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A pragmatic mixed-methods review of changing “case-complexity” of referrals to an intensive support service
- Authors:
- CLIFFORD Adam, KEMP Francesca Georgina
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 14(4), 2020, pp.111-124.
- Publisher:
- Emerald
“Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in “case-complexity”, but had not tested this hypothesis against data. This study aims to investigate this question through a pragmatic mixed-methods approach as part of a wider service evaluation. Design/methodology/approach: Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) scores were used (n = 1,766) to estimate average “case-complexity” of referrals over an eight-year sample period. Two focus groups for IST staff (n = 18) explored why “case-complexity” appears to be increasing. Participant perspectives were subjected to thematic analysis. Findings: Average HoNOS-LD scores have steadily increased over the sample period, suggestive of increasing “case-complexity”. Focus groups identified three broad themes to potentially explain the increased complexity: effects of Transforming Care; people’s changing and unchanging support systems; and issues related to mild and borderline intellectual disability. Many perspectives are grounded in or supported by evidence. Research limitations/implications: Implications and limitations of findings are discussed, including areas for further consideration and research. The well-designed “short-cut” is promoted as a strategy for busy professionals in need of practice-based evidence but with limited research time and resources. Originality/value: The findings and discussion will be of value to anyone involved in the design, commissioning and delivery of mental health and challenging behaviour services to people with intellectual and developmental disabilities (IDD) under Transforming Care. Study methodology is easily replicable to build broader picture about “case-complexity” among UK’s IDD population. (Edited publisher abstract)
The impact of organizational supports on the person‐centered health of people with intellectual and developmental disabilities
- Authors:
- FRIEDMAN Carli, RIZZOLO Mary C., SPASSIANI Natasha A.
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 17(1), 2020, pp.70-78.
- Publisher:
- Wiley
People with intellectual and developmental disabilities (IDD) have significantly poorer health than the general population. A key threat to health programs for people with IDD is commitment from stakeholders, especially service organizations. The aim of this study was to explore the role disability service organizations play in promoting the best possible physical and mental health of people with IDD. To do so, this study analyzed secondary Personal Outcome Measures® data from 1,341 people with IDD in the United States using binary logistic regressions. The findings revealed that organizational supports can play a key role in promoting the health of people with IDD. By paying attention to all of these aspects of health and supports, especially discrepancies in supports, service organizations can work to counteract health disparities in those they support. (Edited publisher abstract)
Special educational needs and disability pathfinder programme evaluation: summary of interim impact findings: research report
- Authors:
- CRASTON Meera, et al
- Publisher:
- Great Britain. Department for Education
- Publication year:
- 2014
- Pagination:
- 8
- Place of publication:
- London
This summary presents the interim findings from the ongoing impact evaluation of the SEND pathfinder programme, through which pathfinder families and a matched group of comparator families are being asked to provide their views on the support they have received. The report reflects the views of 328 pathfinder families who completed their education, health and care (EHC) plans between August 2013 and January 2014, and 1,000 comparison families that experienced the pre-pathfinder systems. The results from the interim analysis provide a range of positive findings, highlighting improvement around a good number of the process variables which are central to the reforms, such as being child / family centred and generating increased satisfaction with the overall process. More specifically, the pathfinder families reported statistically significant improvement in relation to: their views being taken into consideration in assessment and reviews; their suggestions being listened to during the process; the decisions made about their child's support reflecting the family's views; the straightforwardness of the process to obtain support; the effectiveness of information-sharing among professionals involved in their child's assessment; having at least one key worker working with their family; the length of the assessment and planning process; and overall satisfaction with the assessment and planning processes. (Edited publisher abstract)
Evaluation of the Healthcare Commission audit of services for people with learning difficulties: quantitative survey report for the Healthcare Commission
- Author:
- OFFICE FOR PUBLIC MANAGEMENT
- Publisher:
- Office for Public Management
- Publication year:
- 2007
- Pagination:
- 20p.
- Place of publication:
- London
A survey was conducted of managers, clinicians, directors and chief executives who had received the Audit’s self-assessment questionnaire and those whose service had subsequently been visited by the one of the Healthcare Commission’s peer review teams. Two hundred and forty two responses were received. Findings showed that only half of respondents made actual changes as a result of the Audit. Those who received a visit as well as a questionnaire were more likely to have implemented changes than those that received a questionnaire alone. The changes implemented and planned were wide ranging including an increase in user involvement, improved staff training and the development of service user plans amongst many others.
Working on person-centred planning: from amber to green light?
- Authors:
- DOWLING Sandra, MANTHORPE Jill, COWLEY Sarah
- Journal article citation:
- Journal of Intellectual Disabilities, 11(1), March 2007, pp.65-82.
- Publisher:
- Sage
- Place of publication:
- London
This article reviews the practice and policy based literature on person-centred planning in learning disability services in England. Its aim is to identify the implications for the workforce in practice. The analysis found that implementation is often described as partial or slow and characterizes reasons for this at a number of levels, including the slow pace of change in service culture and power relations, immutable funding structures, services’ inflexible infrastructures, high levels of staff turnover and lack of training, inexperience among service management, inadequate staff supervision, and ambiguity among some stakeholders. Little substantial critique exists of the model itself. Analysis of the literature further reveals that the implementation of person-centred planning in practice is assisted by policy encouragement, service development and investment, favourable case reports and personal accounts, practitioner enthusiasm and positive evaluations. This article explores these to consider what facilitates the adoption of new elements of practice.
Stakeholders' views on measuring outcomes for people with learning disabilities
- Authors:
- YOUNG Anita F., CHESSON Rosemary A.
- Journal article citation:
- Health and Social Care in the Community, 14(1), January 2006, pp.17-25.
- Publisher:
- Wiley
This study aimed to discover views of managers and commissioners of services for people with learning disabilities in Scotland regarding (a) current approaches to service evaluation (as an indication of what is to be measured) and (b) healthcare outcome measurement. A postal questionnaire was used to survey 94 stakeholders from the NHS, Local Authorities, and non-statutory organisations across Scotland. Respondents' views were sought on current approaches to service evaluation within learning disabilities; outcome measurement; appropriateness of specified methods of measuring health outcomes; desired future methods of outcome measurement within learning disabilities; and service user involvement in care. A 77% (73/94) response rate to the questionnaire was achieved. Different methods of service evaluation were used by different stakeholders. Staff appraisal was the most frequently identified method (used by 85% of respondents). Specific outcome measures were used by 32% of respondents although there were differences of opinion as to what constitutes specific outcome measures. Overall there was strong support for goal-setting and reviewing (83%) and individualised outcome measures (75%) as appropriate methods for use with people with learning disabilities. The hypothetical question asking what outcome measures should be introduced for this client group had by far the lowest response rate (51/73). The overwhelming majority of all respondents, 68 (92%), reported user involvement in their service. Staff ambivalence to outcome measurement was evident in the research and respondents highlighted the complexity and multidimensional nature of outcomes for this service user group. Managers recognised that outcome measurement was expected but were uncertain how to go about it.
Transforming care: developing a community enhanced intervention service
- Authors:
- FUCHS Karin, RAVOUX Peggy
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 13(3/4), 2019, pp.133-143.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to present the service model and evaluation of Southwark Enhanced Intervention Service (EIS). EIS is an intensive community service for adults with intellectual disabilities whose behaviours challenge in the context of the Transforming Care agenda. Design/methodology/approach The service model is described and the following evaluation data over four years are presented: key performance indicators, descriptive data, clinical outcomes, financial outcomes and qualitative feedback on users’ experience. Findings: The EIS has demonstrated good outcomes for a small number of adults with complex needs by supporting them at crisis point locally and preventing hospital admission or a move to a restrictive environment out of area. EIS has also supported the successful transition back to area of a small number of adults with complex needs. The evaluation has shown improvements in behaviour, wellbeing and quality of life as well as demonstrating financial savings. Families’ and providers’ qualitative feedback indicates that the service has been highly valued and in particular the access to timely multidisciplinary coordination of input. Originality/value: The service was developed around the same time as the start of the Transforming Care agenda. It presents findings of a four-year evaluation at a time when there is limited evaluation of such service models focusing on the Transforming Care aims. The paper presents significant findings in support of guidance and recommendations published more recently as well as reflections on components of effective service delivery. (Edited publisher abstract)
Bespoke STOMP training for learning disability teams - Does it work?
- Authors:
- NANCARROW Thomas, et al
- Journal article citation:
- British Journal of Learning Disabilities, 47(3), 2019, pp.181-187.
- Publisher:
- Wiley
Background: Intellectual disability (ID) is associated with polypharmacy particularly off‐label psychotropics for “challenging behaviour.” NHS England introduced the “stopping over medication of people with a learning disability (LD), autism or both” (STOMP) initiative. As ID services are a professionally diverse group, it is important to know whether teams have suitable knowledge to deliver STOMP. The impact of delivering bespoke STOMP training was evaluated. Methods: A 21‐item multiple‐choice questionnaire was distributed to three specialist ID teams in the south‐west of England. Current best practice and national guidance knowledge on psychotropic medication use in ID were assessed. One team received bespoke training covering the content of the questionnaire prior to completion. Results: Survey participation was 44% (21/48) by the trained team, 34% (15/44) and 70% (7/10) in the untrained teams. The trained team participants scored over 80% on 19/21 questions compared to 15/21 and 16/21 in the untrained teams. Subspeciality analysis of pooled data (n = 43) showed nursing scored more than 80% on 16/21 questions, psychology 15/21 and allied health professionals (AHPs) 19/21. Nursing and psychology both reported STOMP to be a priority. Majority responded “yes” to potentially being involved in STOMP. Conclusions: Better STOMP knowledge and understanding of best practice and guidelines are associated with training. Nursing and psychology are essential to STOMP delivery but scored lower than AHPs. This study recommends semi‐structured STOMP training developed locally with national underpinnings for all specialist ID teams, particularly focussed on front‐line staff directly involved in the management of challenging behaviour. (Edited publisher abstract)
People with intellectual disabilities at the end of their lives: the case for specialist care?
- Authors:
- FORRESTER-JONES Rachel, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 30(6), 2017, pp.1138-1150.
- Publisher:
- Wiley
Background: People with intellectual disabilities have a shorter life expectancy, but healthcare improvements mean that they are beginning to live longer, with associated health difficulties. This means that there is an urgent need to focus research on ageing as well as end-of-life care. This study aimed to explore a specialist intellectual disability service for older people who are dying and how it related to their quality of life and to costs associated with care provided. Method: Data were collected for nine residents and 15 staff members of the specialist service. A single case study design with mixed methods including observations, interviews, standardised questionnaires and costs analysis was utilised. Results: The study found positive results regarding overall quality of life, although individuals had limited social networks. Placement fees paid by local health trusts and social services departments were slightly higher than the estimated cost of care reflecting good financial management by a small voluntary sector organisation. Conclusion: Whilst the philosophical arguments around “specialist” care persist, this service fills a gap in intellectual disability care provision. (Edited publisher abstract)
Local support for people with a learning disability
- Author:
- NATIONAL AUDIT OFFICE
- Publisher:
- National Audit Office
- Publication year:
- 2017
- Pagination:
- 54
- Place of publication:
- London
This report examines how the NHS in England and local authorities seek to improve the lives of the 129,000 people aged 18 to 64 who use local authority learning disability support services. It also assesses the setting up of the Transforming Care programme, which aims to move some of the 2,500 people with a learning disability and/or autism out of mental health hospitals, and progress of the programme. Key findings include: central and local government spend £8 billion each year supporting adults with a learning disability; the Department, NHS England and local authorities have limited measures to assess the quality and impact of health and social care support; from 2012 to 2015, the Department’s progress in moving people out of mental health hospitals and into the community was poor; early indications are that the Transforming Care programme is making progress in reducing the number of people in mental health hospitals; however, programme partners do not yet have confidence that partnerships can close the planned number of beds by 2019 and a number of complex challenges need to be resolved if the ambition of a substantial shift away from reliance on inpatient care is to be achieved. (Edited publisher abstract)