Psychology services for adults with complex needs

The psychology team at The Richardson Partnership for Care plays a crucial role in the care and support of our service users, who have complex needs and acquired brain injuries or learning disabilities. Dr Pedro Areias Grilo, Consultant Clinical Neuropsychologist, heads up the team and is supported by three Assistant Psychologists: Julita Frackowska, Olivia Ferrie and Joseph Szablowski. The Assistant Psychologists are assigned to specific service users according to their needs and the homes in which they live.

Person-centred care
The ethos of the psychology team is the one that runs through the organisation as a whole: the service user is at the centre of everything we do. We are committed to providing individualised care to effectively support the nuanced needs of each service user. We take a person-centred approach and offer interventions to service users based on cognitive behavioural models, dialectical behaviour skills and operant conditioning. All of the interventions offered are evidence-based and follow NICE guidelines.

Psychological reviews
All service users receive an initial psychological review, which includes neuropsychological assessments, a review of clinical presentation, assessment of stability of mood and suggestions for future interventions. This review is then repeated on a regular basis to assess the effectiveness of the therapies and interventions delivered. In addition, we have an ‘open door’ policy at The Richardson Partnership for Care, so all members of the psychology team, and the Assistant Psychologists in particular, can develop close working relationships with the service users. This means that their well-being can be monitored closely on an informal basis and we have found that this helps to maintain their mental health, so any problems can be addressed early, preventing the need for crisis care.

Positive Behaviour Support
Positive Behaviour Support (PBS) is a key part of the psychological support that we provide and an emphasis on positivity is one of our main philosophies. PBS Plans are person-centred and designed with input from the service user to promote positive behaviour. They are supported to set their own goals and to achieve them.

In addition, Pedro and the team are working on an innovative Positive Behaviour Tool to more effectively monitor and encourage positive behaviour. This runs alongside the traditional techniques of reducing negative behaviour.

Multi-Disciplinary Team
The psychology team works closely with the other members of the multi-disciplinary team. (This comprises a consultant neuropsychiatrist, homes managers, service manager, physiotherapist, speech & language therapist and occupational therapist.) Pedro and Consultant Neuropsychiatrist, Dr Seth Mensah, work closely together to balance the use of drug therapies and psychosocial therapies. Where possible, we aim to focus on psychosocial approaches and gradually reduce the reliance on drug therapy to achieve better outcomes for service users over the longer term.

A diagram explaining the psychology services at The Richardson Partnership for Care
A summary of the psychology services offered at The Richardson Partnership for Care

Satisfaction survey: our care home residents

Adults with acquired brain injuries, learning disabilities and complex needs

In addition to surveying the families of service users in our care on an annual basis, we also complete a questionnaire with the individuals themselves, which asks specific questions about different aspects of their lives within the care home. They are asked to respond using a satisfaction rating of 0 – 4 where 4 is the most satisfied. All of our service users have complex needs and some are unable to answer the questions, so staff either help them to answer the questions or observe their behaviours to ascertain their needs.

The results from each individual are combined to give average scores, which are shown below. There are up to five questions in each section, so the totals show an indication of satisfaction in each area.

However, as every person is different, and has different needs, our approach is always individualised, person-centred care.

bar chart showing satisfaction survey results

Service user satisfaction survey results 2017

The following gives you more information about the specific areas covered in the satisfaction survey.

Know how to complain
This question assesses how well the individual knows what to do if they have a complaint. The average overall score across the homes was 3.63 out of 4. It excludes the individuals who were unable to understand the question.

People you live with
This is very important to all of our service users, and satisfaction ratings can vary according to the type of care home as stable populations with long term residents tend to have a higher satisfaction rating. The Mews, which focuses on short-term intensive rehabilitation for adults with acquired brain injuries, naturally has more of a changing population. This can affect the dynamics of relationships between the residents. We work hard to ensure that any incoming service users will not upset the balance in any care home and we continually review our admissions policy to ensure that we receive sufficient information in advance of a full assessment of any potential new residents.

There is very much a family environment within our care homes, and many strong friendships develop between individuals. However, like a family, it doesn’t mean that everyone gets on well with everyone else all the time. Therefore it is important that we focus on relationships between individuals and use mediation and psychology to manage any disagreements. As a last resort, we can move individuals into another of our homes but this is rarely necessary.

Decision making
These questions covered how involved people feel in decisions relating to their care plan and risk assessments as well as making choices in their everyday lives.

Staffing
These questions ascertain how well service users know the support staff in their home and how they feel that they are treated by them: whether the staff are approachable, as well as whether they would like to be involved in the interview process. Many service users said that they would not want to be involved, which has reduced the average score.

Food and drink
As well as being asked about their choice of food and their cultural needs, individuals were also asked about how involved they wanted to be in menu planning and food preparation.

Activities
Many of these questions were qualitative: describing current activities undertaken or potential new ones, so a numerical score was not given. The activities that we provide are very much tailored to the individual and if something is requested but not achievable or affordable then we explore alternatives.

Environment
These questions simply asked how satisfied service users are with the communal areas of the home, the garden and their room.

Olivia and Jo join the psychology team

Assistant Psychologists Olivia Shepherd and Jovita Valuckaite have joined Julita Frackowska in the psychology team, which is headed up by Consultant Clinical Psychologist Dr Pedro Areias Grilo.

The Assistant Psychologists are assigned to specific service users depending on their needs and the homes in which they live. Julita supports service users in 2 & 8 Kingsthorpe Grove who have learning disabilities, autism spectrum disorders and mental health needs. Olivia works with service users at 144 Boughton Green Road and The Mews, providing psychological and practical support for people with acquired brain injuries and mental health needs, and Jo works with service users at 23 Duston Road and The Mews, supporting people with acquired brain injuries, dual diagnosis, mental health needs and behaviour that challenges.

The Assistant Psychologists perform an important role, completing psychometric assessments for service users to monitor cognition, mood, mental state and behaviour. They provide psychological reports for each individual, which include a functional analysis of their risk behaviours which is used to inform their individualised treatment plan. They also offer advice, psychological support (including cognitive behavioural therapy, cognitive stimulation therapy, substance misuse work and relaxation) as well as providing practical support such as budgeting and functional living skills.

Consultant Clinical Psychologist Dr Pedro Areias Grilo heads the psychology team. He is an inspiration to his colleagues due to his work ethic and methodical approach but most of all, he is immensely passionate about making a difference to service users. He works closely with other members of our multi-disciplinary clinical team, especially Consultant Neuropsychiatrist Dr Seth Mensah, to develop individualised treatment plans for service users. He also works directly with the service users to provide therapy, supporting them and monitoring their progress. In addition, Pedro oversees the work of the Assistant Psychologists, both supporting them in their role to deliver therapy and complete standard assessments but also challenging them academically to find better ways of working.

Olivia Shepherd and Jovita Valuckaite

From left to right: Assistant Psychologists Olivia Shepherd and Jovita Valuckaite

John enjoys his first ever holiday

We’ll soon be holding a birthday party at a local pub for John, one of our service users. That may not sound unusual, but on this occasion it is. John has been in our care for over 20 years and has rarely chosen to go out. He has learning disabilities and complex needs and he presented with very challenging and aggressive behaviour when he first came to us.

John has also achieved another major milestone – taking his first ever holiday when he went to the seaside town of Skegness in Lincolnshire for four days. He was supported by Selina, a review co-ordinator at The Richardson Partnership for Care, with whom he has a great rapport.

Skegness beachIt has taken years of hard work and consistent support from our trans-disciplinary team of therapists and our care support workers to enable John to develop his confidence and control his behaviour in order to take this huge step. To help him experience and enjoy the holiday as much as possible, it was booked at short notice. He chose where he went and who he wanted to accompany and support him. During the holiday he was in full control of what he did.

Dr Mick Clarke, a close family member of John said: “John is having the best care he has ever received and your professional and devoted work with him has enabled him to grow in confidence and become a happy man.”

“Selina’s total commitment to him has supported him to the extent that he has finally been able to go on holiday. Your team at the Richardson Partnership for Care has allowed him to blossom into the lovely caring man that was always there.”

“Your plans for him over the years to withdraw drug therapy and support John through specialist behaviour plans has meant he is becoming more socially skilled and a joy to be with. Going on holiday has meant John’s confidence has moved to another level.”

The holiday was such a success that he has requested to go back again next year as well as choosing to celebrate his birthday with a party at an external venue. This story demonstrates that consistent care and support, while providing opportunities for social integration and decision-making can lead to increasing fulfilment and autonomy.  Sometimes this is a very gradual process.

A seal in a pool at Skegness

Selina gains Level 4 Diploma in Adult Care

Congratulations to Selina Vernon, Assessor and Review Co-ordinator at our homes for adults with learning difficulties, who has completed her Level 4 Diploma in Adult Care. This is a new qualification and Selina is the first person to pass it in the UK with training and qualifications body ARC (Association for Real Change).

It was recognised that there was a need for senior people in the residential care sector who were not registered managers but wanted to gain a management qualification. This Level 4 Diploma in Adult Care fills the gap below the new Level 5 Leadership qualification and covers areas such as:

  • Advanced communication skills
  • Implementing equality and diversity policies
  • Facilitating support planning to ensure positive outcomes for individuals and to support well-being

Selina Vernon

Selina Vernon has achieved the new Level 4 Diploma in Adult Care

Selina achieved her qualification by assessment in the workplace with support and quality assurance/verification from ARC. Selina commented: “After completing my assessors’ award, I wanted to develop my knowledge further to be able to better support the individuals in my care and also my candidates. The level 4 was a natural progression with a good range of units to cater for different care environments. The units were relevant and required me to push myself in order to develop my knowledge to achieve the diploma. The support I received from ARC was fantastic.”

Congratulations also go to Joanna Okoro, Mike Femi Ayenitaju and Ranga Gorejena who have achieved Level 3 Diplomas in Health and Social Care.

At The Richardson Partnership for Care our aim to enable people to realise their potential, applies to our staff as well as our service users. Staff are given the opportunity, encouragement and support to build their knowledge and confidence and to better meet the diverse needs of all of the individuals that we care for. As well as the opportunity to take a range of qualifications, all support staff complete a comprehensive training schedule which involves them attending training every three weeks as part of their working rota. This includes statutory training such as health and safety and food hygiene as well as crisis prevention, epilepsy, dementia and working with people with learning disabilities. More information on our training schedule can be found here:

For more information about the qualification, go to the ARC website.

Using online apps to stay in touch

Online applications are transforming the way that we live and work, and at The Richardson Partnership for Care we are using them to help service users and their families keep in touch, and for the families to participate in the review process.

Our service users with learning disabilities have an external review every 12 months where their care team and case workers review their care plan and discuss their progress. The service user can choose whether or not they take part in the review, but under The Care Act 2014, reviews should be attended by a family member or advocate.

Some family members live too far away to attend all of the reviews or find it difficult because of work and other family commitments. We recently arranged for a family to participate in a review using Facetime. This application, similar to Skype, enabled the family to make a video call over the internet.

This was the first time that we had used a video call to enable a family to take part in a review and it was a great success. We received positive comments from the family as well as the care manager. The family were able to contribute fully to all areas discussed: they could see and hear the review team and ask questions as well as providing their thoughts and feelings on the care package. They said that it was just like being there!

On this occasion, the service user declined to take part in the review, but they had a video call with their family afterwards and spoke with their care manager and review coordinator about what had happened in the review.

We are now setting up regular video calls for service users and their families to stay in touch, which benefits everyone and in particular, reassures parents who live some distance away. It also enables family members overseas to stay in touch and be involved.

iPad showing different apps

Scale of over-medication is now out in the open

The Care Quality Commission, Public Health England and NHS Improving Quality have recently published reports commissioned by NHS England into the prescribing of psychotic drugs to people with learning disabilities. The research found that there is an alarming rate of over-prescribing of these drugs to people with learning difficulties: the report authored by Public Health England, estimates that up to 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant or both without appropriate clinical justification.

The research concluded that:

  • There is a much higher rate of prescribing of medicines associated with mental illness amongst people with learning disabilities than the general population, often more than one medicine in the same class, and in the majority of cases with no clear justification
  • Medicines are often used for long periods without adequate review
  • There is poor communication with parents and carers, and between different healthcare providers

Dominic Slowie, NHS England’s National Clinical Director for Learning Disabilities admitted that this is an historic problem and the research was needed to find out the scale of the problem so that action could be taken.

This is something that we feel strongly about at The Richardson Partnership for Care, and we regularly review the medication that our service users take with the aim of reducing it over the longer term wherever possible. Our focus is on behavioural therapy and all staff are trained in managing actual or potential aggression using the least restrictive techniques.

This is what the uncle of one of our service users with learning disabilities said about his care:

“Over a period of ten years, my nephew has presented with very challenging behaviour. Having his time with the Richardson Partnership for Care, his behaviour has improved as a result of excellent care. This consists of reducing the ‘chemical cost’ of drug therapy with a range of behaviour modification and genuine and dedicated care, which we greatly appreciate.”

Michael C

Psychological support
Our team of psychologists support our service users to help them to manage their behaviour and maintain their mental health. We have found that personalised care and the right level of clinical psychology provision has enabled individuals with even the most challenging behaviour to make good progress and reduce their medication.

One of the techniques used by our psychologists to help modify behaviours is Applied Behaviour Analysis (ABA). Support staff complete specialised recording forms, which are collated and analysed by the psychologists. The results help us to understand the relationship between specific behaviours and the environment. This means that things that may negatively affect behaviour can be more positively adapted, as part of a learning process.

In addition, each service user has their own health passport to give them ownership of their medical information and clarity regarding the medication that they are taking.

Care homes shine in independent feedback

At The Richardson Partnership for Care, we strive to have an open relationship with service users and their families so that they can tell us straight away if they are concerned about any aspect of their care or their home. We hold regular care reviews as well as completing an annual survey.

This year we have also encouraged service users and their families to provide feedback directly to the online directory carehome.co.uk. Our homes for adults with learning difficulties, 2 & 8 Kingsthorpe Grove, achieved a recommendation score of 9.6 out of 10 from the directory, and we are very proud of some of comments they received. For example, here is a comment from a parent of one of our service users with learning difficulties:

“Our son was taken in by Jayne Payne in 2009. He was in a terrible mental state, he’d been sectioned in Oxford in 2007 for violence, and he had always lived at home until then. Well, Jane and her staff worked and worked with him until he is almost like his old lovely self. They bring him home to us once a month on the Isle of Wight for two days and he looks forward to this as much as we do. We cannot say enough good things about the home: they saved our lives and our son’s. The medical care is fantastic and they are always loving and tolerant of our son, even on his bad days.”
Jane S

And this is what one of the service users had to say:
“I like it here, I am happy here and all of the jobs I do. I like the staff. I go out for drinks and meals out. I have had my bedroom painted. I like my bathroom. I like my lunches. It is a good place to live.”

Click here to see a summary of the survey results  or here to go to the carehome.co.uk directory

A collage created by service users at 8 Kingsthorpe Grove

A collage created by service users at 8 Kingsthorpe Grove

Sensory awareness groups

We learn about the world constantly through our senses and by interacting with it. This process of exploration and learning starts in childhood and continues throughout our lives. However, people with learning difficulties may not have had the same opportunities to explore and interact with their environment, and people with acquired brain injuries may need to repeat some of these learning experiences.

At The Richardson Partnership for Care, we have recently introduced sensory awareness sessions to the programme of group sessions that we run for our service users each week. They are designed to provide the opportunity for service users to use their senses to learn about and interact more meaningfully with the world.

The sensory awareness course starts with an introduction to the five senses – or methods of perception: sight, taste, smell, touch and sound. Then each session explores one of the senses in more detail, presenting several items to each member of the group and allowing them to become accustomed to their particular properties and the differences between them. We use examples that the service users will find in their everyday lives, including food and drink or items from the home or garden, helping them to embrace their own environment.

The service users can benefit from the sessions in many different ways. The programme aims to:

  • Gain, maintain and/or increase service user abilities to receive and differentiate sensory stimuli
  • Recognise the five senses of the body
  • Stimulate the service user’s appropriate response of sensory experience
  • Provide a multi-sensory experience or single sensory focus, simply by adapting the lighting, sounds and textures to the specific needs of the service user
  • Assist service users to gain the maximum pleasure from the activity
  • Develop the service user’s awareness of the different sensory experiences
  • Provide opportunities for social interaction
  • Increase awareness of own social skills and others around us
  • Help in the development of appropriate relationships
  • Increase confidence and self-esteem when interacting with others

The sessions are evaluated using group recording forms and informal assessments so that the needs and progress of each individual can be properly met and understood. This is in addition to the wider monitoring of service users’ rehabilitation progress.

The sensory garden at 8 Kingsthorpe Grove

The sensory garden at 8 Kingsthorpe Grove

Dementia awareness training

There is a rolling training programme every three weeks for care staff at The Richardson Partnership for Care and one of the topics is dementia awareness. The Alzheimer’s Society estimates that there are 850,000 people living with dementia in the UK, and people with learning difficulties and people who have experienced stroke or head injuries have a higher risk of dementia.

During the training sessions, staff learn about some of the more common types of dementia such as Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia as well as rarer causes of dementia such as Parkinson’s disease, Huntington’s disease, Korsakoff’s syndrome and Creutzfeldt-Jakob disease (CJD).

Symptoms of dementia
Dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem solving or language. As the symptoms can be consistent with different types of learning difficulty or acquired brain injury, it is important for staff to be aware of them and that dementia is a progressive condition. Dementia progresses as the structure and the chemistry of the brain become increasingly damaged over time.

The initial symptoms of dementia for someone with severe learning difficulties may not be typical. They may be changes in personality or behaviour, and therefore dementia may be harder to diagnose.  Our care support workers, home managers and multi-disciplinary team of therapists work closely with the service users in our care and keep daily records as part of their care plan. This familiarity and the knowledge of the care team, combined with regular reviews, help us to identify any health issues that our service users experience. Each service user is registered with a GP and has their own health passport.

Treatment and support
The dementia awareness training looks at how some medications can slow the progression of dementia and how diet and nutrition can help. It also covers activities, memories and how the environment can play a part in helping people with dementia to feel more secure.  At The Richardson Partnership for Care, our homely environment, familiar and structured routine can help people with dementia to feel safe and comfortable.  In addition, our person-centred approach helps to identify each person’s individual needs and supports them during everyday life, however their needs change.

Bedroom at The Richardson Partnership for Care

Our homely environment, familiar and structured routine can help people with learning difficulties or acquired brain injury and dementia to feel more secure

Training materials relating to dementia can be purchased from The Alzheimer’s Society, which provides a wide range of information www.alzheimers.org.uk