Changing lives through happiness
How prioritising the person and what makes them happy has transformed the lives of eight hard-to-help residents with learning disabilities in supported living accommodation.
Ten years ago, support provider Living Ambitions, part of the Lifeways Group, took over support for eight individuals considered ‘the most challenging people in Aberdeen’. They had been written off as ‘no-hopers’ and described as ‘people with such entrenched behaviours who, for their own good and that of others, will never have regular community access’.
Physical interventions were reportedly used many times a day and seclusion was commonplace, as were injuries to service users and staff.
After living most of their lives locked in a hospital ward, what hope could there be for them to live lives with choice, control and community access? Yet they are now happy, in control and living their lives within their community.
Lifeways adopted a new approach to managing challenging behaviour, as a result of which the individuals enjoy going on holiday, eating out, going to parties, shopping and attending concerts. They rarely need physical help to manage their ‘behaviours’, are loved and supported by their families, and are popular with staff.
Support tends to fail when there are breakdowns in communication and unsuitable living environments. The approach Lifeways took was to use positive behaviour support (PBS) to focus on each person, not their problems.
The starting point was to gain an understanding of each person, their likes and dislikes, their strengths and support needs and, most importantly, how we should communicate with them – and them with us – as effectively as possible.
The team developed detailed PBS plans that focus on enhancing quality of life, developing life skills, improving communication and resolving any environmental issues for each person.
Using a partnership approach, the specialist Lifeways PBS team, local support staff and management developed a holistic approach to providing active support. Issues were resolved using skills teaching and graded assistance, and communication was improved between all parties by using symbols, objects of reference and gestures, as well as talking.
The Living Ambitions team’s dedication, professional approach and love for the job delivered excellent results for the people they support. Team members were meticulous with their recording, reporting, debriefing and updating of plans. These plans covered active support and skills teaching as the primary element, as well as total communication, and sensory and environmental considerations.
The plans also included a behavioural functional analysis section that covered each individual’s ‘rules’ – the things staff must get right or avoid – an active and reactive strategy for effective de-escalation, and protocols to avoid known triggers.
The PBS team worked with local staff and external professionals, as well as family members, to compile the PBS plans via a continual series of individually focused PBS workshops.
This ‘whole-team involvement’ enabled the team to remain invigorated, creative and positive, and ensured motivation and retention of staff remained high even when the going got tough.
The involvement of all staff in planning and service delivery also helped them understand and value the needs of each person requiring support. It helped the staff to understand that challenging behaviours are not fundamental to the people being supported, but expressions of unmet support or communication needs. They came to see the person, rather than his or her behaviours.
The team had a simple brief: to make each person happy. This transcends all technical jargon, such as community participation, rights, choice and autonomy, and is something everyone can appreciate. This is not to say that those technical elements are not essential and worthy goals, but it focuses on one straightforward priority: to bring happiness and fun into the lives of the people they support.
The team worked closely with the local community learning disability team to incorporate its input into the PBS plans. Care managers were also kept involved.
Enriching each person’s life was the priority, and any behavioural issues that arose became a secondary consideration. Because each person could do more, develop more skills, build more relationships, and become more fulfilled and valued, many of their ‘problematic’ behaviours disappeared.
As staff became more alert to individual sensory needs, such as touch and noise, many of the events that triggered incidents were also eliminated.
We helped individuals to move to different environments so that they were living with people they wanted to live with, rather than ‘placed’ by the local authority based on availability of rooms instead of on choice or compatibility.
Regular meetings were held with family members to keep them informed of progress. Nearly everyone’s relatives were regular visitors, with some coming daily. These close ties helped to maintain an open and relaxed atmosphere, and enriched the service users’ lives.
All of the residents now go into the community daily, and those who do not are exercising their choice to stay at home on some days. There are fewer incidents and physical intervention is rare. Engagement, skills building and communication have improved.
A recent Care Inspectorate’s report on Lifeways awarded the service ‘Very Good’ for quality of care and support, leadership and management, and ‘Good’ for quality of staffing. Meanwhile, the Living Ambitions team was highly commended at the BILD positive behaviour support leadership awards for its work with the eight individuals discussed in this article.
Assessing compatibility, building relationships and the process of transition
The property the individuals lived in was not conducive to a harmonious life. People shared accommodation, but could not tolerate each other’s behaviours, which resulted in them causing each other physical and emotional harm. Many incidents were reported, including attacks on staff, and the service users were in a permanent state of agitation, which resulted in frequent aggressive behaviours.
With the prospect of a new service user moving in, it was essential to find a solution that would provide a positive experience for the new resident and ensure a safe environment for all.
The Living Ambitions team began a comprehensive process to assess each person’s behaviour and the particular triggers that caused the outbreaks of aggression and emotional distress. This included assessing any environmental triggers and undertaking scenario planning to address future risks.
Shared positive experiences
It was also important to look at shared positive experiences between the service users to make a judgement on compatibility.
Once established, plans were shared with the multidisciplinary team and care management to seek agreement from the local authority, which was achieved. The care manager organised intervention orders and began processes for guardianship to enable the team to complete the plan.
The next stage was to assess the needs of the new service user who had been identified by the care management team. A preliminary meeting was set up with the new service user (DW) and his key worker at a local day centre. A list of questions was prepared that would enable the team to gather information on communication and behaviours ‘that may challenge’. It was also essential to observe DW from a distance to begin assessing his needs fully. Some of the information provided by care staff conflicted with what the team observed first hand, so a meeting was requested with DW’s mother. DW had lived with his family overseas for decades, so it was crucial to gather as much information as possible because no previous records or assessments existed.
After collating information about DW, the team identified another person (BC) who they felt could be a potential match and so a first meeting was arranged.
DW and BC were picked up by car along with DW’s mother. The meeting went well and a second activity was arranged, this time without DW’s mother, to assess how he would deal with the new relationships on his own. During the activity BC would approach DW to shake his hand and DW began to respond, mirroring his responses. DW also started to build positive relationships with the staff.
The third activity was a trip to the local swimming pool – an interest that was already enjoyed by BC and had been recognised as an area of interest for DW, although he had never been swimming previously. Both men were interacting more with each and the support staff, and it was clear that DW was excited to be joining BC on this third outing.
It was agreed that BC and DW would be a good match, so a support plan and a health action plan were written to support this new relationship.
Nine months after the move, the relationship between BC and DW is still positive, with no incidents of aggression towards each other, very few incidents and no staff injuries. Both men have a core staff team whom they know well, and bespoke timetables and support plans have been created for them.
After the first three months a review of the service was undertaken, followed by a visit from the multidisciplinary team in month four. The turnaround in the service overall has been incredible: the atmosphere has changed and everyone appears to be happier. Service users have structure in their lives and incidents that were previously commonplace have significantly reduced. This could not have been done without a strong and supportive team of staff who are dedicated and prepared to go the extra mile to provide outstanding care and support.
About the author
Simon Jones is a nurse consultant at the independent support provider Lifeways, Moreton-in-Marsh, Gloucestershire