1. 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

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

3. SPIEDSPIED SPIED Symposium 1.A conceptualisation of Personality Disorder in Intellectual Disability & Assessment Framework 2.An Intervention Framework 3.Translating theory into practice

4. 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

5. 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

6. 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

7. 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)

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

9. 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

10. 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.

11. 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

12. 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”

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

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

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

16. 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.

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

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

19. 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.

20. 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.

21. SPIEDSPIED Questions / Comments –

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