2014
Outcome Report
Registered Charity Nos: 800797 and SC038972
www.thedtgroup.org
2 COMMUNITY SERVICES OUTCOME REPORT 2014
Overview of 2013/14
20
20 people we offered services to had Learning Disabilities
INTRODUCTION The Community Services division of The Disabilities Trust provides a flexible and adaptable care and support service in the community. Specialising in brain injury care post-rehabilitation, we also work with people with autism, learning difficulties and physical disabilities living independently in the community. The support Community Services provides is flexible and adaptable to the needs of the individual and can be set up wherever there is demand.
OUR SERVICES Accommodation based support / supported living – where necessary we can provide both the accommodation and the support.
92
Own Home – we provide care and support within an individuals’ own home. This is a flexible service designed to meet individual need.
OUR OUTCOMES We use our outcome report to communicate transparent information to those that use our services, their family members and the people that fund or commission our expert care. The report aims to show the changes in a person’s standard of living and lifestyle that we can expect as a result of interventions from our dedicated and specialist teams. We use the measures within the report to improve our services and to help us research further into conditions experienced by those using our services and the management of the condition. The tools/methodologies we have chosen to measure our outcomes are widely used, standardised instruments with robust psychometric properties. To collect our data we welcome participation from the people we support. We ensure that all data collected is consented to and adhere to strict safeguarding protocols to ensure that data is anonymised.
92 people we served in 2013 had primary diagnoses of traumatic brain injury
21
81%
8
21 people (out of 31) no longer needed our support (discharged)
81% of those discharged or transferred went on to receive the same amount or less support
We also supported 8 service users to transfer between our accommodation based support and into their own home
OUTCOME REPORT 2014 COMMUNITY SERVICES 3
We provided services to support 1 person with a diagnosis of autism 8 people 12 peoplewere we provided supported support in for were their ownmale home and 7 female
7 8
7 1
In 2013/14 we provided 12 people we provided support specialist support for people for were male and 7 female with the following conditions; TBI,CVA, Hypoxia, Infection, Neoplasm, learning disabilities, physical disabilities and autism. 19 had other varying diagnoses
11 people were commissioned 12 people we provided support in our accommodation based for were male and 7 female support/supported living services
WE PROVIDED SUPPORT TO 171 PEOPLE
11
12
70% of those used our accommodation based services
Of the 12 commissioned 12 people we provided support service users, 5 were male for were male and 7 female and 7 female
30% required support in their own home
19
4 COMMUNITY SERVICES OUTCOME REPORT 2014
2013 COMMISSIONED SERVICE USERS
Full Time Direct
Independent
Full Time
Part Time
OUTCOME REPORT 2014 BIRT 5
2013 ALL SERVICE USERS
Independent Lorem Ipsum
Lorem Ipsum
Full Time
Lorem Ipsum Full Time Direct
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The outcomes on these pages reflect on our performance in the individual aspects of our service provision.
Part Lorem TimeIpsum
Supervision The Supervision Rating Scale indicates the level of supervision that service users require. Our data indicates that our service users mostly require part time supervision or more. Those who are recorded as Independent live alone or independently however still receive some level of support throughout the day.
6 COMMUNITY SERVICES OUTCOME REPORT 2014
46 49
Ability
Participation
MPAI Average T-Scores
30 = Good Outcomes 60 = Severe Outcomes The Mayo Portland Adaptability Inventory IV (MPAI IV) provides information about the common deficits seen following acquired brain injury. The scale contains three subscales; abilities (i.e. sensory, motor and cognitive abilities), adjustment (i.e. mood, interpersonal interactions) and participation (i.e. social contacts, initiation, money management). Scores around 60 indicate problems in that area whilst scores of 30 show good outcomes. Our scores are in-between, with the adjustment scale indicating good outcomes.
60% -
MPAI: T-Scores
This graph uses the MPAI subscales mentioned above and demonstrates how limiting these may be. The majority of the service users fall between no limitations and moderate limitations. There are some people with severe limitations, highlighting the range of support we provide.
50% -
PERCENTAGE OF SCORES
Ability Adjustment and Participation
38
Adjustment
40% -
30% -
20% -
10% -
0% No Limitations
Mild Limitations
Mild-Moderate Limitations
Moderate-Severe Limitations
LEVEL OF LIMITATION
Severe Limitations
OUTCOME REPORT 2014 COMMUNITY SERVICES 7
Total Average
Verbal Average
Physical Average
Challenging Behaviour Community Services employs the Brain Injury Rehabilitation Trust (BIRT) Aggression Rating Scale. This is used to monitor and record any verbal and physical challenging behaviour that we see. Those within Community Services generally do not display challenging behaviours frequently, as demonstrated by the averages recorded for service users during 2013. The BIRT Aggression Rating Scale is used to record incidences of both verbal and physical challenging behaviour. Scores range from one per incident to six per incident, therefore the Community Services’ average score of three indicates particularly low levels of challenging behaviour.
8 COMMUNITY SERVICES OUTCOME REPORT 2014
Individual Well Being 50% rate effort during rehabilitation as very good*
On average, service users have higher levels of anxiety and depression at the point of commissioning service, in direct comparison to the lower levels which can be seen in the annual assessment results. (see appendix 1.2, page 13)
2% Only 2% rate tolerance of present life as poor*
30% rate current productiveness as good*
All models used are for illustrative purposes
4% Only 4% rate the level of peace with themselves as poor*
72% of all people asked reported a normal range of frequency of feelings and emotions. Only 20% reported mood disturbance**
20% rate social life as excellent*
60% of people asked reported that they were satisfied with their life ***
21% thought that intimate relationships were good*
58% said that they had the important things they wanted in their lives ***
(*appendix 1.3) (**appendix 2.1) (*** appendix 2.2)
In your own words... “Staff are really flexible so short notice invitations or activities can be accommodated. There’s lots of space in the house so no-one feels like they are getting in anyone’s way. We often socialise together – we have parties of coffee”. “The hub of our house is the kitchen, we are always cooking and baking. We have regular parties and get togethers. It’s a great place to live”.
OUTCOME REPORT 2014 COMMUNITY SERVICES 9
Daily Functioning SLEEP
5%
Report High Problems
Y MEMOR N NTIO & ATTE
13%
erage ort Av
Rep
DEPRESSION
42%
ms
Proble
Report Average Problems
AGGRESSION
50%
COMMUNICATION The Neurobehavioural Functioning Inventory (Kreutzer, Seel and Marwitz) is a six scaled measure reflecting symptoms and problems which may occur in daily life recorded simultaneously by those receiving our care and their family members. (See appendix, page 12)
Average
9%
High or Average
MOTOR
92%
Community Services support a diverse contingent of cases and this is reflected within the data. For example we report varying needs in areas such as communication and memory and attention. Few service users fall in the very high range however.
Very Low
Personally Reflected Scores Scores Reflected by Family COMMUNICATION
67%
Report Average Problems
26%
DEPRESSION
MEMORY & ATTENTION SLEEP
2%
60%
Report Average Prob lems
Report High Problems
High or Average
MOTOR
84% Very Low
AGGRESSION
68% Average
10 COMMUNITY SERVICES OUTCOME REPORT 2014
Stakeholder Satisfaction Every year we ask all our stakeholders how satisfied they are with all aspects of our services through questionnaires. The feedback we receive enables us to evaluate our service. We also use the data to further develop and improve our services in the coming year. We ask our stakeholders to rate each element of the service we provide on a scale of 1 – 5 where 1 is extremely unhappy and 5 is extremely happy. We also ask them which of the areas is important to them.
INDIVIDUAL SATISFACTION 97% are happy overall with Community Services 97% are happy with the way they are treated by staff
98% are happy that they are treated like an individual
93% are happy with the choices that they were offered “I like being visited by the Psychologist and being able to discuss whatever is bothering me” “I like having my own independence in my own flat” “I like being listened to and not being told what to do”
FAMILY SATISFACTION “The care and professionalism of the staff” “The interaction with staff has been brilliant. They are informative and always willing to do the best for our son”
90% of families are satisfied overall with Community Services and 93% of families say this is important to them
94% said that they were satisfied with the support available to them and 94% said that this was important to them
94% said that they were satisfied with the benefits of the rehabilitation programme
REFERRER SATISFACTION “Really happy my client has done so amazingly well with the dedication of staff and felt commitment”
98% of those asked said that they were satisfied overall with Community Services
100% said that they were happy and it was important to them that the rehabilitation plan had been put in to practice
97% said that it was important to them and that they were happy with the professional skills and training of the staff
OUTCOME REPORT 2014 COMMUNITY SERVICES 11
Case Study John is 25 years old; six years ago he was hit over the head with a bottle whilst working as a chef and sustained a severe head injury. He was admitted to hospital and underwent emergency neuro-surgery to remove the bleeding from around his brain.
The support he received from Community Services enabled him to maintain the tenancy on his flat and complete the tasks of daily living which enabled him to reintegrate into community life. He was also encouraged to join a football team where he learnt how to coach, which helped him regain confidence in meeting new people and dealing with social situations.
He returned home to live with his family but due to the changes in his mood and behaviour caused by his injury, his relationship with them deteriorated which caused him to move into his own flat. Unfortunately the move was not successful and due to the deficits related to his brain injury, he struggled with debt and ever increasing problems. As a result he was admitted to a Disabilities Trust brain injury rehabilitation service and over a period of nine months structured rehabilitation made such marked progress that he was then referred to the Trust’s Community Services.
Three years on and John’s situation has changed beyond recognition. He has moved into a new house with his girlfriend and together they have had two children. John also now works as a volunteer at a charity shop to gain work experience and is learning to play the guitar. His support has been gradually reduced. This has been so effective that recently all his support was withdrawn for a trial period and, if successful, it will be withdrawn completely.
“My life is brilliant now; I never thought I’d be living in a nice house and have a wonderful family. I want to find work so I can support my family and not be on benefits.”
All models used throughout are for illustrative purposes
12 COMMUNITY SERVICES OUTCOME REPORT 2014
Appendix 1.1
SERVICE USER
FAMILY
The inventory looks at Depression, Sleep, Memory and Attention, Communication, Aggression and Motor. The measure allows us to look at both a service user perspective and a family/staff perspective in each area. Scores can then be interpreted to show the level of difficulty the service user experiences in each area. On most occasions the scores differ depending on who reported it.
Neurobehavioural Functioning Inventory (NFI)
NFI: Depression
NFI: Memory & Attention
80% -
60% -
PERCENTAGE
PERCENTAGE
50% 60% 40% 20% -
40% 30% 20% 10% -
0% -
0% Very High
High
Average
Low
Very Low
Very High
High
CATEGORY
PERCENTAGE
PERCENTAGE High
Average
Low
Very Low
Very High
High
Average
Very Low
Low
Very Low
CATEGORY
NFI: Aggression
NFI: Motor
80% 70% 60% -
PERCENTAGE
PERCENTAGE
Low
50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% -
CATEGORY
50% 40% 30% 20% 10% 0% High
Very Low
NFI: Communication
50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% -
Very High
Low
CATEGORY
NFI: Somatic
Very High
Average
Average
CATEGORY
Low
Very Low
50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Very High
High
Average
CATEGORY
OUTCOME REPORT 2014 COMMUNITY SERVICES 13
POOR
Psychological Well Being
1.2
1.3
EXCELLENT
Ben Yishay’s Six Areas of Wellness
Hospital Anxiety & Depression Scale
Ben Yishay’s Six Areas of Wellness
7.7 6-
6.1 5.2
4-
5.2
PERCENTAGE OF SERVICE USERS
60% -
2-
0-
50% 40% 30% 20% 10% 0-
Anxiety
Depression
Anxiety
2013 Commissioned Service Users
Depression
Effort During Rehab
Tolerance of Current Leavel of Peace Present Life Productiveness with Self
Social Life
Intimate Relationships
2013 All Service Users
AREA OF WELLNESS
CATEGORY & TIME SCALE AGREE
The Wimbledom Self Report Scale
2.2
This scale asks service users to rate how often they feel certain feelings and emotions. Scores are then categorised into Normal which ranges from scores of 0 to 7, Borderline scores range from 8 to 10 and finally Case of Mood Disturbance scores range from 11 to 30 (Agnes et al 2009).
The Satisfaction With Life Scale 70% -
70% -
60% -
PERCENTAGE
50% 40% 30% 20% -
DISAGREE
The Satisfaction With Life Scale
80% 60% -
NEUTRAL
The scale here asks service uses to indicate their agreement with several statements on a 7 point scale. The pie chart indicates how satisfied with their lives our service uses are. The bar chart shows the statements to which the service users provided their level of agreement. It is pleasing to see that for most of our service users they agree that they are satisfied with their lives and have got the important things they want in life.
The Wimbledon Self Report Scale PERCENTAGE OF SERVICE USERS
VERY GOOD
This scale asks service users to rate themselves in certain areas of their lives. The graph gives an overall perspective of how our service users feel indicating that on the whole they rate themselves fairly positively in each area of wellness.
8-
2.1
GOOD
The Hospital Anxiety and Depression Scale (Snaith & Zigmond 1994) assesses the level of anxiety and depression among service users. The measure can be used for those in community settings.
10 -
MEAN SCORE
FAIR
50% 40% 30% 20% 10% -
10% 0% -
0% Normal
Borderline
Case of Mood Disturbance
Normal
Borderline
CATEGORY & TIME SCALE
Case of Mood Disturbance
In most ways my life is close to my ideal
The conditions I am satidfied with So far I have of my life are my life gotten the excellent important things I want in life
CATEGORY
If I could live my life over, I would change almost nothing
Community Services supporting individuals to live their life their way. We seek to maximise independence and choice aiming to enable people to participate in a wide range of activities within the community. We achieve this by putting the individual at the centre of all we do.
Communication
Your Choice
We work with people to find unique and innovative ways to overcome communication difficulties.
Our teams work together with individuals using our services to identify opportunities and life ambitions / goals which can include training, education, social and recreational activities using a person centred approach.
Listening Your feedback Thank you for taking the time to review our report. Feedback about the information and how useful you have found it is very welcome. Please contact us and let us know.
We encourage people to express their views and concerns by regularly talking to staff as well as family, carers and health & social care support teams.
Structure
Flexibility We work with and assist people who either hold a personal budget or are funded by their Local Authority.
Our support allows people to plan, organise and engage with others in their own home and in the local community.
Contact us, make a referral or for more information: The Disabilities Trust Community Services 3 Westgate Court, Silkwood Park Wakefield, WF5 9AD
Tel: 01924 266 344 Fax: 01924 899264 Email: community.services@thedtgroup.org www.dtgroup.org
Community Services is a part of The Disabilities Trust. The Disabilities Trust First Floor, 32 Market Place, Burgess Hill, West Sussex, RH15 9NP Tel: 01444 239123 Fax: 01444 244978 Email: info@thedtgroup.org
www.dtgroup.org
The Disabilities Trust is a company limited by guarantee incorporated in England and Wales under 2334589 and registered as a charity in England and Wales under 800797 (BIRT: 800797-1) and in Scotland under SC038972 (BIRT: SC043579). Registered office as shown.