Case Studies
Case Study 1
Alan (not his real name) came into tracscare after suffering a severe head injury as a result of a road traffic accident. During the time Alan was in hospital after his injury his behaviour was agitated and confused. This was treated with anti-psychotic medication. During Alan's initial placement at tracscare he experienced difficulty with continence at night. He had lost many basic skills with self-care and this had resulted in a debilitating loss of confidence. His ability to self-motivate was severely impaired and required constant support and encouragement.
After two years at one of our Homes, Alan has made tremendous improvements and regained much of the independence that was lost to him. Under the guidance of a Consultant Psychiatrist provided by tracscare, he slowly stopped taking the medication that he had been prescribed in Hospital. Staff supported him to regain self-care and household skills until he was independent in all areas. In time, Alan started weekend visits to stay back Home with his wife. Eventually, Alan started undergoing Occupational Therapy with a view to restarting part-time at his old place of work. Alan's progress in all aspects of his life has been such that he and his wife are making plans for him to return Home on a permanent basis.
Case Study 2
David (not his real name) is an extremely happy and very pleasant 40 year old gentleman, who wanted a chance to prove that he could lead an independent and a fulfilled life of his own.
David had spent approximately ten years in a secure hospital receiving treatment for schizophrenia before being conditionally discharged to Alkare in 2004.
David had become very institutionalised; when he initially moved to Alkare the things that we take for granted such as toileting or making a cup of tea were major tasks for David, who would look to staff for permission.
After discussion with David the Alkare staff agreed to work with him on the small things, building up to bigger tasks such as house shopping, cooking and community interaction. David was extremely paranoid and being amongst people he did not know was very stressful for him.
Staff reinforced that the Alkare home was David’s home at every opportunity; it was absolutely his choice when he ate, slept or drank. It was also his choice what he could eat and drink. Very slowly David started to accept this make his room his own; buying a television, CD player, small items of furniture etc that would be his own property. David was very proud of his belongings, building up quite a large and varied amount of music. David also became very proud of his appearance, buying very smart clothes and taking pride in looking good. David enjoyed wearing a shirt and tie on occasions.
Initially David received very intensive support both from Alkare staff and his external care team. Over time David relied less on staff support and because of this, his care team felt that he should access the community independently. David started making short journeys initially; these would normally be via public transport to the local shopping area. This soon built up into a full day out into the local town centre then further afield, to other town centres; David had become a keen shopper with an eye for a bargain.
It soon got to the point where David did not require staff support at all, not even for help regarding medication. Every aspect of David’s life was being led independently.
David also enjoyed keeping busy through work placement opportunities; this took time for David to feel comfortable with but proved to be an asset in David’s development. Cooking was a favourite and David would work in the kitchen of a local establishment up to three days per week preparing buffets for up to 60 people. (David also achieved a certificate in food hygiene). David regularly attended a local drop in centre where he would brush up on his numeracy and literacy skills, whilst making a lot of new friends away from Alkare.
A multidisciplinary care team meeting then decided that David should move on to less supported living, although David was extremely apprehensive, he was very comfortable living in our home, felt safe secure and in a way part of a family. It took a bit of persuasion and explaining to David, that he didn’t need this level of support any longer; he had worked very hard and had come a long way but it was time to move on to the next stage of his life.
A flat was found in which David would only receive support if he wanted, although he would have to follow some rules. After a number of trial visits to the flat and intensive support from Alkare staff, David eventually moved into his new home in the summer of 2008. To date, this has been very successful.
David maintains his own finances and successfully shops for himself. Every aspect of David’s life is independent. He has settled well into his new home and makes less contact with Alkare staff suggesting that he is enjoying his new life.
Case Study 3
Gavin (not his real name) was admitted to Positive Lifestyles in June 2005, with a moderate Learning Disability and severe Challenging Behaviour. Prior to his admission Gavin had been a patient at numerous secure units.
On his admission to Positive Lifestyles Gavin posed challenges on a day-to-day basis including physical threats but mainly significant environmental damage. This resulted in regularly breaking furniture, smashing windows and causing destruction to garden fences and gates. Gavin often refused to attend to his personal hygiene, refused prescribed medication and would not engage in any meaningful activities. He received significant intensive support from the Specialist Behavioural team and was prescribed physical interventions, which were implemented regularly initially to approximately 4 times per week. These episodes could last for up to one hour at a time.
The staff team gradually built up good relations with Gavin and gained his trust. They developed great understanding of his Challenging Needs and were able to distract and diffuse potentially challenging incidents before they became increasingly problematic. Staff worked tirelessly with Gavin for over 2 years and is at a stage whereby he has completely changed in terms of his challenges, which have greatly reduced.
He has not threatened staff for over 8 months and although they have to be vigilant, his Challenging Behaviour has significantly improved. This has resulted in no environmental damage for over 1 year; all medication has been discontinued, and manages his anger with the use of coping skills. Gavin has experienced a positive transition from a secure unit to residential care, and has enjoyed significant progress in his life, experiencing less staff dependency, and engaging a richer social life attending concerts and going on holiday.
Case Study 4
Tony (not his real name) came into Tracscare from out of county as an emergency placement in 2006, he was a young man 18 years of age with a diagnosis of having an Autistic Spectrum Disorder, Learning difficulties and Challenging behaviour.
The first couple of months went by with little challenge and Tony appeared to settle in well taking part in lots of activities. During the following year it was noticeable that he began to distance himself from staff and other residents and began to refuse to participate in activities that were offered to him, even the activities that he loved to take part in only months earlier. Tony's motivation declined further and began displaying self injurious behaviour and attempted to assault all staff members and fellow residents.
Even with advice from consultants and support from his family the placement continued to break down with the resident now displaying very challenging behaviour on daily basis, he would attempt to assault any staff member that tried to interact with him, he was now neglecting himself refusing to wash, change his clothes or bedding, tidy his room or go out of his room socialise. He was damaging his environment punching holes in the walls, breaking the windows and destroying the plumbing system in his bathroom. He was now very unhappy and showing his dislike to his environment by displaying very challenging behaviour on daily basis. He also physically assaulted a fellow resident and from then on did not have any more interaction or contact with any other resident living there.
It was at this point that a multi disciplinary meeting was held to discuss future of the placement and what was best for the resident, other residents living at the home and the staff team supporting him.
With the Clinical Team at Tracscare now fully involved and their skills in managing very challenging behaviour utilised, it was decided that we would have to look at changing his environment and focus more on providing the right care to make Tony feel more comfortable and assess his daily life skills, his ability to communicate with others and manage any sensory issues he may have.
We quickly agreed that it would be very important to have a structured day with routines that he could quickly pick up and feel comfortable with which would help him manage his daily anxieties. He would receive daily input from a Behaviour Advisor and bring in behaviour therapy and reflexology support.
We would also need to make sure that Tony had a homely environment free from noise. Due to his challenging behaviour and his lack of communication and social skills it was important that he had the independence to walk around and carry out activities but without the distraction of other residents.
The new environment was simple but was very homely with his toys put in his room before he came. It was very important that we had a TV in his lounge area so that even if he refused to watch the TV programmes, we could put the TV on and he could listen to the programmes or music playing which was important as he needed some stimulation to help to distract his mind from negative thoughts.
The resident settled really well into the new placement and with the structured plans and routines he began taking pride in himself, he began washing and showering every day, changing his clothes daily, helping staff change his bedding and tidying up his room, he appeared to enjoy the positive confident staff interaction and asked staff to read with him and play cards with them.
It has been very important that the Behaviour Advisor and CSN have kept visiting on a regular basis to help keep the staff team motivated and encouraging them to continue to follow plans in place which is helping the resident manage his challenging behaviour because after almost four months after Tony moved in to new single bedded unit he continues to look after his environment and takes pride in himself continuing to carry out activities listed above. His challenging behaviour incidents have decreased dramatically and he appears to enjoy life at present talking to staff about positive things in his life and is looking forward to meeting his mum who is visiting Christmas time.
