Last week, we shared a story about how our newest Assistant Director, Ziki Gwatiringa, is working to implement Positive Behaviour Support (PBS) throughout Outward. This week, we’re sharing some of the incredible results PBS approaches are producing with the people we support at one of our services.
Opened in 2020, Anthony Kendall House (AKH) is one of Outward’s newest supported living services. The service is based in Hackney and consists of five self-contained flats for people who have a learning disability or autism and need specialist support to minimise behaviours of concern.
The team at AKH has been working with Clinical Psychologist Dr Steven Carnaby on a monthly basis to help implement PBS strategies.
The most notable success using PBS for AKH has been with Sara (not her real name), a young woman who moved to the service earlier this year. To develop a PBS plan for Sara, the team gathered as much information about her as possible by talking with the important people in her life and observing her likes and dislikes.
“It’s a combination of lots of information from external stakeholders and observations .We did a functional behaviour assessment with an aim of trying to understand the form and function of her behaviours.”
As a young woman living away from home for the first time, the transition to supported living accommodation was difficult for both Sara and her family. At that time, the biggest challenge facing Sara was her diet. For most of her life, Sara had refused to eat and relied upon nutritional supplements, but by working in partnership with our health colleagues and taking on a holistic multidisciplinary team approach, AKH staff began to make progress.
“We noticed that Sara never refused liquids. We said, ‘why not make some soups and put them in her usual cup to drink?’”
This was a success and Sara began to accept soup. Gradually, the team encouraged her to try softer foods, which they spoon fed to her, before finally encouraging her to feed herself and eat solid foods.
“Sara doesn’t like change, so we progressed at her pace, being led by how she is coping with the changes. We had bad days but the team were really now invested and excited about how Sara was beginning to live as normal a life as possible.”
This progress was evidence that Sara could do anything with the right support and by enabling positive risk. The team was proud that after a few months of dedication, patience, partnership working, and promoting choice and control, they were finally arrived in a position where Sara feeds herself three meals a day. She now has a balanced diet with a range of foods that she helps to choose through meal planning and shopping. Sara no longer relies upon any supplements.
The progress had not only impacted Sara’s wellbeing, but also that of everyone around her. Sara’s mother no longer worries about her daughter’s health and dietary intake. The
staff team have also really found this process rewarding professionally and personally.
While the team will maintain this standard for Sara, the sky is the limit with PBS. The aim for teams and individuals who are willing to contribute to their own wellbeing and the wellbeing of others is to continue making progress.
The team now explores different tastes and flavours with Sara. They discovered that Sara loves watermelon and added it to her shopping list.
“We’re still exploring [her favourite foods]. We all come from different backgrounds and London is a multicultural society, so it is good for her to discover tastes and cuisines from all over the world taking into considerations of any allergies, religious and cultural needs,” said Evi Michalaki, AKH’s team manager.
AKH have also been successful in supporting Sara to start taking the bus around London. Before introducing PBS, the team were hesitant to take Sara on the bus because they were aware that children could trigger behaviours of concern, despite the fact she loves the sensory stimulus of the vehicle’s movement. The team decided to try taking Sara on the bus and, after learning from incidents and tweaking their support, Sara now has a freedom pass and uses the buses regularly.
Evi said, “We got her a freedom pass. Now, if she wants to take the bus, she sits at the bus stop outside the service to let us know… She has more control of her life. She has more choice and control. Because of her behaviours, people were scared to try things with her. The less choices and the less control she had over her life, the more behaviours of concern she presented. If you give somebody more choice and control, you these behaviours are reduced. That’s the whole idea behind PBS.”
Sara no longer sits in her room all day watching music videos. She goes out twice a day to parks, explores London, and does more activities at home, including housework, laundry, and cooking.
Evi also highlighted that implementing PBS had been deeply rewarding for her team and useful in all aspects of her role.
“The progress is what keeps the team together. Working as a support worker 1:1 is an isolating job – the things you do aren’t obvious to others. People don’t always appreciate this work in our society. But it’s significant to improve somebody else’s life. That is motivation to continue to do a good job. These outcomes are the best payment a person can have.”
“I have a great team. [PBS] is a team effort and everyone takes initiative and spends time communicating with each other, giving feedback and information. This communication makes the job easier and better for the people we support.”
“PBS is not only for people with autism or learning disabilities… I use PBS for parents, for staff. It is not only about the people we support but everyone. We all have our skills, weakness, and communication needs.”