Successful outcomes from positive behavioural support

Successful outcomes from positive behavioural support

Emma’s achievements are testament to the hard work and dedication of the staff team to support her to improve her life, and undo some of the negative experiences from her 42 previous placements.

I first met Emma* in February 2012 and I was struck by her physical and verbal behaviour towards myself and staff when engaging in conversation with her. Emma is a 48 year old lady with mental health issues (paranoid schizophrenia) who has been in 42 placements throughout her life and experienced very difficult times in her past. Her mental health and behaviour had been shaped by the negative experiences she has had and the people she has interacted with. Emma was often moved when her behaviour became too difficult to manage without being made aware of what was happening. She has developed many institutionalised behaviours in order to cope with her many placements including behaviour around meal times, personal space, medication, personal care and possessions.

Through staff observations it was noticed that Emma has a very poor standard of personal care, where she would bathe only once every couple of months. Improving this was an objective which myself and staff gradually introduced in conversations with Emma over many weeks. We found the opportunity to address this, and Emma eventually agreed to have a wash once a week. Moving forward with this, she has also chosen to use toiletries which was something she would previously not do or discuss, as in her words “I am not a lady.”

Due to Emma’s paranoia, she was extremely reluctant to allow anybody into her bedroom, and has two Yale locks on her door to help alleviate her concerns. In order to address this issue, and to increase Emma’s confidence in the staff team, we asked Emma to help the staff to complete the weekly fire checks. After several weeks, Emma offered to allow staff to check the call points in her bedroom. This was without prompting from staff. She has progressed further and has invited several staff members into her bedroom to show them her personal possessions. She also, with staff support, allowed a repair man into her room to upgrade her television, something which would have been unheard of before.

We initially found that Emma was very distrusting of visitors to the service and would behave in a very negative manner towards them, fearing that they were there to make changes to her life. She would become verbally aggressive, follow them around or refuse to respond to direct, polite conversation.

She would also listen at the door of the room they were in if they were attending meetings. Through observations, Emma’s main trigger was when visitors would smile or say “hello” to her. The staff team have worked closely with Emma, and she is made fully aware of any visitors to the service and why they are visiting in advance. This appears to help to alleviate her anxiety as she is more accepting of them and even willing to engage in conversation.

Due to past history, she has a fear of being taken away from the service and feels that her learning disability nurse and her psychiatrist will influence this decision. Emma has never played an active role in her reviews or appointments with them and will become very verbally aggressive throughout the meeting, often refusing to answer any questions. She will also refuse to be present in the same room and will speak through the door.

For her last appointment, staff prepared Emma for the meeting and she was able to engage in the meeting and indirectly answer questions with staff support. She was able to hold a positive conversation about her well being for approximately twenty minutes without becoming verbally challenging. Her learning disability nurse, who has worked with Emma for a number of years, stated that she has never seen Emma respond so well throughout the appointment and appear so calm and settled. In order to achieve this, we ensured that Emma was kept fully informed as to who was visiting her, why and what their intentions were.

Overall, Emma has proved to be a very complex lady and always will be in the future. We have learnt many lessons from her, with regards to her paranoia and behaviour, but her many personal successes have far outweighed the setbacks that we have encountered over the years. Emma’s achievements are testament to the hard work and dedication of the staff team to support her to improve her life, and undo some of the negative experiences from her 42 previous placements, which Emma still talks about to this day. I believe our success is due to Emma’s trust in our team.

*The name of indvidual has been changed to protect identity.