Clinical Support Services
Our philosophy is unreservedly non aversive in nature. We operate within a person centred model of support. Our practitioners focus on developing wellbeing approaches for a whole range of issues.
Who do we support?
We provide a range of supports for children and young people, intellectual disabilities, autism, acquired brain injury. Currently, these services are in the UK, Ireland and Denmark.
Where do we work.
The settings range from supported living, residential care and schools to direct support of families and individuals
What types of clinical issues??
We are specialists in supporting individuals with a range of behaviours of concern. These include:
- Managing physical aggression,
- Self Injurious Behaviours (SIB),
- Trauma and abuse, both with children and adults
- Self harm
- Risk Assessment
- Development of safeguarding strategies and approaches.
- Restraint reduction.
- Stress management
- Behaviour management strategies for high risk individuals and services.
Introduction to Studio 3 Clinical Support Services
We provide clinical inputs to a wide range of sectors ( Intellectual disabilities, autism, children’s services, ABI, mental health and the elderly) in several European countries. In many instances the people we help to support are viewed as ‘highly complex’. Our clinical team provide a positive focus on psychological wellbeing and positive interventions. To achieve this we adopt a wholistic approach to supporting individuals ranging from ‘one to one’ therapies to providing specialist psychological supervision and coaching support. We encourage both people and organisational systems to develop greater resilience. We achieve this by primarily adopting positive psychological intervention, within a strongly person centred framework. A key to our approach is the extensive practitioner expertise combined with an ‘in depth’ and the academic knowledge base. Of course, as befits Studio 3, our practitioners are unashamedly client centred in their approach.
The best way to understand the Studio 3 approach is to see it in action. This section explains a number of case studies, both individuals and organisations, that will illustrate our work as it works in practice
Individual cases with Studio 3 input
Emma – 48 yrs – regular visits to emergency as ‘ill’ now just visits hospital as part of Studio 3 plan
Emma is a 48 year old woman who when stressed often presentation emergency medicine departments complaining that she is ill. This had led to numerous admissions and expensive medical investigations. It is our view that she truly believes that she is unwell in these circumstances and regardless of her treatment by staff (which is variable) she appears to feel safe in hospitals. We introduced a goal of her avoiding overnight stays and set up a regular visit routine to hospitals, without her need to be ill. She is doing really well at present.
Paul – 42 yrs – moved from regular self injury to become much more settled with Studio 3 input
Paul is 42 years old and lives on his own supervised by support staff. He has had episodes of of SIB, property destruction and overdosing on paracetamol. He is much more settled and these incidents are now rare. A recent review of his service revealed that in 9 years he has been aggressive directly with a member of staff once in all this time. He was asked why this was the case and he replied ‘ why would I hit someone I liked?’
Joanna – 14 yrs – refuses to go to school – now going to school on a sessional basis.
Joanna is 14 years old and refuses to go to school. This refusal process occurred gradually, but, became worse after the sudden death of her younger brother. She sleeps mostly in the day and is often awake at night playing computer games. Her parents sought help. We explained to them that she was highly stressed and her cortisol levels (the stress hormone) were very high at night and too low in the day. This meant that biologically she struggled to sleep. Our intervention focussed on stabilising her cortisol levels by increasing cardiac exercise and attempting a trial of melatonin. She is now less stressed and going to school on a sessional basis.
James – 15 yrs – anger management – Studio 3 support him to understand and help him develop friendships
James is 15 and has lived in several care homes. He has major issues with anger and has been described as ‘difficult to like’. James has a very. Difficult relationship with some of his brothers and sisters. Our staff have supported him to understand why he gets angry and to help him develop friendships. In our view James is a lonely and frightened young man. He is making slow but, significant progress.
Lisa – 38 yrs – has severe intellectual disabilities and autism – Studio 3 developed stress relieving techniques
Lisa is a 38 year old woman with severe intellectual disabilities and autism. She will sometimes strip of her clothes in public areas for ‘no apparent reason’ . We established that this behaviour although distressing was quite rare and tended to occur when her senses ‘modulated’, usually when she was highly stressed. This behaviour was clearly escape related as staff sometimes inadvertently placed too much pressure on her by staying out in social settings for overlong periods of time this led to her becoming ‘panicky’. It is not surprising that she needed to get out of these situation. We taught her a symbol for ‘stop, I want to leave’. The behaviour became not necessary for her as she had a new way to communicate to her support staff.
Martin has a history of mental health issues – ongoing support from Studio 3 has developed a positive approach
Martin has a history of mental health issues. He lives on his own in a small town. He has limited supports from a small team of staff. In the past Martin has been in trouble with police, these involve violent acts usually after he consumes large amounts of alcohol. Our staff have supported him to develop a positive approach to his wellbeing, this includes a physical health plan and a strategy for avoiding drinking excessively. His support is ongoing.
Hans – 17 yrs – presented some risks to childern – Studio 3 support plan developed for family
Hans is 17 years old and lives with his mother in a small town. Hans has been ‘noticed’ to be spending a great deal of his time watching children at the local school. Our team spent time with Hans to establish his ‘interests’. It was clear that he did present some risks to children. Our team established a support plan for his family to follow.
Joe has Asperger Syndrome – Supported by Studio 3 to live in community
Joe has a diagnosis of Asperger Syndrome. He has spent over 20 years in the mental health system. Joe struggles with understanding the mindset of staff. He views the world from a concrete ‘black and white’ perspective. He has sensory processing issues and s in a state of hyperarousal. Our work has focussed on his stress management. We have supported him to live on his own in the community. The story continues.
Campbell – 37 yrs – extremely stressed and aggressive now understands how to manage based on Studio 3 support
Campbell is 37 and can become extremely stressed which leads to aggressive behaviours. We have established that 2 hours every day of cardiac exercise has a positive effect on his level of physiological arousal. We are encouraging him to monitor his stress by checking his heart rate. He now realises that exercise for him is more powerful than medication.
Sally – 31 yrs – moved to a community service from a secure hospital setting with Studio 3 support
Sally is 31 years old and with some specialist training inputs she was moved to a community service from a secure hospital setting. Studio 3 staff trained and supported her team of supporters. In the first six months they adopted a non restraint policy. This meant that Sally would often ‘run off’. It was clear that she was not unsafe in these situations and would communicate with staff using a mobile phone. She was encouraged to learn to safely self regulate. Over 6 months this behaviour became less and less common. She now has greater control over her life and relatively few behaviours of concern. Now when she becomes upset she will often request her support staff to leave her house. She is beginning the process of learning to self regulate.
Sarah has an intellectual disability and self harms
Sarah has an intellectual disability. She regularly bangs her head and has needed to receive medical treatment. Her behaviour support team gets specialist advice from Studio 3. It has been established that her intense episodes of SIB are related to pain. In particular due to chronic stress she has bowel and gastric issues? There is less focus on her behaviour and more of an emphasis on her physical health? She now has a health plan which is addressing these issues.
Liam – 11 yrs – Autism and ADHA – Support for school staff and family from Studio 3
Liam is 11 years old with a diagnosis of autism and ADHD. He has recently been excluded from his school because of behavioural issues. The school are being trained in low arusual approaches and a specialist member of the Studio 3 Team is working with his family and teaching staff to develop effective non aversive behaviour management strategies.
Michael – 32 yrs – Stress management programme developed by Studio 3
Michael is a 32 year old adult with Aspergers Syndrome. He lives on his own and is struggling to understand what his diagnosis means to him. He is supported by people who are trying to get him to understand that he is ‘hard wired’ to be stressed. He is be supported to develop stress management techniques (in particular cardiac exercise) to help him lead a fulfilled life.
Jane – 13 yrs – Abused and now Self Harming – support staff trained in Low Arousal
Jane is 13 and currently lives in a care home for children. She has had an abusive past and finds it difficult to cope with school work. She finds it difficult to trust people. At the moment her biggest issue is that she self harms. Her Studio 3 therapist has hoped her to understand that she engages in these behaviours to avoid thinking about the abuse she experienced in the past.
John – 22 yrs – behaviours of concern and Intellectual disabilities
John was a 22 year old man with many behaviours of concern and Intellectual disabilities. He had difficulties sleeping and is described as irritable. Many if his support staff are wary of him. We supported him by training the staff in low arousal approaches and helped them to understand that sometimes stress overwhelmed him. We also found that his daily activity schedule was too rigid. In the space of a year both the. Intensity and frequency of his behaviours of concern reduced , one of his supporters stated that ‘ when he begins together stressed, he needs space and time and it is really important that we appear calm as our behaviours impacts on him.
Working with Organisations
An organisation which supports children and adults with intellectual disabilities asked for our help with two services that they had recently acquired. Both services had many institutionalised practices. There were many restrictive physical interventions in place. Our approach was to audit the service which involved sending staff into the houses to observe and work along side staff. They found that there were very unclear behaviour support plans and extensive use of restraint. A training programme was devised which included the Studio 3 managing challenging behaviour training, positive supports and mindfulness. Studio 3 staff followed up this training with coaching for the staff and their service managers. Within a year the use of restrictive practices had become a rarity.
A service for older adults adopted a low arousal training approach within a person centred framework. They no longer view physical interventions as an essential component of training. Our approach to validation has become increasingly popular. There is a much greater focus on managing behaviours rather than changing them in the organisation and a stronger focus on stress and wellbeing.
The language we use often influences our thinking. We are working with an organisation to change the language they use about ‘behaviours’. They are not using the term ‘behaviour support plan’ anymore. Instead, they use the. Term ‘stress support plan’, this is helping to alter views about challenging situations. If a person is stressed, why is this happening? How can we reduce stress in their life and increase their ability to cope?
We received a referral from a service for adults with intellectual disabilities, they wanted to develop an in house behaviour support resource. They wanted their clinical staff to apply a low arousal and stress management response to behaviours of concern. We provided additional training in these areas and ongoing supervision. Over the last 5 years the service has become viewed as experts in developing person centred supports for people with intellectual disabilities and behaviours of concern.
Our German colleagues have an expression ‘ Mehr spas’ this literally means ‘more fun’. Imagine targeting enjoyment and fun from a behavioural perspective. We look at daily schedules and timetables and often the appears to be no fun in them at all. We will continue to challenge organisations to view fun and happiness as important goals.
We are attempting to get organisations to avoid using terms like ‘quality of life’ and use broader definition of wellbeing. People criticise us for saying this especially as wellbeing is difficult to measure. Our response to this is that, quality of life is extremely subjective and narrow in focus. Wellbeing is such a broad subject it can encompass, physical, emotional and spiritual components. Is my goal in life a high quality of life or a fulfilled one?
We are supporting an organisation to reduce Restrictive Physical Interventions (RPI’s) by introducing a standard that there needs to be evidence of individualised restraint reduction plans. Managers and key staff have to meet within 72 hours and ask the question ‘how can this be prevented next time?’ This has helped to create a positive culture where staff view RPIs as preventable. There has been over a 50% reduction in RPIs in the last year.