1. Caring for the Carers
Stressors associated with supporting people who express themselves through challenging behaviour and how they can be overcome

2. What is Positive Behaviour Support?
‘Positive behavior support (PBS) is an applied science that uses educational and systems change methods (environmental redesign) to enhance quality of life and minimize problem behaviors’
Carr et al (2002)

3. Feature of PBS (Carr et al 2002)
comprehensive lifestyle change
a lifespan perspective
ecological validity
stakeholder participation
social validity
systems change and multicomponent intervention
emphasis on prevention

4. Characteristics of PBS and PBS Planning
Assessment based
Comprehensive
Proactive
Lifestyle enhancement/inclusion
Person Centred Values
Everyday application
Teaching of alternative skills
Bambara and Knoster 1998

5. Triadic Approach Consultant Mediators Focus person
Significance of natural v artificial environments
(Tharp and Wetzel 1969)

6. Characteristics of the 3 types of participants
Consultants: ‘any one with the knowledge’
Mediators: ‘anyone with the reinforcers’
Focus person: ‘anyone with the problem’
Consultant skills given away to people in natural relationships with focus people – family members and carers.

7. Immediate impact of challenges
Fear; anger; embarrassment
Muscle tension
Feelings of nausea
Heart palpitations/ racing
Sweating
Confusion
Post incident phenomena (physical and mental exhaustion, depression, guilt)

8. Impact of emotions (1)
‘Negative’ emotions associated with aggressive challenging behaviour:
Sadness: 38%
Annoyance: 41%
Despair: 22%
Anger: 24%
Fear: 19%
Disgust: 0%
Bromley and Emerson (1995)

9. Impact of emotions (2) Negative emotions associated with self injury:
Sadness: 38%
Annoyance: 15%
Despair: 32%
Anger: 15%
Fear: 11%
Disgust: 15%
Bromley and Emerson (1995)

10. Impact of emotions (3)
Negative emotions associated with destructiveness:
Sadness: 39%
Annoyance: 22%
Despair: 33%
Anger: 17%
Fear: 9%
Disgust: 6%
Bromley and Emerson (1995)

11. Long term effects of exposure to challenges
Anger
Fear
Guilt
Blame
Unwarranted expectation of aggression
Irritability
Coping by avoidance or confrontation
Loss of interest in job; apathy
Decrease in performance quality
Sickness and absence

12. BURNOUT Burnout is characterised by three elements:
Emotional exhaustion
Depersonalisation; cynicism
Reduced personal accomplishment
(Thompson and Rose 2011)

13. What do staff report as being stressful?
Behaviour that is wearing over time(82%)
Perception that there is no effective way to deal with the behaviour (68%)
Unpredictable behaviour (71%)
Behaviour that is difficult to understand (68%)
Effect of challenges on other service users’ quality of life (43%)
Self Injury (61%)
Aggression aimed at others (50%)
Physical strength of challenging service users (50%)
Bromley and Emerson 1995

14. Why might a carer be more likely to be affected by stress?
Personal stressors such as financial or relationship worries
Habitually negative mind set/lack of sense of control
Physical illness/poor mental health
Negative portrayal of carers in the media
Lack of social support
Preoccupation with job at the expense of other activities/interests

15. Gaps in knowledge PBS principles Mental Health needs
Physical health needs
Autism
Specific conditions – Fragile X; epilepsy
Impact of abuse

16. Relationship between negative attributions and staff behaviour
Service-user behaviour
Attribution
Emotional response
Staff behaviour
Impact on environment

17. What helps? Appointing the right people in the first place
Characteristics of the ‘Hardy’ personality:
Commitment, the belief that one’s life and activities have meaning and value;
Control, the conviction that one can control events;
Challenge, change in one’s life is likely and should be embraced as being beneficial.

18. Significance of Emotional Intelligence
Emotional intelligence in carers, an attribute which incorporates the abilities to
attend to,
understand,
regulate and
repair one’s emotional states

19. Predictors for effective carers
Benevolence Empathy Introversion
‘Benevolence and empathy didn’t surprise me but I didn’t expect introvert to come up at all. I realised that extroverts don’t empower individuals. It made sense that you had to be an introvert because you have to be a good listener. It’s about being a person who is more reflective and observational.’
Bill Mumford (Managing Director, MacIntyre care organisation)

20. Coping styles
Wishful thinking versus practical, solution based problem solving
Importance of sense of ‘self efficacy’

21. Teaching immediate coping skills
Self awareness of appropriate body language
Deep breathing exercises
Active listening and problem solving
Vulnerability points

22. Effective Post Incident Support
Post crisis support
Immediate
Medium/long term
Critical Incident Analysis

23. How to ensure that plans are effective and helpful?
Planning with teams
Matching support to individual teams
Attending to ongoing team needs
Ensuring grasp of theoretical principles
Adequate data gathering and analysis
Create momentum
Regular review
Facilitator knowledge
Clear, understandable language

24. Specific Training Needs
Core Values training
PBS principles inc understanding of functionality
Mental Health Needs
Physical Health needs
Service User histories
Individual conditions and their impact

25. Teaching/facilitating specific stress relieving/ coping strategies
Muscle relaxation
Mindfulness
Assertiveness
Deep Breathing
Cognitive Therapy
Acceptance
Access to counselling

26. Leadership and Management
Positive regard
Celebrating success (SPQC)
Praise and appraisal
Supervision/PDP
Team days; away days; stress management days
Creating cultures of support
Measuring stress levels routinely
Cohesive and consistent organisational culture