Learning Disabilities: Dynamic Registers Webinar – 12 December 2016

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Dynamic registers

November 2016

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Series of Webinars

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Topic Time

Welcome, housekeeping 1 min

Agenda : Webinar 1

Background and context:- What is a register- What needs to be considered- Challenges & benefits

14 mins

A carer’s perspective on registers 10 mins

Cumbria and the North-East TCP:- Developing our risk register- Deciding on risk stratification- Sharing the template for our register

20 mins

Questions and Discussion 15 mins

Close 1 min

Agenda : Webinar 1

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CTR policy ‘At Risk Register’• The ‘At Risk of Admission Register’ will identify those

people who are likely to require a ‘Community CTR’ to prevent their unnecessary admission

• At Risk of Admission Register’ is seen to be a first step in a broader piece of work on ‘risk stratification.’ This work will focus on prevention, early identification and early intervention.

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Service Model – Dynamic Registers

• Local health and care services should develop a dynamic register based on sophisticated risk stratification of their local populations

• enable local services to anticipate and meet the needs of those people with a learning disability and/or autism who display behaviour that challenges, or who are at risk of developing behaviour that challenges

• ensuring local services plan appropriately and provide early interventions, including preventative support.

• • Commissioners should risk-stratify their local population of people with a learning disability and/or autism to enable them to put in place appropriate anticipatory support

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• Risk stratification should focus on prevention and early intervention with the aim of reducing the likelihood of behaviour that challenges by providing support at an early stage to proactively address these risk factors

• It should be recognised that early detection of risk factors and systematic assessments of behaviour is the key to prevention of behavioural difficulties and the basis of early intervention.

• The register will include information that monitors whether the individual is effectively supported and reviewed

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People in

Inpatient or

residentia

l schools

People at risk of admission

People known to services

Total people with a learning disability and or autism

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Some of the key points made in the 2007 Mansell Report:

• Good practice is fragile, and it is not sensible to plan on the basis that challenging behaviour can be readily ‘fixed.’

• The potential for challenging behaviour exists for many service users in many situations; and the problem of behaviour that challenge is not likely to go away.

• The implication is, that the appropriate goal of learning disability services is to support the individual in achieving as good a quality of life as possible in spite of their problems.

• In practice, challenging behaviour will be an enduring characteristic of the lives of many service users.

• There will always be a large pool of people who present some challenging behaviour, which can be made better or worse depending on how well services support them

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• It is important to remember that challenging behaviour is merely a label given to a behaviour on the basis of its perceived consequences i.e. it places someone at risk of harm, or risk social exclusion.

• As such ‘challenging behaviour’ is a label attached to a social interaction or exchange between a person [with a learning disability] and other(s), wherein the characteristics of other parties are as important (if not more so) in determining whether harm or social exclusion are likely result, as the characteristics of a person with a learning disability.

Challenging behaviour is a social construct

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Any Questions?

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Dynamic Registers

My perspective as a carer – Jacky Martel

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To label or not to label

Tomas

Son

Brother

Friend

Grandson

Gorgeous

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To label or not to labelProfound Learning disability

Autism

Sleep disorder

Sensory processing disorders

Depression

Challenging

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Joined up???

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What I want out of a register• Recognition that even if things seem stable extra

consideration needs to be given before changes made

• Not having to emphasise how wrong things can go – having that understood

• Early planning at key transition points such as move to adulthood

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Gorgeous

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Questions?

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Transforming Care in theNorth East and Cumbria

Developing a standardised template:Dynamic Support Register

Dan Maddison & Sarah Dean

Partners in improving local health

NORTH EAST & CUMBRIALEARNING DISABILITIES & AUTISM

TRANSFORMING CARE PROGRAMME

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TCP Dynamic Support Register

• Overseen by the Transforming Care Board• Confirm & Challenge Group• Local Implementation Teams• Task and Finish Group:

• Risk Stratification Process • Data Sharing Process• Standardised Support Register

• Into Community Model of Care.




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Background and Process

• Assessment of current risk registers• Agree process and governance• Case management tool• MDT process pre CTR• Transitions planning • TCP sub group- Dynamic register • Standard risk register – approval• Local Implementation.




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Role and Function

Key Factors:

• Reducing admissions: • Identify risks• Allow contingency planning• Local action preventing admissions• Help guide Care and Treatment Reviews

• Triggers• Link to Risk Stratification• Early intervention.




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DSR Contents

• Patient/Person Information

• Risk of requiring more intensive support/admission

• Community CTR

• Actual Hospital Admission Data

• Overall RAG Rating.




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DSR Contents (continued)




NORTH OF ENGLANDCOMMISSIONING SUPPORT

Sub data:• Primary & Secondary Diagnosis• Current Accommodation Type• Advocacy Arrangements IMCA/IMHA/OTHER• Responsible Authority (incl OOA plans)• Professional Lead• Care Provider• Current care plan

• including risk assessment and contingency plan• Previous admission• Community CTR Date & Outcomes

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Risk Triggers

• Significant life events• Mental illness• History of admission• Significant behavioural challenges• Unstable environment• Having no fixed address• Being in contact with the Criminal Justice System• Admission or presenting “in crisis”• No family carers/advocates• Drug and alcohol dependencies• Issues with transition from child to adult services• “52 –week” residential placement





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Next Steps

Information Sharing Agreement Board Approval Regional CCG Forum Local Implementation Groups Local Authority Support Review Align with Risk Stratification process Northern Region National roll out.





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Any questions?

Daniel Maddison, Project [email protected]

01642 746914Sarah Dean, South Tyneside LA




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Questions and open discussion

Healthcare

Learning Disabilities: Dynamic Registers Webinar – 12 December 2016