Case study – Interventions and Using the HEF to inform care planning

Abasi – Referred to our team because of physical aggression towards staff at his

residential home

Had been arrested twice for assault and was at risk of being imprisoned. Consideration of medical disposal of case

Had also been arrested multiple times for shoplifting – both planned and impulsive

Issue with hoarding in his bedroom which was spreading to the rest of the home

No ‘meaningful’ occupation’

At risk of eviction

Difficult staff attitude towards him

WHAT WOULD YOU DO?

What do you think the health inequalities are?

Which area(s) would you address first?

Which professionals would you involve?

INITIAL HEF Clear focus to the work that needed to be done –

Placement at risk of breakdown Highly restricted activity and engagement Not registered with a GP No recent health check carried out No individual communication plan in place

WHAT DID WE DO? Initial work –

Nursing assessment History-taking with family and from LA and

health notes Weekly meetings with staff Twice-weekly meetings with Abasi, arranged by

him Referred to SLT and social work Worked with psychiatry to complete a DISCO

assessment for autism AP completed a WAIS

INTERVENTIONSCommunication:• Worked with a speech and language therapist to assess

communication skills and put clear guidelines for support staff in place

• Used written communication for Abasi as knew he enjoyed reading and had slow verbal processing speed

• Rest of our work would have been very difficult without this intervention

• Started to use social stories to explain consequences of actions e.g. effect of shoplifting on shop-keeper

• Outcome:• Increased engagement with staff• Participating in activities such as cooking and watching

DVDs• Allowing staff to accompany him out of the home• Reduction in physical aggression – no incidences since

moved placement in November 2012

Genetic and biological:Not registered with a GP. No recent health check or

health screening carried out.• Communicating with Abasi in a way that he understood and

responded to meant we were able to encourage him to register with a GP and have a health screening

• Psychiatrist had referred Abasi for an EEG but he had refused

• Using social stories and explanations using clear words and pictures helped us encourage Abasi to attend

• Outcome• Diagnosed with epilepsy in the fronto-temporal lobe. Now has

an appointment at local neurology clinic to consider treatment plan

• Epilepsy may be affecting his emotional regulation and impulse control – investigating whether this has bearing on the incidents of physical aggression

• Now having appropriate health screening and checks

SocialRestricted activities

• Used work started by OT and communication plans to discuss options for activities with Abasi

• Spoke to his family about past activities and why they thought that he had stopped

• Learnt about Abasi’s collections, instead of penalising him because of them

• Asked staff to follow their own timetable but not to share this with Abasi. Liked novel things.

• Set area in bedroom and shed and time aside for papers and magazines. Protected time to enjoy this. Staff shared in this with him

• Outcome Abasi has enrolled at college – found out that he left due to

difficulties with keeping up and over-estimation of ability. SLT input arranged at new college

Still ‘collects’ things but has cleared the shed and no longer spends most of his time in there

Shares this with staff rather than hiding it

Service quality

Difficulties with staff understanding Abasi’s levels of understanding and difficulties with social interaction. Difficulties with CJS (police, courts and duty solicitors)

Fedback assessment report to staff, with Abasi present. Focussed on positives but also discussed difficulties that Abasi had Met with manager and staff weekly to discuss how things were

working After two months decided to look for alternative placement for Abasi Met with British Transport Police, with Abasi’s consent, to discuss his

case and explain how we were working with him Arranged a planned arrest Attended court to explain our role Worked with a duty solicitor and she became Abasi’s solicitor

Outcome Started again with new staff team, involved Abasi and his mum in

training sessions Living in a more ‘able’ environment Increased interaction with staff and other people at the home Abasi’s solicitor works with staff at the home to ensure he attends

court and manages his fines BTP put an alert on their system for a need for an appropriate adult

Behaviours Have reduced as a consequence of the other actions Behaviour score deals with personal behaviours – his

behaviours were more to do with his social and service quality