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Transforming lives and homes with person-centred thinking

Originally built by parents as a care home for people with learning disabilities and challenging behaviour, Smug Oak has now been redeveloped into six individual flats.

Since redesigning the service, we’ve seen reduced challenging behaviour and improved quality of life for residents. Smug Oak is an excellent demonstration of how people with complex behaviours can thrive in the right environment.

When the care home was built, the approach to challenging behaviour was to group people together, in a safe environment, away from the local community and the general public. It was thought that challenging behaviour was due to a person’s disability and not their support or environmental triggers.

With only this understanding, the parents put a group of people with challenging behaviour together in the same care home. This led to institutionalised conflict and residents hiding in their rooms away from the violent incidents. In reality, the ten adults were not suited to living together. The service went from one safeguarding incident to another. Staff turnover was high, quality of support was low and it was clear this care home needed fundamental changes.

Making a difference

Housing

We re-developed Smug Oak into six independent apartments and used person-centred thinking approaches to make sure the residents moving in were suited to the property and its rural surroundings.

Personalisation

In line with our person-centred approach people would no longer be defined by their behaviour. We focused on their underlying preferences, their choices and their needs. We used Positive Behaviour Support and personalised support plans to enable them to get the best from life and achieve positive outcomes.

Staffing

We matched staff to the people they would be supporting by using a range of person-centred thinking tools, such as One Page Profiles. Our Behaviour Analysts then used Positive Behaviour Support techniques to identify triggers for challenging behaviour and developed alternative strategies with the staff.

Communication

We trained our staff in modern approaches to reduce challenging behaviour. This included a number of creative communication techniques specific to the needs of the people living at Smug Oak.

Positive outcomes

Most of the original residents moved into other services better suited to their support needs. Two people stayed and, although they used to display severe challenging behaviour, they are now living happily and are no longer challenging. Those who moved away are also thriving; one person lives in his own flat and no longer needs extra adaptations because his challenging behaviour has all but disappeared.

New people moving into Smug Oak were all previously identified as being difficult to place in the community.

One man, Alex*, joined us as part of the post-Winterbourne View movement. After being sectioned for ten years due to high levels of challenging behaviour, he came with 24/7 2:1 support.

With support from our Behaviour Analysts and the independence he enjoys in his flat, his challenging behaviour has ceased. He’s now moving in to a flat with only one member of staff; his support needs have halved and the costs to the local authority have reduced accordingly.

Recent years have seen great leaps in our national understanding of how to best support people with learning disabilities and autism. The development of Smug Oak shows how the institutional model of care is flawed and thinking has progressed. We can see that understanding the triggers for challenging behaviours can help define the support needed to reduce them, improve quality of life for people and save support costs.

Our analysis below outlines the approaches and outcomes achieved.

*name has been changed to protect privacy

Positive behaviour support

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

Person-centred approaches

  • Used One Page Profiles to match staff to the people we support
  • Important to and important for tool
  • Perfect week planning

Before and after comparison

Before

  • Traditional care home for people with high support needs
  • Little understanding of environmental triggers
  • Frequent incidents of challenging behaviours
  • Residents rarely left rooms

After

  • Changed to six self-contained flats
  • De-registered to supported living service
  • People now in accommodation suited to their needs
  • Person-centred approaches lead to better outcomes

Key outcomes

  • Savings to local authorities as support needs reduce
  • People able to move to independent living
  • Major reductions in challenging behaviours
  • Improved quality of life

Key data

  • Challenging behaviour has significantly reduced
  • Everyone has more independence
  • One resident's support needs have halved
  • Support costs have been reduced