Photo by Ross Findon on Unsplash

I am delighted this month that Cate who works in adult supported living services has agreed to share a case study with us. Cate intially attended several of my courses in 2018, and has recently repeated the ‘Introduction to Sensory Integration and Sensory Processing Disorder’ to refresh her knowledge, and attended ‘Making SENSE of Behaviour’ in April. While on these courses, she told me about Joe and the difference attending the courses in 2018 had made to Joe’s quality of life. I asked her to share the case as I felt it was such a wonderful example of how understanding an individual’s sensory needs can make such a difference. Change is still possible at age 51! It’s not just restricted to young children. (The client’s name has been changed to protect confidentiality and a generic photograph used).

Joe

“Some years ago I attended a sensory processing course presented by Julia Dyer in Preston.

On the way home (3 hours driving) I began thinking about one of the people I supported, and, as I was thinking about him, I began to plan…….

This is what happened next!!!

Joe came to be supported at the age of 51. He had been excluded from schools and day placements. This was his fifth house move in ten years. He had autism and a mild learning disability. He had very little eyesight. Joe was 3:1 staffing, and only women staff as he was more combative with males. He had experienced a lot of negative interaction with staff and other people and would repeat a huge list of people that didn’t like him and what they had said to him.

The first thing that we did was massively change his interactions with staff, only using positive language and greater recognition of all his positive attributes. He found that he really liked two members of staff in particular and was able to form a good working relationship with them. A lot of the data collected was done by these staff chatting with Joe and asking him questions.

We collected data and discovered that he was very over stimulated visually, despite having very little eyesight. He was very keen on “flashy lights” (emergency service vehicles). He was over stimulated to smell. He was hugely overwhelmed by clutter.

He was motivated by fizzy drinks, so seeking oral sensations, and watching/hearing trains go past him at high speeds.

What We Did

I was very lucky! The team that supported Joe were engaged and enthusiastic to try and improve Joe’s life. He had an overnight stay in a hospital and the team changed his house in 24 hours. We did this with his permission and without him present as it would cause him great distress if he had been in the property while it was being done.

• All staff used same deodorant, body wash, shampoo, washing powder. No perfume. No make up. Hair tied back.
• Staff wore a “uniform” (joggers, t shirts, sweatshirts) chosen in preference for Joe.
• No jewellery except wedding ring.
• House stripped back to only essential items, or particular items of sentimentality chosen by Joe. Everything else in cupboards.
• Staff only to have out in rooms the things that Joe is using at that moment. Then tidied away.
• Black out blinds. Low level lighting for when Joe needed it.
• Re decorate house. (all the same, quite a dark colour)
• Better extractor fan in kitchen. (and quieter!)
• Staff remained calm and spoke in low tone at all times.
• Staff used shorter sentences and simple words. No jargon or analogies. They also gave Joe processing time.
• Staff were mindful of choice that they gave. Kept it at 2 items.
• Staff did not talk about what was happening in the future.
• Staff stopped over checking “are you ok/ do you need anything” this annoyed Joe and caused anxiety leading to him being overwhelmed.
• Staff went shopping for the few items of clothing that Joe liked wearing. They bought a lot of each item, but only 3 of each item was in his bedroom, the rest was stored away.
• Staff offered weighted blanket to Joe after meals, which is when he preferred it.
• Staff ensured Joe always has access to 2 small cars. He will carry them in his pockets and use them when he needs to.
• Staff ensured that Joe has a varied diet of food he enjoys and are mindful that he will put “hot sauce/salt/pepper/chilli’s” on everything!!
• Staff decanted any additional sauces/seasoning into much smaller containers so that less is added as Joe liked to empty the container onto his food.
• Staff reminded Joe that he can use the gym equipment in the park. Staff also joined in with this activity. (He didn’t think its was “his”)
• An old-fashioned rocking chair was added to his sitting room.
• Staff set up “water play” (Joe’s words) as often as Joe wanted it.
• Joe went on walks every day. He did this to go and buy a fizzy drink, or to sit by train crossing or by police or fire station.

What Happened For Joe

Over the next year Joe became much more regulated. The first month after the changes he slept a huge amount, which he had struggled with previously. He became much more able to engage with daily living tasks and much less overwhelmed

We were able over the following 12 months to change his staffing requirements. We slowly introduced men to his staff team and then reduced the ratio of staff to 1:1 in the second year. He was really proud of this! With the physical exercise he was able to have regular bowel movements which he was very pleased about! He did test the boundaries of the changes, but staff gave reassurance and remained giving him quiet validation and positive reminders of all he had achieved. Joe was able, on occasion, to tell us if he wanted to try anything else which we implemented immediately. Having control over his own life and environment delighted him.

On a personal note this was both myself and his fabulous, patient and kind staff team greatest work achievement! Watching Joe relax and start to enjoy moments in his life rather than be the tightly wound, overwhelmed person was just incredible. I am grateful to have been part of it.” Cate