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The Walkway to Wellness – redesigning and embedding secure care services for offenders with intellectual and developmental disabilities using Normalization Process Theory

Lookup NU author(s): Dr Simon Hackett, Dr Iain McKinnonORCiD



This is the final published version of a conference proceedings (inc. abstract) that has been published in its final definitive form by Royal College of Psychiatrists, 2021.

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Aims and hypothesis: To evaluate the redesigning and implementation of secure services for offenders with intellectual and developmental disabilities (IDD) within one service in NE England. Background: National policy on secure inpatient and community services for offenders with IDD has changed substantially in response to Transforming Care, bed reductions, and the development of Provider Collaboratives for secure services. Consequently, this has changed the numbers and profiles of patients as well as the delivery of offender specific therapies. Locally, the reorganisation of our services, including expanding geographical boundaries, has also had a significant impact. This necessitated changes to inpatient and community services, and a new model of care was designed in collaboration with service users and carers, named the “Walkway to Wellness” (W2W). Methods: We used Normalization Process Theory (NPT) to evaluate the implementation of W2W. This involved evaluating training materials & operational procedures via audit, and staff & patient questionnaires using the NOMAD model which supports NPT approaches. Results: W2W staff training took place over a nine-month period, and by the end of 2020, the level of embeddedness and understanding of W2W concepts varied depending on whether the part of the service was driving the changes. Patients’ understanding of the W2W model also varied at this stage with some patients having a better concept of the purpose of their recovery goals, with others needing more communication support from our team. Conclusions: Historically changes to services have been designed by clinicians in response to policy drivers, whereas here we have employed a collaborative approach with patients and carers. The baseline data in this evaluation will modify ongoing training roll-out and the way in which W2W is operationalised. We plan to revisit the staff and patient/carer questionnaires in order to ascertain the progress of implementing W2W over the next twelve-months. This study was supported by Research Capability Funding from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.

Publication metadata

Author(s): Watts O, McKenna D, Charlton A, Hackett S, McKinnon I

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Faculty of Psychiatry of Intellectual Disability Conference

Year of Conference: 2021

Online publication date: 07/10/2021

Acceptance date: 06/09/2021

Date deposited: 14/10/2021

Publisher: Royal College of Psychiatrists