STK has a well-documented history of increased emotional distress and behaviours of concern during the winter period, particularly between October and February. Historically, December has been the most challenging month, with reduced engagement in activities, increased emotional dysregulation, and a lower tolerance for changes in routine. Seasonal factors such as colder weather, reduced daylight hours, earlier sunsets, and the heightened expectations associated with the Christmas period have previously contributed to increased anxiety, reduced predictability, and an escalation in behaviours.

In previous years, STK presented with a marked increase in behaviours of concern during the winter months, often requiring staff intervention through change of face, high levels of reassurance, and close monitoring from a safe distance. Engagement in activities was significantly reduced, and tolerance for seasonal events, particularly Christmas-related activities, was low.

Behaviours directed towards staff included throwing objects, physical aggression such as pushing, kicking, hair pulling, grabbing clothing, and scratching. When accessing the community, STK frequently displayed behaviours including throwing shoes, attempting to grab staff, and damaging items within her reach. Additionally, STK engaged in destructive behaviours within her environment, including throwing furniture, removing her mattress from the bed, and damaging personal belongings. These behaviours have impacted her participation in certain activities and limited opportunities for meaningful engagement during the winter period.

In preparation for the winter period, staff implemented a range of proactive, consistent, and person-centred support strategies informed by STK’s new Positive Behaviour Support (PBS) plan and guided by the PERMA framework from manager DJH and team lead CAE. Key strategies included maintaining a structured and predictable daily routine, increasing engagement in preferred activities such as shopping and outings, providing regular emotional reassurance, and ensuring a consistent and confident staff approach.

Christmas-related activities were introduced gradually and carefully tailored to STK’s individual preferences and tolerance levels. The PERMA plan was embedded throughout the year and used as a central framework to support emotional wellbeing, engagement, and predictability. Preparation for Christmas began slowly, with staff verbally preparing STK daily from the start and throughout December by informing her that Christmas was approaching. She was encouraged to wear Christmas-themed jumpers and pyjamas from the beginning of December through to Christmas Day to increase familiarity and reduce anxiety associated with seasonal change.

As part of the PERMA-informed approach, staff supported STK to access environments containing Christmas decorations, such as pubs, garden centres and other decorated venues. She was encouraged to observe, touch, and stand near decorations at her own pace. Positive reinforcement, including photograph evidence for STK to view were used to promote positive associations with the festive environment and increase tolerance over time.

The PERMA plan had previously proven highly effective earlier in the year when supporting STK to complete household tasks of putting dirty laundry into her red bin within DJH and CAE training. A clear visual and practical cue was introduced by bringing STK’s red laundry basket into view and modelling the task of picking clothes up from the floor. Over time, STK independently associated the red laundry basket with the task and now engages in picking up her clothes with minimal prompting. This same structured, visual, and modelling-based approach was successfully generalised and applied during December and the festive period.

Between October and December, STK demonstrated a significant improvement in her presentation. Incidents of heightened behaviours reduced, and she remained generally settled throughout the winter period. She experienced a notably positive Christmas and engaged in a range of activities that she had historically been unable to tolerate.

On Christmas Day, STK was able to access the communal lounge, listen to music with peers and staff, and share Christmas dinner together in the communal kitchen. This represented a significant achievement, as historically STK had been unable to tolerate or engage in communal festive activities.

Since the start of January, a decline in STK’s mood has been observed, consistent with the ongoing winter period. Her engagement in activities has reduced, and staff have noted emerging behaviours, including screaming, swearing, and bouncing on her bed. There has also been a reduction in her engagement with staff.

At this stage, no incidents of heightened behaviour or behaviours directed towards staff have been recorded. Staff continue to monitor closely and respond proactively. Proactive strategies remain focused on early intervention, consistent reassurance, visual preparation, and increased opportunities for engagement in preferred activities. Should behaviours escalate, staff will continue to communicate calmly, offer space where appropriate, and provide reassurance while maintaining environmental safety. Calming alternatives such as a relaxing bath, a warm drink, or listening to music may be offered. Staff remain vigilant, recognising that STK may continue to display signs of physical agitation during this period.

The positive outcomes observed between October and December demonstrate that early intervention, consistent staff approaches, and the structured use of the PERMA plan were key factors in reducing behaviours of concern and increasing engagement during the winter months. Personalised activity planning and the consistent application of PERMA-informed strategies played a significant role in supporting STK’s emotional wellbeing.

The decline in mood observed in January highlights the continued impact of winter on STK’s emotional regulation and reinforces the need for sustained proactive support, close monitoring, and flexibility in staff responses during this period.

This case study highlights the importance of proactive seasonal planning, consistent and confident staff support, and the effective use of the PERMA framework in supporting STK’s emotional regulation and engagement. While positive outcomes were achieved during the festive period, the emerging decline in mood in January reinforces the need for ongoing implementation, review, and adaptation of these strategies throughout the winter months to prevent escalation and maintain progress.

To further support STK’s engagement, staff will continue to use visual supports around the house and apply PBS strategies to plan activities in advance. Staff will continue to model activities, replicating the successful approach previously used with the laundry task. This will include step-by-step demonstrations and, where appropriate, the use of pictures alongside live modelling to reinforce understanding, reduce cognitive demand, and promote sustained engagement.

Under our managers instruction we have devised an activity plan for the year throughout 2026 as a month-by-month guide on up-and-coming events ie:

February – Valentines Day and Pancake Day – a build-up of activities planned in house
March – St Patricks day – a build up of activities planned in house
April – Easter and Spring – a build up of in house and garden activities planned
Etc

All activities to be completed are written down as a list and will include all service users within Avenue.

Along with inhouse/garden activities the manager and TL are planning odd days out as a group to attend Marwell Zoo etc. The Perma method will be used throughout for all 4 individuals.