Community of PracticeCommunity of Practice

A Case Study A Case Study

‘‘BOB’BOB’

Pen Picture: BackgroundPen Picture: Background Bob is a 34 year old gentleman, with a Moderate Learning Disability, Bob is a 34 year old gentleman, with a Moderate Learning Disability,

Autism, Complex Challenging Behaviour, Associated Communication Autism, Complex Challenging Behaviour, Associated Communication Impairment & Health Difficulties.Impairment & Health Difficulties.

Challenging Behaviours: Self Injurious Behaviour, Environmental Damage, Challenging Behaviours: Self Injurious Behaviour, Environmental Damage, Physical Aggression, Loud Vocalisation, Stripping / Ripping of Clothes. Physical Aggression, Loud Vocalisation, Stripping / Ripping of Clothes.

Health Issues: Type ll Diabetes & Hypertension, Morbid Obesity, CellulitusHealth Issues: Type ll Diabetes & Hypertension, Morbid Obesity, Cellulitus

Resided with his parents at the family home which had been specially Resided with his parents at the family home which had been specially adapted to meet his needs. History of Exclusion from traditional Services. adapted to meet his needs. History of Exclusion from traditional Services. Receiving Specialist Day Service provision. Receiving Specialist Day Service provision.

Significant escalation of behaviour. Crisis situation. Hospital Admission. Significant escalation of behaviour. Crisis situation. Hospital Admission. Alternative Accommodation & Support deemed necessary.Alternative Accommodation & Support deemed necessary.

Rationale for ReferralRationale for Referral Decline in physical & mental well beingDecline in physical & mental well being

Escalation of target behaviour presentedEscalation of target behaviour presented

Significant risk of injury to Bob & othersSignificant risk of injury to Bob & others

Exclusion / Restricted access to community settings & transportExclusion / Restricted access to community settings & transport

Specialist service provision required.Specialist service provision required.

Crisis admission likely.Crisis admission likely.

Avoid Out of County Placement.Avoid Out of County Placement.

Following Referral to PerthynFollowing Referral to Perthyn

Pre placement Assessment Report Pre placement Assessment Report Completed.Completed.

Panel Meeting Held Panel Meeting Held Placement at Assessment & Transition Placement at Assessment & Transition

Unit offered.Unit offered. Transitional Plan ImplementedTransitional Plan Implemented Positive Behaviour Support Plan Positive Behaviour Support Plan

developed developed

Transitional Plan Transitional Plan

Introduction to Assessment & Transition Unit Introduction to Assessment & Transition Unit Identified Nature of Service Provision Identified Nature of Service Provision Established Central Points of Contact Established Central Points of Contact Nature and Frequency of Transitional Visits Nature and Frequency of Transitional Visits Identified Key Staff (core group)Identified Key Staff (core group) Induction Training: ASD / PBM / PBSPInduction Training: ASD / PBM / PBSP GTKY: family home & working alongside staff.GTKY: family home & working alongside staff.

Getting the Environment RightGetting the Environment Right

As a result of Bob’s ‘testing’ of the durability of his environment:As a result of Bob’s ‘testing’ of the durability of his environment: Identified a Safe Area / Low stimulus environmentIdentified a Safe Area / Low stimulus environment Created highly structured & predictable environmentCreated highly structured & predictable environment Developed a series of routinesDeveloped a series of routines Identified a core teamIdentified a core team Created environment conducive to manage target behaviour (film Created environment conducive to manage target behaviour (film

windows / rounded corners / reinforced doors / boxed toilet windows / rounded corners / reinforced doors / boxed toilet facilities / adapted shower facilities / fitted concealment of all pipes / facilities / adapted shower facilities / fitted concealment of all pipes / secured / removed furniture) secured / removed furniture)

Purchased specialist furniture (bed & bedding) Purchased specialist furniture (bed & bedding) Liaison with Care Standards (minimal furniture requirements / Liaison with Care Standards (minimal furniture requirements /

removal of wash hand basin).removal of wash hand basin). Restricted access to high risk areas.Restricted access to high risk areas. Locked doors / secured groundsLocked doors / secured grounds Robust policy & proceduresRobust policy & procedures

Positive Behaviour Support PlanPositive Behaviour Support Plan

Primary Preventions (Highly Structured Daily Primary Preventions (Highly Structured Daily Routines / Environmental Considerations / Routines / Environmental Considerations / Interactional Profile)Interactional Profile)

Positive Interventions (Skill & Competency Positive Interventions (Skill & Competency Development focusing on Activity Scheduling & Development focusing on Activity Scheduling & Communication)Communication)

Therapeutic Interventions (Medication)Therapeutic Interventions (Medication) Behaviour Response Plan (Inclusive of a Behaviour Response Plan (Inclusive of a

medical risk assessment re: contraindications in medical risk assessment re: contraindications in liaison with other health professionals)liaison with other health professionals)

Risk ManagementRisk Management

Risk Assessment & Risk Management Guidelines developed in Risk Assessment & Risk Management Guidelines developed in relation to:relation to:

General Environment: In specific relation to the potential for General Environment: In specific relation to the potential for extensive damage to property.extensive damage to property.

Observation & Support: Due to the nature of behaviour & associated Observation & Support: Due to the nature of behaviour & associated risks to Bob & Others.risks to Bob & Others.

Transport: Due to high risks posed resulting from target behaviour Transport: Due to high risks posed resulting from target behaviour and damage to vehiclesand damage to vehicles

Access to the Community: Due to risk of injury inc. of members of Access to the Community: Due to risk of injury inc. of members of the public & property damagethe public & property damage

Multi Disciplinary Team: Multi Disciplinary Team: Collaborative WorkingCollaborative Working

Care Manager / Case Co ordinator Care Manager / Case Co ordinator PsychiatryPsychiatry DieticianDietician S.A.L.T.S.A.L.T. O.T.O.T. Physio TherapistPhysio Therapist GP / Diabetic Nursing TeamGP / Diabetic Nursing Team Positive Behaviour Intervention Service Positive Behaviour Intervention Service Perthyn Positive Behaviour Support ServicePerthyn Positive Behaviour Support Service MDT quarterly review meetings inc Bob & his familyMDT quarterly review meetings inc Bob & his family

Assessment Since AdmissionAssessment Since Admission

Behavioural Assessment (Functional Analysis, Adaptive Behavioural Assessment (Functional Analysis, Adaptive Behaviour Scale, Aberrant Behaviour Checklist, Behaviour Scale, Aberrant Behaviour Checklist, Motivation Assessment Scale, Sensory Profile)Motivation Assessment Scale, Sensory Profile)

SALT Communication Assessment - Communication SALT Communication Assessment - Communication Board.Board.

OT Sensory Integration Assessment - Sensory Box.OT Sensory Integration Assessment - Sensory Box. Physiotherapy Assessment – Unsteady Gait / Adaptive Physiotherapy Assessment – Unsteady Gait / Adaptive

Footwear Footwear Health Assessment & Health Action Plan Health Assessment & Health Action Plan Skill Assessment – Competency DevelopmentSkill Assessment – Competency Development

Where are we now?Where are we now?

Augmentative communication systems established: making choices Augmentative communication systems established: making choices & less reliant on his behaviour to make his needs known.& less reliant on his behaviour to make his needs known.

Significant reductions in incidents of target behaviour.Significant reductions in incidents of target behaviour. Significant reductions in prescribed medicationSignificant reductions in prescribed medication Expanding activities in house and in the community: Inclusive of Expanding activities in house and in the community: Inclusive of

cooking sessions / access to the kitchen.cooking sessions / access to the kitchen. Increased community presence, regular activities / venues and Increased community presence, regular activities / venues and

external relationships with others.external relationships with others. Ongoing monitoring / support with health monitoring / diet Ongoing monitoring / support with health monitoring / diet Appropriate Family Liaison / Support Networks Appropriate Family Liaison / Support Networks MDT liaison / regular review / family in attendanceMDT liaison / regular review / family in attendance Regular review and update of Positive Behaviour Support Plan & Regular review and update of Positive Behaviour Support Plan &

Risk AssessmentsRisk Assessments

Augmented Communication SystemAugmented Communication System

Activity ScheduleActivity Schedule

TimeTime MondayMonday TuesdayTuesday WedWed ThursdayThursday FridayFriday SaturdaySaturday SundaySunday

AMAM ReadingReading Trip OutTrip Out Make LunchMake Lunch SkittlesSkittles Art & CraftArt & Craft Photo Photo SessionSession

Music Music SessionSession

AMAM Ball GamesBall Games Art & CraftArt & Craft Trip OutTrip Out Cooking Cooking SessionSession

Sensory Sensory TimeTime

Trip OutTrip Out Local WalkLocal Walk

PMPM Trip OutTrip Out Sensory TimeSensory Time PicnicPicnic Reading Reading SessionSession

Trip OutTrip Out Lunch OutLunch Out Family TimeFamily Time

PMPM Photo SessionPhoto Session Music Music SessionSession

Sensory Sensory SessionSession

Music Music SessionSession

Photo Photo SessionSession

Music Music SessionSession

Family TimeFamily Time

Historical Comparison of IncidentsHistorical Comparison of Incidents

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Any Questions?Any Questions?