Anne Graham and David King, Directors at Resolve, and Celia Harbottle, Academic and Freelance Trainer, outline their approach to providing effective and compassionate care and support to men with learning disabilities and autism. All of the residents at Resolve’s homes have a history of offending behaviour, in some cases, serious offences. All have been in hospital or prison and most have had limited opportunities and meaningful life experiences.

A model of best practice 

Our model of practice, which we believe promotes good outcomes for the men we support, was first shared in the Journal of intellectual disabilities and offending behaviour (JIBOD, Dec 16, 7(4), pp186-194). What follows is a brief overview of this approach and the evidence of external assessors including the awarding of the National Autistic Society’s Advanced Autism Accreditation and the Care Quality Commission’s (CQC) inspection reports (Outstanding).

Our approaches are informed by systemic practice and underpinned by models of human occupation (Keilhofner, 2008) which informs occupational therapy, and Total Attachment (Harbottle et al., 2014). Briefly, this is a whole systems model for developing compassionate and participatory practice based on attachment theory and approaches to professional parenting drawn from foster care settings and prevention frameworks for adult safeguarding. It uses Klinean Thinking Environments (1999) to give practical communication to the model. 

The attachment model, which underpins both the support for staff and the framework for care and support, is building calm, consistent and respectful relationships. This enables workers and the people supported to feel accepted; to feel a sense of belonging and inclusion in which skills and confidence can flourish, helping all to feel more effective. This is evidenced by the stability of the service user group and the staff team (JIBOD, 2016, p186).

Feels like home: The philosophy behind Resolve underpins everything we do. For instance, furnishings are modern and homely, the properties don’t have the feel of a care home. Each person we support is consulted in how their room and the communal areas are decorated and they are involved in doing DIY and maintenance, as and when it is needed.

Meaningful activities: Engaging with the community is fundamental. Resolve’s model of care means that from 9am to 4pm Monday to Friday (excluding holidays), the residents are involved in meaningful activities, including volunteering and indulging in their passions, such as fishing, working with horses and building models.

Genuine engagement: The people we support are active in their local communities and have meaningful community presence. We recognise that engagement has to be purposeful and provide people with access to the things they are interested in, because they have to want to do it, to get up and be motivated. We provide opportunities for engagement in different social environments as an equal, believing that this reduces the chances of reoffending as they are part of the community in which they live.

Structure: There is emphasis on providing structure and managing choices. Given that many of those we support have spent a large proportion of their lives in hospital or prison settings, where choices were not given, providing them unfettered choice could create more problems, for example leading to increased anxiety and risks to themselves and the community.

Relationships: Relationships are key to the Resolve way of working, and growing trust, especially between staff and those we support, is central to this. An understanding of each person’s background is important, this helps to provide staff with appropriate training so they can work positively towards helping them to have meaningful lives and to avoid reverting back to offending behaviour.

External scrutiny

We work reflectively and embrace learning from expert external bodies. Scrutiny of our approach comes from the CQC, and eager to have our work examined for its specialist element with regard to support for autistic people, we engaged with Autism Accreditation.

Conclusion 

The external scrutiny, and recognition achieved through the external assessments, has affirmed our belief in the best practice framework we have at Resolve.

We are mindful of the need to constantly invest in our model. It only happens with energy and commitment but because this is whole system and uses everyone’s strengths to scaffold each other, we feel that that energy becomes self-perpetuating with the available, accepting, sensitive and effective team approach we constantly strive to foster.

The progress and achievements made by each of the residents in the home are incredible. We will continue to empower the residents to be part of their support planning in a meaningful way and we will continue to look for creative ways to promote their wellbeing and the wellbeing of our staff. 

Article sources/references:

Graham, A. Harbottle, C. and King, D. (Dec 2016). Resolve: a community-based forensic learning disability service specialising in supporting male sex offenders – our model, approach and evidence base for effective intervention.

Available from:

https://www.researchgate.net/publication/311224763_Resolve_a_community-based_forensic_learning_disability_service_specialising_in_supporting_male_sex_offenders_-_our_model_approach_and_evidence_base_for_effective_intervention 

Harbottle, C., Jones, M.R. and Thompson, L.M. (2014). From reactionary to activist: a model that works, The journal of adult protection, Vol. 16 No. 2

Kielhofner, G. (2008). Model of human occupation: Theory and application, 4th ed. Baltimore: Wolters Kluwer Health; Lippincott, Williams and Wilkins

Kline, N. (1999). Time to think: Listening to ignite the human mind. London:  Wardlock
Schofield, G. and Beek, M. (2006). Attachment handbook. London: BAAF