Unit 27 Dealing with Challenging Behaviour Triggers and Impact

Lesson Objectives To identify a range of possible triggers to challenging behaviour. To recognise the impact of challenging behaviour on the service users, their family, carers and service provider. To identify types, triggers and impact of challenging behaviour in a case study profile of a service user. What would make you ………. exercise

Challenging Behaviour Any service user (or human being for that matter) has the potential to behave in ways which are anti-social, aggressive and likely to have a negative impact on themselves and others. There will always be a trigger ….. A cause (we just have to find it!) After spending five minutes listening to Greensleeves (no, bloody Greensleeves) interspersed with the patronising grind of ‘your call is important to us but please hang another minute while we make another £4 billion out of your sorry arse’ before eventually getting to speak to a human being called Malcolm, you are probably going to feel like telling Malcolm to shove his headset somewhere dark and possibly a bit damp. See? We can all get a bit challenging sometimes. person with severe cognitive impairment caused by dementia or a learning disability behaves in unpredictable, random ways, but all human behaviours occur for a reason and attempting to identify why challenging behaviour occurs is a key aspect of our

What would make you? Violence Aggression Hyperactivity Antisocial behaviour Withdrawn behaviour Self stimulation Speech problems Sexually inappropriate behaviour Psychological disturbances Eccentric habits Inappropriate personal habits Ask group what causes challenging behaviour Individual task – think about what causes challenging behaviour with you? What sets you off? Fill in individual task sheets. Feedback to the whole group – take trigger words to the smart board Show Russian man video. Watch the video and make notes of what you think might be the “trigger” for this behaviour? In pairs come up with something that might have triggered this behaviour. Feedback to the group

Triggers Challenging Behaviour 1? Challenging Behaviour 2? Managing Challenging Behaviour Show each video Ask the students to identify the types of challenging behaviour that they have seen in the videos and any potential triggers for the behaviour What do they think the causes of the behaviours are Take trigger words and put them on the smart board to build a picture of triggers

Triggers Intrinsic Temporary personal Factors Use and abuse of power Alcohol /drugs Persistent personal problems Extrinsic Environmental factors Knowing the effects of your behaviour Use and abuse of power Give this diagram to the group, split into small groups and ask them to think about what each of them might mean and how it might manifest itself. Feedback from the group and explain Remind students to think about this from an equality point of view Think about how behaviours might be stereotyped into groups Are there any specific diversity issues which might affect how people consider triggers types of behaviours Intrinsic – internal conditions such as cornelia de Lang syndrome – give out information Extrinsic – outside influences – something on the outside that makes us display challenging behaviour e.g Peter and the washing pole outside, slamming doors etc, triggers internal behaviours eg ocd. Temporary personal factors – being ill, in pain, afraid, discomfort, children in discomfort Alcohol/drugs – mind altered state. Increased confidence etc Persistent personal factors – e.g having a disability. Perhaps having become disabled, frustration in not being able to do things. Persistent inability to communicate effectively so cant make wishes known. Find a way to communicate. Give example of wanting a drink and not being able to ask for one but its there infront of you and you cant reach it. Demonstrate. How would you indicate that you wanted it? Kicking the table, pushing etc. Environmental Factors – temporary and permanent. Temporary e.g living in poor conditions, living with people you don’t want to, inappropriate rules and regulations e.g boarding school break outs!! Permanent – e.g continual noise e.g tinitus in the ears. Knowing the effects of your behaviour – positive reinforcement. Eg CF Use and abuse of power – domestic violence, carer abuse etc. Or carers abusing service users to get them to do what they want. But what do they all mean Small group work – on the poster think of examples of each of the triggers Feedback to whole group. Explain each trigger with examples Intrinsic -

Finding the cause….. We can start to work out what the person is trying to tell us. Important as it determines the best way to respond the behaviour. The first thing you need to do is to determine what the antecedents to the behaviour are.

Triggers Challenging Behaviour 1? Challenging Behaviour 2? Managing Challenging Behaviour Go back over the video and the feedback they have already given and try to link to some of the triggers,. 8

The Behaviour Response Cycle Calm Trigger Escalation Crisis Recovery Dealing with challenging behaviour – this is what we are dealing with in relation to any challenging behaviour situation! Explain the diagram. The theory bit! Say that sometimes the trigger and escallation are not obvious and what we actually see is the crisis point. This is when people say they didn’t see it coming or there was no obvious trigger. There is always a trigger, we might not always see it! Handout case study the behaviour response cycle Fit this to the video ~ 1 Explain which bit fits which bit. Show video again

The Impact of Challenging Behaviour The service user The family The carers The service provider Physical Intellectual Emotional Social Ask the students who does cb have an effect on? What kind of effects will there be? Discuss these ask the group what kinds of effects will there be under these headings. Refer back to the triggers and the types of challenging behaviour Talk about exhaustion, pain, injury, inability to integrate into society use community facilities, being banned from places etc. Reputation, labelling etc long term effects. Give out challenging behaviour case studies. Ask the questions what are the types, triggers and impact of the CB on the SU, carers, family and the service provider. Conclude session with example of CF – explain the ongoing situation with him.

Impact On the Service User Sleep disturbance Self injurous behaviour Mental Health problems Limitations to social life Health/Social Service Dependence Medication – including its side effects

Family Impact Social and leisure constraints Cost Ill health Sleep deprivation Isolation Mental Health Issues Stress Higher levels of stress for women Effects on siblings Respite care need

Carers/Service Providers Cost Need for specialised services Lack of opportunity

“The detrimental effects of challenging behaviour are not confined to the person but to the total family and those in contact with the client. It is like a ripple spreading out from the person with challenging behaviour touching everyone around them. The closer anyone is to the person who displays the behaviour the harder the ripple hits” Slevin and Sines (2005) cited in Gates et al (2008) Case study

Task Study the case study that you have been given and try to establish: What are the types of challenging behaviour shown? What might the overall cause be? What are the specific triggers for each of the behaviours shown? (relate to the triggers diagram) What might the impact be for the person, their family, carers and service provider?