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Gilbey, Ben, Baliousis, M., Tickle, A., Varela, J. and Woodrow, C. (2024) Consensus Good Practice Guidelines for the Use of Long-Term Segregation (LTS) with Autistic People: A Delphi Study. DClinPsy thesis, University of Nottingham.

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Abstract

Long-Term Segregation (LTS) is used disproportionately with autistic people in Assessment and Treatment Units (ATUs). Recent investigations into the use of LTS with autistic people have highlighted how often LTS was used primarily due to the main ward environment being unsuitable and distressing for the autistic person, rather than due to the need to manage the risk presented by the patient. There have also been instances of LTS being used in an individualised way with autistic people as a means of providing a more appropriate environment in which to provide care whilst they remain in the ATU. This clinical reality presents a difficulty for Multidisciplinary Team (MDT) staff, as current guidance (i.e. The Mental Health Act Code of Practice 1983) stipulates that the use of LTS must end as soon as possible, with the person being integrated back onto the main ward. However, doing so may reinstate the distress that triggered the use of LTS initially. As such there is an urgent need to develop good practice guidelines that can support the MDT to implement LTS with autistic people in a truly person-centred way which is able to meet the needs of this population whilst minimising the risks of poor care highlighted by recent reports. The current study aimed to produce a set of practice guidelines to inform the good practice of LTS with autistic people.

The Delphi method was used to build consensus through a series of four survey rounds. Participants were 14 MDT members who were either currently working or who had recently worked in ATUs with autistic people in LTS. Prior to the survey rounds an interview asking for three proposed guidelines was completed with each panellist. The round one survey comprised the 41 guidelines generated from the interviews and was sent out to the panel to rate in terms of importance and provide comments. Subsequent rounds were informed by the panels previous round of ratings and comments, with feedback being used to amend and combine guidelines. Consensus was set a priori at 80% or more agreement among panellists that a guideline was essential. This narrow level of consensus was used to make use of the iterative process of the Delphi method in developing and refining the guidelines.

The panel reached consensus that 11 guidelines were essential. These formed the final set and were supplemented by clinical vignettes illustrating the guidelines. Guidelines were grouped under two broad categories, those relating to direct LTS care, and those relating to the wider service setting around LTS.

The study was limited by the lack of inclusion of family/carer perspectives. The final set of guidelines contained implications for multiple organisational levels related to LTS, from immediate implementation of LTS to wider service factors such as autism training for staff and regular reflective practice specific to LTS. Consequently, effective implementation of the guidelines will require targeting various organisational layers of ATUs to improve the implementation of LTS with autistic people.

Item Type:	Thesis (University of Nottingham only) (DClinPsy)
Supervisors:	Baliousis, M. Tickle, A.
Keywords:	Long-Term Segregation; autism; good practice; Delphi Study; guidelines; clinical practice guidelines
Subjects:	W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID:	78127
Depositing User:	Gilbey, Ben
Date Deposited:	17 Jul 2024 04:40
Last Modified:	17 Jul 2024 04:40
URI:	https://eprints.nottingham.ac.uk/id/eprint/78127

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