Case Study 1

Carol, late 20’s

Behaviours of concern: Verbal and physical aggression

Background: Carol is in her later twenties. She is a First Nations woman who is close to her immediate family and lives with her aunty who is FIFO. Carol has a significant trauma and mental health history and is supported by one to two people depending on where they are going. Carol has diagnoses of autism, attention deficit hyperactivity disorder, schizo affective disorder, and a cognitive impairment. She is a resilient person who has a great sense of humour. Carol has spent time in involuntary mental health units and has been incarcerated at various times. This is especially important as she might respond to authority and control with fear due to this history.

Support needs: Carol needs support with all her activities of daily living and is supported with 24/7 support workers to keep herself and others safe. Positive Behaviour Support was introduced to investigate opportunities to address Carol’s behaviours of concern by developing her strengths and promoting positive change environmental strategies.

Assessment: The Positive Behaviour Support Practitioner first met with Carol and her support network to understand her needs, and then data collection and analysis was completed. Data analysis and collection informs our understanding of why Carol uses verbal and physical aggression to get her needs met and why she leaves the home unplanned and without support. Support staff completed behaviour recording forms, Carol, her family and staff spoke about her needs and many observations were carried out over several months.

The assessment found that Carol is responsive to, and very aware of, her surroundings and others. She is more likely to use verbal aggression when she feels controlled or judged. She can also become frustrated if she is told ‘no’. Her difficulty with communication means she gets frustrated when someone misunderstands her. Carol is also more likely to use verbal or physical aggression when her she is in mental health distress as this further impacts her ability to problem solve.

Strategies to improve quality of life: Using the above information, the practitioner worked with Carol and staff to set up a weekly routine, so Carol knows what she is doing and when. Carol now writes down all her expectations before going out and has this with her to remember when she is out and about. Staff help her prepare the night before and, in the morning, so there are no surprises during the day. Support workers understand when Carol might need extra support for example after a bad night’s sleep, changes in medication or when medical appointments are coming up. Staff have been trained in effective communication and now have alternative ways of communicating with Carol that does not include the word ‘no’.

Staff have been trained to recognise early behavioural signs that Carol is distressed or anxious and respond appropriately using a variety of strategies that include reassurance, redirection and supporting her to generate and choose from a variety of solutions. To keep Carol and staff safe, they have also been trained in effective response strategies.

Outcome: By taking a pro-active approach and using multi-elemental Positive Behaviour Support there has been a significant decrease in Carol’s behaviours of concern. There has also been an increase in her opportunities to access the community and reduce inpatient mental health admissions, which Carol reports are areas which greatly impact her quality of life.