Case Studies

Our TA and PBM discussed with Oliver that the personal hygiene responsibilities are all important tasks to carry out, pointing out that germs would continue to make him ill and that he would feel better when he was clean. We arranged a trip for Oliver to go to Alfreton with staff and buy some personal hygiene items. He engaged well on the trip and chose the items himself, including:

• Tutti-frutti flavoured toothpaste

• Strawberry mouthwash

• Tea tree face wipes

• Hand sanitiser gel

• Berry scented dry shampoo

• Scented antiperspirant

To try and help encourage Oliver to use these items, a reward chart was set up which allows Oliver to monitor his own progress. On a daily basis, there are also agreed hygiene routines to help him to further manage his personal hygiene.

In addition to the small class-based activities, Oliver engaged in a range of planned activities which all produced very positive interactions between Oliver and staff. These included:

• Assembling his own sensory box

• Bike riding

• Time at parks

• Visiting Brook Garden Centre and Meadowhall

• Walking

The team at Eastwood Grange School developed a range of planned strategies for Oliver to further help improve his skills. These included:

• Oliver using his sensory brush at least four times a day

• Writing in a notebook to state how he is feeling and what is on his mind

• Completing core work in the morning, as Oliver struggles to complete any work and becomes disengaged often after lunch. In the afternoon, he takes part in physical or social activities

• After each lesson, Oliver goes for a short walk to help him avoid becoming restless

• If Oliver is struggling to concentrate in lesson, the use of his sensory box enables him to re-focus, using the items in his box

• When Oliver becomes quiet and doesn’t respond, we try giving him plenty of time to process. We give Oliver two options at the most, and a set amount of time in which to make a decision. Once the time is up, staff will make the decision and communicate this clearly to Oliver

• Having cards with emojis helps Oliver to explain how he is feeling

• A structured and compiled timetable for each day, as Oliver likes to know what he is doing the next day

• Giving Oliver the opportunity to work with the others in class. However, if this starts to unravel, an alternative room is designated for him to continue working 1:1

Oliver and the TA put together a sensory box, and went on a trip to Meadowhall to find items that would help him to settle, when required. Various shops were visited and the items found for his box included:

• Bubbles

• Modelling clay

• Sensory balls

We also bought a fishbowl for sensory tasks and a crossword book, which Oliver says helps him to relax.

Since arriving at Eastwood Grange School and through the staff team identifying Oliver’s requirements, the outcomes have been remarkable, in terms of Oliver’s mental wellbeing and his engagement in both developing new relationships and learning. Oliver has really progressed and both his personal hygiene and communication skills have also increased.

Oliver has been working in a classroom on his own with staff, which has made it easier for him to settle. Oliver is even completing all of his work and asking for more, which would have previously been unimaginable when he arrived at the school.

Joseph experienced a difficult early childhood, with his mother undergoing considerable stress during pregnancy. In order for Joseph to adapt, he developed defence mechanisms to help him cope, and established a strong need for control in his life. He found relationships difficult and would see them as threats. Joseph would therefore view them in terms of taking attention away from him and removing control from him. Staff and other young people can fall into these categories, and he had a fear of people.

With the above, Joseph’s limbic system and defence mechanisms were activated, and he would seek control of situations or people in order to calm and soothe. This would however not gain the desired results because of the impact it had on others and instead triggered the cycle again, where he then needed to try a different approach that might increase in intensity. Joseph would usually require adults to intervene and help with emotion regulation.

The assessment also highlighted the following issues about Joseph:

• Joseph demonstrated poor social interactions, play and communication skills. These may be explained by the pending ASD assessment or linked to the need to control situations or people

• When Joseph struggled with emotional regulation or anger emerge in a classroom, he usually disrupted the class and became the ‘class clown’ or directed his difficulties towards others

• For issues with Joseph’s working memory, clear short instructions that are written down would help him to follow them and remember what is being asked

• Joseph’s physical tic when he became anxious or stressed, that didn’t cause him a problem, can be a good way for staff to know when to start helping him with emotion regulation and self-soothe skills

Planned strategies formed part of Joseph’s What Works Plan, accessed by all staff. This included:

• A guide to a safe space and giving Joseph alone time

• Keeping other young people with whom Joseph has had issues with away from him

• Asking Joseph what the matter is

• Giving Joseph the chance to vent his frustrations

• A weighted blanket or anything weighted, and possible pressure tactics

• Using fans or keeping him cool. Joseph would get very hot in a crisis, potentially increasing his time in crisis

• Giving him processing time but not making this too long to prevent his over-thinking issues

• Safe and familiar staff engaging in physical intervention with Joseph when attempting to damage or displaying signs of heightened and anxious behaviour

• Not following Joseph too closely or having a group of staff with him. He likes staff that he knows to be near, but not up in his face

We are constantly seeing an improvement in Joseph’s behaviour, with the support of staff members at Eastwood Grange School.

In the below, which is summarised from our weekly analysis of physical interventions and serious incidents of Joseph’s attendance time at school, we witnessed a decrease in him being involved in incidents from 24.1% over a term to 13.0%. This is the equivalent of Joseph having one less half-day per week involved in incidents of a serious nature.

Autumn term:

2 - Incidents, including RPIs 24.1%

Spring term:

1 - Incidents, including RPIs 13%

Difference between the 2 terms = -11.1%