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Intellectual Disability & Personality Disorder Project
Service Provision For Service Provision For People with People with Intellectual Disability Intellectual Disability and SPIED: and SPIED: Issues in Translating Theory into Issues in Translating Theory into PracticePractice
Michelle HenwoodStatewide Behaviour Intervention Service
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Session Outline
SERVICE DELIVERY CONSIDERATIONS
A CASE EXAMPLE & SERVICE MODEL
QUESTIONS
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SPIED Symposium
1. A conceptualisation of Personality Disorder in Intellectual Disability & Assessment Framework
2. An Intervention Framework
3. Translating theory into practice
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Service Delivery Considerations
Service ResilienceBreakdown & worldviewLong-term Service Set-Up: - stakeholder involvement
& agreement - documentation - communication - role clarity - robust systemic supportsService Recovery Plan
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Service Delivery Considerations
Duty of Care vs. Dignity of Risk- Informed consent? OPG ?- Senior management contract sign-off- Legal advice (DADHC & NGO)- Pressure off direct care staff
Minimising Risk- Short-term vs. long-term risk- Risk assessment- Risk Management Plan : built into
communication procedures & local service protocols eg. Hospitals protocol
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Service Delivery Considerations
Case Ownership by Disability Services- Providing a voluntary service to a
seemingly involuntary client- This group ARE our clients- Plans are still needed: maybe Case Plans
before IP’s.
Resistance & uncertainty re. new approach
- Staff training & involvement re. SPIED framework
- Shift to complement current practice with new way of thinking & conceptualising
- Patience, respect, perseverance, reassurance, & negotiation
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Service Delivery Considerations
Supporting Personal Boundaries
- Risk of blurred boundaries for staff & clients
- Supervision & support- Guidelines for consistency
Expect the Crisis / Expect the Recovery
- Relates to Set-Up expectations & undertakings (agreements)
- Give staff skills and training to respond to crisis (IPRP)
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So, how could this framework look within a
service model?
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WORLD VIEW“I will be abandoned”“I can’t trust anyone”
THEMES OF BEHAVING“If I’m in control no-one can hurt me”“Reject them before they reject me”
SYMPTOMATIC BEHAVIOURS- Physical aggression (punching,
pushing)- Theft (eg. food & clothing)- Property damage (own & others)- Self-harm (cutting arms & stomach)- Poor self-care & health management
A Case Example - Melissa
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A Case Example - Impact
SELF - PERVASIVE PATTERN FOR PAST 6 YEARS
Repeated placement in custody & released to new accommodationItinerant / homeless lifestyleNo significant relationshipsPhysical & mental health deterioration Frequent contact with police, mental health, hospitalsSerious risks associated with behaviours, health, & lifestyle.
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A Case Example - Impact
FAMILY & COMMUNITY MEMBERS
Family relationships broken downCommunity member injury, loss, & distress
SERVICES
Multiple service providers involved – inconsistent responses – unclear roles
Rarely able to implement because no contact – frustration & withdrawal of services
Functioning in “crisis mode” – huge drain on resources for every service involved
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Service Aims
• The initial goal is to create structure and predictability around the “crisis” nature of Melissa’s lifestyle.
• To offer a similar level of variety and stimulation to her current lifestyle whilst minimising risk to herself & others
• Work with Melissa’s itinerant behaviour by providing more than one “safe base”
• Facilitate increased predictability, safety, and eventually increased stability & connection to one identified “home”
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SERVICE MODEL for Melissa
NorthernRegion
SouthernRegion
CaseCoordinator& Clinician Sydney:
PrimaryResidence
Short Term
Secure Placement
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Short-term secure placement
NorthernRegion
SouthernRegion
CaseCoordinator& Clinician Sydney:
PrimaryResidence
Short Term
Secure Placement
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Primary Residence – Cluster Model
NorthernRegion
SouthernRegion
CaseCoordinator& Clinician Sydney:
PrimaryResidence
Short Term
Secure Placement
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Regional supports - Aims
Statewide contact with government departments
- Need for local & statewide protocols and agreements.
Safe bases & Relationships- Create a relationship with an organisation, not just one person.- Create a choice of safe bases : planned not emergency services.
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Regional Supports
-contact-office
-schedule
- contact-office
-schedule- respite
CaseCoordinator& Clinician -contact
-office-schedule
Short Term
Secure Placement
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Centralised Coordinator & Clinician
NorthernRegion
SouthernRegion
CaseCoordinator& Clinician Sydney:
PrimaryResidence
Short Term
Secure Placement
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“Phone a friend”
One phone numberToll free or reverse charges for Melissa & other identified services. Case Coordinator during business hours & Contact Persons roster after hours. Provision of support, schedule information, central communication point – streamlining & simplicity.
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In a nutshell …
There are many issues and barriers to translating theory into practice for this client group
It is very possible to do this with commitment, clarity, creativity, and understanding.
Acceptance that this is not a quick fix or an easy road is essential to achieving positive outcomes
This is just one example of how this intervention framework could be interpreted.
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Questions / Comments
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