Working with difficult or challenging behaviour

By A De Maria
Do you work with people who have a difficult behaviours of some type?  It may as a result of be a stress disorder, brain injury, intellectual disability, age related such as dementia, or neurological etc.  The list could go on an on if we were to consider who demonstrates challenging or difficult behaviour.

There are many influences on behaviours. Some of these influences are biological, within the person. Others are ecological influences, outside of the person.  How do you manage these when working with people who demonstrate behaviours that you find difficult to handle?  What are you currently doing to modify the ecological influences?

I have the view that all behaviours occur for a reason. Therefore if you analyse peoples’ behaviours carefully you will be in a position to understand what the person is intending to communicate to you.

Remember that many people you work with may not have the abilities to communicate their needs to you effectively. Look at that person who has dementia or has an intellectual disability closely next time you are with them. How effective are they in communicating all their needs to you? Does this difficulty in communication then impact on their frustration level?

You will encounter many people you are supporting in your service who can communicate, but perhaps not effectively.  This may cause them frustration if they feel they are not understood. Of course, there will be many people you will encounter that have severe communication disorders and may not have the linguistic capabilities to express their requirements.

If their needs are not being met, they will try to communicate this to you. If you don’t understand their communication, they will attempt other ways to get the message across. Often these ‘other’ ways may be in the form of challenging behaviour.

This is an important key aspect to always consider when working with difficult behaviours. Of course, there are many reasons for challenging behaviour to occur. It is your job to explore these reasons and provide the appropriate support.  Remember as a worker, you have a duty of care to ensure that you do this properly.

Any education program whether its in-service or self directed needs to consider many aspects and strategies, in order to work effectively and humanely.  There is much legislation that you need to consider.  Let me summarise some of the things you need to consider.

•Be clear on your role when supporting clients demonstrating challenging behaviour.
•Ensure you have the skills needed to carry out your role in supporting clients demonstrating challenging behaviour

•Ensure you understand the basic human needs that need to be met

•Ensure you are aware that challenging behaviour may occur because clients are trying to communicate

•Ensure you understand the reasons why a team approach to challenging behaviour should be used

•If there is a program in place ensure you understand what you should be contributing

•Ensure you know what to avoid when dealing with challenging behaviour

•Ensure you follow your organisations policy and procedures

•Make sure you record a client’s behaviour on the designated Behaviour Observation Chart or Frequency Charts.

Understanding challenging behaviours
There are three key issues you need to understand about challenging behaviours.

Take a moment to answer the following questions to yourself
   
How can we go about reducing someone’s challenging behaviour?
Is it possible to get rid of challenging behaviour? 
What ethical issues could be involved in trying to change someone’s behaviour? 
Where have most of your ideas about changing challenging behaviour come from?   
Do you know other people who share your ideas?
Do you know about any other points of view that are different from yours?
Why do some people become more aggressive than others?   
What sorts of things make people become aggressive?   
Is it possible to predict what someone will do when they become aggressive?
Are there ways of preventing aggression or reducing it?
What should you do when someone you work with becomes aggressive
   

I hope you can answer some of these questions because not been able to certainly does leave you in a risky situation and of course your puts your employer in an embarrassing position

Talk to your supervisor if you are experiencing problems.

Do some training!

Measuring Behaviour
Once we have a clear definition and description of the behaviour we are concerned about, we can begin to analyse it and build a better understanding of why the person is choosing to use it.

To build a more complete picture of the behaviour we are targeting we need to understand more about it. Some of the things which might be useful to know include:
•    When does it happen?
•    How often does it happen?
•    What happens just before it occurs?
•    What happens just after it occurs?

If we can answer these questions we will know how big a problem it is and we will also know if there is any sort of pattern to how, when, and where it occurs.

To answer these questions we need to measure the behaviour. There are many ways of doing this and the particular methods which are used will depend upon what the behaviour is, and what the person’s particular circumstances are. Most often, the process of measuring the behaviour will be part of a planned programme which has been designed by someone who has good skills, knowledge, and experience in analysing behaviour. This may be a senior member of your own team or perhaps a psychologist. As part of the team who is providing care and support to the person concerned, you are very likely to be asked for your views, and you should make an active effort to contribute your ideas. As a team member you will certainly be involved in measuring the behaviour, so it is important you know something about the methods which may be used.

Measuring behaviour means doing three things:
•    observing what happens
•    recording what happens
•    analysing the data.

Observing and recording are both important and it is essential you do them accurately so the data can be analysed properly. Observing the behaviour means looking carefully and making a serious effort to take note of those details which the team has asked you to pay attention to. It also means you will need to be alert and ready to observe the behaviour whenever it occurs.

Recording the behaviour means making and keeping records of what you observe. This will probably involve using some sort of chart or record sheet which will have been designed for the purpose. You may need to tick boxes, record times and dates, fill in squares, or simply write a summary of what you observed in a few words. Whatever method is used it is most important the records are both accurate and objective. This means you must record the behaviour exactly as you see it without trying to interpret it and without trying to explain why you think it is happening. This, after all, is the whole reason for analysing the behaviour and can only be done properly after all the observations are completed.

There are many ways of measuring behaviour. The best one to use will depend upon what the behaviour is, how complex it is, and where, when and how often it occurs. Here are a few of the more common methods:

ABC chart
It is often very useful to analyse challenging behaviour by taking careful note of what happens before the behaviour occurs and what happens afterwards. One way of doing this is by using an ABC Chart. The ‘A’ stands for ‘antecedents’ which is just a word which means ‘what happens before’. The ‘B’ stands for the ‘behaviour’ itself and the ‘C’ stands for ‘consequences’, meaning what happens ‘as a result’ of the behaviour.
   
Using an ABC Chart involves writing a few words to describe, objectively, exactly what was happening immediately before the person used the challenging behaviour and exactly what happened immediately after it occurs. This is particularly useful if we are not sure why the person is using the behaviour. If the person you are concerned about tears their clothing, or throws objects for no obvious reason then an ABC chart might be a good way to start looking more closely at their behaviour.

An example of a simple frequency record chart can be found in my book.
   

   
Frequency Charts
Some behaviour will occur at different times of the day or may occur many times on some days and only a few times, or not at all, on other days. Swearing, hitting other people, screaming and shouting, breaking objects and furniture, stealing food from other people’s plates are examples. When this happens it can be useful to count the number of times which you see the behaviour within a given time period. This may reveal a pattern showing which the behaviour is more frequent at certain times of the day or on certain days of the week This is called a ‘frequency count’ because it simply measures how frequently the behaviour occurs.
   
 An example of a simple frequency record chart can be found in my book.
   
  
Duration Chart

For some behaviour it is important to know not only how often they occur but also how long the behaviour lasts on each occasion. A duration chart can be used to measure both of these. This will show whether the behaviour is the same each time or whether it lasts longer under some circumstances. Temper tantrums, refusing to get out of the shower, holding onto other people are examples of the sorts of behaviours which you could measure effectively with a duration record chart.


                                               
Time sampling   
A Time sampling record chart looks like this:

Name : Margaret Kitson
Location:  Poppy Lodge 
Behaviour: Observe Margaret every hour, on the hour, during the day and mark ‘YES’, if she is holding on to the arm of a staff member.

Date    07:00    08:00    09:00    10:00    11:00    12:00    13:00    14:00   

19/7/03    NO    NO    YES    YES    NO    YES    YES    NO    YES       YES         

20/7/03    NO    NO    YES    YES    YES    YES    YES    YES    YES    YES      

21/7/03    YES    NO    YES    YES    NO    YESS    YES    NO    YES    YES      
   
Timothy often tells lies when he is asked routine questions, such as: ‘Have you made your bed, are you wearing clean clothes, have you finished your homework, did you put your bike away properly?’. This can happen several times each day. To measure Timothy’s behaviour we could use a Frequency Count to count how many lies he tells each day.

Antoinette talks to herself very loudly at times. This can last for several minutes and usually happens three or four times a day. To measure Antoinette’s behaviour we would use a duration record to count how many minutes she talks to herself on each occasion.

Ivan puts his fingers in his ears and jumps up and down on the spot and repeats the same words over and over again. He does this many hundreds of times throughout the day. To measure Ivan’s behaviour we could use Time sampling to record how regular and constant his behaviour is.

To measure Ivan’s behaviour we could use Time sampling to record how regular and constant his behaviour is.
   
    
Naturalistic Observations
If the behaviour you want to focus on is very complicated or is not exactly the same on each occasion, it may be a good idea to carry out a ‘naturalistic observation’. This involves simply sitting quietly and carefully observing and recording exactly what the person does. This can help to clarify what the behaviour actually involves and will give you a better idea of how frequent and how severe the behaviour is. Once you have a better idea picture of the behaviour, it becomes easier to define it accurately and to decide on the best method to use to measure it, so which it can be analysed more fully.

A note of caution, it is important to know you may change the way which the person behaves simply by being there, observing them. You should try not to be obvious about what you are doing and if possible try to observe the person without them knowing you are doing so.
   
In Summary
If we can accurately define and measure the target behaviour we can begin to build a very clear picture of how the behaviour is being used and what purpose it is serving in the person’ s life.
This will allow us to help the person concerned to learn more acceptable and less harmful ways of getting their needs met.

Achieving this, needs the whole team to be involved so everyone can, first of all, agree on what the behaviour is and then make sure everyone is observing and recording the same things

Examples of  record charts can be found in my book.

Feel free to send this link to anybody who needs to learn a little more about working with people who have difficult behaviours.


Come to our workshop


Contact  Antonio De Maria; enable@three.com.au or 0413533138,  for the date of our next program or we can come to you.       

 


For workers working in supported accommodation, recreation services, vocational services in the disability or age care sector. The clients you may encounter could,

·        be an older person...
·        have dementia
·        have a neurological or developmental disability
·        have autism...
·        have a brain injury...
·        have one or more of the above...
 

IMPORTANCE

Care workers, support workers, front line supervisors and any other human service personnel who have contact with people who have difficult behaviours have a Duty of Care to ensure that the service they provide is the least restrictive possible and at the same time keep themselves safe. Employers, have a Duty of Care to ensure that they provide a safe working environment, which needs to include the use of successful intervention practices.

 

AIM of Training

To provide workers with an understanding of the nature of challenging behaviour and its effects on themselves and the client.

 To provide frameworks for explaining why challenging behaviour occurs.

To provide frameworks for responding to challenging behaviours in a way that supports both the client and the staff.

To explore strategies that have worked in:

  •  diminishing the need for aggression
  •  reducing the incidence of aggression
  •  remaining safe during the occurrence of an incident (immediate responses) .

Outline:
 
1.     Introduction / Clarification of objectives and goals.

2.     Assumptions about aggression.
 
3.     Introduction and the model of aggression, defining the basic reasons for why an aggressive incident occurs.

4.     A breakdown of the model of aggression, and links to intervention

5.     Intervention Frameworks for prevention of challenging behaviours by;

·        identifying and documenting behaviours using the right tools

·        identifying background factors and

·        removal of triggers and

·        removal of antecedents that may

·        preventing an escalation an incident.

6.     Goals for intervention and exploring the use of positive programming.

7.     Developing a Behaviour Support Plan that can be implemented right away - No one solution!

 a plan

 environmental manipulation

policy design and  backup

8.     Short Term Strategies than can manage and diffuse the aggressive incident safely.

9. Long Term Strategies using Positive Programming and Quality of Life Approach.

This workshop is an interactive workshop which presents contemporary approaches to working with challenging behaviours in a number of different environments. It challenges many of the myths about what works with people with “aggressive” or unusual behaviours and identifies the links between aversive techniques and poor quality of life.


The focus of intervention is on preventative measures and on safety in dangerous situations. It is a must for front line workers.



Books available on the topic


HLTCSD6A  

Respond Effectively To Difficult Or Challenging Behaviour


CHCCS401A  

Facilitate Co-operative Behaviour


Textbook   

Success with Managing Challenging Behaviours    Pro-Active Approach



 

 
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