Training Ward Staff in Psychological Approaches to Challenging Behaviours Hannah Wilson and Isabel Clarke Chartered Clinical Psychologists Hampshire Partnership NHS Trust Woodhaven, Loperwood, Calmore Hampshire, UK SO40 2TA

Overview Introduction to challenging behaviours and training issues Description of the 2 day training delivered Outcomes and feedback Summary Reflections and ways forward

Challenging behaviours Typical and topical for inpatient work –Incident rate of –Responsible for Vanderslott, 1998; Owen et al, 1998; High arousal …..stress, burnout, time off, etc. Impact on the unit and individuals considerable and often under-reported

Training Issues 1. Practical issues –Whole-unit staff training and MONEY (WDF funding) 2.Issues of scepticism –Psychological training in a medic-led environment 3. Issues of attitude –Ownership of the training – (Hastings & Remington, 1995) 4. Issues of staff well-being –Impact of the nature of the work – (i.e. protection from burn out)

Practical Issues Work force development funding Away from the base –Minstead Lodge Half away from unit on training while other half on shift back at base (2, 2 day workshops) NEED SUPORRT FROM MANAGERS!

Issues of Scepticism Introduction to evidence-based psychological approaches. Recognise the strengths and diversity within the team as well as working towards a consistent, Recovery oriented, approach. Promote development of positive care plans for challenging behaviour using these approaches. –Teaching given on behaviour principles of behaviours to increase, rewards and reinforcements vs. behaviours to decrease and punishment Be able to conceptualise challenging behaviours in helpful ways.

Issues of attitude and ownership Staff ownership of the training to improve application of the approach once training complete Before the training, allocated into teams of 5 and asked to bring a current case to discuss Small group work to formulate the case they brought, develop a positive care plan with clear triggers, reinforcements and integrated opportunity for desired change based on teaching received Two days spread out over two weeks –Try out the approach in the ward environment, record the results, and….. –Be able to report back on and discuss the experience at the second day.

Issues of staff well-being Team building exercises Plus … “Looking at Roles” Exercise Practical tips on “High Arousal DO’s and DON’Ts”

Outcomes re: challenging behaviours All teams clearly able to develop a positive care plan and implemented them Reduction of challenging behaviours for duration of the training

Case Study Triggers: Visitors or Bored High arousal Shout out “Kill you” and make lunge at staff Taken back to room and given PRN medication

New Plan Engage in relevant activity at regular time slots Client given cards to indicate when she wanted PRN that she could hand in to ward staff When card handed in, all staff knew to react promptly so as to reward this more functional request of her needs

Case Study Results

Results/ Feedback Positive feedback from satisfaction questionnaires Staff feeling valued and supported “

Reflections and final thoughts Sustaining the impact?! Weekly care planning/ psychology formulation meetings – raised profile of the benefits of psychological approaches Use of service user presentations in the future Invite medics to attend in future Overall….A valued and worthwhile exercise