Brighton & Hove Adults Services Logo


Top of page

Size: View this website with small text View this website with medium text View this website with large text View this website with high visibility

9.3.3 Values and Philosophy of Support: Learning Disability Accommodation Service

In developing this procedure we have consulted with the following people:
LD Accommodation Managers
Care Standards Officer
Speech and Language Therapist

To be reviewed bi-annually.

AMENDMENT

This chapter was updated in April 2016.


Contents

  1. Mission Statement
  2. Underlying Principles
  3. Historical Context
  4. Regulatory Frameworks
  5. Dignity and Respect
  6. Choice and Control
  7. Rights and Inclusion
  8. Personalisation
  9. Tools/ Models of Delivery
  10. Positive Behaviour Support
  11. The Future


1. Mission Statement

The Learning Disability Accommodation Service aims to:

  • Provide Person centred support to people who have Learning Disabilities enabling them to feel safe and happy;
  • Encourage and empower service users to make their own choices and lead independent and stimulating lives;
  • Ensure service users are empowered to make choices, take risks, realise their aspirations and fulfil their potential;
  • Work in partnership with the people who use our services to deliver care and support to them based on the individual’s needs and wishes;
  • Recognise the importance of environmental needs when sourcing accommodation for the individual;
  • Work in partnership and with integrity to ensure the best possible accommodation solutions are explored to match the needs of our service user’s and to provide a homely space for them.


2. Underlying Principles

In supporting service users to achieve their potential Services approach the work they do from a Capacity point of view. That is that Service Users have the capacity to have increased choice and control in all areas of their life, that their services should be inclusive of their needs, and that this should be achieved with dignity, and respect.

In upholding these principles for individuals, Services should always try to be creative and think outside the box. If an instant solution to improving an area of someone’s life is not forthcoming other options should be considered and explored. Have other services developed alternative support options for Service Users in similar situations with similar needs? Are there other agencies and organisations who may be able to provide extra support and advice.

How increased choice and control may be practically implemented on a day to day basis will naturally differ from Service User to Service User depending upon their needs. Yet however small these changes may be, this should not diminish the increased empowerment this gives an individual over their life.

Safety and our Duty of Care must be considered at all times but this should be balanced against the opportunity for individuals to have increased choice, control, dignity, respect, and/or inclusion in their lives. Services should also consider Service Users level of capacity and their choice at times to make unwise decisions.


3. Historical Context

3.1 Community Care Act

The Community Care Act (2000) is seen as the beginnings of a move towards people receiving social care and support and having more choice and control over aspects of their lives. It specifically focuses on them as individuals and the services they use being more integrated in the local community and providers moving away from old style institutions.

3.2 Valuing People

Valuing People (2001) a white paper specific for people with a learning disabilities states that “People with learning disabilities are amongst the most vulnerable and socially excluded in our society. Very few have jobs, live in their own homes or have choice over who cares for them. This needs to change: people with learning disabilities must no longer be marginalised or excluded”. Valuing people sets out how the Government will provide new opportunities for children and adults with learning disabilities and their families to live full and independent lives as part of their local communities with four key principles:

  1. Rights;
  2. Independence;
  3. Choice;
  4. Inclusion.

3.3 Independence, Wellbeing and Choice

Green Paper Independence, Well-being and Choice (2005) stated as part of its vision that “services help maintain the independence of the individual by giving them greater choice and control over the way in which their needs are met” some of its clear outcomes for Service Users were:

  • Making a positive contribution;
  • Improved quality of life;
  • Exercise of choice and control.

3.4 Putting People First

Putting People First (2007) contains the government's vision of how personalisation of social care services will allow people more control over their own lives and the services they choose.

“Across Government, the shared ambition is to put people first through a radical reform of public services, enabling people to live their own lives as they wish, confident that services are of high quality, are safe and promote their own individual needs for independence, well-being and dignity”.

3.5 Our health, our care, our say

Our health, our care, our say (2007) white paper confirmed that “people want support when they need it, that they expect it quickly, easily and in a way that fits into their lives”.  They want adult social care services to consider their needs with a greater focus on preventative approaches to promote independence and wellbeing.

3.6 Valuing People Now

Valuing People Now (2009) has shifted 2 of the priorities of valuing people (2001) to focus on:

  • Rights;
  • Independent living;
  • Control;
  • Inclusion.
It also talks about personalisation and links this to Putting People First’s vision of “giving people more independence, choice and control through high quality and personalised services”. It emphasises the desires of the majority of people with learning disabilities to live ordinary lives as full members of their communities and encourages the use of public services that support them, rather than segregated services that isolate them.

3.7 Fulfilling and rewarding lives: the strategy for adults with autism in England

Fulfilling and rewarding lives: the strategy for adults with autism in England (2010) set a clear framework for all mainstream services across the public sector to work together for adults with autism to live more independent lives and find work.

  • A new National Autism Programme Board to lead change in public service set out in the strategy;
  • A programme to develop training with health and social care professional bodies;
  • Autism awareness training for all job centre disability employment advisors;
  • Guidance on making public services accessible for adults with autism, like improving buildings, public transport and communication;
  • A clear, consistent pathway for diagnosis.

3.8 Caring for our future: reforming care and support

Caring for our future: reforming care and support (2011) White Paper has two core ambitions:

  • To prevent, postpone and minimise people’s need for formal care and support. The system should be built around the simple notion of promoting people’s independence and wellbeing;
  • People should be in control of their own care and support. Things like personal budget and direct payments, backed by clear, comparable information and advice will empower individuals and their carers to make the choices that are right for them.

It has the following underpinning principles:

  • Health, wellbeing, independence and rights of individuals are at the heart of care and support;
  • People are treated with dignity and request and are safe from abuse and neglect;
  • Personalisation is achieved when a person has real choice and control over the care and support they need to achieve their goals, live fulfilling lives and connect with society;
  • The skills, resources and networks in every community are harnessed and strengthened to support people to contribute to their communities;
  • Carers are recognised for their contribution and are supported;
  • A caring, skilled and valued workforce deliver quality care and support in partnership with others.

3.9 Dignity

The Department of Health Dignity in Care Challenge aims to end tolerance of indignity in health and social care services through raising awareness and inspiring people to take action. The dignity challenge states we should:

  • Have a zero tolerance of all forms of abuse;
  • Support people with the same respect you would want for yourself or a member of your family;
  • Treat each person as an individual by offering a personalised service;
  • Enable people to maintain the maximum possible level of independence, choice and control;
  • Listen and support people to express their needs and wants;
  • Respect people’s right to privacy;
  • Ensure people feel able to complain without fear of retribution;
  • Engage with family members and carers as care partners;
  • Assist people to maintain confidence and a positive self-esteem;
  • Act to alleviate people’s loneliness and isolation.

3.10 Positive and Proactive Care

Positive and Proactive Care (Department of Health 2014) guidance provides advice on the use of restrictive practises when supporting individuals who present behaviours that challenge. It’s aim is to provide a framework within which Adult Social Care Services can develop a culture where restrictive practises are only used as a last resort. time. It identifies key actions that will better meet people’s needs and enhance their quality of life, reducing the need for restrictive interventions. It also sets out mechanisms to ensure accountability for making these improvements, including effective governance, transparency and monitoring.

3.11 The Care Act (2014)

The Care Act which comes into force in April 2015 covers 3 main areas, Care and Support, Care Standards, and Health.

The Act consolidates and modernises Care and Support Law, providing key responsibilities for Local Authorities in relation to:

  • Promoting individual well being;
  • Preventing people’s care and support needs from becoming more serious;
  • Promoting integration of care and support with health services etc.
  • Providing information and advice;
  • Promoting diversity and quality in provision of services;
  • Co-operating generally with its relevant partners, such as other local councils, the NHS and Police;
  • Co-operating in specific cases with other Local Authorities and their relevant partners.

A key aspect of the Act is around person centred care and support planning, making this a legal requirement. Person centred care and support planning puts people in the heart of their care and offers them the opportunity to take control and ownership of the process and outcomes of their plan. It is about making sure that care and support:

  • Is clearer and fairer;
  • Promotes people’s wellbeing;
  • Enables people to prevent and delay the need for care and support, and carers to maintain their caring role;
  • Puts people in control of their lives so they can pursue opportunities to realise their potential.

A key aspect of the Act is around person centred care and support planning, making this a legal requirement. Person centred care and support planning puts people at the heart of their care and offers them the opportunity to take control and ownership of the process and outcomes of their plan. It is about making sure that care and support:

  • Is clearer and fairer;
  • Promotes people’s wellbeing;
  • Enables people to prevent and delay the need for care and support, and carers to maintain their caring role;
  • Puts people in control of their lives so they can pursue opportunities to realise their potential.


4. Regulatory Frameworks

4.1 Care Quality Commission (CQC)

The Care Quality Commission (CQC) provides guidance that compliments the move towards more personalised services, giving greater control and choice to people about where they live and any support that they may need.

They “look at the quality and safety of the care provided based upon things that matter to people” including is the service:

  • Safe;
  • Effective;
  • Caring;
  • Responsive to people’s needs;
  • Well-led.

The Care Quality Commissions role is to inspect services. During an inspection they will:

  • Ask people about their experiences of receiving care;
  • Talk to staff;
  • Check that the right systems and processes are in place;
  • Look for evidence that the services isn’t meeting national standards.

A report will then be provided to the service stating their compliance and recommendations for actions.

4.2 Housing Commissioning Unit

The Housing Commissioning Unit administers the Supporting People Programme, which was launched on 1st April 2003. The programme is committed to providing a better quality of life for vulnerable people to live more independently and maintain their tenancies. The programme provides housing related support to reduce the likelihood of issues that may lead to hospitalisation, institutional care or homelessness. The primary purpose of Supporting People is to provide a wide range of services that provide housing-related support enabling people to move to independent housing or to assist them in maintaining independent living.

The Supporting People Objectives are to:

  • Provide a programme that delivers quality of life and promotes independence;
  • Provide services that are of a high quality, strategically planned, cost effective and complement existing care services;
  • Ensure the planning and development of services is needs-led;
  • Encourage working partnership of local government, probation, health, voluntary sector organisations, housing associations, support agencies and service users.


5. Dignity and Respect

Services should ensure that Service users are treated with dignity and respect at all times in accordance with how any individual would like to be treated by others. In practise this may include examples such as:

  • Ensuring dignity around personal care;
  • Preserving dignity at times of anxiety/exhibiting behaviours;
  • Individual personalities being respected and encouraged to flourish;
  • Cultural wishes are respected and supported;
  • Addressing individuals by they name not nicknames;
  • Using appropriate tone of voice when speaking to Service Users;
  • Respecting their values and life experiences.


6. Choice and Control

Service Users should be able to have as much choice and control over their own lives as possible, in as many areas as possible. In practise this would include examples such as:

  • Being able to deny entry to their space (bedroom or flat);
  • Being able to come and go as they please and have a front door key;
  • Their visitors being able to can come and go as they please;
  • Being able to say “no” to support offered (based upon capacity);
  • Having choice about the food they eat and being part of the planning, shopping and cooking process;
  • Having individual leisure activities;
  • Being able to personalise their rooms and being involved in this process;
  • Making decisions on house issues.


7. Rights and Inclusion

As citizens Service Users have rights under legislative law, these rights should be respected and upheld. In practise this may include examples such as:

  • The right to vote;
  • Tenancy rights;
  • Right to see information about themselves;
  • The right to make unwise decisions (base upon capacity).

Service users should also be supported to be included in all areas of their life both at home and in the community. Fundamental to inclusion is that Service Users are communicated with in a way they can understand and in a pace that is suitable for them.

  • Involvement in planning and undertaking household tasks and house projects;
  • That service users are involved in conversations and their opinions sort and incorporated into service provision;
  • That the space feels like the individuals home and is owned by them not staff;
  • That they are an active and valued member of the community.


8. Personalisation

In line with the Personalisation agenda described earlier, all Service Users should have increased choice and control over their lives and the services they access. Increased levels and development of Personalisation will develop through:

  • Broadening the access to Personal Budgets and self directed support;
  • Increase in choice and flexibility of services;
  • Increased choice of support providers;
  • Availability of Brokerage support.

In practise for our services, this means generating discussions at reviews, both in house and statutory, to look at all the options available to individuals in terms of their support provision.

Services should be personalised to each individual and service users should not be expected to change or conform to service expectations and/or limitations.


9. Tools/ Models of Delivery

As a service we use a variety of models and tools to help implement our values and philosophy of support, including:

9.1 Support Planning

Our process of Assessment, Planning and Review are the building blocks of how services meet our values and philosophy of support. This starts at the beginning of their time in the service and continues throughout the review of their support. The policy states “In every part of the assessment, planning and review process the Service User must remain at the centre. They must be consulted with and involved in all processes at all times, in a way that they can understand and at a pace that is suitable for them”.

The policy also states that Support plans “should also focus on achieving agreed outcomes. So whilst detailing what support the person may currently require for increasing opportunities, managing risk or meeting an identified need it should also identify opportunities for further involvement, development or an increase of independence”.

9.2 Person Centred Planning

Person Centred Planning is a process that looks at what is important to the individual in their life. There is no set idea of how or what person centred planning or plan should look like but the over arching ethos, whatever the approach, is that it is designed specifically for the service user themselves and is used to influence their support package.

The APR policy states about a PCP meeting that “though the meeting should be guided as much as possible by the Service User themselves as part of the process we should look to discuss and consider how involved that individual is in all aspects of their service provision. This can include areas such as”:

  • Their support plan and reviews process;
  • Their home environment;
  • The activities they can access and those they want to undertake;
  • Their future;
  • Housing options;
  • Employment options;
  • Health care decisions; 
  • Health and Safety;
  • Safeguarding;
  • Policy and procedures;
  • Risk assessments;
  • Staff recruitment.

9.3 Positive Psychology

Positive Psychology is the psychology of strengths and well-being, and fundamentally about being happy. There is extensive research available that states all individuals, regardless of whether they have a Learning Disability or not are happier when they undertake activity’s that promote what’s known as “flow”. This is activities in which we get absorbed and lose all track of time. Services are supported by the Behaviour Support process to encourage activities that promote flow.

9.4 Positive Behaviour Support (PBS)

Positive Behaviour support is a model that has been shown to be effective in supporting people with learning disabilities and challenging behaviour. PBS is mixture of value base and research proven to achieve positive changes in an individuals behaviour. See also Section 10, Positive Behaviour Support.

9.5 Active Support

Active Support is process by which to facilitate an increase in meaningful activity, opportunities and skills for people with learning disabilities. The aim is to provide the right amount of assistance at the right time to achieve constructive engagement in social, personal, household, leisure or other typical activities of daily living. In practise this means encouraging the individual to do as much for themselves as possible in all areas of their life whilst providing the support they need. The ethos of active support runs through support planning and person centred planning.

9.6 Inclusive Communication

Inclusive Communication is a term used to describe the use of pictures, objects, signs, gestures and spoken word to enable people to express themselves and understand what is being said. It was set up by Speech and Language Therapists in line with the aims and objectives of Valuing People Now (2009) and the 5 Good Communication Standards (Royal College of Speech and Language Therapists 2012).

9.7 Intensive Interaction

Intensive Interaction is an approach to encourage communication with people who may be difficult to reach or who are withdrawn, in particular people who have severe learning disabilities, profound and multiple learning disabilities and/or autism. The aims of Intensive Interaction are:

  • To enjoy the essence of wonder, joy and fulfilment of communication and relationships;
  • To teach the fundamentals of communication through turn taking;
  • To open up the a variety of experiences with others;
  • To share space with someone in a non-demanding way and on their terms, without an agenda or a fixed task to achieve;
  • To eventually reduce challenging behaviour through better understanding of the individual and what they are communicating.

Intensive Interaction is designed to meet the learning and social needs of people who are developmentally still at early stages of communication development. It is about tuning into the person by listening and observing how and when a person is trying to communicate and responding at their level of understanding; sometimes this involves borrowing some of the person’s behaviours.

All of these models and tools provide the framework to which the staff in our services enable service users to develop and grow. As models of support they can only work in an environment that fundamentally supports and values; choice, control, inclusions, respect and dignity.


10. Positive Behaviour Support

As a Service we support a number of Service Users who can present behaviours that challenge. Such behaviours can mean they are more vulnerable to a decrease in their quality of life, their engagement in the community, peer networks, choices that they have etc.

It is our commitment to ensure we meet the needs of all our service users. To do this we must have a robust, consistent approach that is open and honest and remains up to date with current thinking, research and practise.

The aim of PBS is to increase individual’s quality of life while reducing levels of challenging behaviours. This is achieved through utilising a range of tools and techniques which focus on the function of the behaviour for the individual. What is it that they gain from it, how is this reinforced and what interventions can be used to adapt or change the behaviour to ultimately improve the quality of life of the individual. It should be remembered that this is not necessarily just about changing the individual and their behaviour, it is often also about changing the way we respond to individuals both in our behaviour and communication and/or changes to their environment, routines and choice.

10.1 Organisational Approach to PBS

Ensuring a robust strategic implementation of Positive Behaviour Support involves a level of responsibility of all staff including Senior Managers, Managers and Support Staff.

Responsibilities of Senior Managers:

  • Provision of strategic leadership and guidance on PBS;
  • The development and updating of a service wide strategy (guidance) on the approach to implementing PBS;
  • Reviewing and changing service delivery where needed;
  • Representation at cross sector forums and networks.

Responsibility of Managers:

  • To keep up to date on training;
  • Cascading information to staff;
  • Role model and monitor good practise;
  • Provision of support for staff;
  • Seeking support from professionals when needed.

Responsibilities of Staff:

  • To read and understand information provided on PBS;
  • Actively engage in training and discussion on PBS;
  • Maintain consistency and professional practise;
  • Question/report poor practise.

In practise, implementing PBS in Services involves the utilisation of a number of tools and techniques, procedures and practises including:

  • In house Support Planning process (and associated forms);
  • Specific Behaviour Support Planning;
  • Active Support;
  • Intensive Interaction;
  • CB incident recording;
  • ABC charts;
  • Restrictive Interventions;
  • Functional assessments;
  • Monitoring of behaviours/ health etc;
  • Restrictive Practises procedures;
  • Dols procedures.

All staff receive training in relation to PBS to understand the principles of PBS and associated tools and techniques. This is undertaken regularly to maintain their skills and knowledge and ensure that a consistent best practise approach to the implementation of Positive Behaviour Support is achieved across all of our Services.

As a Service we can also access support, advice and guidance from the Learning Disability Behaviour Support Team. The team is made of specialist staff who are trained in Applied Positive Behaviour. We are also actively involved in the Challenging Behaviour Network, a cross sector forum for the discussion and sharing of information relating to the area of PBS and improving practise.

10.2 Policy

Alongside this guidance, the Service adheres to a number of related policies including:

  • The Integrated Learning Disability Physical Intervention Policy;
  • The Adult Social Care Restrictive Practise policy and Dols;
  • Learning Disability Accommodation APR guidance (Assessment, Planning and Review).

It is important that staff and Managers read and understand these in conjunction with this guidance document and PBS information.


11. The Future

The future of empowerment for service users lies with the continued development of the Personalisation agenda. In practical terms for our Services this means a greater emphasis on reviewing of needs, to consider how individuals can have greater choice and control in their life. For services not to be considered as a home for life but that service users should be encouraged to move on to more independent living where this is appropriate. Self directed support and personal budgets will be fundamental to the future delivery of increased choice and control, as will the overall development of services to meet more individual needs and fit within a changing environment with reduced resources.

The personalisation agenda states “The work on direct payments and individual budgets, alongside that of In Control, are crucial to delivering greater personalisation, choice and improved quality. They are not separate initiatives or fleeting experiments, but fundamental components of a future social care system.”

The personalisation agenda also states the way forward will involve:

  • A common assessment process of individual social care needs with a greater emphasis on self-assessment. Social workers spending less time on assessment and more on support, brokerage and advocacy;
  • Person centred planning and self directed support to become mainstream and define individually tailored support packages;
  • Personal budgets for everyone eligible for publicly funded adult social care support other than in circumstances where people require emergency access to provision;
  • Direct payments utilised by increasing numbers of people.

As Service Users have an increased choice of services to meet their needs and an increased range of options of how to purchase these services, they become, in a sense, their own commissioners.

As a Service Provider in the future we have to be prepared to meet these challenges and respond flexibly and responsively, treating service users as empowered customers.

End