DESIGNING HOMES FOR PEOPLE WITH LEARNING DISABILITIES AND CHALLENGING BEHAVIOURS

OVERVIEW Background/Context – why did we develop a local guide? Overview of the Guide Applying the Guide Benefits Lessons Learned Case Study

BACKGROUND & CONTEXT WHY DEVELOP A LOCAL DESIGN GUIDE? Local market dominated by residential and nursing care services, offering traditional models of care that limited opportunities for independence and control. High levels of out of borough placements High levels of inappropriate or avoidable admissions to residential care settings In 2005/2006 Enfield developed an accommodation strategy for people with Learning Disabilities that set out to: - increase good quality, accessible supported living options locally; - enable people with complex and challenging support and care needs to be cared for within independent living environments that facilitate privacy, choice and control; - enable people with complex and challenging support and care needs to be cared for closer to home, maintaining family and friendship networks

BACKGROUND & CONTEXT WHY DEVELOP A LOCAL DESIGN GUIDE? Following development of the Learning Disabilities Housing Strategy significant investment to improve independent living options for people with learning disabilities. From 2005 – 2010 over £30 million external funding was secured, resulting in the development that included over 70 units of supported housing for people with learning disabilities. Development through remodelling of existing buildings, including listed buildings posing many development challenges, and new builds. The opening of Churchbury Lane, in significant shift in provision to improve the life and increase independence for some of our most profoundly learning disabled people living in the borough. Resulted in the successful relocation of the last four residents from our long-stay hospitals with severe learning disabilities. Life opportunities transformed. Since developed a number of schemes designed specifically for people with more challenging behavioural needs, including Ridge End House, (once a residential care home sited in a Grade 2 listed vicarage). Developments have provided a real in borough alternative for vulnerable people once required to reside outside of borough within residential care environments.

BACKGROUND & CONTEXT WHY DEVELOP A LOCAL DESIGN GUIDE? At this time, comprehensive guidance on designing homes for people with learning disabilities and challenging behaviours relatively sparse and not targeted at architects developers. Required a single, comprehensive and accessible guide to: - raise awareness about the impact of design and environment on the lives of people with learning disabilities and the success of independent living; - share best practice and clear design guidance based on lessons learned and the views of service users and their carers; - provide a basis for constructive dialogue with developers to improve supported living environments  Decided to develop a local guide for challenging behaviour – this followed the completion of Enfield’s Wheelchair Design Guide.

DEVELOPING A LOCAL GUIDE A collaborative approach between health and adult social care services, local support and care providers, housing, planning, service users and their carers Based on lessons learned from developing supported housing for people with learning disabilities and challenging behaviours, and consultation feedback from providers of support and care, and carers themselves.

AN OVERVIEW OF THE GUIDE Understanding challenging behaviour and links with autism General principles of design, includes inside and outside space plus location with the community Interior decoration and furnishings Tips for effective and safe support

APPLYING THE GUIDE Influencing the development of new housing Central to planning policy including the LDF Core Strategy. Mechanism for engaging developers of new housing through the planning system and creating a productive dialogue. Share with partners at the start of development process so expectations are transparent – and include in tender documentation. Not used in isolation - used in addition to service user site visits, service user design selections, workshops with developing partners, architects and service users to increase understanding of user needs. A resource for Carers The guide can be given to parents and carers before they are seen by a professional and changes in the support they give can happen immediately. It’s written in a easy to read format and gives carers information on why their family member may be behaving in a certain way in different spaces in their homes. Many design principles can be incorporated into peoples homes with minimal cost and disruption to family life leading to parent/carers self managing the need and risk Occupational therapists use and talk through the guide with carers during their assessment. Carers have been known to adapt their home and the way they use it immediately

BENEFITS Financial Benefits e.g: minimisation of void periods and associated costs to landlord and local authority reduction in re-fit costs and DFG grant spends facilitates the success of independent living placements reducing reliance on residential care models and crisis accommodation (supporting the prevention agenda) Locally, 86% reduction in residential care placements over a 5 year period. Time Saving Benefits e.g: design right first time reduces design meeting repetition and service user/carer consultation fatigue Relationship Benefits e.g: facilitates productive and constructive working between the local authority and development partners a positive tool for engagement with unknown providers to support market improvement Benefits to People with Learning Disabilities and their Carers e.g: facilitates smooth transition between services improved safety for services users with challenging behaviours and their carers effective tool for parents and carers as part of the moving on process

BENEFITS (CONTINUED) Strategic Benefits e.g: Enfield is now the top performing borough in terms of number of people in settled community accommodation (NI145) We’ve significantly reduced the number of people in OATS and continue to reduce numbers in terms of referrals to residential and nursing care Strategic tool for raising awareness of the needs of people with challenging behaviours Contributed to Enfield achieving Beacon Award for supporting independent living in

LESSONS LEARNED Lessons learned in the application of this guide (there were many!): Not to be used in isolation Not ‘one size fits all’ – although looking to develop ‘core requirements’ Nominations must be appropriate – good dialogue with Housing Panels at an early stage Whilst useful for people with challenging behaviours, the guide opposes many features of wheelchair design guidance – need a common sense approach to hit the right balance for people with multiple disabilities Early planning – limited use half way through build

CASE STUDY RIDGE END HOUSE

FURTHER GUIDANCE Since the development of Enfield’s Guide in 2007/2008, much guidance has been developed in this field that is worth referring to including: Title:A Practical Guide for Registered Social Landlords: Housing & Autism Spectrum Disorder Author: Glasgow City Council March 2010 Title: Living in the Community: Housing Design for Adults with Autism Author:The Kingswood Trust March 2010 Title:HCA non mainstream housing design guidance: Literature review Author:HCA January 2013

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