Mental wellbeing and emotional support for children with vision impairment and complex needs

Post date: 
Friday, 30 September 2016

Fiona Minion and Cynthia Skelcher from RNIB Pears Centre share how they developed a mental health plan and the impact it has had on the children and young people they support.

One in 10 children aged between five and 16 years has a mental health problem, and many continue to have these problems into adulthood. Half of those with lifetime mental health problems first experience symptoms by the age of 14.
 
This number rises significantly for children with vision impairment, learning disabilities, autism and complex needs. (Until quite recently, it was thought that people with learning disabilities didn’t have the same range of feelings and emotional needs as other people. It’s now realised that it’s very common for young people with learning disabilities to experience mental health issues.)
 
At RNIB Pears Centre for Specialist Learning, we offer individually-tailored education, care and therapies to children and young people with multiple disabilities and complex health needs who have vision impairment. Due to their complex needs, the young people we support may have trouble understanding, controlling or interpreting thoughts and feelings. This often leads to challenging behaviours which may disrupt learning.
 
Our in-house learning disability nurse brought together a group of staff who wanted to look at behaviours and what they mean to our young people. For example, what are they communicating? What are their emotions at any one time? How can we find out why they are having problems?
 

We set up emotional support sessions to help young people understand their feelings and realise their sense of wellbeing, recognising that the ability to communicate can help ease or solve problems, lesson anxieties and hopefully manage their inner feelings of self-control.

Working alongside a consultant psychologist, the group started to look at positive psychology, as we all felt we should make a firm commitment to the emotional, mental and physical wellbeing of young people.
 
We adapted Seligman’s PERMA model, which has five core elements of psychological wellbeing and happiness, and used the mental health plan from trauma response within positive psychology, to develop a programme which suits the needs of our unique young people at RNIB Pears Centre.
 
We called it the ‘Pears Positive Mental Health Plan’. The aims are:
  • To see the whole person
  • Find out what positive emotions and engagement mean to the individual
  • Explore how can we assist them to form good relationships with those that are important to them, and
  • Understand what they perceive to be a meaningful existence.

Rebecca’s story

Rebecca (name changed to protect identity) has optic nerve hypoplasia, a congenital condition where the optic nerve is underdeveloped, and is registered blind. She has a multi diagnosis of attention deficit disorder (ADHD), autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD). She also has a cognitive development delay. Rebecca displays challenging and self-injurious behaviour. Rebecca’s placement in long term foster care had broken down, which I believe led to feelings of bereavement and uncertainty in her life.
 
When Rebecca came to live and learn at RNIB Pears Centre, she displayed self-injurious behaviours ranging from head banging on hard surfaces to biting her hands. The latter being so severe that Rebecca’s hands needed reviewing by the paediatric plastic surgeons teams every fortnight. She wore a helmet to protect her face and head and both hands were bandaged which restricted the use of her fingers. She verbalized loudly when anxious and had short bouts of screaming.
 
Shortly after, ‘a team around the child’ was formed. This team included a behavioural nurse specialist, occupational therapist, teacher and team leader from the bungalow where Rebecca lived. Other staff, who were beginning to build a relationship with Rebecca, were also involved. We commissioned a consultant psychologist and also contacted Child and Adolescent Mental Health Services (CAHMS) for advice.
 
We decided to enable teams that support Rebecca to work proactively and, in collaboration, a Pears Positive Mental Health Plan was created to incorporate trauma response prevention, crisis intervention and positive identity development.
 
It was decided that emotional management for Rebecca is vital and should be an integral part of her day. This includes a set therapy session within her weekly school timetable which gives Rebecca some ‘talk time’. Rebecca may also need time to understand her feelings and develop appropriate responses to these, supported by staff she trusts.
 
Our occupational therapist also developed a sensory diet that was incorporated throughout Rebecca’s day. This includes:
  • Regular deep pressure activities, like the use of a bear hug, weighted lap pad or blanket
  • Not overloading Rebecca with too many noises, and
  • Providing a safe quiet area if noise became too much.
The Positive Mental Health Plan gave staff working with Rebecca a deeper understanding of why she displayed behaviours and self-harmed. It also showed staff what activities Rebecca enjoyed and how they could integrate these into her day.
 

Rebecca has now been at RNIB Pears Centre for about 18 months. In that time she has developed immensely. The main area of concern for staff, Rebecca’s self-injurious behaviour, has seen a significant reduction, particularly in her injuring her hands. We have been able to remove the bandages on one hand whilst the other hand is still bandaged but she can use her fingers functionally. She will still bang her head but this is now used more for communication or attention rather than hurting herself.

Rebecca’s behaviour has improved greatly, however this is still work in progress and she will continue to have all the support required to enable her to grow into a confident and happy young woman.
 
This article originally featured in Which School? For Special Needs 2016/17

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