A young person now in education and living more independently

Age: 18

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Reason for referral

Young Person was referred to ABL October 2021, prior to a planned return home from hospital admission.

The young person had been admitted to hospital following refusal to eat (over a period of 24 hours) and in this period of time received medical intervention and was assigned support from a dietician.

Alongside these multiple diagnosis the young person is also struggling with gender identity and starting the process of planning to transition, however, this is presenting as an obsession and a need to fulfil.

Due to family being OCD contimants for the young person they are also unable to support by cooking for food them or being present to provide assistance.

OCD rituals and need for control has caused a tense environment within the family home.

Family relationships are broken.
Multiple incidents recorded around family relationships, hence referral to social care team.

Family struggles to understand young person’s diagnosis and consequently is not sympathetic to this. There is lots of work needed around family interventions and building relationships.

Due to OCD locational triggers the young person is unable to have face to face meetings with CAHMS, therefore ABL are also requested to work alongside CAHMS to help provide psychological intervention under guidance.

Aims and objectives

• To return home and settle back into family life as soon as possible
• To to take medication daily while theraputic psychological intervention is implemented (constant ongoing aim).
• To prepare and eat daily in the family home.
• Through Psychological and practical support young person to gain understanding of OCD and learn strategies to address, rituals and redress stress/anxietiy responses appropriately
• To repair family relationships and install a positve family dynamic – Empower parents to understand and implment an effective and consistent response.
• Build independent life skills and budgeting skills to prepare young person for independent life.
• Daily visitis from ABL PBS Workers with the intent of firstly observing first hand triggers and behaviours. To build positive support relationship to ensure an effective working relationship.
• Develop an ‘agreement’ to include and engage the young person in their recovery. Agreement to include taking medication and eating daily. This will be reviewed weekly on a Friday and a strategy discussed with parents for the weekend.
• Develop an agreed and sustainable budget with young person and parents to ensure that family supporting within their means and developing practical life skills for independent living.
• Addressing rituals and routines though the clinical plan from ABL’s psychologist.
• ABL’s pyschologist to meet daily with parents understand the family dynamics contributing to young persons anxiety and OCD.
• Work with CAHMS and TAC to formulate a dynamic working plan for short medium and long term goals

What plans/strategies have been implemented?

ABL helped the young person to return home from hospital in November 2021, and agreed with ABL to the following conditions:
1) Medication – young person must take their medication daily and in the first instance be open to ABL supervising this.
2) Food – young person needs to attempt to eat daily and use the kitchen to prepare food and to eat
3) Finances/budgets – ABL with the young person will start to look at finances and the development of a sustainable budget that will contribute to life skills.

In order for ABL to be able to work effectively with the young person, they have initially spent a lot of time on relationship and trust building. Over the past 16 years the young person has had professionals come and go and not stay long enough to provide them with long term support, so therefore has a hard time trusting and believing people. This is a key stage, as once a strong and trusting relationship is created it opens the young person up to participating in deeper and more intense interventions.

It was apparent on the first few visits that mum has taken on a lot of the parenting and emotional strain over the past 12 years and had lost herself and her confidence in supporting the young person effectively. ABL have arranged daily psychological supervision from both support workers and ABL’s Clinical Psychologist in the first 2 months in order to help regain her role as a strong and in control parent.

The young person has struggled on and off with taking medication consistently. ABL have helped the young person to work on daily routines and structure and understanding of anxieties and triggers which may be deterring them from this. ABL have used talking therapies to help aid the young person in understanding the importance of medication and to pinpoint exactly how this will help and benefit them.

ABL have been in constant contact with Social Worker and CAHMS to ensure effective information sharing and that all professionals are up to date and working together.
ABL have been in constant contact with the Safeguarding team, and SEN support from School. Whilst supporting the young person with transitioning back to her mainstream school, ABL have helped to advocate any issues and anxieties that the young person has been struggling with whilst settling back in. ABL have also been able to attend school and support the young person to attend and prepare for professional’s meetings held around their care and support.

What resources have been considered for use/used?

ABL are in constant contact with CAHMS, Social Team and School safeguarding team. Due to the sheer depth of this case, and new events/ problems arising sometimes daily, this communication has been key in ensuring all professionals involved are constantly up to date with new information and are sharing best practices.

This case has intense psychological input from ABL’s Clinical Psychologist who has created a Clinical Plan as a basis for intervention.

How effective has the intervention been?

Over the duration of support there has been vast improvement in ABL contact and relationships with the young person. At the beginning of support the young person would avoid contact with ABL. As the support progressed the young person started to engage and have full 2/3-hour sessions with ABL.

ABL have observed and understood family home dynamics and the support and care that the young person was receiving whilst living in the family home.
After multiple meetings and reviews, the young person is now living with a close family member (supported by ABL) in a much more secure and nurturing environment.
Since the change in environment ABL have noticed a reduction in anxieties without the aid of medication and with the support of ABL Health, and the young person is more relaxed and open to speak with other professionals.

ABL worked on budgeting and money management with the family. Family finances are still a concern however this is not as intense, mum gives the young person a monthly budget of which they adhere too.

Furthermore, mum has worked with ABLs clinical psychologist and has shown herself to be more confident in parenting and knowing when to say ‘no’ to the young person. This is still a struggle for mum, however, there has been a lot of improvement.

When AB returned home from hospital there was a period of time where the young person cooked meals everyday within the family home and was eating a mixture of meat, veg and carbs.
The young person is now eating every day and is helping family members to cook meals in the kitchen.

Future Plans

Now that ABL have been able to create trusting relationships with the young person and has noticed a decrease in anxieties meaning we were in a better position to be able to use more psychological input.
The young person was initially hesitant to work with ABL’s Clinical Psychologist but did accept the support as well mum enabling a holistic approach to psychological support.

To continue work on positive interactions between the young person and mum, building a mother child relationship.

To support the young person in completing their GCSE year and planning for the future (including college options and living arrangements).

Key Learning Points

During our initial 10 weeks contact which had a clear purpose which was to allow parents to attend course. ABL identified significant behavioural needs which led to an extension. Behaviours included: Aggressive behaviour towards each other, lack of understanding of emotions, arguing and interrupting each other.
Psychological formulations need to take place by clinical psychologist on H & J to allow further understanding and be able to tailor further.

Overall Outcome

• The young person is now in education, living more independently, a driven individual, booking holidays, keen interest in photography.
• OCD under control.
• No longer requiring any support.

Feedback

Mum explained how the team from ABL have been brilliant so far and she is so happy and grateful to have professional’s helping who she believes really understand the young person and their family situation.

Compliment From Mum

During the ICPC, the young person was asked which people in her life does she feel supported by and they stated her sister and staff members from ABL.

Compliment From Young Person