Pinetree Hospital: Our Treatment Pathways

Our Treatment Pathways

At Pinetree Hospital we offer a dedicated 20 week assessment and treatment pathway with a focus on community discharge from day one.

For those who require further complex treatment and rehabilitation, Pinetree has developed additional specialist and distinct treatment pathways.

Assessment, Treatment and Discharge Pathway (0-20 weeks) Our Assessment, Treatment and Discharge Pathway provides for individuals in crisis with rapid access to a safe learning disability-friendly environment, where they will receive a comprehensive assessment by our specialist multidisciplinary team.

This pathway focuses on reducing psychological and emotional distress, treating mental and/or physical illness, and formulating a person-centred assessment, treatment and discharge plan over a 20-week period.

Our findings and recommendations are clearly presented at a Care Programme Approach (CPA) meeting at week 12, allowing for a planned and coordinated transition to conditions of less restriction (wherever possible) over the following 8 weeks.

When enough progress has been made to facilitate community discharge, we will provide a comprehensive Positive Behavioural Support (PBS) plan to inform future placements of appropriate behavioural support strategies, coupled with pharmacological therapies to help maintain the positive results achieved during the individual’s stay with us. We also work collaboratively with the community placement to deliver a smooth transition and deliver network training if required for the new team.

If the individual requires further treatment on one of our specialist care pathways, this will also be discussed within the 12-week CPA meeting.

Rehabilitation Pathway (timescale agreed at CPA) For those with co-existing mental illness, personality disorder, forensic risks or complex behaviours that challenge, rehabilitation can require a longer period of specialist assessment and treatment in a hospital setting.

Our Rehabilitation Pathway focuses on formulating and evolving an individualised, person-centred PBS plan that provides individuals with enhanced support and responds to risks, whilst maximising their quality of life.

People with an intellectual disability can often present with complex psychiatric and physical comorbidities; this pathway provides a framework to assess and treat mental illness, support behaviours, enhance functional ability and promote independence through engagement in a variety of evidence-based therapies.

The aim of this pathway is to actively engage individuals in moving towards community living.

A key component of this pathway is the application of principles of active support in order to assist individuals in achieving their own person-centred goals, which will assist them in achieving both short and long-term goals centred around rehabilitation and community participation.

Individuals on our Rehabilitation Pathway are offered a wide range of unit and community-based activities that improve their overall wellbeing; establishing therapeutic alliance and, wherever possible, reducing the use of pharmacological treatment. They also have daily access to Vocational and Activity CoOrdinators and other allied health professionals, such as Clinical Psychologists, Occupational Therapists, Speech and Language Therapists (SALT), Dietitians and Physiotherapists. Input from a specialist Social Worker and Independent Advocate is also available.

We recognise each individual is deserving of a bespoke package of care. At Pinetree Hospital, we always seek to find innovative, evidence-based means of providing each individual with a schedule of activity that they will find therapeutic and engaging.

Forensic Pathway (timescale dependent upon individual need) For those with specific forensic risks a ForensicallyInformed Psychological Intervention Pathway is available.

This pathway is available to individuals who present with the following risks: • Verbal threats to harm • Physical aggression (inc. environmental damage) • Intimate partner violence (emotional, verbal and physical) • Sexually harmful behaviour (threatened/attempted/ actual assault, inc. possession of indecent images) • Fire-setting This pathway is delivered by the psychology team on a group and/or individual basis dependent upon the needs of the individual. The aim of this pathway is to reduce identified risk by giving service users the skills to deal with potential destabilisers in the future.

The pathway is built around structured modules and session plans, however these are adapted and individualised to meet specific needs.

Core modules are completed by all individuals on this pathway: • • • •

Getting to know you Managing my emotions Problem solving Getting on with people

Additional modules are offered based on psychological assessment and formulation of need: • Adapted sex offender treatment • Having good relationships (intimate partner violence) • Healthy sex (sexually harmful behaviours) • Anger Management • RESCUE (fire setting) • Substance misuse Upon completion of prescribed modules individuals are then supported to consider relapse prevention by completing “me and my future”.

Outcome measures, including development and review of forensic risk assessments, are used to evaluate progress.

Adapted DBT Pathway (timescale dependent upon individual need) For those with a diagnosis of emotionally unstable personality disorder, or who present with emotional/ relational instability, an adapted Dialectical Behaviour Therapy informed pathway is available. This pathway is based upon delivering the DBT modules of mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.

Complex ASC Pathway (timescale dependent upon individual need) For individuals diagnosed with an Autistic Spectrum Condition, or presenting with traits related to this condition, the following interventions are available based on individually assessed need: • An ASC-friendly environment • Speech and Language Therapy assessment and intervention • Augmentive communication • Structure and predictability • Sensory assessment and intervention • Social stories to promote engagement in activities of daily living, community participation, and understanding of social situations • Visual Aids to support routines

Complex Behavioural Pathway (timescale dependent upon individual need) Individuals placed within Pinetree Hospital who are identified at initial assessment / pre-admission as presenting with high levels of behaviours that challenge (including multiple or complex behavioural issues, significant psychological distress or unstable mental health difficulties) are placed on this pathway for input from nursing, psychiatry, psychology and multidisciplinary professionals i.e. OT & SALT. Assessment will include:

This pathway is delivered through individual and group treatment sessions; as well as through reinforcement of DBT skill use by nursing and support staff. Materials and session plans are based upon the DBT model but adapted to meet individuals’ specific needs and cognitive abilities.

• Review of history and background information

Outcomes are measured on standardised assessments as well as feedback from clients and progress along their rehabilitation pathway.

Intervention will include:

CBT and trauma-focused interventions are also available.

• In-depth functional analysis assessment • Direct observations, monitoring and specific assessments of service user by multidisciplinary professionals

• Service-wide PBS informed practice • MDT input into Care and Treatment Planning, and Risk Assessment and Management Planning • Development of service user PBS plan • Review and monitoring of PBS plan implementation through positive monitoring

Thank you for working with me, thank you for helping me and I want to keep going Service User

Excellent progress made.

Really impressed with the support provided and the effort put in Commissioner

I like receiving certificates for the things I’ve done, it helps me know that I’m achieving things Service User

Pinetree Hospital 904 Newport Road Rumney Cardiff CF3 4LL

Ludlow Street Healthcare Group 5th Floor Harlech Court Bute Terrace Cardiff CF10 2FE

029 2039 4410 info@lshealthcare.co.uk

www.lshealthcare.co.uk @Is_healthcare