Why “restraint reduction” won’t work

Physical restraint has rightly been getting a lot of attention in recent years. Since the BBC Panorama programme on Winterbourne View in 2011 there has been an increased attention towards abusive practices. There are risks that physical interventions can be misapplied and used abusively. There are also significant risks of harm to people who experience physical restraint, such as death from positional asphyxiation, physical injuries and trauma. 

This has led to a welcomed increased level of recording of physical interventions, which in turn is giving greater insight into how much physical interventions are being used in health and social care. The increased recording may potentially be giving a false impression that the use of restraint is increasing. However, the data continues to highlight this is an important area of health and social care that demands further attention.

Physical interventions and restraint is a highly emotive topic. It is easy to form very polarised views on the topic. This can lead to views such as “all physical interventions are bad” or “people who use physical interventions are abusive”. This polarisation can make it difficult to have sensible conversations on this hugely important issue.

Largely in response to the increased negative attention and the public disapproval of physical restraint the terms “restraint reduction”, “restraint elimination”, and “least restrictive” have gained support and increased usage. These are premise setting statements that no one would disagree with. However, as their usage has increased, I feel some of the practicalities of their application requires thought.

This blog is intended to encourage conversation on this difficult topic and challenge thinking. It is in no way intended to promote the use of physical restraint. I have never met anyone that enjoys physically restraining people, and if they do they are in the wrong job. However, there are some situations when there are no alternatives. I strongly support the premise of “restraint reduction”, but I intend to explain here why I believe that having the focus on reducing restraint will not be successful in achieving it and encourage sensible discussions on this further. I state further for clarity, this blog is not against the “restraint reduction” work that is making excellent progress, but aims to provide supportive considerations to help further progress work in this challenging area.

“Restraint reduction” implies “all restraint is bad”.

Physical restraint is usually used when people are extremely distressed. If physical restraint is not used then the person could be at risk of harming themselves or others. People come to work in social care because they are caring and want to make a difference. The negativity associated with physical interventions can lead to people feeling they are bad people for having to do these essential actions that they are doing in a caring way. It can make people think they have done things wrong, when they have done their best in that moment. This risks driving the caring people we want to attract into health and social care away, or drive these practices underground and make them more hidden. We need an open culture that acknowledges sometimes restraint is necessary.

Most of the time physical restraint is applied in a caring way and those applying the restraint are wanting to support the person during their highest point of distress. Physical restraint is the end point of a line of physical supports where the use of physical touch can be supportive. Applying the notion that “all restraint is bad” leads us away from sensible discussions that sometimes restraint is necessary and can be supportive.

What is “least restrictive” for you may be “most restrictive” for me.

Everyone is different, and there is no global hierarchy of what restraint is least restrictive. Some people may find physical contact extremely aversive, whilst others find physical contact comforting. I have supported people who will intentionally prompt being physically restrained in order to achieve the sensory feedback they achieve from this. I have also seen people who have needed 4:1 support due to “no touch” policies where physical support could have meant the person would be safe with 1 or 2 supporting. Is being supported by 4 people less restrictive than being supported by 1 person who can use physical restraint? Is physical restraint less restrictive than chemical restraint, mechanical restraint, or environmental restraint? Each person is different and will find different restraints more/less aversive than someone else. The only person who can really say what is “least restrictive” is the person receiving the restrictions.

For some people we support there can be risks to going out and trying new things. Sometimes, teaching teams in safe, respectful, physical interventions can give teams the courage and confidence to support people to go out and try new things. If the risk is that the person supported could do something that harms themselves or others and the team has no methods of supporting the person when these risks occur then the likelihood is that teams will take fewer positive risks. So the least restrictive option of not providing physical interventions can ultimately be more restrictive if it means people do not go out.

“Least restrictive” can sometimes be “least effective”.

There may be times when direct support is supporting someone in distress and a punch is heading their way and there is no alternative to physically holding someone. There is not time in situations like this to pull out a list of alternative things to try to do instead.

There is also the fable of “how to boil a frog”. The notion here is that if you put a frog in cold water and gently increase the temperature the frog will stay there, compared to if you expose a frog to boiling water it will jump out – please do not try this at home it is a fable and you should never try to boil a frog! However, the same notion here can be true for least restrictive approaches. Least restrictive methods may at times lead to events lasting for longer periods with the restrictions gradually increasing over time and may lead to situations where the end point is more restrictive than would have been if a more restrictive intervention was used to promptly and safely end the situation earlier. Least restrictive may at times therefore mean longer lasting, more distressing, and in the end more restrictive. 

We should look to “replace” not “reduce”

We have learned from Positive Behaviour Support that if our only focus is on reducing behaviours then we miss the function of these behaviours. As a result, if you stop the behaviour you are focussing on then it is likely new behaviours will appear to meet these functions instead as the need has not been met. These new behaviours can be more challenging than the ones that were happening before. 

If we treat physical interventions as a challenging behaviour, we know the same will be true. Focusing on reducing restraint will only lead to different, potentially more restrictive, interventions popping up. If we really want to reduce restraint we need to focus on what restraint is used for and we want to replace restraint with.

“Restraint reduction” is not a behaviour.

In Positive Behaviour Support we focus on what people do, not what people don’t do. People not doing things is not a behaviour. It is also very difficult to measure what doesn’t happen. 

I often use the example of instead of saying “don’t walk on the grass” say “walk on the path”. If you say what you don’t want people to do then they do not know what is the positive expectation for them to do instead. If you say what you want people to do they are more likely to do it. 

The position of “restraint reduction” therefore does not fit with what we know from the science of behaviour change. If we know the science works for the people we support, we know it works for the teams that support them too. We should not be taking the position of what we do not want support to do, we should be stating what behaviours we want to see people doing instead. 

Approaches based on reduction, like restraint reduction, are by definition punishment.

The definition of punishment is an approach that reduces the likelihood that behaviour will happen in the future. Therefore, if our approach to restraint is to reduce it we are taking a punishment based approach towards restraint. We know that whilst punishment based approaches work, their effects are not as long standing as reinforcement based interventions and the quality of the outcomes are poorer. We also know that those who experience punishment based interventions can find them aversive. 

Taking a punishment based approach to our teams supporting people sets the wrong conditions for creating cultures that avoid punishment based approaches with the people we support. We should use lessons learnt from Positive Behaviour Support and aim for positive reinforcement based approaches to develop alternative skills as our strategy to reduce restraint, instead of relying on punishment.

Concluding thoughts

I think there is merit in treating restraint like a challenging behaviour.

In Positive Behaviour Support we acknowledge that challenging behaviours challenge us, but they serve an important function for that person right now. We know simply aiming to reduce that behaviour is not the answer for long term change, and we miss our opportunity to understand what the behaviour is for and therefore the opportunity to teach that person new behaviours to replace the ones that challenge us. Teaching more effective behaviours makes challenging behaviours redundant as we empower people with better skills.

Similarly, without doubt, restraint is a challenging behaviour that we all want to reduce. Yet we know from the science of behaviour change that focussing on reduction alone is not the answer. The answer lies in understanding the function of this behaviour and using a multi-systemic approach to enabling teams to respond in alternative ways.

Whilst we should not ever stop our efforts to “reduce restraint” we do need to be able to have sensible conversations that sometimes restraint is necessary. Being able to discuss this will enable good practices to evolve. Driving these discussions underground, or not having these conversations at all, will not ensure there is safe, person centred practices when restraint is needed. 

One final thought. This blog has largely focussed on how the term “restraint reduction” risks us putting our attention in the wrong place to achieve what we all collectively want. From April 2021 CQC will be expecting all providers to be using physical interventions that follow the Restraint Reduction Network standards. These standards are great progress in ensuring that when restraint is used it is done in a way that ensures peoples human rights are maintained and they are used safely. However, the standards are for the training packages. Is measuring training providers packages the right focus to ensure physical restraint is used safely or is our attention in the wrong place here too? My view would be that our focus should be on how those using the interventions are applying them. Purchasing a safe package does not ensure safe use of that package.

#LDWeek19 #ListenToMe Listening to feedback, concerns and complaints – Ask Listen Do

For this years Learning Disability Awareness Week, PBS4 are focussing on how we ensure people with learning disabilities and their families are heard.

We have been fortunate to be stakeholders in NHS England’s Ask Listen Do project. You can find resources from this project here.

The project has come about as too often people with learning disabilities and their families report that they raise things with organisations, but nothing changes, and they are not listened to. This needs to change.

In all industries the phrase “the customer is always right” is commonly used. Why do people with learning disabilities and their families experience that they are not treated in this way? Perhaps it is to do with the by-proxy way that support is commissioned, meaning the customer status is not given to people receiving the support but given to the people who commission the service instead? Maybe because people who need support are not seen as understanding why things have to be done in a certain way because of their learning disability? Perhaps the families of people who need support are seen as “interfering”, or a problem, or that their views aren’t relevant as their child is now an adult? Whatever the reason, it needs to be challenged and the views of people and their families need to be heard.

If feedback is listened to, it prevents it becoming a concern, and if concerns are responded to it prevents it being a complaint. Whatever feedback is received an underpinning principle of Ask Listen Do is that all feedback should be positively received. Organisations should be as pleased to receive a complaint as they are a compliment. If someone is able to tell you what is not working for them you can know what you didn’t know before and you can do something about it.

Simply put, the basic principles of Ask Listen Do are:

Ask – Organisations should actively seek and encourage feedback from people who receive their services, and other relevant stakeholders such as family members.

Listen – When you get feedback it should be welcomed, fully listened to, and investigated if needed.

Do – Organisations should demonstrate what they have done in response to this feedback and show how the feedback is helping their organisation to develop.

PBS4 has recently updated its “feedback, concerns, and complaints policy” to ensure the principles of Ask Listen Do are firmly embedded in what we do. We have shared this with our managers who are in the process of cascading this through their teams. We are just finalising easier read complaints leaflets and information for families on making complaints. These will be shared with all people we support and their families, and will be available on our website by the end of June. We genuinely want to hear about concerns and complaints and we hope that these efforts increase peoples confidence in doing so, and that our desire for feedback is seen throughout the whole organisation.

PBS, ABA, and Neurodiversity

For a few years now, I have been approached on Twitter and other social media platforms by people who describe themselves as Neurodiverse, or #actuallyautistic. For those who have experienced or witnessed these conversations you have probably noticed that communications can be excessive and offensive. If you haven’t experienced this faithmummy’s blog gives a good description here of a parents experience.

From my experience, no matter what I say it is wrong so I have stopped engaging in conversations with them. They have made extraordinary claims about the things I do without actually knowing anything that I do. These have included claims of abuse and maltreatment of people I support that they have absolutely no knowledge of. I refuse to ignore their interactions, as knowing social media if their comments are left unchallenged they only go to reinforce themselves as their followers have similar views and therefore they self maintain this behaviour. I feel leaving their comments unresponded to or unchallenged only increases the likelihood these interactions will increase to vulnerable parents.

I take no offence in their comments as I have confidence in what I do. However, I am aware that not everyone who sees my responses will know the whole conversation, only the latest tweet. Some have misread my responses and do not understand all of the background conversation that has gone on with this. I wanted to attempt to put something here as an explanation about what their key issues are with me and what I feel are the facts behind this.

PBS is ABA in disguise

Their biggest issue by far is that PBS is underpinned by the science of ABA. From their perspective ABA is only early intensive behavioural interventions, and their understanding of this is it is 40 hours per week sat across a desk doing repetitive tasks for a token economy (discrete trial training). They feel this is abusive to autistic people and is an attempt to “cure” their autism. So in their view, if PBS is ABA then ABA is abusive so PBS must be abusive too.

In reality, early intensive behavioural interventions are broader than 40 hours of discrete trial training. It is not an attempt to cure autism, but an approach to build skills and independence and the skills targeted are those that are important to that person. I personally do not believe it to be abusive, but everyone is entitled to their own opinion. The science of ABA is simply the science of behaviour. It underpins early intensive behavioural interventions but it is so much broader than this.

As with any professional field, there will be practitioners out there who are/have misapplied early intensive behavioural interventions. For people who report their experiences as abusive I do not contest their experience and it is awful that this was their experience. We know some foolish services have pedalled this as a “cure” to autism, which is appalling. Equally we know a lot of “PBS services” do not use evidence based PBS with competent practitioners, and the PBS they provide is poor quality. From my perspective, this further strengthens the need for appropriately trained and regulated practitioners so as accountability can be upheld and practice is delivered to a code of conduct. It is not ok for unregulated, poorly qualified people to claim to deliver behavioural interventions, which if misapplied can be harmful. If they are regulated then the regulating body can police abusive practice and prevent it from continuing.

Trying to “cure” my autism is trying to deny who I am

The #actuallyautistic community see their autism as their identity. It is who they are. The notion that anyone is trying to “cure” autism is offensive because it is part of who they are. Aligned to the social model of disability, it is not their autism that is disabling but it is society not being accessible, and attitudes and approaches that are disabling. When a parent says something like “I wish I could take his autism away” this is seen as a direct attack on them and saying they want to eliminate who they are.

We cannot say whether someone else has a disability. It is totally for the person to decide whether they have a disability or not. Similarities can be seen to ex-servicemen who may have lost limbs but would deny that they are disabled. Autism in itself is not a disability. If the person feels that they are unable to do things because of their autism then they may class themselves as having a disability, but many people with autism would not agree their autism is disabling.

ABA is not a cure for autism. Any claims for a “cure” to autism should be sense checked for quackery. PBS uses the science of ABA to understand the function/purpose of behaviour and instead of simply being focussed on reducing behaviours that we find challenging (as some approaches to challenging behaviour do) PBS looks at the function instead and how we can increase skills to meet this purpose in a better way. We are only concerned with adding things to peoples lives, and those things must be important to that person.

We know better than anyone what every autistic person needs

This is possibly the most challenging aspect of the interactions on social media. I have seen parents being told that they know better than their parents what is right for their child as they are autistic and their parents are not.

We know that autism is experienced very differently by everyone who has it. We know that there is not one thing that works for everyone with autism. The lives and the experiences of someone who has an average or high intelligence, who verbally communicates, and has autism will be very different to someone who has a learning disability, communicates in alternative ways to using verbal words, and has autism. If you haven’t lived in their shoes then you cannot claim to speak for them.

The difference extends to the language used. The #actuallyautistic community generally prefer the term “autistic people” as they see their autism as a key part of their identity and see the “people first” movement as disempowering and supporting the view that autism is a problem. The learning disability community in general prefer the “people first” terminology and would use the language “people with autism”. This is to reflect that we see the person before we see their disability and all people should be treated equally. If you see autism as your identity and not a disability then you can see how the people first language can be offensive. Both approaches to language have their pros and cons and ultimately it is for the person to decide what they find respectful and empowering.

In summary

I have been the focus of extensive tweets from the #actuallyautistic community due to promoting quality PBS. This offends them as they see PBS as being the same thing as early intensive behavioural interventions. These interventions are frequently described as ABA, ABA is actually the name of the science that PBS is based on and does not describe any particular approach. ABA is seen as offensive to autism as there have been some foolish services that have tried to pedal ABA as a “cure” to autism. For them, trying to cure autism is trying to take away from them who they are.

This misunderstanding has led to me receiving extensive and accusatory comments, as many other practitioners and parents have received. I don’t think ignoring this is the answer, but there is limited point in attempting to explain the reality as this will not be listened to. On social media you may only see the latest tweet/post and not the whole conversation. It is likely you will see the characteristics of the responses I receive in direct response to this blog. If you see any tweets from anyone that seem out of character keep in mind that you may only be seeing the latest in a long, complex conversation.

Debrief for family’s

By Jen Fookes

Incidents of behaviour that challenge can often leave staff feeling emotional, shocked, stressed and traumatised.

Debriefing systems for the individual and for support staff after an incident can be a valuable process. Offering support, understanding the behaviour and identifying needs. From lessons learnt support interventions and training to increase skills can be put in place to reduce or avoid future episodes. Supporting the wellbeing of staff means less sick leave, burnout and lower staff turnover. And a happier and more confident staff team.

But spare a thought for the families. They possibly will have had years and years of such behaviour.  With no support or training. This can have a significant emotional impact of their mental wellbeing and quality of life. Leaving families feeling vulnerable, isolated and worn down.

As a mother I have been attacked numerous times, knocked out and bones broken. I’ve witnessed my sons potentially life threatening self-injury, unable to do anything for years. Long term stress and anxiety was just a way of life for me, developing my own ways of dealing with it. Alongside this I had to fight to get the appropriate services he deserved.

Recently my son’s new provider offered me my first ever debriefing session. This helped me to destress after an incident. Helped me to organise my thoughts of how I could avoid the incident happening again. But ultimately, I felt – supported and respected as a parent. I was a valuable part of a team, working together to give my son consistency and the support he needs.

Why I am starting a @WeHateSpoons troll account

We all know there are lovers of Applied Behaviour Analysis and haters. Everyone is entitled to their own views and most people can accept some people think differently to them.

Today I have been having a very interesting chat with a twitter account by the name of ABA Controversy UK – @abaukdiscussion It really doesn’t matter what I said it would be replied with anger and challenge.

Their hatred towards ABA is so deep rooted that they have set up a twitter account to facelessly troll anything pro-ABA out there. If there is anything out there anti ABA it is circulated as gospel. Anything pro ABA is hung up as ridicule. Any questions raised responded with anger and hostility and no clear answers when questions to them are made. This gets people who agree with them to reinforce what they say, and avoids negativity from any other perspectives there may be out there so they are self assured they are right. Another good angle taken is to respond to tweets as “we…” so as it looks like a group of people are pressing the keys. Sadly this is the reality for most of us on twitter. We read what people who think the same as us think and therefore are reassured we must be right. If we don’t like what people say we unfollow or block.

To dedicate so much time and effort into shouting down ABA there must be a driver. Some tweets are suggesting that they may have autism themselves. Perhaps they have had personal experience of ABA that they didn’t like. I don’t know. I’ve tried to approach my discussions with them with an open and inquisitive mind but they seem polarised. To be dedicated to something you really believe is one thing, but I’ve never seen being dedicated to a disbelief with such commitment (anyone who is dreaming of starting a “there is no Santa” group right now should be ashamed of themselves)

I get that there are divides – religion, nationality, gender are the common headline ones. We might disagree about which political party we prefer, brexit or remain, BCFC or Villa, Take That or East 17. Whatever it is, there are common divides. The usual standpoint is my thing is better than yours. This account isn’t that, it’s just “your thing is rubbish”. Isn’t that akin to what bullies do? They are arguing against something but what are they arguing for? (I am still waiting for an explanation of how why is different to function)

What makes me really sad about this is that it is a complete extreme view about ABA. It’s not unique to this account but it is very sad.

ABA is nothing more than the science of behaviour. It’s not good, it’s not bad, it’s not right, it’s not wrong, it’s not angelic, it’s not evil. It’s just a way of understanding behaviour. It’s just a thing.

A spoon is just a thing too. Generally spoons do good. They stir your tea, help you eat yoghurt, soup, cereal. You can balance them on your nose. See yourself upside down in them, play music with them. Generally a very useful thing.  Sometimes spoons can be used for evil. If you don’t believe me just ask Richard Gale

Now if you have seriously just wasted 10 minutes of your life watching that as I have you will now understand why I am starting my @WeHateSpoons troll account. If that is my only perspective on spoons then spoons are evil and I want to make sure the world knows about it.

The truth is the spoon isn’t evil. There might be some people who use spoons to do evil things. But there are plenty of people out there who use spoons for good every day.

ABA is no different. ABA is just a thing. Yep you can find examples of people doing bad things with ABA. Yep some people might disagree with Some ABA approaches and they are entitled to that view. But ABA is much bigger than these things. It is all around us. It is behind every advertising campaign, underpinning what every teacher does in school, every parent does raising their child. There is use in mental health treatments, addiction therapy, pet training, organisation management, it’s behind the healthy eating programmes in all schools now and underpins recycling and green policy initiatives. There are many different interventions that are either solely underpinned by ABA or ABA is key to its working – Positive Behaviour Support, Cognitive Behaviour Therapy, Acceptance and Commitment Therapy, Organisational Behaviour Management, dialectical behaviour therapy and so on.

I’m not denying people have had bad experience of ABA. I’m not saying that people are wrong when they disagree with what they understand ABA to mean. My point here is only that ABA is just a spoon. It is neither good or bad. If your experience of ABA is bad then who am I to say your view is wrong. But that bad experience of ABA may not be everyone’s experience of ABA. Some people use spoons differently.

It’s not just quality of life

You will no doubt have heard someone say Positive Behaviour Support is all about improving quality of life. “We just listened to what he wanted…” or “We did things his way and now we don’t need to restrain him” are some of the common themes you will hear in this perspective.

I agree without a doubt that doing things the way that person wants and improving quality of life are core components of PBS. But I disagree this on its own is not enough to be Positive Behaviour Support. Here’s why.

If you aren’t doing this then what are you doing!

Are there really approaches out there that don’t listen to people, try to do things their way, and try to improve quality of life? How is this any different to any other approach that is out there? If you are in the health or social care profession and these are not your goals you are in the wrong career. It is also something that is very easy to say you are doing but difficult to prove.

When we are saying we are improving people’s lives are we doing it to our beliefs of what is good or theirs? How do we know it is what they consider good if they cannot tell us?

lack of respect for people who are experiencing challenges. 

If the notion is that when people are listened to and their quality of life is good they are not challenging, then the assumption is that if someone is challenging us we obviously aren’t listening and are not trying to improve quality of life.

I have worked with many families and teams who have been challenged. Usually, they are doing their very best in a very difficult situation. If you are a parent who is challenged by your child’s behaviour and you know if you ask for help they will come in and tell you that you are obviously not listening to him enough or you should just try to make his life a bit better would you ask for help?

PBS is more than that

I see PBS as being on a spectrum of interventions. Person Centred Support is a values based approach to supporting people with learning disabilities that focuses on listening to people and improving their quality of life. I would estimate that for around 80% of people whose behaviour challenges others Person Centred Support will address this.

There are some people for whom person centred approaches alone would lead to people rocking in the corner in the name of “choice”. Some people need additional support and encouragement to sensitively try new things, to experience success, and increase occupation. For many of these people Active Support alongside Person Centred Support is needed.

And finally there are a small number of people whose behaviour is challenging their supports to a level that engaging in activities is not easy. In this instance PBS and Active Support and Person Centred Approaches are needed. You cannot do PBS without Person Centred Approaches.

Multi Elimental

PBS needs to be based on the science of behaviour and must be multi elemental.

Firstly we need to understand the function. Sometimes this is simple but other times a detailed functional behaviour assessment is required to properly understand the function of a behaviour. When we understand that function we can then plan how we can support the person to meet that function in a better way.

There is nothing prescriptive about what should or shouldn’t be in a multi elemental approach. However, they are commonly arranged with the following headings:

• Teaching new skills – giving people better ways of getting what they want
• Environmental interventions – changes to the physical environment and people in it (approaches by support) to make the new behaviours more likely and the environment more supportive
• Focussed strategies – reinforcement is key to learning for all of us. People with learning disabilities sometimes need support in understanding reinforcements are connected to actions so we make plans to ensure reinforcement is effective
• Proactive Strategies – how we avoid the behaviours that challenge us from occurring
• Active Strategies – how do we respond to early warning signs that behaviours that challenge us may occur, or how do we manage risks in high risk situations that we know are likely to lead to these behaviours
• Reactive strategies – how do we respond when the behaviours that challenge us are occurring to end the situation as quickly and safely as possible.

A moral decision

Positive Behaviour Support is using the word “Positive” to mean “adding”. People with learning disabilities have learnt fewer behaviours than us to meet their needs. What right do we have to reduce or stop behaviours when behaviours that are effective for them are challenging us? In PBS we are choosing to “add” behaviours instead of reducing them.

Understanding the function of behaviour, changing our focus away from reducing the behaviour to meeting the function instead, and choosing to add behaviours instead of take behaviours away is central to what PBS is about. You can improve quality of life without doing this, but you are not delivering PBS if Quality of life is your only focus.

A different way of “working” #LDWeek17 #TransformingCare #TransformingLives

Keith Jarvis, our Service Development Worker describes how PBS4 is changing the lives of people we employ:

I would like to tell you about another side of PBS, a side that is sometimes forgotten, But is an important part of the support we offer.

That is the journey of our Enablement Assistants, as they see the effect of PBS working. How PBS4 not only changes the lives of the people we support but of the people giving the support.

I came to PBS4 from a care home, I had been in care for around 8 years when I started with PBS4. I came because it was a new company, with opportunities, but I also found that the company is not an in the box organisation.

As I started with the company, it was a little difficult to adjust to doing things the PBS4 way, thinking about the individual and shaping the day, around them and their needs, rather than the company.

As I have developed and progressed within the company, it has been amazing to see how the people we support have developed. I have seen and been part of services joining PBS4 and services progressing, to where the individuals needs have been enhanced so much that they have a staff reduction.

As part of the PBS4 management team, I have seen our Enablement Assistants develop with them, our culture of nurture, shaping, support and Training, means that our staff come to us with the solutions, come to us with a plan for something. They have the confidence to step outside the box, and challenge the system.

We are very privileged to have an amazing team of enablement assistants that work to improve the life of the individuals, in an individual way.

I for one am very grateful for the two way progress PBS4 has had on my life and my way of thinking.

This is LD week, and we celebrate the amazing achievements they have made, but I feel we also need to celebrate the individuals that have supported them to get there as well.

My training #LDWeek17 #TransformingCare #TransformingLives

Ian is a man we support. He was involved in his teams induction training. Here is his feedback

What went well?

It was beneficial for me and the staff. I found it indicated to me that the staff needed a lot of training, which they got. Now I have the right staff and that’s why I’m getting on with them more.

Proact Scip was good for me and I can see it will help the staff to deal with situations. I love the way that the staff can direct you to places and it’s not like hospital where they just put you on the floor and hurt you. Jonathan taught everyone properly and there was one staff that didn’t take it seriously. The other staff took it seriously.

I loved being involved in the Proact Scip because in the hospital I wasn’t allowed to take part. I got a feeling that I was actually in control and the staff were in control. I feel like the moves that were taught would calm me down.

What did you not like?

I couldn’t concentrate for a long time. There was too much information for me.

I didn’t like to sit through the whole day. I know it was beneficial for me as well, but I can’t take in loads of information and I felt overwhelmed which is why I kept interrupting.

Ideas for next time?

Longer breaks. I would like it if my parents took me out for the day. Maybe they could stay for a little bit so they can hear, and I can go out in the afternoon with them because this is when I struggle.

I would like if staff took the information and put it into pictures because of my autism and my learning disabilities, I understand it more if it’s in pictures, even if it’s little figurines (cartoons) in the picture.

A fresh start #LDWeek17 #TransformingCare #TransformingLives

For #LDWeek17 here is how our Enablement Assistant Hilary Taylor-McCaffey is finding her role:

I wanted to share a little bit about my experiences with Ian so far.

I have worked in care for the past three and a half years. Before that I went through job after job, constantly looking for something rewarding and engaging. I constantly felt like I wasn’t making a difference, and so I would move onto the next job looking for that missing spark.

I recently bought a house with my husband and we made the plans to move house. Part of those plans was for me to change jobs, and I was keen to look for something similar to what I was already doing. I answered an ad to work for PBS4 and was lucky enough to meet Ian on the day that I interviewed. We had a great chat and he had great banter, and I was immediately intrigued to learn more about him.

When I started working with Ian I had big plans for him. I suppose I had a sense that I would be walking into his life to help him in some way, and those illusions were soon dashed! Quite the opposite became true: I found I was learning more from Ian than he was learning from me. Instead of me showing Ian how to fit into the world, Ian was showing me how the world should fit around him.

In the few short months I have been working with Ian, he has taught me to meet the world head-on. In this age of self-absorption, Ian reminded me how important it was to talk to people, to make friends on the bus, or just start a conversation with someone in a waiting room.

He taught me to not fear new situations, and to express your feelings in a way where people would listen.

I could go on and on! But I think I’ve summed it up enough. I thought I was getting into care to help other people, but I had no idea how much the people I support would be helping me.

#TransformingCare #TransformingLives #LDWeek17 Improving Communication

Our Enablement Leader, Lisa Malia, shares her experience:

I do a lot of work with PECS (Picture Exchange Communication Systems) with a person we support.

We subscribe to a system called Communicate In Print from Widget. I have made lots of symbols available for the person we support by identifying what is important to her and what she would like to choose. I printed the pictures, laminated them, and organised them in folders so as the person we support and her team know where they are and they can find them quickly. We also have put up a white board in her living room and put the most used ones all around the edges so as anyone can find them quickly.

I introduced them to morning routines using now and next to build consistency, and use them on a choice board for activities and meals.

In October I went around the person’s home and placed PECS on cupboards, rooms and draws. Her routine is for her team members to hold out 2 items of clothing for her to choose from in the morning. Since sorting her draws onto individual items and placing PECS on the draws, some days she will get her clothing for the day including underwear and place them in a pile outside her bathroom with no support before day staff arrive on shift. She does this completely independently now because the pictures have given her structure and predictability. She has never done this before and she is now more in control of her life.

I love the fact PECS have given her independence, consistent morning routines, and clear choices she makes herself. She is in control!