Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
CYPS PBS Pathway and development
of the CYPS Intensive Positive
Behaviour Support Team
Dr Nicola Dodds – Principal Clinical Psychologist
Dionne Hollis – IPBS Pathway Manager
Dr Gill Legg – Consultant Clinical Psychologist
The need for Positive Behavioural
Support (PBS)
• Children with learning disabilities can be at risk of developing behavioural difficulties that can be a challenge.
• Risk factors include impaired communication, impact of cognitive deficits, and potentially additional sensory, physical and mobility needs (Emerson 2011)
• Approximately 40,000 children with learning disabilities may present with behaviour that can challenge services and others (Challenging Behaviour Foundation 2014)
• Positive Behavioural Support is an evidence based approach which provides a multi-element framework to assessing, behaviour and working with stakeholders to write an intervention plan.
• Identifies the need to address carers and parents optimism as a key factor alongside interventions (Durand 2011)
PBS: as a multi-element framework
• Based on VALUES – prevention of challenging behaviour occurs in context of increased quality of life. Uses approaches to build skills and reduce restrictive responses to behaviour
• Based on THEORY and EVIDENCE BASE– an understanding that challenging behaviour serves important functions and gets needs met
• Uses applied behaviour analysis to assess and support behavioural change
• Has a clear PROCESS including data driven approach, functional assessment, and multi – component interventions to change behaviour pro-actively and respond to behaviours reactively
• Support , monitoring and evaluation of interventions over long termGore et al (2013)
Positive Behavioural Support is…
• Non-judgemental (working together as equals)• Everyone working together using a shared plan• Child is at the centre of this plan• Everyone feeling more confident, optimistic and skilled in
supporting the child• Child learning new coping strategies and new skills• Creating more opportunities to make life better e.g going out and
doing more things together• Based on what is important to a child and their family as well as
what is perceived to be important for the person.• Works with the families goals, and what is realistic within the
context of the family life and value base
Strategy for implementing PBS in CYPS
Workforce development functional assessment and
interventions
Pathways and structures that support
clinical process
A data driven approachQuality of data,
Behaviour Support Plans and Implementation
standards
The initial PBS pathway – identifying needs
Limited complexity
Parent focused
Initial plan
6 sessions
multiple functions /
Behaviour Support Plan
12+ sessions + specialist assessment
Brief ----Full FA
Functional Analysis
Initial assessment
Further assessment
Further assessment + intensive support*
Inpatient Intensive assessment
Community Inpatient
Successes and Challenges
• At time of development - not enough staff with a PBS qualification to complete further complex assessment in community
• 4 staff completed PBS Advanced Professional Diploma (8 ongoing)
• 5 staff completed PBS Professional certificate
• 2 BCBA’s
• Needed to develop a standard initial brief assessment
• Developed initial assessment pack which is used in all areas now and MSc project showed promising results
• In house training has continued to be offered in delivering initial assessments and training has been delivered to Cumbria teams also
• Needed intensive support team
• New IPBS team formed through NEW CARE MODELS
What are “New Care Models”?
• Part of NHS England’s ‘Five Year Forward View for Mental Health’
• National pilot
• Opportunity for secondary mental health providers to take
responsibility for tertiary commissioning budgets and
demonstrate ability to innovate and transform services in the best
interests of service users and their families
NTW is delivering “Transforming
Care” through New Care Models
New Care Models fundamentals are to:
• Reduce reliance on inpatient beds
• Reduce length of stay
• Provide Care closer to home
• Reduce out of area placements
Things to remember!
• No “new” money
– We can use funds released from bed/ward closures
– We can use funds we’d otherwise spend sending patients “out of
area”
• Not about doing “more of the same” in community
– CCGs fund community services
– NCM is to fund “enhancements” – typically new services aimed
at caring for people “locally” and avoiding admission where
possible
Intensive PBS service: Aims
• To prevent admission to hospital
• Prevent home breakdown
• Maintain community school placement
• Maintain respite and social care support
• To work with educational/social care provision if sign posted for
residential provision
• To assess the need for inpatient assessment ( Fraser House)
Intensive PBS service: population
The team covers a geographical area that includes:
• North Cumbria
• Northumberland
• North Tyneside
• Newcastle
• Gateshead, Sunderland and South Tyneside
working with Children and Young People’s services that are responsible
for providing specialist learning disability services to children and young
people up to the age of 18.
• TEWV developing enhancement to existing services
NCM : Developing the PBS pathway
to meet population needs
• South of Tyne NTW Project
Gaps and identified needs in existing PBS pathway
• Enhanced ICTS, implementation of Crisis Plans
• Use of Care Education and Treatment Reviews
• Further PBS assessment for complex cases
• Early interventions & Parenting support
• Dynamic Risk Register
• Crisis Plans and Support
Dr Nicola Dodds 2018
Intensive PBS team +
Community and ICTS within NTW
PBS pathway development
The story so far…
• Enhanced Intensive Care and Treatment Service (ICTS)– Training in
LD and ASD completed
• Intensive PBS team formed (IPBS)
• Bi-monthly PBS CYPS network meeting with community, ICTS,
Intensive PBS and inpatient represented in NTW
• PBS Consultations with community teams set up monthly
• PBS workforce development plan+ set up community of practice
• Link to new Trust PBS Steering group and regional PBS steering
group
IPBS core functions of support
Further assessment and PBS interventions
- Functional assessment and Behaviour support plans
- Positive Family Intervention as a core component for intervention
to help families write their own BSP and addresses optimism and
resilience
- Supporting the implementation of plans through modelling and
coaching
• Provision of support and person specific training for other agencies
supporting those children and young people
• Co-ordination of transitions from inpatient and other settings
• Support the development of robust crisis and contingency plans that
work across agencies including local CYPS teams, ICTS, education
and social care
Intensive Support Pathway
• Week 1- 3 – observations, assessments, interviews. Crisis contingency plans and focused support strategies. PFI commenced
• Week 4- 8 – developing the BSP with key implementers, summary statements of functions of behaviours, and meaning. At a glance BSP plan produced. PFI sessions continue
• Week 8 – 12 Implementing Plan and Plan development in PFI
• Pairing ourselves with preferred activities, establishing ourselves as reinforcers.
• Antecedent control, high density of preferred activities. Satiation
• Teaching replacement skills• Reward programmes• Primary + prevention strategies –
environmental, interactions, communication strategies
• Non-aversive reactive strategies
• Coaching and feedback as we implement strategies
IPBS team structure
PBS pathway workforce delivery plan
Foundation level PBS Skills – training for all
• Day 1: Understanding Behaviours Which Challenge
• Day 2: Understanding Behavioural Support Plan
Implementation level Skills – training for specific role/ function on the pathway
• Day 3: Service Specific –
Community team: Initial Assessment
ICTS: How to use PBS in a crisis
Inpatient and IPBS: Further/Intensive Assessment and how to use At a Glance plans effectively
PBS work force plan
Advanced / Supervisory level PBS Skills – training for PBS completing further/ intensive assessments and who can supervise others
Recognised qualification such as
• Advanced Professional Diploma (Wales)
• BCBA
• Need for MSc PBS course
• PBS supervision group and PBS consultations to support learning and application of skills
PBS skill gaps and identifying needs
across whole pathway
• More PBS practitioners / Supervisory level needed in each
team
• Need to develop a better “fit” of training to specific specialist
role, and develop PBS Practitioner roles.
• Need for equitable resources across teams to deliver data
driven approach e.g assistant psychologists, and access to
specialist assessments e.g SALT
• Need for appropriate certified training route for Assistant
Practitioners/ support workers so can develop within PBS key
implementer roles – Apprenticeships in future
• Current courses self directed and online can take time/ not be
completed – need to access local courses supported by
Supervisors in service
Conference: “Steering through the crisis” -
How PBS offers families hope through action
3rd – 5th April 2019
Day 1: Help and Hope: Combining PBS and Optimism Training for Parents of
Young Children with Challenging Behavior. Shelly Clarke, M.A., BCBA
Day 2: Working with families to help implement change. Using Coaching,
modelling and Feedback skills, and an Active Support Model. Professor
Sandy Toogood, Senior Lecturer in Applied Behaviour Analysis, Bangor
University
Day 3: Using a PBS model for high severity behaviors: considerations to
support implementers and receivers of care. Dr. Elizabeth Hughes, PhD,
Clinical Director of the Institute for Applied Behaviour Analysis
Have now led to Regular Practice Development days for CYPS in the Region
– follow up day July 2019 and next planned for November 2019
Learning so far….
IPBS consultations – monthly with each community team
• Cases discussed presenting with behaviours of high severity
• Risk factors are present that make crisis likely e.g respite break down, school exclusion
Themes
• PBS initial assessments completed
• Difficulties in implementing PBS plans – resources and support for families
• Family stress levels and burn out
Intensive PBS Team – Activity
IPBS consultations – till end of March 2019
Area consultations Cases discussed more than once
Led to referral
Newcastle/Gateshead 8 2 2
Cumbria 2 0 0
Northumberland 8 1 1
Sunderland 8 1 2
TOTAL 26 4 5
IPBS Evaluation Planned
Further Assessment, treatment and support for individuals who
display behaviour that challenges
• Specialist Assessment will be provided by a specialist MDT leading
to a Positive Behaviour Support Plan
• Families will be involved in this process with plans being produced
together with professionals which are the best fit for them
• Outcome Measurement: Carer concerns reduction
• Health outcomes improved (Honosca). Behaviours of concern
reduction (behavioural data). Hospital admissions reduced.
IPBS Evaluation Planned
Provision of support, and person specific training for other agencies supporting those children and young people
• Positive Family Interventions delivered to families to support the understanding, resilience and skills in responding to complex behavioural presentations in their child. Outcome measures include Brief Parent Self Efficacy Scale and Questionnaire on Resources and Stress.
• An increase in skills in the regional workforce in services which support children and young people such as respite provisions, schools. Outcome measures: include pre and post confidence ratings following training. Implementation rates for PBS plans.
• Evaluation of impact of consultations
IPBS Evaluation Planned
• Coordination of transitions from inpatient and other
settings
• Assisting in the transitions from inpatient and other settings.
• Developing the capability in families / carers who will be providing
support and provide individual bespoke training. Expertise in PBS
available at times of transition and assistance in implementing and
monitoring a PBS plan.
• Outcome measures: length of stay reduction, Parent/ carer
confidence and satisfaction
IPBS Evaluation Planned
• Support the development of robust crisis and contingency
plans that work across agencies including local CYPS teams,
ICTS, education and social care
• Specialist risk assessments relating to behaviours of concern, and
contribution to crisis and contingency plans which are multi-agency
in approach.
• Outcome measures are reduction in risk behaviours (behavioural
Data). Reduction in admissions to hospital and out of area
placements. Time spent in hospital if admission occurs reduced.
• Any questions?