This document provides an update on actions from the Winterbourne View Joint Improvement Programme Board. It discusses that there are currently around 3,500 people in hospital placements for learning disabilities or autism, with 1,200 in assessment and treatment units, and over 400 having no identified commissioner. It outlines plans for commissioners to review all inpatient cases by June 2013 and develop personalized community support plans, with the goal of all individuals receiving community support by June 2014. The document also discusses the development of a framework for these reviews and future guidance.

1. Time for Action…
• Dave Williams
– Clinical Nurse Specialist Salford LD Team
– Winterbourne View Joint Programme Board
member
– Core Member of CB-NSG

2. Presentation Overview
• Update from Winterbourne View Joint
Improvement Programme Board
• Information about CB-NSG
• Actions

3. Winterbourne
“This isn't just about wicked staff, or weak
management, but it is about the wrong model
of care - people with challenging behaviour
being shunted off for 'assessment and
treatment' as a substitute for working away to
set up the kind of services that would support
them well in the long term”
Jim Mansell May 2011

4. Winterbourne View Joint
Improvement Programme Board
• There are approx 3500 people placed in
hospital placements of which 1200 are seen as
“assessment and treatment units”
• Over 400 people have no identified LA or NHS
commissioner

5. Timetable
• June 2013
– Health and care commissioners, working with service
providers, people who use services and families, will
review the care of all people in learning disability or autism
inpatient beds and agree a personal care plan for each
individual based around their and their families’ needs and
agreed outcomes.
– Then
Health and care commissioners should put plans into
action as soon as possible and all individuals should be
receiving personalised care and support in appropriate
community settings no later than 1 June 2014.

6. Winterbourne View Joint
Improvement Programme Board
• Framework for individual care reviews of people
with challenging behaviour currently in hospital
placements
 Will set out framework for current hospital placements
 Future documents will be published about joint plans
to assist with people returning to their local area
Also NCB will be publishing service specification
guidance in April 2013

7. Question
What would it be like if we got it right?
Individuals and their families would have
the right support, at the right time and in
the right place.

8. Rights and Values
1. People will be supported
to exercise their human
rights (which are the
same as everyone else’s)
to be healthy, full and
valued members of their
community with respect
for their culture, ethnic
origin, religion, age, gend
er and disability.

9. Rights and Values
2. All children who are at
risk of presenting
behavioural challenges
have the right to have
their needs identified at
an early stage, leading
to co-ordinated early
intervention and
support.

10. Rights and Values
3. All families have
the right to be
supported to
maintain the
physical and
emotional
wellbeing of the
family unit.

11. Rights and Values
4. All individuals have the right to
receive person centred support
and services that are developed
on the basis of a detailed
understanding of their support
needs including their
communication needs. This will
be individually-
tailored, flexible, responsive to
changes in individual
circumstances and delivered in
the most appropriate local
situation.

12. Rights and Values
5. People have the right
to the highest
attainable standard of
health and
appropriate support
to enable this.

13. Rights and Values
6. People have the
same rights as
everyone else to a
family and social
life, relationships, h
ousing, education,
employment and
leisure.

14. Rights and Values
7. People have the right to supports
and services that create capable
environments for individuals
which are developed on the
principles of positive behavioural
support and other evidence based
approach and which draw from
additional specialist input as
needed. This will respond to all
the needs of the individual.

15. Rights and Values
8. People have the
right not to be hurt
or damaged or
humiliated in any
way by
interventions.
Support and services
must strive to
achieve this.

16. Rights and Values
9. People have the
right to receive
support and care
based on good
and up to date
evidence.

17. Actions from the charter
• Local authorities and the NHS will know how
many children and adults live in their area and
how many they have placed out of area. On
the basis of information from person-centred
plans all agencies will plan and deliver local
support and services.

18. Actions from the charter
• Services will seek to reduce the use of physical
intervention, seclusion, chemical and
mechanical restraint with the clear aim of
eliminating them for each individual.

19. Restrictive Practice Audit
Name
Mechanical Restraints Restrictive Prn meds Covert Locked Support Date last
including Physical meds doors Plans Reviewed
adaptations/additions to intervention /areas Guidelines
wheelchairs

20. Mindfulness-based approaches
with
family and paid carers
Dene Donalds

21. Presentation Overview
• What is mindfulness?
• Why is mindfulness relevant to family and
paid carers working and living with people
with challenging behaviour?
• Some outcomes from evaluations of
mindfulness-based intervention with family
and paid carers

22. What is Mindfulness?
Mindfulness is the practice of focussing attention in a
non-judgemental, non-reactive way on the present
moment and what is happening in an individual’s
mind, body and the world around them.
Mindfulness forms the basis of mindfulness-based stress
reduction and mindfulness-based cognitive therapy
programmes and there is growing evidence of the
benefits of mindfulness for managing a range of
difficulties including stress, anxiety, depression, pain and
disordered eating.
Chapman 2012

23. Mindfulness and “therapy”
• Mindfulness offers an alternative or an adjunct
to current therapies
• Instead of challenging an individual’s irrational
or negative thinking, mindfulness-based
approaches focus on the individual’s
relationship to thinking itself
• Transformative - changes the way we relate to
thoughts, feelings, emotions, and actions;
changes the way we engage with situations we find
ourselves in.

24. Relevance to challenging behaviour
Positive associations of mindfulness with reduced parental and
care staff distress [Lloyd & Hastings, 2008; MacDonald et al., 2010;
Noone &Hastings, 2011]
Negative associations of avoidant coping with stress for parents
and care staff [Hastings et al., 2005; Devereux et al., 2009]
Literature Search and Analysis of Mindfulness Based Approaches
with people with learning disabilities families and paid
carers[Chapman & Mitchell 2012]
Models suggest emotional reaction to challenging behaviour
effects family and paid carer responses

25. Models

27. Conclusions from research and
presentation
• Challenging behaviour is emotionally
demanding
• Mindfulness based approaches with families
and staff reduce stress support values and
reduce the use of physical intervention
• Focus is on the family member and staff
• Potential to enhance existing positive
approaches to Challenging Behaviour

28. Contact
• Email: dene.donalds@pathways.co.uk
• Mobile:07816 073334