Journal of Intellectual Disabilities, 25(3), 2021, pp.357-369.
Publisher:
Sage
Place of publication:
London
This study evaluates the implementation of Safewards on an assessment and treatment unit (ATU) for people with an intellectual disability. There are no previous studies evaluating this model in this context and previous research has focused largely on acute mental health services. The ‘Patient–Staff Conflict Shift Report’ was used at baseline for 1 month and 1 year later, after all the interventions had been implemented, to evaluate the impact of Safewards. Significant reductions were found in conflict and containment measures used within the service after the implementation of Safewards. Staff who led on the interventions were also asked to give feedback on their experiences, the challenges they faced and how they would like to move forward. Safewards was generally seen as a positive approach by the team. Limitations of this study are highlighted and suggestions for future research are made.
(Edited publisher abstract)
This study evaluates the implementation of Safewards on an assessment and treatment unit (ATU) for people with an intellectual disability. There are no previous studies evaluating this model in this context and previous research has focused largely on acute mental health services. The ‘Patient–Staff Conflict Shift Report’ was used at baseline for 1 month and 1 year later, after all the interventions had been implemented, to evaluate the impact of Safewards. Significant reductions were found in conflict and containment measures used within the service after the implementation of Safewards. Staff who led on the interventions were also asked to give feedback on their experiences, the challenges they faced and how they would like to move forward. Safewards was generally seen as a positive approach by the team. Limitations of this study are highlighted and suggestions for future research are made.
(Edited publisher abstract)
Subject terms:
evaluation, intervention, learning disabilities, therapy and treatment, mental health services;
Advances in Mental Health and Intellectual Disabilities, 6(4), 2012, pp.192-198.
Publisher:
Emerald
This paper explores the similarities between recovery principles and existing approaches in services for people with intellectual disabilities, and reflects on the potential barriers to the explicit uptake of the “recovery” approach in this context. The authors examine existing practices that could be described as recovery oriented, along with reflections on how these relate to the recovery approach. Questions are raised regarding whether practices can be regarded as “recovery oriented”, without first consulting service users. Given the increasing emphasis on recovery approaches within mainstream services, it seems vital to give consideration to the potential for its meaningful application to people with intellectual disabilities and mental health problems.
This paper explores the similarities between recovery principles and existing approaches in services for people with intellectual disabilities, and reflects on the potential barriers to the explicit uptake of the “recovery” approach in this context. The authors examine existing practices that could be described as recovery oriented, along with reflections on how these relate to the recovery approach. Questions are raised regarding whether practices can be regarded as “recovery oriented”, without first consulting service users. Given the increasing emphasis on recovery approaches within mainstream services, it seems vital to give consideration to the potential for its meaningful application to people with intellectual disabilities and mental health problems.
Subject terms:
learning disabilities, mental health services, person-centred planning, recovery approach, evaluation;
Learning Disability Today, 10(5), June 2010, pp.20-21.
Publisher:
Pavilion
Place of publication:
Hove
The author reports that, for many project leads who are working on implementing local “Green Light” action plans to improve mental health support for people with learning disabilities, change is proving difficult and slow to achieve. Green Light is a service improvement toolkit centred on the National Service Framework (NSF) for mental health. It includes a self-assessment checklist to evaluate how well local areas are applying the NSF to meet the specific needs of people with learning disabilities who experience mental health problems. Green Light is designed to help local areas plan action to ensure that people with learning disabilities benefit from improvements in the same way as everyone else. To encourage and support the implementation of Green Light the Care Services Improvement Partnership funded a national programme: Green Light: Making It Happen. The author discusses the themes around the struggle to implement action plans that emerged: a lack of local data; capacity issues and competing priorities; the need to change practices; engagement issues; the challenge of change; and a lack of agreements and pathways. She goes on to consider what helps and list things that appear to have made a real difference in local areas. The New Horizons short briefings series beginning in the Spring of 2010 to inform and update local decision makers is welcomed but the author believes there is still a need for a new Green Light support programme.
The author reports that, for many project leads who are working on implementing local “Green Light” action plans to improve mental health support for people with learning disabilities, change is proving difficult and slow to achieve. Green Light is a service improvement toolkit centred on the National Service Framework (NSF) for mental health. It includes a self-assessment checklist to evaluate how well local areas are applying the NSF to meet the specific needs of people with learning disabilities who experience mental health problems. Green Light is designed to help local areas plan action to ensure that people with learning disabilities benefit from improvements in the same way as everyone else. To encourage and support the implementation of Green Light the Care Services Improvement Partnership funded a national programme: Green Light: Making It Happen. The author discusses the themes around the struggle to implement action plans that emerged: a lack of local data; capacity issues and competing priorities; the need to change practices; engagement issues; the challenge of change; and a lack of agreements and pathways. She goes on to consider what helps and list things that appear to have made a real difference in local areas. The New Horizons short briefings series beginning in the Spring of 2010 to inform and update local decision makers is welcomed but the author believes there is still a need for a new Green Light support programme.
Extended abstract:
Author
COLE Angela, GREGORY Margaret.
Title
Green Light for mental health: a service improvement toolkit.
Publisher
Foundation for People with Learning Disabilities, 2004
Summary
Green Light is a framework and self audit toolkit for improving mental health support services for people with learning disabilities, providing a picture of what services should be aiming to achieve, including quality outcomes, and a self assessment checklist, and aimed at Mental Health Local Implementation Teams and Learning Disability Partnership Boards.
Contents
Part A is a guide to the pack itself and to improving services and support for people with mental health problems who have learning disabilities. Section One introduces Green Light, telling users about the pack and what it's for and giving some ideas about getting the most benefit from the toolkit. Section Two is an easy to read summary designed primarily for use with and by people with learning disabilities. Section Three has two parts which, when added together, give an overall picture of what services should be aiming to achieve. The first gives the national policy context and highlights what the government expects of services in relation to people with mental health problems who have learning disabilities. The second is about quality outcomes for people with mental health problems who have learning disabilities and for their carers, from their own perspectives. Section Four creates a concrete picture of what needs to happen ‘out there' in the reality of services. It highlights key challenges for services in moving towards integrated mental health services for people with learning disabilities; explores what the national policy objectives actually look like in practice, i.e., accessible, integrated mental health support services, using examples from around the UK wherever possible. Section Five is about how to work out what needs to be sustained or changed locally. It introduces the self-assessment checklist and some ready-to-use survey tools which are found in Part B. The self-assessment checklist is at the core of the service improvement toolkit. There is guidance about getting information and evidence to underpin your local self-assessment, and about presenting findings to the Local Implementation Teams and Partnership Board. Part B – the toolkit – has four sections. Section One contains the self-assessment checklist and an action planning proforma. Section Two is a survey of in-patient experience Section Three is a survey of community support experiences. Section Four is a survey of carers' experiences. Throughout the guide there are quotations from the test sites and from people with mental health problems who have learning disabilities, which reinforce points in the text, and references to publications, resources and sources of information. These are listed at the end.
23 references
Subject terms:
learning disabilities, mental health problems, mental health services, social care provision, evaluation;
Advances in Mental Health and Learning Disabilities, 3(2), June 2009, pp.3-7.
Publisher:
Emerald
Green Light was developed to enable service providers to implement the National Service Framework for Mental Health (NSF MH), and asks how good your mental health services are for people with a learning disability. A multi-agency user and carer project in Hampshire has evaluated and improved the quality of existing service provision for adults with learning disabilities who also have a mental health problem.
Green Light was developed to enable service providers to implement the National Service Framework for Mental Health (NSF MH), and asks how good your mental health services are for people with a learning disability. A multi-agency user and carer project in Hampshire has evaluated and improved the quality of existing service provision for adults with learning disabilities who also have a mental health problem.
Subject terms:
learning disabilities, mental health problems, mental health services, quality assurance, evaluation;
Journal of Intellectual Disabilities, 10(2), June 2006, pp.191-210.
Publisher:
Sage
Place of publication:
London
This article describes and discusses 27 interviews that explored perceptions of the effectiveness of advocacy services for people with learning disabilities in the UK. The views of stakeholders on the current position of advocacy services, how services are evaluated and recommendations for change are central themes in the analysis of the interviews. The discussion suggests that although evaluation of effectiveness is increasingly important in the light of policy change and funding constraints, it is not universally in place and available tools are considered to be inadequate for the task. The explanation of this may lie in the continuing debates over the meaning and purpose of evaluation and fears that it is one-dimensional. Future investment and commitment to advocacy schemes will need to address these issues.
This article describes and discusses 27 interviews that explored perceptions of the effectiveness of advocacy services for people with learning disabilities in the UK. The views of stakeholders on the current position of advocacy services, how services are evaluated and recommendations for change are central themes in the analysis of the interviews. The discussion suggests that although evaluation of effectiveness is increasingly important in the light of policy change and funding constraints, it is not universally in place and available tools are considered to be inadequate for the task. The explanation of this may lie in the continuing debates over the meaning and purpose of evaluation and fears that it is one-dimensional. Future investment and commitment to advocacy schemes will need to address these issues.
Subject terms:
learning disabilities, mental health services, service uptake, advocacy, evaluation;
A research into lived experience of Assessment and Treatment Units (ATUs) and other in-patients units for adults and children with learning disabilities and/or autism with ‘challenging behaviour’. Commissioned by South East London Transforming Care Partnership, the research involved a total of 11 people with lived experience, including three adults with autism and/or learning disabilities and eight family members. The study finds that with few exceptions, ATUs are not fit for purpose and actively harm those they are intended to treat. Only one children’s ward and one of eight ATU, PICU or in-patient services were described by witnesses as fully competent at assessment, treatment and resettlement of children and adults with learning disabilities and/or autism. The rest were mixed (in one case) or experienced as fundamentally incompetent and routinely breached the human and civil rights of patients with learning disabilities and/or autism (six cases). Whilst ATUs spend inordinate amounts of time seeking to diagnose or exclude specific mental illness, their primary modus operandi (detention, segregation, seclusion, restraint) deprive patients of the psychosocial aspects of existence (sleeping well, eating well, meaningful activity, exercising, time with friends and family) that are known to keep children and adults healthy and mentally well. While acknowledging that only a full closure programme will ‘fix’ the ATU system problem and stop the human rights abuses which are endemic to it, the authors make a series of recommendations to help improve human rights in ATUs in the interim.
(Edited publisher abstract)
A research into lived experience of Assessment and Treatment Units (ATUs) and other in-patients units for adults and children with learning disabilities and/or autism with ‘challenging behaviour’. Commissioned by South East London Transforming Care Partnership, the research involved a total of 11 people with lived experience, including three adults with autism and/or learning disabilities and eight family members. The study finds that with few exceptions, ATUs are not fit for purpose and actively harm those they are intended to treat. Only one children’s ward and one of eight ATU, PICU or in-patient services were described by witnesses as fully competent at assessment, treatment and resettlement of children and adults with learning disabilities and/or autism. The rest were mixed (in one case) or experienced as fundamentally incompetent and routinely breached the human and civil rights of patients with learning disabilities and/or autism (six cases). Whilst ATUs spend inordinate amounts of time seeking to diagnose or exclude specific mental illness, their primary modus operandi (detention, segregation, seclusion, restraint) deprive patients of the psychosocial aspects of existence (sleeping well, eating well, meaningful activity, exercising, time with friends and family) that are known to keep children and adults healthy and mentally well. While acknowledging that only a full closure programme will ‘fix’ the ATU system problem and stop the human rights abuses which are endemic to it, the authors make a series of recommendations to help improve human rights in ATUs in the interim.
(Edited publisher abstract)
Subject terms:
human rights, learning disabilities, autism, challenging behaviour, mental health services, evaluation, quality assurance;
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)
“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)
Subject terms:
learning disabilities services, evaluation, complex needs, mental health services, learning disabilities, challenging behaviour, service development;
Purpose – The purpose of this paper is to present results from an evaluation of the experience of a move to independent living for people with mental health needs or a learning disability. The discussion focuses on the shift in organisational culture from providing care within a hostel setting to supporting people in their own tenancies.
Design/methodology/approach – The evaluation was underpinned by a participatory action research design. A total of ten co-researchers with experience of using services or as carers were recruited. Qualitative data was obtained from “before” and “after” interviews with residents, staff and relatives.
Findings – Widespread satisfaction was expressed with people's new homes. Many residents were found to be increasingly independent. There was some evidence of concerns regarding the pace and process of change and the introduction of new practices to promote independence.
Research limitations/implications – The timing of the evaluation limited the opportunity for comprehensive “before” and “after” data collection. The involvement of co-researchers required considerable time and support although the experience of those involved was positive.
Practical implications – Learning from this evaluation emphasises the importance of support and preparation for staff as well as residents, in moving from hostel to independent living.
Social implications – This study highlights the advantages of a participatory design in evaluating a major change in service delivery.
Originality/value – This paper raises important issues about organisational change. It contributes to wider debates regarding the implementation of personalisation and recovery-focused agendas.
(Publisher abstract)
Purpose – The purpose of this paper is to present results from an evaluation of the experience of a move to independent living for people with mental health needs or a learning disability. The discussion focuses on the shift in organisational culture from providing care within a hostel setting to supporting people in their own tenancies.
Design/methodology/approach – The evaluation was underpinned by a participatory action research design. A total of ten co-researchers with experience of using services or as carers were recruited. Qualitative data was obtained from “before” and “after” interviews with residents, staff and relatives.
Findings – Widespread satisfaction was expressed with people's new homes. Many residents were found to be increasingly independent. There was some evidence of concerns regarding the pace and process of change and the introduction of new practices to promote independence.
Research limitations/implications – The timing of the evaluation limited the opportunity for comprehensive “before” and “after” data collection. The involvement of co-researchers required considerable time and support although the experience of those involved was positive.
Practical implications – Learning from this evaluation emphasises the importance of support and preparation for staff as well as residents, in moving from hostel to independent living.
Social implications – This study highlights the advantages of a participatory design in evaluating a major change in service delivery.
Originality/value – This paper raises important issues about organisational change. It contributes to wider debates regarding the implementation of personalisation and recovery-focused agendas.
(Publisher abstract)
Subject terms:
independent living, mental health problems, learning disabilities, housing, hostels, evaluation, mental health services;
International Journal of Geriatric Psychiatry, 9(4), 1994, pp.259-272.
Publisher:
Wiley
Aims to clarify some of the concepts and terminology of health system evaluation; to draw on published literature to exemplify these concepts; and to discuss some of the implications of routinely evaluating a system rather than scientifically evaluating particular interventions or programmes. Concludes by arguing that the evaluation of psychiatric services for elderly persons is best achieved by the construction of relatively simple models from an array of complex knowledge.
Aims to clarify some of the concepts and terminology of health system evaluation; to draw on published literature to exemplify these concepts; and to discuss some of the implications of routinely evaluating a system rather than scientifically evaluating particular interventions or programmes. Concludes by arguing that the evaluation of psychiatric services for elderly persons is best achieved by the construction of relatively simple models from an array of complex knowledge.
Subject terms:
intervention, learning disabilities, mental health problems, mental health services, older people, performance evaluation, evaluation;
British Journal of Learning Disabilities, 46(4), 2018, pp.278-283.
Publisher:
Wiley
Background: Research suggests that the use of team formulation within mental health services may improve staff understanding of service users’ difficulties and increase team empathy and reflection. The aim of this evaluation was to investigate staff perceptions of team formulation within an assessment and treatment unit for individuals with learning disabilities. Specifically, the authors aimed to investigate whether staff found team formulation helpful and whether staff felt it impacted their work with service users. Materials and Methods: A survey was completed using a cross‐sectional questionnaire design. Twenty‐eight staff members working on the assessment and treatment unit were asked to complete an anonymous questionnaire about team formulation meetings. Results: The response rate was 54%. The majority of staff agreed that they found formulation meetings to be helpful (80%) and that formulation meetings positively impacted how they work with service users (86%). The most common theme arising from staff responses concerning the most helpful aspects of formulation meetings was “gaining a greater understanding of service users.” Conclusions: The findings from this evaluation show that the majority of respondents felt team formulation was helpful and had a positive impact on their work with service users. These findings support the use of team formulation within mental health and learning disabilities services. Future research could investigate the impact of team formulation on service user well‐being and outcomes.
(Publisher abstract)
Background: Research suggests that the use of team formulation within mental health services may improve staff understanding of service users’ difficulties and increase team empathy and reflection. The aim of this evaluation was to investigate staff perceptions of team formulation within an assessment and treatment unit for individuals with learning disabilities. Specifically, the authors aimed to investigate whether staff found team formulation helpful and whether staff felt it impacted their work with service users. Materials and Methods: A survey was completed using a cross‐sectional questionnaire design. Twenty‐eight staff members working on the assessment and treatment unit were asked to complete an anonymous questionnaire about team formulation meetings. Results: The response rate was 54%. The majority of staff agreed that they found formulation meetings to be helpful (80%) and that formulation meetings positively impacted how they work with service users (86%). The most common theme arising from staff responses concerning the most helpful aspects of formulation meetings was “gaining a greater understanding of service users.” Conclusions: The findings from this evaluation show that the majority of respondents felt team formulation was helpful and had a positive impact on their work with service users. These findings support the use of team formulation within mental health and learning disabilities services. Future research could investigate the impact of team formulation on service user well‐being and outcomes.
(Publisher abstract)
Subject terms:
assessment, teamwork, treatment, learning disabilities, service provision, outcomes, mental health services, staff, evaluation;