It is Monday afternoon. Jack is training a group of police officers (from outside his home area.) He gives them scenarios of things that have happened around him, and how he reacted. The police discuss the response they could make. Jack then describes the response he actually got, and the consequences of that response.
These training sessions aren’t just good police training. They’re good – great, actually – for Jack, who is gradually finding ways to exert control over his chaotic life.
Jack was removed several times from his family home, beginning at the age of four months, sometimes out of area.
A succession of foster families, residential schools and children’s homes followed, each one breaking down due to Jack’s delayed communication skills, aggression and habit of victimising people.
He was permanently excluded from school age 17 and with CCG funding he moved into a children’s home – complete with restraint as a standard practice – which was able to contain him.
There were many court orders in Jack’s life, including restrictions on family and community access, and on who could support him.
Jack has a learning disability, ADHD and an attachment disorder probably stemming from his unsettled childhood. Although his needs fluctuate significantly, he can need 3:1 support. All those around Jack were wary of him, uncertain how to support him best.
Jack was referred to Dimensions based on our local track record of successfully managing other complex individuals through transition. But not everything goes right first time.
The first attempt at transitioning Jack into adult services didn’t succeed. He moved into a house on 3:1 support with three other young people he knew, jointly funded by his LA and CCG.
This lasted six months, during which it was clear from the wave of safeguarding notices that this was not the right environment for Jack (whose behaviours were worsening) or those around him.
Making the most of ISF flexibility
Commissioners agreed with us that the shared environment wasn’t suitable for Jack and that he needed to live on his own.
Due to the extent of Jack’s care needs he became wholly CCG funded and Dimensions helped the CCG, which had not previously implemented one, to understand the advantages of structuring his funding as an ISF – an Individual Service Fund – on a flexible package initially set up at £222k, fractionally above his previous package cost.
The flexibility afforded by the ISF has been absolutely central to the success of Jack’s subsequent support. For example, due to Jack’s fluctuating needs around behaviours that challenge we were able to build ‘standby’ support into the plan and maintain a ‘no agency’ policy.
This allows us to increase staffing and shorten shift lengths at a moment’s notice in case of burnout without having to draw on the anonymous support of agency staff.
With an emphasis on having a highly skilled and experienced staff supporting Jack the flexibility around the ISF allowed us to increase pay to ensure we got the right staff and higher than usual management input for Jack. The ISF allows us to deliver support on a ‘just enough’ basis – we keep track of what has been spent and hand back any unspent funding at the end of the year.
The ISF also gave Jack a measure of control over his life. Previously, the phrase “Jack is 3:1” would irritate him. But by participating in regular decision making over how his flexible support was deployed, Jack is beginning to understand the consequences of his actions, and to feel some ownership over the process.
Jack responds to Positive Behaviour Support
The ISF also meant we could add positive behaviour support delivered by Dimensions’ in-house team to Jack’s support plan. Initially intensive, that support is now successfully fading out – a success in its own right given Jack’s attachment challenges.
Jack’s behaviour analyst, Sinead Byrne, says: “Strategies were put in place with a heavy emphasis on communication, predictability and structure. Staff supporting Jack communicated with him in an honest and open way which was crucial as part of the rapport building process.
“Jack was also supported to talk honestly and openly with staff about his feelings which was an important component of the plan.
“Staff were trained to respond consistently in the event of a crisis and using this approach, incidents of challenging behaviour decreased dramatically. Skills teaching was also used to teach Jack important independent living skills such as using money and engaging in domestic tasks in his home.”
In 2017, Jack was discharged from the behaviour support team
His challenging behaviour was at low levels and the team were confident in supporting Jack without this external input. Jack continues to improve on a daily basis.
Sinead concludes: “Using a PBS approach has ensured a consistent approach when supporting Jack. This has resulted in a dramatic change in his presentation, with people often finding it hard to believe that Jack previously required 3:1 staffing. Jack is a testament to how consistency can bring about significant reductions in challenging behaviour.”
Savings of over 40% on initial support costs
Every six weeks we openly review what is working and not working alongside Jack’s community nurse, CCG and of course Jack himself. As it has become clear that things are on the right track, we have been able to progressively step down his support.
Two years on, Jack’s costs are over 40% down (to £131k) following huge successes around independence, including significant reductions in behaviours that challenge. Things are so good that Jack has recently been able to go clubbing for the first time ever, his staff sitting inconspicuously in the background. For this young man, that is a significant breakthrough.
Jack’s team is clear that the flexibility afforded by his ISF has reversed the downward trend in his behaviours. It has avoided likely ATU admission. It has saved significant costs, significant time, and is currently bringing one young man back from the brink.
- Challenging behaviour has significantly reduced
- Introduction of ISF funding has allowed greater flexibility in his support
- Support costs have been reduced by 40%