CLINICAL SERVICES

Director, Caroline Howorth

A key achievement in 2022 was the appointment of a Director of Adult Clinical Services and the implementation of Progressing Disabilities, SMH Adult Clinical Services was fully established in the organisation.

In 2022, a significant portion of clinical work was dedicated to supporting frontline staff in keeping people safe and well during the COVID pandemic including:

• Alternative Accommodation Forum (AAF)

• Covid screening, vaccinations, interventions and recovery

• Development of clinical information packs and resources (including easy to read formats)

Clinicians continued to learn how to provide clinical supports via online telehealth methodologies while still continuing with direct clinical work in line with local and national guidelines. Significant therapeutic and social work was undertaken in supporting families and people living at home.

In addition:

• Clinical teams focussed on ensuring minimum required training was available to staff online (e.g. Positive Behaviour Support Level 5 Training and Feeding, Eating, Drinking and Swallowing (FEDS)).

• Clinical staff also contributed to the development and provision of accessible, clinically-focussed activities on the organisation’s Activity Hub.

• The Assistive Technology (AT) working group was established and reviewed SMH processes and procedures in assessing and recommending AT devices for adults in the service.

• Ongoing work as regards bone health for service users with follow up DEXA scans, treatment reviews, vitamin D levels established for over 300 service users.

Face to face monthly safeguarding training and refresher training was delivered to all new and existing staff. Clinicians worked alongside frontline staff in responding appropriately to an increase in reported safeguarding concerns and also collaborated closely with all stakeholders in leading out on residential consultations in a time where the challenge of available vacancies was significant.

In order to ensure measurable standards of service, excellence and innovation, the organisation successfully transitioned to IDDSI, in line with national and international best practice and FEDS training became minimum required training for the first time.

Despite the challenges of the period, Adult Clinical Services also saw some important developments in staffing whereby a full time Dietetic Manager and a half time Clinical Case Manager post was recruited.

Key Achievements 2022

SMH spent much time in 2022 consolidating our previous work in preparing for the implementation of the Assisted Decision Making (Capacity) Act (2015). We have developed an ADM policy to guide staff on the Act and have developed ADM online training available for all staff, accessed through the OTC website.

The ADM Steering Group has ensured service users and staff are kept up to date with local and national developments in the area and steering group members have been heavily involved at a national level, influencing the content of HSE E-Learning modules and contributing to national webinars on topics of both ADM and Consent.

Resource materials such as easy to read posters and accessible online workshops were developed by service users to prepare their peers for the implementation of ADM in 2023. Clinicians have contributed and been involved in national advocacy groups including National Consent Policy Advisory Group, National Federation of Voluntary Bodies Planning Group and National ADM Transitional Oversight

Group. We are also fortunate to have representation from the HSE Office of Human Rights and Equality Policy in attendance at our ADM Steering Group meetings to further strengthen the links to national developments.

In 2022, SMH were successful recipients under the UCD Patient and Public Involvement Ignite Initiatives and received seed funding to commence a research project entitled, ‘What is Research?’ – a cross organisational research project focussing on adults with ID as the co-researchers in developing accessible information on the topic of research.

Service Users have also been heavily involved in the ongoing Total Communication project with our charity partners Dundrum Town Centre. Service Users completed a centre walkaround and participated in focus groups to develop the Total Communication Training. Delivery of training to Dundrum Centre staff commenced in June 2022.

Adult Clinical Services held a number of events across 2022, focussing on support, upskilling and development for teams in the service.

• National Health and Social Care Professionals Day,

• Clinicians’ CPD Day with a guest speaker presentation by Ms. Mary Phelan (DCU School of Linguistics and Translation Studies)

2022 also saw the appointment of the first Clinical Specialist HSCP post for St. Michael’s House – in the adult SLT department.

In 2022, the SMH Research Committee was back to meeting on a formal basis and the department was active in supporting recipients of the 2021 SMH Seed Funding Scheme in pursuing their research goals.

Clinicians also focussed on having a broader influence by participating in national working groups, special interest groups and delivering lectures and workshops to medical and HSCP students fostering our relationships with Higher Education Institutes (HEIs) and promoting disability services as a sector of choice.

Adult Clinical Services commenced development, review and implementation of clinical policies in 2022 Significant work was completed in auditing the numbers of individuals engaged in multi-agency service provision and the type of service(s) being accessed. As a result, comprehensive guidelines are now in place for any staff involved in a multi-agency support arrangement and data protection and sharing templates are in place in line with GDPR governance.

Clinical case managers supported 23 service users on the Adult Day Waitlist and 23 School leavers (2022) to transition into a new day service within SMH in 2022, against a complex and ever-changing national context.

Adult clinical services have been involved in a number of cross-organisational projects focussing on the continual quality enhancement including:

• Safeguarding

• MPIO (My Personal Information Online)

• Supported Employment Project (Pobal)

• Positive Behaviour Support (PBS)

Service User Highlights

• Effective individual psychological therapy resulting in decreases in high-risk behaviours.

• Using advanced health care/end of life planning document, with a service user with a life limiting condition, to very positive effect and looking to develop this further

• Service user engagement in ‘Every Moment Counts’ during the October 30 day movement challenge.

• Positive feedback from service users and families on healthy eating and oral health.

• Ageing (multiple organisation initiatives supporting people who are ageing)

• Dementia (further development of processes to support people with dementia)

• ASD

• FEDS and Enteral Feeding

• HIQA Compliance

Challenges for 2022

Staffing represented a significant challenge for the adult clinical teams across 2022. Retirements, resignations, retention and ongoing recruitment issues were experienced. We noted the loss of experienced staff and planned for ongoing upskilling of newer staff to meet SU needs.

Overall, the Clinical Management Team have continued to advocate for an equitable and proportionate allocation of clinical supports to adult services. Service User needs continue to change and/or increase as well as of the pressure of provision of medical and therapeutic inputs to service users not in residential service, with particular regard to those in “clinic only” where many complexities are coming to light. All of this has been against the backdrop of a shortage of clinical staff locally and nationally.

Projects 2022

Accessible Communication Environments in Dundrum Town Centre and National Gallery of Ireland

Strengthening Disabilities Project 2022-2024

Service User safeguarding awareness training Supported Employment Project (Pobal

Updating of the PBS/ Psychology support database Falls prevention policy and clinic development.

Sleep project

Changing Gears – booklet on positive aging.

Activity Hub Website Design

End of life planning with and for service users

Make Every Movement Count project and Advent Calendar

Oral Health Promotion week Sept’22