Evaluating Fenland Behaviour Consultation Clinics: arriving at a methodology Anne Necus Consultant Clinical Psychologist Cambridgeshire Learning Disability Partnership

Fenland Community Learning Disability Team Adult social care managers arranging packages as cheaply as possible. Referrals to MDT Health Professionals Rural Locations attract independent sector providers. Fenland ‘imports’ more people who have Challenging Behaviours from all across Cambridgeshire and other counties. Challenging Behaviours are persistent and costly We have stakeholders with different emphasis – but all want a reduction in Challenging Behaviour.

The Behaviour Clinics Good practice guidance says MDT, assess, functional analysis, formulation and intervention – but does not pay attention to persistence. We changed our service delivery for ‘re-referrals’. Support staff, managers and some family members attended every 4-6 weeks for 4-6 times. Provided a chance to access to MDT workers, to evaluate motivation, commitment and staff ownership.

I have a chance to evaluate the clinics. But How? There are lots of questions The data was either not there or clear enough to make a retrospective quantitative analysis. I interviewed 1 family and 10 others. I covered 7 referrals. Old referral Recent referral Current referral Family --1 (x3) (82.51) Support worker 1 (13.26)*1 (7.54)1 (19.20) 1 (100.06) Day opp’s manager 1 (8.46)1 (16.10) 1 (11.00) - Supported living manager 1 (approx 10 mins) 1 (16.30), 1 (12.14 ) --

Descriptions of what was achieved in the clinic. “I could say, it was very informal. You could say anything and can, you know, discuss the person in depth and not feel worried about that at all. Ehm, it was quite structured. I felt that we had an aim there” -Supported Living Manager

The importance of multiple views and collaboration “But I think with the behaviour clinic, as I said, there’s more. It’s a better discussion. There’s more knowledge coming in either than from just one or two people. It’s more of a whole.” -Day Services Manager

The strength and fragility of team work “Even if people come away from the meeting saying ‘that was a lot of nonsense’ but they are perhaps prepared to – against their better judgement – to try these things. They are a very committed team and very, very caring. They will do anything if they think its going to help P. If its not going to help P, then it’s a waste of time.” -Support Worker

What next? My remaining challenges 1.Correct ‘Delivery’ problems (e.g improve chairing skills) and ‘Missing’ (build an initial visit in every time). 2.Design an audit tool which can check that the clinic is operating using best practice concepts and the findings from this study. 3.To stop and think (but not overthink!) how to answer these performance related questions and this time build in carer and worker involvement. 4.To convince commissioners and service managers that there is a value in continuing to apply research methods to study the performance of the behaviour clinics (costs and outcomes).

What I Learned. That expert advice is invaluable to achieve clarity in asking the right question. To stay objective about a model of service delivery I had invested time into. That piloting and revising is time well spent. That my hope of achieving full service evaluation of the clinic was highly overambitious. By association that the managers and commissioners preference that this evaluation would ‘prove’ efficiency was also overambitious. That involving carers with the research process requires more dedicated time and planning than I gave.

Thank you all for listening and special thanks to Tony and Isabel for teaching me such a lot and spending so much valuable time with me. Mark and my other action learning ‘buddies’ for helping me to think things through. Christine, Lea and all the Teachers for organising and providing a fantastic year.