Our tiers of support
Transforming Support also aims to maximise the opportunity to co-produce support with individuals, families, and health and care professionals by providing a seamless service for each person. It also aims to be transparent and flexible when a person receives a service from Transforming Support. The pricing structure reflects the investment Transforming Support commits to enabling the operation of a quality PBS service and a Support for Living Service. This includes people who use the service being able to access staff support when needed.
Support for Living Service is person-centred and enhanced by a Positive Behaviour Support Team, experienced and trained to standards nationally accredited in supporting people with complex behavioural needs. The team provides following each person’s needs and within the allocated 'Tier of Support', both direct and indirect support. It has a Crisis Intervention and De-Briefing Service and engages as required in Quality Improvement Initiatives, including Service Reviews and Incident Reviews advising as necessary on best practices.
The Tiered Approach
Applying the 'Tiered Approach' to costing services enables every aspect of commissioning a service, from Transforming Support to being personalised to the individual receiving the service. This is in respect of it.
- Decisions about support
- Positive Risk Approaches and Shared Risk Management with Stakeholders
- Staff Recruitment, Training and Management
- Accessing local public health and Social Care Services
- Funding of a Personalised and Bespoke Individual Service.
The Tiered Rate is applied to a Support Plan and Weekly Individual Support Planner that clearly outlines the level of support required, i.e., the staffing ratio for each individual. This will be applied five flexibly about decisions a person we support chooses to use the support but is monitored and reviewed regularly with the person using the service and partners. Increases in hours or levels of support may also vary depending on the individuals’ needs, progress and circumstances, and the commissioners will be kept notified of any requirement for urgent review.
Our support tiers are:
Tier 1 – Basic Service - No PBS Service Required
- A person’s needs do not include support or interventions due to behaviours that may impede or reduce their ability to engage and achieve their potential using the Support for Living Service.
- A person’s lifestyle choices and decisions do not result in assessed risks that mean they or others may be at risk of harm or vulnerable to abuse, thus requiring behavioural interventions.
- Individuals will benefit from being supported by teams with basic training in Person-Centred Active Support, including personalised communication and engagement strategies.
- The person will benefit from being supported by teams who understand Positive Behaviour Support Approaches.
- The approach to supporting individuals includes Person-Centred Active Support and Positive Behaviour Support principles.
- Person supported is not deemed to have behaviours that challenge
- The person supported does not require a Positive Behaviour Plan to manage known behaviours
- The agreed Risk Management plans for the Individual do not indicate a need for behavioural interventions by staff as a means of preventing an escalation of behaviours that challenge.
Tier 2 – Minimal Support
- The person already has an up-to-date PBS plan maintained by the local NHS Positive Behaviour Support Team, which meets their assessed needs.
- Requires standard yearly review with the local Positive Behaviour Support Team with quantitative and qualitative data provided by Transforming Support.
- Known behaviours are low in frequency, duration, and intensity.
- The person does not require restrictive interventions.
- The person can participate in community activities, and the risk of behaviours that challenge or put the person at risk in the community is low.
Tier 3 – Medium Level of Support Required
- The person has a PBS plan that requires review by a PBS service, a local resource which cannot be provided at the time or frequency to meet the assessed need.
- A person's challenging behaviours can occur frequently (at least once a fortnight) but are low in intensity and duration.
- The person has restrictive interventions written up in their support plan, which require regular review and monitoring with staff qualified in PROACT-SCIP (Level 3-5)
- The person may not be engaging in many activities in their own home or have the community presence they have the potential to achieve due to their behaviours or incidents.
- Previous history of incidents in the community has resulted in concerns about the person’s behaviours and the ability of staff to maintain their safety and that of others in the community.
Tier 4 – High Level of Support Required
- The person’s behavioural assessments are not available or serviceable, and there are high-risk behaviours indicating the need for a full functional analysis of behaviour; risk assessments and a positive behaviour plan are required.
- There is a need for ongoing support, training and monitoring of the interventions and outcomes for the person with the Positive Behaviour Support Plan to ensure outcomes are achieved, and the person and others they come into contact with are safeguarded from injury, neglect, or abuse.
- Behaviours that may challenge occur frequently and are high in intensity and duration, e.g., may result in injury, neglect or abuse of the person or others with whom they engage.
- The person is transitioning from an assessment and treatment unit / low secure hospital setting or similar environmental change and has the potential for high levels of behaviour that challenge as they adjust to new circumstances and less restrictive environments.
- Within the past three months, the person has required restrictive interventions such as physical restraint (e.g., PROACTSCIP-r-UK 2 person- seated, supine).
- The person has a recent forensic history (within the last 18 months).
- The person is under or requires legal restrictions, such as the Mental Health Act or the Mental Capacity Act and requires regular monitoring and review with other stakeholders.
- The person is at high risk of exclusion from activities of their choice in their home or community due to behaviours that limit their ability to engage or sustain positive engagement with others in those environments.
- The person has experienced several placement breakdowns, indicating difficult personal experiences with services and underlying personal issues resulting in behaviours that may put themselves or others at risk of injury, neglect, or abuse.
- The person requires high-level staff support in their home to engage in daily life activities in their home and community.