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Case Study 

Names and identifying details have been changed to protect the privacy of individuals.

Edward's Story

We would like to tell you about Edward, a very athletic 12 year old boy with a keen interest in swimming and soccer and a love of imagination play and board games.

Three Steps -

Edward was first referred to Three Steps in 2008 as his behavioural outbursts had left his guardian feeling unsafe in the family home. After a period of assessment and intervention his behaviour began to stabilise and he returned home in autumn 2009. However Edward’s behaviour became unpredictable again, with behaviour outbursts, including verbal and physical aggression in the family home. Edward’s school also reported a significant increase in challenging behaviours and that he was appearing increasingly anxious. He was on a reduced timetable in school due to his presentation, behaviour and mood and he found it difficult to engage with his peers and did not wish to participate in his school curriculum. After a few months at home, Edward returned to Three Steps.

Some of the diagnosis or areas of deficit Edward presented with were impacting his everyday life. These included a diagnosis of Moderate Intellectual Disability which led to some difficulties in communication. Although Edward could communicate verbally, he had difficulties retaining information. Edward was also diagnosed with a mood disorder. When he became anxious or over-excited he struggled to control his emotions and this could lead to high levels of challenging behaviour including physical aggression, verbal aggression and self-injurious behaviours.

Edward was also diagnosed with Foetal Alcohol/Drug Syndrome which led to deficits in social skills, poor judgement and decision making. He had a tendency to fixate on particular topics and often these topics would have a negative connotation for him. Furthermore there was a query of Temporal Lobe Epilepsy with Edward first experiencing possible seizure activity as an infant.

During his time with Three Steps, Edward was supported in many ways by our multi-disciplinary team who worked together with him, helping him to achieve positive changes in his day-to-day life. Edward attended regular Occupational Therapy (OT) Sessions which took place in a specialised OT room located on the grounds of his home at Three Steps. He also took part in monthly Speech and Language Therapy sessions. His psychiatric needs were overseen by our Consultant Psychiatrist who reviewed and altered his medication as necessary. Interventions where put in place to assist Edward in expressing his emotions as well as develop his comprehension and pronunciation skills.

Edward made great progress, acquiring skills to enable him to self-regulate his emotions, which in turn resulted in a marked reduction in aggressive behaviour. He achieved this through the use of social stories, role play, visual thermometers to help him identify his emotions, engaging in calming conversation with the Three Steps team and in therapeutic programmes such as “In My Shoes” with our Counselling Psychologist. This programme specifically explored emotional awareness, identity and relationships.

Edward built strong relationships with the team at Three Steps. The use of social stories and role play greatly helped Edward in retaining information. The team completed daily therapeutic work with him to help him achieve the goals he had identified during his Person Centred Planning process. This led to the completion of a Personal Plan which informed every aspect of Edward’s care at Three Steps.

Edward’s community involvement, activities and social relationships improved greatly throughout 2013 and 2014. Together with his Three Steps keyworkers, he engaged in setting SMART goals which supported him in accessing community activities and helped him to develop social relationships. For example he joined the local Arch Club and Special Olympics Club. Edward went swimming in the local pool and enjoyed visiting the local shops and restaurants. The use of SMART goals helped to reduce Edward’s anxiety, allowing him be more open to trying new things.

Through the therapeutic work completed with Edward, his presentation, behaviour and mood improved. Gradually he was exposed to increased time in school. He displayed positive behaviour and excellent social skills in school and was happy to engage in all programs ran by the school including swimming lessons, cooking classes, out-and-about activities as well as attending his Debutante Ball with his school peers and teachers. Edward finished his school year by attending school five days a week for the full scheduled time, graduating in 2014. He subsequently commenced his adult day placement in November 2014.

One of Edward’s final goals at Three Steps was to increase his independence and prepare him for the possibility of returning to live with his Guardian. An extensive transition plan was put in place, gradually reducing his reliance on the Three Steps team and increasing the time he spent at home. This was done at a pace which ensured both Edward and his family’s needs were met during this transition period. Edward moved home to live full time with his guardian in August 2015. We continue to miss him, but we are so happy and proud to have been part of all the positive changes he achieved.