Periodic Service Review “A tool to influence Therapeutic Outcome” Andy Rivett Lead OT Learning Disability Challenging Behaviour Services Cate Reeves Specialist SLT, Learning Disabilities Intensive Support Team

Aim’s Discuss Barriers to interventions Periodic Service Review (PSR) as framework for change Theory of PSR Practical examples

Barriers to intervention What do we do ? Who is our client ? Barriers to making it happen with staff teams.

Human services Interventions are generally not a simple uni-professional product transaction e.g. pill or equipment prescription Interventions often rely on a complex interaction of Human Services PSR is based on a principle that effective Human Services require behaviour management approach. PSR incorporates Organisational Behaviour Management and Total Quality Management theory

Theory of PSR Read Parsons Green Where pervasive problems exist, the primary cause is ineffective supervision and management Christian and Reitz Management practice is the number one reason why there is a discrepancy between the development and implementation of treatment plans

Changing perspective A HCP recommendation or “prescription ” is not the primary outcome leaver of change Human services require a behavioural “ABA” approach PSR combines 2 opposing Theories Organisational Behaviour MGT (Top Down) TQM total quality management (Bottom Up

You can only control rats as much as you let them control you …

Construction a PSR Establish Outcome / Vision Engage the client in goal setting Engage the Team Operationalise “Quality Outcome “ measure

Outcome Focus Item Responsibilities 1   1 Have we helped you find a new community activity to do in the past week? 2. Did we make a picture of your new activity so you can choose to do it again?

Establish key process standards Operationalise key process strategies to support the goal (Inclusive of your recommendations / treatment protocols) SMART Multi disciplinary Service or Client based

Process Standards Item Responsibilities + / O Comments 1   1 Have staff helped you choose what you want to do with your visual planner today? 2. Have you been told who your main Support Worker is 3. Did your last Support Worker tell you what is happening “Now” “Next” Then” and continue to do this as you move from one activity to the next? 4. Did your staff check with you once during the past half hour if you wanted “more / finish /help/” to do something different, using key Makaton signs?

Operationalised Standards A+ is scored if staff are observed to support Jo to choose activities and complete visual planner, or visual planner is up to date, reflects activities in progress, and Jo reports experience of choosing. A+ is scored if Staff are able to articulate their allocation time, and that Jo knows who is completing planned activities with her A+ is scored if staff are observed to verbally update what is happening “Now” “Next” and “Then” when activity is completed, or Jo is able to state this when questioned A+ is scored if during a 30 minute period of support staff were observed to use Makaton to offer “More / Finish / Help / Different” or when questioned were able to demonstrate signing and when to use it A+ is scored if Jo is supported in an environment which is face to face with staff, or inspection of activity room indicates that this is possible A+ is scored if daily recordings indicate participation in new activity in past week, or Jo is able to state a new activity completed when questioned A+ is scored if on count of visual schedule there is one more symbol present than recorded on PSR from previous week (Starting point 7) A+ is scored if when staff offered help / more / finish / Jo time, they responded immediately in a manner congruent with response   Total +’s scored _________ Signed _______________________ Maximum + score _________ Print Name ___________________ Percentage _________ Date _________________________

If you are invested in a PSR process you must Engage the team to act. Operationalise recommendations Staff training and Development Monitor staff performance

PSR and Outcome Score

Summary Explored barriers and complexity of in human service Discussed a clinical “management” perspective Proposed that PSR can offer opportunity: To assess quality and consistence Evaluate and outcome intervention efficacy To reflect and develop skills Forum to create team values and vision Provide feedback loop.

Practical Examples Discussion

Reflection On reflection why did this happen? Case example where intervention was impaired by management / delivery process Reflection What learnings related to PSR could have contributed to better outcome? What could you do differently in the future?