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Life really can get better: Steve’s journey

Steve* is a man with learning disabilities, suspected autism and a ferocious reputation.

Until 1997 Steve was locked up in a secure hospital’s Challenging Behaviour Unit and was on copious doses of antipsychotic medication. Now he’s free of medication and out of the secure hospital unit.

Steve doesn’t speak, and gets physically aggressive or self harms when his communication – Objects Of Reference or simple Makaton – is misunderstood.

He damages buildings, has limited access to the community and rarely sees his parents.

After Steve left hospital he moved into a Dimensions registered care service.

His reputation preceded him and initially his behaviour and the support he received was none too different. Indeed, the local community once petitioned for him to be removed.

It took a behaviour assessment to turn things around. A new approach to communication was taken (an iPad with pictures and video).

His service was made more robust, meaning he could be left to get on with more household tasks. And his day was made far more predictable.

Those interventions made all the difference. As Steve’s challenging behaviour reduced, staff felt confident and relaxed and he could do more and more for himself. A virtuous circle was created.

Steve’s favourite support staff is now a small Scottish lady. He can go to local shops, the pool and the pub.

Despite initial reluctance on the part of his doctor, he is now completely free of antipsychotic medication. Best of all, he has had his first family Christmas since childhood.

There remains a long way to go. Steve doesn’t get on with his housemate, and so the team has been looking for supported living arrangements for him.

Once again, Steve’s ferocious reputation was cause for concern amongst those agencies familiar only with his past but Dimensions has been able to provide the behavioural data required to make the move.

As part of this, his previous support – 280 hours per week plus sleep in staff just a few years ago – will soon be down below 150.

Steve’s support manager Tony commented “We had to understand why Steve was getting upset, avoid taking it personally and avoid focusing on his behaviour.

We kept asking ourselves, “Why are you communicating in this way? What can I do to help you not feel the need to display this behaviour?” Once the team had this mindset, meeting the needs of Steve was easy.”

So few people believed Steve could change. His story should give belief to all those people currently locked in ATUs or having a hard time elsewhere, and their families. Life really can get better.

*name has been changed to protect identity. Photos are anonymous.

Positive Behaviour Support

  • Identified triggers for challenging behaviour
  • Trained staff in alternative strategies
  • Used creative communication techniques

Person-centred approaches

  • Used One Page Profile to understand his needs and goals
  • Used staff matching tools to find the right support team

Before and after comparison


  • Physical aggression
  • Self harm
  • Behavior that challenges


  • Increased independence
  • Increased happiness and well being
  • Hopes to move from residential care to supported kiving

Key outcomes

  • Free of antipsychotic medication
  • Increased happiness and well being
  • Staff felt more confident and relaxed around him

Key data

  • Challenging behaviour has significantly reduced
  • Steve has more independence
  • Support hours have reduced from 280 to below 150
  • Support costs have been reduced