1. Managing Anxiety and Aggression
Laura Brame
Behaviour Practitioner
Positive Behaviour Intervention Team
Consensus / Gretton Homes
PBS 1-day

2. Prader-Willi Syndrome (PWS) Autistic traits
“Susie”
34 years old
Prader-Willi Syndrome (PWS)
Autistic traits
Lives in a residential service with 6 other individuals with PWS
Susie not real name
Moved into service in 2005.
PBS 1-day

3. Challenging Behaviour
Main challenge = Verbal aggression
Also environmental + physical aggression
Often as a result of obsessive behaviours
(money, post, Christmas)
Incidents fairly severe for this service
7 incidents during baseline assessment phase
Average duration (1hr 20)
Longest incident (5hrs 30)
Big impact on other individuals that lived there
Verbal aggression directed towards staff and other supported individuals
If escalating then may lead to environmental and physical aggression, usually this was directed towards staff
Needs not met immediately, misunderstanding or misinterpreting what had previously been said, uncertainty
Severe in relation to other level of challenges
Longest incident fluctuated in intensity
PBS 1-day

4. Assessment Staff meeting to discuss current strategies
Individualised ABC recording forms, staff questionnaires, rating scales, direct observations
Findings
Uncertainty & Inconsistency
Majority of incidents occurred either around mealtimes or involved food
Staff could recognise triggers post-incident
Uncertainty around ‘best’ practice
Inconsistency between and within individual approaches
Food – involved in some sort of way (activity containing coffee – inconsistency within service menu options)
Staff knew but couldn’t adapt knowledge to prevent incidents occurring
PBS 1-day

5. Function “Access to tangibles” Physical item OR
Resolution to something that Susie perceived to be a problem
Risk factors
Presence of, or discussion around, food
Tiredness
Previous frustration or misunderstanding
Problem – uncertainty around a key worker activity, information had been written in the diary but Susie had forgotten
Food or other obsessions
Risk factors that made escalation more likely rather than being able to quickly reassure and distract
PBS 1-day

6. Interventions Communication workshop Consistent use of visual supports
Different ways of communicating, Difficulties in understanding and expression, Active listening
Consistent use of visual supports
Calendar and diary use, objects of reference
Social story and guidelines around Christmas
Clear expectations, Christmas post box
Positive Behaviour Support Plan & Communication Plan
Ensure consistency and clarity for staff team
Workshop – all staff attended, individualised around Susie
Visual supports to be used both pro and reactive
PBS – includes information around function, triggers, pro and reactive strategies
PBS 1-day

7. Comparative data Post-intervention data = 0 incidents!
Average duration comparison
Decrease of 45%
1hr vs minutes
Longest duration comparison
5 hrs vs hr 30
0 incidents so looked at previous months recordings to gain comparative data (end of intervention introduction period)
PBS 1-day

8. Thank you for listening!
Questions?
Thank you for listening!