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Workshop: Developing the right skills and motivation in frontline staff supporting people who may exhibit behaviour described as challenging: does a practice leadership (PL) style of management help?

Workshop Facilitator: Roy Deveau (Tizard Centre)

Time: 2:05pm-3.05pm

Theaim of this workshop is todiscuss and describe the complexity of frontline manager’s role and the limited research evidence for PL in developing staff skills and motivation in supporting people with ID, who may show behaviour described as challenging, to live in ordinary community settings. Despite the limited research evidence, anecdotal reports and personal commitment to managers perceived as providing good PL is strong. PL may be provided by families in some supported living settings. Whilst acknowledging the limitations of our knowledge of what good PL is, we mayutilise the commitment to ‘good‘ PL to develop a related research agenda,potentially linked topeople being supported to live outside of hospitals, especially those who lived in Winterbourne View Hospital.

The objectives are to:

  • Establish, through discussion, if a generallyagreed description of a good PL is available, despite the complexity and ‘situational’ nature of leadership of practice. Discuss and identify key areas of organisational systems and individual managers that support and mitigate against good PL and how managers might be developed to undertake such roles.
  • Develop research and, more broadly,descriptive avenues for recognising and supporting the development of good PL. These avenues might focus upon people successfully living in small community settings following discharge from hospitals. Those people who lived in Winterbourne View may provide a useful group with significantprofessional/political impact.

Background

Mansell et al. (2004) described the basic requirements for good staff support as having the right ‘skills and motivation’. Skills are best developed through a well described and researched process of‘competency training’ i.e. description of the skill, demonstration of this skill, and opportunity to practice with immediate corrective and positive feedback or on-the job coaching’. On-the job coaching (Jones et al., 2001) isimportant for implementation of Active Support (AS) and is not usually provided by frontline managers (despite acknowledgingits importance)in the absence of training or support (Deveau & McGill, 2016; Jones et al., 2001). Despite significant sums of money and programmes to improve ‘leadership’ in the NHS significant problems remain (Kings Fund, 2015) . PL (is usually differentiated from management or administration) has been defined in the context of AS implementation by Mansell et al. (2004). However, onestudy to examine the implementation of AS (Beadle-Brown et al. (2014) was said to require PL AND good general management i.e. organisational skills usually described as administration (viewedin some respects as oppositional to PL). The discussion over PL or practice management has been described by Clement & Bigby (2007) in Australia and the complex roles (only some of which includes PL) a service manager/supervisor has to play in the USA and Australia (Hewitt et al., 2004; Clement & Bigby, 2007). In essence what this suggests is the leadership of practice is a complex intervention and a recent Editorial in the British Journal of Psychiatry (Crawford et al., 2016) suggests ‘complex’ interventions are not usually replicated on a larger scale using more scientific methods i.e. the good outcomes shown by innovators in exploratory studies are hard to provide on a larger scalein mental health (cf Mansell, 1993)see Deveau 2016 for an outline of complexity theory and its application in IDand PL.

The key issues and challenges are very similar to implementation of PBS i.e. a system wideapproach may be required (McGill et al., in submission) organisational policies and changes may inhibit PLand the importance of managers’ personal interactional styles and values may be effective at specific times and situations, suggesting a continuous(i.e. one off interventions are not effective) approach is needed to close the gaps between policy/research and practice using PL.

Workshop Summary

  1. Welcome and introductions (5 minutes)

Workshop attendees introduced themselves and their experiences / thoughts on practice leadership.

  1. Presentationto give the background and context for this wor .

Roy Deveau introduced the workshop sharing Jim Mansell’s thoughts that for good staff support, staff need skills and motivation. He explained this further stating that skills can be fairly easy to teach, the problem often lies in staff not using the skills and motivation is key in this. Roy went onto explain that leadership is a complex intervention and there is a need for more research to explore this further

  1. Group discussion:

Discussions took place on practice leadership and what good practice leadership looks like. It was felt that energy and commitment is crucial and it is important that is sustained. There is a need to be realistic; people cannot be expected to change everything immediately. Examples of good practice leadership were shared and elements identified what made these successful which included, designing the service around the person, l earning from the person themselves and being able to recognise and articulate this, and working with families in partnership. The starting point needs to be the person and not the organisation. Organisations need to have policies that are valued based.

Discussions were held and agreement that there is a lack of evidence of practice learning in challenging behaviour. Research would be useful and this needs to be shared. Research needs to consider designing and providing long stable services for individuals

  1. Actions:

Discussions were held and agreement that there is a lack of evidence of practice learning in challenging behaviour. Research would be useful and this needs to be shared. Research needs to consider designing and providing long stable services for individuals.

  • The Tizard Centre and CBF will look at capturing practice leadership examples in challenging behaviour. Future research may focus on Winterbourne View individuals. To be completed by March 2018.
  • ARC and Kate Allen will look at capturing, sharing and disseminating good examples of practice leadership. To be completed by March 2018.

Further information/guidance/ background reading

To be provided.

Challenging Behaviour – National Strategy Group November 2017

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Taking these issues forward…

Action / Who? / When? / Other
Capture Practice leadership examples in Challenging behaviour. Possible for future research focus on winterbourne view individuals / Lead:
CBF and Tizard Centre (Roy Deveau) for initial conversation / February 2018
ARC capture and share and disseminate good examples of practice leadership / Lead:
ARC
Kate Allen / March 2018

Challenging Behaviour – National Strategy Group November 2017