PBS Academy outline 1

Positive Behaviour Support (PBS) Academy for England Rationale Delivering evidence-based and high quality supports to people with a learning disability (LD) and challenging behaviours is a specialised activity. Internationally recognised leaders in this field are in short supply in England. Expertise does exist amongst providers, trainers, academics and commissioners but this expertise is spread too thinly and currently lacks co-ordination and thus is not maximally effective. To deliver the vision, outlined in the Mansell reports, of wide-spread, competent community-based supports for children and adults with challenging behaviour this expert resource needs to be harnessed at a national level. The learning disability sector is in agreement about the need to develop capacity and competence in local services, that workforce development is a priority to support this, and also that expert support and consultancy is needed to develop excellence at a local level. We propose a PBS Academy for England (PBSAE) as a vehicle to deliver these widely agreed priorities, and as a way to bring together the LD community around shared priorities. The proposal for a PBSAE is conceived as a part of the solution to the current crisis relating to the care of people with learning disability and challenging behaviours. Additional work will also be needed on commissioning, housing, and broader provider capacity amongst other actions. The PBSAE can be used to support a significant reduction in the numbers of people with LD in inpatient “beds” (Assessment and Treatment Units – ATUs) in the short to medium term. Instead, these individuals can be successfully supported in their local communities. There are examples of local supports for people with LD and complex problems having been implemented successfully in some areas of England, but the challenge is to scale this up and ensure availability across the country. More importantly, the PBSAE will develop sustainable infrastructure and activity to support “challenging behaviour” services long into the future. Although there are some short term priorities that need to be tackled, a sustained commitment is needed to ensure that significant problems do not emerge again in future. Related to this final point about the need for a sustained commitment to support local capacity, epidemiological data suggest that a large number of children and adults with LD have at least one severe challenging behaviour. The administrative prevalence rate for severe challenging behaviour (using a relatively low prevalence figure) is 4.6 per 10,000 of the general population1 – approximately 24,000 individuals in England. Thus, high quality support for individuals with LD and challenging behaviour is a much bigger issue that the 2-3,000 people identified as a priority through the responses to Winterbourne View. What is needed is investment to: 1. Build an infrastructure supporting local services that will ensure that people with a LD never again have to be placed in settings outside of their community and away from their families. This will be achieved partly through better services and partly through evidence-based prevention, including early identification and early intervention. 1

Lowe, K. et al (2007) Challenging Behaviours: prevalence and topographies. Journal of Intellectual Disability Research, 51, 625-636

PBS Academy outline 2

2. As a consequence of 1, deliver a once-and-for-all reduction in the inappropriate use of ATUs to ensure that the ongoing, and much reduced, use of these facilities is appropriate, purposeful and effective. 3. More broadly reduce the use of restrictive practices and increase quality of life for individuals whose behaviour challenges. The PBSAE will be distinctive in a number of ways:  

Independence from all existing organisations and structures, but with a governance model allowing involvement of all stakeholders (organisations and individuals) Ethos and values based on those espoused in the Mansell reports and the underlying philosophy and values of Positive Behaviour Support, in particular: o Close partnership between families/carers and individuals with a LD, academics and researchers, and other LD stakeholders in England o A commitment to evidence-based practice, data-based decision making, continued learning and improvement of supports for individuals with LD whose behaviour challenges services

What will the PBS Academy for England do? The need for the PBSAE will be ongoing - to support continued development of evidence and best practice, maintain standards, and engage with a rolling programme of training and development for stakeholders in the field of LD and challenging behaviour (commissioners; service providers in all sectors; health, social care, and education professionals generally; expert professional staff; families and carers; people with a LD themselves; and the general public). The PBSAE will be a membership organisation, providing a national focus for all stakeholders and a main point of contact for policy makers. The PBSAE will place the leadership for supporting and developing challenging behaviour services into the hands of experts in the field. The PBSAE will need an administrative base, but will primarily be a network of experts distributed throughout England and drawing on expertise from people based in the other UK nations and beyond. Phase 1 – Improving Access to Positive Behaviour Support In Years 1 and 2, the main focus will be on activity designed to rapidly improve access to high quality PBS across England. The focus in this period is specific to achieving that aim, whereas Phase 2 more clearly defines the ongoing role for an Academy.  Developing an infrastructure for the Academy through into Phase 2 and making connections. This will include providing an over-arching organisation to bring together disparate groups that currently exist (e.g., various Communities of Practice, experts by experience, experts in various provider organisations, third sector organisations, statutory services, commissioners). This will ensure additional strength and reach, and local/regional delivery mechanisms. The Academy will also need to begin to develop a national resource library/repository with freely available, high quality training and other materials. A single point for trusted advice is needed. Finally, a core staff and network of consultants and affiliates will need to be established to harness national expertise.

PBS Academy outline 3







 



Establishing national standards for professional staff competencies, organisational competencies, and competencies for families/carers in PBS, providing detailed guidance on the content of PBS training. A framework for competencies at all “levels” within the system will be established (including direct support workers, family members, supervising staff, expert consultants, organisations, local authority areas, commissioning agencies), and will include all skills and knowledge needed to support people with, and at risk of developing, challenging behaviour effectively and safely (i.e., not just specific PBS competencies). Aspects of all of this exist, and are in process (e.g., the Denne et al. work supported currently by Skills for Care)2 but needs to be brought together into a single overarching framework for the sector. Develop accreditation mechanisms at multiple levels (for individual practitioners at various levels, for service providers, and a system designed to develop regional competence – especially at the level of local authority areas), and mechanisms initially for recognition of existing demonstrable competencies. The accreditation model will be based on the competencies framework and also will need to be designed to dovetail with any existing relevant accreditation schemes (e.g., for physical/reactive interventions as currently accredited by BILD, also behaviour analysis professional skills). Over-seeing/commissioning a roll out of regional/local training programmes in PBS designed to establish local expertise and to empower families. All training will be commissioned against the clearly defined competencies framework. This roll out will be designed to inject significant additional capacity into the system in England. The intention is not to replace existing high quality training courses, but to invest in existing resources with a focus on the development of practice leaders. Work with key stakeholders to produce a challenging behaviour toolkit (an all-you-need guide to developing, providing and maintaining effective local services) Via an expert consultation team and local hubs, working with consortia of local commissioners, service providers, families, and people with LD to design lifespan challenging behaviour care pathways and systems across health, social care, and education. For an interim period whilst local capacity is built, there may also be a need for PBSAE teams of recognised experts (fully accredited against standards from the competencies framework) to provide consultation for the most complex cases nationally – especially where an action plan has been difficult to agree.

Phase 2 – Sustainability of high quality local service provision Development work for the ongoing role of the PBSAE will start in Phase 1 and will be rolled out and sustained as Phase 2 of the PBSAE. By Phase 2, a series of regional hubs or connected communities of practice may be needed to provide the longer term infrastructure for the Academy. The longer term function of the PBSAE will be to provide ongoing leadership, and this may include the following specific roles:

2

Denne, L. D., Noone, S. J., Gore, N. J., Toogood, S., Hughes, J. C., Hastings, R. P., Allen, D., Baker, P., & McGill, P. (2013). Developing a core competencies framework for positive behavioural support: Issues and recommendations. International Journal of Positive Behavioural Support, 3 (2), 24-31.

PBS Academy outline 4

       





 

Continue to work via an expert consultation team and local hubs to design lifespan challenging behaviour care pathways and systems across health, social care, and education Maintain a national, trusted resource bank/repository for PBS/challenging behaviour Maintain, update on a regular frequency, and offer an accreditation system for competencies and training and organisational standards in PBS Accredit providers of PBS training Provide a programme of specialist training and ongoing professional development for PBS trainers/supervisors through communities of practice at national and regional levels Provide ongoing specialised training programmes for commissioners, service managers/leaders, and care standards inspectors Provide information and training to empower families and people with LD and enable their involvement in the design and monitoring of services delivered for them Establish comprehensive standards for challenging behaviour services, and advise CQC on any additional standards for monitoring of services specialising in the support of people with LD and challenging behaviour Develop and disseminate Best Practice relating to challenging behaviour and PBS, including resources to be made freely available, running a national annual conference, regional conferences and other events (likely in partnership with other stakeholder organisations in the field – BILD already run an annual PBS conference, for example) Carry out or commission research on challenging behaviour/PBS in partnership with government, charitable research funders, and in partnership with University researchers – through the establishment of a national research network Potentially in collaboration with other organisations (e.g., through the International Journal for Positive Behavioural Support), publish evidence-based practice and PBS research Drawing on the expertise amassing over time within the PBSAE, contribute to future local and national policy relating to challenging behaviour

Structure and governance We propose that the PBSAE should be a cross-sector but independent body. The most suitable governance models will need to be explored in detail, but we suggest that the most appropriate may be a Community Interest Company (CIC) model or similar. A CIC would provide for organisational members across the sector including government and local agencies, as well as the potential for individual members (e.g., accredited practitioners, family “experts”, and associate members). Each member (organisational or individual) typically has one “vote” in a CIC. Such a structure is important for at least two reasons: 1. Ongoing accountability and ownership by the sector, and 2. Association with a potential source of income (from members) to support sustainability. Initially, a short term governance model is probably needed with a single Board of appointed senior individuals. A governance model for Phase 2 can then be developed in concert with the emerging vision for the Academy (and thus is more likely to be fit-for-purpose), and governance of the Academy will also not take up a disproportionate proportion of the time of the very leaders who will be needed to deliver on the Phase 1 objectives.

PBS Academy outline 5

PBSAE set-up and costs In total, an investment of £2.5million is needed over three years to establish the PBSAE and to make the initial short to medium term impact on ATU numbers and local PBS capacity. After three years, the PBSAE will be self-sustainable (probably as a smaller enterprise in its maintenance phase) through membership and other accreditation fees, consultancy income, and research and development income. Key tasks and costs

PBSAE function

Work packages/activity

Resources, and costs Years 1-3

Competencies and standards

Initial 6 month project to finalise and establish competencies framework and associated accreditation and training standards Ongoing accreditation system

1 P/T senior staff member 1 F/T staff member Costs of meetings/travel £60,000 over 6 months 1 x .50FTE Senior staff member 2 x F/T administrative staff Running costs budget Year 1 (part year) – £55,000 Year 2 - £110,000 Year 3 - £110,000

Training capacity, Practice development and leadership

Organisational consultancy and complex individual cases consultancy

Commission training from accredited providers (with a focus on PBS expert level, middle manager/practice leads, and materials for frontline workers and families/carers) Establish national community of practice (CoP) for practice leaders, develop and support regional CoPs, CPD training, PBS leadership training, training of commissioners and other key professionals Six month initial project to develop PBSAE organisational consultancy methodology (assessment tool, action tools) – informed by competencies framework 12 month project to develop PBS/challenging behaviour organisational toolkit (an all-youneed guide to establishing and maintaining local high quality PBS-

Budget for commissioning training Year 1 (part year) - £100,000 Year 2 - £300,000 Year 3 - £100,000 Staffing Director level lead 1.0FTE 2x Senior staff (PBS experts) 1.0FTE administrator Running costs Year 1 - £300,000 Year 2 - £300,000 Year 3 - £300,000 Director level lead 1.0FTE 2.0 FTE senior staff 1.0 FTE administrator Running costs One off budget in Year 1 to fund working groups of experts to develop, pilot test and revise organisational assessment methodology Year 1 - £390,000

PBS Academy outline 6

based supports for people with challenging behaviour)

PBSAE leadership and management = central functions

Establish PBSAE Associate/Consultant database with relevant expertise for organisational and individual complex case consultancy: finance; learning disability/challenging behaviour and PBS; commissioning; housing; project management; coproduction with people with LD and families/carers; planning, data and systems; organisational development Leadership, management, and governance for the PBSAE Collection and interpretation of data throughout the PBSAE functions and activities + other research

Year 2 - £340,000 Year 3 - £340,000

1.0FTE CEO (2x Directors – included above) Central administration and finance roles 3.0FTE (one manager, two junior staff) .40FTE R&D lead 1.0 FTE Research and Data Assistant Organisational running costs Office and meeting/training space Year 1 - £500,000 Year 2 - £500,000 Year 3 - £500,000

Years 1-3 approximate costs and investment needed

Year

Total cost

Investment needed

1 2 3

£1,405,000 £1,550,000 £1,350,000

£1,405,000 £700,000 £350,000

Total

£4,305,000

£2,455,000

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