Unit 27 Dealing with Challenging Behaviour Managing Challenging Behaviour # 1

Lesson Objectives To recall a definition of challenging behaviour and behaviours that challenge. To describe interventions to manage challenging behaviour. To recognise the principles of clear assessment, planning and evaluation of interventions used with people whose behaviour challenges.

What is Challenging Behaviour – A definition? “Culturally abnormal behaviour(s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities.” Emerson,(1 995, 2001,): Re-cap this as a definition

Behaviours which challenge: Violence Aggression Hyperactivity Antisocial behaviour Withdrawn behaviour Self stimulation Speech problems Sexually inappropriate behaviour Psychological disturbances Eccentric habits Inappropriate personal habits Bullying Verbal abuse Recap the original list and prompt memory and examples Behaviour occurs in a continuum it doesn’t just “come out of nowhere”

Working with people who Challenge Assessment Identify Problem Devise Plan of action Intervene Ongoing evaluation

Assessment/Identify the problem Question?: With the examples you have thought about : How is this challenging behaviour assessed? By who? How is the assessment recorded? Group discussion, looking at labelling, stigmatising people. How often are the assessments reviewed. Does the person keep the “label” and the “challenging behaviour” forever. Assessment should be robust with clear targets or outcomes to the intervention what youre trying to do must be clear including reassessment proposals. One person doing as opposed to more than one – multi-disciplinary assessment. ABC recording – one of the ways. Can be variations. Ask group if they have used this. What other ways they have use assessment and observation. Electronic recoding and analysis of behaviour charts, ABC, Challenging Behaviours/Restraint forms, daily diary etc.

Assessment – the Legal Framework Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 says that: The registered person must take proper steps to ensure that each service user is protected against the risks of receiving care or treatment that is inappropriate or unsafe, by means of— (a) the carrying out of an assessment of the needs of the service user; and (b) the planning and delivery of care and, where appropriate, treatment in such a way as to—(i) meet the service user’s individual needs, (ii) ensure the welfare and safety of the service user, (iii) reflect, where appropriate, published research evidence and guidance issued by the appropriate professional and expert bodies as to good practice in relation to such care and treatment, and (iv) avoid unlawful discrimination including, where applicable, by providing for the making of reasonable adjustments in service provision to meet the service user needs Give as handout Recap the legal framework Equality Act 2010 and DDA 1995/2005 makes it unlawful to discriminate against someone with a disability and deny them a full assessment of their needs The human rights act – Article 3 protection from inhumane and degrading treatment Valuing people - personalisation

Working with people who Challenge Assessment Identify Problem Devise Plan of action Intervene Ongoing evaluation

Devise a plan of action Some do’s and don’ts: Empowering Service user and their family should be involved Nature of the intervention plan should be clear and explicit. Person focussed not organisationally focussed A plan of action comes from observation and assessment. Has to be robust and clear. One off observation very rarely gives a true picture of the person. The plan of action must be about everything, the environment, what we do, not just about the person and what they do. We taught the person to respond in this way

Interventions can be: Remedial Preventative Rehabilitative Remedial – reactive. Designed to deal with outbursts, things like diffusing strategies, self protection. Preventative – proactive, stopping things before they start – re-direction Rehabilitative – restoring lost skills, giving people other ways of expressing themselves Habilitative – may the “there” and they cant change so there may be need to change things around them to live with the behaviour – maybe altering the environment to suit the need.

Working with people who Challenge Assessment Identify Problem Devise Plan of action Intervene Ongoing evaluation

Intervene and Evaluate Interventions should be morally and ethically robust Should be risk assessed Goals must be realistic Must consider whose life they are aimed at improving Do staff and others supporting the service user have the skills, abilities and do they agree with the intervention. Should not use adversive type interventions – punishment based Inhumane degrading treatment Harmful Restricitve interventions – to protect from harm and short term and sparing as possible. Human rights Thoughts about rights of consent – can withold consent the same as anyone else. Must be reviewed regularly and risk assessed

Recording/Evaluation There should be a clear, transparent audit trail from assessment to intervention and back again! Clear understanding of the legal framework A clear evaluation method and timeframe with designated accountability for the evaluation. Legal – Data Protection, Freedom of information act, CQC inspection framework, organisational policy and guidance.

Autism and challenging behaviour People with autism may behaviour “differently” Can be a way of communicating Can be a way of self managing a situation/coping strategy In addition to people who have a learning disability autism is a very specialised area. Additional support mechanisms may be required. When assessing a person’s with autisms challenging behaviour its really important to be really sure of the reason for the challenging behaviour Ask the group to think about autistic people that they are working with, the challenging behaviour – why they do it? Is that really the reason? How do you know. Reasons may be much less clear. Often CB is a huge coping strategy. Most people with brain damage, LD< mental health problems can be supported to cope someone with autism may never be able to manage certain situations.

Some Approaches to alleviate challenging behaviours Picture exchange system Cognitive behavioural therapy Relaxation therapy Social stories DRO DRI approaches (positive reinforcement Linking obsessional thoughts to more functional behaviours Diet ( controversial) Pharmacology e.g. for anxiety Sequential diaries Not exhaustive DRO – DRI – positive reinforcement of behaviours that are desirable In DRO we don't want to see any of the "bad" behavior during a certain time period.  In DRI, we want a new behavior to be substituted in place of the one we don't like. Differential reinforcement

And Finally ……………. Tony Osgood, the Tizard Centre.