Allied Health Professionals working in Local Authority

Case study 1

A case study of the impact and interventions of an Occupational Therapist in a Local Authority by Sarah Crawley, Paediatric Occupational Therapist, Doncaster Council

Paediatric OT Case study – Roger

Roger has a diagnosis of Autism, sensory processing disorder, sleep disorder and moderate learning difficulties. Roger attends a mainstream school, however he often doesn’t attend school, spends most of his time in an in house support unit.

Roger is a young teenager and the eldest of 7 children. He lives with his parents in a 3 bedroom Local authority property.

BEHAVIOUR IN SCHOOL

He has 1:1 support in his lessons and access to a “bridge” card, which allows him to leave his lessons when he becomes overwhelmed. Roger also wears ear defenders at school and he leaves his classes 5 minutes early, to help him cope with all the other children in the school moving around the corridors. The use of mood cards are successful in managing his behaviour and help him to communicate how he feels, as sometimes he struggles to articulate verbally when he is anxious/overwhelmed/angry.

BEHAVIOUR AT HOME

Roger struggles to manage the busy home environment. He becomes overwhelmed and his ‘go to’ method to communicate this is behaviours that challenge. It is reported that he can be aggressive towards his mother and siblings. As with many siblings, Roger and his younger brother, do not get on well. Due to Rogers autistic traits, learning disabilities and sensory processing disorder, he quickly escalates disproportionate confrontation and aggression and significant disputes in the household can erupt. Parents find it very difficult to de-escalate and keep siblings safe during this time.

RISKS IDENTIFIED

In order to maintain Roger and his siblings safety, and enable Rodger to manage his behaviour, he requires his own bedroom space. Their current home is not big enough to allow this.

On discussion with the family, it was agreed that the family required a larger property and would need to move on the basis of medical need.

OCCUPATIONAL THERAPY INTERVENTIONS

1. Support the family to be re-homed into a larger family home – a 4-bedroom parlour (2 reception rooms) – Occupational Therapy competed a report to clearly identify Roger’s needs and that of his family. This was agreed between the Local Authority and Housing provider.
2. A house identified by Local Authority (accessible housing team) – OT viewed the property for suitability and identified further works to meet the needs of the family.
3. OT requested a ground floor bedroom to include a shower room. The shower room would benefit the family, as there are 9 people and only one bathroom.  The shower room was agreed based on its accessible design. This would future proof the property as an adapted family home for the next family to move into.
4. All adaptations approved and the property is accepted and the family move in, with the knowledge that a 5^th bedroom and additional bathroom will be created.

OUTCOME

Having the additional bedroom space allows Roger the space for him to settle to sleep without disturbing his siblings.  His siblings can go develop a manageable bedtime routine.

This has had a positive impact on the sleep of all the children, including Roger. The bedroom for Roger is downstairs and it allows him to manage his emotions and regulate himself without having to be too far away from his parents, who can monitor him whilst caring for their other children during the day.

By taking a whole family approach, the dynamics in the house have improved significantly which creates a positive environment for all the children to thrive in.

In Part 3, we will be looking specifically at the role of Occupational Therapists in Local Authorities.