Presentation on theme: "Intellectual Disability & Personality Disorder Project Service Provision For People with Intellectual Disability and SPIED: Issues in Translating Theory."— Presentation transcript:
Intellectual Disability & Personality Disorder Project Service Provision For People with Intellectual Disability and SPIED: Issues in Translating Theory into Practice Michelle Henwood Statewide Behaviour Intervention Service
SPIEDSPIED Session Outline SERVICE DELIVERY CONSIDERATIONS A CASE EXAMPLE & SERVICE MODEL QUESTIONS
SPIEDSPIED SPIED Symposium 1.A conceptualisation of Personality Disorder in Intellectual Disability & Assessment Framework 2.An Intervention Framework 3.Translating theory into practice
SPIEDSPIED 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
SPIEDSPIED 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
SPIEDSPIED 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
SPIEDSPIED 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)
SPIEDSPIED So, how could this framework look within a service model?
SPIEDSPIED 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
SPIEDSPIED 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.
SPIEDSPIED 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
SPIEDSPIED 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”
SPIEDSPIED SERVICE MODEL for Melissa Northern Region Southern Region Case Coordinator & Clinician Sydney: Primary Residence Short Term Secure Placement
SPIEDSPIED Short-term secure placement Northern Region Southern Region Case Coordinator & Clinician Sydney: Primary Residence Short Term Secure Placement
SPIEDSPIED Primary Residence – Cluster Model Northern Region Southern Region Case Coordinator & Clinician Sydney: Primary Residence Short Term Secure Placement
SPIEDSPIED 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.
SPIEDSPIED Regional Supports -contact -office -schedule - contact -office -schedule - respite Case Coordinator & Clinician -contact -office -schedule Short Term Secure Placement
SPIEDSPIED Centralised Coordinator & Clinician Northern Region Southern Region Case Coordinator & Clinician Sydney: Primary Residence Short Term Secure Placement
SPIEDSPIED “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.
SPIEDSPIED 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.