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InPsych 2016 | Vol 38

Cover feature : Psychology innovation in the public sector

Supporting people with high complex needs in the disability sector

Psychologists working in the public sector in disability are often asked to assist disability carers to support people with a disability with high complex needs to reduce their behaviours of concern such as self-harm or harm to others. Here we describe two examples from psychologists working in the public sector where psychology is making a difference in increasing positive outcomes for people with high complex needs.

The first example comes from the work of the Senior Practitioner-Disability in the Department of Health and Human Services, Victoria. The Senior Practitioner role was established by the Disability Act in 2006 to research, monitor and provide education to disability services on how to reduce the use of restrictive interventions such as restraint and seclusion. The case of James below highlights how the work of the Senior Practitioner has encouraged services to find innovative ways to reduce the use of restrictive interventions. In this example, two clinicians from the Senior Practitioner's team (a psychologist and a nurse) supported James's carers to adopt best practice. They encouraged the carers to focus on understanding how James communicated, and the function of his behaviours. They encouraged the carer teams to work together so there was consistency in care across settings. They showed them how to use their data on mechanical restraint use so they could see whether their interventions were working.

James is a 38 year old man who has multiple disabilities and no functional verbal communication. He began to show self-harm from the age of two years. To stop self-harm, mechanical restraints (splints and helmets) were prescribed. The mechanical restraint did not work and over time had led to more severe levels of self-harm. As a first step the clinicians from the Senior Practitioner’s team suggested the carers get

a comprehensive assessment to find out when and why James self-harmed. A functional behaviour assessment revealed that the function of his behaviours of concern was an attempt to seek assistance from carers such as helping him get away from situations he didn’t like. His carers were able to use this information to support him to meet his needs and he stopped self-harming. At 38 years of age James is visibly happier with no signs of self-harm and is now being taught to use technology to communicate for the first time, “more”. No mechanical restraints have been used in the last 17 months.

In the next example, a senior psychologist from the Ageing, Disability and Homecare Department of Family and Community Services, NSW supported carers to form a therapeutic relationship with a young woman who showed self-harm.

Emily is a 24 year old woman who has mild intellectual disability and a background history of significant trauma including emotional and physical abuse. Emily’s behaviours of concern included severe head banging and self-harm resulting in lacerations that often required medical attention. To prevent the self-harm, seclusion and chemical restraint were used. An analysis of the behaviour revealed that Emily’s traumatic history impacted on her ability to regulate her emotions and she had developed a pattern of communicating distress by showing self- harm. The psychologist encouraged the carers to focus on building a relationship with Emily and teaching her functional skills to increase her independence. The results showed that as the relationship between Emily and the carers developed, there were significant reductions in self-harm behaviours. Seclusion is no longer used.

Psycholgical innovation in disability

The work with James and Emily above highlights a number of important skills and knowledge that public sector psychologists working in disability have that can assist carers to improve their support to people with high complex needs including:

  • Understanding the need for a comprehensive assessment of the factors that may impact on a person who shows behaviours of concern (see APS Restrictive Practices Guide, 2011). Helping carers understand the functions of James’s behaviours was critical in finding ways to support him well.
  • Knowing how to address organisational factors involved in changing the behaviour of team members, such as the need for collaboration and leadership (see National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Sector 2014, link below).
  • Teaching carers to use positive behaviour support skills, such as teaching the person skills they can use instead of the behaviours of concern to communicate distress (Cook et al., 20121).
  • Knowing what data to collect and analyse to determine efficacy of interventions was essential. It was important for Emily’s staff to collect behavioural incident data as well as quality of life indicators to show improvement over time.

The first author can be contacted at Lynne.Webber@dhhs.vic.gov.au

Useful resources:

References

  1. Cook, C. R., Mayer, G. R., Wright, D. B., Kraemer, B., Wallace, M. D., Dart, E., Restori, A. (2012). Exploring the link among behavior intervention plans, treatment integrity, and student outcomes under natural educational conditions. The Journal of Special Education, 46, 3-16.

Disclaimer: Published in InPsych on June 2016. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.