Applying Recovery Through Activity in a secure learning disability service

Purpose The purpose of this paper is to describe the nature and impact of a restraint reduction strategy implemented within a secure learning disability service in response to the national Positive and Safe programme. Design/methodology/approach The strategy was comprised of three primary interventions – Safewards, positive behavioural support and data-informed practice – and utilised a programme management approach to ensure effective delivery. Baseline measures were collected from 12 months of data prior to implementation of the programme and the frequency of each category of restrictive intervention was then measured prospectively on a monthly basis throughout the duration of the programme. Findings Upon completion of the programme the following results were achieved: elimination of prone restraint – elimination of mechanical restraint – 42 per cent reduction in general use of restraint – 42 per cent reduction in use of seclusion – 52 per cent reduction in rapid tranquilisation. Originality/value The paper adds to the growing body of evidence that carefully designed interventions can reduce the frequency of seclusion and restraint. In this case, Safewards and PBS have combined to exert their effect. Data-led practice and senior leadership were also found to be of critical importance. Finally, the need for a stable workforce is considered.

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“Shared Pathway” national pilot project: the experience of a secure learning disability service

Journal of Learning Disabilities and Offending Behaviour ◽

10.1108/20420921211280088 ◽

2012 ◽

Vol 3 (2) ◽

pp. 98-110 ◽

Cited By ~ 1

Author(s):

Fola Esan ◽

Melanie Pittaway ◽

Beatrice Nyamande ◽

Alex Graham

Keyword(s):

Learning Disability ◽

Pilot Project ◽

Disability Service ◽

Secure Learning

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Outcomes from the National High Secure Learning Disability Service: findings and challenges

Advances in Mental Health and Intellectual Disabilities ◽

10.1108/amhid-06-2014-0023 ◽

2015 ◽

Vol 9 (3) ◽

pp. 116-123 ◽

Cited By ~ 7

Author(s):

Catrin Morrissey ◽

Ben Hobson ◽

Emma Faulkner ◽

Tamsin James

Keyword(s):

Length Of Stay ◽

Learning Disability ◽

Outcome Measures ◽

Emotional Problem ◽

Outcome Studies ◽

Self Report ◽

Content Type ◽

Disability Service ◽

Secure Learning ◽

Clinical Measures

Purpose – The “outcomes revolution” in healthcare has yet to impact strongly on secure intellectual disability (ID) services in the UK. The purpose of this paper is to review the service-level outcome studies that exist for this population, and to explore some of the challenges of conducting such research. It further describes some illustrative routine outcome data from the National High Secure Learning Disability Service. Design/methodology/approach – Routinely collected outcome measures (length of stay; violent incidents; Emotional Problem Scale (EPS) Behaviour Rating Scale and EPS Self-Report Inventory) were analysed for two overlapping cohorts of patients resident in the high-secure service between 2008 and 2013. Findings – The median length of stay of those discharged during the study period (n=27) was around 9.9 years (range one to 40 years). A significant proportion (25 per cent) of discharges resulted in an eventual return to high security. There did not appear to be a treatment effect over two to three years using staff-rated global clinical measures, but patient-rated clinical measures did reduce. Violent incidents also reduced significantly over a longer period of four years in treatment. Research limitations/implications – There are identified challenges to research design and outcome measurement which need to be addressed in any future cross-service studies. Originality/value – There are relatively few published outcome studies from forensic ID services. None of the studies have used clinical measures of changes or patient-rated outcome measures.

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