Steve

TEETH CLEANING CARE PLAN(modelling)

o I would be grateful if you would escort me to the bathroom each morning and evening and support me to clean my teeth. Would you please ensure that my toiletry bag is in the bathroom when I arrive.

o I will firstly place a small amount of toothpaste on my brush and begin to clean my teeth. Please could you demonstrate how I can go about cleaning my front teeth.

o If I appear agitated and rub the top of my head with the palm of my hand, or mutter swear words under my breath, please stop the demonstration and ask me if I would prefer not to clean my teeth at this time.

o If I appear happy to continue, please demonstrate how I might go about cleaning my back teeth. Your encouragement and praise would be greatly appreciated.

o If I appear agitated and rub the top of my head with the palm of my hand, or mutter swear words under my breath, please stop the demonstration and ask me if I would prefer not to clean my teeth at this time.

o Next, would you kindly demonstrate how I can clean the backs of my teeth. Your praise and encouragement would be valued.

o Would you now ask me to clean my tongue. I understand the importance of this action, with regards to my halitosis, and I am generally happy to do this. However, should I present with challenging behaviour (i.e shout at you, shove you), you should inform me that it will not be necessary for me to proceed with this activity.

o Please demonstrate how I might go about cleaning my tongue; offering praise and encouragement.

o When I have placed my toothbrush and toothpaste back inside my toiletry bag, would you kindly encourage me to take the bag to my room so that I can place it inside my cabinet.

Steve

MEAL-TIME CARE PLAN(physical prompting)

o Please ensure that I only have a small amount of food on my plate at meal times. This will reduce the risk of me choking.

o To further reduce the risk of choking, and to avoid any instances of challenging behaviour towards other clients, I would be grateful if you would ensure that I am constantly monitored during meal times.

o If I should load a large amount of food onto my fork or spoon, would you please touch my left forearm (I am left-handed) to indicate that I may be at risk of choking. I would be grateful if you would praise me for removing some food from my fork / spoon.

o Should I become verbally aggressive towards a member of staff; tell me, in a calm and reassuring tone, that they are not interested in taking my food.

o If I still appear somewhat agitated, or if I begin to rub the top of my head with the palm of my hand, please assure me (in a quiet tone) that no one will attempt to steal my food.

o If I should begin to swear at a member of staff, or make threats of violence, please ask me what it is that has upset me and then offer reassurance in a calm and soothing tone.

o Should I continue to swear or make threats, kindly ask me if I would be happier to eat my meal later. If I say that I would, please escort me into the lounge area until I have confirmed to you that I am ready to eat my meal.

o If I am observed to eat my food at a rapid pace, would you please place a hand, very gently, on my left forearm to indicate that it would be safer for me to take my time and eat slower. Praise for my compliance would be appreciated.

o I value a high level of praise during meal times for my pleasant and sociable behaviour.

Steve

HOUSEHOLD ACTIVITY: DUSTING

(low arousal - interaction)

o Each morning after breakfast I participate with the cleaning of the home by dusting the lounge area. I can achieve this independently but I would be grateful if you would observe me as I carry out this activity.

o I sometimes refuse to dust the lounge but with a little gentle encouragement and some praise for my previous efforts, I will usually take up my duster and set my mind to the task.

o Should I flatly refuse, please do not pressure me to complete the task. o I may at times appear agitated. You can support me to complete the

dusting by offering encouragement and reminding me that I usually enjoy a nice mug of tea and a few biscuits when my work is done.

o If the actions of a staff member appear to bother me, please assure me that they are not making fun of me.

o If I start to shout at a staff member, or attempt to lash out and slap the person, ask me in a firm but calm manner to stop. Remind me later on

to apologise to the individual for my poor behaviour. I like to say that I am sorry for my actions but I sometimes need reminding.

o I take pride in dusting the lounge and I like carers to praise my efforts and comment on my thoroughness.

Steve

MEDICATION CARE PLAN (shaping)

Please tell me when it is time for me to have my medication. If I say that I don't want my medication at this time, please offer

encouragement and tell me I need to have my tablets because I may become poorly without them.

Ask me to go into the kitchen to collect a cup of water for when I am given my tablets. Sometimes I will go to the kitchen and forget why I went there. Please remind me to remove a cup from the top drawer and half-fill it with cold water from the tap.

I may simply bring back an empty cup. If you would remind me to half-fill it with cold water I would be grateful.

Steve

Pen Picture and Behavioural Intervention Strategies

Steve is a forty year old gentleman with moderate learning disabilities and

challenging behaviour. He lives in a residential home with six other clients.

Steve likes to brush his teeth first thing in the morning; and a teeth cleaning

care plan, based on a modelling strategy has been put into place to support

him. Steve appreciates it when a staff member demonstrates how someone

goes about cleaning their teeth. Steve likes to help out around the home and

takes pride in doing the dusting each morning. He is supported to do this with

an intervention strategy that incorporates low arousal. Steve values gentle

encouragement when carrying out his work. He likes to receive praise for his

efforts, and when the work is done he likes to receive a cup of tea and a

biscuit.

During meal-times, Steve has been seen to choke on food items. For this

reason, a meal-time care plan, based on a physical prompting strategy, has

been put into action. A staff member will gently rest one of their hands onto

Steve’s forearm to indicate that he is loading too much food onto his fork /

spoon. An intervention strategy focused on shaping Steve’s behaviour has

been introduced at medication times to remind him to collect a cup of water

from the kitchen.