Progress update Dr Sophie Doswell North Central London Transforming Care Partnership Positive Behaviour Support project Progress update Dr Sophie Doswell

Expected outcomes of the project Develop PBS skills, knowledge and practice across NCL (Community teams, Providers and Families) Develop an outcomes-based evaluation framework to support the future commissioning of support providers Establish a Provider Forum to support the sharing of best practice and continuous development of PBS skills  

Project actions To meet the expected outcomes of the project A survey will be conducted to identify current good practice and gaps in relation to PBS practice Training will be offered to fill gaps NCL PBS policy to be developed We will co-produce and pilot family interventions A forum will be set up to support providers A framework for commissioners will be developed, linked to PBS competence documents

Survey aims To identify current practice across the NCL TCP in relation to PBS. The priority for the survey was adult services, particularly provider services, however children’s services were also included. As the survey aimed to highlight current PBS practice as well as gaps, services identified as working with individuals with behaviours of concern were prioritised to take part in the survey.

Process of the survey Key professionals across NCL TCP were identified commissioners of learning disability/autism services lead PBS practitioners within Community Teams in each borough These professionals identified key providers to contact Brokerage and internet searches identified other providers who offer services to individuals with behaviours of concern All special schools were contacted No specialist autism health services were identified

Process of the survey All potential survey participants were contacted via e-mail to invite them to undertake the survey. A telephone or face to face interview was offered to all participants. If individuals did not respond to the initial e-mail, follow up took place by a further e-mail or telephone call. Due to difficulty engaging special schools, a Survey Monkey version of the survey was developed and sent. The survey took place between June and July 2018.

Who was surveyed? Type of service Number contacted Number completed Adult Learning Disability Services 6 5 Commissioners 3 Mental health services 1 Provider services (accommodation) 76 46 Provider services (day centres and respite) 36 13 Children’s Learning Disability Services/CAMHS Special schools 27 Total 157 74

Key findings There appear to be gaps in PBS expertise and provision within children’s services, including schools and for individuals with autism who do not have a learning disability. There is a good understanding of PBS across adult community teams with a number of professionals trained to coaching level in each borough. Restraint training is only offered by one community team, a third of providers report training in restraint. Providers are more likely to have staff trained at awareness level and then fewer staff at higher levels, there is a significant gap at foundation level for direct care staff.

Key findings The majority of PBS is undertaken by psychologists within the community teams, both in adults and children’s services. The majority of community teams and services do not have a PBS policy. The majority of services and community teams are not aware of and/or using the PBS Academy competency documents within their services. Services use a range of approaches to augment PBS There is innovative practice happening across NCL but there are limited opportunities to share this

Recommendations Further targeted work is needed to develop the PBS offer within children’s services. Funding has been agreed from NHS England to support an early intervention and prevention project in children’s services. It is currently unclear who would offer PBS if this is required for individuals with autism without a learning disability, this requires further consideration across NCL. The oversight and reporting of the use of physical restraint requires further consideration across NCL. A gap in foundation level training for direct care staff has been identified, so training from the project team will focus on offering this

Recommendations The survey highlighted opportunities for professionals other than psychology undertaking PBS within community teams, so commissioners and team managers may wish to consider this further. An NCL PBS policy is needed, this is being developed by the project team in liaison with other professionals and could be used as an example for provider services. The forum will provide opportunities for providers to share augmentative and innovative practice. Professional groups have identified there are already sufficient PBS forums and opportunities to share best practice across NCL. Increased use of the competence framework is needed across the boroughs in community team and provider services, this will be highlighted through the forum and training.

Next steps Foundation level training has been developed and offered to direct care staff across NCL Over 175 staff across the 5 boroughs have signed up A provider forum has been set up A process for developing a policy has been agreed across NCL Awareness training to be offered via borough structures (eg training was offered via the Provider forum in Barnet for 50 providers) Family engagement to co-produce input where a family member has behaviours of concern