Case study: TA’s Story
TA’s story shows that rehabilitation from brain injury can have additional complexities if someone also has learning difficulties. However, consistent support from a dedicated team can lead to positive engagement in a range of therapies and long-term stability.
1. Background
At the age of 5, TA was assessed as having special educational needs and attended a community special school in London until the age of 16. Whilst at school, TA exhibited challenging behaviours, and teachers were particularly concerned about frequent sexual approaches towards other pupils. However, it was noted both at school and subsequently that TA’s awareness of sexual education was particularly poor for his age and he had needed support from his teachers to address this and his social boundaries.
TA lived with his mother until he was diagnosed with a brain tumour at the age of 50. After treatment in hospital, he was admitted to a nursing home for one year before returning to his mother’s home. However, due to the severity of risk TA presented to members of the public, he was admitted to Richardson Care (144 Boughton Green Road) in 2015.
2. Behaviour on Admissions/Risks
Upon admission to Richardson Care, TA presented with challenging and aggressive behaviours. The antecedent to these appeared to be being prompted in regards to personal hygiene. Other known triggers for his aggression include being told what to do.
I like the care here, staff are okay and support me.
3. Interventions
The multi-disciplinary team at Richardson Care assessed TA and worked with him to devise care and positive behaviour plans to meet his overall needs. The plans are reviewed on a regular basis and intervention offered, including:
- Psychology input- Cognitive Stimulation Therapy, Relaxation Group and 1:1 sessions that have a focus on emotion recognition, frustration tolerance and positive communication. These sessions provide TA with the opportunity to discuss any issues or anxieties as well as structured time socialising with other residents. He receives positive feedback on his behaviour, reassurance and if within his ability, encouragement to complete tasks independently.
- Positive Behaviour Support (PBS) Approach/Plans – care plans, risk assessments and intervention guidance; working with TA to recognise and reinforce positive behaviours.
- Consistent support from care workers, due to a low turnover of staff, enables TA to build a good therapeutic rapport with staff, helping him to manage his behaviours.
- Social and environmental factors offered at Richardson Care, such as daily activities, consistent structure and routine, opportunities to socialise and build positive relationships with other residents.
4. Progress/Current Presentation
Throughout TA’s placement at Richardson Care, his challenging behaviours continue to be the priority to address. However, due to the standard of care and skilled staff at Richardson Care, the seriousness of aggression has been kept at low levels of frequency and severity. As a result TA’s quality of life improved at home and in the community. Over the last few years the psychology team has monitored these behaviours to identify progress. The graph below shows a reduction in aggressive behaviours (OAS-MNR) and inappropriate sexualised behaviours (SASBA) since his admission to Richardson Care.
In contrast to when he was first admitted, TA now consistently attends all psychology sessions, without prompts and with full engagement. He currently values these sessions and regularly seeks out the Assistant Psychologist to provide him with additional activities.
On his arrival TA presented with suspicions towards all medication and vocalised that he believed previous medication had caused the development of his brain tumour. However, with the continued support of the team at Richardson Care TA has become more tolerant of taking his regular medication.
I can do lots of things and I find the psychology sessions helpful.
TA benefits from the consistent and supportive approach taken by staff in regard to his care. This helps him to present with pro-social behaviours and has allowed him to expand the range of activities he chooses to participate in. Under normal circumstances, these include: shopping twice weekly, going bowling, attending Headway, going to pantomimes, Rock Club events (parties and social activities) and even day trips or short holiday breaks facilitated by the home.
When we play bingo I always call the numbers out.
TA has numerous interests that he continues to engage with. He is an avid Elvis Presley fan and spends time listening to his music or watching documentaries about him. TA also regularly watches Planet of the Apes or various TV game shows. TA enjoys celebrating annual holidays such as Halloween and Christmas, always putting in the effort to dress up accordingly on these occasions. He is always keen to engage in conversation with staff about his interests and is always one of the first to suggest or engage in activities going on within the home.
5. Conclusions
TA’s quality of life has been greatly improved during his stay at Richardson Care. His well-identified challenging behaviour is managed up to an extent where he is able to enjoy a wide range of activities and his independence is promoted and encouraged. We would consider this to be a successful long-term placement.
I enjoy when I bake with the staff, I usually make biscuits.
