forensic aspects, external experts for areas such as Lifestar outcomes and diabetes etc. Bespoke sessions: induction also featured these sessions involving the clinical teams that have been working with people, to supplement the team’s general knowledge but is also vital in developing support plans. All of the team spent some time getting to know the people being supported as part of the assessment process, involving travel to the person’s current placement and spending as much time as possible with them and shadowing current staff. Local knowledge – we’re fortunate in that we have an extensive infrastructure in Milton Keynes, with a wide variety of services and expertise available. We’ve been able to draw on that to bring that specialist knowledge as part of induction, both with some structured sessions and the opportunity to spend some time working in those services and developing experience and learning good practice.
- Wide range of partners – this slide just wraps up what is a common theme with our work together, in that it really is a shared approach, with lots of discussion and reaching consensus. In the recruitment and induction stages of the project, MKC committed to contributing to our induction presentations, which was a real treat for us, and probably fair to say, not that common in our experience of local authorities. MKC also brought their clinical teams and training resources into bat for us to support us in bringing a newly recruited team up to speed, and in terms of information sharing and support, this has been really important. Clinical teams in current settings – as mentioned earlier, this has been key part of the induction and training, but we’ve found that working with current providers has been absolutely indispensible. Criminal Justice Agencies: this will be a significant area of work, although because the services are still developing there has been limited interactions so far in this area. However, we have worked in conjunction with the Probation Service to develop a combined diploma in Community Justice and Social Care, which is fully accredited and unique in the UK. Housing providers: working alongside landlords to resolve any short term issues (general housing management issues etc) is something that will become more important as time progresses, it’s early days yet but this will be a big area for us.
- Paperwork needs to be completed, however the person doesn’t want to continually be answering the same questions, these two document are very similar so it is possible to use one or the other, if necessary the answers could be transferred from one document to the other. The transition work, started with discussions around the best way to conduct transition, how long should this be, and what things need to be in place to enable a smooth transition from hospital to home. It will vary from person to person, but it is important to get the timing right to reduce anxiety around the move. On Track staff attend CPA meetings, which enables us to meet the person we would be supporting and begin the process of transition. We are introduced to the person by someone who they already know, and as the MKC team all know each person well, they are able to do this in a warm and positive way. Getting Transition right is important when moving someone from a secure setting into supported living, many aspects, which people rely on to feel safe cannot be replicated. Therefore it is important to recognise the ones which can be transferred over to the new setting as this will help the person to be able to predict some aspects of their new environment. Close collaboration with current providers can help considerably with this. On Tracks methodology requires our staff to collaborate at all stages of transition and therefore arrangements have been made for our staff team to work alongside hospital staff to observe how best to support someone. By working together in this way the person will be able to start to get to know their new staff team, and begin to build up relationships whilst remaining in a situation that they are able to predict and feel safe with. This fits in to our On Track model that Tracy spoke about earlier of commissioning, therapy and social care working towards a shared aim. During transition all aspects of the persons life should be considered, not only where they will live, but what will they do during the day, what needs to be in place around health needs, and family. By thinking and talking to the person about all aspects of life will help develop trust, help the person to know they will be safe, and that they have some control over events. Transition is exciting and scary at the same time, if they can see the people they know and who know them well working in a positive way with their new staff team this will help them feel safe and have confidence around the next stage in their life.
- Families are anxious about people returning to the local area, the people we will be supporting have been away for extended periods of time, often they were unwell when they left, families are unsure if we will be able to provide support that will keep the person well. Milton Keynes Community team have been very supportive around meeting families, providing the links for our teams and working together to develop new relationships. This has been done by the community nurse/social worker arranging and supporting the first meeting. This again demonstrates how well the collaborative model works. It is important that all parties within the model have a clear and consistent approach, this needs to continue once transition ends and a service begins. This is achieved by regular meetings, these need to be weekly to begin with, and then reduced only when the service begins to settle down, there needs to be a system in place which enables quick access to specialist professionals, these regular meetings can involve all the professionals required at any given time, ranging from medical to housing. Frequency will change going down when things are going well and increasing at the first sign of any changes from the norm, by using this flexible model we aim to keep the person at home with increased support as far as possible, reducing the need for re-admission. The person and their family are involved at all stages and see that their choices and their opinions count throughout and close collaboration improves the success of this approach.