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Trust, Resilience and the Right Support: Ryan’s Transition to Community Life

Highlights

  • Transitioned from an assessment and treatment unit to his own home, avoiding high secure placement
  • First person supported through the pilot Community Transition Services project
  • Developed a daily routine centred around his passion for running and physical activity
  • Built a strong alliance between support workers and family, rooted in trust and shared goals
  • His story became a blueprint for future transitions

Strategies Used

  • Phased engagement on the hospital ward to build trust and understand Ryan’s needs
  • Intensive Positive Behaviour Support (PBS) implemented before and during the transition
  • Co-produced care plan developed with input from Ryan and his family
  • Property sourced and prepared in collaboration with housing services
  • Support team handpicked to match Ryan’s energy and interests
  • Step-by-step transition planning for safety, empowerment, and consistency

Outcomes

  • Successfully avoided unnecessary high secure hospital placement
  • Reintegrated into the community with a tailored support plan
  • Improved physical and mental well-being through daily activity and routine
  • Strong, positive relationship formed between family and care team
  • Proved the effectiveness of person-centred, community-based transitions

Ryan’s journey from a secure hospital setting to thriving in his own home is a powerful example of what can happen when personalised support, trust, and collaboration come together. Facing the possibility of a high secure placement, Ryan’s transition was instead shaped by listening to his needs, building strong relationships, and recognising his strengths, especially his love for physical activity.

With a dedicated team and renewed trust from his family, Ryan now lives independently, stays active every day, and continues to build a life that reflects his true self.

The Story

Ryan is an active, determined young man whose story reflects what’s possible when the right people believe in your potential. When our team was first introduced to Ryan, he was in an assessment and treatment unit, with conversations leaning toward placing him in a high secure setting — an outcome no one believed was in his best interest.

Despite the challenges, Ryan’s resilience stood out. He had spent a long time in hospital care, and his family had been tirelessly advocating for him. What he needed wasn’t more restriction, it was tailored support and a team that truly understood him.

The Approach

From the start, our Community Transition Services team focused on getting to know Ryan as a person, not just a care plan. We phased onto the hospital ward to observe and work alongside him, building a strong relationship over several months. This approach helped us get a real sense of his needs, strengths, and preferences.

The team implemented intensive Positive Behaviour Support (PBS) strategies directly on the ward. Over time, they collaborated closely with Ryan’s family, drawing on their insights and lived experience. It wasn’t about reinventing his care — it was about listening to the little things that made a big difference.

His care plan was shaped through co-production and trust. The support team worked in coordination with housing services to prepare a property that met Ryan’s needs, and a step-by-step transition was planned to ensure his move from hospital to home was not only safe but also empowering.

Positive Outcomes

Ryan’s transition home became a pivotal moment, both for him and the team that supported him.

Once home, Ryan began to thrive. One of the key discoveries during his transition was his love for physical activity. This became central to his daily routine, with support workers selected specifically to match his energy and pace. He now runs every day, and his overall well-being has flourished.

His family, once fatigued by years of navigating systems that failed to listen, became strong partners in his support journey. By building mutual trust, the relationship between the care team and Ryan’s parents transformed into a powerful alliance focused on what mattered most — Ryan’s future.

He was the first person supported through our pilot Community Transition Services project. His success proved that with the right approach, even the most complex transitions can lead to lasting, life-affirming change.

Building a Life Beyond a Hospital Setting

Ryan’s story is a testament to what’s possible when support is human, consistent, and genuinely tailored. He didn’t just avoid a high secure placement — he reclaimed his independence, formed strong relationships, and shaped a life that reflects who he is.

Through Community Transition Services, Ryan’s story became the blueprint for many others.

Discover more Impact Stories from our Case Studies

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Bridging Back Independence: Emma’s Transition to Community Life

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Luke’s Transition: The power of compassionate and consistent care

After experiencing multiple unsuccessful placements and significant behavioural challenges, Luke now lives in his own home, achieving goals once considered unattainable. With the help of dedicated support workers, Luke’s transition to his new home was carefully planned to ensure his comfort and safety. By using visual communication tools and creating a supportive environment, Luke’s team helped him overcome frustration and anxiety, leading to a brighter, more independent future.

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