For those who work with and care for people with severe learning disabilities, dealing with challenging behaviour
can be one of the most difficult aspects. This film looks at how local authorities, private
and voluntary services can improve practice to reduce and prevent difficult anti-social behaviour.
Challenging behaviour is a range of problems people have from things like aggression towards other people,
temper tantrums, destroying property, through to self-directed behaviour – self mutilating behaviour,
self-injurious behaviours. Challenging behaviour occurs because people have vulnerabilities which are exacerbated
by the way they are supported. If people can’t communicate well we think that that is a big issue
in producing challenging behaviour. There are some congenital conditions that cause learning disability
that are associated with higher rates of challenging behaviour, but in broad terms the issue is communication.
In Surrey forty year old Lisa has a history of challenging behaviour. Profoundly deaf and severely autistic she is
one of ten adults living in two five bed units at Stonepit Close, which is run by the National Autistic Society.
The service was established nearly fifteen years ago now. It was started from scratch,
from plans, looking at trying to provide a home for adults with autism, across the spectrum.
The house is split into two; it has got five people with autism in each house, and we cater for the whole 15 00:02:12,030 --> 00:02:18,160 spectrum of autism. The home was designed to cater for its residents’ needs, with large living areas,
low arousal interiors and several gardens to give individual space. The philosophy at the heart of Stonepit
Close is SPELL, the society’s framework for understanding and responding to the needs of people with autism.
The core principles is about an individualistic and person centred and honest approach.
We try and really understand the history behind the person, to understand the person more 20 00:02:53,060 --> 00:02:57,080 makes us understand and empathise with why they might be challenging.
We have got one individual’s behaviour plan, it is based around what sort of things that he displays.
This individual has his anxieties, and he does tend to throw cups as a way of communicating with us,
and what we do is, we monitor what sort of incidents that he is having, and then what we do is we look
at the incident forms and track it back to what has triggered it.
Careful monitoring of Lisa’s behaviour since she moved into Stonepit Close has enabled staff to
understand it and help her progress. 27 00:03:30,020 --> 00:03:37,170 When Lisa first moved in Lisa was extremely challenging; she used to continually stand up, sit down, stand up,
sit down, she was always moving. She ground her teeth, she used to push staff; it is quite difficult
to find out when she is showing signs of pain.
Lisa has now learned to use a language of signs and symbols, which enables her to
communicate to support workers like Jan her basic needs and desires.
Okay, so Lisa has just signed that she wants a cup of tea, in her book.
So we will have to go and get you one won’t we?
Learning this technique makes a huge difference to Lisa’s wellbeing and ability to cope with life.
It means a little bit of independence for her; she is joining her social group, it is better interaction
with peers, it also means that she can get what she wants, she can show her choice in all aspects of
her life, whether it be an activity or whether it is something as small as choosing her breakfast cereal.
If you put the communication in, and make sure that he knows exactly what she is doing at any given time in the
day, she is a lot easier, she is a lot calmer, she knows what is happening, it reduces the anxiety straight away.
Backing up Lisa’s signing skills is a dedicated staff team constantly watching for,
and monitoring in her person-centred plan, any changes to her behaviour or wellbeing.
It starts off with an assessment prior to the person moving in to work out what the person’s needs are,
and then obviously everything is catered down from that. And I suppose over the years we have all worked
out what Lisa’s normal range of behaviours are, and then obviously if she shows something that is
a little bit different from that we will realise that there is something either wrong with her physically,
or wrong with the activity. That goes for all of the service users that live here.
We have quite a few meetings, whether it be with justthe staff on a monthly basis, or whether 48 00:05:42,160 --> 00:05:48,220 it is with care managers, or parents, families and obviously the individual themselves. 49 00:05:48,220 --> 00:05:54,090 But communication is key to how you manage consistency.
Forty years ago services for people with challenging behaviour, in so far as there were such things,
were all about groups. People were herded into a room, they were the back wards of the institutions.
Now we understand that because this is all about relationships, it is all about communication,
it is all about interaction between the environment and the individual, we have to individualise what we do.
Pam found one example of this approach when her daughter Diana, a resident at Stonepit Close,
began exhibiting challenging behaviour on the way to the day service.
Her reaction when the bus started off was that she would undo her safety belt and get up
and whack the other clients. And so we were back into, oh dear she is being disruptive to other clients. 58 00:06:47,220 --> 00:07:00,150 So the psychologist that was part of the working team here came and discussed it, and she said, well what we
will do is Diana is to be taken separately on her own to the day centre, and we will get her all settled in
with activities while the mini bus comes back to the house and then collects the others. And this worked
really well, and so that was their way of coping.
And I think it is important that the resources are here to make that adaptation really.
Now we understand that person-centred approaches – not just person-centred planning, but actually person centred
ways of working with the person – are absolutely central, and the services that we design
for people whose behaviour presents a challenge need to be tailored to that individual.
There are some really good places to eat. They serve like; obviously you want to taste some local.
- Local food, yes, and local beers. [Speaks a foreign language] - Yeah lovely. 68 00:07:58,230 --> 00:08:03,170 I will tell you what, I am going to become a natural you see, and with the locals it will go down really well.
For Kevin, another resident with Aspergers Syndrome, holidays abroad, funded partly by his own money,
have improved outcomes. Three years ago, when he first came, his challenging behaviour
would have made foreign travel unimaginable.
On an almost daily basis he was having very many behaviours, quite severe behaviours, not just within the
home but within the community as well, which was impairing his ability to go out. This was obviously having a 74 00:08:32,230 --> 00:08:38,040 knock-on effect on his family, because his mother was becoming quite distressed by the amount of phone calls
that he was having. He was phoning her daily really to say that he was anxious, he couldn’t cope living there.
We did assess him quite closely, we looked at some of his behaviours that he was displaying, and what was
triggering them. And we worked out quite quickly that Kevin likes to do well, he is also keen that his structure
is very rigid, or well planned shall we say. And because we are aware of what his behaviours were and what set
an anxiety off, we made sure that all of his activities were carefully looked at, carefully planned. He does pose
a risk when he is anxious, and he has an aversion to tall people, and so we make sure that when he is out in
the community he has generally got two staff; one to support him, that he can talk to,
and one to keep him fully informed of what is happening, of any changes to the activity.
Preventing Kevin’s anxiety is a priority for staff wherever he goes, but it is particularly important
when travelling abroad. The two staff who will accompany him have made a detailed plan outlining the trip,
so potential anxieties, triggers for Kevin’s challenging behaviour, are greatly reduced.
With the folder it is like it is a guide for myself, to know about what I am doing, about what times the
flights are, where I will be going, and the place that I will be staying at, and the places I will be visiting.
It is just to put it in a word and pictorial form to help me to be able to see and to have a read of what I am doing
every day, to make things clearer. I have found the right place here, and I couldn’t be any happier or any luckier,
I have to say. It has been the making of me, it has made me a different person from what I was before, much
different I would have to say, and more for people on the Asperger’s end of the autistic spectrum,
because places like here are definitely few and far between, they are hard to find that is for sure.
There is now widespread acceptance, I think, that the goal of services for people whose behaviour can present
a challenge is to provide a good quality of life for those people, even though they have challenging behaviour.
So you don’t have to stop being a naughty boy before you get into decent services where people treat you
like a human being. You get treated decently, you have a rich quality of life,
and we cope with the challenges that you present.
In Cardiff it is baking day for Henry at the Ty Ddraig Day Centre, also run by the National Autistic Society.
Henry is one of twelve people whose challenging behaviour had excluded them from other services. The centre was
designed around their needs; a low arousal environment with wide corridors and plenty of space. Each person spends
the day guided through activities specifically designed to challenge them appropriately; like Amir,
who is working on basic number skills and colour recognition with support worker Lee. 103 00:11:48,030 --> 00:11:49,140 How many yellow pegs?
- Three, four. - How many?
- One, two, three four. - Excellent, four.
Once you have given people those opportunities to increase their skill levels, whether or not it has an impact
on their self-esteem, I suppose, depends on the individual. Then they start doing things
and it replaces, it gives them functionally equivalent skills, that replace the need
them to communicate through using what we would term as challenging behaviour.
As with Stonepit Close in Surrey, the National Autistic Society’s SPELL framework, encouraging an empathetic,
individually designed approach is also central to life at Ty Ddraig.
Less than two years after opening David and the team have already seen impressive results.
I know everyone’s behaviour has improved because we monitor and re-track it, and we have lots of review meetings.
Virtually all of them came in on the two to one staffing ratio, and for at least five of them that has been
dropped to one to one. They are all fairly content and fairly happy, families certainly are happy as well,
and it has given us a glimpse, and their families I think, of their potential in the future,
which maybe wasn’t so bright about eighteen to twenty months ago. 118 00:12:59,130 --> 00:13:04,060 Thirty year old Imran had a history of especially challenging behaviour. 119 00:13:04,060 --> 00:13:08,030 Until the team began working with him his skills were minimal.
What we normally do is conduct a functional skills assessment, which enables us to learn what people
are capable of, and everyone said in the right place with the right approach he has got amazing potential.
Now Imran is one of Ty Ddraig’s success stories.
His staffing ratios have gone down, and he knows how the service works, he can navigate around it, he uses a
three step communication system where he can tell us what he is doing; what he is doing now, what he is doing next,
what he is doing then. And that gives him a lot of reassurance, and it also means he can make clear choices.
Exercises to improve Imran’s motor skills have paid off, and soon he will be able to start helping out at home.
The second exercise Imran was doing was matching socks, and rolling them together to put away in the laundry.
The idea is that that will hopefully enable Imran to be able to transfer that to home. And he just gets a lot of
self-satisfaction from doing things himself, he just need to be given the opportunity. But he does need to learn through
rotas, so sometimes it is a lot of repetition. But the whole idea is that he transfers that to another environment.
He is a very intelligent man, he picks things up so quickly, but he does need a bit of a push because
he will choose not to. But he is capable of so much and you do get a sense of achievement when actually you have
been working with him now for two weeks on something and then he has picked it up
and he is doing it on his own independently.
We don’t need more reports, we don't need more policy statements, what we need is people to actually develop
individual services, one by one, for each of these people in their local area. And if we started doing that,
a number of things would happen: first of all those individuals would get a better life; secondly, we'd begin 138 00:15:01,220 --> 00:15:09,090 to build the expertise locally about how to do this and how to sustain it; and then thirdly we'd stop
wasting so much money on poor quality placements that aren't really part of the solution.