1. Community of Practice A Case Study ‘BOB’

2. Pen Picture: Background  Bob is a 34 year old gentleman, with a Moderate Learning Disability, Autism, Complex Challenging Behaviour, Associated Communication Impairment & Health Difficulties.  Challenging Behaviours: Self Injurious Behaviour, Environmental Damage, Physical Aggression, Loud Vocalisation, Stripping / Ripping of Clothes.  Health Issues: Type ll Diabetes & Hypertension, Morbid Obesity, Cellulitus  Resided with his parents at the family home which had been specially adapted to meet his needs. History of Exclusion from traditional Services. Receiving Specialist Day Service provision.  Significant escalation of behaviour. Crisis situation. Hospital Admission. Alternative Accommodation & Support deemed necessary.

3. Rationale for Referral  Decline in physical & mental well being  Escalation of target behaviour presented  Significant risk of injury to Bob & others  Exclusion / Restricted access to community settings & transport  Specialist service provision required.  Crisis admission likely.  Avoid Out of County Placement.

4. Following Referral to Perthyn  Pre placement Assessment Report Completed.  Panel Meeting Held  Placement at Assessment & Transition Unit offered.  Transitional Plan Implemented  Positive Behaviour Support Plan developed

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

6. Getting the Environment Right As a result of Bob’s ‘testing’ of the durability of his environment:  Identified a Safe Area / Low stimulus environment  Created highly structured & predictable environment  Developed a series of routines  Identified a core team  Created environment conducive to manage target behaviour (film windows / rounded corners / reinforced doors / boxed toilet facilities / adapted shower facilities / fitted concealment of all pipes / secured / removed furniture)  Purchased specialist furniture (bed & bedding)  Liaison with Care Standards (minimal furniture requirements / removal of wash hand basin).  Restricted access to high risk areas.  Locked doors / secured grounds  Robust policy & procedures

7. Positive Behaviour Support Plan  Primary Preventions (Highly Structured Daily Routines / Environmental Considerations / Interactional Profile)  Positive Interventions (Skill & Competency Development focusing on Activity Scheduling & Communication)  Therapeutic Interventions (Medication)  Behaviour Response Plan (Inclusive of a medical risk assessment re: contraindications in liaison with other health professionals)

8. Risk Management Risk Assessment & Risk Management Guidelines developed in relation to: Risk Assessment & Risk Management Guidelines developed in relation to:  General Environment: In specific relation to the potential for extensive damage to property.  Observation & Support: Due to the nature of behaviour & associated risks to Bob & Others.  Transport: Due to high risks posed resulting from target behaviour and damage to vehicles  Access to the Community: Due to risk of injury inc. of members of the public & property damage

9. Multi Disciplinary Team: Collaborative Working  Care Manager / Case Co ordinator  Psychiatry  Dietician  S.A.L.T.  O.T.  Physio Therapist  GP / Diabetic Nursing Team  Positive Behaviour Intervention Service  Perthyn Positive Behaviour Support Service  MDT quarterly review meetings inc Bob & his family

10. Assessment Since Admission  Behavioural Assessment (Functional Analysis, Adaptive Behaviour Scale, Aberrant Behaviour Checklist, Motivation Assessment Scale, Sensory Profile)  SALT Communication Assessment - Communication Board.  OT Sensory Integration Assessment - Sensory Box.  Physiotherapy Assessment – Unsteady Gait / Adaptive Footwear  Health Assessment & Health Action Plan  Skill Assessment – Competency Development

11. Where are we now?  Augmentative communication systems established: making choices & less reliant on his behaviour to make his needs known.  Significant reductions in incidents of target behaviour.  Significant reductions in prescribed medication  Expanding activities in house and in the community: Inclusive of cooking sessions / access to the kitchen.  Increased community presence, regular activities / venues and external relationships with others.  Ongoing monitoring / support with health monitoring / diet  Appropriate Family Liaison / Support Networks  MDT liaison / regular review / family in attendance  Regular review and update of Positive Behaviour Support Plan & Risk Assessments

12. Augmented Communication System

13. Activity Schedule TimeMondayTuesdayWedThursdayFridaySaturdaySunday AMReading Trip Out Make Lunch Skittles Art & Craft Photo Session Music Session AM Ball Games Art & Craft Trip Out Cooking Session Sensory Time Trip Out Local Walk PM Trip Out Sensory Time Picnic Reading Session Trip Out Lunch Out Family Time PM Photo Session Music Session Sensory Session Music Session Photo Session Music Session Family Time

14. Historical Comparison of Incidents

15. Any Questions?