Pam Westmoreland (Social Worker) Darren Parkinson (Community LD Nurse) Calderdale Disabled Children’s Team

 Repeated referrals coming into the team for Children/Young People who had problems managing their anger  All Young People in same school  Positive benefits of group work instead of 1:1 - opportunities for mutual learning - time/resource issues

 Anger is a normal human emotion - it can lead to challenging behaviour but can also have a positive effect (Harris, 2001)  Programme based on Cognitive Behavioural Therapy (CBT) approach orientated towards skill development (Taylor and Novaco, 2005)  Research shows that CBT can be effective for people with mild LD and some with more severe LD (Willner, 2005)  Limited amount of literature on outcomes of interventions for people with LD (Willner, 2005)

 Multi- Disciplinary approach - - Intensive Support Nurse (LD) - Community Nurse (LD) - Social Worker - Clinical Psychologist Student - Teachers (x2) - Teaching assistant - Signing Support (BSL)

 Discussion with families and schools about issues  Baseline evaluation sheet – completed by parents and/or school staff  Use of Anger Log Sheets – weekly – completed by school staff with students – very useful tool

 13 sessions in total - carried out every week for a full school term  Sessions last for no more than 1 hour  4 children in group aged 14 – 17 with mild to severe LD, 1 Young Person with additional hearing impairment  2 staff from Disabled Children’s Team and 1 from School  Programme now run twice – different Young People

 Why manage anger?  Experiencing Anger in the body – Physical Signs/Feelings  Behaviour/Feelings Recognition – Identifying Anger  Anger Hierarchy/Anger Tornado  Coping mechanisms/Strategies – what to do when you feel angry

 Boardmaker symbols – used to reinforce verbal information  Helps to identify emotions, physical signs of anger, identify strategies to help etc  Other pictures/visual information also used  Visual information beneficial for Young People with limited Verbal Communication

 Used throughout sessions – very effective  Used in helping to identify emotions - staff act out emotions – Young People then identify  Role Played both ‘made-up’ scenarios and ‘real’ scenarios – based on anger log information  Staff model at beginning – children copy and develop once confident  Repetition beneficial

 Games – trust game at beginning as ice- breaker  Quiz – used at halfway point for revision  DVD’s – Transporters - Fawlty Towers

 Guided Relaxation – used at end of every session  Helps calm Young People down before leaving for next lesson  Young People really enjoyed this!

Based on Taylor and Novaco (2005) but adapted to children’s particular needs e.g. increased need for visual reinforcement, repetition, role play Effective communication Interpreting other peoples communication Thinking differently about anger Personal Reminders (in ‘Anger Book’) Deep breathing, Counting to 5 or 10 Leaving the room Walk away Asking for help Role Play really important in developing these skills Visually reinforced strategies with symbols/pictures

 Home, school and other agencies involved all received a copy at end of programme  Enable consistency between settings  Explains what makes each person angry  Explains what to do if feeling angry

 Evaluation sheets provided to school – not returned, however positive verbal feedback from staff  Student evaluation sheets – evaluated positively  Positive informal evaluation from Young Person’s placement

 Reflected on need for increased visual reinforcement after 1 st programme  Need for increased contact with home/placement  More formal evaluation would be beneficial  Programme reflected research that more positive outcomes are achieved for more cognitively able Young People  Strategies need to be constantly reinforced in all settings  Benefit of different disciplines working together to devise and deliver programme  Feedback and observations were that sessions were overall enjoyable and positive for all Young People

 Harris, J B (2001 Working with Anger in Therapy – A Gestalt Approach, Manchester Gestalt Centre.  Taylor, J L + Novaco, R W (2005) Anger Treatment for People with Developmental Disabilities – A theory, evidence and manual based approach.  Willner, P (2005) The effectiveness of psychotherapeutic interventions for people with learning disabilities: a critical overview; Journal of Intellectual Disability Research, 49 (Part 1) pp73-85.