Michelle Henwood Statewide Behaviour Intervention Service

1. Service Provision For People with Intellectual Disability and SPIED: Issues in Translating Theory into Practice Michelle Henwood Statewide Behaviour Intervention Service

2. Session Outline • SERVICE DELIVERY CONSIDERATIONS • A CASE EXAMPLE & SERVICE MODEL • QUESTIONS

3. SPIED Symposium • A conceptualisation of Personality Disorder in Intellectual Disability & Assessment Framework • An Intervention Framework • Translating theory into practice

4. Service Delivery Considerations Service Resilience Breakdown & worldview Long-term Service Set-Up: • stakeholder involvement & agreement • documentation • communication • role clarity • robust systemic supports Service Recovery Plan

5. 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

6. 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

7. 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)

8. So, how could this framework look within a service model?

9. A Case Example - Melissa 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

10. A Case Example - Impact SELF - PERVASIVE PATTERN FOR PAST 6 YEARS • Repeated placement in custody & released to new accommodation • Itinerant / homeless lifestyle • No significant relationships • Physical & mental health deterioration • Frequent contact with police, mental health, hospitals • Serious risks associated with behaviours, health, & lifestyle.

11. A Case Example - Impact • FAMILY & COMMUNITY MEMBERS • Family relationships broken down • Community 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

12. 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” Service Aims

13. SERVICE MODEL for Melissa Northern Region Case Coordinator & Clinician Short Term Secure Placement Sydney: Primary Residence Southern Region

14. Short-term secure placement Northern Region Case Coordinator & Clinician Short Term Secure Placement Sydney: Primary Residence Southern Region

15. Primary Residence – Cluster Model Northern Region Case Coordinator & Clinician Short Term Secure Placement Sydney: Primary Residence Southern Region

16. 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.

17. Regional Supports -contact -office -schedule Case Coordinator & Clinician Short Term Secure Placement -contact -office -schedule - contact -office -schedule - respite

18. Centralised Coordinator & Clinician Northern Region Case Coordinator & Clinician Short Term Secure Placement Sydney: Primary Residence Southern Region

19. “Phone a friend” • One phone number • Toll 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.

20. 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.

21. Questions / Comments –

22. Michelle Henwood Statewide Behaviour Intervention Service michelle.henwood@dadhc.nsw.gov.au