G's Story - Physical and Sensory Needs
G lived with her fosterparents. G has diagnosis of severe Learning Disability, sensory needs, autism with behaviours of concern, epilepsy and poor mobility. Social services sought alternative accommodation as sensory needs were difficult to meet at foster home and she required 24-hour care due to frequency of seizures. Her foster parents were also struggling to manage her behaviours of concern which also appeared.
G was known to have very complex needs and needed a service that could meet her needs, Outlook Care was approached to find a placement for her. Staff from Outlook Care carried out a full needs assessment, this was completed with G, her brother, social worker, advocacy worker and foster parent. From the assessment a full picture and understanding was gained of G’s needs.
G preferred 1:1 support rather than group activities as she would become overwhelmed. It was agreed that 70 hours of 1:1 per week should be provided as G requires constant supervision due to epilepsy and behaviours of concern that can impact on her and others.
Some key areas of need highlighted were:
- 4/5 seizures per day but unpredictable
- Physically assaulting others by pulling hair or throwing objects.
- High risk of falls due to seizures, G's wheelchair, is used mainly when out in the community.
Transition Plan
The Transition plan was agreed to support G with input from a behaviour specialist, a SALT team (speech and language therapy) and occupational therapists. For 2 days per week, a day service was allocated until a sensory room was developed in her home, with the plan toreduce seizure frequency and for staff to introduce positive behaviour techniques to observe, understand and support a decrease in the behaviours of concern.
Support Delivery
It was agreed that what was important to G was understanding her likes/dislikes to mitigate risk of stress induced seizures. G likes to wake up by herself or for staff to prompt her, but staff have to leave her to come out of her bed in her own time. She strongly dislikes people standing straight towards her, so she is supported from side for feeding and personal care. G loves pedicures and manicures and through fundraising does this at least three times in a week. The epilepsy team was engaged with G to check if they could agree a cluster seizure plan identifying behaviours and presentation of G prior to seizure for staff to record, observe and learn from. This fed into her PBS (Positive Behaviour Support) plan.
Outcome
We are now able to see from G's physical/emotional presentation when a seizure is due, resulting in fewer injuries for G as we can support her to a comfortable space such as her room or a comfortable space in other comfortable areas where staff can oversee her and support her during and after any seizure activity.
Additional changes we made included:
- Staff had further training on epilepsy management.
- Epilepsy alarms/sensors were fitted in G's bedroom.
- Bathroom/bedroom/dining room/chairs redesigned to be lower risk because of unpredicted falls.
- Low profile bed purchased to reduce risk of falls following seizure.
- Grant was secured to develop a sensory room.
G now loves to play in the ballpool when she is feeling anxious, this activity helps to calm her and further reduces seizure frequency and/or behaviours of concern. She also now participates in simple cooking, music, and sensory activities within the home. She loves the sensory room and spends a lot of time in it with staff, as a result does not need to attend day service which she found stressful.
Her 1:1 night support ceased due to epilepsy alarms and sensors alerting staff, this was and is less intrusive for her. Incidents reduced from average 4-5 per quarter to no major incident in past 24 months. Injuries from seizures reduced significantly due to safer living environment and better understanding of the link between seizures and behaviours of concern. Frequency of seizures reduced from 3-4 per day to 1 per day or every other day.
The positive transition and interventions have changed the daily life of a young woman who presented with complex needs, at Outlook Care.
We treat the person not the condition using Positive Behaviour Support strategies - well done to G and the staff who support her so well.
H's Story - Profound and Multiple Learning Disabilities
H lived in a children's service. At 18, she wanted to live independently as any young adult would - however H has diagnosis of Learning Disability, behaviours of concern, limited capacity about health and safety plus H didn’t understand the impact of how some of the behaviours of concern that she demonstrated, had on others.
Before looking for a new home, the Social Worker who was working with H to find a new home identified that 1:1 support for 16 hours a weeek was required to keep H and others safe. H had no family input but did have a relationship with her mother in hospital, who was the appointee. H, due to her disability, used an iPad as a communication tool but would break them regularly, then not having her iPad functioning, was and is, a trigger for her to engage in behaviours of concern almost daily, if she was and is unable to express herself. H visited other services with her social worker.
Transition Plan
Following a meeting with other professionals a best interest decision was made for Outlook care to support her. H moved into a new home in 2014 and welcomed by the staff at her supported living service. We worked closely with H and other professionals to work out and implement a transition plan that would work for her, an agreed that 105 hours 1:1 assistance per week would assist not only assist her with the transition from children's services, but enable staff to support her in managing her behaviours of concern in a way that would not impact other housemates. H had 16 hours of 1:1 support per week, but this has relied heavily on shared hours which were not sufficient and could have caused the move to fail.
Twenty of our care staff were trained in the NAPPI positive behavioural support model to more effectively support H's behaviours of concern that were present when she felt unable to communicate (such as throwing objects, grabbing people, taking items and objects from others and pinching and biting). The NAPPI training enhanced their skillsets enabling them to more effectively:
- Understand ‘green’ calm behaviours and how to promote them
- Understanding ‘amber’ escalating behaviours and how to reducing them
- Respond to ‘red’ behaviours to keep H and others safe.
- Retrieve from grabs
- Distract and deflect behaviours
We also worked with other professionals to develop a sensory room which H could use to reflect and engage with staff in.
Support delivery
H was institutionalised and lacked confidence, had not undertaken any daily living skills. We supported H, initially to gain her trust, and then slowly started to work with her to improve her confidence. Challenges, especially in relation to replacing broken ipads were identified and we observed H to understand why the iPad was being used and what for. The iPad was not only used to communicate by G, but was also a soothing sensory tool. Without the iPad, H was distressed. Gradually we introduced the picture exchange communication system (PECS) to replace the use of the iPad. Over a period, H would take a staff member by the hand and select a picture to show what she wanted. H has dozens of pictures to communicate with such as: Door= I want to go out / Sensory room= I want quiet time / Bed= I want to go to my room / Tea = I want to choose drink etc
The sensory room and staff training combined to support H to manage behaviours of concern with incidents reducing to less than weekly. H's service was delivered in partnership with H and a Social Worker, SALT team (speech and language therapy) and a Positive Behaviour lead.
Outcome
H is happy living in her new home, her 1-1 support has been reduced significantly, she enjoys her activities and is supported by a staff group who understand her specific and complex needs. Outlook Care works with the person and their support circle to ensure their needs are identified and then supported.
