1. Unit 27 Dealing with Challenging Behaviour
Managing Challenging Behaviour # 1

2. 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.

3. 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

4. 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Withdrawn behaviour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”

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

6. 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.

7. 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

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

9. 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

10. 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.

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

12. 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

13. 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.

14. 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.

15. 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

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