Background

Nural had been in and out of hospital for half her life. Before she came to Look Ahead in East London she’d spent eight years in a secure unit.

She has learning disabilities, autism, schizoaffective disorder, emotionality unstable personality disorder and exhibits behaviours of distress – as well as having physical problems including diabetes and mobility issues.

The complexity of Nural’s conditions cause her to experience severe mood swings, which have resulted in incidents of verbal abuse and physical assaults.

Many of Nural’s placements had broken down before or she had attempted to leave them.

Following a detailed assessment, Look Ahead decided that Nural could be offered a placement to suit her needs and a plan was put in place that focused on supporting Nural to regain control during periods of distress and to gradually re-integrate her back into the community.

Transition to Look Ahead

Look Ahead staff visited Nural in hospital and talked to staff about how best to support her and how to prevent her behaviours of distress. In addition, they shadowed staff to learn about what was working well for Nural and what wasn’t. They wanted to ensure that Nural’s placement would be a success this time.

Nural also visited her new home at Look Ahead, so that she could familiarise herself with the environment ahead of her arrival.

Look Ahead staff are trained in Maybo, the human-rights based model of care that promotes respect and individual choice to lessen her behaviours of distress. They learnt to speak to Nural in a calm voice, using clear and simple language to manage her anxiety. In particular if Nural had to wait for something, staff explained why and exactly how long the wait would be, putting Nural back in control.

Settling in

Initially Nural had wanted to return to the familiarity of a hospital environment but by using a positive behaviour support framework, staff re-directed Nural, emphasising that she now had a new, safe home.

Staff have enabled Nural to get more involved in her own support and she has developed relationships of trust with the team. They support Nural to choose her daily menu using pictures, while Nural is fully involved in day-today activity planning and making her own choices, whether it’s doing a puzzle, playing a game, or tidying up the house.

Staff applied learnings from visiting Nural in hospital, recognising the importance of routine in Nural’s life. They determined that she was best supported by having a set structure to her days, with a timetable of activities in place, as even minor disruptions to her routine could be upsetting.

Nural has since been fully involved in planning her days and supported to use a calendar, which has resulted in her feeling much happier. In fact, Nural is so involved in her day-to-day support that she even gives the handover to new members of staff coming on shift!

Look Ahead staff have also worked in close partnership with mental health teams, occupational therapy and a dietician and Nural’s overall health has steadily improved.

Monthly visits were arranged to see family, while Nural was provided with a mobile phone, enabling her to call or send messages to family whenever she liked. In previous settings this had been restricted.

Empowering Nural has been key to improving the quality of her life, coupled with her re-integration back into the community. Her life has been truly transformed.

Person-centred support

Putting the individual at the heart of decision-making is key to Look Ahead’s approach. We know that it empowers individuals, enabling them to achieve greater independence and that it improves wellbeing

From the outset Nural has been involved in decisions over her care. She took part in interviewing staff and gave feedback, choosing the key worker who would go on to support her, as well as selecting the furniture and curtains for her own flat.

Look Ahead staff support Nural to write her own shopping lists and make her own menu choices on a daily basis. She has the flexibility to change her mind. This has resulted in Nural improving her diet, helping her to lose weight and get her diabetes back under control. The service has bought her a walking frame with a seat to enable her to go out more, with the ability to rest.

Progress

Nural’s quality of life has improved on every measure. On coming to Look Ahead, Nural needed 2:1 support, but this has been reduced to 1:1.

Staff have got to know Nural and understand her triggers and how to de-escalate situations. If Nural becomes upset about a disruption to her routine, Staff explain calmly why there has been a delay and how long that will be, supporting Nural to accept the situation.

Nural now attends college with a support worker, where she studies art and healthy cookery and enjoys socialising with friends.

She takes trips locally to parks and the library, while enjoying outings further afield to London Zoo, as well as a recent day trip to Brighton.

She continues work with staff to decorate her home, where she is very settled. Her placement with Look Ahead is the longest one she has ever had.

Happily, she has also taken her first ever holiday!

Service manager Adeola Adejuwon said: “Nural has achieved so much at Look Ahead. She now communicates much more and has made some real accomplishments to be proud of.”

In 2021, Nural was nominated for Look Ahead’s customer award and won it. She received her award from Look Ahead’s CEO, Chris Hampson. A truly memorable event for Nural and her network.