Taking a neurobehavioural approach we are experienced in psychological assessment and behavioural analysis to formulate positive behavioural management plans to support successful transitional rehabilitation of the individuals we support.
Our model of care enables us to draw upon a wide range of interventions, from environmental changes to medication, or person-centred support plans and specialised diets. At St Peter’s Hospital our focus is on reducing distress, maintaining personhood and improving quality of life. Promoting connection is at the heart of our approach to psychosocial intervention – connection with other people; connections with a sense of self through memories and familiar occupation, and connection with the surrounding environment.
On arrival all our patients undergo a 16-week assessment which then helps formulate clear and time-focused care and transition plans.
In addition, our transitional rehabilitation service includes training for new providers, families and locality teams to share an increased understanding of the individuals’ needs and care plans, in order to support successful onward placement.
We also offer longer term rehabilitation for those individuals who may require lengthier support or whose condition is likely to deteriorate further.
Our Care Pathways also support the development of care partnerships and empower both service users and their carers. We also use them as an essential tool to incorporate local and national guidelines into everyday practice, manage clinical risk and meet the requirements of clinical governance.
Assessment & Treatment Pathway
(up to 16 weeks)
We provide a comprehensive sixteen-week multidisciplinary assessment for the transitional rehabilitation of individuals with complex organic conditions, including significant mental and physical health needs and challenging behaviours.
At the end of the sixteen-week assessment period, our assessment findings are translated into clear recommendations for the individual’s future care. Our assessment is focused on achieving positive outcomes for the individuals, their families and the commissioners of the service. During the assessment period, care and positive behavioural management plans can be tested for their efficacy and adapted as necessary for successful discharge and move on
Recovery and Wellbeing Pathway
For those with brain injury and progressive neurological disorders, behaviours that challenge can require a longer period of specialist care and treatment in a hospital setting.
Our Recovery and Wellbeing Pathway focuses on formulating and evolving an individualised care plan that provides these patients with enhanced support and responds to risks, whilst maximising their quality of life.
People with progressive neurological conditions can often present with complex psychiatric and physical comorbidities; this pathway provides a framework to assess and treat mental illness, enhance functional ability, and promote independence through engagement in a variety of evidence-based therapies.
Patients on our Recovery and Wellbeing 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 treatments. They also have daily access to specialist communication and swallow assessments, provisions of specialist feeds (including PEG), physiotherapy, specialist GP and dental services, occupational therapy and dietetics.
Specialist Palliative Care Pathway
The behaviour of a small number of our patients can remain challenging as they enter the terminal stages of their illness.
In partnership with St David’s Hospice, we have developed a Specialist Palliative Care Pathway that provides for those that are unable to transition to a nursing home or hospice setting. We also work closely with these patients’ families to support them and their loved ones during this time.
