Positive Behaviour Support and it’s potential to be life changing

Lucy (not her real name) is a 32-year-old lady with an Intellectual Disability, Cerebral Palsy and Obsessive Compulsive Disorder. Lucy lives in Supported Disability Accommodation and requires 24-hour care and support. She has a very supportive sister.

Lucy is supported by a Behaviour Support Practitioner, Speech Pathologist and Occupational Therapist at Outcomes Connect.

Lucy presents with repetitive Behaviours of Concern around food. Behaviours include:

  • Standing at the cupboard focussing on food items throughout the day
  • Taking food from others at home
  • Not sleeping and looking for food during the night. This includes checking cupboards and cooking meals when others are asleep

Lucy lives with environmental restrictive practices (locked cupboards) at home as a result of these Behaviours of Concern.

When Lucy becomes heightened over concerns with food, her participation and independence in daily life are negatively impacted. Her mental health and wellbeing are compromised and her Behaviours of Concern will escalate.

If Lucy is not supported appropriately at these times, she will become physically aggressive towards others ie. she will kick, punch and hit people around her, and attempt to self-harm.

By developing a Positive Behaviour Support Plan with Speech Pathology and Occupational Therapy input, it was understood that these behaviours were heightened when Lucy was unable to self-regulate her own emotions. Lucy did not engage in these behaviours prior to her mother passing away. It was also clear that unexpected changes in Lucy’s routine, being supported by unfamiliar staff, inconsistencies with care and support and not being understood, led to increased frequency and intensity of these behaviours.

Strategies to support Lucy’s positive behaviour around food were implemented by the Outcomes Connect team. This included:

  • Lucy being supported to be more involved in making choices in her life.
  • Reducing Lucy’s food-related anxiety by providing her with regular access to food choices throughout the day. Lucy now has access to a fruit bowl and lunch box (with her choice of snacks) throughout the day. This has increased her choice and control with food and reduced the intensity and frequency of her behaviours of concern around food.
  • The Outcomes Connect clinicians and the Care Team have worked together to develop a structured daily routine and an activity choice board. Using the choice boards within Lucy’s daily routine has allowed her to be actively involved in her daily routine and has increased her choice and control daily. Activities include helping around the house, particularly with grocery shopping and unpacking food items with staff.
  • Lucy is also encouraged to have a coffee and snack with others at home and engage in social conversations. Her activity choices are dynamic and updated in line with Lucy’s likes, changes in preferences and as her opportunities and experiences expand in daily life. This has led to a reduction in the intensity and frequency of her behaviours of concern around food. Ongoing training and support are provided to the Care Team around the importance of routine, consistency and structure to support Lucy’s participation during the day.
  • Additional visual resources to support Lucy’s routine include a calendar of her daily schedule, a photo menu plan and social stories to support her participation in ‘everyday’ situations.
  • The Outcomes Connect and Care Team have worked together to develop a communication script to support care and support staff with consistency around positive communication with Lucy.
  • The Outcomes Connect Team have worked with Lucy to support her to build her skills with emotional regulation. This includes her own self-awareness when feeling frustrated or distressed and practical strategies to support her communication and sensory needs. Lucy can identify when she is feeling upset, and she is now able to choose activities to support her to feel calm in her environment. This support has led to a reduction in the intensity and frequency of her Behaviours of Concern around food.

Lucy’s increased participation in her daily life and increased ability to have choice and control has clearly led to increases in her quality of life and a reduction in her Behaviours of Concern. These outcomes have been acknowledged by everyone around her, including her family, care and support team and management.

It is expected that the need for Lucy to live with restrictive practices (locked cupboards) will reduce (and possibly be eliminated) with ongoing, consistent support.