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Message from the MD

Difficult, dysfunctional and challenging behaviour

If we have a square peg we make a square hole

At St. Anthony we specialise in the amelioration of difficult and dysfunctional behaviours.

The approaches to this task are as various and as complicated as the people we help, but the common themes are these:

• Creating contexts in which the disabling behaviours are less important (and less useful/harmful to the person doing the behaviour)
• Working to develop and encourage alternative behaviours
• Working to develop life skills that enable people to move into more independent settings.

A well trained staff group is essential in these tasks. The Avens group has its own in-house training organisation that is City-and-Guilds accredited. In addition to mandatory training we use the Non-Abusive Psychological and Physical Intervention methodology to secure staff and client safety. Adopting these methods in 1998 resulted in an 80% reduction in the number of recorded “incidents”.

Thumbnail Case Studies

1. Mr. A was diagnosed with Tourettes and may also fit the Asperger category. He craves attention but was unable to judge social situations. A result was that his approaches were seen as unwelcome pestering with the inevitable result that he was rejected and became very annoyed and destructive. Regular counselling over more than ten years enabled him to learn the boundaries of acceptable social behaviour. Another behaviour that prevented him participating fully in normal adult life was a compulsion to spend all his money as soon as he got it. As a result of a lot of staff effort he learned the benefits of saving for medium term gratification. He now lives in his own flat.
2. Miss B. arrived with a severely challenging reputation having wrecked the group home to which she had moved from a long-stay hospital. In addition she had assaulted a number of staff including several non-residential social workers. The most descriptive (DSM IV) diagnosis is a “pervasive developmental disorder” a category that could be placed within the autistic spectrum. On arrival she frequently screamed, threw objects and assaulted staff. She exhibited, until quite recently, obsessive behaviour including repetitive verbal routines. It turned out that personal space was a major issue and that she suffered severe distress in social situations. A consequence of unpredictable behaviour was poor dental hygiene coupled with a complete lack of dental care over many years. Once her distress levels were reduced she allowed dental treatment. It emerged that she must have suffered a lot of dental pain, exacerbating her problems. She now lives with five others and can manage social encounters quite well. Continued attention to detail ensures that the difficult behaviours no longer occur.
3. Mr. B arrived with a reputation for inappropriate sexual advances directed to young males. The top priority was his safety, and the protection of others. We constructed a lifestyle that did not place him in harm’s way. At the same time he received counselling on the risks associated with his behaviour. Living with a stable peer group has enabled him to develop more appropriate relationships. In this secure emotional environment the target behaviours have disappeared. His safety is maintained through careful and discreet monitoring.
4. Mr. C. arrived having wrecked his previous home. Although he directed no aggression towards others he seemed determined to reduce his own living quarters to squalor. He also rejected help with personal care and his standards of personal hygiene were unacceptable. It turned out that these behaviours were a response to lack of control over his life. Careful consultation prior to any change, including, for example, the need to bathe, steadily reduced the target behaviour over a period of years. Accepting a level of eccentricity in the arrangement of his accommodation is a reasonable trade off against good personal hygiene and the end of serious destruction. Although Mr. B still has an occasional lapse, the frequency is a small fraction of what it used to be.