Case study: Yvette’s story
Yvette is a 48-year-old lady who contracted Lyme’s disease in 2008. In 2016, Yvette moved to Richardson Care after many failed placements. She is a remarkably positive lady who has been able to transform her life. Her story demonstrates that given the right support and opportunities, along with dedication, it is possible for someone with a severe brain injury to return to living in their own home.
When she arrived at the Richardson Mews, Yvette’s cognitive difficulties were word finding, lapses on her memory and limited attention. At times, she would become extremely frustrated with not being understood, which would lead to verbal outbursts. She was also experiencing extremely low mood.
Her goal for rehabilitation was to improve her independence so that she can return to living in the community. Yvette also wanted to improve her speech and cognitive abilities, such as memory and problem solving.
When meeting with the Richardson Care Multi-Disciplinary Team (MDT), and as part of our person-centred care approach, we supported Yvette to be involved in the making of her care and positive behaviour plans. Yvette identified her rehabilitation goals: to improve her independence so that she can return to living in the community and be near her family; to improve her cognitive abilities, particularly language, memory, attention and problem solving.
Immediate Intervention
The Richardson Care MDT met regularly and discussed Yvette’s case. Yvette was offered a holistic approach to help her succeed and achieve her identified rehabilitation goals. She has been offered weekly psychology and Speech and Language sessions to support her in working towards her goals. She was also supported by our neuro physiotherapist and overall gains were immediately identified.
I never had my own bathroom and shower and own kitchen in my room before.
Effective Interventions and Approaches
Relaxation Group
The Psychology Team at The Richardson Mews offers a weekly Relaxation Group. It is open to all service users to attend and aims to support them in learning skills that help them relax. We employ a variety of relaxation techniques including progressive muscle relaxation, guided imagery and breathing techniques. Yvette attends this group on a regular basis and has reported benefits from her attendance.
I want to share my story as people only see my car [wheelchair], they don’t see me.
Cognitive Stimulation Therapy Group
We also offer Cognitive Stimulation Therapy (CST) on a weekly basis at the Richardson Mews. This is a therapy that focusses on using a variety of different topics each session to improve overall cognitive abilities. For example, practising money handling and pricing shopping lists, as well as completing word game tasks such as crosswords. Yvette is a regular attendee at the CST group in the Richardson Mews and has shown some improvement in her attention span and memory.
Positive Behaviour Support Approach/Plan
A Positive Behaviour Support (PBS) plan is a care plan that is designed with Yvette in order to promote positive behaviours. Staff use the care plan to understand what Yvette needs in order for her to make progress in her rehabilitation. This is a person-centred approach and is commonly accepted as best practice within care services.
Current Presentation
The Overt Aggression Scale – Modified for Neurorehabilitation (Alderman, Knight & Morgan 1997) works by staff recording aggressive behaviour and coding them into four distinct categories (Verbal Aggression [VA], Physical Aggression against Objects [PO], Physical Aggression against Self [PS] and Physical Aggression against Other People [PO]). Each category has four levels of severity: 1=mild, 2=moderate, 3=severe, 4=extreme. This data can then be used to determine the frequency and severity of aggressive behaviours and currently is one of the measures used to indicate progress in neurorehabilitation.
You can see here behavioural data relating to Yvette, which was collected weekly by the Assistant Psychologists. The data collected indicates a 60% decrease in aggression during one year of behavioural interventions.
Of particular interest is the reduction in aggression towards other people and verbal aggression, which for her indicates that she is better able to manage her frustrations. It is likely that the improvement in her speech has allowed her to communicate better with care staff, therefore being able to communicate her needs, wishes and informing them how she would like to be supported.
Yvette has a remarkably positive outlook following her brain injury and the progress that she has made at Richardson Care. She often states that she ‘lives every day as if it were her last’ and is happy with her recent progress. Yvette uses a motorised wheelchair to get out and about and she leads a busy life.
When I moved to this home I couldn’t talk much, and they’ve helped me with this – thank you Jenni!”
Next Stages
Yvette has now moved into her own house, which has been converted to meet her needs. She is supported by carers who come to the house on a daily basis. Yvette is now closer to her family so is looking forward to doing more family activities together. She is very excited about becoming more independent and living in the community.
From Yvette’s Case Manager
“I acted as Yvette’s Case Manager and was instrumental in moving Yvette from her previous nursing home to Richardson Partnership for Care as Yvette wished to be nearer her family and to work towards moving into her own home in the community. With the support of Richardson Care she has achieved her goals.
Richardson Care has been able to offer Yvette support, care, occupational therapy and psychological support which she required to achieve her goals.
The Mews differed from her previous placement because, most importantly, they respected Yvette’s individuality and wishes. She has had a “voice” at the Mews. Speech and Language Therapy has assisted Yvette to communicate and a great improvement has been seen and she is now a proficient communicator.
Being a young woman, Yvette has benefitted from being with a younger age group of residents.
Access to regular Psychologist input has assisted the care team in reducing any frustrations or difficult behaviours Yvette might display. She has received the standard of personal care she expects and desires which has resulted in less frustration for all concerned.
Yvette has benefitted from the location of The Mews close to the shops and supermarkets and her weekly outings – she has attended the day centre and church and has the use of The Mews’ vehicle for individual outings each week or joins in with other group outings. She has had very successful annual holidays, which she has enjoyed arranged by The Mews.
Yvette has enjoyed the activities offered by The Mews: crafts, music sessions, wheelchair dancing and all the social activities which have been on offer – including visits by Elvis Presley!
Most importantly for Yvette, she has known that her possessions and money have been safe at The Mews (she experienced acts of theft at her previous placement).
As previously mentioned, Yvette has a “voice”: at The Mews she can communicate her wishes, views, dislikes and she knows she will be respected. The Mews has enriched and improved Yvette’s quality of life.
[The team at] The Mews has also worked closely with myself as Case Manager to assist Yvette to achieve her goals.”
June Hodge
Case Manager
