Activities for adults with acquired brain injuries

Building confidence and self-esteem
As well as specific therapeutic inputs, such as occupational therapy, physiotherapy and psychology sessions, service users in our care can also choose to take part in a range of activities each week, depending on their needs and abilities. These activities include music sessions, arts and crafts, ASDAN learning sessions, swimming, visiting local cafes, shops, etc. Not only are they fun and enjoyable activities in their own right, but they are also important in providing a ‘normal’ lifestyle and they support the therapeutic regime provided by the Multi-Disciplinary Team.

One popular activity for several of our service users with acquired brain injuries is Rock Club. It brings together people using different brain injury services in Northamptonshire to take part in a wide range of different activities: Anything from a disco and karaoke night to a bake-off competition, film night or quiz.

Halloween is a big event and the fancy dress disco is eagerly anticipated. Sallie Maris, the Arts and Crafts Co-ordinator at The Richardson Partnership for Care helped some of the service users prepare their Halloween costumes, which was all part of the fun.

Dressing up for HalloweenPreparing for the Halloween party

The Rock Club summer fun day was also a big occasion, with a barbecue, side shows and a visit from ‘Party Animals’ – an organisation that enables people to have close encounters with reptiles, rodents and mammals so they can learn more about them, overcome their fears and build confidence. Terry, one of our service users with an acquired brain injury was inspired to create this poster after the Rock Club summer fun day because he enjoyed it so much.

Terry's Rock Club poster

Rock Club events are held in Northamptonshire every other month, but the benefits extend to both before and after each occasion, and they are just part of the programme of activities included in the care plans for our service users.

As well as being very enjoyable, a varied activity schedule is important to service users in many ways: It helps them to build relationships with other people in a safe, supportive and good-humoured environment. This improves their well-being, self-esteem and confidence. In addition, the activities themselves help to improve motor skills, dexterity, co-ordination, concentration, memory skills, communication and vocal skills.

Summer holidays and activities

The excitement has been building as the holiday season is now well underway and we’ve had weeks of glorious sunshine. Holidays are planned months in advance and our service users, who have acquired brain injuries, or learning disabilities and complex needs, are supported in choosing where they would like to go.

Wherever possible, we try to accommodate specific requests for holiday destinations and they are financed by accruing a certain amount each month then topped up if someone needs something extra. Service users go away in small groups or individually, depending on their needs and preferences. They are supported by their care workers and they are involved in the decisions on who accompanies them.

Our service users enjoy the activities, atmosphere and the change in environment that a holiday brings. Some people need familiarity and routine so we balance this with the opportunity for enjoying new experiences. This year, some of our service users have been on a boat or seen the sea for the first time. Going on holiday is paramount to their health and well-being and is instrumental in their social inclusion and positive feelings of self-worth. There are also physical benefits of being outside and taking part in new activities.

This year popular holiday destinations include the Isle of Wight, Hemsby in Norfolk and Skegness in Lincolnshire – which is also close enough for a day trip. Billing Aquadrome is a local holiday park with good facilities, which is popular as it combines a change of scene and a relaxed holiday environment with a very convenient location. In addition, one service user has enjoyed a weekend trip to Blackpool, and others have visited their respective families in Malta and Serbia. We’ve also enjoyed day trips to London, the coast, zoos and country parks. Summer activities have also included trampolining and swimming, and one of our service users went to a David Byrne concert in London. We support our service users to lead a fulfilling and active life as possible.

A boat moored off the Norfolk Coast

Bowls sessions provide a range of benefits

One of the most popular activities that we arrange in-house for our service users is the weekly bowling sessions that we hold in the main hall at The Mews each Monday.

We are fortunate to have Duggie Mitchell on our team, who is an experienced bowling instructor and has played competitive bowls for 35 years with success at Club, County and National levels. Duggie joined the board of Disability Bowls England in 2016 and continues to be inspired by the achievements of people with disabilities. His experience, skill and enthusiasm for the game as well as his empathy with the service users have contributed to the success of the sessions. Duggie is assisted by Lisa Hutchins, the Administrator at 144 Boughton Green Road, who helps with the organisation and keeps the score.

Bowling adapted to suit the players
The format of the game is Short Mat Bowling, which is very similar to Carpet Bowling. A mat 45 feet long and 6 feet wide is laid out in the main hall with guards at either end to stop the bowls running too far. A jack is placed at one end of the mat and each player uses weighted bowls to try and hit the jack. We have adapted the rules to meet the cognition needs and suit the various abilities of the players. They bowl eight balls each and Lisa records the number of ‘strikes’. People from all of our homes join in and we have a league in which around 20 players take part. One of our service users who is blind has mastered bowling very successfully. Other service users come along to watch and support, and it’s a lively, social occasion with lots of cheering.

Key benefits to individuals
What may just look like a leisure activity is actually an important element of our service users’ care. As well as being very enjoyable, the bowling sessions also help to improve:

Physical strength and dexterity
Co-ordination
Cognition and communication
Motivation and self-esteem
Social Skills

Duggie has been running the sessions for around two years and new players can join in at any time. He has noticed significant improvements in some of the participants and says: “I have seen so much change in many of the group since we started: going from little or no eye contact or verbal communication in the early days to total interaction and response. My partner and I went along to the Christmas party recently and it was lovely to have them recognise us and want us to join them dancing.”

Thank you to Duggie and Lisa for their help and commitment to these sessions. They have contributed to some significant improvement and much enjoyment for our service users.

Duggie Mitchell demonstrating short mat bowls

Duggie Mitchell demonstrating short mat bowls

Satisfaction survey: our care home residents

Adults with acquired brain injuries, learning disabilities and complex needs

In addition to surveying the families of service users in our care on an annual basis, we also complete a questionnaire with the individuals themselves, which asks specific questions about different aspects of their lives within the care home. They are asked to respond using a satisfaction rating of 0 – 4 where 4 is the most satisfied. All of our service users have complex needs and some are unable to answer the questions, so staff either help them to answer the questions or observe their behaviours to ascertain their needs.

The results from each individual are combined to give average scores, which are shown below. There are up to five questions in each section, so the totals show an indication of satisfaction in each area.

However, as every person is different, and has different needs, our approach is always individualised, person-centred care.

bar chart showing satisfaction survey results

Service user satisfaction survey results 2017

The following gives you more information about the specific areas covered in the satisfaction survey.

Know how to complain
This question assesses how well the individual knows what to do if they have a complaint. The average overall score across the homes was 3.63 out of 4. It excludes the individuals who were unable to understand the question.

People you live with
This is very important to all of our service users, and satisfaction ratings can vary according to the type of care home as stable populations with long term residents tend to have a higher satisfaction rating. The Mews, which focuses on short-term intensive rehabilitation for adults with acquired brain injuries, naturally has more of a changing population. This can affect the dynamics of relationships between the residents. We work hard to ensure that any incoming service users will not upset the balance in any care home and we continually review our admissions policy to ensure that we receive sufficient information in advance of a full assessment of any potential new residents.

There is very much a family environment within our care homes, and many strong friendships develop between individuals. However, like a family, it doesn’t mean that everyone gets on well with everyone else all the time. Therefore it is important that we focus on relationships between individuals and use mediation and psychology to manage any disagreements. As a last resort, we can move individuals into another of our homes but this is rarely necessary.

Decision making
These questions covered how involved people feel in decisions relating to their care plan and risk assessments as well as making choices in their everyday lives.

Staffing
These questions ascertain how well service users know the support staff in their home and how they feel that they are treated by them: whether the staff are approachable, as well as whether they would like to be involved in the interview process. Many service users said that they would not want to be involved, which has reduced the average score.

Food and drink
As well as being asked about their choice of food and their cultural needs, individuals were also asked about how involved they wanted to be in menu planning and food preparation.

Activities
Many of these questions were qualitative: describing current activities undertaken or potential new ones, so a numerical score was not given. The activities that we provide are very much tailored to the individual and if something is requested but not achievable or affordable then we explore alternatives.

Environment
These questions simply asked how satisfied service users are with the communal areas of the home, the garden and their room.

Summer activities for Service Users

The summer is always a special time of year when, hopefully, the weather allows us to make the most of being outdoors, enjoying the sunshine and fresh air. When it comes to holidays, we make sure that they meet the needs of our service users, who are supported in deciding where they go and who accompanies them. Holidays take a lot of planning, which starts early in the year. But this pays off as they are really enjoyed by the service users who speak fondly of them on their return.

2 & 8 Kingsthorpe Grove – adults with learning difficulties
As many of our service users in these homes have been with us for a long time, they have built friendships and are aware of each others’ strengths, abilities, likes and dislikes. They go away in small groups and are involved in choosing their holiday companions and location. They like familiarity of holiday destinations and routine, so we work to get the balance right, taking into account relaxation and adventure. Destinations have included Yarmouth, Devon, the Isle of Wight and EuroDisney.

Individuals with acquired brain injuries
For our service users with acquired brain injuries, their needs can be more wide-ranging so we tend to organise holidays for small groups of two or three people, and some one-to-one holidays. One of our service users at the Mews had his first holiday since his brain injury 18 years ago when he went to Hemsby in Norfolk with two staff members. He had never wanted to go on holiday previously but had settled in really well since admission, so we offered him the opportunity. He went early in the season before it was too busy and it went really well. He normally mobilises in a wheelchair but he walked whilst in the holiday chalet.

Wherever possible, we try to accommodate specific requests for holiday destinations. The holidays are financed by accruing a certain amount each month then topped up if someone requires something extra. One lady wanted to go to the Eden Project, so with the help of the case manager, we sourced an adapted holiday home and we liaised with a local doctors’ surgery who were able to provide medical support. She went for a week with two carers.

One of our service users went to stay with his family in Serbia, while others shared a caravan at a holiday park in Skegness. Three people went for the first half of the week, three people went for the second half of the week and two joined them for a day trip in the middle. A good time was had by all – they enjoyed the evening entertainment in the clubhouse and daytime activities included going to the amusement arcade, the beach and the funfair, as well as paddle-boating and horse-riding.

In addition, a couple of service users went for a “Revitalise” holiday to Essex, where they joined in with activities such as armchair exercises, bingo and karaoke and had day trips to Clacton and Southend.

Not only is an annual summer holiday an enjoyable experience, for service users with acquired brain injuries, it is also an important part of their rehabilitation programme. It is part of our focus on ‘normalisation’, enabling them to live as close to a normal life as possible and to enjoy things that they may have done before their brain injury, such as having a picnic or fish and chips by the seaside.

The Norfolk Coast

The Norfolk Coast

Structured skills development for adults with learning difficulties

In May 2012, The Richardson Partnership for Care became an officially-recognised accreditation centre with ASDAN – the Awards Scheme Development Accreditation Network. The organisation provides courses to thousands of training providers, which offer flexible ways to accredit skills development and enrichment activities.

For service users with learning difficulties, ASDAN offers the flexibility to complete modules in different ways according to each individual’s abilities, preferences and concentration levels. It also means that service users can gain accredited qualifications in a familiar environment, working with people that they know and trust.  Receiving a certificate for their efforts also provides a sense of achievement and fulfilment, which often encourages them to progress to further learning and qualifications.

As Arts & Crafts is a popular activity within our homes for adults with learning difficulties, we started the ASDAN programme with the Creativity module. This has led onto modules in Independent Living (Introduction and Progression levels) and Numeracy Skills (Introduction and Progression levels). Sallie Maris, our ASDAN Co-ordinator finds creative ways to encourage the service users to participate in the modules and gain new skills. For example, learning numeracy skills may involve baking a cake, dividing it into segments and sharing it with others. We are now starting modules called ‘Myself and Others’ and ‘Personal Care Routines’.

Evidence must be provided for each task and assessments for each module are independently verified. Each individual is awarded a ‘grade’ for their module as follows: Experience recorded, Sensory experience, Physical help, Spoken help, No help. These ‘grades’ ensure that people with disabilities can still be treated fairly and their qualifications properly accredited.

The scatter diagram below shows the ASDAN qualifications obtained by service users with learning difficulties in Creativity and Independent Living, where 1 represents ‘Experience Recorded’ and 5 represents ‘No Help’.

ASDAN awards for adults with learning difficulties

John enjoys his first ever holiday

We’ll soon be holding a birthday party at a local pub for John, one of our service users. That may not sound unusual, but on this occasion it is. John has been in our care for over 20 years and has rarely chosen to go out. He has learning disabilities and complex needs and he presented with very challenging and aggressive behaviour when he first came to us.

John has also achieved another major milestone – taking his first ever holiday when he went to the seaside town of Skegness in Lincolnshire for four days. He was supported by Selina, a review co-ordinator at The Richardson Partnership for Care, with whom he has a great rapport.

Skegness beachIt has taken years of hard work and consistent support from our trans-disciplinary team of therapists and our care support workers to enable John to develop his confidence and control his behaviour in order to take this huge step. To help him experience and enjoy the holiday as much as possible, it was booked at short notice. He chose where he went and who he wanted to accompany and support him. During the holiday he was in full control of what he did.

Dr Mick Clarke, a close family member of John said: “John is having the best care he has ever received and your professional and devoted work with him has enabled him to grow in confidence and become a happy man.”

“Selina’s total commitment to him has supported him to the extent that he has finally been able to go on holiday. Your team at the Richardson Partnership for Care has allowed him to blossom into the lovely caring man that was always there.”

“Your plans for him over the years to withdraw drug therapy and support John through specialist behaviour plans has meant he is becoming more socially skilled and a joy to be with. Going on holiday has meant John’s confidence has moved to another level.”

The holiday was such a success that he has requested to go back again next year as well as choosing to celebrate his birthday with a party at an external venue. This story demonstrates that consistent care and support, while providing opportunities for social integration and decision-making can lead to increasing fulfilment and autonomy.  Sometimes this is a very gradual process.

A seal in a pool at Skegness

ASDAN achievements recognised

Congratulations to the service users at The Richardson Partnership for Care who were presented with their ASDAN certificates at a special awards ceremony at The Mews.

ASDAN stands for the Award Scheme Development & Accreditation Network. It offers educational programmes and qualifications with flexible ways of accrediting skills for learning, employment and life.

The Richardson Partnership for Care is an ASDAN-accredited centre, which means that we can provide ASDAN programmes in-house for our service users.  They help them to develop skills, achieve accredited qualifications and increase their independence and self-confidence.

ASDAN certificates on mantelpiece

The ASDAN certificates on display on the mantelpiece

Sallie Maris, our Arts & Crafts lady, manages the programme in which around 30 service users with learning difficulties or an acquired brain injury are currently participating. The Independent Living and Creativity modules are our main focus as they help to bring back skills that have been lost as well as providing enjoyment, engagement and a sense of achievement.

Each service user completes a portfolio to show what they have achieved and there are various pass levels: experience recorded, spoken help and no help. These enable progress to be recorded and achievements acknowledged with accredited qualifications.

More information about ASDAN

Residential care in the heart of the community

There is much debate on whether community-based support is better than ‘institutional care’ but of course, it depends on the individual. It also depends on the type of care and support. One of the best ways to describe our specialist residential care homes is ‘a place that feels like home’. Yes, we deliver effective intensive short-term rehabilitation and long-term rehabilitation for adults with acquired brain injury. We also provide care and support for adults with learning difficulties and behaviour that challenges. And we have a high support worker to service user ratio, but we strive to provide an environment that feels like a home, not an institution. It’s safe, comfortable and homely. Our homes provide companionship, and protect vulnerable people from social isolation, loneliness and hate crime.

Community engagement
We also enable service users to be part of the local community. All of our care homes in Northampton are situated close to local shops and facilities, as well as within easy access to the town centre. For service users who are able to, popping out to the local shops means that they feel part of the local community and ‘normal’, especially when they see people they know. It’s also part of our focus on ‘normalisation’ for service users with an acquired brain injury. Enabling them to live as close to a normal life as possible is an important part of their rehabilitation.

We are fortunate that we have some great local pubs where the staff understand the needs of our service users and are very welcoming and helpful. In December we held a 60th birthday party for a service user at the local pub. Donald enjoyed a lovely meal with his sister, all his fellow service users from his home and members of staff. He’s been living in our care home for over 20 years and it was a really lovely occasion. And the pub staff even sang ‘Happy Birthday’ to him!

Donald's birthday cakeCompany ethos
As well as everyday trips to the shops and special occasions, there are also trips to the cinema, sports centres and cafés. They help every service user to become familiar with their local environment and make them feel at home. It’s all part of the ethos of The Richardson Partnership for Care, ensuring that service users are treated with dignity and respect, actively supported to make their own choices and given the opportunity to participate in community activities.

Donald and his sister

Donald with his sister at his birthday party

Using online apps to stay in touch

Online applications are transforming the way that we live and work, and at The Richardson Partnership for Care we are using them to help service users and their families keep in touch, and for the families to participate in the review process.

Our service users with learning disabilities have an external review every 12 months where their care team and case workers review their care plan and discuss their progress. The service user can choose whether or not they take part in the review, but under The Care Act 2014, reviews should be attended by a family member or advocate.

Some family members live too far away to attend all of the reviews or find it difficult because of work and other family commitments. We recently arranged for a family to participate in a review using Facetime. This application, similar to Skype, enabled the family to make a video call over the internet.

This was the first time that we had used a video call to enable a family to take part in a review and it was a great success. We received positive comments from the family as well as the care manager. The family were able to contribute fully to all areas discussed: they could see and hear the review team and ask questions as well as providing their thoughts and feelings on the care package. They said that it was just like being there!

On this occasion, the service user declined to take part in the review, but they had a video call with their family afterwards and spoke with their care manager and review coordinator about what had happened in the review.

We are now setting up regular video calls for service users and their families to stay in touch, which benefits everyone and in particular, reassures parents who live some distance away. It also enables family members overseas to stay in touch and be involved.

iPad showing different apps