Robert* has Paranoid Schizophrenia and is a service user at Heathcotes Mapperley in Nottingham.
Robert moved to Heathcotes Mapperley after spending time in a hospital setting in the Nottingham area. Robert presented as verbally aggressive and was confrontational with other service users. Robert would lie across doorways, obstructing the path of staff and other service users and he often refused to get dressed. His personal hygiene was poor and he refused to wash regularly.
Staff began by offering Robert one-to-one support with time to calm down after incidents of verbal aggression. Staff utilised NAPPI techniques to redirect and refocus Robert and worked with him to building a strong, trusting relationship and rapport. If Robert became verbally aggressive staff followed NAPPI SMART principles and de-escalation techniques and attempted to engage him in alternative conversations or activities. If Robert obstructed the doorways, staff utilised the NAPPI behavioural scale to redirect him and offered activities to reengage him.
Staff began prompting Robert to take a shower or a bath and discovered that Robert struggled to support himself getting out of the bath. Suction cup grab bars were purchased for Robert and his willingness to bathe regularly improved and Robert now enjoys choosing his own clothing after his shower in the morning.
Robert now enjoys daily community access to local shops, meals out, nature walks and a drink in the local pub! Robert is a lot more independent; he makes his own drinks and snack and sometimes prepares these for the other service users as well as playing an active role in the day to day running of the household. He is developing his money management and budgeting skills and uses the cash machine to withdraw his money for the week. Robert enjoys walking along the river and spending time with animals and he now had his own pet budgie for which he is responsible for taking care of.
Robert is happy and enjoys a good relationship with staff at Heathcotes Mapperley. He continues to develop his skills and looks forward to the future.
Sam* has a Learning Disability, Autism, Epilepsy and associated Challenging Behaviour and is a service user at Heathcotes Sawley in Long Eaton.
Sam arrived at Heathcotes Sawley with five escorts after his previous placement had broken down and immediately attempted to assault other service users. He was agitated and staff identified that ‘No’ was a trigger word for him. He refused to engage with staff and would only accept meals if he ate alone. Due to the challenges Sam presented with, his activities had been limited to two short walks per day. Sam had spent a number of years in a hospital setting and was assessed as a risk to himself through his extreme challenging behaviour and his deliberate self-harm including banging his head against walls and windows, hitting and kicking himself. Sam’s Epilepsy had a severe impact on his daily life; he was experiencing a lot of seizures and rescue medication was required up to three times daily.
A referral was made to a Consultant Neurologist who reviewed Sam’s medication which led to a rapid improvement in his seizure activity and rescue medication is now only required approximately once per month.
Shortly after Sam moved in to Heathcotes Sawley, staff completed intensive interaction training to help them communicate more effectively with Sam in order to start building a rapport with him. All staff are trained in Non Abusive Psychological and Psychical Interventions (NAPPI); techniques which have been instrumental in managing Sam’s very challenging and unpredictable behaviour. Staff used NAPPI techniques to stay one step ahead and take a proactive, consistent approach to identify triggers and stress factors for Sam, allowing them to reduce the impact of any challenges presented.
Sam responded positively to having a consistent approach and developed a good relationship with staff at the service. Staff really understand Sam and his needs well and how to support him effectively. The staff team have also worked to develop a strong working relationship with the local community multidisciplinary team who take an active role in supporting Sam.
Sam now eats with other service users and enjoys a wide range of activities including shopping for new clothes! Sam has visited the seaside several times this year and recently visited West Midlands Safari Park to celebrate his birthday. He enjoys going on holiday and will be going to Blackpool this year where he plans to go Go-Karting. Sam accesses the community every day; he enjoys walking and going out in the unit vehicle and he is now learning how to make the most of public transport.
Sam is a lot more independent; all service users at Heathcotes Sawley are encouraged to get involved with the day to day running on the household and Sam is able to make a hot drink, do his own laundry, wash the dishes and vacuum his own bedroom and the communal areas of the house.
Sam is happy and optimistic about his future. He is working towards becoming even more independent and the team at Heathcotes Sawley are working with Sam’s family to identify the next step as soon as he is ready.
Michael* has a learning disability and epilepsy and is currently a service user at Heathcotes Blackburn.
Prior to Heathcotes Blackburn, Michael had spent long periods of time in a hospital setting. He was very reliant on staff for most of his activities of daily living including preparing and serving meals and household chores and keeping his bedroom clean and tidy. Michael was very withdrawn and had become more and more reluctant to socialise in the local community. Michael was also exhibiting challenging behaviour, both physically and verbally, and would make threats to staff and peers.
To begin with, the team utilised NAPPI techniques to identify the root cause of the challenging behaviour. Using the NAPPI red and green scales, Michael and his team identified his behaviour triggers and also the positive influences on Michael’s life that can help prevent the triggers that ultimately lead to challenging behaviour. The scales helped staff to understand Michael’s needs and ensure everyone is agreement in how to work with him. Once triggers and positive influences were identified, staff supported Michael to find a solution to any concerns, improving his confidence in himself and encouraging him to be more independent. Michael soon felt confident enough to express himself verbally rather than physically. He will now ask to sit and talk with a familiar member of staff and use talk time to work out solutions to anything that is bothering him.
Staff then supported Michael to develop his independent living skills, encouraging him to help out with household chores such as vacuuming, window cleaning and kitchen duties, all of which will help him when he leaves Heathcotes Blackburn. Michael went on a step further and started to prepare and cook his own meals and began to look for new recipes he would like to try. Michael now plans out the weekly menu and purchases the weekly shopping for the service. Staff supported him to be aware of a healthy diet and he has become very good at finding healthy alternatives to the more unhealthy options.
Staff then worked with Michael to improve his integration into the local community. Michael chose some social groups that he was interested in attending, one of which was the Gateway Social Club disco. Michael helped out at Gateway, collecting glasses and returning them to the bar and he has made a close friend via the event who he now enjoys cooking his new recipes for! Michael has further developed his confidence in socialising again and joined a local music group where he plays instruments enjoys taking part in karaoke. His rendition of ‘Sweet Caroline’ always gets other group members up on their feet dancing!
Michael is a popular and valued member of his local community. He now volunteers at the British Heart Foundation furniture store three times per week where he helps out at the till and helps customers with their purchases.
Staff continued to develop the positive working relationship they had developed with Michael and supported him to get involved with his care planning. Michael will now use the computer to formulate his activity plan; he is especially fond of using photographs of him doing his favourite activities in the planning stage as they remind him of the things he has achieved and how far he has come.
Recently, Michael decided he would like to decorate his bedroom. He chose a new colour scheme, furniture and decorative accessories and takes a great deal of pride in his handy work, especially his Blackburn Rovers canvas. Michael has been lucky enough to meet all the players and cherishes his signed shirt.
Staff have supported Michael to maintain a good relationship with his two sisters and with whom he enjoys a weekly family dinner. He invites his friends made it the various social clubs to dinner at Heathcotes Blackburn and is very happy with his social life.
Michael continues to make progress and everyone at Heathcotes Blackburn is proud of the steps he has made toward more independent living. He has recently requested training in health and safety so he can join the Health and Safety Committee at Heathcotes Blackburn and he has also expressed an interest in a first aid training course.
Michael has developed very good independent living skills at Heathcotes Blackburn which will provide him with a solid foundation for a sustainable future placement. He leads a happy and fulfilled life and is optimistic about his future.
Joe* has a Learning Disability, Bipolar Disorder and Asperger’s Syndrome and is currently a service user at Heathcotes Norton in Sheffield.
Joe was transferred to Heathcotes Norton from a local hospital ward after having spent a significant period of time there. He was very unsettled on arrival and found the unfamiliar surroundings difficult. Staff had worked with Joe during the transition period but he was not used to being in a community environment and he refused to engage. He began to isolate himself from his peers and staff members and would spend the majority of his time alone in the garden or sitting in the quiet lounge.
When Joe did interact with staff and other service users, he was often verbally aggressive and sometimes physically aggressive. Staff used re-direction techniques and change of face and environment to support Joe during periods of aggression and over time, staff built up a trusting relationship with Joe. Staff provided Joe with reassurance about his new environment and encouraged him to identify new interests that he could pursue at Heathcotes Norton. Joe chose to take up gardening in the large garden at Heathcotes Norton and identified a public house that he would like to visit!
Staff implemented a structured routine to help support Joe and encourage him to plan his own activities and meals to help him to take control of his daily life and become more independent. He is fully involved in the regular service user meetings and has been shopping on several occasions to purchase household items for the service. Joe is now an active member of the local community and enjoys interacting with others, both within the service and the local neighbours. He enjoys regular visits to the park, pubs and restaurants, shopping centres and local attractions.
Staff have supported to Joe to develop his independent living skills; he is able to do his own laundry and maintain his personal hygiene. He ensures his own bedroom is clean and tidy and he helps with preparing meals and cleaning the kitchen.
Staff have worked with Joe to maintain links with his family; they come to visit him every week and enjoys going out with them. The team at Heathcotes Norton are working closely with Joe’s family to introduce home visits; all parties understand that this may take some time but everyone is committed to this goal.
Joe is now able to communicate what he does and doesn’t want to do and as a result, the incidents of challenging behaviour have reduced massively.
Joe’s Social Worker at Rotherham, Doncaster and South Yorkshire NHS Trust is extremely pleased with the progress Joe has made at Heathcotes Norton and said:
“Joe’s transition from the hsopital ward to Heathcotes Norton was well planned. Risk management and care plans were in place and his introduction to the service went better than anyone could have expected given the complexity of this gentleman. His parents have reported an excellent transition; they feel comfortable raising any concerns and are happy with the service.
I have visited the service myself and have seen photographs of Joe doing the washing up which he has not done for years. I am astounded and have shared the photograph with my colleagues within the multidisciplinary team, all of whom are very pleased. Joe’s outlook looked very bleak at one point; he had lost 50% of his body weight and he was very depressed. So many people have contributed to his recovery and Joe’s progress is a very satisfying outcome for everyone from Dieticians, Occupational Therapists and GPSs to Psychiatrist, ward staff, advocates and of course, Heathcotes. When something goes wrong with someone’s placement, we are made aware quickly and clearly. What we don’t often do is share the good stuff and this is good stuff!”