Tim was referred to Choice Care by the transitions team at his residential school as he approached the end of his time there. He had been excluded from another school in the past and lived in a four-bedroom property by himself, as it was felt that sharing with others would be unsafe. However, the high cost made this approach unsustainable and an alternative solution was needed as he entered adult services.

Tim is autistic, extremely ritualistic, can be highly destructive to his environment and aggressive towards his carers. He is also extremely intelligent, has great charisma, loves to socialise and is well liked by those supporting him.

It was felt that Tim would benefit from a single person annexe, giving him plenty of space and access to his own private garden. However, it was important not to isolate Tim as when settled, he likes to be around other people and it’s important that he has opportunities to mix with his peers in a safe and controlled manner. So, we selected the site of a six-bedroom home where other young people of a similar level of need to Tim were living. It is also close to his family.

Tim’s annexe was built with reinforced walls and ceilings, carefully designed and located fixtures and fittings and a private garden with plenty of space to burn off energy. We also included a number of entrance and exit points for staff if they needed to put some space between themselves and Tim when he became agitated.

Tim was initially assessed as requiring 2:1 support, 24 hours a day and 3:1 support when in the community. This was clearly very costly and our commitment to the commissioning team is to help reduce such levels of support wherever possible.

Following a carefully planned transition, in which Tim’s school and family were fully involved, he moved into his new home. Our detailed records of behavioural incidents helped us to understand when and why they were occurring and to identify any patterns. At Tim’s 12-week review, we felt we were ready to start reducing night time support and put in place a comprehensive plan and risk assessment to achieve it.

As well as involving Tim in designing his own environment, other factors that supported him in settling included:

• a staff team he knows and trusts;
• assistive and communication technology to ensure staff safety and give us the opportunity to risk assess reduced support;
• and the excellent ‘can do’ attitude of the home’s staff and management team.

Tim is at the start of his adult life and has the potential to achieve a great deal as he continues to mature. We will continue to work with him, his family and the funding authority to reduce his staffing levels, as and when safe to do so, and his progress so far gives us confidence we will achieve this.