Shared learning database

Dorset Healthcare University NHS Foundation Trust / Dorset County Council
Published date:
May 2019

In 2015, a child who was fully looked after in a local authority specialist children’s home, with complex needs (Autism Spectrum Disorder, Learning Disability and abuse history) was in crisis. The placement was breaking down due to significant challenging behaviour. Following an unsuccessful national search for specialised care, an approach based on group supervision evolved and has become a key part of supporting this child. The group is co-facilitated by an Occupational Therapist and Educational Psychologist. It creates a safe and supportive environment which enables care/education staff to share feelings, take considered risks and learn about attachment. The impact is that they have remained in placement in their local area. Challenging behaviours have significantly reduced. They are progressing in their independent living/self-care skills and leisure activities. The staff are committed and value the group. They have grown in confidence and skill which is having an impact for other children. This has also saved the cost of private placement.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The group and approach has evolved over the last 3-4 years as a result of being in crisis with no alternative. The initial aims were to provide support and facilitate collaboration across agencies and develop a true team around the child. Aims have since become clearer: facilitation of group supervision that creates a safe place to share experiences feelings, take considered risks and learn about attachment.

This links to the NICE guidance PH28. This guideline covers how organisations, professionals and carers can work together to deliver high quality care, stable placements and nurturing relationships for looked-after children and young people.

Reasons for implementing your project

The young person was in crisis. The placement had given notice. A search was made nationally for a specialised placement to support her complex needs (Autism Spectrum Disorder, Learning Disability and abuse history). Although providers made assessments they were unable to offer a placement as their needs were too complex. These placements were approx. £7000 per week. This was 4 years ago. The young person has remained in placement and is due to transition to adult services.

As it was an evolving approach, baseline data was gathered retrospectively. There are now requests for this approach to be replicated with other young people so clear baseline assessments and data gathering have been identified.

How did you implement the project

This is an approach that has evolved out of a crisis. Funding had been agreed for specialised placements but the search was not successful. Therefore a bespoke package was agreed 'in house'. Services already working with the young person came together on a more regular basis. Agreements had to be made to release education staff and funding of independent drama therapist to attend group.

With a retrospective view this approach matches with the NICE guidance recommendations.

Key findings

Initials aims were evolving so these have really been surpassed. We didn't set out expecting that there would be such passionate commitment from the group members and the level of development of their skills. 

Key learning points

We are embarking on replicating this. We are clear that this approach is for the most complex children/young people who are in care. We have learnt that it is a process of learning and sharing that have enabled staff to get to this point and therefore it is not a quick fix. It is an approach that holds the child/young person at the heart with a holistic view as well as supporting the health and wellbeing of staff supporting that young person. It also has a knock on effect for other children those staff might be supporting.

We have had agreement to develop facilitators - therefore we are providing some initial training in readiness for these next groups starting.

This approach could be likened to a ‘Team Around the Child’ meeting. This is different. There are a number of things that make it different:

This approach follows a structured format involving check-ins, headlines, and takeaways. Group members will present on their headlines uninterrupted and then it opens up for discussion. It is held monthly, held in a neutral setting, and is co-facilitated. Notes are taken but as it is a supervision type group these are not stored on clinical records but key points are. Facilitators have a post debrief. This is not a decision making meeting however it does explore issues and enables staff to take ideas back.

We are better prepared to measure the baseline and reviews for future groups.

Contact details

Victoria Ware/Deborah Gill
Clinical Specialist Occupational Therapist/ Senior Educational Psychologist
Dorset Healthcare University NHS Foundation Trust / Dorset County Council

Tertiary care
Is the example industry-sponsored in any way?