Resetting the balance: from despair to self-determination
| Published date | 09 September 2013 |
| Date | 09 September 2013 |
| Pages | 70-76 |
| DOI | https://doi.org/10.1108/JIDOB-09-2013-0019 |
| Author | Ian Hall,Brenda Crossley,Mark Mercer |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour |
Resetting the balance: from despair
to self-determination
Ian Hall, Brenda Crossley and Mark Mercer
Ian Hall is Head of Learning
and Organisational
Development, Brenda Crossley
is a Practice Education
Facilitator and Mark Mercer is
a Clinical Specialist Positive
Behavioural Support, all are
based at Calderstones NHS
Partnership Foundation Trust,
Blackburn, UK.
Abstract
Purpose – A case study approach to highlight the use of cognitive neurological rehabilitation in the therapeutic
management of two service users who have a diagnosis of learning disability and who have exhibited the
extremes of aggressive and challenging behaviour. The purpose of this paper is to explore the remarkable
progress made by two service users for whom services seemed to be at a loss as to how to meet all but there
basic needs.Their journeysfrom hopelessness tooptimism and recoveryare both attributableto the cognitive
neurological rehabilitation model and how staff and service users worked together to gradually regain control.
Design/methodology/approach – A case study approach highlighting the value of training, team working
and a therapeutic model and the impact this has made on service users who, in the past, where labelled as
highly disruptive and potentially untreatable.
Findings – That the cognitive neurological approach is effective in managing service users who have
certain cognitive deficits in a structured and supportive way that allows positive progress towards recovery.
Practical implications – A very practical intervention that can be taught and supported. An intervention
that appears to achieve excellent clinical results.
Originality/value – Very original and effective approach to care and treatment of service users with
diagnosis of learning disability living in conditions requiring security.
Keywords Case study, Practice, Recovery, Behaviour, Clinical, Therapeutic
Paper type Case study
This paper seeks to explore the remarkable progress made by two patients for whom services
seemed to be at a loss with as regards meeting all but their basic needs. The catalyst for both
their journeys from a situation of hopelessness to one of optimism and hope lies in the
application of a cognitive neurological rehabilitation approach to care delivery.
Cognitive neurological rehabilitation is a relatively new concept. Its origins lie in the support of patients
suffering acquired brain injury.Early v isionaries in the late 1980s and early 1990s, such as Dr Howard
Jackson and Professor Roger Wood (Wood, 1987) proved conclusively that, given the correct
philosophy, intervention and environment any individuals with cognitive difficulties could make huge
progress using this form of rehabilitation. In 2002 this was taken a step further by Dr Jonathon Rogers
who developed a training handbook and programme to support staff working with patients with
acquired brain injury and schizophrenia in a high secure setting (Rogers and Pitman, 2004).
After completing a train the trainers module in 2006 delivered by Dr Rogers, the author and his
colleagues have further adapted and developed the model in order to work with patients with
learning and associated difficulties, many of whom reside within conditions of security, and
many of whom were transferred with transferred “special project” status. These individuals
required dedicated staff teams because of the complexity of their care needs, usually as a result
of extremes of challenging behaviour and high levels of aggression.
The value of the cognitive neurological rehabilitation approach is that it is truly holistic in the care
philosophy and extremely person centred as well as practical in application and understanding.
PAGE 70
j
JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
j
VOL. 4 NO. 3/4 2013, pp. 70-76, CEmerald Group Publishing Limited, ISSN 2050 -8824 DOI 10.1108/JIDOB-09-2013-0019
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