Respond's Department Of Health Strategic Development Grant 2010-2012
In February 2010 Respond received a 2 year grant from the Department of Health as part of its Voluntary Sector Investment Programme for Innovation, Excellence and Strategic Development Fund . The project aimed to make individuals and commissioners much more aware of Respond’s services and thereby improve access to Respond’s specialist services for children and adults with learning disabilities whose lives have been affected by domestic violence, sexual abuse or other trauma. The aim of the grant was for Respond to improve its ability to provide improvements in emotional health and wellbeing for service users. It was also an aim that the families and carers of service users, and the professionals involved in their lives, would also be supported in order to improve the intervention outcomes of recovery from trauma and improved lives.
Below is a list of outcomes for the project plus the way the outcomes were delivered.
1. Through the provision of individual counselling and psychotherapy children and adults with learning disabilities who have experienced domestic violence, sexual abuse or other trauma, are better able to communicate with those around them and are better able to express feelings or thoughts that are troubling them.
This was delivered through increases in service user numbers and data collated showing improvements in psychological, behavioural and relational abilities.
2. Better communication between staff caring for victims of sexual violence and a better understanding of how feelings may translate into ‘challenging behaviour’ to enable staff to deal with aggression, depression and other mental health problems.
Delivered through the provision of more training for professionals and awareness raising activities for carers.
3. Improved working relationships across service boundaries between professionals involved in the care of people with learning disabilities. This will have the effect of improving support and care of these service users.
Delivered partly through Respond’s afternoon seminar series and partly through involvement in chairing network meetings for service users and being more involved in MAPPA and other multi-disciplinary forums.
4. Carers being better able to support people with learning disabilities by themselves being supported with appropriate advice and information. This will lead to people having a much more supportive environment in which to live.
Delivered via Respond’s Helpline and website. Also through providing individual support sessions for carers via the phone and at the same time as service users themselves are having treatment.
5. Nationwide training for practitioners working with people with learning disabilities on subjects such as recognising signs of abuse, dealing with challenging behaviour and therapeutic responses to trauma for victims of sexual or domestic violence. This will have the effect of improving the care and allow for earlier interventions than previously possible.
Delivered through increases in training provided and papers delivered at relevant conferences for professionals.
6. A space for young people and adults with learning disabilities to explore their abusive behaviours and gain insight into some of the reasons for it. This will lead to a reduction in abuse being perpetrated and will protect the public, especially the most vulnerable.
Delivered increases in forensic services and encouraging awareness raising around the importance of sex education and early interventions following signs of sexually harmful behaviours. The board of Respond decided to create the new role of ‘Consultant Forensic Psychotherapist’ to lead the development of all of Respond’s forensic work and this has so far been very successful.
Numbers of people supported
The total number of Respond beneficiaries for each of the 2 years of the project were:
April 2010 – March 2011
Individual service users – 115
Group service users – 85
Risk Assessments - 2
Family members – 139
Professionals Trained – 383
Professional consultations – 135
April 2011 – March 2012
Individual service users – 132
Group service users – 105
Risk Assessments - 8
Family members – 186
Professionals Trained – 498
Professional consultations – 177
In a number of cases that we are aware of Respond’s community-based services have meant that some service users who might have been needed inpatient treatment have been able to remain in the community and receive appropriate services that have saved unnecessary expenses. This has also allowed people to stay in touch with their friends, families and familiar surroundings and to continue to receive local support. Respond promotes early intervention strategies designed to reduce expense and escalation in harmful or offending behaviours. These services are certain to have the effect of increasing productivity in both health and care services as Respond specialises in the areas of abuse and abusing that generic services are often wary of addressing.
The project has been evaluated in monthly senior management team meetings and with the board in its monthly meetings.
What went well – An increase in levels of case management of referrals to Respond services, leading to improved communication between carers and professionals. Improved relationships with commissioners and/or improved ability to help referrers to make a strong case to commissioners for the lead to refer to Respond.
What didn’t go so well – Changes in commissioning has meant that it has been hard to develop significant relations with many commissioners. The lack of funds available has meant that only the most ‘challenging’ service users are referred. This means extra work is needed in terms of case management and networking. Extra resources are therefore needed to pay for this that means fees need to increase, thereby making the intervention appear to be more expensive.
Engaging with Commissioners
As mentioned above engaging with commissioners was a main objective of the project. This has been partially achieved but proposed changes in commissioning has meant that it has been complicated to engage with them fully. Local commissioning forums have been approached but are often unwilling to hear from a small national provider. To that end we approached the Department of Health to discuss our concerns about small national providers, along with the Clinic for Boundary Studies. We met with Bob Ricketts, Director of Provider Transition, and had an interesting discussion about the needs of small organisations, like Respond, and how difficult it is to reach local commissioners and thereby be heard locally. We agreed that there should be something the Department could do and it was left for Mr Ricketts to see what he could do.
We have shared our learning with other voluntary sector organisations such as Voice UK and the Anne Craft Trust. We have also attended the London LD Health Network meetings to talk about the project and the needs of people with learning disabilities who have been abused. This group is made up of commissioners and other professionals from across London who work in learning disabilities.
Respond has a good track-record of providing accessible services for people with learning disabilities that attempt to reduce health inequalities and improve access to psychological treatments. We believe that good mental health is essential for all, especially those with learning disabilities. This project has become a cornerstone in Respond’s drive to help those at most need in our communities and to thereby help people with learning disabilities to achieve all they possible can with impunity.
We have learned that accessing commissioners for small national providers is complex especially when service level agreements are not necessary. We have had more success in working with potential referrers in social services and in health who are needing to secure funding from commissioners in order to refer someone to Respond. We have also sadly had to make use of the tragedy that happened at Winterbourne View in order to influence commissioners to commission services for victims of abuse. Risks we have identified are really to do with the changing field of commissioners from PCT’s to GP’s. We are unsure of the way things are going to develop but remain optimistic about being heard and getting our key messages across to them too. We feel that very significant progress has been made towards the aims of the project. Commissioners are much more aware of Respond’s services and the positive outcomes achievable for service users, their carers and the professionals supporting them. Referrals have increased and Respond’s services have developed in order to address new demands for consultation and supervision.