Learning Disability Today
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In this guest blog, Certitude’s approach to supporting people with complex needs is explored, which has an emphasis on good communication, effective planning and shared risk.
Over the past year, Certitude has participated in Making it Real for Everyone. This is a joint project between the Winterbourne View Joint Improvement Programme (JIP) and Think Local Act Personal, which aims to show how providers and commissioners can work together with families to provide local personalised support to people with challenging and complex needs. The work has focused on enabling families to stay living together through outreach and respite support. Certitude sees this as critical support if the increasing numbers of people who continue to be admitted to assessment and treatment units is to be reduced.
Here, Mary Schumm, Certitude’s director of learning disability services, talks about the project.
“In our view, support should start with the individual and their family and friends. If people can be helped within their community and by their natural support networks, that’s a success. We believe that by tailoring support around a person’s individual needs, they can avoid being referred – or re-admitted – to treatment and assessment units. One size does not fit all. If we can get support right in the individual’s local community we can achieve the long-term objective of ensuring these units are not required in the first place.
“At the heart of what we are doing is good communication and planning. Ideally, we try to sit down with an individual and their community team, psychologist, case co-ordinator and families as soon as we are asked to support or, if the person is in transition, six months before we begin our support. Then we meet up regularly as our support continues.
“Sharing information, listening to one another and building trusting relationships with everyone involved in the person’s life is crucial for a successful outcome for an individual. Family involvement is particularly important; a relative’s personal insight and experience is invaluable. Sharing the risk together is a very important element of planning and support.
“This idea of shared risk is important because if we all agree on a plan and something goes wrong we can openly reflect on what happened rather than seeking blame. Being open and honest with one another should help us to get the right approach from the start, but if things don’t work out we have to be up for trying again using what we’ve learnt. If we want to enable a person to have choice and control over their lives we have to recognise that we’re not going to get it right every time and we’re committed to learning from our mistakes.
“Once the support team have confidence in one another it is a question of building trust with the person we are supporting. At the moment we are working with a young man in his early 20s who is extremely anxious and whose home situation is quite unstable. We began by supporting him at home, and then at our small (3-bed) respite service during the day to give his family a break, and to enable him to relax in a safe environment. We have matched staff to his likes and dislikes and he is beginning to relax around them and see the house as a safe place; a home from home. Our aim is that he will eventually feel comfortable enough to stay overnight so that if an emergency occurs he can come here rather than the situation becoming so difficult at home that admission to an assessment and treatment unit is the default solution.
“In addition to establishing strong support networks with existing local services we have created our own Intensive Support team who bring specialist skills; the team comprises a person-centred planning manager, a communication development manager, a positive behaviour support manager, positive behaviour support practitioner and a family support manager. Depending on the support needed, each of these specialist roles can be called upon to support an individual, their family and their support team.”
Aisling Duffy, Certitude’s chief executive, adds: “The work of the Winterbourne View JIP and the recently published ‘Winterbourne View – Time for Change’ report by Sir Stephen Bubb has shone the spotlight on improving community support and we welcome that wholeheartedly. The report makes some positive statements about what is needed to make long-lasting change. However, the real work is in making it happen and we look forward to seeing NHS England’s response and action plan. Without doubt, the commissioning of support needs to start from a rights-based approach, which is at the heart of the LB Bill. People who have learning disabilities and their families are citizens whose rights, desires and wishes must be heard, respected and acted upon. This can be the only starting point for getting it right.
“Working in REAL partnership with individuals and their families, advocacy, community teams and commissioning bodies to enable people to receive the support they need locally has made a positive difference to people’s lives. Sharing our approaches through Making it Real for Everyone, and learning from others has been a valuable experience and the people we support are already feeling the benefits.”
“Investment in effective and person-centred support to individuals and their family, that is timely and can flex as needs change is essential if we are to prevent people from being admitted to these units in the first place.”