Thinking outside the box to improve patient care

Pictured above: (L to R) Developmental Service Worker Carmen Ng and Behavioural Therapist Phoebe So demonstrate how the picture exchange communication system works.

By Patrick Callan, Communications Coordinator

Not all innovation involves reinventing the wheel. Sometimes all it takes is using existing parts differently. Case in point: a book and a button. 

When these everyday items were paired together by coworkers on CAMH’s Adult Neurodevelopmental Services (ANS) unit, they completely transformed the life of a non-verbal patient with autism, who we’ll call Robert to respect his privacy. 

“He used to get upset and bang on doors if staff didn’t attend to him quickly,” says Phoebe So, Behavioural Therapist, ANS. “There would be lots of loud vocalization, as well as pushing and scratching staff. Once he got so angry he bit his own hand and it started bleeding.”

CAMH’s Adult Neurodevelopmental Services supports people aged 16 to 60 who have an intellectual disability with mental health concerns, severe challenging behaviours or autism spectrum disorder.

Phoebe met Robert last June when she started working at CAMH. She had previously worked with children with autism at Surrey Place in Toronto and had an idea to try using the Picture Exchange Communication System (PECS) to help Robert communicate his needs. For example, if a non-verbal person wants an apple, they find the image in a picture book and show it to someone who then provides assistance.  

“He picked it up in no time,” Phoebe says. “It was great.” 

Robert is currently at phase three in PECS and can identify individual objects. The next step would be using pictures to build sentences. 

“He’s not there yet, but we’re pretty proud of him being able to use single words. It’s really impressive,” says Phoebe. “Right now, his main motivation is things to eat - like celery, parsley, coffee, juice and water. He’s also identified simple activities like going for a walk or going to his bedroom.”

But it wasn’t the picture book alone that helped transform Robert’s quality of life. 

Enter the button. 

Despite having the communication book in place, Robert still had difficulty getting staff’s attention when he needed something.

With that in mind, Carmen Ng, Developmental Service Worker, ANS, decided to install a button just inside the care station on the unit. 

“I thought a BIGmack button or a recordable button would be beneficial for him,” says Carmen, who is also Communicative Disorders Assistant and conducts speech and language therapy with people who have autism and intellectual disability. 

Carmen set up the button with a recorded message saying, “I need something.” This allows Robert to simply press the button when he needs something and then staff presents the book for him to choose an image. Previously, staff often had to guess what he wanted, which was very challenging for him and staff alike.

“When the button was paired with the communication book he immediately gained a new skill,” she says. “As a unit, we’ve seen a decline of banging, grabbing, and his quality of life seems to be better as well. He’s less agitated and aggressive, and we’re able to provide better care for him, which I believe is an improvement in his quality of life.” 

Now, when Robert does get frustrated, sometimes all the staff need to do is point to the book and he calms down and self-regulates, adds Phoebe.

Bridget Akioyamen, Manager, ANS, says some patients on the unit are non-verbal and it can be very challenging to figure out how to make it easier for them to communicate their needs.  

“The system Phoebe and Carmen put in place is the result of team creativity to support a very challenged patient and enhance his quality of life,” she says. “It’s such a little thing, but it has reduced the frequency of aggressive behavior. I think it’s wonderful.”