11 minute read
EXCEEDING EXPECTATIONS
How positive behaviour support can deliver life-changing outcomes
Mark Henry, head of behavioural support and mental health at Exemplar Health Care, discusses how bespoke interventions can enable people who display behaviours of concern to thrive, and shares the stories of three service users who have been supported by its specialist team to achieve this
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Where people have complex health conditions, this can result in behaviours which can make safely caring for them a challenge. While many people who display behaviours of concern are able to live in ‘mainstream’ residential homes or supported living, others thrive in care homes that specialise in care for people with these complex behaviours.
Behaviours of concern can have a range of causes, often involving damage to the brain or a mental health condition. People can experience such behaviours due to: • dementia • a brain injury, such as from trauma, or medical insult to the brain such as a tumour, haemorrhage or infection • a disability the person was born with, or genetic conditions • stroke.
At Exemplar Health Care, the people we support usually display behaviours which have made it difficult for them to interact with others safely or effectively, such as physical or verbal aggression or offensive language. Many of them have been deemed to have behaviours that are considered ‘too complex’ for mainstream nursing and care services. Our community-based homes and OneCare services provide person-centred care and rehabilitation that focuses on maximising independence, building everyday living skills and empowering people to live their best lives. Through our specialist care, many people are able to find new coping strategies and learn skills to manage their feelings. Our approach to behaviour support focuses on how we can prevent the need for restrictive practices and reduce the frequency and intensity of behaviours of concern, so that people can live a fulfilling life and integrate with society without their behaviour restricting what they can do. Our trained teams work with individuals to understand the reasons for their behaviour, to learn the skills to manage their own behaviour, to identify, remove and reduce any trigger factors and implement strategies to reduce the frequency, duration and impact of incidents of behaviours of concern. We look at psychological methods of distraction and diversion before other methods are considered. Our care homes have high staffing levels which enable us to work at people’s own pace and build trust. Our homes also have in-house Activities and Life Skills Teams that support people to take part in everyday activities that are meaningful to them, which helps to reduce feelings of frustration for people who display behaviours of concern. All of our care and nursing colleagues complete our Exemplar Positive Behaviour Support (EPBS) training which has been certificated by the British Institute for Learning Disabilities Association of Certified Trainers (Bild ACT). This confirms that the learning meets the Restraint Reduction Network (RRN) Training Standards 2019. The certificated EPBS training includes up to five days of learning – two of which cover PBS theory, psychological support, self-protection skills and break away techniques, and up to three days of level two training which covers restrictive practices. The training provides colleagues with the skills and knowledge to protect people’s fundamental human rights and promote person-centred, best interest and therapeutic approaches to supporting people when they’re distressed. We also have a central team of Mental Health and Behaviour Support Specialists who support our colleagues and service users who display behaviours of concern, including crisis or rapid intervention when a person’s behaviour is escalating. The team is made up of Behaviour Support Specialists who take the time to observe the individual, understand the reasons for their behaviour and suggest strategies to reduce distress or discomfort which might be causing the behaviour. Through dedicated, bespoke support, our team - working closely with our service users - are able to deliver outcomes that truly change lives.
Wayne lives with central pontine myelinolysis (CPM), a neurological condition that happens in the pons area of the brain. When he moved to Dearnevale in 2016, he was told he only had 12 weeks to live. When Wayne first moved to Dearnevale, his behaviours of concern were due in large part to the frustration of his situation and very short life expectancy. Our high staffing levels have enabled Wayne to progress at his own pace and build trust with the Care Team, developing strategies to recognise when he’s experiencing anxiety, and to manage these symptoms before they escalate. Over the past few years, the number and duration of incidents of behaviours of concern have reduced dramatically.
Rebuilding mobility
When Wayne first moved to Dearnevale, he was at high risk of falls and received one-to-one support to mobilise safely. Regular sessions with the in-house Physiotherapy Team have supported Wayne to stand and improve spasticity in his hands and arms. He’s now able to make small movements independently, such as turning in bed and lifting his legs when getting dressed.
In 2018, John experienced a thin acute subdural hematoma and contusion following a fall. This led to an acquired brain injury, dysphasia, poor short-term memory, epilepsy, poor vision and Bell’s palsy. Before John experienced his injury, he owned a building business and worked seven days a week - his only rest time was Sunday afternoon when he went to the local working men’s club for a rest and a pint. John’s spare time was spent with his young daughter or playing football. He coached the local pub football team. The team at Dearnevale has helped John to develop strategies to recognise when he’s experiencing periods of agitation that could escalate to behaviours of concern. He can now vocalise when he is feeling this way, and recognises when he is about to experience seizure activity. Our high staffing levels enable John to progress at his own pace and build trust with the Care Team. During his time at Dearnevale, the number and duration of incidents of behaviours of concern have reduced dramatically.
Improving nutrition
Wayne has received input from Dieticians to support him to eat orally again. He’s had his PEG feeding tube removed and is able to eat and drink thickened fluids orally. Wayne only uses his PEG for top ups. Wayne has also been supported by Speech and Language Therapists to enable his speech again, which has supported his independence and reduced feelings of frustration.
Getting a passion for life back
Wayne prefers spending time on his own, which staff respect. He enjoys supporting Liverpool FC and watching other sports such as snooker and tennis. He occasionally joins in group activities – especially when karaoke is on! Wayne enjoys a good relationship with family, and now sees them more than he ever did. He has a wicked sense of humour and wants to write a joke book to send to all Exemplar Health Care homes and spread some laughter.
Over the past few years, John has enjoyed sessions with the in-house Physiotherapy Team to build his body strength and range of movement. Now, he enjoys walking in the local community with colleagues and goes to football training and plays on a local team. He’s just started jogging with a coach to build his fitness. Being active and staying fit has improved John’s wellbeing and reduced feelings of agitation.
Rebuilding mobility
When John first moved to Dearnevale, he was at high risk of falls and received one-to-one support to allow him to mobilise safely.
Developing life skills
John enjoys regular sessions with the inhouse Life Skills Team at Dearnevale, and has developed his hand and eye co-ordination and enjoys completing the Rubix cube. He asks staff to mix the cube for him and has successfully completed the puzzle 423 times! John has also developed his level of concentration and has begun playing the keyboard, as he did before his injury. He’s completing self-taught lessons that he accesses online, with the aim of performing at the Christmas talent show. With the support of the team, John has begun preparing his own meals in the therapy kitchen. He loves helping out in any way he can, and volunteers to clean the therapy kitchen and hoover the training every Monday.
Meet Karen, resident at Tyne Grange care home in Newcastle upon Tyne
Karen had a spinal cord injury eight years ago which resulted in quadriplegia. She also has a personality disorder and displays behaviours of concern. Karen moved to Tyne Grange in 2020. She has complex needs in terms of her physical condition, and displays behaviours of concern with regular selfharm and emotional dysregulation. Karen has had many previous placements that have broken down, mainly due to the complex behaviours of concern that she displays. With 1:1 support from our Care Team, and input from the Therapy Team at Tyne Grange, Karen now enjoys a good quality of life.
Physiotherapy
Karen has a session with the home’s in-house Physiotherapist twice per week. These sessions have improved her upper body and hand dexterity, strength and range of movement in her legs and her transfer and mobility practice. Karen’s movement has improved significantly and she has progressed from requiring a full hoist to using a stand aid to being able to walk using a walking frame. She's achieved 54 metres of independent walking with a walking frame. We’ve set a goal for her to be able to walk across the Millennium Bridge from Newcastle to Gateshead independently.
Occupational therapy
Karen works on preparing food and baking, increasing independence with personal care, accessing the community, building self-esteem and managing her emotions through sensory/ self-soothing work. Karen really enjoys her time spent accessing the community. Her goal is to find a local class to start a new hobby and meet other people.
Behavioural support
Our high staffing levels have enabled Karen to progress at her own pace and build trust with the Care Team. This has reduced the number of instances of behaviours of concern. Her selfharming behaviours have dramatically decreased. Karen’s built a great rapport with the staff at Tyne Grange who have got to know her well and have learned how to manage her emotional needs. Karen has also explored a variety of activities and interests. She loves doing arts and crafts, going shopping, making friends and is the home’s Service User Ambassador.
Wiltshire Farm Foods and The BDA Collaborate On ‘Ready, Steady, Blend’ Challenge to Raise Awareness of MDT Approach
For those living with swallowing difficulties, there are several considerations and challenges that can arise when cooking nutritious meals to the correct texture. To demonstrate these, Wiltshire Farm Foods and the British Dietetic Association (BDA) have combined forces to produce a video that launched during Dietitians Week. The aim of the video is to raise awareness of the practical implications of dysphagia, and to ensure that healthcare professionals (HCPs) – particularly Speech and Language Therapists (SLTs) and Dietitians – have takeaways they can then put into practice. Since the adoption of the IDDSI (International Dysphagia Diet Standardisation Initiative) framework by the BDA and RCSLT in 2019, there has been significant focus put on helping HCPs understand descriptors and how each texture can be achieved in a health or care setting. However, there has been less emphasis placed on supporting those with swallowing difficulties at home. The BDA and Wiltshire Farm Foods together recognised there was an opportunity to further explore this topic, with this ‘Ready, Steady, Blend’ exercise resulting from the collaboration. The ready meal provider challenged SLT Lindsey Collins and Dietitians Laura Clarke and Alison Smith to create a Level 4 puréed meal from a Wiltshire Farm Foods Roast Beef Dinner. During the ‘Ready, Steady, Blend’ practical session, the HCPs were given blenders, thickeners and various cooking utensils to ensure the meal was the correct consistency to meet IDDSI Level 4 guidance. The IDDSI framework provides a common terminology to describe the characteristics and consistencies of various texturemodified foods and drinks. Specialist meal providers, such as Wiltshire Farm Foods, have expertise in supplying meals developed in alignment with IDDSI guidance; these are always designed with dietetic input, to ensure the needs of more nutritionally vulnerable service users are met. Clinical Specialist SLT, Dr Lindsey Collins, was invited to discuss the diagnostic phase of dysphagia, also stressing the importance of collaboration between HCPs in the video: “It’s about recognising what we know and what we don’t know. SLTs have our specialist knowledge, as do Dietitians. It’s really important to not assume that the other already knows something. We’re not the final say on our service user’s eating and drinking needs, and it’s about working together as a MDT. Discussion and ultimately, collaboration, is key.” Resulting discussion amongst the HCPs demonstrated the learnings taken from the challenge and, moving forward, how consultations with those with dysphagia could be improved to achieve more open dialogue, safer outcomes, and better access to a wider range of appetising and nutritious meals. The video launched during Dietitians Week (20th – 24th June) and is available to view on the BDA’s website. In the spirit of collaboration, Wiltshire Farm Foods is also encouraging HCPs to attempt their own ‘Ready, Steady, Blend’ challenge at home and share the images across their social channels.
To watch the video, visit: specialistnutrition.com/blog.
