All staff in direct contact with vulnerable people need to be aware of preventing challenging behaviour; fundamental to this is understanding the reasons for someone’s distress, communication that meets the person’s needs and high quality care and services delivered by the team of professionals working with them.
Education and training are central to promoting and supporting change. Staff who may be required to deal with people in crisis and conflict scenarios must have specialised training.
Six Key Principles which guide our practice:
- Compliance with the relevant rights in the European Convention on Human Rights at all times
- Understanding people’s behaviour allows their unique needs, aspirations, experiences and strengths to be recognised and their quality of life to be enhanced
- Involvement and participation of people with care and support needs, their families, carers and advocates is essential, wherever practicable and subject to the person’s wishes and confidentiality obligations
- People must be treated with compassion, dignity and kindness
- Health and social care services must support people to balance safety from harm and freedom of choice
- Positive relationships between the people who deliver services and the people they support must be protected and preserved
- Rigorous governance is needed to ensure that positive and proactive care is the main approach within services to reduce excessive reliance on restrictive interventions and to ensure that if they are used, it is only ever as a last resort, and they are undertaken in a proportionate and least restrictive way.
We believe that corporate training strategies need to be explicit regarding learning outcomes relating to:
- the experience of people who use services
- trauma informed care
- core skills in building therapeutic relationships
- the principles of positive behavioural support
- legal and ethical issues
- risks associated with restrictive interventions
- staff thoughts and feelings on being exposed to disturbed behaviour
- the use of safety planning tools and advance decisions
- alternatives to restrictive interventions
- effective use of de-escalation techniques
- the risks associated with restrictive interventions and how these risks can be minimised
- the use of breakaway techniques by which to disengage from grabs and holds
- safe implementation of restrictive physical interventions; and
- post-incident debriefing and support for staff and people who use services.
Managers need to be aware of their responsibilities for implementing national-level guidance and monitoring compliance with it and around risk assessment, encouraging reporting, reviewing incidents and identifying additional training and support needs.
All staff require training on developing personalised care strategies and plans for preventing and managing challenging behaviour.
Security and/or emergency response team members need to have a full understanding of their powers, rights and responsibilities, including in relation to procedures such as clinical holding, detention, removal and special observation. They need training in how to prevent, calm and manage challenging behaviour and may need training in the medical risks associated with the use of physical intervention in individuals who may be acutely unwell.
Support staff (receptionists, domestic staff, porters, catering staff, cleaners) need to have an awareness of the common signs and triggers of challenging behaviour, related risks and simple prevention and calming strategies. They also need to understand their role in preventing and managing challenging behaviour.
Other agencies such as ambulance and police services, also need to be made aware of relevant guidance and protocols if it is foreseeable that their personnel may also become involved in an emergency situation and/or in physical intervention on an individual, where these can involve substantial risk.
Any person who can reasonably be predicted to be at risk of being exposed to restrictive interventions must have an individualised behaviour support plan.
Positive behavioural support (PBS) provides a framework that seeks to understand the context and meaning of behaviour in order to inform the development of supportive environments and skills that can enhance a person’s quality of life.
Within PBS-based approaches, underlying difficulties are seen as the target for therapeutic intervention.
- Using person-centred, values-based approaches to ensure people are living the best life they possibly can.
- Skilled assessment in order to understand probable reasons why a person presents behaviours of concern; what predicts their occurrence and what factors maintain and sustain them (this area of assessment is often referred to as a functional assessment)
The use of behaviour support plans which have been informed by an assessment of these factors in order to ensure that aspects of the person’s environment that they find challenging are identified and addressed, that quality of life is enhanced and that wherever possible people are supported to develop alternative strategies by which they can better meet their own needs. These are referred to as primary preventative strategies.
– The behaviour support plan must detail the responses such as de-escalation techniques, distraction, diversion and sometimes disengagement to be used by carers/staff when a person starts to become anxious, aroused or distressed. These are referred to as secondary preventative strategies and aim to promote relaxation and avert any further escalation to a crisis.
- Behaviour support plans include guidance as to how people should react when a person’s agitation further escalates to a crisis where they place either themselves or others at significant risk of harm. This may include the use of restrictive interventions. Within behaviour support plans these are as identified as tertiary strategies.
LEGISLATION AT THE CORE OF OUR PRACTICE
European Convention of Human Rights and The Human Rights Act 1998, in particular;
- Article 2; right to life
- Article 3; prohibition of torture, inhuman or degrading treatment
- Article 5; right to liberty and security of person
- Article 8; right to respect for private and family life Article 10; freedom of expression
- Article 14; prohibition of discrimination
- The Mental Health Act 1983 as amended by the 2007 Mental Health Act Mental Capacity Act 2005 (MCA)
Deprivation of Liberty Safeguards (under MCA 2005),
Health and Safety at Work Act 1974 (and other H&S legislation), Common Law. (Offences against the person act 1861)
- Statute Law
- Care Bill (currently in draft form) 2013-2014
The Children Act 2004 where relevant