Occupational Therapy News OTnews November 2019 | Page 27

LEARNING DISABILITIES FEATURE
have been using care pathways to support service users, their
families and care staff. This includes a pathway for behaviours that
challenge.
Our occupational therapy role in this pathway sits within a wider
multidisciplinary team approach and referrals to us may be requests
to assess and optimise an individual’s occupational performance.
As occupational therapists, we would assess an individual’s
occupational performance in the context of their social and
physical environment (RCOT 2017). We were using a variety
of assessments, but could not find a specific planning and
assessment tool that addressed the interplay between high-risk
behaviours, occupational performance and the environment for
this service user group.
We also saw costly decisions being made without any robust
assessment that allowed for multi-agency or multidisciplinary
discussion of potential risk issues and how these might be managed
or reduced.
As a pragmatic response, we conceived the Safe Home Developing the SHEA: phase one
Environment Assessment (SHEA) as a means of addressing this gap. local learning disabilities services are realising the potential cost
and resource saving implications from its use and, as a result, they
have been referring directly to the occupational therapy team for
SHEA assessments and have welcomed our proactive response
to those individuals entering the community from long-stay
hospitals.
Feedback from care providers and families has been positive, as
the SHEA highlights areas of priority in terms of managing risks to
maintain an individual’s service or in the consideration of their future
service.
A social worker said: ‘I found the document very helpful as it
highlighted a lot of information that could otherwise be missed. I have
used the document whilst updating X’s care and support plan. The
document made it much easier to access the information and to look
at recommendations… it was a great help.’
Families have also expressed their appreciation of being involved
in the assessment process, particularly in providing a historical
perspective and sharing knowledge about their loved-ones.
Collaborating with others in the transforming care process has
helped with the success of using the SHEA. Joint working with
colleagues with PBS expertise is proving beneficial from a functional
perspective in instances where it is envisaged that restrictive
interventions may be needed.
Its practical application with ‘real-life’ cases has helped to develop
some credibility with providers, clinicians and commissioners of
service.
The development of the ‘site-visit’ component and solutions
guide has also received some funding from NHS England in 2018.
In January 2019, we presented the work so far at the inaugural AHP
Autism conference in Oxford, as a practice initiative.
What is the SHEA?
The assessment has two parts. Part one is an assessment tool
that helps identify high-risk behaviours within the person’s home
environment, such as destruction of property, history of absconding,
smearing of bodily fluids and sensory sensitivity to environmental
stimuli such as noise and light.
We support this with an occupational therapy report identifying
areas of risk, prioritisation of safety issues and recommendations
to support the individual’s daily occupation and reflects individual
sensory preferences within the planned home.
Part two is a site visit tool that may help when new
accommodation is identified and its suitability needs to be
determined. The therapist then matches identified risk issues with
solutions for the proposed placement.
A solutions guide is currently being developed, which has useful
links to adaptations, guidance, and fixtures and fittings.
The SHEA can be used for a number of situations. First, in existing
home environments where a person may be displaying challenging
behaviours of concern and there is a need to adapt or modify their
current home. Second, if a person is to move to a new placement
and suitable accommodation needs to be identified and assessed for
its safety.
We consider the SHEA as one component of creating a capable
environment. In identifying potential risks early, it can help in the
design of resilient, sustainable and personalised home environments.
This may help reduce placement breakdown and hospital
admissions, and importantly, support people close to home.
The SHEA also operates from the principal of promoting the least
restrictive option, being hopeful that by reducing potential triggers to
challenging behaviour, the team supporting the individual can focus
on other proactive goals to promote independence and choice and
provide high quality care to improve life outcomes for a complex and
vulnerable group.
The SHEA was developed in 2016 and piloted by our small team of
occupational therapists within East Sussex and Brighton Community
Learning Disabilty Teams over 18 months. The pilot helped to identify
the most common high-risk behaviours, which are now reflected in
the current revised tool.
The emergent themes include high levels of destructive behaviour
requiring robust environments, absconding risks in younger age
groups (for example, those transitioning into adult services), and
environmental factors that calm and reduce arousal as part of
Positive Behavioural Support (PBS) plans.
Though the current number of individuals in our local
transforming care cohort is small, we are focusing on high-cost,
high-risk individuals where good initial planning around the physical
environment can help with long term sustainability and reduce costs
associated with need for frequent repairs and damage to a property.
This bespoke tool has become an invaluable component in
our occupational therapy assessment toolbox. Commissioners of
Developing the SHEA: phase two
The second development phase is to make the SHEA an ‘easy-
read’, accessible tool by capturing service-user views and enabling
their involvement in the planning of their environment.
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