Developing independent life skills

Age: 18

Gender: Female

Contract Duration: 27 Months

Reason for referral

B was presented to ABL in 2019 with diagnosed ASD, complex trauma and queried emerging emotionally unstable personality disorder.
Presenting risks were identified as accidental death, self-harm. B had recently been discharged from residential psychiatric care and had a recent attempt to jump off a bridge with an alleged intention to end her life. The assessment stated B has vulnerabilities in context of her ASD and difficulty forming appropriate relationships.
B was subject to a court order of returning to psychiatric care by the Social services as they feel B is not safe at home and her Mum cannot provide adequate care to keep her safe.
ABL was asked to facilitate PBS for B in the hope that positive interventions would enable B to live at home safely with her Mum, subsequently preventing her from returning to in-patient psychiatric care.

Aims and objectives

• Prevent readmission into residential psychiatric care
• Reduce Anxiety.
• To provide B with the skills to identify and self-manage her emotional needs.
• Develop self-awareness skills.
• Provide coping strategies.
• Encourage independent living.
• Psychoeducation.
• Improve communication skills, life skills and social skills.

What plans/strategies have been implemented?

• Relationship building
• Help to build self-esteem.
• Mindfulness activities to prolong concentration and focus span to help contain anxiety and trauma symptoms.
• Emotional literacy and regulation activities.
• Negative self-talk challenging.
• Self-care and self-soothing activities.
• Preparation for therapeutic trauma work.
• Psychological education brain trauma, emotions, depression, and anxiety.
• Deliver sensory diet.
• Thera-play activities
• Safety plans.
• Home projects for pets. (active planning) Accessing the community safely.
• Supporting B to make autonomous decisions for herself and care of.
• Supporting with withdrawing of psychiatric medication.
• Support post and during self-harm episodes.
• Infection control of self-harm sites.
• Psychological support purging.
• Positive risk taking.
• Supporting sensitive disclosures.
• Psychological support of flashbacks and treatment options and management.
• Psychological support to ascertain if memories are real or imagined of historic abuse.
• Psychological input and direct support for ASD.
• Support managing money, meal plan support.
• Psychological education surrounding hearing voices.

What resources have been considered for use/used?

Cooking, Arts and crafts, Sensory activities, mindfulness, access to the community for days out, work experience, Psychological Support, local parks, farms, technology such as laptops/phones.

How effective has the intervention been?

Initial work to develop positive relationships with B proved to be successful with B engaging well with ABL staff, and adjusting quickly to new staff whenever they have come along. These relationships have been long lasting and crucial to B’s progress. This has also encouraged Bs communication skills – when ABL first met B she had limited communication and would self soothe by rocking a lot. B is now able to communicate effectively with a significant reduction in rocking behaviours.

This development in communication has given B the confidence to speak up for herself and to communicate with other professionals in regard to her care – e.g. B can now call the doctors herself to make appointments, can call her Social Worker for updates, B has had constant contact with her solicitor in regards to the process of supported living.

B has developed self-awareness skills and is now able to recognise and verbalise her feelings and able to recognise emotions in herself and others. Furthermore, B is able to recognise when to reach out for help as appose to self-harming – an increase in positive relationships with adults has resulted in B finding the confidence to seek help. Following on from this, B’s self-harming/ crisis episodes have reduced dramatically. B is now at the point where she is mostly able to bring herself out of a crisis and self soothe, this has contributed to B no longer presenting at A+E.

B is no longer under the care of a psychiatrist and no longer at any immediate risk of being admitted again as a tier 4 patient.

At the begunning of the referral with B, she expressed her hopes and aims for the future. One of these hopes was: ‘B would like to live in a supported living environment that can meet her needs and care for her animals by 2022. B would find it helpful for her to prepare for an independent lifestyle by continually reinforcing use of coping strategies for her anxiety other than self-harm to stay safe and to reduce suicidal thoughts. This will incorporate psychological daily interventions to recognise emotional dysregulation and to be able to effectively self-regulate using adaptive coping strategies.’
B has been accepted into supported living which she will be moving into as of March 2022! The staff have been in contact with B about possible pets she will be able to look after whilst living there. This is an amazing achievement!

B has developed independent life skills and is now able to cook independently without seeking help for each step of the process. B has been exposed to a variety of different recipes which she will be able to cook from scratch and have the confidence to do so whilst in supported living.

ABL have supported positive risk taking throughout their time with B. This has allowed for B to build up confidence whilst being out in the community, and also shown that people around her believe they can keep her safe and that she can also be active in keeping herself safe when being out.

B has developed the skills to critically think, analyse and reflect on situations. These skills will be imperative for B as she moves onto her new chapter living alone.

B has reported that she is hearing the voices in her head less and less. This may be a reflection of Bs improvement in self-awareness and control and being able to self-regulate.

Another of B’s original hopes was that ‘B would like to have finished her GCSE’s by 2021 and would like ABL to support her needs to understand the content in the context of her abilities’. B has been completing her GCSE’s online and ABL have been present during these sessions to help and support. B has struggled on and off with accessing this education however is still working towards obtaining her GCSEs.

Future Plans

For the rest of the time that ABL have working with B they will be ensuring a successful transition into supported living.
ABL will support B to making sure she has the skills that she needs to be able to live on her own and supporting her to pack everything from her old house and move over to the new one.

Key Learning Points

B’s case lead noted how this case highlighted the importance of how getting to know the individual is crucial before implementing any form of intervention. In this case originally certain aspects such as hygiene and healthy eating were made a priority, however it was apparent that B was simply complying with this and it wasn’t beneficial to her personal support.

Once psychological input was in place to understand the reasons why these certain aspects needed attention, a more personalised plan was able to be created an therefore was more effective.

Overall Outcome

Moved to supported accommodation.
Regulating self-much better
Still self-harms on occasion
Supporting themselves
A strong relationship with peers
Considering becoming an ABL ambassador
ABL have now stepped back

Feedback

B stated that the life style improvements that have been made are as a result of the positive interventions ABL have put in place to support her, and that for the first time she has felt heard and been given the tools to mentally develop herself to be able to recognise and understand her own needs and have the ability to make informed choices.

Feedback From ‘B’

“I just wanted to use this opportunity to thank you for all your hard work with B. I really appreciate all your input and support. It has been immensely helpful and has made a massive difference to B and enabled me to take the therapeutic risks and work towards her discharge. Your grasp of autism and the need to take positive risks has been invaluable, as this approach was not always shared by others. I personally feel that we can underestimate the harm that we can do to people in the pursuit of ‘safeguarding’.
You are a credit to ABL and I hope they realise just how much you have done and how hard you have worked
I wish you all the best in the future and look forward to working with you again with other clients”

Compliment From Consultant Psychiatrist