Paula's 8 Step
1)Paula gets very distressed on returning from the day centre to her small well managed and safe residential home.
2) She talks very rapidly and it can be hard to understand her. Often she shouts, screams and cries.
3) The staff has to spend a lot of time calming Paula down. After some time, which can last up to 45 minutes, she calms down and seems back to her usual self.
Step 1 Deciding where to start
The priority was to try to reduce the duration of Paula’s distress. Staff at the day centre and at the home had been in frequent contact to ensure that there weren’t any identifiable causes in either place that could account for her distress.
Paula’s screaming, crying and distress on her return were selected as the most important behaviours to focus on
Setting- the transition from the daycentre coach to the house where Paula lives.
Triggers- not being listened to or having time to talk, and being told to go to her room and relax.
Results – staff got into a situation that the more they told Paula to go to her room, the more she screamed and the more time different staff spent with her trying to calm her.
Step 5: WHY? What is the meaning of Paula’s behaviour from her point of view?
Paula finds the transition from one place to another difficult and is not always sure what is going to happen. Although she likes going to the day centre, a lot happens during the day. On her return she tries to communicate to the staff what has been going on, but she struggles to get the words out and gets frustrated and angry. The staff tell her to go to her room and hang up her things and relax, but she is not ready to relax. There is too much on her mind and staff is not paying enough attention to her and helping her to settle down and letting her know what is happening.
Step 6. PREVENTION for Paula
Establishing a new routine for Paula and the staff.
Assign one member of staff to meet and greet Paula on her return.
Once Paula has taken off her coat, invite Paula to sit down with the member of staff in a quiet space. Tell Paula that you would like to hear what has happened during her day. Say you are going to talk for 10 minutes (use timer) and then you are going to go with Paula to put her things in her room and get started on her drawing. The principle of Now and Next was used to orient Paula and give routine and predictability.
Step 7: Replacing Paula’s behaviour with new skills (What do we want her to do instead?)
Paula started to see that staff would help her to talk about her day, and the meeting and greeting ritual helped her to manage the transition from Daycentre to Home. Paula came to see that she didn’t need to scream to get someone to listen to her and as she was calmer she could tell her story better. The set time for the event, helped Paula to know when to stop and move on to the next task and was a realistic demand on staff’s time.
Step 8: Change the results for Paula, and encourage behaviours we want to see.
Paula and staff both knew what would happen on her return. Paula knew that staff was interested in what she had been doing and what had happened to her. She seemed especially pleased when staff took notes of what she was saying and kept those in a folder she had chosen. This meant that she felt important and wanted.