Mansell Report Update Offers New Challenges To British Care Providers

The SHARED Approach is a clinical system that is in turn based on Positive Behavior Support and which enables support staff to implement the key features of Positive Behavior Support in a person centred and consistent manner.

The second half of 2007 was a significant time for those who make and follow policy developments for people with learning disabilities in England. Included in this raft of policy and guidance is the update of the Mansell Report, 'Services for People with Learning Disabilities, Challenging Behavior or Mental Health Needs authored by Professor Jim Mansell. The Mansell Report Update was published in October 2007 and seeks to distil best practice for people with challenging behavior acting as revision of the original report from 1993. It makes a series of recommendations for all the agencies involved in supporting people with learning disabilities and challenging behavior. In reflecting on this latest report it is encouraging to note that everyone is agreed on the need for high quality services available as close to home as possible. There is a further trend to reduce the size of services and enhance the skills of members of staff. The development plans for many organizations operating in the sector have reflected these trends. Originally it was only possible for some people to access evidence based and effective services for people with challenging behavior by moving to other parts of the country. There are now services throughout the land and there have been many examples of people being offered the opportunity to move closer to home and still receive the quality of support they need. However some people have, like many others in modern Britain, been keen to move to a different area where they have made friends and put down roots. We continue to support that as a positive choice for people with learning disabilities in the same way as it is! for anyone else. A Clinical Model...That works. The SHARED Approach is a clinical system that is in turn based on Positive Behavior Support and which enables support staff to implement the key features of Positive Behavior Support in a person centred and consistent manner. Service providers who do not employ agency staff are most able to maintain the kind of consistency of relationship that under pins these clinical programs. As Mansell points out, there have been difficulties with evidence based practice for people with learning disabilities and we seem to be moving towards a resolution. Some organizations offering services in this sector are more optimistic than the report authors about the long term future of people with severe challenging behavior having seen the results of this work in the lives of many individuals over the past 20 years. A Clinical Model ... that can be seen to work Castlebeck, a well established service provider based in the north of England has now completed the development of a person centred system for measuring outcome. It is called Castlebeck Progress and it is based on the "social construction" of challenging behavior that Mansell seeks to promote. The Castlebeck team are hopeful that this will help everyone focus on the benefits of support to the individual. Keeping this in mind it is encouraging that we are also beginning to realize that there isn't always a "quick fix". Rather it is a question of carefully understanding the support that a person needs to reduce the impact of challenging behavior on both everyday life and important relationships. Castlebeck Progress involves an approach similar to that of person centred planning. An individual works with a circle of people to decide on the unique profile of outcomes that will suit that individual. This is based on a social model of challenging behavior where we look at the core problems a person has (e.g. poor self esteem or a history of abuse), the ways in which these problems effect the person's everyday life (e.g. aggression, destructive patterns of relationship), the kind of support a person needs to minimize the impact of the problems and begin to get back to community living. Once the circle has agreed a profile of outcomes for the individual, measures are taken of each part and the work begins to make things better. The circle then re-gathers after a year and sees how things are going. This type of approach welcomes the Mansell Update and we are looking forward to using this as encouragement to keep working for better lives for people with challenging behavior.