Transforming lives and homes with person-centred thinking

Originally built by parents as a residential care home for adults with learning disabilities and challenging behaviour, Smug Oak has now been redeveloped into six individual flats – a ‘core and cluster’ housing model.

Since redesigning the service, we’ve seen reduced behaviours of distress and improved quality of life for the people we support there. Smug Oak is an excellent demonstration of how people with complex behaviours can thrive in the right environment.

When Smug Oak first opened it was made to be a care home for adults with learning disabilities. Their approach to managing challenging behaviour was to group people together, in a safe environment, away from the local community and the general public.

At the time, it was thought that behaviours of distress was due to a person’s disability and not their support or environmental triggers.

With only this understanding, the parents put a group of people with behaviours of distress together in the same residential care home. This led to institutionalised conflict and residents hiding in their rooms away from violent incidents.

In reality, the ten adults with learning disabilities were not suited to living together. The service went from one safeguarding incident to another. Staff turnover was high, quality of support was low and it was clear this care home needed fundamental changes.

What changes did you make to improve the care home?

Since becoming a part of Dimensions, we have made massive strides to improve Smug Oak and the quality of life for people with learning disabilities we support there.

Housing
We re-developed Smug Oak into six independent supported living apartments and use person-centred thinking to make sure the people moving in are suited to the property and its rural surroundings.

We ensure that individuals have opportunities and feel part of their community.

Personalised care
In line with our person-centred approach, people are no longer defined by their behaviour. We focus on their underlying preferences, their choices and their needs. We use Positive Behaviour Support to make personalised support plans to enable them to get the best from life and achieve positive outcomes.

Staffing
Our colleagues understand the individual needs and triggers of the people with learning disabilities and autism they support in our supported living environments and care homes.

We match colleagues to the people they support by using a range of person-centred thinking tools, such as One Page Profiles. Our Behaviour Analysts then use Positive Behaviour Support techniques to identify triggers for behaviours of distress and to develop alternative strategies with our colleagues.

Communication
We train our colleagues in modern approaches for reducing behaviours of distress. This includes a number of creative communication techniques specific to the needs of the people living at Smug Oak.

How have Dimensions made a difference?

Most of the original residents moved into other services better suited to their support needs. Two people stayed and, although they used to display severe challenging behaviour, they are now living happily and are no longer challenging.

Those who moved away are also thriving; one person lives in his own flat and no longer needs extra adaptations because his behaviours of distress has all but disappeared.

It became clear that much of the behaviours of distress was exacerbated by unsuitable housemates and a culture of acceptance.

New people moving into Smug Oak were all previously identified as being difficult to find suitable places for in the community.

One man, Alex*, joined us as part of the post-Winterbourne View movement. After being sectioned for ten years due to high levels of behaviours of distress, he came with 24/7 2:1 support.

With support from our Behaviour Analysts and the independence he enjoys in his flat, his behaviours of distress has ceased. He’s now moving into a flat with only one support worker; his support needs have halved and the costs to the local authority have reduced accordingly.

Recent years have seen great leaps in our national understanding of how to best support adults with learning disabilities and autism. The development of Smug Oak shows how the institutional model of care is flawed and thinking has progressed.

We can see that understanding the triggers for behaviours of distress can help define the support needed to reduce them, improve the quality of life for people and save support costs.

Our analysis below outlines the approaches and outcomes achieved.

*name has been changed to protect privacy