When Toby arrived at Fullerton House School three years ago, he was displaying a high frequency of behaviours that can challenge. Toby would often ‘corner’ staff in his bedroom then grab out at them. Due to the intensity of his physical aggression, physical interventions were required on a frequent basis to keep Toby and others safe and well. Toby was unable to tolerate many things in his physical environment, particularly in his kitchen; he engaged in high levels of property damage, often injuring himself. He could not manage waiting or traveling with others. Toby was also doubly incontinent and wore pads.
The Multi-Disciplinary Team (MDT) at Fullerton House School, consisting of experienced education, care and therapy professionals, set about better understanding Toby’s complex needs in order to support him in the best way possible.
The main ‘triggers’ to Toby’s behaviours that challenge were identified as communication attempts not being understood, delays in waiting for food and too much information. Toby did try to use some signing and speech but generally, this wasn’t effective in communicating his wishes and feelings clearly.
The MDT’s Speech and Language Therapist (SaLT) supported care and education staff with various strategies to try to improve the effectiveness of Toby’s communication. PECS (Picture Exchange Communication System) was trialled, but Toby struggled to understand the system and would often rip it up. A communication aid called GoTalk9 was very useful at times, but sometimes it proved to be too slow and caused some frustration. The school kitchen staff learnt all the signs for the lunch menu options and, supported by an Assistant Psychologist Support worker (APS), Toby was able to make his food choices using Makaton signs. Toby’s class teacher underwent additional Makaton training to support the use and teaching of signs in every lesson. All school staff were taught 5 new signs a week and a visual resource was placed in Toby’s accommodation.
The MDT’s Occupational Therapist (OT) worked with Toby’s care and education team to help him better engage with everyday school life. Initially, a bus harness was used successfully to keep Toby safe on the school transport. A deep tactile support plan was implemented along with appropriate staff training. The MDT supported OT led initiatives and trials regarding the use of sensory equipment and activities to help Toby to better regulate his own emotions and feelings.
A full Functional Behavioural Assessment was carried out by the MDT’s Clinical Psychologist and recommendations made to help reduce the number of incidents and need for physical interventions. The MDT led on the implementation of these recommendations and staff workshops to ensure a consistent approach in supporting Toby. An APS worker implemented a programme created by the Behaviour Therapist to develop waiting skills and a toileting programme.
Three years on, supported by the MDT approach, Toby has made fantastic progress. Toby can now use a wide variety of Makaton signs spontaneously and independently in many different environments including school, home, restaurants and supermarkets. He no longer requires a harness when travelling on the school bus. The need for any physical intervention has significantly reduced; Toby is now able to self-regulate and request items or techniques that will support him to better regulate his feelings and emotions. Toby can now wait for longer periods and can manage his frustrations much more effectively. He is now fully continent. Toby lives happily in a house with a fully functioning kitchen with all appliances and no longer engages in any property damage.
Toby’s family have a very strong relationship with him, but when Toby first started at Fullerton House School, the quality of his interaction with his family wasn’t always the best due to the presentation of his complex needs at the time. However, because of his amazing progress, this has changed immeasurably. For example, Toby can now go for a meal with his mum in a restaurant and choose what he would like to eat. He even now goes shopping with Mum! These are both things his mum did not think would ever happen again. Over the years, Toby’s family have also developed a very strong connection with the service as a whole. The MDT approach has allowed all key professionals and family to work supportively and collaboratively together in Toby’s best interests. A great example of how the whole school staff team (including teachers/teaching assistants, care support managers/workers, kitchen staff, SaLTs, OTs, psychologists, behaviour analysts) and families work positively in Hesley Group schools to achieve great outcomes for the young people we support.
Fullerton House School is a specialist residential school, offering education and care for 52 weeks per year, for people aged 8 to19. The people we support have complex needs including behaviour that may challenge and a learning disability, often in association with autism.
For more information about the Hesley Group visit our website at www.hesleygroup.co.uk
