Adam* is a determined individual who knows what he wants from life. He is friendly and welcoming and enjoys domestic endeavours – such as housework and cooking – as well as visiting the cinema and shops.

He leads an active lifestyle and frequently goes for walks, drives in his car and goes to his local pub, and has a close relationship with his family.

Back in 1984, Adam was moved to a unit of a long-stay hospital for people with a learning disability, following several failed placements. As a strong-willed person, he often became frustrated by being denied the choices he wanted in life and, as a result, exhibited challenging behaviour, which ranged from self-harm to threatening actions against other people. This frequently led to him being physically restrained and staying on the ward for most of the day.

United Response staff from our north east division first met Adam in 2005 when he was 35 years old. Initial plans were to create a supported living scheme for him in his local area but, due to health and safety concerns, the team had to pursue a different approach.

In order to give him the intensive support he needed within the unit, Adam’s support team began to work alongside hospital staff, increasing his support until, after a few months, he had 12 United Response support workers caring for him full time. During this transition period, he was also moved to an upstairs ward where he had his own bedroom, sitting room, office and a shared bathroom.

As soon as United Response got the go-ahead to provide full support to Adam in the hospital setting, they began to help him overcome his challenging behaviour.

A person-centred approach to challenging behaviour

John*, Adam’s then-service manager who managed the process, stresses that a person-centred approach was vital with Adam.

“You have to be around Adam and get to know his behavior to understand what he’s telling you,” he says. “It has to be an approach focused entirely on him. Only then can you help him overcome the difficulties he has.

“We noticed that Adam had trouble expressing himself and would often say the wrong thing, which made him agitated,” he recalls. “For instance, when we asked Adam if he wanted a cup of coffee and he said ‘no’ when he meant ‘yes’, we would give him the chance to change his mind; this would avoid any distress and challenging behaviour that might otherwise have arisen.”

The results were dramatic. Gradually, with consistent support, Adam’s challenging behaviours ebbed away and he no longer required full restraints to calm him.

“Adam’s physical restraints decreased because he had more input into his own life and more freedom to choose what he wanted - even simple things like deciding when to have a cup of coffee,” asserts John. “He does have his off-days, but we look into why and find out the cause. More often than not, he is just feeling under the weather.”

Moving Adam out of a long-stay unit

As time passed, Adam’s confidence grew, his challenging behaviours continued to improve and Adam got his own car so that he could go out every day – a sense of independence that he really enjoyed. Discussions then began about moving him out of the long-stay hospital he had lived in for the past two decades.

Based on what support staff and the people closest to Adam – his family and friends – knew about Adam’s personality and what is most important to him, plans were put in place to relocate him to a single-person supported living service. Since he is at his happiest when outdoors, a rural setting seemed most appropriate, and Adam and his family specified that it should have “a bubble bath” and be near to a chip shop.

United Response and local commissioners enlisted the help of a local housing association to find his ideal house. In the end, they managed everything but the chip shop!

Family input comes first

Successful support centres on knowing the person and responding to their needs, so working closely with families is vital. Family members can provide a wealth of personal information about an individual and immediate insight into why they might be behaving in a certain way.

As John explains, it was United Response’s number one priority to show Adam’s family that his new living arrangements would not leave him in a vulnerable situation.

“Initially, I don’t think Adam’s family were fully confident that we could provide the right level of support for him in his new house,” says John. “But we have proved that we can: Adam is not as challenging as before and his family can see this. We have been able to win their trust and they are comfortable with the progress that he has made.”

When Adam first moved out of hospital and into a large, rural house of his own, he was given 2:1 residential support and 3:1 support in the community, but this level is gradually being reduced.

He now has a vastly improved level of personal choice and has been involved in deciding everything from the location of his new house to the colour of the walls. And, as John believes: “He is a million times better for it.”

*Names have been changed.

Gail Dawson, senior area manager, north east division.

Find out more about how we support people with learning disabilities, or make a support enquiry. You can also download resources for families such as our Family Charter here.