Practitioner: John Ball, therapy consultant.
Field: Young people who display challenging behaviour.
Location: Southern England.
Client: Dave*, 15 at the time of referral, now 18.
Case History: Dave was 12 when he was taken into care. In his mid-teens he was diagnosed with learning difficulties. He had struggled at a succession of residential special schools.
Dilemma: Dave is highly excitable and is easily over-stimulated, overreacting to both praise and disapproval. The dilemma is how to get him to engage with people in meaningful activities that also divert him from offending behaviour.
Risk Factor: Dave has been in court several times because of aggressive behaviour. Unless a successful intervention is found he seems destined to end up serving a long prison sentence.
Outcome: With nurturing and creative planning, Dave gets a service tailored to his needs. He responds well to the boundaries and the introduction of a smallholding. As a result, his offending diminishes and his behaviour improves.
*Not his real name
Dave* was 12 when he was taken into care after serious concerns about his home life where there was a lack of boundaries on sexual and aggressive behaviour, writes Mark Drinkwater. In his mid-teens, he was diagnosed with learning difficulties, but by then had been in court several times for offences related to aggression. Those concerned with his care feared he was destined for an adult life in prison.
At 15, Dave was referred to New Forest Care, where the initial assessment is based on the service user’s needs. “I assess what’s needed rather than see if someone can fit into an existing service,” says therapy consultant John Ball.
At first, Dave was a “ball of anxiety”. He had difficulty expressing himself and chose socially unacceptable ways of showing he was anxious. “He didn’t know how to deal with complex social situations,” says Ball. “Often, he would break things if he became upset because he didn’t know how to communicate appropriately.”
Initially, staff and residents were wary of Dave, whose aggressive behaviour often resulted in him being physically restrained. This was unpleasant, and an unsatisfactory response for those involved.
Finding the right approach with Dave was tricky. “Some approaches, such as cognitive-behavioural therapy, wouldn’t work with him as he does not have the capacity to understand the thought processes,” says Ball. “We needed to find something that would be appropriate for his level of understanding.”
The answer was to impose firm boundaries about acceptable social behaviour. Staff agreed a strategy to be consistently firm with Dave if he was behaving antisocially.
This was successful, but Dave needed more than this: he needed a safe environment with structure and purpose. Ball and his colleagues persevered with Dave, trying to find opportunities to promote positive behaviour through activities to channel his energy and enthusiasm. They set about looking for some socially acceptable interests, proactive strategies that diverted him from aggressive or sexualised behaviour.
Dave had shown some interest in manual work on his college course. “He did day release at a garage,” Ball says. “He did not enjoy the placement that much but he found that he could do the simple jobs well, such as cleaning the floor.”
With this knowledge, New Forest Care developed a smallholding for Dave at one of its properties to take charge of pigs and rabbits and rear rare breeds of chickens.
The initiative fuelled his interest in farmyard animals and how to look after them. This was the breakthrough with Dave’s development that Ball had been searching for. “The key was to find something that caught his imagination.” Ball says.
The smallholding has introduced a new dimension to the work at New Forest Care. “Other residents have become interested in horticulture and use the raised beds for salad and vegetable crops,” Ball says.
Dave’s offending behaviour is now history. His new-found responsibility has given him a sense of purpose. “He’s found his place and gets to talk to visitors who pass by,” he says. “It’s therapeutic for him and has had a positive effect on his behaviour. Meeting lots of people on a daily basis has calmed him down a lot. It gives him the feeling that he’s got a place in the world.”
* Names have been changed
Weighing up the risks
Arguments for taking risk
● Building on service user’s strengths
Everyone deserves services that build on their strengths. New Forest Care provided a combination of proactive and reactive strategies to help Dave manage his antisocial behaviour.
● Dave’s service is tailor-made
The service’s person-centred approach ensured they could tailor a service to needs as an individual. The smallholding provided a meaningful activity, with the opportunity to engage with lots of people in a safe environment.
● Wider appeal
Other service users might also be able to take advantage of this initiative.
● Long-term crime prevention
Without intensive support, Dave could have ended up in the adult criminal justice system, severely affecting his life chances.
Arguments against taking risk
● Expensive intervention
The intervention is expensive in terms of staff time and resources when budgets are tight.
● Significant set-up costs
The smallholding required significant set-up costs. If it doesn’t work, it will seem an expensive facility.
● Danger of reverting to old ways
If not managed well, there is a danger that Dave might revert to his inappropriate behaviour, which would put other service users at risk.
Practitioner: Mike Cane, social worker, Wiltshire social services
The fresh start at New Forest Care has been positive. It is pleasing to see the needs-led assessment, because starting with a list of services to fit someone into is limiting and curbs the imagination.
Although others earlier had put much into getting Dave this far, John Ball got straight to the root of the problem. Key approaches to Dave’s destructive behaviour must surely have been firm boundaries and consistency. Past successes, such as doing simple jobs well, were important seeds to nurture.
The person-centred approach is a vehicle to highlighting what someone likes doing, what others like about them and so on. I have seen people with learning disabilities with low self-esteem positively glowing with pride at person-centred reviews.
Some think that farmyard activities are old-fashioned and liken them to arts and crafts sessions. But it can be genuinely therapeutic. I once witnessed a man, an elective mute, who started talking to a goat, presumably because it was non-threatening to him.
A new life of chickens and vegetables would not suit everyone, of course. But the success in this case was down to identifying what was important for this individual.
Published in the 27 August 2009 issue of Community Care under the heading ‘Animals work their magic’