1. 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

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

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

4. 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

5. 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

6. 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

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

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

9. Outcome Focus Item Responsibilities 11
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?

10. 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

11. Process Standards Item Responsibilities + / O Comments 11
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?

12. 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 _________________________

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

14. PSR and Outcome Score

15. 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.

16. Practical Examples Discussion

17. 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?