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Case study: Tammy

Tammy is a young woman with key diagnoses of Attention Deficit Hyperactivity Disorder (ADHD), Dyspraxia, a moderate Learning Disability, and Attachment difficulties with Emotional Dysregulation.

Prior to the request for a placement at Beechwood College Tammy displayed challenging behaviour of high frequency, severity, and management difficulty. Tammy had experienced an increase in her intense and unpredictable behaviours. Physical aggression displayed by Tammy could be of very high severity and management difficulty. Tammy presented a high risk to herself and others as a result of the challenging behaviours that she displayed.

This level of behaviour also meant that it was difficult for Tammy to fully engage in education and therefore achieve in line with her potential. She had significant difficulties transitioning to different activities with different staff and going home at the end of the school day.

What support did the College provide to Tammy?

  • Tammy found the move away from her family home understandably difficult and on her arrival at Beechwood College, and for a number of weeks following, her level of challenging behaviour rose significantly which required a significant amount of input.
  • Multiple and frequent MDT meetings involving the college staff teams, her family and those external professionals involved in her care were held to ensure that her placement at Beechwood College remained in her best interest.
  • Significant changes were made to her living environment and to her staffing to ensure that her safety and the safety of those around her was maintained at all times and that she received the input and support that she required.
  • Although academically suitable, Tammy was unable to follow the Band 2 curriculum pathway; her behavioural presentation and her need for a highly consistent and predictable environment and familiarity with staff meant that Tammy would benefit most from a class group that was static in nature as this would alleviate the need for her to transition appropriately to other areas of the College. Tammy joined a higher ability Band 1 tutor group that could facilitate this.
  • As part of a comprehensive and detailed PBS plan, Tammy had a personalised set of College rules combined with a reward systems that operated throughout the College day.
  • Tammy was introduced to a number of different social skills and understanding groups in which she had the opportunity to explore and develop the concepts and skills required to maintain healthy relationships with those around her.
  • Included in Tammy’s support team was a specific member of staff with a clinical background, who was able to lead in the sharing of information and ensure that Tammy’s PBS plan strategies were implemented.
  • Tammy initially settled well into her tutor group however, as her ability to self-regulate and communicate her needs improved she began to request to use a small separate classroom. She used this on an irregular basis if she felt that her sensory need for space and quiet were increased, but when happy and engaging in activities she remained with her class.
  • Specific differentiation within the class environment and throughout her daily activities ensures Tammy is provided with a range of short duration tasks in quick succession with a number of opportunities for personal choice and breaks for self-regulation. This helps to ensure that her attention is maintained and she can be fully engaged in the task at hand.
  • A sensory assessment and subsequent sensory diet provided Tammy and her support staff with suggestions and strategies to help her best meet her sensory needs. This included regular breaks and opportunities for movement and sensory engagement.
  • A community access graded plan was put in place to ensure Tammy had weekly access initially to the community, and a vehicle access graded plan was put in place to allow her to access a vehicle with her peers.

What have been the Outcomes for Tammy?

  • Tammy still requires a high level of staff input and multidisciplinary input however, the number of challenging incidents that she has in any one period has significantly reduced throughout the duration of her placement.
  • Tammy’s early education at Beechwood College was successful in reintroducing her to formal education, providing her with consistency and allowing her to develop the skills that she required to regularly and more fully engage in education. These skills have allowed her to move to a Band 2 tutor group and subsequently participate in the afternoon options groups, selecting topics that she has an interest in and further developing her academic skills.
  • The community access graded plan was a success, resulting in Tammy accessing a range of activities in the community several times a week by using a vehicle and by walking. The radius restriction was lifted and Tammy has made several long distance home visits, which have all been a great success.
  • Tammy now accesses the College minibus with her peers once a week.
  • Tammy is able to engage in tasks for longer periods of time and typically requires less breaks to self-regulate.
  • Tammy is now more willing to discuss things that trigger her with staff and will use a mood thermometer to tell staff if she feels she is starting to escalate.
  • Beechwood College is liaising closely with Tammy’s family and the external professionals involved in her care to ensure that her next placement is suitable and stable, will continue to develop the skills that she requires, and offers her the best possible quality of life.

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