Discussion around deadline of 1st June 2014 – also what is an inappropriate placement?
Anecdotal case study about how someone can come out of a secure setting with more behaviours than they went in with.
The reality is that a lot of these people are removed from their direct communities and relocated out of area, to places that are perceived to be more equipped to deal with their behaviour.
What do people understand by the term PBS?
Individual flats with some shared communal areas, or even shared homes that can be split into two separate living areas.We don’t know statistics, but in our experience, the majority of people tend to be sectioned because of behavioural issues rather than forensic issues.
Winterbourne PBS Amanda & Alison
WINTERBOURNE There Must beAnother Way…….But What Is It ? Network Name Lancaster & Preston Community LD Teams
Who We Are We 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. Network Name Lancaster & Preston Community LD Teams
Aims of the WorkshopTo raise awareness of Positive BehaviouralSupports.To work collaboratively in a multi-professionalforum in order to develop strategies to minimisethe risk of abuse of vulnerable adults.To generate action plans to put into practice withinthe workplace. Network Name Lancaster & Preston Community LD Teams
Exercise When you hear the words “Winterbourne View” what does it mean to you?Network Name Lancaster & Preston Community LD Teams
These are some of the thoughts my colleagues and I felt…..• Safeguarding • Torture• Restraint • Guidance• Abuse • Lack of• Lack of care supervision• Sadness • Anger• Despair • Threat• EvilNetwork Name Lancaster & Preston Community LD Teams
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. Network Name Lancaster & Preston Community LD Teams
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 neededassessing and moved him out of area.Assessment was supposed to take 6 months, but Simon wasaway for 3 years.He ended up at Winterbourne View. Network Name Lancaster & Preston Community LD Teams
Winterbourne One Year OnSince the inquiry, Simon has moved back to the care home near his family that he did not want to leave in the first place. 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.”Network Name Lancaster & Preston Community LD Teams
What led us to Winterbourneand the Mental Health Act asan answer?Working with people who challenge services when distressedmay cause risk of serious harm, not only to the personthemselves, but members of the public and staff teamssupporting them. Physical intervention, restrictive practices andthe use of the Mental Health Act have historically been used toreduce the risk of harm, sometimes disproportionately.When developing care plans for these people, we have toconsider risk, duty of care and proportionate responses. Network Name Lancaster & Preston Community LD Teams
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. Network Name Lancaster CommunityCommunity LD Teams & Preston LD Team
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? Network Name Lancaster & Preston Community LD Teams
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 Network Name Lancaster & Preston Community LD Teams
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) Network Name Lancaster CommunityCommunity LD Teams Lancaster & PrestonLD Team
Staff responses to behavioursthat challenge services.As reported at previous sessions of PBS formanagers 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? Network Name Lancaster CommunityCommunity LD Teams Lancaster & PrestonLD Team
This “Person” could save your life Please Don’t DiscriminateNetwork Name Lancaster CommunityCommunity LD Teams Lancaster & PrestonLD Team
GROUP EXERCISE To reduce the potential for Challenging Behaviour what needs to be in the care plan?Network Name Lancaster & Preston Community LD Teams
Gold Standard Care PlanIs this the WAY????Or have we forgottensomething??? Network Name Lancaster CommunityCommunity LD Teams Lancaster & PrestonLD Team
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 Network Name Lancaster & Preston Community LD Teams
What is involved in a PBS Plan?• Functional Assessment (including Support Plan)• Sensory Assessment• Medication• Primary and Secondary Prevention Strategies• Reinforcement Inventory• Motivational Assessment Network Name Lancaster & Preston Community LD Teams
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 Network Name Lancaster & Preston Community LD Teams
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. Network Name Lancaster & Preston Community LD Teams
Any questions?Network Name Lancaster CommunityCommunity LD Teams Lancaster & PrestonLD Team