Flexible proactive and boundary crossing are all features associated with good social care for people with complex needs


As you know, we here at the Learning Disabilities Elf are committed to bringing you the evidence on what works in supporting people with learning disabilities. Occasionally though, we come across research that is not specifically focused on learning disabilities, but might be of interest.

This review by the NIHR School for Social Care Research is a a case in point. The review is about good support for people with complex needs. They looked at complex needs through the auspices of three distinct groups,

1. Young adults with complex or life-limiting conditions
2. Adults with brain or spinal injuries and complex needs
3. Older people with dementia and complex needs.

However, I think the lessons that come from this review could just as easily apply to people with learning disabilities and complex needs.

They found that people with complex needs valued person centred support, placing a high value on the time taken by those supporting them to get to know them well.

The reviewers found a good deal of literature on the subject, but state that there is a “no robust evidence was found in support of any particular approach” with the most robust evidence of effectiveness being related to four models of organising services:

  • a multidisciplinary specialist team;
  • intensive case management;
  • specialist social work;
  • inter-professional training.

They identified a number of features associated with good support,

At the level of individual support, these included

  • Meeting practical, emotional and social needs
  • Being reliable and well coordinated and with continuity in support

At the level of the organisation of the service they found key features associated with good support included

  • Flexibility
  • Availability of Specialist expertise
  • Access to information
  • Proactive approaches

At the level of commissioning the features wer

  • Availbility of Specialist expertise
  • Ability to cross boundaries

The researchers recommend carrying out some rigorous evaluations of models of support for people with severe and complex needs involving  comparison groups and clear reporting of costs and outcomes.

Good support for people with complex needs: What does it look like and where is the evidence?, Research findings, Gridley, K., et al, NIHR School for Social Care Research, London.

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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