Great Interactions: Helping people overcome trauma as part of a Positive Behaviour Support (PBS) approach
Last November I attended a conference about trauma and its impacts for people with a learning disability. It made me stop and think about how many of the people we support have been through traumatic experiences in their lives. I also learnt that people with learning disabilities often aren’t diagnosed as having trauma related illnesses, but are instead labelled as having ‘challenging behaviour’. I have been thinking a lot about what we can do to better recognise the impacts of trauma for people we support and to help them to recover. This got me thinking about a few success stories and I realised that the common theme in what had made a difference was Great Interactions.
Sally moved into MacIntyre’s School last year. She had previously experienced traumatic restraints and as a result was very nervous, particularly during personal care. This resulted in some significant behaviours of concern directed towards herself and other people. Staff quickly recognised the impact of her previous experiences and the importance of building really good, trusting relationships with her. The staff team focused on using their Great Interactions to slowly gain her trust. Most significantly, the team used their creativity to explore different ways to engage Sally positively. They carefully observed and recorded her reactions to different approaches and reflected on what they had learnt regularly with the support of a member of the School PBS team. This helped them develop a detailed set of guidance ensuring everyone could support Sally in a way that makes sense to her. It was a hard journey for the team supporting Sally but with commitment and Great Interactions they have achieved amazing things. Sally now attends school every day, accesses the local community, allows staff to wash her hair, has returned to a healthy weight and, most rewardingly, she now smiles regularly! Incidents of behaviours of concern have also reduced significantly.
Jake moved into his own home supported by MacIntyre in 2016 after 10 years of living in various residential school and hospital settings where he experienced very frequent restraint and seclusion. These experiences and Jake’s separation from his family have been extremely traumatic. As a result Jake was extremely anxious about contact with people and communicated primarily through extremely frequent incidents of aggressive and self-injurious behaviours. The team in Jake’s new home worked closely with PBS Coaches and Clinical Psychologists to understand his behaviours fully and develop a plan. The plan started by very slowly and gradually introducing staff into Jake’s environment for short periods of time. Using careful observation and reflection the team have been able to very slowly build their interactions with Jake. Understanding his previous experiences has helped the team to understand why Jake can sometimes react the ways he does to their presence and has helped them to remain patient and reflective about how their interactions impact him. Understanding the communication styles that help Jake to relax and those that seem to trigger trauma memories has been one part of this. As a result, Jake now trusts the staff team and they are able to enjoy activities such as swimming and eating meals together. He has also started to communicate using his voice and no longer takes any psychotropic medications.
Zaffie is supported by MacIntyre No Limits. Recently she was supported by her Community Learning Facilitator and Hannah Grimshaw, Lead PBS Coach, to attend a PBS Special Interest Group and talk about her life experiences. Zaffie also experienced an extremely traumatic time before starting support with No Limits. During her presentation she described her first meeting with her No Limits staff and how different it was to the previous professional who had visited her. She described the warmth she felt at that first meeting which helped her accept the support and eventually leave her house for the first time in a long time. Zaffie was naturally very nervous about her first time public speaking and I remember observing Hannah while they were waiting positioning herself opposite Zaffie and using gentle touch on her hand to help her feel calm. Zaffie’s Community Learning Facilitator had also listened to Zaffie and understood the importance of eye contact to her. As a result they arranged the presentation as a seated interview between the two of them allowing Zaffie to experience a Great Interaction with her Learning Facilitator throughout. It was clear from her presentation that without MacIntyre Great Interactions from day one Zaffie would never have come on such a huge journey from being too fearful to leave her house to now having presented in front of several large audiences.
"Through just one relationship with an understanding other, trauma can be transformed and its effects neutralized or counteracted."
(Fosha, 2003, p.223)
Your Great Interactions really can transform lives.
I will be running a workshop about trauma and PBS at the March PBS Special Interest Groups and would love to hear your stories of how Great Interactions have helped other people overcome trauma and anxiety.
Head of Positive Behaviour Support (PBS)
* People’s names have been changed in this blog