Community learning disability teams: the need for objective methods of prioritization and discharge planning

Abstract

As part of caseload management for community learning disability teams (CLDTs), it would appear reasonable that services would have a mechanism for prioritizing referrals and discharge planning. However, any formal mechanism in relation to these two aspects apparently is lacking within the literature. This theoretical article attempts to illustrate this evidence-base need, and demonstrate how a prioritization and/or discharge planning system would aid CLDTs. In light of the scarcity of material for the learning disability sector, information has been examined from other health domains such as mental health. The paper also presents a discussion on whether rationing of services is best done via explicit or implicit means. Issues related to setting referral criteria and the allocation of referrals are also considered. Although suggestions have been made for CLDTs, it is difficult to do so whilst the evidence base for this sector is so lacking.

Diverse Conceptualizations of Deinstitutionalization as a Barrier to the Implementation of Discharge Policies

“…The literature stresses that a discharge effort is a very complex process, and one that requires a number of conditions for its successful implementation (Caffrey & Todd, 2002; Oxtoby, McGuiness, & Morgan, 2002). However, the effort under investigation was not developed according to these conditions.…”

The evolving role of community nurses for people with learning disabilities: changes over an 11‐year period

“…This often due to a perceived need at service or trust level to keep people on caseloads. This is compounded by an apparent reluctance among many CNLDs and their managers to discharge people effectively (Caffery & Todd 2002) because people may be re‐referred to the service, albeit it months or years later. The average caseload of CNLDs in Northern Ireland continues to be above 40 people.…”

Community services and transforming care: reflections and considerations

“…Poor staffing, excessive caseload levels, inadequate staff training, ineffective teamwork, and stringent eligibility criteria have all been reported to negatively impact the effectiveness of CLDTs (Messent, 2003;Pimental and Ryan, 1996;Slevin et al, 2007;Walker et al, 2003). These barriers are likely to adversely impact the (Walker et al, 2003), appropriate case prioritisation (Todd and Caffrey, 2002), the ability to meet more complex needs of service users (McKenzie et al, 2000;Slevin et al, 2008), the provision of rapid high quality services for all service users (Clare et al, 2017;McInnis et al, 2012), and the improvement of services in line with government directives (Messent, 2003). As a consequence, CLDTs have reported increasing role rigidity, low morale, diminished personal well-being, and increasingly bureaucratic working practices (Clare et al, 2017;Farrington et al, 2015;Millward and Jeffries, 2001;Slevin et al, 2008).…”

“…Todd, M. and Caffrey, A. (2002), "Caseload management in learning disabilities", Nursing Times, Vol.…”