SweetTree’s complex care service is designed to understand and meet the needs of those who are excluded from traditional services, the people whose needs cross boundaries and don’t fit into standard assessments. They range from clients with high functioning autism, whose IQ is too high to qualify for traditional support services, to those whose needs might be invisible, presenting normally outside the home but suffering from a disorder such as excessive hoarding. Complex care can mean complex physical care needs or complex emotional or behavioural needs and, for some, it means both.

Laura Cheek is SweetTree’s Complex Care Service Manager, whose job is to unravel the puzzle to ensure the bespoke services put in place meet the individual needs of each client. Laura joined SweetTree after 13 years’ experience with Westminster Social Services, where she piloted a project to design a complex care service. Laura completed her Assistant Psychologist programme in New York, before gaining her MEd in Autism in the UK. She is working towards a doctorate in Social Care Management. Laura said: “At SweetTree we have taken our person-centred ethos to a new level, designing a bespoke service for people whose behaviours and presentation are too extreme to fit existing services, or who have several different needs.

“The aim was to say, if you don’t fit into any box, we’re happy to work with you. We will figure out how to help you.”

The team works with individuals with learning disabilities or brain injuries but who may also have mental health issues related to traumas such as domestic violence, childhood sexual or emotional abuse, or discrimination relating to gender identity. Laura explained: “People may have complex health presentation. Their life experiences are such that they require a really holistic way of working to move forward.

“The aim was to say, if you don’t fit into any box, we’re happy to work with you. We will figure out how to help you.”

“We have a student who has a stoma bag, peg feeding tube, and a central venous line and needs medical support, but can manage their own health condition with our support. Another client has a full-time job and lives in his own property but needed to be part of society. Our job is to build confidence, so the person can step into the real world, whether it’s going to the pub or supermarket by themselves.”

“We may need to risk assess the location to be sure they can make the journey for themselves.”

SweetTree’s complex care clients may be referred by Clinical Commissioning Groups, local authorities or may self-refer. Aged from 17 to 70, some live in residential homes, others have life-limiting conditions and live with parents or family. Laura said: “I work with the individual for the first few sessions, unpicking what support they need. Sometimes we point out problems they haven’t realised. We also liaise with their multi-disciplinary team. It’s very holistic and very bespoke. Then I introduce staff alongside myself and help them to apply the support plan and our ethos. “We use a co-production model, the individual and I write their support plan together. “It is important to take the person as they choose to present themselves, in terms of emotional age and their gender or sexual identity. Their diagnosis is acknowledged, but our focus is on figuring them out, listening to them and identifying how we can help.”

Support packages range from a few hours a week to 24-hour care. Some individuals exhibit challenging behaviours and SweetTree staff are trained to physically intervene. They are also highly trained in therapeutic approaches, such as talking someone through their aggression and asking questions about why they are angry or afraid. “We try to avoid physical intervention by choosing another way of managing the situation,” Laura explained.

Around 30 members of staff work in the team. Their intensive training covers practical and theoretical knowledge and understanding the SweetTree ethos and approach. Laura said: “Staff with a talent for working in complex care have that openness and interest in the whole person, they are hungry to know more and understand, and are willing to spend time exploring each individual’s history and triggers. “Complex care is so intriguing, you have no idea what dilemmas will arise. If you like doing puzzles you will love this kind of work, constantly figuring out how to achieve something, going through the maze of need.”

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