Case study: Kay’s Story
When she was only 18 months old, Kay contracted Encephalitis and consequently experienced severe epilepsy. At the age of 13, she underwent surgery on her frontal lobe, which further exacerbated the brain damage. Kay also has a diagnosis of moderate learning disability.
Background
Kay lived at home with her mother and grandmother before moving to specialist residential schools and other settings. At the age of 27, Kay moved to The Richardson Mews. She had previously resided in a private hospital but the placement broke down due to her risk behaviours and the inability to manage Kay in that environment.
Behaviour on Admission
Kay’s challenging behaviour was thought to be underpinned by poor impulsivity control and a reactive approach to challenging situations due to her brain injury.
On admission, Kay presented with severe verbal and physical aggression towards herself and others. She also would make false allegations towards staff and other residents, disregarding staff prompts and instructions compromising her and others overall safety.
Immediate Intervention
The Richardson Care Multi-Disciplinary Team (MDT) met regularly and discussed Kay at length. The team liaised effectively and Kay was offered an holistic approach to help her succeed and improve her quality of life.
I love it here because I like staff being fair. And I get to do a lot of activities like art, CST [cognitive stimulation therapy] and relaxation.
The first step was to evaluate the environment in which Kay was living. The MDT conducted a functional analysis of her presentation, her risk and her overall clinical and social needs. As a result of the risks presented to herself and others, after 15 months Kay moved to 23 Duston Road, another Richardson Partnership for Care home. It was thought that 23 Duston Road would offer the effective relational, environmental and procedural support that would meet Kay’s overall needs. Immediately after the move to 23 Duston Road, Kay’s pro-social behaviours increased significantly. She clearly benefited from being exposed to a low stimulus environment (i.e. smaller environment and fewer residents).
Other Interventions
A combination of other interventions were also implemented, which included direct and indirect psychological work as well as an extensive review of her psychiatric medication. Kay also benefited from a tailored programme developed by Occupational Therapy and she was reviewed by a Speech & Language Therapist and Physiotherapist.
Effective Interventions and Approaches
1. Positive Behaviour Support (PBS) Approach/Plans
The approach focuses on teaching pro-social behaviours. It aims to understand challenging behaviour as well as triggers and ensuring quality of life. PBS plans aim to allow others to recognise episodes of challenging behaviour as well as reduce the likelihood of them actually occurring. Kay was involved in the making of her PBS plan, which is followed by care staff in order to support Kay to reduce challenging behaviour, teach her new skills and therefore, promote her quality of life.
Thank you care staff for helping me and supporting me all the way through my life.
2. Psychology Groups: Progressive Muscle Relaxation
Relaxation sessions use breathing techniques and encourage the participants to focus on different groups of muscles by tensing and relaxing those muscles in order to relax the body and mind. Kay, with staff encouragement and prompts, engages well in the exercises and appears motivated to continue participation.
3. Psychology Groups: Cognitive Stimulation Therapy (CST)
CST sessions aim to improve cognitive skills (e.g. memory, language, communication skills, attention), improve mood and increase confidence by engaging participants in themed activities carried out over several weeks. Kay, with appropriate staff guidance, engages well in all tasks prepared and reports motivation to continue her participation.
4. Psychology 1:1 Sessions
These support Kay to contain her impulsivity and identify emotions as well as developing problem solving skills. Overall, the aim of the sessions was to support Kay to identify destabilizers and triggers and act on them rather than react. Kay is now able to regulate her emotions (e.g. low mood, anxiety, anger, etc.) and contain her impulsivity and use appropriate self-monitored behavioural interventions (such as removing herself from the situation or environment, or engaging herself in another activity). She is also provided with other psycho-educational support on topics like hygiene and online safety.
5. Psychiatric review
Her current psychiatric medication is reviewed on a monthly basis and/or when needed by the neuropsychiatrist.
In the future, I would like either to stay here or go on more home visits or go to supported living in Islington. Thank you care staff for supporting me and helping me gain skills that I need to move on.
Current Presentation
At times she continues to present risk towards others, but this is contained effectively. Kay is now able to reason and reflect on her behaviour post an incident, which aids with the recognition, prevention and containment of future risk behaviours. Kay is now more able to effectively identify destabilisers and precipitant factors and thus manage them with staff support as well as independently.
Currently, Kay also continues to benefit from consistent daily structure and routine as well as the low turnover of support staff summing to a more suitable environment for Kay. She continues to be encouraged to use her daily living skills in order to acquire, maintain and enhance her skills, which is in line with her aspirations to move onto more independent living accommodation. Kay continues to be closely monitored by support staff and the psychology team for any changes in her presentation.
Staff at the Mews, thank you for helping me and for letting me come to activities at the Mews, like bowls, pantomimes, exercise classes and Elvis Presley karaoke.
Thank you care staff.
for taking me on home visits and holidays.
Having lots of activities keeps me busy and occupied.
Thank you care staff for supporting me and advising me when I’m upset.
