(Archdiocese of Glasgow).
2.
When responding to challenging behaviour it is important to remember that what works for one may not necessarily work for another. All cases should be treated individually and risk assessment carried out for each client.
I support a client who becomes aggressive and verbally abuses staff and others in certain situations. This is due to him having sensory impairments resulting in a poor field of vision. The reaction to sudden movement and unexpected sound causes him to become distressed and shout and swear at whoever may be there at the time. It is important that when this client visits our project that all staff are careful not to alarm him or move him in his wheel chair without asking him. As a response to this behaviour all carers now ensure that when supporting this client he is aware of who is around and what is going on and by structuring the surrounding environment and individual planners minimise distress to the client. It is also important to talk to him in a low calm voice and make the surrounding environment as relaxing as possible for him. In cases where this client goes on an outing on the project bus a member of the care team will sit along side him to keep him informed of what is happening. By keeping him informed and aware he and any others travelling on the bus will be less stressed.
I have also worked with another client who will from time to time strip her clothes off in inappropriate places. She does this as a result of many years of solitude spent in an institution. By taking off her clothes she will gain attention even though it is negative. As a response any member of the care team who has to deal with this will remove her from the situation right away to avoid any fuss being made over her and causing a scene in front of other clients. By informing her in an assertive tone of voice that this behaviour is inappropriate and informing her she is perfectly within her rights to do it in her own room, the situation is dissolved with a minimum of fuss. Her right to do as she wishes is also protected however it is pointed out that she has the responsibility to do it in her own space without upsetting others.
3. (A)
Two appropriate skills for dealing with challenging behaviour would be as follows:
Use of the appropriate verbal communications. This can be in the form of defusing any challenging situations by remaining calm and attempting to distract the client from the cause or reason of the behaviour. This can be very effective as the client may feel that a carer is willing to listen and take into account the reason for the behaviour and act upon it.
Using Active listening techniques when dealing with the behaviour reinforces this. It is important to acknowledge the feelings of the client and to listen carefully to what they are saying without jumping in or trying to pre-empt what they are trying to say or explaining their feelings. While using this method it is vital not to relate the situation to any others and avoid judging the client on their actions. The overall response in this situation would be to:
LISTEN, to what the client is saying.
EVALUATE, the causes of their feelings
REFLECT, on how the situation could be better dealt with if required.
(B).
There are several intervention techniques available for responding to challenging behaviour. The policies of my work placement however do not name a specific approach, but state that “Only approved techniques” should be used and physical interventions should be “last resort” and “only used when staff have been fully trained”. My own personal feelings are that the intervention approaches used in the “Therapeutic Crisis Intervention” (TCI) method are a better and perhaps safer approach. TCI lists five intervention approaches, which are as follows;
S. Structuring
T. Teaching
A. Accounting
R. Reflecting
R. Relating
All five approaches have advantages and disadvantages, and I will focus on the Relating approach as I feel it could be the most affective if used properly and in the right situation.
The main focus of the relating approach is, “building relationships and getting close to” the client. By building bonds and good relationships a better foundation is set from which to respond to behaviours seen as challenging. A client will be more likely to open up and express their feelings to a carer whom they trust and feel is on their side. This is also a good response when a client is suffering from depression and feels they need a friend or someone to take an interest in them. The relating approach is also useful when working with young people who may need a role model and perhaps in cases where a young person has had bad experiences with an adult will allow them to re-build trust and confidence in others.
There are however negative aspects to the relating approach with client’s becoming dependant on one particular carer, creating inconsistency within the care setting. It is also the case that not all people have the same ability to build relationships or indeed to maintain them.
All interventions should be needs based and particular to the circumstances. It is vital that carers are aware that what works for one may not work for another.
(Wright 2002)
4.
When I started out in care work I had no real concept of what challenging behaviour was or meant. I have learned along the way however that it can and does have many forms and different interpretations. I have a colleague who states that, “he cant help it, he is a really nice guy” as a response to the behaviour of one particular client. This may be true, however the behaviour in question is still a challenge and has to be addressed accordingly.
I have also read with interest that these forms of behaviour are mainly from clients with learning disabilities, which I would argue is untrue. Challenging behaviour comes in many forms and from many different areas of society. By adopting the correct approach in a particular situation we are more likely to be able to respond to such behaviours. I have learned that by addressing all cases on an individual basis success is more likely to be achieved, creating a better, safer environment for all concerned.
