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Improving Transitions Into Care with Technology

A case study with Community Living North Bay

Group of people gather outside on a track, one of them using a wheelchair
Photo from Community Living North Bay

Community Living North Bay is a not-for-profit service provider located in North Bay, Ontario. They have over 250 staff members who provide a variety of services to the people of North Bay and the surrounding areas.


 
group of people gather outside a house
Photo from Community Living North Bay

Before using Wearable Technology


In October 2019, CLNB had a new person join their care. Her name is Alana. She had previously been living at home with her family and was getting ready to move into a group home managed by CLNB.

The support team was a bit nervous about how Alana would navigate the transition from living at home to group living. Alana was probably going to be nervous too. You can never really know how someone will react to a shift in their living situation. For many, it can be a significant stressor. Plus, as a support team, it takes time to get to know the person you support. You can expect a fairly steep learning curve, not to mention that the person who is moving has to get used to a different environment and make all the adjustments that come with living in a new home.


The support team at CLNB had confidence they would gain Alana’s trust and knew they would be able to help her thrive, but they predicted that they had a long road ahead. Initially, they anticipated it would take years for them and for Alana to navigate this big shift in her life.


The first few weeks were really challenging. It was clear Alana wasn’t able to be herself. With all the new things in her environment, self-regulating was incredibly difficult and sometimes anxiety would take over. Studies show upwards of 59.7% of people who have an intellectual or developmental disability struggle to communicate. Alana is one of them. Sometimes she was not able to let her support team know when she was starting to feel anxious, which led to escalations that required the use of intrusive measures. To manage her anxiety, there were a number of different strategies inherited from a previous support plan that the team would use to diffuse tensions. This included an as-needed anti-anxiety medication protocol, and as a last resort, an environment protocol.


An environment protocol refers to changing the physical environment of the person being supported to reduce stressful stimuli. This can include using a seclusion room to remove someone from a stressful environment.


Behaviors that challenge can take a long time to address. Getting to the root cause of such big emotional releases takes time, dedication, and patience. But, without being able to assess the cause of behaviors that challenge, interim treatment options are limited and can be inadequate. While medication and environment protocols can be effective in reducing acute anxiety, they tend not to enable any long-term improvements in anxiety. In other words, they can work well in the moment, but they can’t treat the root cause of anxiety. Environment protocol use, in general, is considered an outdated practice with negative outcomes for all parties involved.


For Alana, the use of an environmental protocol was truly a last resort option. The ultimate goal was to eliminate this protocol entirely. The team knew they would be able to get there eventually by learning all about Alana - her likes and dislikes, how she expresses herself, the things that trigger her anxiety, and all the factors that influence her wellbeing. They knew that they would be able to overcome the barriers affecting her quality of life given time and the right tools.


 

Introducing Wearable Tech in the Support Environment


Awake Labs met CLNB shortly after Alana had joined them in the group home. At the time, the support team was on the lookout for tools that would enhance their support and help them learn everything they could about Alana. One of these support workers is Kim. She is the primary person who worked with Alana. With her years of experience and expertise, Kim knew that she and Alana would eventually be able to thrive together. She hoped that Awake Labs could help them get there faster. So, CLNB signed on to pilot the Awake Labs technology and with the consent of Alana and her family, they took the leap.


The technology uses a smartwatch, mobile app, and dashboard that measures stress and strong emotions in real-time. What this means in a day-to-day context, is that Alana wears the smartwatch during the day. When her levels of strong emotions rise, Kim gets notified on the mobile app with a little “ding” and a prompt to check in and observe Alana’s surroundings and her behaviour. Alana and Kim spent the first few weeks collecting data and patiently observing their surroundings and Alana’s non-verbal communication whenever they received a notification.

After a few weeks of monitoring the app for notifications and recording their observations, Alana and Kim were learning a lot. Kim began understanding how to see subtle signs of distress in Alana. Alana began to notice when she was getting uncomfortable and began to feel she could reach out for support. Within a matter of months, there was a noticeable shift in their relationship. Now when Alana was upset she would say “Kim, I need a hug” rather than holding in all her stress until she became totally overwhelmed.


With the help of the Awake Labs technology, Kim and Alana built trust. Alana knew Kim would be there to support her when she needed and together they implemented the support techniques and skills Kim had expertise in. Soon enough, they were able to work together to de-escalate Alana’s stress when it became too much.


This had a noticeable effect on Alana’s use of as-needed anxiety medication, which was reduced by 64% after six months using the Awake Labs technology. Because of Alana’s better understanding of her own emotions and the strength of their relationship, after 6 months there was an 86% reduction in the use of the environmental protocol. Within the year, they removed the use of the environmental protocol from Alana’s support plan entirely.


Other staff members noticed that Alana was calmer while Kim was on shift. Kim worked with the other staff to show them how to use the technology. She showed them how she used the tool to learn about Alana and how to support her. This mentorship enabled the other staff at the group home to have confidence in their skills, which has led to better relationships and communication between Alana and all her support team at CLNB.


In a matter of months, CLNB was able to get to a place of comfort with Alana’s support. Kim was no longer just reacting to Alana, but able to proactively meet her needs. Today, Alana has successfully transitioned into her new home. Her relationships with her housemates and with the staff who support her are strong and trusting, and Alana continues to thrive in her new community.

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