ABI Service at Guild Lodge

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    Acquired Brain Injury (ABI) Service at Guild Lodge

    The Acquired Brain Injury service line sits within Specialist Services as part of the wider Mental Health Network.

    The ABI service extends the options for being able to offer an integrated care pathway within the North West of England for individuals who have identified secure care needs associated with brain injury.

    This allows a better matching of care provision with individual patient need, and develops service and staff expertise in a specialist area where secure ABI provision is otherwise very limited

    All of the staff within the ABI service therefore undertake ABI training.1 In 2015 the ABI training package received a Lancashire Care NHS Foundation Trust ‘Highly Commended’ award. This course continues to develop and adapt to our service training needs.

    Since July 2018 the ABI service has been offering Challenging Behaviour training within the Secure Network, as an intensive 1 day course.

    There is also an emphasis on staff supervision through formulation meetings and shift supervision to ensure a consistent approach and continuous learning.

    We have high levels of uptake of staff supervision and completion of Trust mandatory training throughout all grades and professions in the ABI service.

    Ward Environment and Ecology

    The ABI service provides a specialist pathway of individualised care using neuro-cognitive and neuro-behavioural rehabilitation models of care.

    Neurocognitive rehabilitation is the process of relearning cognitive skills that have been lost or altered as a result of damage to brain cells/chemistry. If skills cannot be relearned, then new ones have to be taught to enable the person to compensate for their lost cognitive functions.

    Neurobehavioral rehabilitation is identifying a patient's challenging behaviours, any environmental and internal factors that might be contributing to the occurrence of the behaviours and responses to the behaviours that make it more likely to continue.

    It is a whole environmental/ecological approach which relies on specialist expertise of staff delivering care.

    The ABI Service consists of:

    • Two Medium Secure Wards – Bleasdale and Whinfell (18 beds total)

    • One Low Secure Ward – Langden – (15 beds total)

    The wards aim to provide a low stimulus environment, providing high levels of structure and a positive predictable routine.

    The Staff Structure

    These ABI wards each have a full diverse MDT inclusive of:

    • Medical  

      • Consultants - Neuropsychiatry and Forensic

      • Junior Doctors

      • Clinical Practitioners

    • Occupational Therapy

      • Occupational Therapy team based at the therapeutic resource centre

      • Ward based OT

      • Technical Instructors

    • Nursing

      • Designated Matron for service

      • 3 full nursing teams lead by Ward Managers and Team Leaders

      • A professional mix of Mental Health, Learning Disabilities and General/Adult Nurses

    • Psychology

      • Consultant Neuropsychologist

      • Associate practitioners

    • Speech and Language Therapist

    • Social Worker and administrative staff

    • Physical healthcare team (provided across site)

    • Independent Advocacy is also provided

    Patient Centred Care

    Each ward had a weekly Care Team Meeting comprising the MDT. This is an inclusive meeting and the patient advocate is actively involved. Alongside the CTMs, all patients have Care Programme Approach reviews – initially at 8 weeks following admission and 6 monthly thereafter.

    It is essential that a Local Care Co-ordinator is identified prior to admission and that contact is maintained with them throughout the patient’s pathway. The LCC is therefore invited to attend CPA but is also welcome to attend CTMs. Similarly, for patients transferred from the prison estate, Probation Officers are likewise engaged.

    Each ward has a weekly community meeting and patients have the opportunity to join in with Service User Champions meetings. There is access to advocacy.

    All patients have access to ‘easy read’ documentation to maximise understanding opportunities. This is individually produced for specific patient needs supervised by our Speech and Language therapist.

    Maintaining Carer Support

    Contact with families is intrinsic to recovery and rehabilitation. Given the wide geography of our catchment area, this can be difficult. Our ward social worker undertakes a carers’ assessment and we aim to facilitate family contact as soon as possible following admission.

    We are currently exploring use of Skype to further improve the frequency and ease of contact. Visits can take place either within a dedicated family room or on the ward, dependent on individual risk assessment.

    Transition / discharge planning

    At the heart of our service is a focus on rehabilitation, compassion and instilling hope. At the point of initial assessment we begin to develop a Positive Behaviour Support Plan2 (PBSP) which is dynamic and holistic.

    This plan helps the MDT to work collaboratively with the patient to identify realistic and achievable goals to progress in their pathway. The PBSP follows the patient as they progress. Goals are established early in admission and are regularly reviewed.

    Given the nature of the patient group many of the goals are focussed on challenging behaviours.

    Outcome Measures

    We use standardised Outcome Measures to ensure interventions we are using are effective.

    These outcome measures include:

    • Secure HoNos

    • HoNos ABI

    • OAS-MNR - Overt Aggression Scale modified for neurorehabilitation

    • SASNOS - St Andrew’s Swansea Neuro-behavioural Outcome Scale

    • SASBA – St Andrews Sexual Behaviour Assessment

    We also complete neuro-rehabilitation outcome measures in line with the Royal College of Psychiatrists Faculty of Neuropsychiatry guidance on ABI and UK-RoC. These include:

    • Fim-Fam

    • Northwick Park

    • BINI

    • EQOL –ABI

    • MOHOST