'Sustainable service developments for adults with complex needs within a community setting'. Our presentation looks at the Transforming Care Agenda and how support service providers can assist local authorities and practitioners in developing the right person centered support within a community environment.

1. Presentation titlePresented on 29 June 2017 at Health Plus Care
by Jocelyn Savage
Business Development Manager, Dimensions
Sustainable service developments
for adults with complex needs
within a community setting

2. 2
Who is Dimensions?
• National not-for-profit organisation
• Employs around 7,000 staff and supports around 3,500
people and their families across England and Wales
• Worked in the sector for over 40 years
• Supports people with learning disabilities and autism,
including those with challenging behaviour and complex
needs
• Supports people in their own homes or in shared
housing
• Promotes independence and support people in their
community, to live the life they choose

3. 3
What we’ll be discussing
• Service development for people who communicate their
needs through challenging behaviour
• People who have, at some point, been assessed to be
too high risk to live within the community
• People who are now part of the Transforming Care
agenda

4. 4
“Behaviour can be described as challenging when it is of such an
intensity, frequency or duration as to threaten the quality of life
and / or the physical safety of the individual or others and is
likely to lead to responses that are restrictive, aversive or result in
exclusion.”
NHS England: Service model for commissioners of health & social care services

5. Transforming
Care
Thinking differently and
trying new things

6. 6
The driver behind innovation and systemic change
A real alternative to hospitals / ATU’s
Different approaches
Mixed results
Learning into action
Transforming Care Agenda

7. 7
We need to minimise the
need for hospital/ATU
admissions
Transforming Care Agenda
The driver behind innovation and systemic change
A real alternative to hospitals / ATU’s
Different approaches
We need to try new ways
of developing and
delivering services
We need to think
differently and learn from
each other

8. 8
We tried providing
innovative alternatives to
ATUs
Transforming Care Agenda
Mixed results
Different approaches
We tried service
development against
austerity measures
We had national
knowledge and
experience to draw on
Learning into action

9. 9
“In general, transfer from institutional to community services (i.e. the provision of enriched
environmental, physical and social circumstances) has not reduced challenging behaviour or
mental health problems and given the functions served by some challenging behaviour, there are
good reasons to expect increases in some cases. It is not therefore simply a matter of switching the
service model and expecting the problem to disappear”
Mansell report – revised 2007
“We can make lives better, we can create better community support and
we can facilitate meaningful life. But in doing so we are exposing more
risks.”
Jocelyn Savage, 2017

10. Developing
sustainable
services
Silo or collaborative
approaches?

11. 11
Finding the right balance: what we’ve tried
• Developed and implemented specialist services over short and long
timeframes
• Increased Managers’ localities by adding more services and increased
Management capacity through recruitment
• Worked independently with minimal external input and worked in
collaboration with a full team of clinicians and stakeholders
• Used our qualified, experienced and dedicated in-house behaviour
support team and worked with those provided by community teams

12. 12
Finding the right balance: collaboration is crucial

13. 13
From all we have tried, what does the evidence
in our lived experience tell us are the most
important elements to developing safe and
sustainable support services in the community?

14. 14
T
R
I
E
D
ime
esource
nvolvment
xpertise
evelopment process

15. 15
If you provide the time to develop, resource to
sustain and involvement of stakeholders…
…we can provide the expertise and lead the
development process in delivering a high quality
service for people with challenging behaviour.

16. TRIED
Breaking it down into
practice

17. 17
We know…
AJ needs to move quickly
and the best option appears
to be a swift move
elsewhere.
Increased risk of service
breakdown.
Time pressures can cause
instability and poor decision
making.
! ! !
People are twice as likely
to have successful support
if a functional behaviour
assessment for behaviour
support has been used.
This is backed by research
from multiple papers and
recommended in May 2015
NICE guidelines.
We talk to as many people
as possible, read as much as
possible and go back as far
as possible to influence each
person’s service design.
This takes time

18. 18
We know…
Clinicians, other
professionals and family
members all have busy
schedules.
Austerity and
restructuring means
recruitment is necessary.
DOLs applications
must be made in far
in advance
Staff must be trained to
deliver a specialist
service.
A suitable home must
be secured.
And more...
This takes time

19. 19
We recommend
A minimum of a 6
month lead in time to
do it properly.
A full functional
behaviour assessment
A staged approach
Future proofing
properties
Referrals ‘list’ Transition age
planning

20. 20
We know…
We have to be realistic
about the true cost of
specialist services.
Investment in their infrastructure to ensure
stability can save long running costs.
Cost of under-resourcing is
significant and distressing for
everybody.
New services need a
dedicated Manager to
bring together a new
team, embed practice and
manage logistics.
Services that include
behaviour support need
investment but costs can
be reduced over time.
We have a golden window
of opportunity to establish a
culture of sustainability and
consistent team training.
“Services which have high aspirations need good management if their goals are
to be realised in practice.” – Mansell Report
This needs resourcing

21. 21
We recommend
Full time dedicated
Managers
A maximum of 3
complex need
services
Assistant Managers
Contingency funds Enhanced PPE

22. 22
We know…
“Care and support should be delivered with the aim of
improving the persons quality of life. In order for it to be
successful, it will require multi-disciplinary and multi agency
working, as well as skilled informed responses from specialist
health and social care services, in partnership with the person
and those who provide day-to-day support.”
NHS England: Service model for commissioners of health & social care services
This needs involvement

23. 23
We recommend
The person The persons loved
ones
MDT: SaLT, OT,
Psy, Social
Worker
Discharge /
planning meetings
Ongoing clinical meetings in the
first year

24. 24
We know…
Our operational managers
and front line staff are crucial
for good support.
As an organisation we must offer what they
need to perform their roles effectively.
Our 14 Behaviour Analysts and 35
BILD accredited PROACT SCIPr-UK
trainers train and support our teams.
Train staff in functional
behaviour assessments, sharing
the person’s history, triggers and
warning signs and proactive and
reactive strategies.
These need developing into
the person’s support plan
and day-to-day work.
Physical interventions are
a last resort, strategies to
avoid raising anxiety and
distress and how to bring
an incident to a safe and
early close.
Having time to deliver this training prior to the person moving in is essential in giving the team the tools they
need to manage through a valuable period of time.
This needs expertise

25. 25
We recommend
5 + days of service
specific training prior
to a person’s move in
Including all relevant
courses
Role playing
scenarios
Behaviour support
input
Appropriately resourced –
return funding if not
Service Level Agreement
between Dimensions and

26. 26
We know…
Each person’s new service
development is a project,
with a project manager.
Communication,
co-ordination, driving deadlines, flex
and react to variables.
Best placed within the development team,
don’t distract operations from their duty of
care to people they support.
PRINCE 2 project
management approach
has worked well.
Clearly defined roles and
responsibilities, discussed
at regular meetings and
defined against best
practice guidelines.
Workbook outlines every
task imaginable, ordered
to the right times and
contingency plans for
missed milestones.
The project team remains for the first year of a new support service to review the operational performance and
ensure we are delivering to contract requirements.
This is the development process

27. 27
We recommend
Dedicated Project Management Roles and responsibilities
5 stages
1. Assessment
2. Design & Negotiation
3. Development (pre transition)
4. Implementation (team / property in place)
5. Performance review
Decision Makers / Clear
decision points
Regular project meetings
– focused on development
workbook

28. 28
Successful criteria for service sustainability
S
U
S
T
A
upport model
nique
afe/services nearby
raining
ccomodation fit for purpose
I
N
nclusive community/activities
etworking with other agencies/orgs

29. 29
Final thought:
“Developers’ seek to provide local services which really
do address individual needs, and therefore give higher
priority to funding services which, with more staff and
more training and management input, are more expensive
than ordinary community services”.
Mansell report – revised 2007

30. 30
Thank you
Jocelyn.Savage@dimensions-uk.org
www.dimensions-uk.org
@DimensionsUK
0300 303 9001