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LD Commissioning Workshop: Better and more cost effective support for people with complex needs and challenging behaviour
 

LD Commissioning Workshop: Better and more cost effective support for people with complex needs and challenging behaviour

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Bob Tindall, Managing Director, United Response: Better and more cost effective support for people with complex needs and challenging behaviour

Bob Tindall, Managing Director, United Response: Better and more cost effective support for people with complex needs and challenging behaviour

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    LD Commissioning Workshop: Better and more cost effective support for people with complex needs and challenging behaviour LD Commissioning Workshop: Better and more cost effective support for people with complex needs and challenging behaviour Presentation Transcript

    • Better and more cost effective support for people with complex needs and challenging behaviour 1 March 2012
    • United Response – as national charity that supports people with learning disabilities, mental health needs and physical disabilities to take control of their lives The Association for Supported Living – a not-for-profit organisation dedicated to the continuous improvement of supported living services for people with learning disabilities
      • “ We must not treat the events in the (Winterbourne View) programme as simply the result of bad people doing bad things. There have been too many events over the years to allow this interpretation ….. The kind of treatment seen on the programme reflects the broader social status of people with learning disabilities. This is not a status to which anyone would aspire. ”
      • Peter McGill, co-Director of the Tizard Centre,
      • University of Kent Tizard Learning Disability Review,
      • June 2011
    •  
    •  
      • Research & guidance
      • Examples and implications
      • Obstacles and ways forward
      • “ Severely challenging behaviour refers to behaviour of such 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 or delay access to and use of ordinary community facilities. ”
      • Emerson et al
      • Aggression
      • Self-injurious behaviour
      • Damage to property
      • Socially inappropriate behaviour
      • AND
      • Self-stimulatory behaviours
      • Stereotyped or ritualistic behaviours
      • Withdrawn behaviours
      • Refusal or avoidance
      • Service competence as well as individual characteristics
      • Preventing the development and worsening of challenging behaviour is a priority in order to avoid escalation and danger of behaviours becoming ingrained
      • Maintaining local links is also a priority
      • Service planning and delivery should be highly individualised
      • Effective services invest heavily in training and good first line and middle management
      • Hospitals and large group models of care provide poor quality of life
      • Small number of people can take up disproportionate amounts of time and money
      • Three types of approach from senior managers of local service agencies: Removing, Containing or Developing
      Mansell Report 2007 (and also 1993)
      • 34% of people placed out of area (inner London 63%)
      • Mainly people with challenging behaviour, autism, mental health needs, complex health needs
      • Mainly young
      • Main reason is lack of local services
      • Mainly large settings
      • Services poor at getting external support, engaging people at home and in community
      • Use of expensive, out of area services has a negative impact on local investment
      Emerson et al, “Commissioning Person Centred, Cost Effective, Local Support for People with Learning Disabilities” (SCIE Adult Service Review 20, 2008)
      • McGill & Poynter, Tizard Learning Disability Review,
      • April 2011 “Characteristics of the Most Expensive Residential Placements for Adults with Learning Disabilities”
      • Mean placement cost was £171,000 per annum
      • Range was £83,000 to £333,000
      • Hospitals had the highest costs
      • High costs associated with people who have challenging behaviour and specific syndromes
      • £0.9 million spent on five most expensive placements
    • ASL – “There is an Alternative
      • Positive examples of community-based support for people with complex needs and challenging behaviour
      • Much better lives
      • Services dating back to 2003
      • To show what we can learn from what is already in place
      • 38 examples in one week, reduced to 10
      • £814,000 saved across the 10 examples
      • Ordinary housing – one family placement
    • Key factors:
      • Person centred
      • Investment in skill
      • Leadership
    •  
      • Sustained effort
      • Local back-up
      • Will
      • Work to be widened out to explore commissioning practice
      • What are the obstacles to setting up a local, comprehensive service for people with challenging behaviour?
      • 2 answers, each on an individual Post It note