Meeting theCOMMUNICATION needs ofIndividuals within a ID Low

Secure Service– five years oflearning and reflections.

Aims of today.

• Background to our service

• Demonstrate how we have developedadapted information to support care andtreatment outcomes.

• Highlight how an Inclusive communicationapproach is being established

• An overview of the 5 good communicationstandards

• Future plans – evidencing and promotingthe effectiveness of resources

The Service

• Background

• Lister Ward is a purpose built 16 bedForensic Low Secure I.D. Service forMen.

• The service opened in November2012, as part of NottinghamshireHealthcare Trust.

• The service was developed within anestablished mental health hospital.

Where does communication fit?

• Into our initial assessments

• Into our risk based assessments

• Within a model of formulation

• Within therapeutic approaches

• Discharge planning

• Team philosophy

Objectives of servicedevelopment

• Person-centred culture.• Positive Behaviour Support framework.• Enhance staff knowledge and skills• Develop an inclusive communication

philosophy in team-consistent approach MSP• Adapted programmes to increase involvement

of patients.• Understanding Individual’s readiness to

engage-needs around communication,interactions, vulnerability.

• Future research into outcomes of using comicstrip, story boards etc.

Some of the serviceachievements

• Easier read formats for all information.

• Individual communication needs are integrated into patients’pathways.

• Organisational change- other wards

• Consistency of approach- MSP headings used throughout, CPA,Ward Round, Care Plans.

• Established adapted Treatment programmes

• Adapted self assessments pre and post groups

• Ward round project 2013

• An established communication pathway- Construction, presentation,debating groups

• SLT’s and Nursing running joint groups

• Recognition of the value of SLT role on other wards.

1My Recovery – what I’ve learnt in hospital

2. My Risky Behaviours

3. Getting insight – staying safe5. Making sensible plans

4. Recovering from drink and drug problems6. Staying Healthy

7. My life skills8. My relationships

Lister Ward

MSP CPA Adapted Report.1) My Recovery

You have been doing work on thinking about how you talk topeople about women.

We have thought about sexist and non-sexist language.

You have worked with SLT on thinking about what you learnt in the Ican feel Good group. You have remembered work from the group:

Using mindfulness

The three Be’s: – be confident, be gentle, be truthful.

2) My Risky Behaviours

The team follow your communication guidelines – this means thatwe can share information with you in the right way.

You have been thinking about your communication risks in theEQUIP group and about ‘no muttering, no scowling’.The team want to carry on helping you think through situations. This

helps you understand situations better.

Doing mindful breathing helps your risks get smaller.

Talking to staff helps stop your feelings from boiling over.

We would like you to know more about your communication risks asthis will help you to work with the team and make your risks smaller.3) Getting insight – staying safe

You have finished the I Can Feel Good Group – you have learntabout mindfulness and this is helping you to stay safe.

When you feel calm you are good at talking about your pathwayand what helps you stay safe. ‘Being civil’

You are getting better at knowing talking to staff make you staysafer.You talked to staff in the EQUIP group about difficult situations.

Building the Service

MDT sharing skills and expertise.

MDT, Organisation, Individualson the same journey together.

Real life examples of languagedisorder in intellectual disability:

• Police arriving at someone’s door “has the catgot your tongue?”

• Person trying to ‘remove’ tattoo example:

• “I know you. I know where you work”: personwith ASC being perceived as using stalkingtype behaviour

• “my solicitor said to fight it” – memory andverbal recall issue

• “I think we’ll stop there” – “but we’re notmoving” – literal interpretation of language

Incorporating the Five GoodCommunication Standards at Lister

Introduced as RCSLT commitment in concordat, now reframed as:

• There is good information that tells you how best to communicatewith someone.

• People are helped to be involved in making decisions about theircare and support.

• Others are good at supporting someone with their communication.

• People have lots of chances to communicate.

• People are helped to understand and communicate about theirhealth.

Audit 5 good communicationstandards.

• Why audit?

• What do we learn

• How do we link this to our PBS overview

• When to revisit?

Audit 2018

5 Good Communication StandardsSELF ASSESSMENT – Lister Ward

How are we doing?

Standard 1: There is a detailed description of how best to communicatewith individuals.

0

1

2

3

4

5

01/03/2018

red

amber

green

ACTIONS: How we liaise with family regarding communication guidelines

Audit 2018

Standard 2: Services demonstrate how they support individuals withcommunication needs to be involved with decisions about their careand their services.

0

2

4

6

8

10

01/03/2018

red

amber

green

ACTIONS: Staff signing training to be booked Consider issues regarding consistency of patient timetables Staff training on management of hearing aids Consider more use of Talking Mats Care opinions for action

Audit 2018

Care opinions for actionStandard 3: Staff value and use competently the best approaches tocommunication with each individual.

0

1

2

3

4

5

6

7

8

9

01/03/2018

red

amber

green

ACTIONS: Consider nurses for additional communication champions Care plan audit Consider including communication guidelines into new staff

induction

Audit 2018

Standard 4: Services create opportunities, relationships and environmentsthat make individuals want to communicate.

0

0.5

1

1.5

2

2.5

3

3.5

4

01/03/2018

red

amber

green

ACTIONS: Remain aware of transition period for patients from higher security /

community Develop the whole staff team on the ward to use socially accurate

information independently

Audit 2018

Standard 5: Individuals are supported to understand and express theirneeds in relation to their health and wellbeing

0

0.5

1

1.5

2

2.5

3

3.5

4

01/03/2018

red

amber

green

ACTIONS:

Clarify if the communication guidance have been added to healthAction Plans

Continue to make use of Disdat assessment where appropriate.

Therapies and Delivery

• Review of current therapeuticinterventions the resources available.

• Staff skills and knowledge/trainingopportunities. (ID specific offenceprogrammes).

Therapeutic interventions-

• SOTSEC-ID

• Expressive language pathway-Lego,presentation

• I Can Feel Good group

• Fire Setting Group

Practical exercise

What is a comic stripconversation?

• Talking about the past, present or the future:

• Where are you? Who else is there?

• What are you doing? What happened?

• What did other people do?

• What did you say? What did other peoplesay? (use conversation bubble)

• What did you/other people think when yousaid that? (use thought bubble)

• How were you feeling? How might the otherperson have been feeling?

Background to the approach

A Comic Strip Conversation is aconversation between two or more peoplewhich incorporates the use of simpledrawings.

Comic Strip Conversations use symbols torepresent social interactions and abstractaspects of conversation, and colour torepresent the emotional content of astatement or message

(Gray, 1994).

Comic strip

Colour chart

Feelings colour chartSurprised(grey)

Happy, friendly, good.(green)

Frightened, worried,anxious(yellow)

Teasing, angry, unfriendly,bad, frustrated(red)

Jealous(pink)

Sad, uncomfortable,helpless(blue)

Facts. Things we know(black)

Comfortable,(brown)

Questions(orange)

Proud(purple)

Confused(lots of colours)

Guilty(pink and blue)

Tense(red and yellow)

Who might the approachsupport

• The approach was developed for people onthe autism spectrum

• People who have difficulties with pro-socialbehaviours

• People with a learning disability / borderlineIQ

• People with a SLCN• People with a diagnosis of: psychosis,

schizophrenia, anti-social PD, emotionallyunstable PD, PTSD/trauma

• This is not an exhaustive list – more a list of ourexperience to date

Making Sense DVD Clip

ApproachesTalking Mats

What is a Talking Mat?

• A talking mat is an interactive resourcethat uses pictures, symbols,photographs to help people withcommunication difficulties give theirviews and express their opinion.

Talking Mats

Ideas for using Talking Mats• To find out how someone feels about

major life changes.• The talking mat offers a way of exploring

feelings on topics that might otherwise betoo complex to talk about. It helpspeople detangle their thoughts andfeelings on certain topics and breakdown information into manageablechunks.

• Capacity assessments

Talking Mat

Who might the approachsupport

People who appear to be very ableverbally but find it hard to integrate lots ofideas. They help to act as a thinking tool.

They help people who have difficultyexpressing themselves for a range ofreasons including:

• They don’t know what the options are

• They can’t keep on track

• They are highly anxious

Summary:

Accessible /Individual

Care plans /reports/ therapy interventions and delivery.

Organisational development of understanding the needs of theservice.

LEAST RESTRICTIVE INTERVENTIONS

Person Centred Care and Treatment.

Skills building, generalisation of learning.

MDT skills and knowledge support the communication needs of theservice.

Individuals motivated to attend and participate in groups.

Group retention of numbers.

Developing/supporting PBS Culture.

Adaptions

• Adapting Pre and Post Measures

• Considering the Speech, Languageand Communication needs of thepopulation.

• Adapting information in line with theAccessible Information Standard

Accessible Information Standard2016

NHS and Social Care must do the five followingthings:

1. Ask

2. Record

3. Highlight & plan

4. Share

5. Take step to support

The Accessible Information Standard2016

https://www.solent.nhs.uk/page_sa.asp?fldKey=615

Measures

Adapted example

Hospital Care Plan example.WARD: LISTER HOSPITAL NO:

RIO NO:

SURNAME: FIRST NAME:

DATE IMPLEMENTED:

Current Clinical Issues/Risks:(Why is this care plan/RM Plan in situ? For example if it relates to violence or aggression what are the pastbehaviours, what are the analogue behaviours etc. If it is a care plan to address mental state what are the relapsesigns?)

Aim/Objective of Care Plan/Risk Management Plan:(What does this plan aim to achieve/address, i.e. to facilitate recovery, monitor relapse signs, manage illicitsubstance misuse, monitor adherence to leave; physical health etc)

Patient Objective:(What does the patient want to achieve in this care plan? Are they declining input into the care plan? Do they haveany Advanced Directives that they wish to be considered by the clinical team?)

Interventions/Actions:(What is the role of the pt? What actions are required by the care co-ordinator and other members of the MDT?What happens in certain situations e.g. Awol; violent and/or aggressive behaviour etc)

TITLE OF CARE PLAN/RISK MANAGEMENT PLAN: Section

Individual Care Plan.

Moving forward

• Research- Quantitive measures tosupport our findings

• Continue with development andpromotion of service

Working towards inclusiveCommunication in the services we

support:

• In order to gain positive multi-disciplinaryhealth outcomes and CJS/NHSE/ outcomes, aperson’s speech, language andcommunication needs to be recognized. Indoing so, we then provide the opportunity forinclusive communication and reasonableadjustments to be made, which then directlyimpacts on the ultimate outcomes we areseeking in society.