6th Annual Social Work & Social Care Research in Practice

Conference

Room 2 – Deerpark – AM Chaired by Pauline Leeson Children in Northern Ireland

An Evaluation of Social

Work in Involving

Patients with Dementia

in Decisions Related to

Hospital Discharge

ROBYN LENNOX, SENIOR SOCIAL WORK PRACTITIONER

Context

Hospital Social Worker, Antrim Area Hospital

Observation of practice issues

Literature Review ‘Service User Involvement in ‘Best Interest’ Decisions During Discharge from

Hospital; a Systematic Narrative review’

First step, to evaluate current practice

Co- designed with Dementia NI

Context Continued

Patient

involvement

Professional Organisation

Preferred

level of

participation

Increased

Satisfaction

+Self-

determination

Partnership

Person

centred

Reduced

LOS,

avoidance

of crisis and

readmission

Time,

resource,

PPI in

policy

decisions

Aims and Objectives

Aim

To improve social work practice in the Northern Health and Social Care Trust in involving service users with Dementia, in decisions related to complex hospital discharge.

Objectives

Evaluate current practice including what is working well and what could be improved

Clear recommendations to improve practice in the Northern Health and Social Care Trust

To gather perspectives from practitioners in relation to the recommendations from 'Service User Involvement in ‘Best Interest’ Decisions During Discharge from Hospital; a Systematic Narrative Review

Methodology

Qualitative study

Focus Groups

Sample

Total 30 with representation from all CMHOPTs and main acute HSWT

Data Collection

semi structured interview style

Thematic Analysis aided by Nvivo

Ethical Approval

Discussion of Findings

Barriers to Involvement

Communication

Assessment of Preferred Level of Participation

Preparation

Advanced Care Planning

Shared Decision Making

Participation Tool

Learning Outcomes

Shared Learning between settings

Streamlining existing tools to standardise practice and

improve governance

Further Research into Advanced Care Planning in

Dementia Care, lets test the boundaries!

Involvement of Dementia patients in research

Elizabeth Tanner

Southern Health and Social Care

Trust

STAFF EXPERIENCES AND

PERCEPTIONS OF ASSESSING

INDIVIDUALS WITH A DUAL

SENSORY LOSS AND LEARNING

DISABILITY

Definitions

People are defined as having a dual sensory loss

“If their combined sight and hearing impairment causes

difficulties with communication, access to information

and mobility. This includes people with progressive

sight and hearing loss.” (Think Dual sensory, DOH

1997 p7).

The definition of learning disability is

“a reduced intellectual ability and difficulty with

everyday activities which affects someone for their

whole life” (MENCAP 2014)

Context

2011Regulation & Quality Improvement Authority Inspection

2015 SENSE research ‘Identification of Deafblind people and Associated Support Needs in NI’ (Quinn & Gray 2015)

2016 systematic narrative review of literature ‘Can Effective Interaction be Enhanced when working with individuals who are Deafblind?’ (Tanner unpublished)

Discussions with Professor Jan Van Dijke & Director of SENSE.

Literature Review June 2016

Paucity of literature - Prain et al (2010,2012) Janssen et al (2003,2010)

Why is effective interaction important?

Current levels of interaction when working with individuals who are

deafblind and possible reasons for these findings.

Can levels of effective interaction be increased? What works?

Gaps in evidence.

Aim & Objectives

To examine the experiences and perceptions of staff when assessing

individuals who have a dual sensory loss and learning disability.

To gain an understanding of current assessment processes when

working with an individual who has a dual sensory loss and learning

disability. To discover what assessment tools staff are currently using.

To explore whether these current assessment processes promote

person centred assessments.

To explore how staff promote engagement and partnership working

within the assessment process.

To explore whether staff feel that they have adequate knowledge

and skills to undertake assessments with individuals with a dual

sensory loss and learning disability.

To identify gaps in service.

To help inform the future development of policy, practice and service

development to individuals with a dual sensory loss and learning

disability on a local and strategic level.

Methodology

Qualitative Research-to ‘explore meanings, perceptions &

constructs in real world contexts where there is ltd

research’ (Campbell et al 2017)

Sample size - 12 participants from across sensory

disability, learning disability & children with disabilities

teams

Semi structured Interviews

Findings & Discussion

Preparation

Skills

Resources

How staff learn

Partnership working

Levels of Engagement with the

Service User including Skills &

Resources to Promote Engagement

Respondents commented on minimal interaction with the Service User

themselves

Uniqueness of the individual’s communication methods

Staff didn’t consider they had adequate skills

Core social work skills, tools and Resources being used.

Findings supported by literature ( Bloeming-Wolbrink 2015 & Janssen

et al 2003)

Training

Currently there are different levels of training

across the staff & across the teams.

Impact of training on practice

Awareness training for a more robust identification protocol

Targeted training with realistic aims and objectives.

Challenges in training

Challenges in training:

“it’s difficult because these individuals are so different and they

present so differently that I almost need to go to training about ‘A’

or ‘B’. Something specific about ‘A’ who has this syndrome and has

dual sensory loss and a learning disability and how do I

communicate with her, show me resources I could use but it would

be very specific to her and that training I could only use with that

individual.” (Respondent 11)

Observation

Observational skills are ESSENTIAL when assessing.

Observing the individual can contradict information gathered from other

sources.

Observation across settings

“Just by observing I learned a lot about what she could do by

taking her away from the home; a different setting worked. It was

only the second visit and I was impressed. I wouldn’t have known

that if I hadn’t taken her out of the house.”(Respondent 9).

“You see things written down about the diagnosis but when you go

out sometimes, what you see is very different.” (Respondent 11)

Recommendations

There is the need for a more robust identification protocol for

individuals with a dual sensory loss and learning disability in order to

establish service needs and for individuals to receive relevant, bespoke

and robust needs led assessments. An increased awareness, use of

and review of the current screening tool may begin to address this

issue.

Consideration to be given to video analysis and team and individual

coaching. There needs to be ongoing discussion as to whose role this

is and if this can be effectively implemented.

All staff to be cognisant of the power of observation across a range of

settings as an essential skill to aid and inform the assessment process.

Further agreement and discussion is required of the role of the

recently appointed deafblind specialist worker.

Training needs analysis to be undertaken in relation to dual sensory

loss and learning disability. Training to be revisited and revamped

and targeted appropriately. Training objectives need to be realistic

within the remit of the organisation whilst recognising the

uniqueness of the service user group.

Consideration needs to be given to the roll out of dual sensory loss

awareness training across the directorates.

.

Senior managers need to take cognisance of the fact that

assessments in this area take longer. The Trust should consider ring

fencing time for these assessments.

Greater consideration to be given to staff contributing to best

practice forums and sharing current areas of good practice and

effective use of tools and resources. This learning can then be

cascaded throughout the relevant teams.

.

This niche area would benefit from larger scale research across the

four remaining Trusts in Northern Ireland. It would also be valuable

to undertake research with carers and service users in order to

present a more holistic, comprehensive picture.

A wider dissemination of the findings from this research so that

learning is shared and debate is stimulated with key practitioners

and managers across the Trusts

“I would swing from the lights if I

felt that I was really getting it and

assessing somebody spot on.”

(Respondent 6)

To conclude

Society has a responsibility to ALL individuals and service providers

have a responsibility to take into account the perceptions, needs and

wishes of ALL individuals when assessing, no matter how complex

their communication.

The first study of it’s kind in Northern Ireland and it is hoped that the

findings and discussion will stimulate debate.

Problem Solving Justice

Presentation to 6th Annual Social

Work and Social Care Research

in Practice Conference

6th March 2019

Gillian Montgomery Assistant Director, PBNI

Overview

Problem Solving Justice

Problem Solving Justice

The Problem Solving Pilot Projects

Enhanced Combination Orders

Problem Solving Courts: Domestic Violence, Substance Misuse & Mental Health

Problem Solving Justice/Problem Solving Courts

• Indicator 1: Reduce crime and the harm and vulnerability caused by crime (prevalence rate)

• Indicator 38: Increase the

effectiveness of the criminal justice system

• Indicator 39: Reduce re-offending

DOJ Problem Solving Justice

Portfolio

Enhanced Combination

Orders

Concern Hubs

Domestic Violence

Perpetrator Programme

Substance Misuse Court

Family Drug & Alcohol

Court

Problem Solving Justice

PSJ addresses the root causes of offending

Innovative, creative early interventions

PSC’s alternatives to imprisonment

Treats the individual

risks & needs

Joins up justice & other key

services to achieve the same goal

New Problem Solving Approaches

Enhanced Combination Order (ECO)

Problem Solving Courts

ECOS: The Pilot

To provide a framework for future innovative practice with the aim of reducing recidivism

Rehabilitation, reparation, restorative practice & desistance, with the added benefit of being

considerably less costly to the state

The Big Three

Mental Health

Domestic Violence

Drugs

Benefits of Problem Solving Courts

Treats the root causes & problems

More options for sentencers

Reduce prison

populations

Reduced recidivism

Fewer victims

Cost effective

Treats the root causes & problems

More options for sentencers

Reduce prison

populations

Reduced recidivism

Fewer victims

The First Problem Solving Courts

Substance Misuse Problem Solving Court

Belfast, Laganside Magistrates’ Court

DV Problem Solving Court

Derry/Londonderry Magistrates’ Court

Non-Adjudicated DV programmes

Western Trust Area

Assessment & Supervision Team

Promoting Positive Relationships

Programme (PPRP)

Promoting Positive Relationships

Programme (PPRP)

Treatment partner with Addiction NI

Respectful Relationships

Intervention (RRI)

Respectful Relationships

Intervention (RRI)

Why a Substance Misuse Court?

Substance Misuse has a significant impact on society…

In 2016, NSPCC helpline received 152 calls from people in NI relating to Substance misuse.

In NI, the NSPCC made 394 referrals to external agencies relating to substance misuse since 2013.

Between 2001-2016 there have been 3,636 alcohol related deaths in NI Between 2006-2016 there have been 796 deaths related to drug misuse in NI

Why a Substance Misuse Court?

Substance Misuse has impact on society in

term of victims of crime.

For example, 77% of PBNI service users were deemed to have either

an alcohol or drugs related offending issues.

Substance Misuse Problem Solving Courts: Assessment Model & Care Pathway

Referral

• Court eligibility

• Referral by District Judge

01

Assessment

• Social Background & Offending/ Risk Assessment

02

Suitability /Individual Care Plan

• Individual Needs

• Contracting • Social

assessment

03

Court Review

• Submission of

joint assessment

• Review plan &

treatment plan agreed

04

Treatment

• Therapeutic treatment

• Substance testing

• Recovery/ relapse prevention

05

Interim/ Final Court

Review

• Case management progress

• Treatment

summary • Onward

support

06

Specialist Court – Judge McElholm – Derry/Londonderry Domestic Violence Team

Assessment for suitability

Risk Assessment

Adjournment for Intervention

Domestic Violence Problem Solving Court (NI)

Promoting Positive Relationships Programme (PPRP) or Building Better Relationships (BBR) Monthly reviews at Court

Successful completion & outcomes Role of Women’s Aid

Benefits of this approach

Domestic Violence Problem Solving Court (NI)

Are Problem Solving Courts Effective At…

1. Reducing recidivism during treatment? YES

2. Reducing recidivism after treatment? YES

3. Reducing time in prison? YES

4. Improving connections to treatment? YES

5. Saving Money? YES

Hope…

Hope for the individual

Hope for community &

victims

Hope for the family

Hope for the Criminal

Justice System

Gillian Montgomery

Assistant Director Probation Board for Northern

Ireland

Tel. No: 028 90 262400

Email: gillian.montgomery@pbni.gsi.gov.uk

Thank You