Integrated Care Fund Challenge Session

1. Integrated Care Fund Challenge Session Positive Behaviour Support Scheme – Community Inclusion

2. Project IntroductionOverview of service provided • To develop a Positive Behaviour Support (PBS) Scheme Service which supports existing services to be able to provide for individuals with Learning Disabilities and complex needs within Carmarthenshire. • The PBS Service will provide additional support for individuals with Learning Disabilities who also exhibit behaviours that challenge. • The PBS Service will offer proactive preventative interventions to avoid placement breakdown and escalation into specialist, out of county or hospital settings.

3. Staff structure

4. Funding arrangements

5. Project tie-in with ICF objectives • Able to provide a service to people who don’t currently meet Health PBIS thresholds – preventing escalation requiring more intensive support. • Able to provide bespoke training to staff teams – over and above the Positive Behaviour Management training currently provided. • Preventative intervention service reducing service breakdown and hence admission to acute services. • Supporting people returning from services further away from their home. • Improve access to services for individuals with complex needs including behaviours that challenge.

6. Project key achievementsPerformance • PBS staff have had a presence across all LA day services and respite service offering general service level advice and support and also specific guidance and interventions for individuals. • PBS staff are facilitating ongoing support of weekly walking groups targeting improved health and well being objectives through access to regular exercise and non-confrontational discussion opportunities. • PBS team undertaken bespoke staff training in relation to individuals specific needs. • Supported the transition of individuals into services who had the potential to display behaviours that challenge and hence likely to have required more intense service provision.

7. Key achievements and outcomes • 2 Individuals are now in receipt of a more appropriate respite service with increased confidence in the staff team supporting them and better parent satisfaction. Both parent/carers had previously expressed concerns about the ability of the service to provide the care and support required by their sons. • The PBS team has been able to support the successful transition from Beechwood college to Manor Road for one individual with another one being planned for 2019. • The PBS team prevented a breakdown of an individuals day service by providing advice to the service team around reasonable adjustments to accommodate the individual, and support to the individual around self control techniques to manage their own behaviour. • Team established and additional training implemented. • Increase in the number of nights respite provided at TirEinon for people with complex needs including behaviours that challenge.

8. Activity • Since the setup of the PBS scheme in Dec 2017, the scheme has worked with 29 individuals. The intensity of the input required has varied from advice and guidance to staff through to observations and development of bespoke plans for individuals. • The referrals to the PBS service have required contact with each of the LA Day services, STEP’s Units, Ground Maintenance, TirEinon Respite service and a number of individuals who are not currently attending any of the mentioned services. • Professional links with Health PBIS and Childrens PBIS Services. • Links made with Beechwood College, Ysgol Bro Dinefwr, YsgolHeolGoffaand YsgolMaesy Gwendraeth.

9. Performance indicators • 22 of the TirEinon staff team have had additional bespoke training to build confidence in working with an individual. This individuals parents now have increased confidence that the service is currently able to meet his needs, although they remain to be convinced that the service could provide additional support to him. • Commissioners have new confidence in the ability of services to respond to the needs of individuals who display behaviours that challenge, this has been said and the number of referrals to services has increased. • The contribution of the PBS team is not always recognised as the day/respite service is seen as improving. This is a positive thing as the work they are doing with staff must be having a positive impact. • Increasing number of nights used in TirEinon by people who challenge.

10. Performance indicators

11. Value for money / return on investment • Cost of the team per week is approximately £3,075 per week. • Avoiding one placement breakdown or admission into acute services saves money. For example the cost of Beechwood college for one individual was £1258.64 per week. The current cost of a day service in Manor Road is £610.05 per week. This is a saving of £650 per week. • Supporting a young person in Manor road instead of in her home for 3 days per week is a saving of £210 per week. Just the work undertaken with these 2 individuals is a total of approximately £860 per week into the system (not into savings within the Day services). • Future planning for other individuals identified as returning to Carmarthenshire this year and in future years. This is more likely as staff confidence increases so the work undertaken to create the savings outlined above will continue to make additional savings that will not be quantifiable through this team. • Working with service providers to identify smart ways of delivering the right care and support for an individual before resorting to increasing staffing hours and therefore cost.

12. Key case study / studiesHow has the project has benefitted individuals (patient experience) SH - Prevented placement breakdown in Grounds Maintenance. LJ - Intervention that prevented family breakdown. RD - Prevented placement breakdown in TirEinon. Parents now have more confidence in the service and this is shown in the reduction in complaints to the service and to his Care Manager. JI - Breakdown of current day service provider Perthyn. Able to support transition into Maeslliedi day service. IG - Transition from Beechwood to Manor Road day service.

13. Key case study / studiesHow has the project has benefitted individuals (patient experience) • Bethan Harvey Assistant Team Manager Transition - I have had two experiences working with the PBS tier 1 services since they have started.  On both occasions I was pleased with their bespoke approach to meeting services users with behaviours that challenge and their needs.  The team’s focus was a “can do attitude” in the face of adversity. They worked creatively with other colleagues in the multi-disciplinary team and worked together for positive change for the service users. For example, one young man was experiencing difficulties in respite and staff were struggling with his behaviours. The PBS team worked with the staff to understand the behaviours, worked with them to develop routines and activities and now his respite is a much more positive experience for him and respite staff.

14. Sustainability plan 1How will the project be sustained in the future? Will ICF funding be sought in future or will it become self-funding / core-funded? What are the implications if the project were to cease (i.e. is there an exit strategy)? Please use this opportunity to demonstrate the value for money your project has/will achieve. • As a preventative service it is difficult to show that savings have been made – more that expenditure hasn’t had to happen. Young people often tri-partite funded therefore it can look as if adult funding is more expensive. • Support worker post in services could be replaced with PBS worker posts but this would not be cost effective as direct support would always be the priority. • Additional work with Care Managers and wider MDT to ensure that Care Plans do not over prescribe 1:1 and 2:1 staffing. • If the PBS team were to cease the PBIS and community nurses would have an increased workload/longer waiting list/people hit crisis prior to intervention (less preventative work more reactive to crisis).

15. Sustainability plan 2 • Potential to delete the PBM Co-ordinator post freeing up the funding and moving the functions to the PBS scheme manager and team. • Confidence with the commissioners is not yet established enough to remove the PBS team. • Staff confidence is still in its infancy in relation to dealing with people (especially new people) who pose a significant challenge.

16. Project developmentForward development of the project – where could it go in 1 / 2/ 3 years if funding continues, new directions for exploration. • Further work with Children services/Transition – work from age 14, creating a through life Challenging Behaviour Pathway of support. • Potential for further out of county placements to be returned or avoided in the first instance. • Further work in relation to how staffing is utilised in a smart way avoiding over reliance on 1:1 and 2:1 staffing. • Linking in with Accommodation and Support work to ensure correct levels of staffing. • Enhancing staff training. • Further work with parents/carers e.g. support group facilitation etc. • Continuation of flexibility in the intensity of the work.

17. ConclusionSummary & reflection • Agood opportunity to be able to reflect on how services react to people who challenge and to make necessary adjustments. • In the future we will be able to evidence an increase in commissioners attempting to place individuals in our day services before looking for external providers? • The process for services to access PBS Scheme support is now clear and understood by services, where in the past it was unclear who’s role it was to provide this support. • The project is still developing but has highlighted the need for the additional support to services and individuals to prevent breakdown and escalation.