Rocky is a 35-year-old woman who has profound learning disability, severe Autism, anticipatory anxiety, and PICA.
She is very smiley and inquisitive of everything that is happening around her. She is nonverbal and communicates through signs and objects of reference.
Rocky lived at home until 2008 when she was moved to a residential home. After moving to two further homes, she transitioned to one of Iris Care Group’s supported living homes in May 2020.
Prior to her arrival, Rocky had experienced recurrent losses and disruptions over the prior years; changes in placement and support services/workers and her sister moving away.
Rocky had been prescribed various mood stabilizers, anti-psychotic medication, and antidepressants. She was also prescribed PRN medication which was being given to her daily however she was still displaying daily prolonged periods of distress, crying screaming, self-harming, aggression towards others and low mood and poor mental health.
Rocky was not responding to input from specialist teams, she was not responding well to new medication and continued to display elevated levels of anxiety and distress of a severity, frequency, and unpredictability that presented immediate risk to herself, others, and her home.
Rocky’s PICA presented in behaviors such as trying to ingest magnets, screws, hooks, bottle taps, beads and as a result she was at risk of gagging and chocking and aspiration. Rocky was also not accessing the community and, when not in a state of high distress or anxiety, spent her time sitting in her room in the dark not wanting to engage with her support. She had also lost her hair, had marks and bruising from self-injurious behaviours, and had lost a considerable amount of weight resulting in her needing support to be able to walk at times.
Rocky’s conditions have a significant impact upon her cognition, and she does not demonstrate any awareness of risk and is fully reliant on staff and those around her to support her daily living.
As these complex needs and behaviors posed a risk to herself and others it was decided to move her to her own flat with Iris Care Group.
Following her move, Rocky initially continued to present with heightened levels of anxiety and distress. Often displaying aggression towards staff and others, property damage, self-harm, refusing to wear clothes. Rocky was wary of getting close to staff and trusting them and for this reason she was choosing to isolate herself in her flat; she was refusing to let staff in and sending them away every time they were trying to interact with her.
With support from a new dedicated support team and other professionals, such as the CLDT and LDISS teams, a newly personalized support plan and PBS plan was introduced and Rocky started to respond well to this new approach.
Staff worked consistently in gaining Rocky’s trust, supporting her to make her own choices and decisions as much as possible and supporting her with her needs. The team worked closely with Rocky to understand and learn her preferred way of communication to be able to problem solve and be responsive to her needs.
A predictable and easy to follow timetable of support and activities was introduced which allowed Rocky to better manage her anxieties. Staff also started introducing activities in the house which enabled Rocky to have opportunities to engage in activities that were both meaningful and based around the things she liked. Rocky was now accessing the community for the first time in many years for walks and going to local shops to purchase her items of her choice.
Initially Rocky needed a lot of support to start accessing the community but with reassurance, use of social stories, and pictures the team enabled her to be more open and trusting of staff and less likely to want to self-isolate. Rocky is now opting to engage with her staff more, now spending time in communal areas and she will now regularly sit with staff in the kitchen.
Staff have supported Rocky to utilise safer strategies to manage her anxieties and supported her to extend her communication to share her wishes, choices and feelings that are no longer dependent on behaviours that present risk to her or others. This has had a significant impact on reducing self-harm behaviours and, with the support of her family, she now encouraged to engage in positive distraction activities when anxious.
With time and consistent support Rocky is now selecting her own clothes, is choosing her own meals, completing small daily tasks such as picking and preparing her own snacks, doing washing up, plating her own food at mealtimes, and with staff support completing cleaning tasks around her flat. Rocky is also now engaging in new activities such as arts and crafts, coloring, completing small jigsaws. She is also going out for walks multiple times a day.
Rocky will still experience periods of distress and anxiety however the personalized support she now receives means staff are now able to problem solve confidently and support Rocky respecting her wants and wishes and without the need of having to offer PRN medication.
The CLDT and LDISS teams have provided feedback that, after coming to see Rocky, they feel that she is now the happiest she has ever been they can see the difference the support she now receives is having on her life. Her mother is also very happy and grateful to the team for the support Rocky receives.
“I wanted to tell you how amazing it was to see Rocky. Instantly I could see that she was present. Lots of bright eye contact smiles & hugs. Rocky’s skin on her legs & arms were clear & unblemished without the usual self-harming marks. In fact, I thought Rocky could have done an advertisement for a dove self-tanning product, her skin healthy glowing. Rocky opened three bottles of color changing bath bubbles & collected three small containers, pouring equal measures in each & wiping up the excess spills with a cloth. It was the best visit that I have had in a very long time. It only goes to show how much progress Rocky is making & what therapeutic work your team is accomplishing. Thank you.” Rocky’s Mum
Rocky’s newfound trust in staff, along with the reassurance that she can pursue her interests even in the face of unexpected challenges, has resulted in a transformative and significantly improved quality of life. And this change is clearly evident to all those who know her.