Specialist commissioning
Case study: wrap-around psychology for a person with complex needs in supported accommodation
An anonymised example of how a commissioned package works in practice. Details have been changed or left out to protect the person’s privacy.
The situation: restrictive care and no route into NHS psychology
A person with complex needs was living in a supportive placement in supported accommodation. Because their needs were so complex and severe, local NHS psychology services were not able to offer the level of specialist support they needed.
The placement staff were supportive, but support alone was not enough to reduce restrictions safely. The person had not yet developed the skills to manage distress safely on their own, such as regulating their emotions and getting on with other people. As a result, restrictive care practices stayed in place to manage risk, which limited their independence.
Many people were involved: family members, commissioners, care staff, clinical teams and the person’s legal representatives in the Court of Protection.
Checking NHS options first
We started by helping the person explore every NHS pathway open to them. That way, statutory options had been fully considered before any private provision was commissioned.
A menu of specialist assessments
We offered a set of specialist assessments that can be difficult or slow to access through the NHS. The commissioners chose from it as needs changed over the course of care:
Therapeutic assessment and treatment
Ongoing, using evidence-based approaches such as Dialectical Behaviour Therapy (DBT).
Mental capacity assessments
For the Court of Protection.
HCR-20 violence risk assessment
A structured assessment of violence risk.
Specialist neuropsychological assessment
Firesetting assessment and intervention
Building skills, not only managing risk
Treatment focused on the core skills the person needed to manage distress safely: regulating emotions, building relationships and tolerating distress.
To keep frequent sessions affordable for the commissioner, the work was split between two levels of staff:
Senior clinical psychologists
Wrote the formulation, designed the intervention and oversaw the work.
Assistant psychologists
Ran structured skills sessions day to day, under close clinical supervision.
Working with the people around the person
We worked directly with the placement team and the person’s family. We trained staff to support and reinforce the person’s new skills in day-to-day situations, as they happened.
Outcomes
Fewer restrictions
As the person built their skills in managing emotions and relationships, they were able to work towards reducing the restrictions on their care.
More independence
Rather than relying only on care staff, the person developed the skills to make friends of their own.
Intensive support within budget
Using assistant psychologists under expert supervision made intensive, skills-focused therapy possible within the agreed budget.
Clarity for the legal team
A clear psychological formulation and regular progress reports gave the legal representatives and the Court of Protection the evidence they needed to judge whether reducing restrictions was safe, proportionate and in the person’s best interests.
Commissioning a similar package?
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