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Demonstrate how reflection on own role in an incident of challenging behaviour can improve the promotion of positive behaviour

I always reflect upon my own role following an incident of challenging behaviour because this helps me to recognise and understand my own feelings after the event as well as take an objective look at what I did well and what I could have done better.

 

This reflection allows me to come up with ideas and strategies for handling future incidents differently and improve my skills as a support worker. If I feel I have done something incorrectly I will speak to the individual to get their opinions and ask them what I should do differently in future. I may also obtain guidance from my colleagues and manager.

Work with others to review the approaches to promoting positive behaviour using information from records, de-briefing and support activities

The importance of documentation and record-keeping is realised when it comes to reviewing approaches and support plans for an individual. Using the information gathered from records, debriefings and activities, the support team and the individual concerned can come up with strategies to help promote positive behaviour and prevent challenging behaviour, which will contribute towards their well-being.

 

For example, I worked with a client who would get very aggressive in the mornings when support staff prompted him to have a bath. Using the information from the incidents reports, my team and I ascertained that one of the reasons for his behaviour was that he was still quite groggy and tired in the mornings, so we asked him if he would prefer to have a bath in the early evening instead. The client agreed to this and the incidents of challenging behaviour at bath time decreased dramatically.

Work with others to analyse the antecedent, behaviour and consequences of an incident

Following an incident, it is the policy of my company to fill in an ABC chart. This should be filled in by support staff that were present during the incident, however it is always useful to speak to the individual themselves as they are best placed to know the reasons for their behaviour. Getting cooperation from the individual also helps them to reflect on the incident.

 

ABC charts have three columns; A for antecedent (what happened before the incident), B for behaviour (what happened during the incident) and C for consequences (the consequences of the behaviour).

Describe the steps that should be taken to check for injuries following an incident of challenging behaviour

Following an incident of challenging behaviour, individuals should be checked for injuries, ideally by somebody that was not involved in the incident. If physical interventions were used, it is important to carefully check for injury on the areas where physical contact took place. First aid should be applied where necessary, however if first aid is not sufficient the emergency services should be called. It is also important to record any injuries on the incident report.

Demonstrate how to debrief others involved in an incident of challenging behaviour

As mentioned above, my company’s policy is to have a post-incident review within 72 hours of an incident happening, which gives everybody involved a chance to air their views about how they were and are feeling in a non-judgemental way. It may also be necessary to speak privately to individuals about an incident. I will also usually pass on my incident report to everybody involved to ensure they agree with it and I haven’t made any mistakes and/or omissions.

Describe the complex feelings that may be experienced by others involved or witnessing an incident of challenging behaviour

Having witnessed and been involved in quite a few incidents of challenging behaviour, I know that they can bring about feelings of anger, anxiety, upset, depression and guilt. They can also bring about positive feelings such as pride in how you handled a situation and improved self-confidence and self-esteem when you have done a good job.

 

Describe how an individual can be supported to reflect on an incident including how they were feeling after the incident

An individual can experience a wide range of emotions after an incident including embarrassment, anger, pain, guilt and sorrow. It is important that they have the opportunity to discuss these feelings to help them move on from what happened. By discussing these feelings, an individual will be able to apologise to anyone they have hurt, have changes made to their support plans to prevent repeat occurrences and learn lessons from the experience.

Describe how an individual can be supported to reflect on an incident including the consequence of their behaviour

The individual should also be encouraged to discuss the consequences of their behaviour. these could be positive (e.g. they got they what they wanted) and/or negative (e.g. they damaged one of their possessions) and they will often be linked with negative feelings (which are discussed in the next question).

In many cases, the consequences of the individual’s behaviour will be negative – they may have hurt themselves or broke something that they cherish or hurt somebody or been arrested. By being open and non-judgmental with the individual, you can help them to understand that are no better off because of their actions and are most probably worse off because of them, which can help make it less likely of a future incident occurring.

Describe how an individual can be supported to reflect on an incident including their behaviour

It is also important to discuss the incident itself so that the individual can develop responsibility for their actions and work on trying to stop it happening again in the future. Again, it is useful to not attribute blame on the individual and be sympathetic towards them as they may be suffering with complex feelings of guilt or embarrassment. Asking the individual what they hoped to achieve by their actions can be useful and it may be necessary to discuss with the individual what interventions they would like staff to use if this behaviour re-occurs.

Describe how an individual can be supported to reflect on an incident including how they were feeling at the time prior to and directly before the incident

Part of my company’s Challenging Behaviour Policy is to have a post-incident review within 72 hours of the incident ending. This gives everyone involved (both clients and staff) an opportunity to speak frankly about what happened, how they felt (and still feel), the triggers that led to the incident and what can be done to prevent a similar incident in future.

 

It is important to try not to apportion blame during this review, try to understand the point of view of others and come up with practical solutions to avoid these sorts of situations in the future.

 

The individual who exhibited challenging behaviour should be encouraged to discuss how they felt before the incident happened and what they think could have been done to prevent the incident. This information is vital to adjusting the individual’s support plan so that the triggers that caused the behaviour can be avoided in future.

Demonstrate methods to support an individual to return to a calm state following an incident of challenging behaviour

Again, the methods used to help an individual return to a calm state after an incident of challenging behaviour will be person-centred.

 

For some of my clients, simply leaving them alone to calm down themselves works well. For others, it may mean talking to them and giving them lots of attention – especially if the reason for the incident was because they felt they were being ignored. Some clients may need to get into bed and have a nap to return to a calm state and others may need to listen to soothing music.

Demonstrate how to complete records accurately and objectively in line with work setting requirements following an incident of challenging behaviour

Following an incident of challenging behaviour, I am required to fill out an incident report and an ABC chart. These should be filled in objectively, sticking to the facts and be free from my own views and opinions about the incident.

 

The incident report is an objective and detailed account of what happened and the ABC chart is an overview of what happened before, during and after an incident. A copy of our Incident Reporting Policy and Procedure is attached to this document as evidence.

Explain the steps that are taken to maintain the dignity of and respect for and individual when responding to an incident of challenging behaviour

Maintaining the dignity and respect of an individual is of the utmost importance when responding to incidents of challenging behaviour. Physical interventions should never be used unless there are serious risks to the individual or others and even then, the minimal restrictive force necessary should be used.

Demonstrate how to respond to incidents of challenging behaviour following behaviour support plans, agreed ways of working or organisational guidelines

The response required for incidents of challenging behaviour are person-centred and so will vary from individual to individual, as outlined in their support plans. For example, one individual I work with will cease their challenging behaviour if they are ignored, whilst another may need to be distracted with music.

 

As well as knowing and understanding the individual, there are some responses that are universal when responding to challenging behaviour including those outlined in best practice and in my company’s Challenging Behaviour Policy & Procedure, which is attached to this document.

 

It is also necessary to write and maintain reports of all incidents of challenging behavior and contact other professionals if necessary including the police, GP, psychologist or social worker.

Identify types of challenging behaviours

Types of challenging behaviour include:

 

  • Self-injury (e.g. headbutting a wall, biting own arm)
  • Aggressive behaviour (e.g. hitting, screaming, verbal abuse, spitting towards others etc.)
  • Inappropriate sexual behaviour (e.g. masturbating in public, exposing genitals etc.)
  • Damage to property (e.g. breaking windows, kicking in doors, smashing up guitars etc.)
  • Stealing

Demonstrate how to model to others best practice in promoting positive behaviour

Sometimes it is necessary to model best practice in promoting positive behaviour to other people so that they can learn from example. Modeling best practice can be directed towards clients, colleagues, families, friends, health and social care professionals and members of the public.

 

For example, a common occurrence in my role as support worker is when I am out shopping with an individual and the shopkeeper addresses myself instead of the individual that is making the purchase. When I am asked a question by the shopkeeper, I do not answer for the individual but instead repeat the question to them so that they can answer for themselves. Usually, after doing this once, the shopkeeper will continue by addressing the individual and not me.

 

Another recent example is when I supported an individual to go to the dentist – something that they were very anxious about. Upon entering the room with the dentist, I told the dentist that I was really proud of the individual for building up the courage to come here today. The dentist took the hint and also gave the individual lots of praise.

Highlight praise and support positive aspects of an individual’s behaviour in order to reinforce positive behaviour

Positive behaviour can be reinforced by using praise and encouragement when an individual does something good.

 

For example, I work with an individual who is occasionally incontinent when out in the community. We put a support plan in place for staff to remind him to go to the toilet before going out. Several months later, we were getting ready to go out and he went to the toilet himself without being prompted. When he came out of the bathroom I told him how awesome he was for remembering to go the toilet and how proud I was of him and he repeated this positive the next time too, and he now remembers about 90% of the time.

 

I also worked with an individual that became very agitated at the thought of going to the dentist, so much so that staff had given up trying to persuade him to book an appointment. Over the course of several months, I observed that he always brushed his teeth twice a day and I praised him for his routine and how he kept his teeth in great shape. On occasions, I would also make a point of telling him how sparkling white his teeth looked and how I wished I’d taken care of my teeth as well as he does. Then, one day I mentioned to him that his teeth were so great, he should probably show them to a dentist so that they could see what a fine job he was doing and make sure there weren’t any problems at the back where he couldn’t see himself. After a little consideration, he happily agreed. After the dental appointment, I praised him for having a checkup and explained how much I admired him for conquering his fears. He’s never had a problem going to the dentist since.

Evaluate the effectiveness of proactive strategies on mitigating challenging behaviours

As part of my job role, I observe and manage challenging behaviour and use this knowledge to implement proactive strategies that can mitigate future similar behaviours. This is an ongoing process and involves constantly working with the individuals concerned to establish what works and what doesn’t and tweaking the strategies where necessary.

 

Proactive strategies are preferable over reactive strategies because their purpose is to prevent incidents of challenging behaviour, resulting in the avoidance of the negative repercussions that the behaviour may cause, thereby contributing to the individual’s well-being.

 

As an example, I work with an individual that has a history of superficial self-harm. When he first moved in, I spoke with him about ways we could prevent this behaviour from happening in the future and we agreed that all sharp implements that could cause him harm should be kept locked away and only accessed when necessary. This included kitchen knives, tools such as screwdrivers and his shaving razor. We also agreed on staff conducting a spot check of his bedroom each day to ensure there were no dangerous items in there. Since he moved in, there has not been an incident of self-harm, so this strategy is working well.

 

Another example is an individual I worked with that had auditory hallucinations which upset him and caused him to become aggressive towards people and property. Indicators that he was hearing unkind voices were that his head would drop and he would get an angry look on his face. Support staff would then ask him if he was hearing voices and then remind him that they were ‘talking rubbish’ and he could tell them to ‘get lost’. In around 90% of cases, this strategy would avoid episodes of violence.

Explain how a range of factors may be associated with challenging behaviours

There are a range of factors that may contribute to challenging behaviours including:

  • Boredom
  • Lack of boundaries
  • Mental health
  • Lack of understanding
  • Emotional expression
  • Excessive demands
  • Not having enough money to buy something

 

Challenging behaviours may be caused by one or more of these or something different entirely. It is important to understand the factors that result in challenging behaviour for each individual to establish a strategy for managing and/or preventing it.

Evaluate the impact on an individual’s well-being of using reactive rather than proactive strategies

Reactive strategies are more likely to disrupt the well-being of an individual than proactive strategies because they are used after an instance of challenging behaviour has already begun, so the individual has to deal with the consequences. This can include feelings of regret, guilt or unresolved anger as well as tangible repercussions such as a member of staff no longer wanting to work with them, spending time in a police cell or having to pay for damages to property they have caused. In contrast, proactive strategies aim to prevent a situation developing into one where an individual displays challenging behaviour and avoid the consequences that may follow it.

Explain the importance of reinforcing positive behaviour with individuals

By reinforcing positive behaviour, an individual learns that the behaviour is good and is more inclined to repeat it in future. Many incidents of challenging behaviour are caused by the individual requiring attention from others, but if an individual learns that they can get much more pleasant attention by behaving positively, they are more likely to satisfy their craving for attention in positive ways.

Explain the importance of maintaining a person or child centred approach when establishing proactive strategies

A person-centred approach is important in all aspects of an individual’s support because they have the right to be involved in all decisions that concern them. It is all the more important when establishing proactive strategies for dealing with challenging behaviour because the individual knows more about the reasons why they have they incidents of challenging behaviour than anybody else, so are best-placed to provide information about how to avoid them. In addition, everyone is unique and so are their triggers so proactive strategies should also be tailored uniquely to the individual using a person-centric approach.

Explain the importance of identifying patterns of behaviour or triggers to challenging behaviour when establishing proactive or reactive strategies to be used

It is very important to identify which triggers or patterns come immediately before an individual has challenging behaviour because this information can be utilised to avoid (proactive) or manage (reactive) challenging behaviour in the future. It can also provide important information about the reasons for the change in behaviour. For example, if an individual has an incident of challenging behaviour immediately after two support workers are laughing and joking with each other in another room, it may be that the individual thinks that they are laughing at him behind his back. The proactive solution would be for support workers to not laugh and joke unless the individual is in the same room and involved in the conversation. The reactive solution would be to explain to the individual that they were not laughing at him.

Identify the proactive and reactive strategies that are used within own work role

Within my own work role I use both proactive and reactive strategies. One of my clients suffers from paranoid schizophrenia and would often have episodes of challenging behaviour when it was time to go for his weekly medical injection at the doctors. We worked with him and his GP to arrange for his support to be changed so that a nurse came to his home to administer the injection, which radically reduced his challenging behaviour. This is an example of a proactive strategy. Another example of a proactive strategy is dimming the lights or drawing the curtains for a client that is hypersensitive to light when they are looking upset and talking it over with them. If this clients behaviour escalates, he will stomp around slamming doors and verbally abusing staff. We then use reactive strategies such as ignoring him until he has calmed down. Another reactive strategy we use with a particular client is to do impressions to make him laugh when he is angry. He doesn’t stay angry for long.

Explain the difference between proactive and reactive strategies

Proactive strategies are techniques to prevent challenging behaviour happening, whereas reactive strategies are techniques that are used during an incident of challenging behaviour. Proactive strategies are always preferred as an incident of challenging behaviour can be very stressful for an individual and affect their well-being. Looking at triggers or antecedents that lead to challenging behaviour and trying to avoid or nullify them is an example of a proactive strategy. Distracting an individual whose behaviour is challenging is a reactive strategy.

Describe safeguards that must be in place if restrictive physical interventions are used

If restrictive physical interventions are used or are likely to be used then there must be safeguards in place to protect vulnerable individuals from abuse. Some of these safeguards include proper staff training about when and how to use restrictive interventions as well as detailed policies and procedures to guide their actions. Every incident of restrictive intervention should be recorded and regularly reviewed by a manager. As mentioned above, all staff be using the least restrictive intervention and physical interventions should only be used as a last resort.

Explain why the least restrictive interventions should always be used when dealing with incidents of challenging behaviour

The least restrictive interventions should always be used when dealing with incidents of challenging behaviour. This is because restrictive interventions are invasive to an individual and deprive them of their basic liberties, which is unlawful except in exceptional circumstances.It may also be intimidating and frightening to them especially if they are in a confused state and could escalate the situation further. In addition, it may be necessary to justify any actions taken at a later date. Finally, thinking in terms of the least restrictive intervention creates a good mindset for any challenging behaviour you have to manage in the future.

 

Explain who needs to be informed of any incidents where restrictive interventions have been used

If a restrictive intervention must be used, it is necessary to contact the service manager. Depending on the situations, the emergency services may need to be contacted (police if a crime has been committed or an ambulance if there are injuries). Social Services and health professionals (e.g. GP, psychologist) may also need to be informed and the family of the individual may also need to be contacted.

Explain when restrictive interventions may and may not be used

Restrictive interventions should ideally not be used at all but the law recognises that on occasion there may be situations where this is necessary. Restrictive interventions should only be used when the individual or somebody else is at risk from harm or to prevent a crime being committed.