Oh boy, was I depressing myself yesterday. I’ve been trying to tidy up my Word folders and came across the Folder with all the correspondence, logs, reports etc. in from 2010. Two things strike me from this painful trip down memory lane. Firstly, it’s amazing that Steven survived with his spirit intact. There are pages of “Incident logs” that have single figure sentences that to anyone with an ounce of humanity demonstrate graphically the distress that Steven was experiencing. Of course, humanity was lacking amongst the compilers of the reports, so they ended up being used as evidence to support their plans for court. The second thing that leapt out at me was how eminently reasonable and respectful I was in my letters. But also, I was arse clenchingly submissive. I remember Amanda, our barrister, expressing her shock that when I had to sit face to face with any of the Hillingdon power players, I went from articulate confidence to a bumbling, passive wreck. It was a fair observation.
Here’s a letter I wrote around about September 2010. I don’t think it needs too much context as it becomes clear that I am responding to a letter they had just sent me. This was about the time when they had come clean and admitted they wouldn’t let Steven return home & were looking for an out of area placement for him. In their letter, they listed all the things they felt were wrong with my care of Steven:
Re: Steven Neary
I am writing in response to your letter dated 10th September 2010 and to M’s letter from last week. Thank you for your time in co-ordinating the response. I am especially grateful for the feedback you give in paragraphs 10 to 12. It is useful to receive the professional’s judgement of the areas where you believe my caring capacity for Steven is lacking. I don’t think I’ve ever received this is in black and white before. I hope you acknowledge my forthcoming questions and comments as I intended; i.e. a learning experience for me.
You state: “We also believe that you do not recognise or accept the level of risk that Steven presents to himself and others – nor the possible need of a secure placement (via the courts) if further specialist support is not sought”.
Can you state what else I can do to demonstrate that I do recognise the risk? I was instrumental in writing the risk assessments with M. I believe that I try at all times to adhere to the instructions in the risk assessment. It has also been me who has changed or dropped aspects of Steven’s community programme when I consider there to be un-necessary risks. For example, after noting from PBST’s reports that bus and train rides were becoming difficult for Steven to manage, it was my suggestion that these be dropped from Steven’s programme.
When I am out with Steven in the community, I am constantly alert for potential triggers. Perhaps you could check with the support workers who are with me on these trips as I am sure they will confirm that is the case. I did request at the Deprivation of Liberty Order appeal meeting that members of PBST or D carry out observations of how the support staff supports Steven when he is out and this was intended to include me in the observations. To the best of my knowledge, this hasn’t been done, certainly not whilst I am present.
As you know I have also been meeting several of the stakeholders recently and sharing ways in which Steven and I relate, which in turn reduce his anxiety levels and minimise the risk of challenging behaviour. Perhaps you could check with the support staff, who are regularly asked by Steven to phone me, often when he is distressed or anxious. I’m sure they will confirm that a short conversation with me usually alleviates his anxiety.
So, could you clarify what further steps you would like me to take in this area of risk recognition?
You state: “We have concerns that you use food treats excessively as a means of gaining Steven’s compliance. It will be necessary for you to fully embrace behavioural guidance provided by the PBST when having your son at home”.
Could you give some further clarification as to what you mean by “fully embrace behavioural guidance”? I have acknowledged before there may have been some occasions prior to Steven’s time away where I have given in to Steven’s demands for foods but am now armed with more strategies in how to deal with issues around food.
Since Steven has been under the control of PBST, I have been asked to demonstrate several things around food. The two main issues have been having less food available and portion control. I was also advised by R to use food as an area to improve Steven’s negotiating skills. So, depending on the time Steven will be home for a particular visit, I only put an appropriate amount of food in the cupboard. (For the first few home visits I did take photos of the food cupboards and fridge on my mobile phone but I was never asked to produce them, so stopped taking them) Secondly, I believe that Steven has been responding pretty well to me exercising portion control. I can think of five occasions in over 120+ home visits where Steven has returned to the kitchen to try and “top-up” the original portion he has been given. Thirdly, I have been trying to follow R’s advice and encourage Steven to negotiate food and this, compared to a year ago, has been an excellent piece of work.
So, is there anything else I can do to demonstrate that I take the issue of food seriously?
Under-reporting of Home Incidents:
You state: “The Council has been concerned about the under-reporting of behavioural incidents in the family home – this relates to a differing perception of risk and what constitutes an incident. We would want to ensure that we reach a common understanding about risk and recording.”
Can I ask if you referring to pre-ATU, post ATU or both? In June 2008, I was instructed by D to keep a log of any incidents that occur in the community. There was no mention made of recording incidents within the home. I did this religiously. For the first few months, I hand delivered that month’s logs to the Civic Centre but never received any feedback, so stopped handing them in but continued to compile them at home. Following mine and Steven’s move in August 2009, I became aware that I was going to be under close scrutiny now that I was on my own, so through my own volition, decided to include home incidents to the log. This I continued to do until Steven’s removal from my care on 30th December 2009. I acknowledge that I didn’t record “near misses”; this was a concept I had never heard of until I was shown the first log of incidents by PBST. I suppose up until you told me otherwise, I had always considered “near misses” as evidence that the risk management strategies were successful. Near misses are something, of course, that I will include in any future records.
If the statement relates to Steven’s home visits since he’s been away, I would have thought that my reports of the visits have been quite detailed. Also, apart from the two Saturday overnight visits, there has always been at least one other support worker present, so our reports should tally. Would it re-assure the authority that I am not deliberately leaving out incidents, if there was always a member of PBST present (like Tuesday evenings)? Once again, I am committed to learning from this experience and would welcome any input about the way I report Steven’s homes visits.
You state: “We would want to develop a carefully considered plan to return Steven to his home which would partly consist of stays with you that are not “treat visits” but “real life” where low level demands are placed upon Steven to test out his responses and the management strategies within the home environment”.
My apologies if this sounds pedantic but do you mean that the visit itself is a “treat” or something else? Up until the 8th July, all the home visits were termed “transition home visits” and since then I have just viewed them as a normal part of Steven’s week. I’m not sure where the “treat” comes in. I would say that Steven probably finds more things to occupy himself with on a home visit and he tries to cram in a lot on a home visit but it is still “real life” as he knew it up to December 2009.
Can you clarify what you mean by the phrase “low level demands”? Whilst on home visits, Steven clears up after himself; took charge of his own laundry (when on overnight stays) and prepares some of his own meals. If I have that definition correct, can you point out what else you would expect Steven to be doing on his home visits as that will prove useful for my understanding and subsequent planning of the visits.
In M’s recent letter, he refers again to a “risk”; this time in connection with the Facebook Campaign Page. Could I ask for some clarification as to what the Authority see as the risk here? All the people in the photos and videos have given their consent to being shown online and the posts by the members of the group have been unanimously supportive.
In conclusion, I want to thank you for your feedback and I hope this letter demonstrates my commitment to working on the issues that you have identified.
From → Social Care