T is a 45 year old man with a profound learning disability, Autistic Spectrum Disorder traits, Behaviours that challenge, and quadriplegia. He came to Ashdown Care from a long time spent living in a care home environment. He presented with extreme anxiety and depression which resulted in him needing to feel very secure within his environment which meant he needed to be able to see and monitor everyone who entered his room. T’s challenging behaviour included severe self-harm (resulting in him poking his own eye out and continuously causing trauma by ripping out his catheter), biting, hitting, and screaming continuously throughout the night, and lashing out at support workers and strangers when out in the community. T finds it difficult to negotiate day to day demands and his capacity to monitor and control his impulses are limited.
T’s behaviours were recorded on a daily basis and certain patterns were observed. Based on detailed records a Positive Behaviour Support Plan and corresponding risk assessments were developed.
A comprehensive communication plan was developed over a period of several months and the following triggers were identified:
- He would not communicate with anyone with dark hair.
- When he raised his finger he was telling us to leave his room.
- When he rubbed his head he was anxious.
As a result T was also offered a structured day time activity programme which was developed based on his preferred activities these included:
- Using a sensory room in a local activity centre
- Going out in bus.
- Going out for meals.
- Going out to watch live music.
T was given lots of positive attention and feedback throughout the day/evening. Staff continued to offer this regardless of any disruptive behaviour he may have shown. Initially the risks to the public and staff were minimised by only taking T to wide open spaces with very little community integration where he could have a trip out. Over a period of several months the triggers for his behaviours were monitored as more community integration was introduced into his weekly activities. Eventually staff were able to support T to use public transport and attend live music events. T stopped all self-harm and his displays of continuous screaming decreased significantly.
By providing consistent support and positive approaches in a phased way by all members of staff the frequency of T’s challenging behaviour in an internal and community setting was dramatically reduced and his quality of life improved. This experience changed our working practice because initially the professionals involved in T’s care could not envisage this amount of progress being made with this individual and did not really encourage us to take positive risks. However the support staff involved in T’s care believed that they could achieve these outcomes for T, we decided to support their development plans under close supervision from both the Manager and Social Workers. This case study demonstrates that with sustained effort of a highly experienced staff team, the life of what may seem like a very difficult individual can be enhanced to a level which could not have been imagined in a care home environment. Our mission statement was updated to include a commitment to forming a multicomponent framework for developing an understanding of behaviour that challenges rather than a single therapeutic approach, treatment or philosophy.