Can anyone advise, My granddaughter with severe learning disability and non verbal went into crisis while eating and attempted to stab herself with a fork. She can use both a spoon and fork but the day care centre she attends have now said she can only use a spoon while eating. I can understand the reasoning behind this but tried to see if there was any kind of cutlery she could use that would be both safe and usable for her. She is a young adult. I feel that without a fork she will just use her hands more to feed herself which she tends to do anyway and we are trying to encourage her to use cutlery especially in a public setting. She has very limited understanding.
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Hey,
Firstly I would want to be considering if this is a one-off type event, if it is not typical for her to become so dysregulated and use self-injury to express herself - then it feels very restrictive to blanket ban the use of a fork.
There needs to be some analysis of the day/event, trying to identify the fast and slow triggers which got her to that point. An ABC chart would be a good idea to consider what was happening for her in the lead up that may have been a trigger. Thinking about how she was supported in the moment that may have prolonged the situation and led to using the fork that what. And also consider what was the outcome, as this might help us understand what she might have been seeking/communicating.
I would be encouraging them to be taking positive risks. Drawing up a plan which would help indicate the following:
- What behaviours and indicators would suggest it is/is not safe to use a fork on a specific day
- What are the supports that can be put in place to enable the use of a fork - for example, a member of staff sitting next to her, or being close by etc etc
- What are the strategies for keeping her happy and settled during her meal - this could be a wide range of factors including distraction, environmental adaptations, offering breaks for movement etc etc
- And if needed, what is the plan to keep her and others safe if she gets to that point again. Again this could be a stepped plan, starting with removing others from her vicinity up to something like getting multi-agency agreement that holding her wrist and collecting the fork is the safest option (if a specific criteria/threshold is met)
All of the above is just my thoughts based on your one paragraph. There would be far more to consider and include in risk managing when a young adult is known to you.
However, it is absolutely right to be pushing back against blanket decisions, as there will absolutely be times when it is appropriate and safe for her to be using a fork. Even if, based on the information available, it is a appropriate in the moment to make this blanket decision, there should be a plan about re-introducing and re-exploring the use of a fork at some point in the future so it does not become her ‘norm’.
Many thanks for the helpful comments and information. The gradual supervised introduction sounds good - she has one to one support so it’s ongoing anyway. She does tend to self harm when upset by biting herself which she did also do during the incident and would also try to bite others if she was restrained in any way so holding her wrist and taking the fork away would probably pose a greater risk. I think she may be pre menstrual which affects her mood we’ve tried using the contraceptive patch to regulate her cycle and steady her moods but unfortunately it seemed to make things worse.