Shared Approach: 3 keys (and a certain conceptual framework)

Before we trip into 2011 let's make a quick return to 2008 and the three keys to the Shared Approach in mental health assessment [NIMHE, 2008] which are copied below.

In between each one I have highlighted how the Health Care Domains Model can contribute ...

1) active participation of the service user concerned in a shared understanding with service providers and where appropriate with their carers;

In the end (or at the beginning!) a model of care or assessment tool is only as good as the person using it.

To progress with key #1 there are in fact two locks to open. These are in the form of 'using' and 'user'. H2CM incorporates the individual from the outset. The model encourages consideration of the client's beliefs, preferences, and experiences ... Can the client and carer actually use the model themselves to help understand their needs, their care plan and interventions? Is there a homework exercise there for them?

Do they have capacity to decide? Do they need support - an advocate? How do we ensure the carer is factored into the care equation? Well, in h2cm that's through the social domain.

2) input from different provider perspectives within a multidisciplinary approach, and;

Do you know what "different provider perspectives within a multidisciplinary approach" look like?

Well just envisage that for a few moments. ...

A scary exercise, eh?

In order to take those different perspectives and integrate them a common framework is surely needed?

Artists are lucky they use perspective as an integrative lever on paper, canvas, or whatever medium.

Clients, carers, health and social care professionals need a canvas of their own, BUT one that is sufficiently generic and agnostic to be 'owned' by all. 

3) a person-centred focus that builds on the strengths, resiliencies and aspirations of the individual service user as well as identifying his or her needs and challenges. NIMHE (2008)

H2CM can support and foster person-centred care. The model is situated: there is one (changing) situation with the person at the center. Whatever the context -

strengths, resilience, stresses, vulnerabilities, aspirations, needs, challenges

- the care domains model is fit for purpose. Health and social care is dynamic, in person-centred care that focus needs to change accordingly. Our assessments and evaluations need to resolve the SCIENTIFIC, SOCIOLOGICAL, POLITICAL, INTERPERSONAL and SPIRITUAL dimensions of care while assuring the BIG picture.

Reference:
The National Institute for Mental Health in England (NIMHE) and the Care Services Improvement Partnership. 3 Keys to a shared approach in mental health assessment. London: Department of Health; 2008.
Available from: http://www.3keys.org.uk/downloads/3keys.pdf

Concept albums and voice signatures

In .net magazine (Sept 2010, p.42) Jeffrey Zeldman makes reference to the web we grew up with being as obsolete as concept albums. It's true that music distribution has suffered a series of step-downs from the format that previously conveyed the concept album visually. Many LP covers are classics in themselves. The switch from LP record covers, to CD, and then to mp3 ... downloads means concept albums are indeed fewer; but maybe the reduced visual impact means that new concept albums are less noticed too?

Could the concept album experience a renaissance: online? Story telling has never been completely lost. The web and world's media depends on content: the appetite for stories and music is voracious - Hollywood is famished. Successful narratives prove their worth by doing surprising things with concepts that prompt re-telling down the ages. The concepts may change, but the structures and elements of the stories are timeless.

Concepts obviously remain central to making sense of everything: self, others, the world and the future that includes the new web. In the health career model we have a concept album. It is a care concept album comprising several snapshots or frames. It is also person-centred.

It has a voice that has its own musical signature, it is unique - that is if the album is truly person-centred and listened to.

.net September also includes a brief interview with the creators of The Specials website, which takes the form of a docu-soap about five friends with learning disabilities.

When we listen stories can be told:

great things can follow.

Music Gym - flexes its muscles

Hi,

My name's Matt, and I'm the Roadshow Coordinator for Decoda with some information which I hope will be of interest to those of you in or around the area of Lancaster and Preston.

Decoda have been successfully running a Music Gym down in Hastings for the past five years, continually developing and refining their techniques and technologies, whilst building a rapport with those who attend week after week. Using an innovative combination of music, images, space and fun the Music Gym provides an effective, flexible platform to engage and entertain people with a variety of complex needs. It’s also a great opportunity for parents, carers and those they care for to meet others from the local area and socialise. Others have described us as:

'fantastic use of colour and music, very interactive and inviting.'

'A really intriguing and dynamic approach'

'An excellent resource – we need more like this.'

'A great range of innovative, creative equipment... lots and lots of fun.'

'... a wonderful innovative idea.'

We have been invited to bring the Music Gym to Lancashire this month, and so we’ll be at the Salt Ayre Sports Center in Lancaster on the 16th and 17th of August, and at the Caritas Deafway home in Preston on the 18th [Deafway, Brockholes Brow, Preston, Lancashire, PR2 5AL].

If you would like to see the gym in action prior to making a decision (Or just see it in action without attending), I see no reason why you would not be allowed to observe any of the sessions we’re holding at the Salt Ayre. I appreciate that it is very difficult to form an opinion of what we do without seeing it in action, and this is a really good chance to do so. The 16th has been set aside for children under 16 years of age, whilst the 17th is for adults. Preston is undecided to be totally honest, we were contacted towards the end of last month, and are in the process of ironing out the final details. One benefit of this is that it’s an ideal date for those individuals who require a less busy venue, as we have not that long to publicise it. It is however a smaller venue than the Salt Ayre, so we may not be able to have our full facilities on offer on that date.

The days have been divided into 5 slots each as follows: 10.00-10.45 11.00-11.45 12.00-12.45 13.00-13.45 14.00-14.45

From our experience in Hastings, I would predict that the 11.00 slot will be the quietest, whilst the 14.00 slot will be the busiest, should that have any bearing in your decision.

In our continuing efforts to bring this to as many people as possible we are offering these places at £7.50 each if booked in advance £10 at the door (carers come free), additionally where this may be helpful, siblings can attend the session for £2.50. This is a great opportunity for people in the local area to get together, try out the facilities and enjoy the real benefits of the Music Gym.

Places can be booked online http://www.decoda.org/node/50 by phone or by post (contact details below).

If you require any more details, or have any questions at all please do not hesitate to contact me roadshow@decoda.org

Many thanks, Matthew Saunders, Roadshow Coordinator

Decoda - a social enterprise benefiting the local community South East Coast Regional winners of the Innovative Health and Social Care Technology Award at the NHS Health & Social Care Awards June 2009

Theaklen House Theaklen Drive St. Leonards on Sea TN38 9AZ Tel: 0845 2938354 websites: www.decoda.org www.musicgym.org www.myspace.com/decodamusicgym www.soundtherapy.org.uk BBC's South East Today film about the Music Gym is at http://www.youtube.com/watch?v=8j7v7pQ9kYQ

My source:
Foundation for People with Learning Disabilities

New challenging behaviour charter launched

I noticed the item below (with links and images added here) on the Foundation for People with Learning Disabilities Forum. It makes a very important point:

"The label 'challenging behaviour', has become misused over time."

My worry is that this finding is not just relevant to individuals with learning disability and their families, but other groups.

People with dementia, especially in the latter stages can present with behaviour that is increasingly described as 'challenging'. Care facilities are being commissioned and designed with the requisite care, staffing and environment to provide care for people in an effort to provide the highest quality and standard of nursing care.

To some extent these are distinct groups with specific needs. So the use of 'challenging' in one context obviously has a different currency and meaning in another. Whilst the practise and care environments may be separate, is there no place where cross-over may occur? I remember a local RCN meeting presentation that highlighted the demographic trend of dementia within the learning disability population.

To start a painting we often start with a wash:
efficiency - puts a broad brush in the hand.

As we aspire to provide person-centred care
what type of brush do you hold?

We paint with the words we use - take care.

---

The Challenging Behaviour - National Strategy Group has launched a charter to promote the human rights of individuals with learning disabilities who are perceived as challenging.

Up to 27,000 people with learning disabilities in the UK may have been given a label of challenging behavior, resulting in this group of people being - stigmatised and socially excluded denied the right to ordinary lives in the community, to education, recreation and employment placed in institutional settings a long way from home and families.

The label challenging behaviour, has become misused over time. Rather than being used as a term to encourage carers and professionals to understand the underlying reasons for a person's behaviour, 'challenging behaviour' has been used as a diagnostic label, viewed as being intrinsic to the person.

The Challenging Behaviour - National Strategy Group want people (and organisations) to sign up to the charter to register their support for the principles it contains and to commit to action to improve the lives of children and adults who are labelled as challenging. We need as many people as possible to support us, so please ask your friends and family to sign up too.

To read the charter, including an easy read version visit:

http://www.challengingbehaviour.org.uk/

ENDS

What is the Challenging Behaviour - National Strategy Group?

The Challenging Behaviour - National Strategy Group (CB-NSG) was launched on November 7th 2008. The CB-NSG is a key national group to address the needs of children, young people and adults with learning disabilities whose behaviour is perceived as challenging.

Members of the CB-NSG include family carers, representatives from the Department of Health, Royal College of Psychiatrists, British Psychological Society, Royal College of GP's, NHS Trusts, researchers, service providers and a range of practitioners, regulators, commissioners and third sector representatives. The group is action and outcome focused and comes together twice a year to monitor progress, share best practice and develop coordinated action plans.

What is challenging behaviour?

"Behaviour can be described as challenging when it is of such an intensity, frequency, or duration as to threaten the quality of life and/or the physical safety of the individual or others and it is likely to lead to responses that are restrictive, aversive or result in exclusion." (Challenging behaviour - a unified approach; RCPsych, BPS, RCSLT, 2007)

Challenging behaviour is things like hitting your own head against a wall, pulling curtains down or pulling someone's hair. Often people do this because they cannot communicate with words and they have little or no choice and control over what is happening to them. How do I find out more?

To find out more about the Challenging Behaviour National Strategy Group, please refer to 'All change' the Summer issue of 'Challenge' today. This issue focuses on the work of the National Strategy Group and includes articles from Dr Roger Banks (Consultant in the Psychiatry of Learning Disabilities), Jackie Edwards (Family carer) and Bob Tindall (United Response).


'Challenge' is the newsletter of the Challenging Behaviour Foundation and is available free of charge by emailing: info at thecbf.org.uk or downloading from www.challengingbehaviour.org.uk

Helen Marron
The Challenging Behaviour Foundation
Email: info at thecbf.org.uk

Learning Disability & Hodges' model

It is Brian E Hodges who created Hodges' model in the early 1980s and one of his qualifications is RNMH - Registered Nurse for the Mentally Handicapped. Today this course and qualification is known as RNLD, that is - Registered Nurse for Learning Disability. What has not changed is the foresightedness and need for a political care domain within the model.

You might well ask:

What is so foresighted about that?

Well a moments reflection and we can soon appreciate the extent to which the following have changed since the early - mid 1980s, not only in terms of theory, policy and practice, but attitudes also:

• learning disability - independent living
• human rights
  
• institutionalised care
• role of medication - side effects, consent
• mental capacity
  
• epilepsy
• educational opportunity
• special needs
• social inclusion
• nurse training
• social care
• outcomes directed care
  

The foresight that Brian extended in realizing the opposition of intrapersonal - political retains its relevance today. There is still so much to do.

There is much more that the existing and any new website could offer in supporting the care agenda, its delivery and refinement for this group of people and their families. It pains me that to date there is a gap here on W2tQ (a paltry six tags), website and links content. By rights the links pages deserve a specific listing for this client group, either in the intrapersonal or political domains. What do you think? More than this though what future content types might support the care, welfare and well-being of people with a learning disability? If you have any ideas, suggestions, or guidance to offer please get in touch.

Additional links:

British Institute of Learning Disabilities
BILD 2010 Conference: 5 to 7 May 2010 – The Grand Hotel, Malahide, Dublin
Centre for Studies on Inclusive Education
Foundation for People with Learning Disabilities
Mencap

1st Contact: ET and care on the front line

ET as in 'extraterrestrial' may seem remote from nursing and health care, but where there's a will....

Health and social care appears to become ever more specialised with each turn of the policy machine. People's lives are experienced as being ever more complex. Health care is filled with uncertainty and the public present with multi-diagnostic, person-centred, choice bearing, (usually) recovery directed problems, needs and strengths.

Pity then the care workers on the front line, at the point of 1st contact. Like the baseball catcher it helps if they can field the knowledge and skills required to cover physical, mental health and possibly learning disabled clients. You have to hope that coaches recognise that Hodges' model can help the team be aware and fully prepared to cope with 1st contact supporting and facilitating what follows. So, how does your team get to grips with complex care?

Additional links:

Baileff, A. (2004) Developing high quality first contact nursing in Southampton NHS Walk-in Centres. At, Innovations in Partnership, Practice and Education, 3rd Annual Scholarship Conference, Portsmouth UK, 2 Jul 2004. Southampton, UK, University of Southampton. http://eprints.soton.ac.uk/9197/

Declaration of Principles Concerning Activities Following the Detection of Extraterrestrial Intelligence http://www.setileague.org/general/protocol.htm

Image and source: Louisville Slugger OXFB Omaha Pro Series 13 Inch First Base Baseball Mitt from http://www.anacondasports.com/

Physio-Political ... musings, songs and dances...

Just as the weekend dawned I shared Hodges' model as a loop-the-loop when it comes to interdisciplinary crossover and cross-fertilization. In that post I ventured that PHYSIO-POLITICAL is probably the one that is least familiar in health. What do you think - the four candidates being -

SOCIO-POLITICAL
PSYCHO-SOCIAL
PSYCHO-PHYSICAL
PHYSIO-POLITICAL?

If I had to justify PHYSIO-POLITICAL as least familiar, it is one of the most obvious individually; in that if you lose your freedom of movement, or freedom of expression and self-determination you are going to make a real (rather on-the-spot) song and dance about it.

Perhaps this is why it is only in the past few decades that disability rights and disabled access have come to fore in health and social care and government policies and law. There is also a realisation with ageing populations the extent to which PHYSIO-POLITICAL impacts on our quality of life. If you cannot transfer from chair to toilet let alone walk - that spells 'trouble'. This is a double-whammy when allied with the PSYCHO-PHYSICAL, suddenly cognitive abilities also enter the frame.

The 'PSYCHO-PHYSICAL' is mentioned in Gardenfor's book Conceptual Spaces (more on that to follow too), which set me to wonder that each of these disciplinary fields needs to be revisited regularly in policy terms. For example, bound within the socio-political is economics with the problem of poverty ever present in the news.

For individuals with learning disability from a psycho-physical perspective they may be further compromised with the social emphasis on visual, health and ICT literacies and the information society plus a reduction in the meaningful activities they can pursue. This is a difficult debate (raised in the literature I notice), but one that needs to be addressed.

If people also lack the mental capacity - PSYCHO-POLITICAL - to make decisions for themselves then PHYSIO-POLITICALLY speaking they will depend on others to make that song and dance on their behalf.

(I never expected to get so caught up with hyphens - weird that - when I originally selected the domain name for the website over a decade ago I used a hyphen. ...)