1. Clinical Progress Tracker: Plotting progress, measuring outcomes &
planning for a timely discharge

2. Stepped Care Model

3. Transforming Care – National Challenge…
Winterbourne 2011 – out of sight – out of mind = risk of abuse and governance poor.
Too many people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition, are cared for in a hospital.
In February 2015, NHS England publicly committed to a programme of closing inappropriate and outmoded inpatient facilities and establishing stronger support in the community.
People with learning disabilities are more at risk of significant physical & mental health problems than the general population.
More trauma
Increased socioeconomic deprivation
Schizophrenia is three x more prevalent (RCN, 2015).
Diagnosable psychiatric disorder 4.5 x more prevalent
Many people present with a complex set of needs such as co-existing neurodevelopmental issues (e.g., epilepsy, ASD, ADHD) and genetic conditions resulting in increased risks and vulnerabilities

4. Transforming Care – The Local Challenge…
2.5 years
14 months

5. Being clear on our role in responding to the National Model

6. Service review findings …
MDT evaluations about clinical progress and readiness for discharge were too subjective & unreliable…
There was not a clear way of monitoring and celebrating the positive progress achieved by service users

7. We need a clinical system that …
Clarity about why the person requires inpatient care (due to complexity, risk and acuity) – linked to Care & Treatment Reviews.
Is systematic and reliable in assessing:
Treatment efficacy
Service user progress
Risk management and positive risk taking successes
Supports good clinical habits and routines:
Everyday recording
Everybody recording
Every week review (MDT)
Develops the workforce:
Knowledge, skills and involvement
1. Assessment: (biopsychosocial)
physical health
mental health
communication assessments
psychological assessments – functional analysis
neurodevelopmental assessments
social and adaptive functioning
2. Formulation: need, clarify diagnoses and plan intervention strategies
3. Intervention: treatment and support
4. Pre-discharge: transition work and workshops
5. Discharge
6. Post discharge support: CPA, CTR, PBS
Person centred outcomes
& Quality of life
Feeding into pathway

8. Development of the Clinical Progress Tracker
Team engagement & feedback =
Service users struggled to directly self-report on how they were feeling.
Conditions such as Autism Spectrum Disorder, schizophrenia or severe depression, anxiety or psychosis coupled with learning disability posed a barrier to self report.
In line with Positive Behaviour Support the team wanted to capture positive progress as well as indicators of risk or decline.
Development process =
Literature review of behavioural measures of challenging behaviour, psychiatric symptomatology & adaptive functioning.
The clinical progress tracker was developed using behavioural indicators of mental health, well-being and risk/challenging behaviour.
In total 36 items were included covering a range behaviours. These behaviours were mapped onto three categories:
Green – positive, pro-social behaviours indicating positive well-being, adaptive behaviour & coping
Amber – early warning signs of unease or mild distress or symptoms of mental illness
Red – moderate to severe signs of risk and indicators of poor mental state

9. The Clinical Progress Tracker

10. The Clinical Progress Tracker

11. Implementation
The clinical progress tracker has been fully implemented since October 2015 (3 years 7 months)
Three times per day Development Workers have recorded behaviours (morning, afternoon and night shifts)
Each week data across all shifts has been totalled and percentage scores for red, amber and green graphically presented within MDT paperwork
This information has enabled an accessible infographic supporting clinical review & evaluations of treatment, progress and discharge planning

12. We listen & talk to them Clinical monitoring Clinical progress
How do we track clinical progress with
service users in Firshill Rise ATS?
We support them to give feedback & ask questions
We meet with them one to one to return feedback
We listen & talk to them
We monitor and record their clinical progress every day
At the end of the week we have a clinical picture
Clinical monitoring
We graph the clinical progress & discuss it at weekly MDT
It helps professionals, the person and carers to see what is working and how they are doing
Clinical progress

13. Outcomes Decreased length of stay = 28 people discharged since started
reduced length of stay / restriction
improved quality of life - supported into the community to lead a good and meaningful life
Building the Right Support & PBS
Other System Benefits
More skilled and engaged workforce
Clarity regarding discharge planning
Supports existing CPA and CTR
Better partnership working with family/carers, social services & independent sector
Local reduction in beds from 7 to 4 = investment in community services
Regional commissioner purchasing beds

14. Outcomes Decreased length of stay = 28 people discharged since started
reduced length of stay / restriction
improved quality of life - supported into the community to lead a good and meaningful life
Building the Right Support & PBS
Other System Benefits
MoreMore skilled and engaged workforce
Clarity regarding discharge planning
Supports existing CPA and CTR
Better partnership working with family/carers, social services & independent sector
Local reduction in beds from 7 to 4 = investment in community services
Regional commissioner purchasing beds

15. Final thoughts and aspirations…
Developing individuals
Developing teams & care partnerships
Practice based evidence – supporting NICE
Solving real life problems – national & local strategy
Making a difference to the care people receive
Next steps – develop an App + community focus