Who
An autistic individual who has experienced a number of difficult experiences in her childhood which have led to difficulties in making and maintaining relationships, building rapport with others and particularly transitioning between activities and spaces
Why
She was moving home due to a placement ending – she required extensive support to ensure this move went smoothly including trauma informed processes, compassion, planning and involving her at every stage.
She had not left her home for 18m, her bedroom for 6m, and was on her phone for approx. 19 hours a day with minimal interaction with staff. She often declined to eat and wash.
How
Building rapport – to learn from her and the current team about what she likes, what makes her happy and what her wishes are.
Core Team – trained and supported by the PBS team in Active Support and Trauma informed care. A combination of modelling, prompt fading, desensitisation was used to gradually build trust. A low arousal/demand approach was used with indirect instructions (led by PDA strategies) to ensure she felt safe. Staff were incredibly patient and took her lead – joining in with activities that she liked.
Choice – she was involved at all stages – making choice and saying when she did and did not want to get involved.
Progress
Over a period of a few weeks she began to lift her head and make eye contact. She began to make choices by pointing and taking coloured pencils. She started to smile and seek comfort from the staff. They supported her to wash and to change her clothes.
Over time she started to get out of bed and to seek support.
The move – To do this, we focused on her interest in being a princess. The team talked about how they might decorate her new flat to look like a castle, and showed photos of the flat and asked her to draw where she might want her furniture, or what colour decorations she wanted. She prefers darkness so included this in the planning and brought items such as a red carpet to act as a fun prompt of where to walk! She also had sensory items for the car as well as visuals, videos and other preferred items to help her feel safe.
The move was eventually successful and she has now been settling in – she washes daily, does her chores, uses the toilet and leaves her home daily. She has built strong trusting relationships and has been able to access all health/medical centres to support her well-being. She has even started college! She has times of difficulty and will find transitions hard – her team are patient and never rush her. She is continuing to explore new activities and in turn her time on phone has reduced (19hrs to av. 7), increasing her sleep time (8hrs compared to 5) and overall health.
Next Steps
To explore using public transport so that she is not constrained by taxis and to continue to build her confidence in college and making friends.