We are currently undertaking a service development and pathway review in relation to community-based open rehabilitation and step-down provision for adults with mental health needs, neurodevelopmental conditions, learning disabilities and complex psychosocial presentations.

1. Current Demand and Placement Need
• Does your organisation currently commission or utilise open rehabilitation or step-down rehabilitation services from independent providers?
• Approximately how many individuals are currently placed within open rehabilitation or community rehabilitation settings?
• What are the most common presenting needs requiring this type of placement?

2. Hospital Discharge and Delayed Transfer Pressures
• Approximately how many individuals are currently experiencing delayed discharge from:
• Acute mental health wards
• Rehabilitation wards
• PICU or low secure settings
• Specialist autism or learning disability services
• What are the most common barriers to discharge?

3. Out-of-Area Placements
• Does your organisation currently place individuals outside of its local area for rehabilitation or step-down support?
• If yes:
• Approximately what proportion of placements are out-of-area?
• What are the primary reasons for out-of-area placements?
• Is reducing out-of-area placements a current strategic objective?

4. Service User Cohorts
• What service user groups are currently most difficult to place within community rehabilitation settings?
• Are there identified gaps in provision for individuals with:
• Autism
• Learning disabilities
• Dual diagnosis
• Personality disorder
• Complex trauma
• Forensic histories
• Behaviour that challenges

5. Current Provider Market and Sufficiency
• Does your organisation currently identify a shortage of rehabilitation or step-down placements?
• Are there specific rehabilitation models or service types currently required but limited in availability?
• Does your organisation have a current rehabilitation, mental health, or accommodation sufficiency strategy? If so, please provide a copy or link where available.

6. Placement Models and Support Levels
• What support levels are most commonly commissioned?
• 24-hour staffed rehabilitation
• Waking-night support
• Positive Behaviour Support models
• Transitional or move-on support
• What are the most common referral pathways into these services?

7. Spend and Commissioning
• What was the approximate total spend on independent rehabilitation or step-down placements in the last financial year?
• How are such services typically commissioned?
• Framework agreements
• Spot purchasing
• Approved provider lists
• Block contracts

8. Quality and Outcomes
• What are the most important factors considered when sourcing rehabilitation placements?
• What outcomes are considered most important when evaluating placement success?
• What are the most common reasons for placement breakdown?

9. Commissioning Contacts
• Please provide the structure or generic contact details for the teams responsible for:
• Rehabilitation commissioning
• Complex mental health commissioning
• Learning disability/autism commissioning
• Hospital discharge pathways