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: [email protected]
Thank You