The Role of the CNS in Supporting People with an Intellectual Disability whose Behavior Challenges'

1
The Role of the CNS in Supporting People with an
Intellectual Disability whose Behavior
Challenges.

• Assessment and intervention development for
  people with an ID and challenging behaviour.
• CNS template for outreach work.
• Intervention documentation and monitoring.
• Ensuring consistency.
• Staff training and education
• Measuring and evaluating outcomes
• Expansion of role/ANP role.

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• Regional BEHAVIOUR SUPPORT SERVICE
• Arras Iona
• Drumillard, Castleblayney, Co Monaghan
• Service consists of
• 4 Bedded residential assessment unit
• Specialist Outreach Team
• Catchment Area
• Meath, Louth, Cavan, Monaghan
• Covering an area of 6, 387 SQ kilometers Total
  population of approximately 308,000
• Currently there are approximately 2,020 people
  with an intellectual disability on the boards
  database

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Specialist Outreach Team

• Consultant psychiatrist (sessional)
• Two senior psychologists
• Two clinical nurse specialists
• Unit manager-CNM 2
• Clinical nurse manager 3
• Principal social worker
• Manager

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CNS template for outreach work
MDT Referral meeting
Set up case referral meeting/roles and
responsibilities
Write up intervention plan
Case assigned to CNS
Intervention plan meeting
Assessment process begins Development of interim
reactive management strategies
Phone contact with referral agency within 48
hrs Assess appropriateness of referral
Implementation monitoring/intervention
monitoring pack
Information-gathering meeting arranged within
7-10 days
Conduct behavioural assessment and formulate plan
Support, guide empower staff
Report back to MDT
Discharge arrangements
Referral accepted
Referral not accepted
Refer back to referring agency
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Assessment.

• Process of info gathering and documenting same in
  measurable terms
• Holistic
• Systematic/multi-disciplinary
• Environmental
• Consultative

• Identify target behaviours
• Rating scales,i.e abs,abas,icap,conners,
  motivational assessment scale(MAS) etc.
• Pass-add checklist,mini-pass add.
• Behaviour checklists

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Assessment Process

• Meeting the Person
• Direct observation
• History behavioural/medical
• Indirect observation
• Continuous recordings
• Hourly observational recordings
• Hourly interval recordings

• Incident analysis sheets
• Epilepsy/Episodic checklists
• Duration recordings
• Event documentation
• Post incident reviews
• Sleep monitoring charts

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Intervention Development

• All recordings sent to CNS on a weekly basis
• Review and analysis of same conducted
• ABC and Incident analysis sheets sent to CNS for
  review
• Feedback and pertinent advice given to staff
• Review meeting convened(if nec).

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Intervention Development

• Reactive management strategies formulated(if nec)
• Evidence based
• Escalation cycle
• Env.Accommadations,de-escalation,re-direction,phys
  ical intervention.
• Discussed with MDT
• Staff training delivered
• Review and analysis of recordings
• Functional analysis

• Hypothesis generation
• History,assessments,analysis of recordings
  incidents.
• Direct observation consultation
• Constructional approach
• Positive behaviour support
• Lifestyle change, skills teaching, reduction in
  problem behaviour, increased quality of life

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Behaviour Intervention Summary
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Intervention documentation

• Assessment report and intervention plan
• Person centred plan
• Reference in risk assessment
• Core files
• Behaviour management guidelines
• Specific behaviour protocols i.e. provision of
  intimate care, self-injurious behaviour

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Intervention monitoring

• Intervention management pack
• Behaviour intervention summary
• Intervention monitoring record
• Assigned key workers
• Daily procedure staff checklist
• Fortnightly outreach reviews
• Quarterly MDT case reviews
• Continuous review of all recordings by CNS

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Ensuring Consistency

• Consultation and inclusion
• Rationale Philosophy
• Caretaking styles
• Intervention management pack
• Clearly written understandable plans
• Modelling
• Ongoing review and direct support

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Staff Training Education

• Local level
• Regional level
• Dept.level/Nurse education.
• Formal
• Informal
• Identified need
• Adult learning principles

• Relevant applicable
• Practical demonstrations
• Practice self-monitoring/evaluation
• Individual support
• Embedded within an overall organisational
  training strategy

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Measuring Evaluating Outcomes

• Outcomes are a result of interventions
• Quantitative or Qualitative
• Agreed
• Non-specific treatment outcomes
• Person centred plan

• Continuous review
• Incident reports
• Hourly observational recordings
• Data analysis
• Baseline recordings
• Service user consultation

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Expansion of Role

• Clinical focus
• Consultant
• Service user advocate

• Nursing Interventions i.e.
• Behaviour management-
• Over activity/Inattention, Case
  management,Documentation,reduction of aggression
  during intimate care
• (Centre for Nursing Classification and Clinical
  Effectiveness) Univ.of Iowa

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Expansion of Role

• Education Training
• Research Audit

• Autonomous
• Leadership
• Expertise
• Action Research

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ANP Core Competencies

• Autonomy in Clinical Practice
• Expert Practice
• Professional Clinical Leadership
• Research