Discussions About The Family Functioning Essay At Nua Health Services' Meadows.

About Nua Health Services and The Meadows

Discuss About The Family Functioning Coping Behaviors Parents.

The Meadows is a medium support residential department of Nua Health Services and I finished my placement at The Meadows. Nua Health care caters to the complex needs of children and adults by providing wide range of service like community outreach service, day care service and residential support services. It has a role in fulfilling complex needs of clients with mental illnesses like dementia, intellectual disorder, autism, asperger syndrome, acute brain injury and many other mental health issues.

The main purpose of the agency is to provide individualistic care to service users by means of person centered care plan that fulfills individual needs as well as future needs of clients. Its goal is also understood from its mission statement which states that ‘Nua Health Services believes in supporting people to live a meaningful and personalized lifestyle’ (Nua Healthcare Services, n.d.). The company’s interest in patient-centered care is also understood from the value of dignity and respect, partnership, personalized and community support. Dignity and respect implies fulfilling the unique needs of each individual. Partnership involves working in collaboration with other service users. Personalized care involves giving freedom to client to proceed at their own pace and the value of community implies encouraging users to contribute for the welfare of the community.

Since ‘The Meadows’ is a residential service that provides care to people children and adults with disabilities, it must comply the Health Act 2007 legislation, the Disabilities Regulation 2013-2015 and fulfill the National Standards for Residential Services for Children and Adults with Disabilities. In addition to this, to protect the agency from legal and ethical consequences, following the Data Protection Act 1998-2014, Health and Welfare Act 2005, and the Employment Equality Acts 1998 – 2011 is also necessary. Apart from this statewide and national legislation, the actions of the Nua Health services are regulated by the Health Information and Quality Authority (HIQA). Because of HIQA regulation, all persons in the management positive are registered with HIQA. The quality of services is also inspected to ensure compliance with relevant legislation by means of announced and sudden inspects. The inspection is classified into seven themes including Governance and Management, Use of Resources, and Responsive Workforce, Individualised Supports and Care, Effective Services, Safe Services, Health and Development and Leadership.

All actions at the Nua Healthcare services is guided by the HIQA regulation, Disability Regulations 2013-2015  and the Health Act 2007. To ensure that the policies and regulation are in parallel with national standards, the policies are regularly reviewed and amended. One example of the policies at the organization is that all staffs must possess level 7 qualification or engage in the process to obtain level 7 qualification. This policy is related to the theme of responsive workforce as the policy paves way for recruitment of individuals who have genuine interest in social care.

Compliance with Legislation and Regulations

The above mentioned social intervention was specially developed for people with autism spectrum disorder (ASD). ASD is a mental condition associated with communication impairment, poor social functioning and aggressive and self-destructive behaviour in an individual (Altiere & von Kluge, 2008, p. 83).  Similar symptoms were also found in the service user for whom I applied the intervention. The review of client history revealed he avoided conversation although he could interact with people. He did not display his emotions very often, however this suppression of emotion resulted in sudden outburst of anger. In such situation, patient was exhibit aggressive and assaultive behaviour. He also had low self-esteem and was reluctant to talk with unfamiliar people. I decided to use the 1:1 protected conversation time intervention for the service used after consulting my supervisor because it will facilitate development of interpersonal skill in client and address feelings of worthlessness too.

The common diagnostic features found in patient with Asperger syndrome and ASD are poor social development, difficulty in development of communication and presence of strong and repetitive behaviour (Baron-Cohen 2008). Similar features were also found in the client as the patient came with poor interpersonal skills, need for reassurance and difficulty in beginning a conversation. To apply the KIT model, the profiled of the service used was developed first (Collingwood, 2005). The profile of the client are as follows:

The client is a 26 year old Romanian male with keen interest in music. He was adopted in childhood and lives with his sister, however he has poor family relationship. The service user is low in self-esteem and struggles to control his emotion. This often results in a crisis situation.  However, the positive aspects of his profile is that he has good sense of humour and high level of intelligence. He wears bright coloured clothes and he is found to be hypochondriac as he get anxious even for a very minor issues. The client has also revealed that whenever he get to know about his appointment with a psychiatrist, deliberately displays challenging behavior. He explained that he reacts in such a way to get new medications for his challenging behavior.

The next stage of the KIT model is to identify and incorporate theory to practice. The theories that I used to inform were the autistic mind (Baron-Cohen, 2008) and Biestek’s Relationship-based practice ((Trevithick, 2003) and theory that I used to intervene was ‘Unconditional Positive Regard, Person Centred Care, and Advocacy’ theory. Apart from this, I also used my personal skills and values related to ethical consideration, skilful assessment of client and communication process with client. I also followed the national legislation of Health Act 2007. The main goal of the intervention was to establish therapeutic rapport with client and enhanced interpersonal skills and self-esteem of client.

1:1 Protected Conversation Time Intervention for ASD

The approach that I took for the effective implementation of the intervention was to deliver it in an environment which the used preferred to be safe. The service user selected the conservatory for conversation with me as he was familiar with the place. However, it was not satisfied with the place as it was the private space of client and it increased many ethical challenges for me. To start the conversation with the service user, I offered to make cup of tea for him. By this approach, I wanted the user to get some time to himself. He readily agreed with my suggestion and I asked him to sit in a place which was comfortable for him. This helped in developing a controlled emotional and comfortable environment for client (Trevithick, 2003). I approached the service user with unconditional positive regards and acceptance of the user’s views. I was aware about the things that resulted in anger and exaggerated emotional response in the user. His current behavioural issues were also linked to his past life and family experiences, hence I decided not to ask about his life history during the conversation. I decided to start with his interest. During the conversation, used small deliberate sentences and walked across the room while speaking indicating that he was fidning it hard to speak for long time. I tried to give assurance the client in this circumstances and asked him to make himself comfortable.

The duration of the intervention was 15 minutes initially, however as several weeks passed, the duration of the session became 15 minutes. My strategy was to be non-judgment and not giving any judgment or negative reaction to what the client was disclosing to me. If the service user was getting irritated by any question, then I redirected him by starting a topic which he enjoyed such as questions on his favourite band. This allowed users the time to process the question and give the desired response. With the passage of time, the service user became very comfortable with me and at this stage I asked him that if he was feeling angry, he should either discuss the matter with me or his family. This would help in assessment of the user’s emotion and eliminating possibilities of negative or challenging behaviour in the service user.

The intervention was found to be highly beneficial for the service user as his interpersonal skills improved significantly and he also approached other staffs whenever he felt angry. Now he approaches me as well as other staffs when begins to feel agitated. My supervisor was also pleased with the pace at which improvement in communication and emotional outcomes were observed in the client. Despite such improvement, the service user is continuing with one-on-one intervention and he used this to develop his personalized daily activity planner. He still experience challenges in expressing his emotion, however he consults staff members immediately now for any form of support. He also goes for a walk in the woods with staff and interact with him and also other services users whom he disliked previously. Despite such improvement in social skills, he stills needs to develop his interpersonal skill so that he can confidently engage in open dialogue with other people. I am very satisfied with the improvements seen in the service user and I feel that such improvement would help him to live a meaningful social life with confidence and raises self-esteem.

Profile of Service Used for Intervention

To get guidance regarding the best way to implement the intervention, I researched relevant theories like ‘Understanding autism’ (Baron-Cohen, 2008)  and the ‘Theory of mind in people with ASD and Asperger syndrome (Baron-Cohen, et al., 1997).  The main rational for reviewing theories related to the intervention was  just to ensure that I had good awareness about the problems in user with whom I was going to work. I considered the mind-blindness theory which states that people with ASD or asperger syndromes can find other people’s behaviour threatening and confuding (Baron-Cohen, et al., 2008).  With this theory, I learnt that I should not irritate the service user with too many questions and ensured that I speak with him in a calm and even tone so that he could easily engage in communication with me without any hesitation. The theories of Biestek guided me regarding seven principles of attitudes that is necessary for a carer to adapt. This would help in better adjustment of client with his environment (Trevithick, 2003, p. 165). 

I approach client with positive regard at all times and this was necessary to fulfil the principle of person-centered care and comply with the client’s preferences for his treatment. I also followed ethical consideration in practice by being careful not to extend the intervention to the point resulting intolerance and agitation in the service user. The needs assessment of the services user was done by the application of the KIT model and this helped in the utilization of appropriate theories to develop the interpersonal skill of client.

It is the responsibility of all social care workers to get professional supervision by working with their line manager on a monthly basis. In case of Nua Health care services, all social care staff have the mandate to receive at least 12 supervision sessions in a given year. In compliance with this requirement, I got professional supervision throughout my placement stages on the last day of the month. This professional supervision was useful in reflecting over my performance throughout the month and getting feedback related to any changes needed to improve professional practice. I could not agree with the supervisor on some agenda, however I learnt that constructive criticism will eventually improve my professional skills and approach needed for service delivery. I also left all my personal issues and never discussed about it with my supervision as this would interfere with the purpose of the counselling session. Unless and until the personal issues was not affecting my professional performance, I refrained from discussing with my supervisor. However, I discussed with my supervisor regarding the issues related to lack resources to implement intervention at the desired setting. My supervisor was able to give me the right advice regarding issues were I had a vague idea and such explanation helped me to overcome thee challenges in practice. On the whole, I can concluded that supervision is the most useful resource at The Meadow which not only improves my performance, but also identify areas where I need to develop my skills. It also gave me the opportunity to bring forward my concersn infront of the supervisor every month.

Theories Informing Intervention

The privatization of the social sector has resulted in increases influx of people into the sector and this has resulted in recruitment of professionals from diverse national and cultural background. I believe that such privatization has benefited the sector and me personally too. I can say this because certain life experiences also supports social care workers in professional practices and this enables to apply their clinical and social care knowledge base in a flexible environment. It is a profession that demands flexibility and amalgamation of ideas from people coming from diverse background, culture, religion and nationality. Such form adaptability and flexibility in work is also necessary to ensure that people coming from different cultural background are not discriminated or oppressed in any form. This consideration is important not only for working with clients at the setting, but also for working with other staffs members in the agency.

To ensure that I engaged in professional practice in a culturally competent manner and implement anti-discriminatory action  for any such cases, I reviews the feminist theory of social care practice (Clifford, 2002). This theory was important for me to expand my knowledge base for practice and ensure that I deliver fair and equitable treatment to client without any violation of ethical and professional conduct in practice. The review and analysis of the theory also helped me to engage in critically reflective practice so that I could review my practice strategies and consider its implications on different service user group. This form of preparation also allowed me to review the implications of any action from others perspective. This also made me vigilant about need to learn about cultural values of individual client and respect those cultural differences while working with diverse client in the workplace. Nua Health Care services is also responsive towards any anti-discriminatory practice by ensuring that implement all action in line with set organization procedure and guidelines related to complaint procedure ad Employment Equality Acts 1998-2011. This ensured that ant-bullying, harassment and communication guidelines and employee handbook were accessible to all staffs. This consideration enhanced the provision of disseminating Code of Conduct for all staff within the service to develop an inclusive and supportive workplace.

The implementation of person centred plans and specific plans for patients are some of the tenets of the Nua Health care service. The empowerment approach was incorporated in care plan so that social workers implemented interventions to enhance the skills of service users and enable them to live life with independence. This approach enables wide range of consumers with mental disability to take control over their life and lead it with a high spirit. This approach was implemented by individual staffs by the use of structured task analysis and detailed assessment of the needs of the service users. I followed all this professional approach while working at the Nua Health Care services. I also reviewed the guidelines related to policy and procedure on person centred care planning, advocacy, guidelines on safe practice and the policy related to finance. The positive aspect of all this guideline is that they are guided by national standards and legislation for instance the HIQA and the Health Act 2007. The centre where I started my placement specialized in providing support and assistance to people diagnosed with autism spectrum disorder. Through my placement experience at the company, I can say that extensive research is necessary to properly execute the policies and procedure and provide the right support to service users.

Effective Implementation of Intervention

While doing research regarding my learning goals, I found that challenges in dealing with empathy explained about social-communication problems found in client with autism. I also learnt about the new concept of ‘heypr-systemising that argues that narrow interest of autisms people and their strong attention to detail are some of the strengths of people with autism (Baron-Cohen, 2008).  Stress and anxiety is a common issues in clients with mental disorder and the theories on managing stress in people with autism brings forwards the point that when care used key words or phrase to communicate with client, then such strategy are effective in accommodating and responding  to the special needs of certain service user. This can help to manage people with high level of anxiety with great professional expertise. The tone of voice and the body language of carer also had an impact on patient. For instance, people with ASD have reported that when they hear words in a specific tone of voice from an individual, it support them to initiate controlled action or maintain self-control (Baron, et al., 2006).  I can explain this with one of my placement challenges where a client with ASD for whom food was the source for emotional trigger. I got to know that in the past, the patient would become verbally aggressive whenever a person came to him with an item of food or seasonings like salt. He requested for the food and displayed heightened behavior. I learnt that he tend to exhibited such behaviour because he did not wanted to shared his food. I repeated the phrase ‘sharing is caring’ to him several times throughout the week and the same client now repeats the phrase during the time. The sign of improvement in behaviour is also understood from the fact that he not believes in sharing, but also offers food and condiments to others at meal time.

During my placement at Nua Health Care, I carried out extensive risk assessment for service users and used all my clinical skills to maintain a homely and inclusive environment for client. I maintained safe environment for client by maintaining good hygiene standards, conducting environmental safety assessment on a daily basis to ensure that neither the service user or the staffs were at risk of any injury or health issues. Maintaining an inclusive environment also enhances satisfaction of client with services and facilitated client preference  for daily activities as outlined the daily activity planned for individual client. This also helped to direct client to any kind of clinical appointment that they needed as per their request.

Benefits of Intervention on Service Used

My placement was an enriching experience for me as it helped to improve both my social work skills as well as documentation skills. I became proficient in report writing skills and developed the skills to professionally collaborate with multiple staffs. I developed many incident reports, accident reports, standard referral forms and HIQA notifications whenever there was a need to save client in case of safety related issues or to manage daily administrative task. The provision to work with supervisors at the company and the application of the employee competency framework was also a unique experience for me as it gave me the opportunity to identify my weakness and plan accordingly to enhance my skills for professional development and handling of complex task in the future.

Apart from special focus and interest on the safety and well-being of service user, I also realized through my placement experience that I need to focus on my own self-care needs too. I began to rationally think about my own self-care needed by means of reflective practice for others. I realized that I had the skills to manage my emotions and state of mind both while at work or at home. I also paid attention to my own physical well-being so that I could easily handle strenuous and hectic work the agency. I was too much involved in work and use to check my emails while at home or made work related calls whenever I had an off day or I was not in shift. I did all this to ensure that that I comply agreed upons responsibility of providng support to service users and colleagues. However, while I managed stress in work by finding some time to spend with my family. For stress relied, I also switched off from work for a temporary period. To ensure that work did not disrupted my time with family and my self-care needs, I also left my phone at home whenever I left for day trips with my family. The only exception was when I was on-call.

The above mentioned strategy gave me the opportunity to rewind and relax and have quality leisure time with family. This helped me to develop a strong bond with my 1 months old son. I also decided to give more time to myself, however I could hardly manage this priority because of professional work commitment and overload of college task. However, based on such time-constraint in fulfilling my self-care needs, I decided to have atleast one evening in a week to engage in video games and go for country walk. This were my personal interest and was my personal way of relaxing after a hectic work schedule. I and my partner go for two evening walks per week to have relaxing time and drink glass of wine. We also go to move to unwind.  I took such step to ensure that people closest to me do feel that neglect them and give more preference to work responsibilities only. Such strategies are essential to lead a content and high quality of life.

Continuous Improvement of Social Skills

While deciding to develop my learning goals, my preference was to consider development of knowledge based skills as this is the element that is central to my work and outcome of clients. The Meadows was a center that specialized in supporting people with ASD and asperger syndrome and I decided that as a competitive professional, I should be aware about all research theories related that enhances my interpretation of issues present in client. This was also essential to provide the best support to clients coming to me with their issues. The theories given by Baron-Cohen (2008) was useful in strengthening my undertstanding related to management of stress in people with autism spectrum disorder (Baron, et al., 2006).  These theories led the foundation for developing knowledge and skills related to appropriate method of communication with  ASD people and the manner in which I should present myself while working with such service users.

During my consideration for learning goals, I did not used Johary Window (1959) for reflection. However, I discovered my strength in the process and I realized that I was good in managing my emotions. I use the steps and stage of the Gibbs Reflective cycle (1988) to reflect on my daily work priorities and found that this is useful in prioritizing my work goal for the day and coming out from any crisis or challenging situation with service users. I aim to utilize this model of reflection throughout my professional career.

Based on reflection on the professional intervention that I used in my placement, I can say that it gave me the right practical exposure. My research related to the theory of (Burton, 2001) also enhanced my skills related to risk assessment and decisin making capabiity during high risk situation. I also research several organizational policies and procedure on behavioral support, challenging behavior and restrictive practice and review HIQA notification and other standards mentioned in the HIQA and Health Act 2007. It also upgraded my professional skills by developing incident reports and responding post-crisis situations according to the guidelines mentioned in the company policies. I also ensure to comply with National standards as far as possible to avoid ethical and legal action and promote learning and professional development.

I was instructed by my supervisor to undergo training for safeguarding from the Nua Healthcare services, as a part of my Professional training curriculum. I have not received any confirmation date to commence the training as of yet. I decided to develop my professional expansion, by researching about various other area and took courses respectively via the eTraining courses offered by the Nua Healthcare through HSEland as well as the Social Care Training provided by government of Ireland.

Conclusion

I observed that this particular client liked to spend the most of his time inside the botanical conservatory during his time our centre. When I found him, he was rapidly pacing, more than usual for his condition and rigorously tapped his hands together to draw attention. I went close to reassure the client and provided an open-ended communication by asking him if he was interested to tell me what was bothering him. I tried to console him as I observed that the patient was feeling nervous and beginning to symptoms of restlessness. I decided to make him feel comfortable and question him to sit down and to share his distress with me so that I can help him. At that moment, a fellow peer entered the conservatory, who had particularly known this client previously since many years. My fellow peer had informed me that he had come to provide help for the client. During my conversation with my peer, I started to realise that the client was recollecting previous traumatic memories that he suffered, which was troubling him and that, was creating his distress. I thought this might lead to the client exuding an aggravating behaviour and the client would cause harm to himself as well as to us. I repeatedly tried to reassure the client and calm his down with methods are used to induce relaxation but it was all in vain. I had foreseen that the patient’s current condition would a reach a point of crisis, which is why I requested my peer to warn everybody in the kitchen and stay clear from the area so that both of us could accompany the client into the back of the centre’s garden. I followed the guidelines, which would help in situations like this. The plan was to take behaviour supporting techniques, strategising to calm those behaviours and apply strategies to lower the level of the client’s aggravated condition. A third peer of mine came in and pulled off the corners of the curtain and shut them before looking outside the window to make sure there was no one in the area. It had to be made sure that the patient’s privacy was not jeopardised by looking outside to make sure no one was present. After we went to the back of the botanical greenhouse, the client showed extreme aggression so much so that he went as far as attempting to assault me and my peers. All of us tried to use the best way possible to block the assault form the client, bt it was all in vain. We decided we had to resort to use our physical strength to restrain the client to protect ourselves and for the sake of the client who would have eventually hurt himself in the process. I tried to reason with the client and offered consolation by speaking in low soft and calming time so as to lower the patient’s aggression. The whole process was in vain as the client still ignored our efforts to calm him down and  fell on the ground dragging us along with him so unleash himself from the MAPA technique of restrain that we utilized. The client by this time had begun to verbally abuse me and my peers along with his continued efforts to physically assault us. We had to restrained him for the second time, this went on for some time until the client finally could calm down and I decided to contact the on-call manager to receive the approval for administration of PRN medication for helping the client with the aggression management and help him go back to his conscious to normal. As soon as the client returned from his state of trance, he apologised repeatedly to me and my peers while sitting down with us. The client although calmed down then but still showed symptoms of lingering aggravation so me and my peers decided to remain seated in the gardening location until the patient completely went normal and tried to engage in a conversation with the client to understand the reason for his sudden fit of anger.

 My initial instinct after assessing the condition of the client was that like an intuition that the situation might get out of hands, as the client has had a previous history of assaulting a care provider in this centre, which was the root cause of my concern for the client. I had previously been in similar situations where i had to restrain difficult and aggressive clients, so my safety was not my primary priority. I was quite aware of the situation but was concerned about the patient’s well being, so I decided to go through with the usual procedure as I have on numerous occasions in this care facility. As soon as I tried to reach to reason with the client, I felt penitence for the sake of the client and at the same time, I felt disappointment for myself since I was not able to analyze the situation sooner and prevented any such progression of the heated situation. I could have familiarized with the client beforehand to gain his trust and prevented this whole situation. In the time when the aggressive inducement was occurring, I was much more apprehensive about the client rather than my peer and myself. My intuition told me that as soon as the client would lose himself in his fit of anger, he would lose sense of present, consciousness and I wanted to do everything to prevent any sort of way, which could harm the client, like falling, slipping and tripping due to loss of balance. I felt reassured when I realized neither of us encountered any ort of physical harm in the course of the incident. I sympathizes with the patient for his condition because he seemed indubitably remorseful about his behavior.

I came into the realisation that any patient who seems cheery and good can transform at any given point of time and display aggression, which reaches alarming levels. The positive things to focus on in this case was positive outcome is achievable for any kind of aggressive display by the patient if the plan for behaviour support is followed  and strategies that address aggression  as assessing the risks can help achieving best outcome. I learned about myself that i do not display any fear when faced with aggressive clients and keep my professional commitments above everything else. My life experience has taught me not be fearful and provide the best care possible. The negative impact i take away from the situation is that my lack of vigilance gave room for the patient to cross the level of containment and which could have been avoid by timely intervention as I was not familiar with the patient. Similar platform for training is provided to the staffs, which is known to me and that affects the professionalism and no patient, situation is to be taken for granted or else situation will go out of hands.

To assess the sensibility of the situation I reached out to the client the next morning, as per the client’s request who wanted to retire for the day after the occurrence of the incident. I tried to make sure that I properly communicated with the patient anf found out the prevuiously thre days prior a certain family member had came to see the client. This incident has previously occurred whenever this client received family visits. The client confided in me that he has no wish to receive family visits as he is not of much liking for them. I assured the clinet that the Meadow facility is a safe haven for him and the aim of the facility is to provide him  best quality of care. I had a debriefing session with the client’s family letting them know his wish to never see them again to help the clinet in future.

Conclusion

The incident aforementioned has taught me that inherently I  am able to positively consider a patient’s situation and I possess the skills to manage critical moments. The incident taught not to expect all my peers to possess similar perceptions like mine in times of difficult situations and their inducers. I will be required to improve my vigilance ability for improve care providence for clients and peers alike. The incident was preventable had my peers and I intervened earlier, on the other hand maybe this was one of thise situations where no one has control over. Last;y the im[portant lesson I taught myself was that possessing the ability to check emotions provider was unhappy with the current setting and displayed physical aggression. The decision was not appreciated amongst the care giving staff due to her previous history of assault. The facility instructed the assigned nurses to take the woman for a post dinner drive for twenty to thirty minutes and then return to her dwelling for a night-bath and rest. I proposed to take her for her routinely drive and for the first time after the 1:1 decision. I brought the car around for her post-supper drive and parked at 18:50 pm and played the CD she preferred and she was seated in the fat end of the seven seater SUV, according to the risk prevention guideline. Initially it was fine as I offered her reassureance for the anxiety propagation, since I was not her usual care provider for the day. We were 1.5 miles due north of the centre when the client started to rip the ceiling-light of the car’s interior and started to scream.  I tried to provide calmness to the patient but and wanted to the standard practice but it did not work for long. The client managed to jump out of the car so swiftly that I was compelled to hit the brakes immediately. I pulled the accelerator and at that moment, the woman climbed on the driver seat pulled over. I tried to give her breathing lessons to calm her down but she refused and spat at me and started to throw the car interiors. It was dark and the cra was on the side of the road, which I was aware of. I somehow managed to call the centre and asked for help who arrived within ten minutes. I tried to engage calming techniques with the patients and the staff members arrived to calm her down and we took her to the centre.As soon as the realization hit me that the patient already had hold of the hood in the middle of the vehicle I was driving, I was struck with panic that since we were in the main road after dark, away from the centre we would be met with an accident, if another car was speeding towards us. If I had not been able to pull the car on to the side, we could have met with an accident and lost lives. I was more concerned about the client is well was being bound by duty and managed to remain focused and contacted the service centre for backup. It was a proud moment as a profession care provider that I had not lost my composure on the patient. Had I not acted swiftly and managed to pull the car on the side, and followed the centre protocols, regarding service care user aggression management, the situation could have taken a different toll. Although, I was disappointed with myself since I failed to contemplate or foresee the situation and understand that the patient could have been distressed because I was taking her out alone.  I was put into a clear perception of what it is like for patients, living in The Meadows Centre, who suffer from Autism Spectrum Disease, a condition that makes a person undergo sudden fit of anger and aggression and exude extreme behaviour due elevated anxiousness. As directed by the guidelines of standard practices in the centre, when encountered with a similar incident, the staff members are supposed to make room for people who are specially appointed to deal with aggressive patients.  This acts a technique odd distraction for the client which gives time for the care providers focus on the patient and minimize the negative impact on the staff members. The incident helped me realise that despite me trying to help the clients in the facility with my best, it is not possible for me assess and prevent situations like this at all times. I also need to understand the importance of stepping back when one of my peers, who is more familiar with the client wants to jump in and help. Whereas, the current facility allowing the client to be monitored by 1:1 care provider from 2:1 provider client ratio previously, the client is still not acceptably well to be allowed to dwell with the community, as she may be harm toReflecting on the previous history of the client it can be observed that she had previously exuded acts of aggression like assault and material destruction in her house or car for which she was being treated in this facility. It can be contemplated that the client was not comfortable with the current staffing situation and felt threatened when she was assigned to care providers. Christmas was due to arrive that time of the year, and all the lightings and decorations were put up all over the centre, which must have aggravated her. The patient showed aggressive outlet of her fear like, she has multiple times of the time previously in the centre around the time of Christmas. The second factor I am contemplating that she was not accustomed to be around anyone else but a female care provider who took her out for post-supper drives and another male carer and since I was unassigned from her previously due to the new arrangement she felt distressed.

I conclude at the end of this report that the incidents that occurred in my facility developed a sense of confusion internally that I was not competent enough to address the condition and me not contacting my supervisor in time for help, which could have prevented the situation. In spite of being in a state of knowing the strategies for supporting behavior, knowing the assertive regard for unconditionally the patient condition and following the professional standards set by the centre, I still failed to distract the client and the incident occurred. Briefly I would to address that the learning outcome, social-care is practice requiring full support from a constructive team. Asking for help from peers is a constant nature of care provided by the profession. Primarily the thought that bothered me was that I had let down myself as well as my peer and could not display best possible ability to handling difficult patients, in spite of following the guidelines and policies and kept both of us in safe zone. In future, I need to tell myself that it not mandatory to handle every situation alone and my peers can be asked for help in difficult situations.

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