The Psychology Consultation Service (PCS) is a new service introduced in County Wexford. It is run by psychologists working with adults with intellectual disability (ID), with the aim of focussing on the contemporary needs of clients, and it has been provided in addition to the service operated through the waiting list system.
The PCS is committed to review and development. A key element in this process involves seeking dialogue and feedback from the professionals with whom we work. This article reports on the evaluation of the PCS, which has now been in operation for a one-year period.
PCS—What’s all this then?
The PCS is presently provided by two psychologists throughout County Wexford, rotating around five different centres in the towns of Wexford, New Ross, Gorey and Enniscorthy. The PCS considers the overall psychological needs of individuals— including emotional, social and behavioural. The process of consultation involves a psychologist talking with people who have a concern, issue or query, usually a manager or keyworker. It can, at times, also be beneficial to meet the client and their family members. Sometimes we are just able to reassure services that they are doing the best job with the resources they have. Sometimes we can guide staff towards new intervention strategies. Staff attending the meetings are given direction regarding the psychological care of the person and onward referral may be made. The work is collaborative— it is important to explore and make sense of the situations and contexts in which people are living. Through this process we engage with others in finding solutions and making progress.
Check out the consultation model
The model of consultation we use is based on an interactionist model of psychology for understanding human behaviour. We believe behaviour, whether learning or social, relates to situations and contexts as well as to factors relating to the person. Consequently, we believe that ID services can make a difference, and we want to help them to contribute in the many spheres of development, participation, learning and achievement.
The ‘white horse effect’
It is our belief that operating a waiting list system makes our service less flexible and less responsive to need. Waiting lists mean that it takes time for the psychologist to get to a name on a list, by which time, the problems have often changed or the situation deteriorated or even dissipated. Staff in the services may become frustrated or disbelieving in our service. It puts pressure on us too, as expectations can rise unrealistically during the long wait for the psychologist, who then enters the scene on a white horse and is expected to fix any problem. In contrast to this, we want to work alongside the staff;, we believe that we are all part of the system which can affect positive change in a service user’s life.
Research design, data and findings
The participants in the PCS project were from adult ID day and residential services in Co Wexford. A total of eleven participants were interviewed; two from each service and three from one of the larger services. Each participant was invited to complete a semi-structured interview. Participants were encouraged to voice their views, perceptions and attitudes. The following qualitative questions were put to the participants:
What was your understanding of the Psychology Consultation Service?
In reference to this question; it emerged that some staff were, at first, unsure of what to make of this new service:
At first I was unsure what it was about. There was a lack of knowledge about it. I thought I was in trouble. When I attended though, I found it beneficial to both clients and staff. I felt I wasn’t doing anything wrong. The feedback and suggestions were excellent. I wasn’t fobbed off as a staff. My feedback and issues were taken on board.
Everything was discussed that we as staff wanted to discuss in relation to the client.
…Really we didn’t have a clue about from your side what you were putting in place. But I knew it would be an aid to staff in understanding the needs of some of our service users…
Other themes that emerged were in relation to what staff needed and wanted the service to be like. There was an emphasis on team working, efficiency and accessibility:
My understanding was that it would be what I got, practical hands.on advice on how to manage different behaviours that maybe staff found challenging. …It feels like part of a team. I feel like I can ask for advice and you can come back to me with information.
I saw it as a structured process that was set up to make psychology services easy to access. It allowed frontline staff to identify the service users who needed the input. …There was no time wasted. We emailed information in advance. When the consultation service commenced it was straight into the issues for the client.
From my point of view it made psychology services accessible to our service users, if we ever had a problem somebody was at the end of the phone. I could put a face to the service. Before staff were at a low ebb feeling like they had no backing…
Was the service helpful and if so why?
All of the participants said that they found the service very helpful. The aspects that were most helpful included: approachability of the psychologist, being able to deal with contemporary issues and learning and feedback from the psychologist. The themes that emerged in relation to this open question were around the way it has empowered staff and given them confidence, empowered managers when working with staff and helped to focus the work:
It gave confidence to the staff team…. Frontline staff now feel equipped to write up programs, not waiting for manager to fix things. They are not afraid to use own initiative…
…It is a huge help in helping me work with clients and from a management perspective it has improved how
I communicate with my staff in relation to clients needs.
Other themes that emerged included the importance of having objectivity and liaison with external services increasing their access to the psychology service.
Very often we had bits and pieces of solutions as staff members anyway, its being able to have a methodology about how to approach a service user. The opportunity to bounce ideas off someone who doesn’t have your own baggage. I’m in this service with these service users for 21 years with these core group of service users. Like all relationships they become in need for refreshing. You take a lot of stuff for granted. We lack methodology of approach.
Having written feedback was very good. It gave more of a unity to the whole process. We are glad to have you on board. We recognise the importance of liaising with other services. We have people coming into us with a level of need. Prior to this service, the gap has been communication, we have made referrals and it has all been disconnected as we do not get feedback.
Four of our services have accessed psychology services this year. The previous year it was one.
Staff also spoke of the effect the service had on their own services in that they needed to focus and prepare in advance. That the PCS might help with prevention was also mooted.
Having to do up profiles and staff having to meet and talk and discuss and then when the session took place services users were put at the centre of consultations. All staff were on the same hymn sheet. It got staff to focus even before session took place; it led to a consistency in approach.
We identified the client in need at the time. In doing that we are able to put a management plan together rather than waiting for six months or so and the situation deteriorating. It is about making situations manageable while they are on the waiting list.
People here are keen to up skill and apply best practice. The PCS helps in preventative work.
What would improve the PCS?
In answer to the question of what might improve the service, one theme emerged very strongly in relation to having more of this type of input. There were also comments in relation to planning, making more staff aware of the PCS and reviews. Examples included:
The duration and frequency, I would like to see the service being provided all year round; to know that it
is there. That it is a stable service.
More of it! Put it in black and white, the structured timetable.
We want continuity, stick ability! …reviews would be beneficial, even if short. If nobody is coming back, staff go off the boil.
Summary and conclusion
The reaction from services in general was very positive and it has been an extremely informative and rewarding process. The anticipated aim of working with those in contemporary need has been achieved. In addition, there have been many other bonuses achieved by this style of working, such as the effect on team working and empowerment of staff. From our point of view, the PCS is a responsive and valid service. We would like to thank everyone who has participated thus far and who took part in this survey. Our future aims are to consider the suggestions made and incorporate them into our plan for the PCS into the new year.