Posts Tagged ‘problematic behaviour’

Today “The House of Lords science and technology committee said ministers seemed to be mistaken in their use of what is known as the nudge theory.”  ( http://www.bbc.co.uk/news/health-14187802 ) Nudge theory is the idea that changes are made to the social and physical environment without legislation that encourage (or discourage) specific behaviour. One example of this would be for fast food restaurants to have salad rather than chips as the default side order.

The committee made the point that a balance of approaches should be used rather than relying solely on ‘nudging’ people.  This seems a blindingly obvious ‘finding’ for anyone who has worked personally or professionally around changing problematic behaviours.  Perhaps this is more about where power and influence truly lies rather than personal perspectives on what is a sensible approach. 

My point here is there is already a very well balanced set of approaches to something like illicit drug use where the agenda is quite simple.  The problems with balanced approaches and the use of legislation become far more complicated when things like minimum prices for alcohol and supermarket food labelling are on the agenda.  The challenge with the use of legislation here is that some influential organisations and individuals might lose money; suddenly there is apprehension about moving forward.

It’s great to see all the ‘courageous’ stands by politicians about ‘the press’ in light of the News of the World scandal.  But it seems unlikely that the same courage is going to follow through into other areas.

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According to a report out today:  “The gap between the poorest pupils and their better-off peers in struggling  schools in England is wider than in other schools, research suggests.” http://www.bbc.co.uk/news/education-14082644

In schools below the national average standard a Sutton Trust study found that primary school children eligible for free school meals were half as likely to achieve their targetted standards as other pupils and by secondary school this had dropped to one third as likely.  The BBC news report commented that “these attainment gaps are significantly larger than the gaps between free school meals-eligible pupils in all schools and their peers who are not eligible for free school meals” .

It seems, from the news report, that this is to cause a high level of focus on these underperforming schools, and through them target the children who are struggling.  Although this is a necessary measure there is little or no mention of interventions outside of school.  From our experience of working with adults who have been undeperforming poverty stricken children it seems obvious that support needs to be offered in the homelife to give any chance at all of positive changes in the school life.  It’s a bit like focusing on achieving housing for a rough-sleeper without taking account of any of their other issues.  But sadly it seems by the time someone has ended up sleeping-rough or similar they are fairly used to having their life divided up into silos of support need instead of being treated as a whole person.

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Jon, one of our support workers shares the experiences of a day ‘at the office’ in Huddersfield:

As I was walking down to the Mission to meet Tim I bumped in to Julie who I have been doing some short term work with regarding her abusive relationship and domestic violence. She had blood on her coat and clothes and what appeared to be a cut on the side of her head. I spent some time talking to her and tried to get her to either go to the doctors’ or to let me call her an ambulance due to the fact she had a head injury. She refused to go seek any medical help and insisted she was fine. While talking to her she informed me that she had been stabbed in the leg with a screwdriver repeatedly and had been attacked by her husband but she still refused to see a Dr or to have an ambulance called.

As I had an appointment to go to and I could not get anywhere with Julie and she insisted on staying in the park I went to meet Alan. I managed to book him an appointment at the Doctors’ in order to talk to the Dr about his mental health and the options available to him for treatment. While waiting for the appointment we managed to phone and restart a benefits claim for him and he is now just waiting for the statement to be posted ou.

I also called the addiction service for Alan to talk to his worker there about his community order. When I managed to talk to his worker there she told me that he had not been engaging, as we knew, and that all efforts on their part from home visits and outreach that they had been unable to re establish contact. His worker was keen to help me to help Alan re engage with herself, his
CPN and probation and gave me the names and contact details of his probation officer and his CPN. On contacting these I managed to establish that Alan has been discharged from the mental health team due to non engagement, however they are willing to re asses him if the need arises. I was also told by probation that if Alan re engages with either the addiction service or probation or both them he would not be in breach of his community order and they could work to sort things out for him. I made an appointment for Alan at Lifeline tomorrow at 10am, his worker agreed to contact me to let me know if he did or did not attend so that we can discuss ways to help him to engage.

At the doctor’s appointment Alan was told that he needed to start re engaging with the addiction service as his short to medium term problems were best addressed by them and that once engaging with them more medium and long term solutions could be considered for his mental health. Alan gave the doctors’ permission to share his information with me and to contact him through me. From this I learned that when Alan was discharged from hospital his assessment was that there were no mental or psychological needs and that he was not in need of any medication. I am not sure if this diagnosis/assessment is still accurate as Alan talks about hearing voices and has told me he is a paranoid schizophrenic. He does exhibit signs of increasing paranoia and has been very agitated since the passing of a friend of his.

Later on when I went back to the mission I was told that an ambulance had been called for Julie as she was looking to be very sleepy and people were worried about her injuries. I talked with the paramedics and because she refused to be taken to hospital there was little they could do except to inform us of the signs to be aware of with head trauma. After this Julie wanted to go to a housing appointment we had booked previously and so we went up and presented at housing.

Initially they processed the application as a domestic violence application but after going through the interview and checking details the only places they could offer were in Keighley or Rotheram, neither of which Julie wanted to go to for differing reasons. As she had been sleeping rough for 2 nights we managed to go down the rough sleeper process rather than domestic violence. Once this was done they found her some temporary accommodation in until such a time as they can give her a temporary flat.   Julie was over the moon with this and was very thankful that I had managed to get her somewhere to stay and said that although she still felt scared she did feel safer. I called into the mission with her on the way back in order to make a referral for clothes as the only ones she had were the ones she was wearing and they were all covered in blood. Julie appeared to be ok when I left but I’m still worried and will catch up with her again as soon as I can.

 Jon, Support Worker

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Our support worker in Bradford, Mat, who is new to us and quite new to our service user group is asking some great questions!  For instance yesterday he spent a few hours trying to support a guy to get some housing who had just been evicted from a hostel.  As always with our service users things are never straight forward and there is probably more to learn, but the reason for his eviction (or at least a contributing factor) is to do with him either having alcohol or consuming alcohol on the premises.

The challenge for Mat is that the guy only moved into this hostel about a week ago.  He has a massive alcohol problem.  So Mat’s questions are why was this person referred to and housed by a hostel that has such strict rules about alcohol on the premises.  The job in hand today should have been done a week ago and without the challenge of a recent eviction making supported housing providers nervous about this guy’s behaviour.  We’re confident that he’s no angel, but if square pegs are forced into round holes something has to break and it’s usually the vulnerable that come off worse.

My worry is that we live in a society where it’s all too easy to point at people like our service users and say ‘it’s your own fault, you should behave properly’ but when you consider this not unfamiliar story of how someone was set up to fail maybe the fingers that are pointing need to take a u-turn!


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One of the individuals, Karen, who is on my case load had been impossible for me to engage with as I had never had the chance to meet her.  I had heard a lot about her from various agencies, all expressing a great deal of concern for her well being as she leads an extremely chaotic life and isn’t receiving any support from any other services due to her problematic behaviour.  She is a rough sleeper, an alcoholic and a chronic street drinker, she also has mental health problems and was hospitalised nearly 100 times in 2008 for various issues including self harm and deliberate overdose. She has some serious, possibly life threatening, physical health problems.  She has been arrested hundreds of times too and is known to be extremely abusive and aggressive. 


 I found out Karen was in court so decided to turn up and introduce myself.  When I arrived I saw someone being escorted from the court who was very abusive and distressed, from what I knew I realised this was Karen.  I introduced myself and although she was still extremely agitated I tried to engage with her.  When we were outside the court she was surrounded by a group of people who seemed to be taking advantage of her financially and who were also being quite verbally intimidating towards her.  I stood and had a cigarette with her and she was very hesitant about talking to me and was extremely guarded, she didn’t understand why I would want to talk to her if I didn’t have an agenda.  Karen was quite distressed and kept saying that the people she was with were taking her money and she couldn’t cope like this, I tried, gently, to get a little bit more information from her but all she would say was that they were taking her money and her alcohol and she couldn’t stop them.  She also kept saying that she had been really ill, she wouldn’t really go into detail but just kept repeating that she had been ill.  During this time she was getting very distracted by the group of people milling around outside the court so I suggested that we maybe go for a coffee and a chat, she looked very suspicious but said ok. 


We walked into town and as soon as we were on our own she really seemed to open up, she told me about her kids which were taken into care, about her cat, that she had had since she was young, that died because her ex-partner neglected it when she was sectioned.  Although she was very distressed and emotional when recalling this, Karen was actually quite articulate and said that she understands how people perceive her but that she’s not a bad person, despite what people think.  She mentioned that she wants to see her kids but that she’s ashamed of her appearance and the ways she acts when she drinks so she tried to stay away because it’s not fair on them.  On the walk into town she made sure that she stopped and gave every Big Issue vendor £1 and she even had a bit of banter with some Community Support Officers.  She said that I had got her on a good day, she hadn’t been drinking that much but that some days she could “feel her head going” and that she was really struggling to cope at the moment, I asked her if she would like me to accompany her to the doctors and it turned out that, because she struggles to engage with services including her GP, she had been without any medication for nearly 8 weeks.  The medication she was without was for her mental health conditions and it was essential that she took it regularly.  I called her GP’s surgery and explained the situation to them, after some persuasion they agreed to fax a prescription to a chemist in the town centre. I went with Karen to the chemist and waited with her while she got her medication.  During this time we were having a bit of a laugh together but she still didn’t understand that I didn’t have an agenda, she couldn’t get her head round the fact that I just wanted to see if there was anything I could help her with. 


By the time I left her, Karen had asked me to make sure I was there next time she was in court and also to accompany her to an appointment she had with ADS (Addiction Dependency Solutions).  I received a phone call the following day from ADS saying that Karen had gone in to the office and told them that she now had a support worker that would be coming to her appointments with her.  I have had a look for her on outreach a couple of times since then but there has been no sign of her, I’ve received a couple of calls from other agencies over the past few days stating their growing concern for her.  I’ll go to her next court date and see if she turns up, hopefully I can start to offer her some support because she is clearly extremely vulnerable, not just due to her health and mental health problems but she is also at risk of financial and emotional exploitation.  Karen’s self esteem is obviously very low, she really thinks very little of herself which is reflected in her destructive behaviour and frequent bouts of self harm.  Despite her challenging behaviour, Karen is someone who has a lot of potential and I’m really looking forward to working with her.

Fiona, Support Worker


The purpose of our work is to find the best way forward for each individual.  Fiona had recognised that Karen’s case was far more complicated than any one issue that she faces.  As someone who is so used to being restricted from services and told what to do Fiona saw the value in offering Karen some humanity.  This will build the foundation for further work.  The fact that Karen’s medication issue was resolved in this first meeting is a real bonus.


The key to our work is to not get too hung up on individual issues or our assessment of the ones that should be dealt with first.  We have to allow the people we work with to have some say in their care.  In this case Karen’s health and mental health issues are a real concern, as well as her rough-sleeping.  But Karen’s main worry is that she is being intimidated and having her money and her alcohol taken from her.  If Fiona did not listen to these concerns and remain supportive about them then it is very likely that Karen would refuse to engage with her.












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