The youngest person yet to use a one-page profile!

The youngest person yet to use a one-page profile. Baby James was just three days old when his mum created his profile to help hospital staff understand how best to support them both.

James' one-page profile

James’ one-page profile

Written by mum Deb

James arrived a day after his due date, after around 16 hours of labour.  The cord was around his neck, he was in a difficult position, and so we were advised that we needed a vacuum delivery. He was born just before 8pm under a blue moon.  He was the most beautiful purplish slippery floppy thing that I had ever seen.  After a brief cuddle, he was whisked away to the special care nursery to await a visit from the pediatrician.  My friend and student midwife persisted with staff until they returned my baby to me, looking a healthier shade of pink and gazing endlessly at me with his deep dark blue eyes.

Aside from a bruised and swollen head, he was deemed healthy and okay to see the doctor in the morning.  The nurses decided that I was too fatigued to responsibly look after my baby that night, so he was taken back to the special nursery and I spent a sleepless night euphoric, yet pining for my baby boy. My first night as a mother held the strangest combination of immeasurable joy and a complete sense of powerlessness.  I knew my baby and I would both be better off together, but just couldn’t seem to organise my thoughts well enough to do anything about it.

James spent most of the next day sleeping and being woken for feeds.  We struggled to get James to feed which resulted in us both being pushed, poked, guided and prodded in spite of the hospital’s ‘hands off’ policy in relation to support with breast feeding.  By day three I was exhausted and emotional, and James had started to cry every time I tried to position him for a feed.

I had shared my own one-page profile with as many staff as I could, and virtually every new nurse that came on shift sat down with me and we talked through it together.  A couple of staff used it as an opportunity to basically tell me I knew nothing relative to their extensive experience, but the majority listened attentively and asked clarifying questions.  Heartened by this, I scrawled down James’ first one-page profile while he slept and I should have been resting.

In those early days of fatigue and confusion, writing out James’ profile helped me to make sense of my thoughts and to begin to understand this little person.  At a time when any sense of control was fleeting at best, James’ one-page profile provided a way to assert how we’d prefer to be supported.  I received mixed responses from staff, but I have one particularly positive memory that has stayed with me.

It was around two in the morning and a midwife who was close to my own age sat quietly beside me as I attempted to feed James.  As she read our profiles she related stories about feeding her own three children.  She talked about how each baby was different, each wonderful and puzzling, and each very much their own person from the moment they arrived.  She was encouraging and reassuring, and she provided guidance without any sense of pressure.  She told me that our profiles helped her to know exactly what we needed from her rather than guessing and having the usual feeling as though she’s just not quite getting it right.

An added bonus from writing James’ profile at such an early point has been looking back at it so many months later and remembering details that I am sure I would have forgotten otherwise.

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One-page profiles in hospitals – Something to shout about!

By Julie Malette, HSA Canada

Julie Malette

Julie Malette

Our work in health care settings is fairly new in Canada.  In November, I worked with the North Bay General Hospital’s Mental Health team and I am quite excited about the direction they are taking in terms of listening to the patient voice and focusing on being more person-centred.  We spent two days focusing on person-centred thinking and one day on person-centred reviews.

The hospital’s mental health department is currently transitioning from traditional multi-disciplinary team meetings where the focus is often on clinical goals and meetings are lengthy, to what they call the ‘One Patient One Plan’ approach where mini-team meetings occur weekly with a core team of supports and focus on the patient’s priority goals.  We will be working together to look at how person-centred thinking skills/tools can be helpful with this approach.

Soon, I will also be spending time with key leaders from both the mental health and the medicine departments of the hospital to support them to develop their one-page profiles.  The hospital would like to start with its leaders who will then support their staff in developing their own one-page profiles.  This is a very important step. One-page profiles in hospitals could totally revolutionize the way patients and staff are supported. It means that healthcare workers will be supported to understand the person, not just the condition and that patients will be able to communicate what is important to them and how best to support them. Starting from within means we can really embed the concept of using one-page profiles deep within the culture of the hospital and this will give it the commitment it needs to grow and be used well by both staff and patients.

Our colleagues in the UK have already introduced one-page profiles into two hospitals and their recent pledge for NHSChangeDay (to support patients and colleagues working and using health services throughout England to create one-page profiles) has significantly raised the profile of what this could achieve in health. Nurses, Hospital Chaplains, Patients, Therapists, GPs and Hospital CEOs are mobilizing to have their own one-page profiles in support of the pledge. I’d love to see something like this happen in Canada.

I’ll keep you updated on how our own health one-page profiles are progressing and leave you with these thoughts: Imagine you were in hospital and your healthcare team really got and understood you as a person. Now imagine you are a health professional and because of a simple, easy to read sheet of paper you had all the information at your finger tips to make someone feel understood, well cared for and well supported when treating them. This is what one-page profiles in health could help us to achieve. To my UK colleagues – I wish you every success in your pledge. To my Canadian friends – what about doing something similar here?!

 

An alternative to setting targets through SEN Statements

A wonderful example of how one-page profiles can help schoolchildren who experience autism communicate what is important to and for them whilst sharing their personal skills and gifts in a way that works well for them. Connor’s story demonstrates how one-page profiles can be used in person-centred reviews as an alternative to solely setting targets through SEN Statements; putting him at the heart of all decision making.

Connor's school one-page profile

Connor’s school one-page profile

Written by SENCo Debra Ayers from Blaenbaglan Primary School

Connor is eleven years old and has a dual diagnosis of speech, language and communication difficulties and autistic spectrum disorder. He is very caring and loves singing and drama. His personality endears him to adults and he has built some good friendships. He speaks as he finds and has a sense of humour if the joke isn’t on him.

Connor’s one page profile was created in readiness for his transition to Comprehensive school so that the new people in his life could get to know him a little before meeting him and Connor could tell them what he thought was important for them to know about him.

Connor completed ‘what’s important to me?’ independently and ‘good day bad day’ was shared with staff to create ‘how best to support me’. His peers, staff and family contributed to ‘what we like and admire’. He created his profile in school using ‘Pages’ (i-pad) and included a video. The profile was completed over the course of five teaching sessions in a week.

Connor’s profile is on display in school and has been shared with staff in his new school, his family, the LEA and professionals who are currently working with him. It was sent out with his invitation to his first person-centred review. It has been used in preparing for this review through discussion with Connor, his mother, teacher and speech and language therapist, identifying what’s working / not working and possible outcomes to be considered in the review meeting. It’s a working document which he can amend and add to.

He has loved making it and it portrays so much about him, even down his choice of colours and use of video. It has helped staff working with him gain a deeper insight into his views in and out of school. It has certainly helped us realise the importance of not assuming we know everything! Even his mother was surprised at one thing he included in ‘best ways to support me’. It helped us realise how astute Connor is about his likes, strengths and needs. It has helped family and professionals realise how they can support him and use the profile as the link to encouraging him to become increasingly independent by offering something that we know he wants or is important to him and putting in strategies that will enable this to be successful.

Connor loves sharing his profile with others and it has helped him to build relationships with less familiar adults and peers. The profile, as part of the person-centred review process, has, undoubtedly, made Connor central to the decision making process and the outcomes are pertinent to him at this moment in time, rather than having targets set linked to his Statement of SEN and what we as parents and professionals consider to be important for him.

We thought we knew Connor well before producing his one-page profiles but he still surprised us and his mother. It gives an amazing insight that we just hadn’t managed to achieve before! The person-centred review process, has changed the way we will prepare for and conduct review meetings. Connor is now at the heart of the process, being fully involved in the meeting and actively buying into the outcomes because they are important to him.

With great support you can achieve great things

A powerful story about one man’s journey from a secure hospital ward to happily living in his own home, using his one-page profile to direct his support and communicate the things that are most important to him.

Michael's one-page profile

Michael’s one-page profile

Written by Tracie Gudgeon of Care UK

When we met Michael he was living on a secure ward with two people supporting him at all times. The people supporting him wore personal attack alarms and were charged with 15 minute observations. This is worlds apart from where he is now. Twenty-nine year old Michael now lives in his own home which he loves people to visit. Not only will he greet visitors with warmth and affection but he will remember how they take their tea and coffee and any other small detail from the last time they were there.

Back when Michael was living on the secure ward a person-centred transitional plan was arranged to see how life could be better for Michael.  It was vital that the people supporting him understood what Michael’s autism looked like for Michael and that they really understood who he was.

We started spending time with Michael in his hospital and worked with him to develop his Circle of Support. A Circle of support is a group of people that come together with the common purpose of helping the person at the centre of the Circle to achieve their goals. We looked into who the important people in Michael’s life were and this in turn led us to learn more about what matters to him.

We started to work alongside his existing support team to help us get to know Michael and would spend time just sitting with him or joining him on his daily routines to understand his world better. Michael started to express himself more during this process and would share with us his aspirations and dreams. We leant that he would like to learn to swim and ride a bike and he shared this with us through pictures.

Michael’s one-page profile captures the confident, fun and outgoing man that he is. With the right support and vision Michael now has his own space and directs his own support. His one-page profile clearly communicates what is important to him and how best to support him so that those people involved in Michael’s life know just how to support him in a way that makes sense.

Michael will think nothing of walking into a room of strangers and socializing with them now and attends a local club night with his friends every Friday – at long last he feels like one of the lads.  Only just recently we saw Michael confidently presenting his thoughts and views to an audience at a regional working together for change event.  The transformation is inspirational.

Michael has now learnt to ride his bike and has twice weekly swimming lessons which are recorded in his one-page profile. He has a busy social calendar, and is an active advocate at our Care UK Listen to me Group. Michael’s support is directed by his one-page profile and his story is evidence that with great support you can achieve great things.

My profile evolves with me

An example of how people use one-page profiles in the workplace to help build effective and harmonious working relationships. Steve’s story also highlights how one-page profiles work best when they continually evolve with a person.

Steve's one-page profile

Steve’s one-page profile

Written by Dimensions

Steve Inch is the co-chair of Dimensions Council. He retired from his role as Dimensions’ Deputy Chief Executive in 2012 and now spends some of his own time working to develop Dimensions’ involvement strategy.

The Dimensions Council is a representative body of the people Dimensions’ support, and brings important issues to the Board’s attention twice a year.

Whilst at Dimensions Steve was introduced to one-page profiles and created one with his friends, family and work colleagues past and present. In the section where people describe what they like and admire about Steve, his calm, fair and considerate nature is highlighted; something that helps put the people that work alongside him at ease.

Steve’s one-page profile has been used to introduce him to the members of Dimensions Council, particularly those that have not worked with him before. Is was important that he found ways to help people understand his work-style as well as his general approach to people and life, so Council members could work with him effectively and harmoniously.

Steve has shared his one-page profile with all the Dimensions Council members. He has also shared and reinforced elements of it within Council meetings and everyone has had opportunity to read it carefully in their own time, in fact all Council members have a one-page profile and they are all shared across the entire membership.

Steve keeps his one-page profile up-to-date by reviewing it in his own time when reflecting on his learning from both his work and life experiences. If ever his one-page profile is updated he shares this with his co-chair and the Council membership so that it continues to evolve with him.

What they can achieve still amazes me!

Cath’s journey to being a fitter and healthier person demonstrates how one-page profiles can still bring surprising results, even for those who work with them daily and know their worth.

Cath's one-page profile

Cath’s one-page profile

Written by Cath Barton

In my early forties I became more concerned about my weight, fitness (or rather lack of) and overall health and wellbeing.  I was in the habit of crash dieting before a holiday or big event, only to put the weight back on, ending up feeling deflated and unsuccessful.  I knew I wasn’t alone in this and some people spent their life feeling this way. The difference for me was that I am a Person Centred Planning Coordinator. My day job is to use person-centred approaches. I had the resources and knowledge to identify the things that are important to me, think about the support that works best and make positive changes.  I had even used one-page profiles for myself and family in my personal life but for some reason I hadn’t thought to apply it to my health and wellbeing before now.

I promote person-centred approaches passionately and needed to practice what I preach and use the tools at my disposal to create and support change within my own life.

I decided to develop a one-page profile specifically for keeping healthy. Not to focus on dieting, as I knew that in the past this had been a short term solution, rather to think about what was important to me about keeping healthy and the support I needed to achieve this.

I took some time thinking about what worked well for me, what did good healthy days look like, when did I feel I had achieved, how could I have more days like this? I recorded the information, shared it with my family and put it on our achievement wall in the kitchen where it was easy to see.

I’m constantly amazed by the changes that can be achieved from information recorded on a single sheet of paper.  I feel much more in control of my health and fitness. Simply having the information at my fingertips has helped me to focus.  It’s made me much more positive about exercise too, not seeing it as a chore but remembering how good it feels afterwards.  I’ve even started Pilates and swimming and met some interesting people through this.

I wanted to be able to make long term changes, not quick fixes and my one-page profile supports me to do this, incorporating healthy eating and exercise as part of my daily routine with support and encouragement from those around me.  It will always be a work in progress, to review regularly and keep up to date. But this time I won’t be obsessing over the scales. I’ll be asking myself how I feel.

New learning for me was also how powerful the appreciation section in the one-page profile can be.  It’s not about fishing for compliments or simply having positive words recorded. For me it was recognising what others admired about me, qualities I might not have recognised myself but which boosted my confidence and desire to achieve.  I want to uphold people’s views of me; be determined and strive for success. Having others recognise that I can succeed is a powerful motivator.

So did my one-page profile help to support positive change?  Most definitely!  I’m fitter than I have been for a long time, I’ve found an exercise I love to do and have a good balance in my life.  One of my proudest moments was swimming my first mile.  I’m still amazed by the difference it has made and grateful for the success my one-page profile has supported me to achieve.

Choosing how to spend your time

Winifred's one-page profile

Winifred’s one-page profile

How a one-page profile can help people with dementia reconnect with their past, recall happy memories and make decisions about who they want to spend time with and what would make them happy.

Written by: Gill Bailey

Ninety-two year old Winifred Baguely can be heard singing and laughing as she helps the housekeeper out with her daily routines at Bruce Lodge where she lives. Winifred, who has dementia has always been warm, loving and generous but she hasn’t always been this satisfied and relaxed in her new home; until she produced a one-page profile with dramatic effects.

One-page profiles for both staff and people living at Bruce Lodge were introduced to achieve two things. For staff, it enabled a greater understanding of each other and meant that each week team members spent time away from their day to day activities to do something that they personally felt was an important part of their role. For the people living there with dementia, the one-page profiles acted as a job description, allowing them to direct their own support and ensuring that the people providing the support understood what was important to them.

All staff at Bruce Lodge, including housekeepers and maintenance staff, produced their own profiles. This exercise allowed the people living with dementia to be matched well with the staff team and choose who they wanted to spend extra time with based on their interests and what was important to them. Winifred chose to spend her time with Beryl the housekeeper because she said she enjoyed helping out with the daily chores such as polishing, sweeping and mopping. Winifred’s two daughters and staff at Bruce Lodge helped uncover this by sitting down with her and chatting over tea and biscuits to inform the one-page profile. They asked about good days and bad days, past and present. What was going well and what needed to change. What Winifred had enjoyed in her life in the past, and what she would do, if she could, in the future.

Winifred’s new relationship with Beryl and extra responsibility has had an extraordinary effect on her happiness and wellbeing. At home she would routinely clean the house, so before this was identified in the one-page profile as being important to her, a big part of her life and identity had been missing.

Maureen and Bernie, Winifred’s daughters, have noticed the change that the one-page profile has made to Winifred. She is happier, chatting more, using fuller sentences, sleeping better and is generally ‘’more alive’’. Maureen goes on to say; “The difference is astounding; mum was a housewife, a practical person who spent her life caring for her five children and our father, who died 20 years ago. Her desire to care for people was never blunted but the ability to do so was robbed from her and that left her very frustrated. These chores are helping her connect with other things from her past and are opening up new pathways in her mind. The first thing that we noticed had come back was her language – within a week of working with Beryl she was recalling words much better and introducing me to other people by name, whereas before she didn’t know who I was.”

Winifred now has enhanced choice and control over how she lives her life and how she is supported on a day to day basis.  Winifred can often be found well into the evening, long after the housekeeper has gone home, sitting and folding the laundry. This has simply become the way she chooses to spend her time and the impact this has had on her happiness is evident for all to see. Not only is her smile lighting up her own room but she can be seen beaming all over the home as she reconnects with what she loves most; helping to look after others and bringing joy to the people she lives with.

An important part of the community

An example of how a one-page profile has helped one man’s team of support workers understand what is important to him and how best to support him in a social care setting.

Barry's one-page profile

Barry’s one-page profile

Written by Sam Potter

Barry came to live with us on 16 April 2012 from the St Helens Stewart assessment unit. He had been admitted to hospital under section two of the mental health act, from another nursing home after his behaviour became aggressive and they felt unable to support him. Barry had been known on a number of occasions to attack other people he was living with and this was an area of concern for the staff team there.  When first coming here, Barry was unsettled and would often have outburst. We knew that Barry had a history of hiding medication or refusing to take it, which led to a fluctuation is his mental state.

When Barry arrived at Woodlands, staff set about getting to know him, his likes, dislikes and his social history. We worked closely with his wife to do this. Staff worked towards building a detailed picture of how Barry communicates his likes and dislikes and his escalation signs so we were able to notice his mood changes early and help him stay calm.  All of this information was recorded on Barry’s one-page profile. When Barry appeared aggressive the team used soft de-escalation techniques and nursed him in quiet areas to help him feel safe.  We worked closely with Dr Koumuravelli (Psychiatric Consultant) and Janet Parry (Community Psychiatric Nurse) to get his medication balance correct.

Initially Barry continued to behave as he had done before, often refusing to engage with support staff. However as staff got to know Barry and how best to work with him to reduce his anxiety we have seen a marked improvement – this was continually recorded on his one-page profile. It was noted by nursing staff that when Barry seemed most unsettled it appeared to be linked in with a reoccurring urine infection so we began to regularly test for this.

Barry now engages with support staff and with the correct approach and prompt will shower, shave, meet his care needs and even take part in activities. The one-page profile means that all staff learn how best to support Barry quickly and importantly that they see him as an individual with his own qualities, likes and dislikes.

Barry’s overall happiness and general demeanour is greatly improved. Barry is an important part of the community here at woodlands and we continue to work with him and his family to try and improve his quality of life.

Can one-page profiles work in mental health?

Written by Sarah Carr, independent Mental Health and Social Care knowledge Consultant www.sarahcarrassocs.co.uk

Sarah carr

Sarah Carr

When I wrote my one-page profile I was thinking specifically about mental health and prevention. I reflected on what helps and hinders me and what makes me feel safe. I think my profile is a very effective tool for self-management – sometimes I lose sight of what can affect me! Because I had complete control over what is in the profile, I represented myself in a way that is true to me – I didn’t have to use a diagnosis, explain my history or fit into a category. I communicated who I am and what I need without having to label myself. In this way profiles can help with overcoming the stigma associated with psychiatric diagnosis and can challenge self-stigma. Like many people with mental health problems, I have a negative view of myself and fairly low self-worth. Here, I was especially challenged by the part where I had to think about what people appreciate and value in me, my gifts and my strengths. Although it was a hard exercise, for me it was a form of therapy. Finding good things about yourself and committing them to writing as part of a profile to be shared so you can be understood fully can be a powerful exercise for someone with low self-worth or internalised stigma. At the moment I’m using my profile to remain aware of what keeps me safe and well (and to remind me of what people value in me!) but if I should experience a crisis again I would use the profile to communicate with mental health practitioners and as a way to aid my recovery – that is recovering my life and self.

As an independent mental health and social care knowledge consultant, my lived experience of mental distress and service-use informs my work. I really wanted to join the conversation about one-page profiles on this blog site because I believe they have the potential to address many of the difficulties that people who experience mental distress or use mental health services often encounter.

One-page profiles in a mental health crisis

If someone is using mental health services a one-page profile can be a powerful way to communicate and maintain their personhood in what can often be a dehumanising, medicalised system. For someone who finds themselves in crisis and is admitted into hospital, a profile can be a very effective way of communicating who they are and what good support looks like at a time when they might not have the capacity or opportunity to do so in any other way. Many people who have been patients in psychiatric hospitals say that they felt reduced to their symptoms or diagnosis and weren’t understood as whole people with interests, strengths, talents and preferences. We now know how detrimental this can be and clinical guidelines are in place to emphasise the person-centred, human elements of mental health support such as empathy, optimism, dignity, respect, support for self-management, emotional support, being known and having appropriate activities. A one-page profile, written by the person when they feel well, with support if needed, can be an effective way to support continuity of understanding about an individual in changing circumstances and fluctuating mental health. They could be used alongside more formal Advance Directives, which are designed so the individual gets a say over treatment and other practical decisions should they become too unwell to make decisions themselves.

In the workplace

Many workers and workplaces struggle with understanding how to recognise and address the stress that can lead to new mental health problems or a relapse of existing ones. Employers may find workplace accessibility and reasonable adjustments difficult to understand for mental health. Stigma continues to be very a difficult issue for people with mental health problems who are job seeking or in employment. But as in mental health services, the solutions are often rooted in simple things like communication and being understood as an individual. Both these aspects are addressed in a one-page profile which could help facilitate a person with a mental health problem to self-manage at work and help their manager or colleagues to be supportive in practical ways. If an individual is having problems with workplace stress or is recovering from an episode of mental distress, the ‘how to support me’ part of the one-page profile can help with implementing reasonable adjustments and ensuring accessibility. Mental health stigma can be reduced and crisis prevention promoted in the workplace if every employee has a one-page profile, designed to communicate individual strengths, preferences and needs to line managers and HR personnel.

To summarise, I think that if used well, in mental health services profiles could significantly improve the experience of users and if applied in the workplace, this simple approach could make it a much safer and more accessible place. In both cases, it’s about being known as a person and being able to communicate what’s important to you, which can help with prevention and self-management as well as getting through a crisis period.

Seeing the child that I see

A strong example of how this mum’s battle to constantly advocate and inform has transformed since creating her son’s one-page profile. Now she is able to sit back and listen as she has the confidence that the people supporting her son understand him well and see the child that she sees.

MalcolmWritten by Malcolm’s mum

My son Malcolm is almost 10 years old and is a very smart, funny boy who is such a positive, contagiously happy fellow. We had known from his toddlerhood that he had some delays in his development and seemed to be oblivious to much of the activity around him. It was very clear that he was bright and much of what we saw could be fluffed off as being a third child and my mom had said that boys seem to speak later than girls, so we weren’t concerned.

When Malcolm was 6 he was assessed for Aspergers and Autism. His older brother was diagnosed with Aspergers when he was 6 and Malcolm seemed to be progressing socially and speech-wise, much slower than his peers. At that time he was not clearly on the Spectrum. By the time he was 7, the paediatrician labelled him with Attention Deficit Disorder (ADD) and put him on medication. The medication certainly helped but when he was 8, he started to show signs of emotional struggles that seemed greater than the ADD label. After he was assessed by a team at The Children’s Treatment Network in the spring, they had found his characteristics seemed consistent with an Autism diagnosis.

When Malcolm started his grade 4 year at the age of 9, there were so many new staff members to the school, including the principal, that it seemed a good idea for me to create a one-page profile for them to get to know my son and to know how to help him through any social/emotional struggles he may experience during school. The year prior, he had started to hit himself in the face when he was overwhelmed with frustration, I felt that the staff could understand more about what drove this behaviour, how to recognise the triggers and therefore how to support him to avoid it, as well as how to guide classmates in supporting him in a non-judgmental way.

As a part of my role with Community Living, I have been creating one-page profiles for various facets of people’s lives to help others get to know them. I created a profile for my son for him to enjoy his own information, for him to feel that he doesn’t have to tell each staff member, respite contractor or Camp Councillor about his struggles but can simply hand over his profile for them to learn from. I provided the information and observations as well as found photos of pride for him (the faded photo of him getting a bulls eye in archery) and Malcolm proofed it.

Malcolm’s one-page profile has been shared with his Respite Contractors, his homeroom teacher, and all other supports in his life at school. We have also used it for his transition into a new school where he will be attending Extended French.

It has been very helpful to us as parents. It is easy for people to jump to conclusions about the behaviour of our son as it isn’t a common reaction for a child to try and hurt himself. The profile makes staff aware of this possibility arising but it focuses more on what great things my son can do and interests he has, and it helps people quickly want to get to know him so he can feel safe and appreciated without the stress of a poor reaction from others.

I have found that teachers and students are more protective of him and will rally around him when others might make fun of him or respond negatively.

Whether it is because of the one-page profile or because he is surrounded by a great group of people, it isn’t clear why he is now so engaged and cared about. But it is clear that the profile has eased the constant explanations, the reactions of others, and the quick to judge comments. Our energies are now focused on the future and not having to continuously inform and advocate.

I have found that our time is better spent with teachers and support staff just getting updates and funny stories during meetings now. I really enjoy just listening during a conversation rather than informing and so often there is only positive information being passed to us and not the constant worries of the staff who may not understand why Malcolm is acting in a certain way.

I believe that Malcolm’s one-page profile has helped others move past the negatives and the uncertainties and just see the child.