Impact Training

Challenging Behaviour

  

 

by Stuart Sorenson

Associate Trainer

 

 

 

 

Defining the issue

When conducting training on Challenging Behaviour I always start with a general definition. It's in two parts:

Challenging behaviour is behaviour that:

• we disapprove of;
• we think we need to respond to.

Much of what we think of as Challenging Behaviour doesn't need to be a problem. It's simply the service user making a choice about how to spend their time. We don't always need to get involved just because we might make a different choice for ourselves.

 

How we view this behaviour

However there are many factors that influence health and social care workers and they do tend to 'muddy the waters' when we're trying to make sense of our responsibilities and the demands of our duty of care. One of these factors is to do with the reason why we come into this field in the first place.

People become care workers for many reasons but one factor that is common to most of us is that we want to help people. Many of us get our own sense of value from doing a good job and making a difference. This makes us vulnerable because the evidence that we're making a difference often comes from the appreciation of other people such as relatives or members of the public. These people judge us not upon the complete picture of our work but upon the small 'snapshots' they get without much background information.

It's common for people to judge care workers by the appropriateness (or normality) of the way our service-users behave. Some behaviours are not 'normal' and so we are pressured to change them because others will not understand the whole picture.

Basically we know that this service-user's behaviour will reflect badly upon us. Others will doubt that we're doing a good job and this effects our self-esteem. We are slowly but inexorably pressured to take it personally.

The workers try to overcome the behaviour that they see as challenging – not because it is challenging in any real sense but because it challenges the workers ability to feel good about themselves. So we strive to portray an 'appropriate' front to others who may judge us. The upshot of this is that workers are at real risk of losing focus over time and acting not in the best interests of their service-users.

Even when the behaviour really is challenging and does need a response we still get caught up in the idea that 'normal' is the only acceptable outcome.

We fall into the trap of blaming our vulnerable service-users for behaving like vulnerable service-users.

 

How to respond

Take the example of aggressive behaviour. It is unreasonable to expect a service user to move from extreme violence to peaceful interaction in one single step. There are stages they need to go through.

Beginning with physical assault they might move first to threats, then to verbal abuse followed by barely controlled anger and then finally reasonable discussion. It is necessary to reinforce this progress at every stage. So good behaviour management means praising the person who merely shouts and 'storms off' rather than hitting out.

The problem is that people often discourage the half way stage (shouting) because they see it as 'bad' when in fact it's a real improvement.

Effective behavioural management means praising all the stages from A to B. This can be hard but it is vital.

 

How do we know when our approach is working?

Behaviour that achieves its intended goal will increase (positive reinforcement) whilst behaviour that does not achieve its intended goals will fade away and eventually discontinue.  This is the basic principle behind all behavioural strategies and it is important. It means that if a behaviour repeats then it is working for the service-user. Our response might be precisely the outcome the service-user is after.

For example I remember hearing about an elderly gentleman who regularly used to assault other service-users. The staff would take him to one side and 'tell him off' each time but the behaviour continued. It became clear that the only time that he had any significant human contact was when the staff told him off. So he assaulted others to get contact.

When the team started routinely approaching him and starting ordinary conversations with him the behaviour stopped. He was getting the payoff – the contact – without the need for the challenging behaviour.

 

If you do the same things you will get the same results.

If the behaviour continues in spite of your interventions – do something else.

Albert Ellis suggested that people are not 'bad' but that sometimes their behaviours can be inappropriate. In those instances they might be helped to modify their behaviours without ever getting into judgements about 'good' or 'bad' people.

People often talk about service-users as 'manipulative'. Actually everyone manipulates. Manipulation is simply another term for 'adopting a strategy'. When I telephone my friend, Graham and suggest a night out in the local pub I'm manipulating him. He wouldn't have gone out if I hadn't 'phoned. The only issue is whether or not the strategy is acceptable – whether it's appropriate or not. So there's no 'blame' and no judgement here.

The other big explanation is 'attention-seeking' and that could very well apply to the elderly gentleman I mentioned above. Instead of 'attention seeking' think about 'attention need'. Everyone needs human contact of some sort. If the only attention you ever got was when being told off by staff how would you behave?