Health conditions:

• James has been diagnosed with Autism, learning difficulties, challenging behaviour, anxiety, and rheumatoid arthritis. James is suspected to have a personality disorder; James does not want to work with psychology/ psychiatrist for a formal diagnosis.
• James has had an ongoing health concern with his face becoming discoloured. His face will go red/ purple. It is currently being investigated to see if it is an allergic reaction or something else.

Medication:

• Codeine 15mg 2xtablets 8:00am and 19:00pm
• Sertraline 100mg 1xtablet 8:00am
• Risperidone 1mg 1xtablet 8:00am and 19:00pm 10-12 hours gap
• Lansoprazole 30mg 1xtablet 8:00am To wait 30-60 minutes for food
• Propranolol 40mg 1xtablet 8:00am
• Lymecycline 408mg 1xtablet 8:00am
• Fexofenadine 180mg 1xtablet 8:00am
• Circadian 2mg 1xtablet 19:00pm
• Adaplene gel PM only
• RoActerma 162mg 1x injection once a week on a Wednesday. James goes to the doctors to have this administered.

Behavioural management:

Known behaviours:

• Abrupt/sarcastic tone.
• Lack of eye contact.
• Appearing to isolate himself in his bedroom.
• Staring for long periods of time at a person/object/wall.
• Body Language – tense/restless or he may pace.
• Vocalisation – high in volume/low in pitch.
• Shouting or groaning.
• Does not want anyone close to him.
• Disturbed sleep/decreased appetite.
• Pretending to be fictional characters – usually crime related or violent characters from films or series.
• Appearing to mimic behaviour or speech of other individuals.
• Appearing to tell untruths about staff to family, staff members or service users.
• Verbal abuse.
• Screaming.
• Damaging property.
• Physical abuse (historically directed at Mum and brother) kicking/hitting.
• Disengaging from others.
• Saying staff will not let him eat/leave his room.
• Contacting mum and becoming verbally challenging towards mum – screaming / swearing.
• Intentionally pressing the fire alarm although there is no risk or sign of a fire.
• Appearing to tell untruths about staff to family, staff members or service users.
• James has been observed to be in his bedroom and have a two-way conversation with himself. For example, James has been observed to say, “Don’t fucking push me” “Don’t you fucking pinch me”.
• Contacting family or other professionals and shouting via phone call.
• Calling care management during these times

Triggers:

• Mum
• Being in pain with his arthritis
• Not understanding/processing conversations.
• Feeling people are laughing at him.
• Wanting to be supported by staff already on 1-1s/saying he doesn’t want allocated 1-1.
• Sensory overload (smells/taste/temperature/texture/sounds/too much activity around him).
• Not being able to speak to Dad on the phone.
• Speaking to Dad on the phone.
• Saying ‘No’ to James.
• Certain members of staff
• Finances- amazon spends
• Medication times
• Ignition- Neil
• Not being able to do something he wants to do
• Staff sickness
• Not having a 1:1
• Routine change
• Boundaries

How to manage this:

• Move others out of the area if it is safe to do so.
• Ensure there is a second member of staff within earshot.
• Be alert of your immediate environment and any objects that could be used impulsively in a dangerous manner (if possible, remove in a casual manner).
• Ensure your exit is clear.
• Pay attention to signs of physical pain/offer pain management strategies.
• Offer James a ‘way out’ – if he is in the middle of an activity, offer him the chance to end the activity. Do not put any further demands on him.
• Reduce environmental noise.
• Offer personal space/quiet space and no physical contact.
• Reduce talk to minimal, use a soft, neutral tone.
• Keep a predictable routine and familiar staff.
• Consistency is key – when James is displaying challenging behaviours, no more than 2 staff members to complete welfare checks/communicate with James unless there are concerns or if behaviours appear to be escalating.
• When completing welfare checks, 2 members of staff are to go upstairs but only 1 should be visible to James.
• If appropriate, emergency services such as the police may need to be called to help contain the situation.
• James appears to calm down once he has vocalised his feelings through swearing, shouting, and screaming. Staff to allow him time to express his feelings.