Staff handbookStrategies for dealing with challenging behaviour“Positive behaviour management– Positive behavioural support is a person-centred approach to people who show or at risk of showing behaviours which are challenging. It involves understanding reasons why an individual may be showing certain challenging behaviours and considering the person which includes their life history, physical needs, emotional needs and any other factors which can have an impact on their behaviour. PBM involves assessing broad social and physical context in which the behaviour occurs and planning and implementing ways of supporting and assisting the person to ensure that their behaviour is improved and to enhance the quality of life for themselves and those around them. An example of this can be that staff in any profession such as teachers may choose to react to challenging behaviour with praise. This encourages the individuals to focus on the good and positive aspects of their behaviour which they may then be more likely to repeat to receive more praise and admiration. As a carer I have the responsibility of ensuring my residents are kept safe and protected so because my resident who suffers from Alzheimer’s has begun in engaging in behaviour which is harmful and self-destructive I would use positive behaviour management as a way of dealing with this. This would include thoroughly assessing the factors which could be impacting my resident which therefore makes them hurt themselves as a result, this can be something which has happened to them in the care home or something which happened in the past which is the reason behind it. As my resident suffers from Alzheimer’s disease, this has many symptoms such as confusion, personality changing such as becoming more aggressive, hallucinations so seeing and hearing things that aren’t there and being delusional so they believe things that aren’t true as well as low mood or anxiety. All these symptoms can be factors impacting my resident which causes them to therefore harm themselves. This could be out of frustration of not being able to express themselves properly. This strategy is effective when dealing with my resident who’s engaging in self-destructive and harmful behaviour. This is because, positive behaviour management involves thoroughly understand why an individual may be showing certain behaviours or actions, this is useful as by knowing what may be impacting them, you can focus on vital needs they may have to help encourage them to stop engaging in such behaviour. Also, by understanding, it may also encourage the resident to therefore feel comfortable and confident in me as their carer as they will know that my job is to help and protect them. This can then better my relationship with the resident and I can ensure that my resident understands engaging in self-destructive behaviour is dangerous and makes things worse. However, this strategy may not be useful when dealing with my resident. This is because, my resident may not wish to cooperate with me which makes it more difficult to understand why my resident may be engaging in self-destructive behaviour. This strategy would then be ineffective as if I don’t understand what my resident is going through I won’t be certain as to what methods can be used to support and assist the resident. It may also be ineffective as my resident may choose to keep personal things private such as pervious traumas, family history, emotional needs etc which means the help I provide my resident with may not be the help they require, which therefore means it’s a waste of money and time as it may not positively impact my resident due to them not needing it. ”Person-centred planning- This provides a way of helping an individual plan all aspects of their life to ensure that the individual remains central to the creation of any plan that will affect them to make sure that their needs are properly met and to ensure that they aren’t getting care they don’t require or want. Person centred planning is about making changes in a person’s life and planning for the future to make sure that their future is bright and is properly planned. PCB ensures that the individual stays in control of their life, the plans made, who is involved in them, whose help they will need to make the plans happen as well as many other things. Those managing an individual’s planning will need to ensure that it is revisited often as an individual’s plan can change and vary naturally overtime. Person-centred planning can have many positives effects on an individual for instance: this may help improve their social skills, having a positive mind-set, help with budgeting, pursuing personal interests, being comfortable in social environments and many more. As a carer I would use person-centred planning as a way of dealing with my resident harming themselves and engaging in self-destructive behaviour. I would ensure that I regularly updated my residents planning as individual’s future plans can change overtime, by doing this my resident will also feel respected as it conveys that I care for their future and their life does have a value. By focusing on the resident and solely what they want and need, this ensures that their requirements are met and fulfilled so that they do not have to worry about this. By having less stress and less things to worry about, my resident may feel a lot more relaxed and confident, therefore they may then stop harming themselves as a result. An example of this can be: setting up a timetable of different activities to help keep my resident fit and healthy, this can include different activities everyday such as yoga, Zumba, swimming and many more. This can be person-centred planning as exercise may be what my resident needs to be healthier. This therefore may keep my residents mental and emotional health well, as exercise may relieve stress and worries. This strategy can be effective for many reasons, one being that focusing on my resident’s needs and requirements means that my resident is not getting help they don’t require so then money and time won’t be wasted. Person-centred planning consists of focusing solely on what my resident requires to maintain a healthy physical, emotional and mental well-being. For example, to improve my residents mental state, as a carer I would ensure that I am aware of any of their thoughts and what they want to do to ensure that they are still in control of their life and their decision. For instance, setting up a fixed day where my resident can see their friends and family, whether it’s within the care home or elsewhere, this is effective as it can encourage my resident to stop engaging in self-destructive behaviour as by seeing their family and friends regularly can ensure that they are content. However, this strategy isn’t effective as this strategy requires good communications skills and as my resident suffers from Alzheimer’s it can mean that my resident has communication problems. There may then be a speech barrier which makes this strategy ineffective. This is because my resident may not be able to express any worries and opinions they have which can make it difficult to plan for my resident’s future as I may not be sure whether my resident is happy with these plans or not.“Effective communication-Effective communication is about understanding emotion and the intention behind the information and data. For communication to be effective, you need to be able to clearly convey a message and be able to listen to what is being said and makes the other individual feel heard and understood. Effective communication can include using words which everyone can properly understand, in a suitable tone of voice and body language and considering the context of communication improves its effectiveness. Effective communication combines a set of 4 skills: engaged listening, nonverbal communication, managing stress and asserting yourself in a respectful way. An example of effective communication can be that in a school, a teacher may use effective communication when speaking to parents about their child’s progress. They will use words that can be understood, use a suitable tone of voice and have a straight posture in order to be formal and professional. To care for my resident, I would use effective communication to properly get my point across. By having effective communication, this can ensure that communication between my resident and I are clear and effective, this way we can both understand each other’s point of view and make sure that there are is no confusion or miscommunication. This may be useful to care for my resident as by having clear conversations where we understand each other, I can ensure that my resident isn’t stressed or worried due to not understanding me. This may then mean that my resident won’t resort to self-destructive behaviour as a way of dealing with this due to their frustration. However, if I did not use effective communication it could mean that my client is frustrated and irritated due to not understanding me well, this can lead to my resident becoming stressed trying to understand what I meant which can lead to them harming themselves as a way of coping with the tension and the confusion. This strategy is effective as having effective communication ensures that there is no confusion between my resident and I, this is useful as there won’t be any confusion or miscommunication. Not understanding each other can lead to my resident being confused and stressed. Therefore, as there is no miscommunication, my resident will thoroughly understand me and will be able to reply back to what I say properly. Another reason why it is effective is because having effective communication between my resident and I makes sure that my resident is confident and comfortable with speaking to me about their issues or any worries they have. This can then encourage them to stop any challenging behaviour. However, effective communication may be ineffective too. This is because, effective communication could be seen as over explaining certain things to ensure that they thoroughly understand the point I am trying to make. This is ineffective as this could confuse my resident further which is a problem as they may then misunderstand my points due to over thinking it. This means that effective communication may not be a two way thing, I may believe that I am using correct and effective communication but my resident may disagree. Also, my resident has Alzheimer’s which has symptoms of words with speaking and writing and memory loss. This may be ineffective due to these symptoms as everything I say to my resident, they may not be aware of it as they may forget it which means they won’t thoroughly understand me which then makes communication difficult. As my resident also may struggle with communication due to this disease, communication may be hard as I may not understand what my resident is trying to say or my resident may be unsure as to how to communicate certain points which can cause frustration leading to my resident engaging in self-destructive behaviour as a coping mechanism. ““Appropriate body language-Body language is a type of non-verbal communication in which physical behaviour, as opposed to words, are used to express or convey information. Body language includes facial expressions, body posture, gestures, eye movement, touch and the use of space. Using correct and appropriate body language may mean information is properly communicated so that it’s understood successfully. An example of body language can be that someone who is feeling down and miserable may have a frown on their face, may be slouching and may also have their face in their hands. From this, those around the individual which understand and knowledge that they may feeling sad or down. Another example can be that staff in hospitals, schools, care homes and many more may make eye contact and have a straight posture to show the individuals they are listening, paying attention and understanding what the individual is saying. To care for my resident, I would use appropriate body language to convey that I am listening to my resident and paying attention as showing them that I am listening to what they must say may encourage them to stop with the self-destructive behaviour. My resident may do this due to the feeling that they aren’t listened to or paid attention to. When an individual is pushed to the side and their opinions and feelings are disregarded, they may become frustrated so these negative feelings can lead to wanting to carry out self-destructive and harmful acts. This strategy is effective because it ensures that there is good communication between my resident and I, this is useful as having good communication ensures that we don’t misunderstand any points made. It also makes sure that my resident feels respected and feels as though they aren’t a burden to me. As a carer, I would need to ensure that I have a correct posture to ensure that my resident knows that I am listening to what she has to say and any opinions or worries. For instance, when my resident is speaking to me I would need to make sure to have a straight posture and not slouch, also ensure that my arms aren’t crossed or leaning on my cheek, this can make my resident believe I am not interested or I am getting bored. Appropriate body language is useful in encouraging my resident to stop engaging in self-destructive behaviour this is because my resident will see that I’m worried about her and do care for her. However, appropriate body language may not be effective and this is because not all individuals understand body language properly, this can then cause misunderstanding and cause both staff and residents to get a wrong message. It is also ineffective as the resident may be paying attention to what I have to say so the resident may not notice my positive body language. ““Promoting self-esteem-Self-esteem shows an individual’s view of themselves and their self-worth. It is their attitude to themselves so what they think of themselves. This can be either negative or positive so if someone had a negative view of themselves such as they thought of themselves as unworthy they are likely to have a low self-esteem where as someone who regards themselves as worthy and important, they are likely to have a high self-esteem. An individual’s surroundings can also have an impact on their self-esteem. This is because, those around them may help either raise their self-esteem through praises, compliments and respect shown to them or can lower it by not respecting them or their choices, being negative towards such as calling them names which causes them to feel insecure or upset. An example of this can be that staff in a care home may encourage the residents to be independent which helps raise an individual’s self-esteem as its proof to them that they can do something without assistance from others, this could make the individual proud of themselves which then leads to their self-esteem improving. As a way of dealing with my resident harming themselves I would use this strategy to encourage my resident to stop this challenging behaviour. Promoting self-esteem can include me complimenting my resident and praising their positive behaviour for instance if my resident had got themselves dressed and ready and I had praised them saying well done this may encourage my resident to continue with this behaviour and may also feel good about themselves which then raises self-esteem. Raising my resident’s self-esteem and their self-confidence may lead to them being confident and comfortable with themselves which may then lead to them no longer feeling the need to harm themselves as this could have been done due to them feeling insecure about themselves. A low self-esteem and low confidence could lead to an individual being in a dark and lonely place so by ensuring that they are happy with themselves may encourage them to stop with this behaviour. Promoting self-esteem could be effective. This is because promoting self-esteem means raising my resident’s self-confidence. This is vital as it’s a possibility that by using this strategy and making my resident feel good about themselves, it may encourage my resident to no longer engage in self-destructive behaviour. It is effective because my resident may no longer feel low about themselves or feel anything negative so they may then stop engaging in this behaviour. However, this strategy may not be effective for many reasons. It is likely that by raising my resident’s self-confidence, it may be raised too high which means they may become blind to their faults or anything negative about them. This is not useful because this could make communication between my resident and I very difficult. Another reason why it may be ineffective is because my resident may notice that I am trying to raise her self-esteem which she may not be happy about. My resident may believe that I am trying to change her instead of accepting her for who she is. This may then lead to my resident engaging in self-destructive behaviour due to her thinking that I am not accepting her for who she is. ““Anti-Discriminatory Practice – This means treating a person or group unfairly because of a characteristic, such as gender, disability, age, ethnic origin, skin colour, nationality, sexuality and/or religious belief. Discrimination has been described as putting prejudices into practice. All organisation which people work for must have policies which give guidance on the anti-discriminatory practice to ensure that anyone is not getting discriminated against at work. Employers should provide training sessions about the anti-discriminatory practice to raise awareness and to inform people about how they could prevent and deal with discrimination. As a way of dealing with my resident harming themselves and engaging in self-destructive behaviour, I would use this anti-discriminatory practice. By using this strategy, I can ensure that my resident is treated with respect and dignity and ensure that they are treated equally so that they don’t feel like they are the odd one out or as if they are less important and significant compared to others. This is useful as it may encourage my resident to no longer engage in harmful behaviour as negative feelings such as feeling less important and feeling like you don’t belong may cause you to feel self-conscious and doubt yourself which is why this strategy is useful. By treating all the residents equally, I can ensure my resident feels as though they are important and they aren’t the odd one out. This strategy is effective for many reasons, for instance it makes sure that all individuals within the care home feels equally as important and no one is left feeling lonely. This is effective as it can ensure that my resident does not engage in self-destructive behaviour. This is because I’ll be treating her the same as other residents, with care compassion and respect. This means that my resident won’t be worried about what individual’s think of her or even feeling like she doesn’t belong. It is effective also because this practice ensures that all individuals are given equal chances and opportunities. This is effective as my resident may then feel more like an individual and have opportunities to do what she wants, such as any goals or ambitions she has which won’t be dismissed due to her age, gender, ethnic background etc. This is useful as this may encourage my resident to stop engaging in self-destructive behaviour as she will be given equal rights and opportunities so she won’t feel like the odd one out. However, this strategy may not be effective when dealing with my resident who is showing self-destructive behaviour. This is because, in some circumstances there may be times where as a carer I would need to choose one resident over the other, such as if there was an argument I may have to choose a side and get the other individual to apologise. This may then cause my resident to feel as though they are being discriminate against which can lead to her engaging in harmful and self-destructive behaviour as a way of coping with this. ““Empowering and Involving Individuals- Empowerment for health is a process in health promotion through which people gain greater control over decisions and actions affecting their health. Empowerment may be a social, cultural, psychological or political process through which individuals and social groups are able to express their needs, present their concerns, devise strategies for involvement in decision-making, and achieve political, social and cultural action to meet those needs. By empowering people and giving them the power and authority to do or say things, this may encourage individuals to be more independent and determined. Involving individual’s means that you are involving the individual in things that involve them such as decision making about their health and wellbeing. As a carer I would use this strategy as a way of dealing with my resident harming themselves and showing self-destructive behaviour. By empowering my resident and involving them in things that involve them such as decisions about their medication, visits, small decisions such as diet and exercise etc, this may encourage my resident to stop with these types of behaviours and harming themselves. This is because it is likely that my resident may decide to show these types of behaviours and harm themselves out of frustration and anger due to not having control over their life and not being able to decide for themselves what’s most suited for them etc. By empowering my resident and giving them power, they may feel as though they do have control and their life is still theirs which can then overtake any negative emotions they had, eventually stopping the self-destructive behaviour. This strategy is effective because empowering my resident teaches them that they can be independent and do the things they wish to do with the help of myself and other carers. This is useful as by giving them control over their life, this will help them understand that although they are living in a residential, she still has control over their lives. Empowering and involving the individual in all activities will make them feel as though they belong and they will also be included. This may then encourage my resident to stop engaging in self-destructive behaviour as they won’t feel left out or feel as though they aren’t wanted. Having no negative feelings may not lead to wanting to engage in self-destructive behaviour. However, this strategy may not be effective, this is because my resident may believe that I am trying to change them which could cause them to worry about the way they are leading to self-destructive behaviour as a way of coping with these negative feelings of my resident doubting themselves. ““Risk Assessment- This means thinking about what might cause harm to people and decide whether you are taking reasonable steps to prevent that harm, t is something you are required by law to carry out. A risk assessment includes identifying sensible measures to control the risks in your workplace. There are many ways to assess the risks in a workplace: identify the hazards, decide who might be harmed and how, evaluate the risks and decide on precautions, record your significant findings and review your assessment and update if necessary. To deal with my resident showing self-destructive behaviour and harming themselves, I would do a risk assessment of my resident’s surroundings such as their bedroom, toilet, lounge area etc to ensure that there are no items which can be used by my resident to cause themselves harm. An example of this can be: forks and knives in the dining room may be placed out of reach from my client to ensure that this cannot be used to hurt themselves. Risk assessments are vital to do this is because this can help protect my resident’s life. This is vital to do as if my resident was triggered for any reason such as an argument with another resident or a disagreement with a staff which can cause her tension and frustration leading her to hurt herself as a coping mechanism. If a risk assessment was not done, it would be easier for my resident to hurt herself which is what we want to stop. Risk assessments can be effective when dealing with this challenging behaviour. This is because, this can essentially stop my resident engaging in self-destructive behaviour. It will help me keep my residents safe and protected from any danger or hazards. Another reason why it is effective is because risk assessments may limit the rate of accidents and incidents within the care home which is important as it will make the environment safer for all individuals. However, this strategy may not be effective as although risk assessments are useful, they don’t always stop accidents from happening. Accidents and incidents can occur at all times due to anything within the residential house. Also, things within the care home may not always go the way expected, for instance although risk assessments may be done, it is possible a new situation occurs which no one is prepared for. This is ineffective as you cannot always be prepared for it.“Workforce training-Workforce training is a widespread group of programs focussed towards producing workers whose skills match with economic demands. This ensures that the staff and the workforce are getting the best quality presentation. Workforce training also makes sure that they are keeping them motivated and reducing turnover. ETI ensures the organisation knows certain and effective training so that the organisations investment increases productivity and employee satisfaction. This helps to improve and develop the skills of existing employees or members of any organisation. As a carer I would use this strategy to prevent my resident from engaging in self-destructive behaviour. This is because by having training I can teach other staff members to cope with certain situations effectively and ensure that they are doing their best to prevent residents from harming themselves. This also shows residents that our main aim to keep all residents safe and protected which can help them understand and encourage themselves to not engage in challenging behaviour as we don’t want them to get hurt. Work force training is an effective strategy because it will help me learn new techniques of dealing with residents who may be showing challenging behaviours. This may help the residents stop engaging in challenging behaviours as they may realise that I am interested in their safety and that I am putting effort into caring for them by trying to develop my skills. Another reason as to why workforce training is effective is that it may encourage staff to continue working and they won’t be worried about any harm. This is useful as they may then be positive and confident in how to deal with all situations. Also, work force training means that there will be fewer accidents as the staff will know how to prevent these accident from occurring. However, the work force training strategy could be ineffective as staff may never need to apply what they took away from the training while they are working with their residents as not all situations which are addressed in training will happen in real life so then this means a large amount of money may be spent for training that will never be used and a lot of valuable time will also be lost. This is another reason why it’s not useful as training is usually very long which means the staff could lose concentration throughout training so then they won’t exactly take in any information. ““Providing Active Support- Active support is a person-centred approach to providing direct support. The main reason behind active support is to ensure that people with even the most significant disabilities have a constant, daily support to be involved in a variety of life activities and opportunities of their choice. The main results of active support are to provide more control, improve confidence and increase independence. As a carer I would use this strategy to deal with my resident harming themselves and showing self-destructive behaviour. By providing my resident with active support this would ensure that my resident is able to do things those around them may be doing and have opportunities to do things which they never got to do etc. By doing this, my resident may feel more ordinary, like everyone around them and be able to do everyday things, whether it is on their own or with support. It is likely that my resident felt frustrated with themselves due to not being able to do certain things so by providing active support, they may feel more able and feel quite proud of themselves for accomplishing certain things which can then encourage them to not harm themselves. Active support consists of utilising activities that need to be done e.g: shopping, tidying the bedroom, gardening etc. This strategy is effective when dealing with my resident engaging in self-destructive behaviour. This strategy could help change my residents view of themselves and see them in a more positive light. This is effective when dealing with challenging behaviour as if my resident is more confident which may lead to them no longer wanting to engage in self-destructive behaviour. It also effective as my resident will learn new skills and techniques which is effective as this can help develop my resident’s intellectual development and make her feel prouder of herself which is useful when trying to stop her from engaging in self-destructive behaviour. However, this strategy could also be ineffective because some residents may decide that active support is not what they wish to have. As they don’t want this, it may be hard to assist them in daily things which can then lead to them engaging in self-destructive behaviour as their needs may not be met. Another reason as to why it is an ineffective strategy is that residents may decide that they would prefer to depend on the carer so then they aren’t doing anything for themselves. This isn’t effective as the resident won’t be learning anything or being independent. This could teach them to depend on staff at all times even when it isn’t suitable so this can cause the resident stress when they can’t depend on anyone. ““Medication- People accessing care services often require assistance with medication. Organisations such as a care home have the responsibility to ensure the correct, safe and proper use of medication and the staff that are responsible for the management of medication are suitably trained and are competent.  As my resident suffers from Alzheimer’s disease, the main medication may be: donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) which could all be used to treat Alzheimer’s and all work the same way. To care and deal with my resident showing harmful and destructive behaviour I would ensure that my resident’s medication intake is correct so the correct medication which has been prescribed to them, the correct dosage and at the time recommended. This is because, not providing the correct medication can cause problems to my resident which can therefore impact my resident’s behaviour causing them to harm themselves due to any side effects. Also, my resident may be in pain and unwell which can include having an infection or in discomfort. This can result in my resident harming themselves as a way of coping with the pain, so a carer I would ensure that correct medication is given to help ease the pain and ensure that they aren’t hurting so they no longer feel the need to harm themselves out of frustration. Medication could be a very effective strategy to use for my residents. This is because medication is a fast treatment and a quick way for my residents to feel better and their health to improve. Therefore, if medication helps them feel better, it is likely that they won’t engage in challenging behaviour anymore. Another reason as to why medication is an effective strategy is that it could change a person’s mind-set. For example, placebo which is a fake drug may be used to help the resident feel better. If they think the medication is making them feel better, they may be encouraged to do things and be more active du