CONTROL DE TRANSITO

enhancing therapy with LGBT clients linking to the

non-specific therapeutic skills

(Jeffery & Tweed,

2014). Participants were conflicted in their

approach to TDSO when working with LGBT &

straight clients and it was noted that TDSO

happens in many ways. Concealment was an

important finding, suggesting that LGBT therapists

expect prejudice and discrimination from straight

clients related to minority stress model (Meyer,

2003).

References:

CHRE (2008). Clear sexual boundaries between health care professionals and patients: Responsibilities of health care professionals. London: Council for

Healthcare Regulatory Excellence; Hanson, J. (2005). Should your lips be zipped? How therapist self-disclosure and non-disclosure affects clients. Counselling

and Psychotherapy Research, 5(2), 96–104

Jeffery, M.K., & Tweed A.E. (2014). Clinician self-disclosure or clinician self-concealment? Lesbian, gay and bisexual mental health practitioners' experiences of

disclosure in therapeutic relationships. Counselling and Psychotherapy Research: Linking research with practice, DOI: 10.1080/14733145.2013.871307;

Meyer , I.H. (2003). Prejudice, social stress and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychological

Summary of Service-Related Research and associated Impact (SSRI)

Trainee(s) Supervisor(s) Placement Cohort Date

Completed

Adam Harris Dr Liz Boyd Learning

Disabilities Psychology

2012 December

2014

Research background and context

Learning Disability (LD) inpatient services across the UK need to evidence their effectiveness at helping service users transition from secure settings back to the community or to supported living. Inpatient units support Service Users who have reached crisis point in their community setting and require a hospital stay. With LD services this is usually because there has been an increase in challenging behaviour that cannot be managed safely in the community. LD Inpatient setting also provides assessment and treatment facilities for service user with LD when they have become unwell.

There is also growing need to evidence that vulnerable adults are kept safe from abuse and neglect in inpatient settings following recent high-profile cases e.g. Winterbourne. Furthermore given the current economic client there is increased pressure for inpatient services to be evidencing that they offer value for money or provide the “added value” for the premium paid by placing authorities. Therefore it was suggested that a review of the service user perspective of being an inpatient within the current service, would help evidence the service’s “added value”.

seen as “experts by experience” providing leadership for their own care (Lloyd, Hemming & Tracy, 2013). NHS professionals are required to adhere to the National Institute for Health and Clinical Excellence (NICE) guidelines for best practice although for patient choice and need, clinical judgment and flexibility in treatment is acceptable (NICE, 2004; 2006). Part of key role for Clinical Psychologists is to ensure developing and monitoring outcomes for individuals and services (DCP, 2011).

The role of inpatient assessment and treatment units for people with LD is currently being scrutinised nationally, following the Winterbourne enquiry (DoH, 2012). Inpatient services are currently under review across England, under NHS England, due to Winterbourne case. This report summarises a service evaluation of the Trust’s Rehabilitation Service for Adults with Learning Disabilities (AwLD) in August 2014.

Research aims

Clinicians within the service were keen to formally ascertain the experiences of current service users regarding current care and support being received within the inpatient service. Of specific interest were the service user’s perspectives of how they have experienced rehabilitation, taking into account what has helped and what has hindered their progress since admission. There was local interest in the effectiveness of the inpatient service for clients with LD due to the inpatient service being small and therefore expensive in comparison to larger providers who may be “preferred” by placing authorities. There were further drivers for evaluation due to recent shortcomings highlighted in care inpatient settings e.g. Winterbourne. In response to these drivers, the trainee and supervisor conducted semi-structured interviews and analysed the audio- recorded data that was transcribed. Thematic analysis (Braun & Clarke, 2006) was used to gain an understanding of the service user’s experience of the inpatient service.

What the research discovered

From participants that were eligible to be interviewed (n=5) (dependent on (a) cognitive ability, (b) level of distress/anxiety caused by process (c)

communication abilities) the analysis revealed 15 themes related to the service users perceptions of their care. Themes included: current placement versus other placement; home versus hospital; freedom versus restriction; our involvement; power; feeling secure; recovery; external/social support; access; activity; active support model; staff meeting needs; orientation; physical environment; placement is alright. For ease of reading the themes will be separated into the benefits of the inpatient service and the drawbacks of the inpatient service.

The Benefits

The analysis indicated that service users thought that there were benefits of being an inpatient in the LD Service. Participants were able to compare their experiences of being in the current service to previous placements (e.g. medium secure, supported living, independent living). One of the main benefits highlighted by participants was the current inpatient setting were a lot smaller than their previous placements. Important advantages of this included: it being less noisy, staff having more time to meet service user needs. Other benefits included staff being available to provide 1:1 support when it was requested or for staff to help participants resolve issues and worries quickly. There was a sense that participants felt safe and cared for during their time at the inpatient unit.

Participant’s felt involved in timetabling how they would spend their time and they appreciated having responsibilities within the service, this included taking on responsibility for house chores (e.g. cooking, cleaning, and gardening). This enabled the participants to become skilled and more independent and helped them distinguish the progress that they were making. There was also the opportunity for participants to give feedback and recommendations about how the service could be made better. There was another clear advantage of being an inpatient in this service; this was the onsite activity centre.