This specification must be read along with the overarching specification which applies to all services

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1 This specification must be read along with the overarching specification which applies to all services 1. Population Needs 1.1 National / local context and evidence base National Context Local Context 2. Outcomes 2.1 NHS Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely Domain 2 Domain 3 Domain 4 Domain 5 Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill-health or following injury Ensuring people have a positive experience of care Treating and caring for people in safe environment and protecting them from avoidable harm 2.2 Local defined outcomes These service will contribute towards maximising independence, choice and maintaining the child in their family and educational/ community setting, increasing emotional health and wellbeing and decreasing behavioural difficulties for children with learning disabilities. 2.2a Specialist Service for Learning Disability Service (SSCLD) improves health outcomes including behaviour for children with moderate to severe learning disabilities. In Bristol this includes outcome focused interventions to Children in the Bristol locality who require short term Intensive Support to enable children with learning difficulties and additional complex needs in crisis i.e. exhibiting challenging or severe autistic behaviours, experiencing placement breakdown due to their Page 1 of 10

2 behaviours or co-morbid mental health problems.them to overcome/manage psychological or emotional trauma or behavioural difficulties. 2.2b Positive Behaviour Support Services (Bristol and South Gloucestershire) for those with learning disabilities who are on the autistic spectrum, whose challenging behaviour, places them at risk of home or school breakdown. To increase quality of life and adaptive behaviours alongside the prevention and reduction of challenging behaviour To reduce out of authority inpatient and residential placements by supporting children and families locally To reduce family breakdown For Parents / Carers / Support Networks: Increased awareness of the needs of this group of children and young people. Increased understanding of the factors that contribute to difficult behaviours in this group of children. For Professionals working with Children and Young People with LD and challenging behaviours: To develop the knowledge and skills of staff working with this group of children and young people which will enable greater knowledge and understanding of the intervention and risk management. To increase the capacity of professionals to respond to the needs of children/young people who have learning disabilities and complex needs. 2.2c Bristol City Council d Learning Disability Arts Therapies Bristol and South Gloucestershire. 1 Bristol City Council specification in development Page 2 of 10

3 Service users will experience improvements in several of the following areas: Communication Emotional Spontaneity strength Self-esteem Independence Self-expression Confidence Concentration Assertiveness Interaction with others Adaptability to change Mental health needs Relationships Motivation Challenging behaviour Statistical information will be reported on those receiving a service and their outcomes in terms of improvement in emotional health and wellbeing and behaviour, as reported by parent/ carer and child. 80% of patients achieve their treatment goals within the time period set down in their intervention plans. Outcome Goals are reviewed at least 3 monthly (and plans amended as necessary). Aim to discharge service users as promptly as is therapeutic possible and to record referral & discharge rates. 3. Scope 3.1 Aims and objectives of service Purpose of Service 3.1.1a SSCLD teams are community based services and provide outpatient and domiciliary services for children, young people, their families and carers. They include a range of professionals including LD Psychiatry, Psychology, LD nurses and support workers. The service can provide comprehensive assessment advice and support on a range of needs associated with children and young people with moderate to severe learning disabilities and those who have additional mental health needs. The service is delivered in clinics, homes or educational and community settings. The SSCLD teams work collaboratively and are embedded with the Local Authorities 0-25 services for those with Special Educational Needs and Disability and have close working relationships with health, social care and education commissioners. In Bristol there is additional resource for an intensive service providing Page 3 of 10

4 hands-on support for individuals undergoing a period of crisis due to challenging behaviour, mental health issues, placement breakdown or transition to adult services. This provides In-depth assessment Providing advice and support to commissioners, carers and other service providers and professionals Offering flexible, intensive and time-limited interventions Providing alternatives to and input around inpatient assessment discharge. Where appropriate, training to parents and carers on positive behaviour management Additionally support and consultation to carers and other professionals 3.1.1b The Positive Behaviour Support Service provides a person centred model and framework to deliver individually tailored, evidence based, therapeutic interventions c Bristol City Council d LD Arts Therapy To provide outcome focused interventions to Children in Bristol and South Gloucestershire localities who require Arts Therapies to enable them to overcome/manage psychological or emotional trauma or behavioural difficulties Outcomes and Aims of service 3.1.2a The SSCLD service Provides multi-disciplinary comprehensive assessment and therapeutic interventions for children and young people with learning disabilities. Offer specific consultation and intervention services for learning disabled children (including those with learning disabilities who are on the autistic spectrum). 2 Bristol City Council specification in development Page 4 of 10

5 Deliver therapeutic support to children in local communities and support families and carers in the home, school and in respite centres b In addition the PBS service has a number of primary outcomes; Offer specific consultation and intervention services for learning disabled children (including those with learning disabilities who are on the autistic spectrum) whose challenging behaviour places them at risk of home breakdown. Deliver intensive therapeutic support to children in local communities and support families and carers in the home, school and in respite centres. Provide multi-disciplinary comprehensive assessment and interventions for children and young people with learning disabilities. For Parents / Carers / Support Networks: Engagement in consultation, assessment and treatment and specifically for the PBSS to engage with intervention programmes across all settings. Provide interventions through appropriately qualified staff that will support the child and parents and carers to reduce behaviours that place the child at risk of home breakdown or breakdown in other settings c Bristol City Council d Arts therapies (Art, Drama and Music) involve a psychotherapeutic relationship between the therapist and the individual within a clinical setting. Central to this relationship is the use of a creative medium that allows for additional and alternative means of communication and expression. Through this relationship individual clients are able to explore their emotions and feelings in a safe, trusting and facilitating environment. This service offers specific therapeutic input into the following areas: 3 Bristol City Council specification in development Page 5 of 10

6 Emotional needs Attachment Disorders Mental health needs Challenging Behaviour Sexual, emotional or physical abuse Bereavement and loss Complex physical needs Additionally, the service offers support and consultation to carers and other professionals. The level of services will reflect the level of investment by LA area. 3.2 Service description / Care pathway 3.2a SSCLD work with children with moderate to severe learning disabilities. They will work with CAMHS for the small number of children and young people with autistic spectrum conditions and severely challenging behaviour. The service provides a triage for referrals consisting of a weekly meeting with a representative of each profession; referrals are discussed and allocated to a member of the team. They also run Parenting groups, parent and young person participation groups and training for parents and carers in positive handling. Bristol team includes former function of Bristol Intensive Resource Team. 3.2b The Positive Behaviour Support Service will work with the group of children with Learning Disabilities, Autistic Spectrum Disorder (ASD) and with behaviours that challenge their home and other settings. The Positive Behaviour Support Service will complete an initial assessment of need, an understanding of the challenges and triggers presented by the child s / young person s behaviours and consider how to manage the behaviour. The Positive Behaviour Support Service will provide an appropriate therapeutic intervention programme, based on the assessed need for children and young people referred to the service. This will be an individual based programme and will work with the family and/or other placements depending on the assessed need. Page 6 of 10

7 Families / carers will be supported, through appropriate services to help them understand their child s behaviours and support the management of such behaviours, and work towards improved outcomes for the young person and their family. 3.2b.1 Therapeutic interventions and programmes that are offered will be informed by the comprehensive assessment, taking into account the nature of the assessed risk, nature of concerns, the child / young person s age, their needs and capabilities. The therapeutic intervention programme will be evidenced based and outcome focused. It will be informed by the initial and ongoing assessed needs of the young person. Based on the assessment an Intervention Plan will be agreed indicating a number of goals the young person and their parents / carers / support network will work towards. These will be reviewed at three monthly intervals, involving the young person, their parents/carers/support network, key professionals. Positive Behaviour Support services will work collaboratively and be embedded into the 0-25 services in both Bristol and South Gloucestershire. 3.2b.2 Referrals will be accepted will be processed through the revised Complex Needs Group. 3.2b.3 All children, young people, parents/carers and referrers will be expected to provide appropriate informed consent, which will address expectations, responsibilities and confidentiality. 3.2c Bristol City Council d LD Arts Therapies Assessments An initial screening process will access suitability for Arts Therapies. The care plan and the subsequent interventions are drawn from the full assessment applying relevant theoretical models and informed by good practice guidance. 4 Bristol City Council specification in development Page 7 of 10

8 Information & Training The services may, where appropriate, provide individual specific information and training to carers. Where requested the team will develop and deliver training for staff teams working with children with a Learning Difficulty. (NB There will be no charge where this training relates to a specific individual for whom the teams are providing therapy or an intervention and is part of their agreed care plan otherwise a charge will be levied for staff training.) Referrals All referrals will be acknowledged within 7 working days. Each team will provide statistical information on referrals categorised as urgent and non-urgent (urgent 2 day response up to 2 weeks non urgent.) Accessibility / acceptability The referral system is open to anyone to use e.g. Carers, GP s CAMHS, Schools, Paediatricians, Psychologists or residential provider or through the appropriate Learning Difficulty Service. 3.3 Population covered 3.3a The SSCLD service will be for children and young people with moderate to severe learning disability with a BNSSG GP. 3.3b The Positive Behaviour Support Service will be for children and young people with LD and / or ASD and challenging behaviours with a Bristol and South Gloucestershire GP. 3.3c Nursing / support workers for residential short breaks is managed by Bristol City Council 5 an cover children and young people with a Bristol GP. 3.3d Arts therapy will be available for children and young people with a Bristol or South Gloucestershire GP. 3.4 Any acceptance and exclusion criteria and threshold 5 Bristol City Council specification in development Page 8 of 10

9 3.4a SSCLD for children with moderate to severe learning disabilities with health needs including behaviour who require an assessment and usually a therapeutic intervention. 3.4 b The Positive Behaviour Support Service must have been referred through agreed processes with commissioners. 3.4c Bristol City Council d Arts therapy To be agreed 3.5 Interdependence with other services / providers All cases will be worked in collaboration with all agencies involved with the young person. 4. Applicable Service Standards 4.1 Applicable national standards (e.g. NICE) 4.2 Applicable standards set out in Guidance and / or issued by a competent body (e.g. Royal Colleges) 4.3 Applicable local standards 5. Applicable quality requirements and CQUIN goals 5.1 Applicable Quality Requirements (See Schedule 4 Parts [A-D]) 5.2 Applicable CQUIN goals (See Schedule 4 Part [E]) 6. Location of Provider Premises The Provider s Premises are located at: SSCLD, Art Therapy and PBS services will be co-located with Council 6 Bristol City Council specification in development Page 9 of 10

10 services in the Children s Hubs or with the 0-25 Disability Services where possible. Bristol City Council 7 located in residential short break settings. Location in North Somerset to be clarified 7. Individual Service User Placement 7 Bristol City Council specification in development Page 10 of 10

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