Transforming care: developing a community enhanced intervention service
| Pages | 133-143 |
| Published date | 12 June 2019 |
| DOI | https://doi.org/10.1108/AMHID-11-2018-0048 |
| Date | 12 June 2019 |
| Author | Karin Fuchs,Peggy Ravoux |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Transforming care: developing a
community enhanced intervention service
Karin Fuchs and Peggy Ravoux
Abstract
Purpose –The purpose of this paper is to present the service model and evaluation of Southwark Enhanced
Intervention Service (EIS). EIS is an intensive community service for adults with intellectual disabilities whose
behaviours challenge in the context of the Transforming Care agenda.
Design/methodology/approach –The service model is described and the following evaluation data over
four years are presented: key performance indicators, descriptive data, clinical outcomes, financial outcomes
and qualitative feedback on users’experience.
Findings –The EIS has demonstrated good outcomesfor a small number of adults with complexneeds by
supportingthem at crisis point locallyand preventing hospital admissionor a move to a restrictiveenvironment
out of area. EIS has also supported the successful transition back to area of a small number of adults with
complex needs. Theevaluation has shown improvementsin behaviour, wellbeing and qualityof life as well as
demonstrating financial savings. Families’and providers’qualitative feedback indicates that the service has
been highly valuedand in particular the access to timely multidisciplinary coordination of input.
Originality/value –The service was developed around the same time as the st art of the Transforming Care
agenda. It presents findings of a four-year evaluation at a time when there is limited evaluation of such service
models focusing on the Transforming Care aims. The paper presents significant findings in support of guidance
and recommendations published more recently as well as reflections on componentsof effective service delivery.
Keywords Intellectual disability, Transforming care, Challenging behaviour, Intensive support,
Enhanced support, Positive behaviour support, Systemic
Paper type Technical paper
Developing enhanced community services for people with significant intellectual disabilities and/
or autism presenting with behaviour that challenges and/or mental health problems is a key remit
of the Transforming Care agenda (NHS England, 2017). There is numerous national guidance
and policy highlighting what good provision should look like for people with intellectual disabilities
who display behaviour that challenges, with recent salience on intensive/enhanced community
provision. (Department of Health, 2007; NHS England, 2015; National Institute for Health & Care
Excellence, 2015, 2018).
“Building the Right Support”(NHS England, 2015) sets out the need for areas to ensure that they
have in place the specialist community-based services needed to support people with intellectual
disability and/or autism who display behaviour that challenges, including intensive support. The
model does not dictate the design of these services, but rather sets out a number of core aims
and functions in order to meet the needs of this group. The “Model Service Specifications”
recommends that intensive/enhanced support provision should aim to reduce/manage
behaviours that challenge, reduce/prevent the use of restrictive practices, hospital admissions
and out of area placements through four core functions of support: Assessment, treatment
and support for individuals who display behaviour that challenges; provision of support, and
person- specific training for people supporting those individuals; coordination of transitions from
inpatient and other settings and crisis response (NHS England, 2017).
The recent National Institute for Health & Care Excellence (2018) guidance reinforces these
recommendations further by highlighting the need for enhanced support for families; early
intervention; timely availability of specialist assessment and behavioural support and intensive
Received 30 November 2018
Revised 20 February 2019
16 April 2019
Accepted 29 May 2019
The authors would like to thank
Sophie Simpson for overseeing the
financial data analysis, to Sophie
Le, Laurence Palfreyman, and An
Le for the support with the data
analysis, to current and previous
EIS team members and trainees
on placement who have actively
contributed to the ongoing
evaluation of the service, for the
invaluable support from senior
managers across health and social
care who supported, invested and
shaped the service from the
beginning, and also to clients and
their families who have been
central to our learning and the
development of the current
service model.
Karin Fuchs is based at Sussex
Partnership NHS Foundation
Trust, West Sussex, UK and
was previously based at
Southwark MHLD, South
London and Maudsley NHS
Foundation Trust, London, UK.
Peggy Ravoux is based at
Southwark MHLD, South
London and Maudsley NHS
Foundation Trust, London, UK.
DOI 10.1108/AMHID-11-2018-0048 VOL. 13 NO. 3/4 2019, pp.133-143, © Emerald Publishing Limited, ISSN 2044-1282
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
PAGE133
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