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Improving Lives: Supporting Adults with Learning Disabilities conference
- 1. Kirsty Roche Locality Manager and Complex Behaviour support lead. PROACT – SCIP and positive Behaviour Support Trainer
- 2. 2
- 3. 3 Background
- 5. 5 Mr A and his Behaviour Consultant
- 6. 6 Mr A and his Behaviour Consultant
- 7. 7 Outcomes
- 10. 10 Now
Editor's Notes
- Hello my name is Kirsty Roche and I work for an organization called Dimensions, we are an organization supporting individuals to live the life they want with at times some quiet complex and behaviors that challenge. I have been involved with many different individual’s but I would like to share with you one specific example today which I will refer to the Gentleman as Mr A.
- A referral came through to Dimensions in 2011 for us to potentially support a gentleman out of a secure treatment unit to live in supported living within the community. This gentleman had a hard past and he had come across abusive treatment from his family and experienced a breakdown of a college placement due to behavior’s he presented.
- Mr A had moved into a secure treatment unit which his opportunities and experiences were very limited and controlled which impacted on his quality of life. Mr A presented Challenging behavior’s such as physical aggression towards the environment and people around him on a regular basis due to the severity of his behavior’s this resulted in control and restraint been used, these inventions were used with Mr A on a 3:1 basis and resulted in his support package been assessed at this level for all aspects of his needs.
- Dimensions feel it is very important in making a difference in a person’s life that we need to work in partnership with all the people involved in an individual’s life. In this partnership working Dimensions acknowledged they would start support Mr A with control and Restraint but also communicated and felt very strongly that this would be reviewed and withdrew at the earliest opportunity, this was communicated as the Values Dimensions work with belief we support people with Positive behavior support using a proactive approach. Dimensions have established a Behavior support team to ensure the teams are supported in the way they are supporting and to ensure they support within the positive behavior support approach. The Behavior support team are involved to ensure the individual has a positive behavior support plan to meet their needs and identifies the training the teams will need to ensure this can be facilated.
- A behavior consultant was involved with Mr A from the beginning, they would complete an assessment to help them determine the function of the behavior been displayed enabling them to set proactive strategies in place to support the individual to get their needs met without the need to display behavior’s that challenge. All professionals and Mr A new staff team worked closely together to gather all information needed from visiting Mr A and completing observations and talking to his old team form these sources a Behavior plan was completed and also kept live to update as and when this was needed while people were building relationships with Mr A, the most important part of this process was the team building a rapor with Mr A to build trust into their relationships.
- Dimensions recognize that people change in relation to their behavior’s, likes and dislikes and embed in the team that the information is to be updated on a regular basis for any changes. In the period of the team and Behavior consultant was getting to know Mr A it was agreed that Mr A presented behaviors for him to escape from situations he was in, once the function was identified we just allowed him to escape aversive situations but also we started to teach him another way to escape stressful situations by teaching him to use his words as in the meetings you conducted with Mr A, in other words, the function remained but his response changed once he learnt a more appropriate way to communicate his needs when this was acknowledged the Behavior team then trained the team to be personalized around Mr A and to be able to work Proactively in responding to Mr A warning signs and diverting him away from situations without the need for Mr A to present behavior’s.
- Outcomes The whole approach to support Mr A is always aimed to improve his quality of life, using the positive behavior support program to support him to proactively get his needs met. The team were actively supported by the manager through this process, this entailed the manager been around the team on a daily basis and actively role model the support needing to be provided. The team needed positive support on a daily basis in order to support Mr A through the process and building their relationship with him. This Included a debrief for all staff after any behavior’s was presented this was a process to support the team to understand the incident and be able to reflect on their support provided and help identify any changes needed. I also worked closely with Mr A as the manager for his team, with this I met with Mr A on a regular basis, I worked closely with the behavior team in relation to the question I need to ask in these meetings and how to respond. These meetings turned out to be very important way in been able to read what was causing Mr A any anxiety then supporting the team to adapt their support where needed. Examples of the out comes from these meetings were Staff not to wear certain items of clothing as these caused high anxieties for Mr A Changing the items Mr A could use within the home to ensure he still had full access to anything he needed I also worked closely with Mr A as the manager for his team, with this I met with Mr A on a regular basis, I worked closely with the behavior team in relation to the question I need to ask in these meetings and how to respond. These meetings turned out to be very important way in been able to read what was causing Mr A any anxiety then supporting the team to adapt their support where needed. Examples of the out comes from these meetings were Staff not to wear certain items of clothing as these caused high anxieties for Mr A Changing the items Mr A could use within the home to ensure he still had full access to anything he needed Certain colors of buses and also the hiss noise they make when they pull up was identified as issues for Mr A All these updates from the meeting may be very small to you and I but these small changes helped reduce the anxieties for Mr A and reduced the behavior’s around these, which was immediately communicated to the team and his behavior support plan was immediately updated ensuring this is relevant and promoted a proactive way of recognizing what didn’t work for him. Within these meetings there was also an opportunity to build on Mr A Skills enabling him to have more control over his life and been able to manage his anxieties especially in the community, I worked with Mr A to determine a different way he can tell his team that he isn’t happy and wanted to leave. Through the conversations between myself and Mr A HE decided that when he said ‘HOME’ to his staff then they would get him out of there (in his own words), the team would immediately act on the word ‘ Home’ and generally call a taxi and leave. This has been a successful way of working with Mr A and also gives him control and has reduced his behaviors in the community, opening up many new places for him to explore impacting on his quality of life for the better. A big part of the support for Mr A was around the care of his Mic-key button, he presented high anxiety around this and how people will see this about him. When we first started working with Mr A this was a subject which he did not like to talk about or others talk about around him. With building the trust with his team and passing the control back to Mr A we started exploring if Mr A could take on the care for his own Mic-key Button. I had conversations with Mr A in the meetings and he expressed he would do this himself, we acted on this immediately and worked with his community nurse to train Mr A to be able to do his Care himself. The team positively encouraged this and supported him by watching videos and working with his nurse to be able to support Mr A appropriately, Mr A was supported for 3 months to learn this skills and then observed and signed off by a nurse to have gained this knowledge and now completes his own care, he is extremely proud of this and it is now not a trigger for him and will proudly talk about this with others.
- As you can see the level of incidents are no more than 1 per month on average since 2014, with some months reporting no Behaviors of Concern, and shows the positive behavior approach is successful in reducing behaviors and as a consequence improve Mr A Quality of life.
- From Starting working with Mr A Dimensions reduced the support ratio within 3 months Mr A was been supported 2:1 in the community from 3:1 and down to 1:1 within his home, this soon reduced further to be 1:1 at all times. Control and restraint was then removed within 6 months and was replaced by a least restrictive approach of PROACT-SCIP, this was then removed within 12 months due to low levels of physical aggression and was managed through proactive support. In changing the package and improving Mr A quality of life impacted on his support needs resulting in saving the local authority £178,000 per year.
- Mr A has successfully continued to live in the supported living service that he moved to with Dimensions in 2011, he has continued to be supported on a 1:1 basis both the community and his house. Mr A continues to build his confidence in his community by making successful community connections on a daily basis. There is occasions he may become overwhelmed but the intensity and severity of Mr A behaviors have reduced dramatically. He continues to make amazing progress with his team and is able to experience new situations with the support of the team he has choose and trusts which he has done recently in attending a socializing Disco with success which has always been a activity he has struggled with but wishes to continue attending these now he is able to.
- Why successful you may ask? A massive contribution for this been successful was from Mr A himself and the support we have shown him that we will listen to him both verbally and through the behaviors he used to show. Giving Mr A the control over his life and responding to what he was communicating encouraged a relationship to form with us and build trust. Mr A now decides all the decision he is able to and is supported to make sure his decision is carried out, from who supports him, what he eats when he eats and what he wants to do on a day to day basis. The team also feel supported along the journey with Mr A and that they are listened to and their feedback is taken seriously as they were the people who were building the relationship with him.