The Intensive Therapeutic and Short Break Service (ITSBS) is a specialist service providing intensive support to a small number of children and young people (aged 5-17 years) who are at risk of a move to residential placement. The ITSBS provides clinical psychology-led assessment, intensive interventions and short breaks for children and young people who experience severe challenging behaviour and have a diagnosis of learning disability or autistic spectrum disorder. The service is based within the Ealing Service for Children with Additional Needs.
The Intensive Therapeutic and Short Break Service (ITSBS) is a specialist service providing intensive support to a small number of children and young people (aged 5-17 years) who are at risk of a move to residential placement. The ITSBS provides clinical psychology-led assessment, intensive interventions and short breaks for children and young people who experience severe challenging behaviour and have a diagnosis of learning disability or autistic spectrum disorder. The service is based within the Ealing Service for Children with Additional Needs.
Access
Referrals are usually received from professionals working with the family in social care, paediatrics, or children and young people’s mental health services, or the joint funding panel for residential placements. Each referral is then discussed in a multi-agency meeting, with cases prioritised according to risk of residential placement, rather than a waiting list.
Preventing long-term residential placement
The ITSBS provides support to manage challenging behaviour with the aim that children and young people who are at high risk of requiring a residential placement can remain with their families and access support in their community for as long as possible. Research on the service had demonstrated that this model provides a cost-effective, flexible alternative to expensive, and often out-of-area, residential placements or schools.[1], [2]
There are four phases to provision of care: 1) assessment and care planning; 2) intensive therapy and training on behavioural support; 3) an option for a 2 to 3-week residential break; and 4) step-down and transfer to learning disabilities teams, or discharge, where appropriate.
Biopsychosocial assessment
Individualised care plans are developed collaboratively with the child and young person’s family and professional network. These are informed by a comprehensive clinical psychology assessment, based on observations, standardised measures, functional assessment and interviews across a range of settings, including home and school, and with input from a range of disciplines.
Evidence-based interventions
The model integrates a range of approaches including: Positive Behavioural Support (PBS), system support, psychological interventions such as CBT, narrative therapy, family therapy, Solution-Focused therapy, and short breaks.
Support for families and carers
Support for family and carers is central to the ITSBS model. The clinical psychologists work intensively with families to increase confidence and skills in behavioural management strategies. Additional help such as buddying, domiciliary care and psychological support are also offered.
Multi-agency working and collaboration
ITSBS is a collaboration between specialist children and young people’s mental health services and social care. Clinical work is led by clinical psychologists with the support of an allocated social worker and input from other disciplines, such as speech and language therapy and psychiatry as needed. Regular meetings and consultation with all agencies involved is established from the outset to ensure collaboration and coordination at all stages of assessment and intervention.
Further details
Commissioning
Ealing Local Authority (Children’s social care). Clinical psychologists are employed by CAMHS within the West London Mental Health Service Trust
Providers
West London Mental Health NHS Trust and Ealing Council
Workforce (whole-time equivalent)
Dedicated posts: 1 clinical psychologist (band 8a) and 1 assistant psychologist (band 5). Additional professionals are pulled in from the wider multi-agency Ealing Service for Children with Additional Needs and social care and short break input provided from the children and social care team block budget
Population size
All ages – 343196, under 18 – 81873 (Office of National Statistics 2016 mid-year population estimates for Ealing)
Caseload
The average time on the service caseload is estimated at 14 months with considerable variability across individuals.
Access and advice – consultation lines, triage and signposting
[1] Reid, C. Sholl, C. and Gore, N. Seeking to prevent residential care for young people with intellectual disabilities and challenging behaviour: examples and early outcomes from the Ealing ITSBS. Tizard Learning Disability Review. 2013; 18: 171
[2] Iemmi, V. Knapp, M, Reid, C, Sholl, C. Ferdinand, Trachtenberg, M. Positive behavioural support for children and adolescents with learning disabilities. Tizard Learning Disabilities Review. 2016; 21:169
