Residential care, rehabilitation and support for adults with learning disability

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(Supportive Help Attaining Realistic Effective Development)

To share expertise, knowledge and experience, to inform, involve, teach, train and empower.

Assessment

Castlebeck believes that human development/progress does not occur in a vacuum. We carefully assess the conditions in which the service user's development is likely to take place and/or is inhibited before attempting any intervention. The aim of the assessment is to ascertain the support and help required by the service user to gain progress, development and independence.

Aims / Outcomes

To pursue the least restrictive, least aversive, most socially acceptable, most clinically valid and most effective means to develop the service user. The SHARED Approach incorporates holistic/humanistic approaches, social learning theory, behaviour profiles and other associated psychological therapies, utilising the Care Programme Approach and Person Centred Planning. Other models, research and considerations are utilised which may "'better fit" ' with the individual's wants, likes, needs, rights and development. Castlebeck pursues, as a minimum, the following outcomes:

Speed & degree of effect of interventions; long term effect; appropriate behaviour shown across a number of different settings and people (generalisation); social and clinical validity; increased quality of life; rehabilitation towards a community setting.

Process 1: Environmental Tuning

An attempt to change the conditions that may stimulate inappropriate responding - "to smooth the fit" between the person and all that surrounds him/her. This involves potential adaptations of:

Settings	Age/functionally appropriate, physical arrangements of room, materials, sequence/timing of activity, organisation etc.
Interactions	Interpersonal factors - peer respect, cultural differences, need for socialisation, attention requirements, choice, equality etc
Instructional Goals	Attainable, dependent on ability, challenge v difficulty etc.
Pollutants	Distractions, disturbances, noise, overcrowding, perceived threat and other negative effecting stimuli
Population	Characteristics of others, nature of others' behaviours, number of people, age/gender mix, skill mix etc

Process 2: Positive Programming

(Teaching a new set behavioural skills, via systematic instruction and modelling, to increase social repertoire and to facilitate social integration)

This is very much the heart of Castlebeck's ethos. Many of the service user's excessive behaviours are a result of skills deficits e.g. aggressive response to frustration as a result of deficit in ability to cope/tolerate. Castlebeck provides Positive Programming within our Day Service provision. The teaching/training is centred on:

General Skills	Everyday Life Skills - Independence
Equivalent Function	Appropriate ways of behaving to reach function that was met by inappropriate behaviour
Related Function	Replacing function if inappropriate behaviour with a relevant positive function
Coping/Tolerance	Dealing with the "'context'" that may lead to inappropriate behaviour e.g. rehearsal, avoidance. Means/End Thinking

Process 3: Behavioural Principles/Treatment

Behaviour can be triggered by factors that help to prop/prompt it (stimuli). It is usually maintained via the consequence of reward/reinforcement. Castlebeck utilises Stimulus Control, Instructional Control and Schedules of Reinforcement with the service user in order to maintain effort, achievement and appropriate behaviour. We also can use Behavioural Modification/Psychological Therapies to: decrease, increase or maintain a response strength and/or develop new behaviours.

Process 4: Coping and Tolerance (CAT) Programme

The CAT programme is devised to help prevent excessive behaviours reaching "crisis" point. However, it can also be used during and/or after an incident of excessive behaviour. It is, in essence, the management of excessive behaviours. The CAT programme is a tool, for the service user and the staff, to ascertain the rationality of the behaviour, to maintain safety and dignity, and to create the Means/End Thinking to prevent future occurrences. CAT can involve: Active Listening; Stimulus Change/Control; Cognitive Elements; Relaxation; Rehearsal; Inter-Positioning; Capitulation and Treatment Review.

Care Plan Design

Each service user will has their own individual Care Plan. The service user is involved in its design, creation and content. The Care Plan will specify the methods to be used to achieve agreed short/long term goals and outcomes. Before implementation takes place Castlebeck ensures that the following Therapy/Treatment issues are raised:

Have the goals been adequately considered? Has the choice of treatment methods been adequately considered? Is the service user's participation voluntary and when another person or agency is empowered to arrange for therapy, have the interests of the service user been sufficiently considered? How will the adequacy of treatment be evaluated? How will the therapist refer the service user to other therapists when necessary? Is the therapist qualified to provide treatment? Are interventions legal/ethical? Who has accountability/responsibility? Is confidentiality protected? Are there advocacy needs?

People Skills & Resources

Castlebeck is aware that it is fundamental to have the correct support in place if development is to occur i.e. competencies/experiences/qualifications of the people involved and the time/place/equipment used. We have the necessary people to pursue General Skills Training, Specific Skills Training (deficit & excessive behaviours), Multi- disciplinary Teams etc. We very much utilise other's relevant and helpful to the service user (Circle of Support) i.e. family, relatives and friends.

Evaluation

A multi-disciplinary approach is taken to care delivery and evaluation. Clear goals and outcomes are evaluated by the team using CPA meetings, Case Conferences, Clinical Reviews and ad hoc reviews. Information is shared with all stakeholders, including the service user. Progress can be illustrated through the use of: Social Functioning Progress Charts; behavioural graphs showing frequency, intensity and duration of excessive behaviours and the comprehensive written report which incorporates HoNOS.