Case study: John’s story
John’s story demonstrates that finding the right placement with consistent care and support, while providing opportunities for social integration and decision-making can lead to increasing fulfilment and autonomy. It can be a gradual process, but it also shows that an holistic psychosocial approach with regular neuropsychiatry reviews can reduce the reliance on drug therapy.
Background
At a young age, John was diagnosed with Moderate Learning Disability and Asperger’s Syndrome. His impulsive behaviour meant that by the age of seven he was placed in a care home. He also attended a special needs school where he continued to display behaviours that challenged. Between the ages of seven and twenty, John was admitted to fourteen different settings, including five psychiatric hospital admissions. Most of the placement breakdowns were as a result of John’s aggressive behaviour towards others.
Behaviour on Admission/Risks
Upon admission to The Richardson Partnership for Care in June 1998, John displayed verbally repetitive and obsessive behaviour concerning food and fluid intake and compulsive behaviour with regards to spending money.
He presented a multitude of risks including self-isolation, mood fluctuation, inflexible behaviour and anxiety when presented with changes to his routine. John would also become verbally and physically aggressive as well as sexually inappropriate towards others. John had little insight of the effects of his behaviours on others.
Interventions
A holistic approach was devised by the Multi-Disciplinary Team (MDT) at The Richardson Partnership for Care, which continues to support John. Some interventions include:
- Social, procedural and environmental factors offered at the placement, like consistent structure, meaningful activity, therapeutic rapport with staff and opportunities to socialise and build positive relationships with other residents
- MDT interventions (particularly neuropsychiatric and neuropsychological input, including regular medication review)
- Positive Behaviour Support (PBS) Approach/Plans, care plans, risk assessments and intervention guidance
- Psychology input – group and individual sessions that aim to allow John to express his feelings and aspirations, socialise with other residents, share experiences and learn positive ways of dealing with his emotions. The sessions also aim to reduce anxiety, provide reassurance and feedback regarding his behaviour.
- Psycho-education – e.g. teaching John social norms
Progress/Current Presentation
John benefits from a consistent approach from staff and has demonstrated progress regarding integration and his abilities to create positive relationships with other service users and staff. When John experiences difficulties in regulating his aggression, he is able to ask staff for help. Current behavioural interventions support him effectively, thus there has been a decline in his physical aggression towards others. John’s risk behaviour is currently well managed within the home.
John has made significant progress through interventions lead by the comprehensive Multi Disciplinary Team. John has been able to improve his communication and his tolerance to others. He has developed new interests such as baking and going on day trips. John has contact with his family, particularly with his aunt and uncle, who visit him regularly.
By 2016, John had developed his confidence and was able to control his behaviour sufficiently to enable him to take his first ever holiday; he went to the seaside town of Skegness in Lincolnshire for four days. He chose where he went and who he wanted to accompany and support him. During the holiday he was in full control of what he did.
Shortly after the holiday, John’s uncle told us: “John is having the best care he has ever received and your professional and devoted work with him has enabled him to grow in confidence and become a happy man.”
“Selina’s total commitment to him has supported him to the extent that he has finally been able to go on holiday. Your team at The Richardson Partnership for Care has allowed him to blossom into the lovely caring man that was always there.”
“Your plans for him over the years to withdraw drug therapy and support John through specialist behaviour plans have meant he is becoming more socially skilled and a joy to be with. Going on holiday has meant John’s confidence has moved to another level.”
On another occasion, John’s uncle and aunt told us: “We visited John yesterday and we were greeted by a very calm and cheerful young man. We both know how much work this takes and we are very grateful for this. We are so grateful for your tremendous work and commitment over the years to him, and we also know how much you care for him. More importantly he knows how much you all care and love him in spite of his incessant verbalising. We are very proud of our nephew and we are extremely grateful for your expert work in moving away from drug therapy to modifying his behaviour through psychosocial approaches. John is a much healthier man because of your imaginative and professional strategies you use to manage his behaviour and we thank you for this.”
John’s Comments
He has lots of activities and has a good life in here.
He has a lot of friends here, he likes Ian.
Staff understand John.
He always goes out for checkups and blood tests at doctors.
Staff looking after John, he gets what he wants but not every day, he cannot have it every day.
