1. Services For Children & Young People Who Display Challenging Behaviour Well Matched and Skilled Staff A Pamphlet for commissioners Dr Sarah H Bernard Consultant Psychiatrist The Michael Rutter Centre London

2. Services For Adults with Learning Disabilities who Display Challenging Behaviour Well Matched Skilled Staff A pamphlet for commissioners Dr Peter Baker Consultant Clinical Psychologist Sussex Partnership NHS Foundation Trust

3. Why Have These Pamphlets Been Written? Suggestion arose at a CB-NSG meeting during an action planning group on commissioning. Suggestion arose at a CB-NSG meeting during an action planning group on commissioning. Child and adult pamphlets Child and adult pamphlets In order for commissioners to be well informed In order for commissioners to be well informed

4. Background Challenging behaviour is more common in people with LD Challenging behaviour is more common in people with LD Underlying causes are multiple Underlying causes are multiple Association with childhood mental health problems Association with childhood mental health problems Communication difficulties increase risk of CB Communication difficulties increase risk of CB Not a diagnosis – descriptive Not a diagnosis – descriptive Early intervention important Early intervention important Family breakdown more common Family breakdown more common Isolated siblings Isolated siblings

5. Contents 1. Which professionals should be involved? 1. Which professionals should be involved? 2. What should you look for from a service? 2. What should you look for from a service? 3. Skills required 3. Skills required 4. Monitoring 4. Monitoring 5. Case vignette 5. Case vignette

6. The Workforce Psychological/Mental health services Psychological/Mental health services Physical needs Physical needs Social care Social care For children & young people: Education For children & young people: Education Key point – best practice guidance emphasises the need to have a multi-disciplinary approach to the assessment and treatment of challenging behaviour in order to meet the individual needs of each person Key point – best practice guidance emphasises the need to have a multi-disciplinary approach to the assessment and treatment of challenging behaviour in order to meet the individual needs of each person

7. What should you look for from a service? Comprehensive assessment Comprehensive assessment Holistic approach Holistic approach Key point – to understand the individual needs of a person who is displaying CB, a range of assessments are required and this information should be used to inform how the person is supported Key point – to understand the individual needs of a person who is displaying CB, a range of assessments are required and this information should be used to inform how the person is supported

8. Skills Training Training Supervision Supervision Communication strategies Communication strategies Key point – Supporting a person with severe learning disabilities perceived as challenging is a skilled role and support staff must have appropriate, adequate and on-going training and supervision Key point – Supporting a person with severe learning disabilities perceived as challenging is a skilled role and support staff must have appropriate, adequate and on-going training and supervision

9. Monitoring – children’s version Satisfaction surveys Satisfaction surveys Burden of care surveys Burden of care surveys Measures of behavioural disturbance Measures of behavioural disturbance

10. Monitoring – adult’s version Robust organisational framework Robust organisational framework Behaviour support plans include preventative strategies Behaviour support plans include preventative strategies Individualised timetable of community activities Individualised timetable of community activities Skill development Skill development Key point- good services use a range of ways of checking and improving the quality of their services to ensure it delivers good outcomes for people and their families Key point- good services use a range of ways of checking and improving the quality of their services to ensure it delivers good outcomes for people and their families

11. Conclusions Commissioners need to be well informed Commissioners need to be well informed It is not just about using the cheapest service It is not just about using the cheapest service Communication between those commissioning the service, those offering the service and those using the service is essential Communication between those commissioning the service, those offering the service and those using the service is essential