Coming Home Out-of-Area Placements & Delayed Discharge for - PowerPoint PPT Presentation

Coming Home Out-of-Area Placements & Delayed Discharge for People with Learning Disabilities and Complex Needs Anne.macdonald3@gov.scot

Overview of Presentation • Brief description of project • Findings • Summary of issues • What makes for good support • Recommendations • The way forward

Description of Project

Background to the Project • Long-term aim for people to live in their local communities • Need to develop capacity in Scotland for local, specialist, community-based services • Keys to Life recommendations (2013) • KtL Implementation Framework (2015) • 2 year project from April 2016

Keys to Life Recommendations • Scottish Government to establish the Scottish data on out-of-area placements • Scotland to build the capacity to deliver specialist services more locally • By 2018, people with LD & complex needs who are in facilities outwith Scotland, to be supported to live nearer their family in Scotland

The Vision • That all people with learning disabilities will be able to lead full, healthy, and productive lives in their communities, with access to the same range of options and life choices as any other member of society. • That support to people with learning disabilities needs to be framed in the broader context of equality and social justice, not just within the narrower focus of service delivery; in particular, that better lives, for people with complex needs is a human rights issue.

Aims of the Project • To gather accurate national data on adults with LD who are out-of-area or delayed discharge • To explore the type of support required for this group • To take a national strategic approach to finding support solutions • To identify sustainable local alternatives to out-of-area placements & to reduce delayed discharge • To scope the use of Positive Behavioural Support in Scotland and consider its use to support this group

Data Collection • Named contact in each HSCP • Individual returns from each HSCP • Specific return for each individual (16+) with LD who is either delayed discharge or out-of-area • Delayed discharge (27 questions) • Out-of-area (29 questions) • With a LD (autism-only excluded) • Based on date 31 st January 2017

Other Sources of Information • Meeting stakeholders o HSCP (commissioners, social workers, care managers, psychologists, psychiatrists, LD nurses,) o Social care provider organisations o Families & carers’ groups o Other (SG, MWC, SWS, NES, SCLD) • Visiting services • Liaising with colleagues outwith Scotland • Consulting research & good practice guidance

PBS Data Collection • To scope the use of PBS across Scotland including: o What PBS training is being done & by whom o Process of implementation o Whether evaluation is taking place • PBS questionnaire sent to: o HSCP o Social care providers o Carers’ groups • Consulting research and good practice guidance

Findings

Out of Area Group

Out-of-area Group • 705 people out-of-area. This is only from 30 HSCP, so likely to be underestimate; 79 of these people were out of Scotland. • 45% out-of-area more than 10 years, and 23% out-of-area for 5-10 years. • Of the 705 people, 453 had gone out-of-area not through their choice, or their family’s choice (65%). • Main reason for out-of-area placements was lack of specialist services available locally (53%). • Of the 453, 109 were said by HSCP to need repatriated; these are the priority to return group. This is likely to be an underestimate as for another 100+ the need for repatriation was not decided, or this data was missing.

Priority to Return (109) Characteristic Options Percentage Gender Male 72 Female 28 Autistic Yes 49 Forensic Yes 18 Age 16-17 6 18-20 17 21-34 34 35-44 16 45-54 16 55-64 7 65+ 4 Mental health diagnosis Yes 21 Challenging behaviour Both current & historical 65 Current but not historical 1 Historical but not current 16 No current or historical 17 Don’t know/missing 1

Challenging Behaviour Types of Percentage Support for Percentage Use Challenging Behaviour Displaying Challenging Behaviour Current challenging behaviour 66 PBS input 37 Physical aggression 55 Active support 32 Verbal aggression 39 Communication strategies 50 Self-injury 31 Psychological therapies 19 Self-neglect 17 Sensory diet 6 Property destruction 40 Risk Management Percentage Use Disruptive behaviours 28 Physical restraint 21 Non-compliance 26 Seclusion 11 Sexual challenges 18 As required medication 44 Removing clothes 11 Additional staff 41 Absconding 1 Environmental restriction 36 Smearing 5 Technological restriction 9 Substance misuse 1 Mechanical restriction 1

Placement Prior to Out-of-area 33% 35 30 25 20 16% 14% 13% 15 12% 10 6% 3% 5 2% 1% 0

Barriers to Repatriation Guardianship Issues 3% Legal Issues 4% Family Issues 3% Lack of Service Providers 26% Lack of Accommodation 45% Lack of Funding 2% Missing 17% 0 10 20 30 40 50

Delayed Discharge Group

Delayed Discharge Group (67) Characteristic Options Percentage Gender Male 66 Female 34 Autistic Yes 36 Forensic Yes 21 Age 18-20 2 21-34 37 35-44 22 45-54 24 55-64 13 65+ 2 Mental health diagnosis Yes 40 Challenging behaviour Both current & historical 73 Historical but not current 10 No current or historical 5 Don’t know/missing 12

Delayed Discharge Group (67) Characteristic Options Percentage Placement still available Yes 10 No 70 Don’t know/missing 20 Repeat admission Yes 33 No 49 Don’t know/missing 18 Previous placement Family home 16 Supported living 34 Hospital (NHS/private) 16 Care home 6 Other 9 Missing 19 Discharge to Supported living 46 Care home 5 Other 5 NA, no plans 25 Missing 19

Reason for Admission Challenging Behaviour 48% Service Breakdown 9% Other* 16% Missing 27% 0 5 10 15 20 25 30 35 40 45 50

Length of Admission 10+ Years 22% 5-10 Years 9% 3-5 Years 13% 2-3 Years 9% 1-2 Years 17% Less than 1 Year 12 Missing 18% 0 5 10 15 20 25

Length of Delay missing 33 up to 10 years 1 up to 5 years 1 up to 3 years 5 up to 2 years 6 up to 1 year 21 0 5 10 15 20 25 30 35

Barriers to Discharge Geographical Issues 1% Coordination of Funding 3% Other Legal Issues 2% Lack of Service Providers 15% Lack of Accommodation 51% Lack of Funding 3% Missing 25% 0 10 20 30 40 50 60

Challenging Behaviour Types of Percentage Support for Percentage Use Challenging Behaviour Displaying Challenging Behaviour Current challenging behaviour 73 PBS input 43 Physical aggression 67 Active support 24 Verbal aggression 49 Communication strategies 40 Self-injury 31 Psychological therapies 24 Self-neglect 9 Sensory diet 3 Property destruction 28 Risk Management Percentage Use Disruptive behaviours 28 Physical restraint 37 Non-compliance 31 Seclusion 10 Sexual challenges 21 As required medication 63 Removing clothes 6 Additional staff 18 Absconding 2 Environmental restriction 43 Smearing 3 Technological restriction 5 Substance misuse 0 Mechanical restriction 2

Summary of Issues

Impact of DD and OOA • Impact on individuals is significant and can include: breakdown in family relationships & friendships; loss of their home; stress, confusion & uncertainty about the future; loss of community networks & access to the community; being subject to restrictive practices; loss of skills and opportunities • Impact on services can include an over-reliance on hospital or out-of-area placements, sometimes at the expense of developing local community expertise; lack of access to inpatient support for those who need it, delays and barriers to admission

Summary of Issues • Many social care services struggle to meet the demands of providing quality services to this group, both in terms of staff with the necessary skills and suitable housing to meet complex needs . • Social care faces a number of challenges which impact on their ability to provider this level of support. • However, that many people with complex needs and challenging behaviour live successfully within supported living settings. • Successful services are related to a number of factors; we need to think about models of support which are likely to be less fragile, without losing a commitment to person-centred support.

Summary of Issues • Challenging behaviour is a major factor resulting in service breakdown and hospital admission. Additional support needs such as autism or mental health issues are also significant factors. There is a therefore need for effective and timely access to expert intervention, both to prevent crisis , and to help deal with crises when these arise. • The fact that challenging behaviour is such a significant factor also points to the need for earlier intervention with young people with learning disabilities who are at risk of developing challenging behaviour. Over 80% of the group had historical challenging behaviour , meaning that these are very likely to be individuals who would have benefited from early intervention.