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CHCDIS002 Follow established person-centred

behaviour supports Learner Guide

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Table of contents

Table of contents ……………………………………………………………………………………………………………….. 2

ABOUT THIS RESOURCE ………………………………………………………………………………………………………. 5

ABOUT ASSESSMENT ………………………………………………………………………………………………………….. 5

Assessment Conditions ……………………………………………………………………………………………………… 11

pre-Requisites ………………………………………………………………………………………………………………….. 11

Topic 1 – APPLY A PERSON-CENTRED APPROACH TO MINIMISE BEHAVIOURS OF CONCERN ……… 12

Social model of disability ……………………………………………………………………………………………….. 13

The impact of social devaluation on an individual's quality of life ……………………………………….. 13

Legal and ethical considerations for working with people with disability: ……………………………….. 13

Dignity of risk ……………………………………………………………………………………………………………….. 13

Duty of Care …………………………………………………………………………………………………………………. 13

Human rights, including the United Nations Convention on the Rights of Persons with

Disabilities (UNCRPD) …………………………………………………………………………………………………….. 14

Mandatory reporting …………………………………………………………………………………………………….. 14

Privacy, confidentiality and disclosure …………………………………………………………………………….. 14

Work health and safety ………………………………………………………………………………………………….. 15

Codes of conduct ………………………………………………………………………………………………………….. 15

Constraint/Imprisonment ………………………………………………………………………………………………. 15

Abuse ………………………………………………………………………………………………………………………….. 16

Practice standards …………………………………………………………………………………………………………. 16

Support the person to maintain their activities of daily living in accordance with organisation

policies and procedures and the individualised behaviour support plan ………………………………….. 18

Consider the person’s individual needs, strengths, capabilities and preferences when engaging in

activities of daily living and routines …………………………………………………………………………………… 20

Specialist services and referral options ……………………………………………………………………………. 21

Provide a safe environment for the person conducive to positive and adaptive responses ……….. 25

Organisation policies and procedures relating to behaviour management, including: accident

and incident reporting …………………………………………………………………………………………………… 28

Critical incidents/emergency situations …………………………………………………………………………… 30

Restrictions on the use of aversive procedures …………………………………………………………………. 30

Least Reasonable Restriction ………………………………………………………………………………………….. 31

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Factors that may contribute to behaviours of concern, including: environmental …………………. 32

Consider the person’s emotional well-being in the context of the behaviour …………………………. 33

Factors that may contribute to behaviours of concern, including: emotional ……………………….. 33

Consider the person’s health status in the context of the behaviour …………………………………….. 35

Factors that may contribute to behaviours of concern, including: physical…………………………… 35

Consider the person’s medication in the context of the behaviour ………………………………………. 36

Factors that may contribute to behaviours of concern, including: medications …………………….. 36

Record all observations accurately and objectively in consultation with supervisor using terms that

can be clearly understood ……………………………………………………………………………………………. 37

Topic 3 – Provide positive behaviour support according to individualised behaviour support plan 39

Recognise the difference between appropriate and inappropriate interventions when addressing

behaviours of concern and Interpret and follow behavioural support strategies and Ensure that all

interventions are in line with the plan and organisation policies and procedures ……………………. 39

Indicators that people have unmet needs ………………………………………………………………………… 39

Risk assessment ……………………………………………………………………………………………………………. 40

Positive behavioural support ……………………………………………………………………………………………… 41

Principles and practices of positive behaviour support which focuses on the individual person 41

Positive lifestyle enhancement strategies ………………………………………………………………………… 42

Principles of effective communication and ways to implement these to minimise behaviours of

concern ……………………………………………………………………………………………………………………….. 43

Follow organisation procedures to ensure safety of the person, self and other people and Respond

to critical incidents in accordance with organisation’s intervention and notification procedures .. 46

Reducing or changing setting events and triggers …………………………………………………………………. 46

Incentive programs …………………………………………………………………………………………………………… 47

Monitor strategies to determine effectiveness in consultation with supervisor………………………. 48

Identify and report changes in person’s needs and behaviours in consultation with supervisor …. 49

Behaviour recording …………………………………………………………………………………………………………. 49

Follow referral procedures in consultation with supervisor ………………………………………………… 51

Specialist services and referral options ……………………………………………………………………………. 51

Topic 4 – Complete documentation …………………………………………………………………………………….. 53

Comply with the organisation’s reporting requirements ……………………………………………………….. 53

Maintain documentation according to organisation’s requirements ………………………………………. 55

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This resource covers the unit CHCDIS002 – Follow established person-centred behaviour supports. This unit describes the skills and knowledge required to implement behaviour support strategies outlined in an individualised behaviour support plan for a person with a disability. This unit applies to workers in varied disability services contexts. Work performed requires some discretion and judgement and may be carried out under regular direct or indirect supervision. The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice.

ABOUT THIS RESOURCE This resource brings together information to develop your knowledge about this unit. The information is designed to reflect the requirements of the unit and uses headings to makes it easier to follow. You should read through this resource to develop your knowledge in preparation for your assessment. At the back of the resource are a list of references you may find useful to review. As a student it is important to extend your learning and to search out textbooks, internet sites, talk to people at work and read newspaper articles and journals which can provide additional learning material. Your trainer may include additional information and provide activities, PowerPoint slide presentations, and assessments in class to support your learning.

ABOUT ASSESSMENT Throughout your training we are committed to your learning by providing a training and assessment framework that ensures the knowledge gained through training is translated into practical on the job improvements. You are going to be assessed for:

• Your skills and knowledge using written and observation activities that apply to

your workplace.

• Your ability to apply your learning.

• Your ability to recognise common principles and actively use these on the job.

UNIT Introduction

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You will receive an overall result of Competent or Not Yet Competent for the assessment of this unit. The assessment is a competency based assessment, which has no pass or fail. You are either competent or not yet competent. Not Yet Competent means that you still are in the process of understanding and acquiring the skills and knowledge required to be marked competent. The assessment process is made up of a number of assessment methods. You are required to achieve a satisfactory result in each of these to be deemed competent overall. All of your assessment and training is provided as a positive learning tool. Your assessor will guide your learning and provide feedback on your responses to the assessment. For valid and reliable assessment of this unit, a range of assessment methods will be used to assess practical skills and knowledge. Your assessment may be conducted through a combination of the following methods:

• Written Activity

• Case Study

• Observation

• Questions

• Third Party Report

The assessment tool for this unit should be completed within the specified time period following the delivery of the unit. If you feel you are not yet ready for assessment, discuss this with your trainer and assessor. To be successful in this unit you will need to relate your learning to your workplace. You may be required to demonstrate your skills and be observed by your assessor in your workplace environment. Some units provide for a simulated work environment and your trainer and assessor will outline the requirements in these instances.

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1. Apply a person-centred approach to minimise behaviours of concern

1.1 Support the person to maintain their activities of daily living in accordance with organisation policies and procedures and the individualised behaviour support plan 1.2 Consider the person’s individual needs, strengths, capabilities and preferences when engaging in activities of daily living and routines 1.3 Identify problems with engaging or motivating the person and seek appropriate assistance 1.4 Provide a safe environment for the person conducive to positive and adaptive responses

2. Review context of behaviours of concern

2.1 Recognise behaviours of concern outlined in the individualised behaviour support plan 2.2 Consider what happened before, during and after the behaviour of concern 2.3 Consider the type, frequency and triggers of the behaviour 2.4 Consider environmental factors in the context of the behaviour 2.5 Consider the person’s emotional well-being in the context of the behaviour 2.6 Consider the person’s health status in the context of the behaviour 2.7 Consider the person’s medication in the context of the behaviour 2.8 Record all observations accurately and objectively in consultation with supervisor using terms that can be clearly understood

3. Provide positive behaviour support according to individualised behaviour support plan

3.1 Recognise the difference between appropriate and inappropriate interventions when addressing behaviours of concern 3.2 Interpret and follow behavioural support strategies 3.3 Ensure that all interventions are in line with the plan and organisation policies and procedures 3.4 Follow organisation procedures to ensure safety of the person, self and other people 3.5 Respond to critical incidents in accordance with organisation’s intervention and notification procedures 3.6 Monitor strategies to determine effectiveness in consultation with supervisor 3.7 Identify and report changes in person’s needs and behaviours in consultation with supervisor 3.8 Follow referral procedures in consultation with supervisor

Elements and Performance Criteria

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4. Complete documentation 4.1 Comply with the organisation’s reporting requirements 4.2 Maintain documentation according to organisation’s requirements

This

describes the essential knowledge and skills and their level required for this unit.

Performance Evidence

The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:

• Provided positive support in response to at least 3 different situations of

behaviours of concern

• Responded to at least 1 critical incident relating to adverse behaviour in

accordance with individualised behaviour support plan and organisation’s policies

and procedures

Knowledge Evidence

The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of:

• Principles and practices of positive behaviour support which focuses on the

individual person

• The social model of disability

• The impact of social devaluation on an individual's quality of life

• Positive lifestyle enhancement strategies, including:

o positive reinforcement

o motivation

o stress management

o engagement in meaningful activities

Performance and knowledge evidence

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o support relationships

o nutrition

o environmental and systems improvement

• Organisation policies and procedures relating to behaviour management,

including:

o critical incidents

o accident and incident reporting

o restrictions on the use of aversive procedures

• Principles of effective communication and ways to implement these to minimise

behaviours of concern

• Indicators that people have unmet needs

• Factors that may contribute to behaviours of concern, including:

o physical

o emotional

o environmental

o medications

• Specialist services and referral options

• Legal and ethical considerations for working with people with disability:

o codes of conduct

o dignity of risk

o duty of care

o human rights, including the united nations convention on the rights of

persons with disabilities (UNCRPD)

o constraint

o imprisonment

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o abuse

o practice standards

o work safety and health

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Assessment Conditions Skills must have been demonstrated in the workplace or in a simulated environment that reflects workplace conditions. The following conditions must be met for this unit:

• Modelling of industry operating conditions, including:

o scenarios that present behaviours of concern that occur in real work

environments

o individualised behaviour support plans

o the organisation’s policies and procedures in relation to behaviours of

concern and critical incidents

Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.

pre-Requisites This unit must be assessed after the following pre-requisite unit: There are no pre-requisites for this unit.

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Topic 1 – APPLY A PERSON-CENTRED APPROACH TO MINIMISE BEHAVIOURS OF CONCERN Welcome to the unit CHCDIS002 – Follow established person-centred behaviour supports. This unit describes the skills and knowledge required to implement behaviour support strategies outlined in an individualised behaviour support plan for a person with disability. This unit applies to workers in varied disability services contexts. Work performed requires some discretion and judgement and may be carried out under regular direct or indirect supervision. The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice. In this unit you will learn how to:

• Apply a person-centred approach to minimise behaviours of concern

• Review context of behaviours of concern

• Provide positive behaviour support according to individualised behaviour support

plan

• Complete documentation

Let’s begin!

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Social model of disability According to the social model of disability, ‘disability’ is socially constructed. The social model of disability sees ‘disability’ is the result of the interaction between people living with impairments and an environment filled with physical, attitudinal, communication and social barriers. It therefore carries the implication that the physical, attitudinal, communication and social environment must change to enable people living with impairments to participate in society on an equal basis with others.1

The impact of social devaluation on an individual's quality of life

Social devaluation is an outlook or view of persons value to be less than the others in the group or society. The impact can be somewhat great to a person’s needs, psyche, and care in that they our undervalued thus less respected. The outcome becoming they are looked over and not appreciated for their potential value or actual value. This can not only affect the individual though the society itself. Society can be negatively affected because the underestimating of that person’s value could harm the group. In other words if the person is assessed more positively of their values or given more value on their first perception of this person the group has greater chance to succeed.

If this person feels devalued they will become resentful, shielded, and this will cause conflict between parties (the person that feels valued versus the person that feels devalued). Within psychological boundaries the person’s care or needs go neglected, making that person feel useless, angry or ashamed often without fault of their own. If this person is under medical care, these responses can trigger anxieties, health problems that may have been in recovery, or were recovered. Thus, the needs are harder to meet for this person when they are perceived as having less value.2

Legal and ethical considerations for working with people with disability: In order to work with people with a disability, you need to understand your legal and ethical responsibilities and consider them at all times. Discrimination It is essential to ensure that the person with a disability is not discriminated against and receives the same level of care, choice and respect as any other person. The disability discrimination Act must be adhered to at all times throughout service delivery and contact with the client.

Dignity of risk Dignity of risk is the legal requirement to ensure that all persons with a disability has the legal right to choose their own medical treatments even if the professionals involved feel that this is not the correct choice for them.

Duty of Care Duty of care is ones legal obligation to take reasonable care to prevent others from being harmed. This means that if a worker identifies something that could reasonably be considered to be a risk, then that employee must, in response take reasonable action to

1 https://pwd.org.au/resources/disability-faqs/social-model-of-disability/ 2 https://www.quora.com/What-is-social-devaluation-How-does-it-impact-a-person-s-cares-and-needs

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eliminate that risk. This means that if a client is presenting with indicators of harm it is important that these are responded to according to legal requirements and duty of care needs. All relevant risk assessments, observation tools and activities should be carried out when any of these indicators are present. It is essential that when a client presents with a need for a particular service they will in fact be referred on to that service. Legal requirements and duty of care obligations include:

• Ethical referral

• Comply with state and territory legislation

Human rights, including the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) It is essential to ensure that all of the person’s human rights are respected and upheld at all times. All human rights legislation as well as the United Nations conventions on the rights of persons with a disability is respected and upheld. These treaties provide persons with a disability with a range of rights including, respect, dignity, self-determination and the right to choose what happens to them in their lives.

Mandatory reporting In addition to the general level of duty of care and ensuring that adults risks are minimised and managed it is important to keep in mind that in some instances such as when a child is presenting with indicators of harm, neglect, abuse or risk of harm that appropriate legal and ethical factors are considered. Child protection requires knowledge of relevant state mandatory reporting legislation and its application. It will be necessary for all community services workers to ensure that they both know and comply with the legislation related to the reporting of these indicators in children for their jurisdiction.

Privacy, confidentiality and disclosure In regards to community service work is viewed to in legal terms as the protection of personal

information. In order for one to comply legally with regulations surrounding confidentiality, an

individual is not permitted to share a client’s personal information with co-workers, third parties or

even friends and family of the client. The legal exception to this rule is when sharing the information

could prevent harm being done to the client or anyone in the greater community.

There are many ways to keep information confidential. The following are examples of some of these

methods:

• Individual files are locked and secured

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• Support workers do not tell other people what is in a client’s file unless they have

permission from the client

• Information about clients is not told to people who do not need to know

• Clients’ medical details are not discussed without their consent

• Adult clients have the right to keep any information about themselves

confidential, which includes that information being kept from family and friends

Work health and safety It is essential that all aspects of the work health and safety Act are upheld at all times and that appropriate controls and steps are taken in order to effectively identify any hazards in the environment and to take appropriate measures to minimise, manage and report on them.

Codes of conduct This Code of conduct outlines an organisation’s expectations for the standards of behaviour and conduct expected from paid staff, contractors, volunteers or business partners. They are expected to be familiar with the Code and use it always. It applies in all circumstances and at all times including when working or otherwise representing organisation. A code of conduct cover aspects of expected behaviour such as:

• Respect

• Professionalism

• Safety

• Leadership and management

• Legal requirements

• Breaches

Your organisation will have a written code of conduct, that you must abide by. Check your workplace to identify your responsibilities in relation to the code.

Constraint/Imprisonment Restrictive practices involve the use of interventions and practices that have the effect of restricting the rights or freedom of movement of a person with disability. These primarily include constraint/imprisonment/restraint (chemical, mechanical, social or physical) and seclusion. People with disability who display ‘challenging behaviour’ or ‘behaviours of concern’ may be subjected to restrictive practices in a variety of contexts, including:

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supported accommodation and group homes; residential aged care facilities; mental health facilities; hospitals; prisons; and schools. 3

Abuse People with disabilities are among some of the most vulnerable people in our society due to their dependence on others for care and support or because of social isolation, their place of residence or the nature of their disability.

• People with a disability, especially women and girls, are twice as likely as other

women and girls to experience violence.

While anyone can experience violence, abuse or neglect, people with disabilities are at greater risk. And of all people with a disability, women and girls with disabilities are at even greater risk. A person with a disability, has the rights to freedom, respect, equality and dignity. They have the right to live to their full potential, to have control over their own life and to live free from abuse or neglect.4

Practice standards In Australia we have the NDIS Practice Standards. The NDIS Practice Standards create an important benchmark for providers to assess their performance, and to demonstrate how they provide high quality and safe supports and services to NDIS participants. Together with the NDIS Code of Conduct, the NDIS Practice Standards will assist NDIS participants to be aware of what quality service provision they should expect from NDIS providers. The core sections of the practice standards cover things such as:

• Rights and responsibility for participants:

o Person-centred supports

o Individual values and beliefs

o Privacy and dignity

o Independence and informed choice

o Violence, Abuse, Neglect, Exploitation and Discrimination

• Provider Governance and operational management:

o Governance and operational management

3 https://www.alrc.gov.au/publications/8-restrictive-practices/restrictive-practices-australia 4 https://www.betterhealth.vic.gov.au/…/people-with-a-disability-who-experience-violen…

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o Risk management

o Quality management

o Information management

o Feedback and complaints management

o Incident management

o Human resource management

o Community of supports

• The provision of supports:

o Access to support

o Support planning

o Service agreements with participants

o Responsive support provision

o Transitions to or from the provider

• The support provision environment:

o Safe environment

o Participant money and property

o Management of medication

o Management of waste5

5 https://www.ndiscommission.gov.au/sites/…07/NDIS%20Practice%20Standards.pdf

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Support the person to maintain their activities of daily living in accordance with organisation policies and procedures and the individualised behaviour support plan Working in disability, aged or community services, your clients will have a range of dependence and autonomy over their daily activities. This will depend on their living arrangements (living in an aged care facility, a group home, with their family or independently in the community. They may have total control of their routines, some control or need to be assisted in almost every area of their lives. A routine provides your clients with stability, predictability and safety. There are a number of ways you can help your client to maintain their daily routines. Where ever possible, your client should be engaged to develop suitable and practical routines that will support their own goals, hopes and aspirations for now, and the future. These goals might be something as simple as making breakfast, through to catching public transport, studying or finding employment. Your organisation will have its own policies and procedures to support both you and your clients manage their daily routine. It is essential you understand and work within the organisations policies; procedures, resources and authorisations when assisting your client manage their routines. There are a number of ways you can support your clients in maintaining routines. These include:

• Ensuring their routines fit in with existing Workplace Health and Safety

requirements, ensuring that their daily routines do not have WH&S impediments

preventing them from undertaking their routines. A WH&S impediment may be

something like a faulty wheelchair, slippery bathroom floor or a lack of knowledge

or aptitude to utilise kitchen appliances in a safe manner

• Working with your client to develop skills to manage their daily routines. This may

include engaging the client to note down (if possible) the tasks they are required

to do in a time period. You may need to engage your client and physically teach

them skills, such as brushing their teeth, making a cup of tea or making their bed.

• Engaging the client to help them own their daily routines. When a client feels

engaged and has a sense of ownership and control over their routine, they are

more likely to have healthy attitudes and reception to the development of their

routine.

• Focusing on self-care. For many clients, developing a new routine and new skills

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may cause them significant anxiety and stress. It is important to help your clients

recognise when they may be feeling overwhelmed, anxious or stressed in a

particular situation. This can be coupled with appropriate relaxation techniques,

such as breathing exercises, light stretching, a glass of water or a relaxing activity.

• Developing reinforcement and remembering strategies. Your client may benefit

from a daily ‘tick chart’ to mark off what tasks they are required to do, the times

they want to achieve them by, any materials they require to complete the task

and who they can contact for assistance to complete the task.

• When establishing a new routine, it may be appropriate to interrupt and redirect

the client, if they are getting off track, anxious or stressed over an activity. You

may need to discuss with the client what their train of thoughts and actions are,

how these thoughts and actions are assisting the completion of their routine and

what they may need to do to adjust and realign with their routine

• There may be instances where you will need to seek assistance, or make referrals

to the client’s other support services. The client may have other health, or mental

health issues that require more in-depth management or advanced strategies. It is

integral that you work within your organisations policies and procedures with

your client. By stepping outside these boundaries, especially when it comes to the

client’s health or mental health, you risk putting yourself, the client and the

community at risk by mismanaging the client and their conditions.

Routine formation and management may be a constant requirement with some clients, depending on their capability, skills and motivations. Some clients may need gentle guidance, others will need more intensive management and support to assist them in forming and maintaining a new routine. Whenever you are supporting your clients, it is essential that you do so within your organisation’s policies and procedures.

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Consider the person’s individual needs, strengths, capabilities and preferences when engaging in activities of daily living and routines As well as an individualised plan for your clients, over time, you will develop a professional working relationship. You should see trends emerging on how your clients prefer to undertake their daily routines and activities. Similarly, you will uncover their strengths and areas where they may want to develop the capability. Inherent in an individual plan is that your client’s activities are centred on them, their health, goals and needs. It would be counter-productive to disregard an individualised plan and institute a strict routine that prevents a client from being empowered to control their own activities and growth. When developing an individualised plan and cultivating a working relationship with a client, there are a number of ways you can ascertain their needs, strengths and preferences. These include:

• Discussing with them what their needs, strengths and preferences are. As simple

as this sounds, the client may be a great source of knowledge about themselves.

Depending on their level of communication and capability, they may be able to

articulate a range of preferences, needs and desires they have.

• Discussing with the clients previous caseworker, if possible. When a client’s case

manager changes, a ‘best practice’ case management approach is for the old and

new case managers to have a handover discussion. This involves the old case

manager discussing each client, their individualised plan and any informal

knowledge they have gained, to assist supporting the client and the new case

manager.

• Discussing with the clients spouse or approved contact person. There may be

situations where the client is unable to communicate, for a variety of reasons. In

these situations, the client may have a parent, representative, trustee or contact

person who is authorised to discuss issues on their behalf. This contact person

may have considerable knowledge of the client and be able to direct you towards

how to perform and undertake effective daily routines for the client.

As you work with your client, their needs, preferences and capabilities may change. They may develop capability in a particular area, or inversely, have diminished capacity in other areas. An example of this may be a client in an aged care facility with failing health. They may initially have a high degree of independence and capability, but this fades as they age or health issues arise. You will need to adapt the client’s daily routine to suit their particular phase in life, being receptive to changes, however small, to their needs or preferences. It is

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integral whenever changing a plan, activity or routine that this is documented in the client's individualised plan. This ensures that any future caseworkers can quickly see any improvements / reductions in the client’s capability and any changing needs they have.

Specialist services and referral options You may also need to seek services, advice or referrals from other areas within your organisation, or external referral services. You may notice that a client has trouble with their daily showering or bathing routine, which could mean specialist assessment or equipment is required to help the client. By consulting the client (or organisations) specialist, you may need to introduce new appliances or apparatus to support the client, meaning a change to their daily routine. Situations where outside referral may need to be sought include:

• The client may need to be assessed by a specialist

• Counselling services may be required

• Special or expert support may be required

Referral in the act of referring or directing a client to a service that is able to better meet their needs when you cannot. Your relationship with your client, along with their ongoing needs and capabilities will develop over time. It is important that you remain aware and responsive to these changes.

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Identify problems with engaging or motivating the person and seek appropriate assistance

In an ideal world, you will establish great relationships with your clients, they will engage in their individual plans and you will work together to make their lives better. Without a doubt, a career in the community, aged and disability sectors can be richly rewarding and you will help many people. There will be instances, however, where you may find it difficult engaging a client, where you do not see the results you otherwise expected and you are finding a client, or clients particularly challenging. Issues that may arise with engaging clients may include:

• Communication issues, where you find you do not understand your client's

communication style, or they are not understanding you

• Personality issues. Any relationship can be strained at times due to personality

clashes

• Differences in implementing an individualised client plan. An example of this is

where a client has different (even unrealistic) expectations on the implementation

of their plan, and this is a barrier for them in engaging in their plan.

• A client who has health or mental health issues that require support outside of

your expertise or training

• A client who does not believe they require any assistance and refuses to engage in

ongoing support

There may be a number of underlying reasons why a client may not be engaging you, many of which have practical remedies. These remedies focus around you, the client’s engagement and the clients individualised plan. Self-awareness and self-identification of any issues you may bring to a relationship is always the most important aspect to look at, when you find your client is not engaging with you in a positive or practical way. Self-reflection can often be a difficult process, especially if you are engaged and want to help your client reach their goals. Some ways that you can investigate if your actions or behaviours are impacting the client’s engagement include:

• Asking your supervisor / team leader for honest feedback on how you may appear

/ act to others. Your supervisor may be able to identify a particular trait / aspect of

your approach that could need development. It may be something as simple as

engaging your client in friendly conversation or working on being patient with

clients when they are not managing a particular activity in a timely manner. Your

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supervisor may be able to suggest some practical changes to your outlook or

approach that can improve your clients engagement

• Asking your client, if possible, on their expectations with engagement with you.

Caution should be taken with this approach, as if the client is already feeling

uncomfortable or disengaged with you, this may be seen as a threat to them.

Alternatively, you could ask a co-worker or your supervisor to tactfully ask the

client how you can improve the relationship.

• Investing time into your own personal and professional development. You may

need to brush up on personal communication skills or your professional approach.

Any extra skills you have is like an extra ‘tool in the belt’. You might not have to

use every tool in every situation, but sometimes having extra knowledge can help

bring a difficult or disengaged client around to engagement in you and their

individualised plan.

Your client too may have their own reasons for not being engaged. It could be a personal preference, bias or prejudice they have. Sometimes, there may be a health, mental health or medical issue that prevents them from engaging in their individualised plan. There could be a range of other reasons why they may not be engaging. In these situations, you can positively impact the client in the following ways:

• Demonstrating that you are trained, motivated and engaged in them. You might

not be able to change their personal preferences or biases; however, you can

demonstrate that you can make a difference in their life. It is up to them to decide

if they engage in you professionally.

• Ensuring that, where possible, you understand any underlying health, mental

health or wellness issues that impact on the client’s ability to engage. An example

may be that the client is suffering from chronic pain and is simply unable to focus

on anything except pain management. In these situations, you may need to

engage the clients treating medical practitioner and inform them of their inability

to fully engage, due to their pain. The treating medical practitioner may be able to

suggest an alternative method of pain relief or referral for pain management.

• The client may not be engaged in their actual individual plan. You will always be

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monitoring and referring to the clients individual plan. However, you may find

that the client themselves needs a ‘fresh start’. If possible, you may want to start

fresh with the client and re-write their whole plan. Their current plan may be

totally unsuited to their current situation, needs or plans.

If you find your client is not engaging, despite your best efforts, it is always appropriate for you to discuss the issues you have observed with your supervisor or team leader. They may be able to suggest some alternative actions or activities that may help the client engage in their individual plan. Other areas you may be able to refer to, or seek advice from could be senior caseworkers who may have had a similar experience in the past, the client’s family or spouse, to see if they can make any suggestions or a past case manager, to see how they managed a particular situation.

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Provide a safe environment for the person conducive to positive and adaptive responses Working in the community, aged or disability sectors, an employee can usually expect to work with individuals who have come from a marginalised, disadvantaged and even sometimes, a violent background. Clients may come from a range of backgrounds, have a history of mental health issues, alcohol or substance abuse, physical or mental abuse and chronic health conditions. Many of your clients will have individualised care plans or individualised action plans. An individualised care plan or action plan usually contains:

• A brief summary of the clients health / mental health concerns

• A list and contact details for any treating practitioners they may have

• Any privacy concerns, restrictions or permissions they have to who can access, or

not access their information

• An agreed upon plan for the organisation to support the client, including any

regular appointments, health referrals and support services

• Any incident reports

• The clients goals, hopes and aspirations

• Any case notes pertaining to the client

As many of your clients have experienced unpredictability and often unsafe environments in the past, it is integral that you keep your routine interactions and actions with your clients as safe and predictable as possible. You can do this by:

• Ensuring you are on time for any appointments or meetings with the client. This

fosters trust and an environment of predictability. It also supports the client

manage and keep their commitments to you and others. By being on time and

present for appointments with your client, you demonstrate your willingness to

help, your commitment to their health and rehabilitation and the importance of

them being involved and engaged in their health and wellbeing

• Ensuring, where possible and practical, you alert your client of any changes to

appointments or meetings well ahead of time. If your client is required to utilise

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public transport or rely on others to help them get to appointments, it is integral

that this is communicated with them as soon as possible. This keeps the client

safe by ensuring they are not travelling or exposed in a manner that will make

them feel distressed or unsafe

• Ensuring your work environment, external activities and client visits are compliant

with relevant WHS requirements. Your office and any external activities your

client is engaged in should already be WHS compliant. However, your clients place

of residence may not be.

• In consultation with your client, you may need to engage a WHS consultant to

ensure their home is safe – not only for them, but you and any other members of

your organisation that is required to provide in-home services.

• Identifying, reporting and rectifying any unsafe situations, equipment or instances

at the first available opportunity. This could be as simple as reporting a chair in

your office as broken, through to notifying your organisation of an unsafe vehicle

or equipment. You will have your own statutory requirements for reporting

unsafe, broken or malfunctioning equipment to a relevant person or department

in your organisation. It is recommended you understand your organisations

policies in relation to any WH&S reporting with broken or faulty equipment

• Being prepared for any interactions with your clients. This means having followed

up on any previous meetings, being prepared for any issues the client may bring

up, any discussion points or concerns you may have. This helps foster a safe

emotional environment for your client.

As well as providing a safe environment for your client, it is important to create a safe environment for yourself and your co-workers. This could be as simple as ensuring you use any organisational equipment and vehicles in a safe manner, reporting any broken or damaged equipment in accordance with WH&S reporting requirements and ensuring any workplace hazards are addressed in an appropriate manner. There are a number of ‘external’ factors you can influence or control to create a safe and predictable environment for clients. In addition to this, your clients may need their own boundaries or behavioural expectations to help them create a safe and predictable environment for themselves.

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In some cases, your client may display inappropriate behaviours that can endanger themselves, you, other clients, other staff members or members of the community. These behaviours may include:

• Inappropriate sexual behaviours, such as public masturbation or making sexually

inappropriate comments

• Violent or inappropriate physical behaviours, such as aggression towards others,

yelling or screaming

• Destruction of property

• Not undertaking tasks in a safe manner, such as kitchen tasks or workplace

activities

You may be required to develop positive, predictable strategies that will keep the client safe if they are exhibiting inappropriate behaviours. These may include:

• Reminding the client on what the appropriate behaviours are

• Distracting the client, if they are exhibiting inappropriate behaviours and re-

directing them into positive or appropriate behaviours

• Engaging in other staff members, if interaction is required

• Having a clear action plan, developed in consultation with the clients family,

treating medical practitioners and specialists if the client is displaying increasingly

violent, inappropriate or dangerous behaviours.

By reinforcing predictable (and positive) responses to inappropriate behaviour: you help foster an environment that encourages the client to display and model appropriate behaviours. This creates a safe, predictable for the client, you and any other people involved in the client interaction.

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Recognise behaviours of concern outlined in the individualised behaviour

support plan and consider the type, frequency and triggers of the behaviour

Working in the disability, aged or community sectors, you may come across some clients who, on occasion, display disruptive or even violent behaviour. This behaviour can sometimes impact:

• The client

• You, the caseworker/ case manager

• Any other clients

• Members of the community

• Other caseworkers / case managers

Behaviours that are likely to put the client at risk may involve:

• Aggressive behaviour towards themselves or others

• Acting in an unsafe manner, or against instructions

• Undertaking activities in an unsupervised manner

When any type of aggressive, violent or disruptive behaviour occurs, it MUST be documented in the client's file, in line with organisational policies and procedures, at the most practicable time.

Organisation policies and procedures relating to behaviour management, including: accident and incident reporting Many organisations will have an incident report that should be used, whenever a client is displaying these types of behaviours. An incident report typically has information such as:

• The client's name, date of birth and address

• The location or locations of the incident

• The actual behaviours that you observed the client display

• If the client was hurt during the incident, including a catalogue of what injuries

Topic 2 – Review context of behaviours of concern

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the client sustained

• If any other persons were hurt or injured, including a catalogue of any injuries

they sustained

• If there were any identifiable triggers of the event. This may include loud noises,

an unfamiliar environment or occurrence, after eating a particular type of food,

after a difficult or stressful activity or any other identifiers preceding the client's

behaviour

• How the client was managed during the episode, such as diversionary tactics, self-

relaxation techniques, physical restraint

• If any third parties or referrals were made. This may include contacting the police,

ambulance or fire services; the clients treating medical practitioner, family or

emergency contact person

• Any first aid that was administered to the client or other persons

• Post-event treatment for the client and any persons involved, including

counselling or de-briefing

• Any other observations that have been made around the event (such as the client

has had a change in medication, a change in routine or a disruption to the client’s

usual routine).

If the behaviour is ongoing, these reports will provide valuable insight into possible triggers, warning signs or danger points that may predict the client’s behaviour escalating. When trends can be identified, measures can be put in place to mitigate or prevent these episodes. Any trends can be documented in the client’s individualised plan, to help prevent future events.

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Critical incidents/emergency situations These are incidents or situations where challenging behaviour occurs for the first time or so infrequently that it is unpredictable. The challenging behaviour must be of such an intensity and duration that it is highly likely it will cause injury to the person, staff members or others without the use of restraint or seclusion. If the behaviour recurs a Challenging Behaviour Intervention plan must be developed. Guidelines for the management of emergency situations should be located in your organisations policies and procedures.

Restrictions on the use of aversive procedures Aversion therapy is a form of behaviour therapy in which an aversive (causing a strong feeling of dislike or disgust) stimulus is paired with an undesirable behaviour in order to reduce or eliminate that behaviour. There may be occasions where some form of restrictive practice may need to be employed to manage some instances of challenging behaviour. Except in emergency situations, but they:

• Should only be used as part of a challenging behaviour intervention plan

• Should involve the least reasonable restriction of the person’s rights

• Should be used only when all other options have been explored and

• Should be time-limited

Examples of aversive practices or punishment include:

• Physical abuse (e.g. pushing and hitting);

• Psychological abuse (e.g. Ridicule, threats);

• Any practice involving the application of unpleasant conditions (e.g. Cold bath,

squirting liquid into a person’s face, etc…);

• The cancellation of an activity as ‘punishment’ for challenging behaviour which

occurred earlier in the day.

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Least Reasonable Restriction

• an intervention that:

o a) is not more restrictive or intrusive than is necessary to prohibit the

person from inflicting harm on themselves or others; and

o b) is applied no longer than necessary to prevent or contain the danger.6

6 https://www.nwss.org.au/policies-procedures/aversive-restrictive-and-intrusive-treatment-practices-policy- and-guideline/

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Consider environmental factors in the context of the behaviour and consider

what happened before, during and after the behaviour of concern

Factors that may contribute to behaviours of concern, including: environmental As mentioned in the previous section, it is important to document the facts around a client incident. This is typically done on an incident report. Incident reports should be able to demonstrate the following trends:

• Any particular locations / environments where the client has displayed behaviour

that harms themselves or others

• What was occurring at the time the client displayed these behaviours. The client

may not display dangerous behaviour at any particular location (such as a

shopping centre or doctors surgery), however, they may seem to escalate when

they are in a confined space, such as a lift, a car or small room. Similarly, there

may be other wider environmental factors that are linked with the client’s

behaviour – loud noises, bright lights, crowded areas or unfamiliar stimulation,

such as a change to their home environment

• What any other clients were doing when the incident occurred? Your client may

‘feed’ off other client behaviour, if in a group or after being with the group. Your

client may find it difficult managing their reaction to another client's behaviour,

and react in a similarly negative manner

Your client may have very predictable responses to environmental cues, or react in very unpredictable ways when presented with the same environmental stimuli. Environmental factors can often bring unpredictable situations, many of which are unavoidable. You may find trends. However, that allows you to mitigate or lessen the impact of environmental factors on the client's behaviour. You may note that the client sometimes displays risky behaviour whilst in shopping centres. However, this seems to be less noticeable when there are not as many people in the shopping centre, such as during a weekday, as opposed to the weekend. There may be environmental factors as simple as if the client had a good sleep the night before if their behaviour is brought about by being hungry or thirsty or even the time of day. For these reasons, it is integral that your incident reports and daily interaction notes with the client document the severity of risky behaviour, any foreseeable environmental impacts and mitigation practices you employed to reduce the impacts of the behaviour.

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Consider the person’s emotional well-being in the context of the behaviour Emotional wellbeing is important for everyone. An emotional strain can place stress on almost everybody, and without the skills to channel, manage and deal with emotional strain, some clients may react in negative or risky ways. You may have clients who can clearly articulate how they are feeling, any causes of their thoughts and emotions and be able to suggest ways to mitigate any anticipated risky reactions. If your client can do this, it is essential that you document this and modify plans to prevent this from occurring. An example of this could be if you are working in an aged care facility. An elderly client may be able to articulate that they find the communal dining setting can cause them significant emotional distress, leading to them feeling frustrated, agitated and unable to sleep. You can look to mitigate this by organising the client to eat after the main dinner sitting, or, if practicable, eating in their room. You may have other clients, however, that are unable to articulate any emotional concerns they have and seem to react out of the blue.

Factors that may contribute to behaviours of concern, including: emotional Sources of emotional frustration or diminished emotional resilience in clients may stem from:

• A difficult situation or interaction in their home, care facility or activity they are

involved in

• A sense of tension in their family or social environment

• A lack of sleep

• Unmanaged pain

• A change in carer, caseworker or nursing staff

• A feeling of helplessness in treatment, recovery or communication

In situations where your clients may not be able to articulate their emotional concerns, it may be appropriate to seek further information on a client’s mental state from other carers, the client’s family or any other treating practitioners. Even an informal conversation with one of these people may uncover significant, helpful information that could assist mitigating or reducing negative or risky behaviour. An example of this may be a client who lives in a group home with other girls who have a mental disability, such as Downs’ Syndrome or severe autism. By ‘checking in’ with the group home leader, you may be able to ascertain that there is a new resident who has changed the dynamic of the home. This may influence your client’s emotional well-being and contribute to risky or dangerous behaviour.

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The more information you have about the client’s emotional well-being, the better you can prepare, anticipate and even explain a negative or risky behaviour in the client. This can help prevent injury to the client or others prevent damage to property and help keep the client in a positive state of emotional well-being. The results of poor or diminished emotional wellbeing may be manifest in a number of ways. These may include:

• Acting out in a dangerous or unsafe manner, either as a single incident or a

sustained number of incidents

• Displaying behaviours or symptoms such as screaming, scratching skin, rocking or

appearing to be in an escalated or withdrawn state

• Displaying behaviours that make others feel uncomfortable, such as inappropriate

sexual behaviour. This may include inappropriate sexual touching of others, public

masturbation or inappropriate sexual conversations.

• Interfering with others privacy, especially in a residential facility. This may include

going through another’s belongings without their consent or permission, invading

their personal space or asking inappropriate personal questions.

This type of behaviour may indicate an emotional upset in the client. It should be documented in the client's file. Appropriate referrals should be made to follow up any subsequent symptoms and causes of this behaviour.

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Consider the person’s health status in the context of the behaviour Factors that may contribute to behaviours of concern, including: physical Physical health and wellbeing can have an impact on anyone. An injury that incapacitates a person can lead to frustration, anger, boredom and even a sense of helplessness. Coupled with pain, poor physical health or injury can produce undesirable or risky behaviours in your clients. Notes pertaining to a client’s physical health should be recorded in their individual plan and any diary notes in the client's file. The client may have given your organisation to seek some information from their treating practitioners, for the purpose of assisting them in their personalised plan. Their treating practitioners may supply a letter when the client’s physical health has changed or be able to discuss the client’s situation over the telephone. Some medications may have a negative impact on a client’s ability to control or regulate behaviour, leading to the client displaying negative or risky behaviours. Where possible, you should try to be informed of any new medications, or changes in dosages of medication for your client. This is particularly relevant if your client is suffering from mental illness, changes in medication, however slight, can sometimes produce negative results quickly. These changes should be documented in the client’s individualised plan and any diary / case notes. If a client is suffering from a health, mental health or physical issue, this should be taken into consideration when planning activities or making routines. It may take the client longer to undertake even basic activities, and pressuring them to complete a task in the usual time will frustrate the client, possibly leading to negative behaviours. Extra consideration should be given to your clients when they are suffering from these conditions, to prevent risky or dangerous behaviours. It is integral to document any information you have about the clients health, mental health or physical injuries they may have, to allow for any.

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Consider the person’s medication in the context of the behaviour Factors that may contribute to behaviours of concern, including: medications Similar to health issues or considerations, a client’s medication may have an impact on their behaviour. Whilst a client’s medication may influence their behaviour, a client not taking prescribed medication may also have a negative impact on behaviour. Some mental health issues are managed with a combination of medication and other therapies. Mental health medication is usually prescribed by the clients General Practitioner or a psychiatrist – only they are authorised to prescribe, alter the dosage or change a client’s medication. The clients treating General Practitioner or psychiatrist may be able to supply you with a list of any medications the client is on, the dosage and fact sheets on any possible impacts / side effects of the medication. These fact sheets similarly should document any effects on the client should they cease or change their medication. This information must be kept on the client’s individualised plan and in their client notes. Your organisation may be required to administer this medication (especially if the client is in a registered care facility) and it is essential to know the precise dosage information for the client. If a client has been instructed to change or modify their prescribed medication, you may want to document any changes in their behaviour, even if these changes are not negative or risky. This information may be fed back to their treating practitioner for analysis. It is essential to remember that in your role, you are not authorised to modify, change, remove or increase a client’s medication. If you have concerns over the clients medication, have any pertinent information or observations on the impact the medication is having on the client, you are best placed to document and discuss this with the clients treating medical practitioner. The treating medical practitioner will then determine the best course of medical treatment for the client.

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Record all observations accurately and objectively in consultation with supervisor using terms that can be clearly understood When a client has displayed risky or dangerous behaviour, especially if this behaviour has been sustained over a period of time, you should have collated considerable information on the possible causes, triggers, impacts and follow-up of these episodes. You should have collated information on the environmental factors and observed emotional state of the client. You may be able to identify any health issues impacting behaviour and chart the effect of medication on the client’s behaviour. Your documented observations will be utilised to formulate an individual response plan to prevent, manage and recover from any risky or dangerous incidents. An individualised action plan will typically include:

• Any known impacts on the client exhibiting risky or negative behaviour. These

may include any known environmental, emotional, health, medicinal or other

factors that have been identified to cause distress and risky behaviours

• Any known mitigating or moderating measures that can be put in place, when the

known stressors are present. This may include delaying an activity if a client has

changed medication, reducing the intensity of a routine if a client has sustained an

injury or temporarily cease an action if a client has experienced a significant

emotional event

• An action plan for if a client starts displaying risky or dangerous behaviours. This

may include removing a client from a situation (such as locating a quiet room, free

from stimulation), diversionary tactics, appropriate physical restraint, appropriate

contact of emergency police or ambulance services, if this is deemed to be a

suitable action

• Post-event follow-up. The client’s ongoing wellbeing is a priority after an event.

They may suffer from significant embarrassment, loss of face, dignity (especially if

emergency or police are called to respond to an incident) or even possible legal

consequences, if during an event, the client committed a crime. Post-event

follow-up is essential to assist the client in resuming the care they need, to

support them and to re-engage in their rehabilitation and management

• Review of the action plan. Even though a plan may be in place, there may always

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be room for improvements, review and updating. The individualised action plan

should be responsive to the client’s current needs, not a static document

primarily based on past events.

The individual action plan needs to focus on the inclusion of the client, not their exclusion. Plans that remove or isolate the client from their usual activities, such as working, social outings or spending time with family or friends need to be avoided where possible. It is paramount to have an individualised action plan that assists with the continuation of their education, development of skills and capability. Once a suitable individual action plan has been formulated and implemented, future events should be reduced and the impacts of such events should be reduced, assisting the client.

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Recognise the difference between appropriate and inappropriate interventions when addressing behaviours of concern and Interpret and follow behavioural support strategies and Ensure that all interventions are in line with the plan and organisation policies and procedures

Indicators that people have unmet needs This theory argues that people may exhibit behaviours of concern when their needs are not met for example hunger, thirst, toilet, pain, fatigue, temperature, over/under stimulation and lack of social engagement. The strategy suggested in this theoretical approach is to seek to understand the individual unmet needs and manage these needs before the behaviour occurs. Unmet needs may relate to:

• Physical well being

• Emotional well being

• Environmental context

• Medications

• Conditions and dual diagnosis

Having unmet needs may relate very heavily to behaviours of concern. A behaviour of concern is any behaviour which causes stress, worry, the risk of or actual harm to the person, their carer’s, staff, family members or those around them. The behaviour deserves consideration and investigation as it is an obstacle to achieving the best quality of life for the person with dementia and may present as an occupational health and safety concern for staff. These behaviours must be addressed in an appropriate manner; remember, you are dealing with adults, not children! Some of the behaviours you may identify could include:

• Raised voices/angry tone

• Threatening language

Topic 3 – Provide positive behaviour support according to individualised behaviour support plan

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• Screaming

• Damaging property

• Throwing things

• Infliction of injuries on themselves

• Restlessness

• Fighting

• Pacing back and forth

• Not speaking at all

Of course, there will be many more to add to this list but this gives you a guide to the types of behaviours you may witness. If you do come across any of these behaviours, there are things you can do.

Risk assessment Performing a very quick risk assessment will get you on the way to deciding the most appropriate response to their behaviours.

• Assess the risk. Is anyone in danger?

• Leave the situation (if possible) and remove others from the situation.

• Decrease stimuli for the person (if there is something that is visibly upsetting

them, remove it from the scene)

• If the behaviour continues, you will need to escalate the crisis according to your

policies and procedures. (this may mean contacting supervisors, police or

emergency services)

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Positive behavioural support Principles and practices of positive behaviour support which focuses on the individual person Positive behavioural support (PBS) is based on decreasing behaviours of concern and improving the person’s quality of life. Positive behaviour support planning tells us the best way to work with an individual who shows behaviours of concern and gives us ways to improve the quality of life for the person and does not just deal with behaviour. This approach places an emphasis on the need for responsiveness to a person’s feelings and needs and has the following defining features:

• Valuing the person, deliberately building a sense of self-worth, and acknowledging

all attempts at positive interaction

• Creating situations where the person is placed at their best advantage

• Acknowledging and trying to interpret what the person is communicating via the

behaviour

• Analysing the functions of the behaviour

• Teaching the person other ways to meet their need or communicate their feelings

• Gently supporting and leading the person to a calmer state

• Providing encouragement and feedback about personal successes along with

aspects of

• Difficult situations the person may have handled well.

For positive behaviour support to be successful it requires:

• Teamwork

• Seeing the person’s strengths and being committed to the person

• Seeing the person and seeing the behaviour

• An appreciation that all behaviours have a purpose

• Being positive

Possible consequences and outcomes of the consistent implementation of positive behaviour support strategies. The person may learn:

• That their feelings will be noticed and acknowledged

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• Where and when behaviours are appropriate and valued

• How to manage situations and emotions that have previously led to difficult

situations

• That considerate and cooperative behaviour is acknowledged, gets things achieved

and

• Leads to good feelings

• That they can make a difference by influencing others in ways that are mutually

pleasing

• And positive7

Positive lifestyle enhancement strategies In order to provide positive behavioural support you can also make some changes in the persons lifestyle. There are several strategies that can be used to encourage positive behaviour. These include:

• Positive reinforcement – positive reinforcement involves the addition of a

reinforcing stimulus following a behaviour that makes it more likely that the

behaviour will occur again in the future. When a favourable outcome, event, or

reward occurs after an action, that particular response or behaviour will be

strengthened.

• Motivation – everyone has motivation for something. Whilst one person has the

motivation to go to the football, others have motivation for shopping. We are all

different. Finding out what motivates each person can help in managing

behaviour that is unacceptable.

• Stress management – managing stress is vital to ensuring behaviours are

acceptable. If a person is feeling stress and possibly cannot convey that, then

negative behaviours are often the end result. Take care to look for things that

stress the person and where possible, try to remove that stressor.

• Engagement in meaningful activities – if people feel they are participating in

7 http://www.dhs.vic.gov.au/__data/assets/pdf_file/0004/603463/pbs_facilitators_manual.pdf

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meaningful activities they are more likely to manage their behaviours. This is

linked to motivation. If people feel like they are participating and what they are

doing means something to them, their families and the outside world, then they

are likely to be happier.

• Support relationships – making sure people have supports in place is very

important. If people feel supported and feel they have somewhere to go when

they need to talk or need a hand, then they are less likely to feel helpless or alone.

This will have a positive impact on their behaviour.

• Nutrition – poor nutrition can contribute to stress, tiredness and capacity to be

motivated, and over time, it can contribute to the risk of developing some

illnesses and other health problems such as: being overweight or obese. tooth

decay and high blood pressure.

• Environmental and systems improvement – Every person has special needs of

some kind, and some people cannot handle an environment that fails to

accommodate theirs. For example, an easily-distracted person surrounded by

environmental stimuli could be a problem. People who have trouble hearing or

seeing may act up because they're frustrated about not being able to effectively

interact. Irritating stimuli, such as strong aromas or uncomfortable proximities,

which may impact high-sensitivity people.

Each person will have a plan that outlines the behaviour management strategies that are implemented for this person. Please make sure you follow that plan and report any changes to the behaviour to your supervisor.

Principles of effective communication and ways to implement these to minimise behaviours of concern There are numerous ideas on effective communication principles, so a quick look on google can give you more ideas, however, the following are fairly standards across all theories:

• Establish a Warm Atmosphere

• Actively Engage People’s Interest

• Be Believable

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• Speak With Your Own Voice

• Use Gestures Well

• Remember That Your Knowledge Is Limited

There are a number of communication strategies that can be applied when working with people who are expressing behaviours of concern. Using communication effectively to achieve the desired outcome can be a challenging process. The following techniques can be helpful:

• Use a calm tone of voice and lower your own voice to respond to loud aggressive

tones

• If you know the person’s name, attempt to establish a rapport with them by using

their name and introduce yourself by name to remind the person that you are a

person too.

• Indicate that you acknowledge the grievance and offer to help by asking open-

ended questions about why the person is behaving the way they are. Avoid talking

about past grievances by insisting on asking what had happened on that day.

• Use non-verbal communication methods to express concern such as nodding your

head and saying “I understand how you feel…”

• Provide the person with space to think about their response to your questions by

offering them some time to think. Step back and move away to give them a sense

of physical space.

• Discuss realistic option to resolve the situation by being clear about what you are

trying to achieve.

• If there is a quiet room or private space that you can direct the person to where

the room promotes calm try to take the client to that space.

• Try to appear confident even if you don’t feel that way.

• Avoid the use of the word “no” which may promote a hostile outburst

• Don’t use threats and avoid arguing with the client when they are expressing

behaviours of concern

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• It is important not to make promises that cannot be kept

• Try not to block the client’s access to the exits and find a way that you are not

blocked from the exits yourself.

• It is important not to make the assumption that the client will become violent

because this will lead you to unintentionally adopt a defensive posture that may

trigger an aggressive response.

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Follow organisation procedures to ensure safety of the person, self and other people and Respond to critical incidents in accordance with organisation’s intervention and notification procedures

The Victorian Charter of Human Rights and Responsibilities 2006 is one important law that sets out our freedom, rights and responsibilities. This formal recognition of our rights protects all people from injustice and allows everyone to participate in and contribute to society. Disability support professionals, therefore, have the right to work in a safe and supportive environment. At all times, you must ensure you are safe in these situations. Your safety is just as vital as those around you and you will be required to know and understand the procedures around working in these types of situations. Disability support professionals have the right, especially when supporting people who show behaviours of concern and are subject to restrictive interventions, to:

• Adequate information and training in positive behaviour support

• Be actively involved in the assessment process and not just be informed of what

to do

• Receive appropriate ongoing professional development

• Access debriefing following a stressful workplace incident

So too do your clients have the right to be safe. This includes the person that you are caring for. It is your duty of care to keep them and yourself safe and to ensure you notify the relevant people in relation to the incident.

Reducing or changing setting events and triggers This consists of setting the occasion for positive behaviour by increasing the events that produce desired behaviour. For example:

• Providing the person with greater access to preferred activities

• Providing the person with clear instructions

• Giving the person more time to spend with favourite staff

• Placing a tray with books on the lap of a person when you know this inhibits them

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from breaking the bus windows.

It also consists of decreasing or eliminating setting events that trigger the behaviour. Some examples include:

• Reducing the number of demands made.

• Giving instructions in a way that is not directive (for example, ‘The table is ready

to be set when you’ve got a chance’) if assessment reveals that directive

instructions act as triggers.

• Providing the person with a room of their own.

• Slowing down the morning routine if you know the bus will be late and waiting has

been shown to act as a trigger.

• Often putting together a Do’s and Don’ts lists to ensure staff consistency.

Incentive programs These provide the person with some very strong incentives to stop the person needing to use behaviours of concern.8 No matter what the intervention, always make sure it is in line with the individual plan, support plan and/or policies and procedures for your organisation.

8 https://manualzz.com/doc/2984272/positive-behaviour-support-getting-it-right-fro…

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Monitor strategies to determine effectiveness in consultation with supervisor At the forefront of all that you do as a carer is to ensure the safety, dignity and self-esteem of your clients. There will be times that you will need to intervene in the client’s actions or behaviours. You will have established action plans in place to ensure this is done in the most productive manner. In reviewing the client’s action plan, you must ensure that the strategies involved uphold the client’s dignity and self-esteem. Things that will demean or belittle the client are inappropriate. Ways to uphold a client’s dignity and self-esteem include:

• Not berating the client, or talking down to them if their behaviour or actions are

escalating

• Not making fun or mocking the clients ability, capability or impairments

• Not acting in a violent or cohesive manner towards the client

• Not ‘punishing’ the client for an inability to complete a task or activity

Your strategies should be reviewed, where possible, with the engagement and input from the client. They may be able to articulate how they feel in situations, how they like to be helped and what would affirm their dignity and self-esteem. You should also constantly review your own attitudes, responses and behaviours towards your client’s dignity and self-esteem. You can monitor your own responses by thinking through how you reacted to a client in a particular situation. Were you too firm in a situation? Did your response take away their ability to think, input or decide for themselves to react? Did you ‘follow all the rules’, yet talk in a disparaging or negative way towards the client? It is essential that you review and monitor your own responses to the client, ensuring they uphold their dignity and self-esteem. It is important that whilst you monitor the strategies to determine their effectiveness, this must be done in consultation with your supervisor.

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Identify and report changes in person’s needs and behaviours in consultation with supervisor

Behaviour recording Key steps in completing functional behaviour assessment Step 1 – Defining the behaviour of concern. You need to write the behaviour in a way that the actual behaviour of concern can be easily understood by others, that can then be used to gain reliable documentation on when and when it does not occur. Step 2 – Finding out as much information as possible about the behaviour, for example:

• What happens before the behaviour?

• What happens during the behaviour?

• What happens after the behaviour?

This will require the use of recording forms such as STAR Charts or questionnaires like the Motivational Assessment Scale. Step 3 – From information collated via the recording forms/questionnaires, come up with an idea (hypothesis) about why the behaviour is occurring, that is what purpose/function does the behaviour appear to be serving for the person. Some of the most common reasons why behaviours of concern occur:

• Gaining social interaction

• Escape or avoidance of demands

• Gaining access to preferred activities or tangible objects

• Sensory feedback (hand flapping, eye poking)

• Pursuit of power and control over own life

• Reduction of arousal and anxiety.

Step 4 – Test your idea (hypothesis) by systematically introducing strategies such as environmental changes, skill development strategies and planned responses to behaviours. These strategies must be linked to why the person is using the behaviour. The introduction and consistent implementation of these strategies should result in a reduction to the frequency and intensity of the target behaviour and over time, an increase in the person’s quality of life.

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Step 5 – Regularly monitor, evaluate and review the effectiveness of the strategies: Thinking about what worked and what needs to change. Ongoing data collection will be required to monitor or check that your ideas about the behaviour are correct.9 If you would like further information on this subject, please go to https://manualzz.com/doc/2984272/positive-behaviour-support-getting-it-right-fro… You will find a full discussion and instruction on behaviour support there.

9 https://manualzz.com/doc/2984272/positive-behaviour-support-getting-it-right-fro…

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Follow referral procedures in consultation with supervisor Specialist services and referral options Your organisation will have policies and procedure relating to referring clients for behaviours of concern. This could include referrals to:

• G.P.

• Counsellor

• Specialists

• Another referral source

Before you refer any client for further assistance, you must always check with your supervisor. They will have the authority that you need to refer and will probably have a list of preferred specialists to refer to along with all their contact details. In most cases, you will be required to complete a referral form similar to the one below.

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Comply with the organisation’s reporting requirements Documentation and good record keeping are at the heart of best practice with ongoing client management. Good documentation allows for the:

• Accurate recording of events, incidents and observations

• Identification of trends, ongoing issues

• Identification of strategies that assist a client

• A secure and central location for any actions plans for the client

• A central point of reference for all the client’s documents, rather than a

haphazard system where information can easily get lost

Documentation will also be a legal requirement in many situations, especially with incident / client management, medications, treatment schedules and privacy requirements. You will need to be familiar with your organisations policies and procedures in relation to reporting requirements. Information on what the reporting requirements can usually be located:

• With your team leader or supervisor

• On your organisation's intranet

• Within HR or personnel

• With your training and development department.

Ignorance is no excuse for poor or bad documentation. The risks of poor or bad documentation to the client, yourself and the organisation can be great. Your organisation’s reporting requirements will clearly define what needs to be documented, where, how, why and when. Your organisation may have an electronic database for recording information. These may be electronic client files, electronic documents or electronic recording of information. Inversely, there may be paper-based files or information. Usually, each client will have their own file – this could be paper or electronically based. This file will typically be divided into

Topic 4 – Complete documentation

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basic client information, medicinal or treatment information, treating practitioners and specialists, emergency contact information, any private information or concerns, information release waivers, any action plans or strategies in place and generalised observations. You need to become familiar with each section of the clients file, to ensure you know where to document what information. Each organisation will have its own style of documentation. This ensures that all employees are documenting using the same ‘codes’, style and ways. As there is often much that needs to be documented, many organisations have their own style of shorthand to quicken the process of documentation. This may be formal, or informal. Regardless of this, it is essential that you understand the style of documentation, to keep the flow and tone uniform for any other organisation’s employees. Each different type of document will need to be completed in different timeframes. An example of this is you may need to document immediately once a medication has been administered. Other documents may not be able to be completed immediately – an incident or accident report for an example. These may take considerable time and cannot be completed on the spot. Generalised observations may be documented at the end of a shift or interaction, to ensure the clients observations and records remain current. Documentation is important as it gives a clear record of the client’s actions, behaviours, interactions and any other observations made. Documentation is often both a legal and organisational requirement. It is an important and serious part of your role, the proper time and attention needs to be given to it.

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Maintain documentation according to organisation’s requirements Your organisation will have clear requirements for documentation. This will include:

• What to document

• Where to document

• The style of documentation

• When do document

There will be a wealth of information that needs to be documented. This can be client- specific information, program information, plans or strategies, inter-organisational notes, emails and any other organisational files. Client-specific information will be documented in a range of places, depending on the nature of the information. This may include:

• Client observations, medical notes and generalised client information to be

documented in the client's file

• Clients individualised plan, action plan or any other health or rehabilitation plans

also to be included in the clients file

• Any referrals made to the organisation for the client to be filed in the client's file

• A copy of any documents / referrals made to external organisations, health

partners or specialists, as well as any responses from these stakeholders to be

held in the clients file

There will be information that is not client specific that does not need to be filed in the client's file. You may be required to prepare inter-organisational notes or communications, such as meeting minutes, emails confirming a new decision or direction or organisational contact lists. These will usually be documented in individual, organisational documentation templates. For example, your organisation will usually have its own template for meeting agendas and minutes. It is essential that you correctly document organisational notes in the correct places, using the correct template. This ensures uniformity of messages, documentation and assists with the ease of reading. Working in aged, disability or community services, you may also be required to create documents or information for your clients, groups or facility. These could be simple documents, such as a safety sign for a particular activity or equipment, instructions for using an appliance or directions for an activity or strategy. Your organisation will have policies and procedures on how this is to be documenting, considering any linguistic or cultural

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requirements. It is always advisable to contact a communication specialist in your organisation if you have any queries on public communication or messages. By following organisational documentation requirements, you ensure that you keep an accurate record of what has happened, what needs to happen and any other directions. It keeps the flow of information uniform and allows for the quick and easy identification of important information, as it is required.

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Now that you have completed this unit, you should have the ability to follow established person-centred behaviour supports. If you have any questions about this resource, please ask your trainer. They will be only too happy to assist you when required.

summary

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“Aversive, restrictive and intrusive treatment practices – Policy and guideline.” (n.d.) Web. 01 July 2019. https://www.nwss.org.au/policies-procedures/aversive-restrictive-and- intrusive-treatment-practices-policy-and-guideline/ “Social model of disability.” .” (n.d.) Web. 01 July 2019. https://pwd.org.au/resources/disability-faqs/social-model-of-disability/ “What is social devaluation? How does it impact a person’s cares and needs?” (n.d.) Web. 01 July 2019. https://www.quora.com/What-is-social-devaluation-How-does-it-impact-a- person-s-cares-and-needs "Positive Behaviour Support Getting It Right From The Start …" (n.d.) Web. 01 Jul. 2019 https://manualzz.com/doc/2984272/positive-behaviour-support-getting-it-right-fro. “Restrictive Practices; Restrictive practices in Australia.” (n.d.) Web. 02 July 2019. https://www.alrc.gov.au/publications/8-restrictive-practices/restrictive-practices-australia “People with a disability who experience violence, abuse or neglect.” (n.d.) Web. 02 July 2019. https://www.betterhealth.vic.gov.au/…/people-with-a-disability-who-experience- violen… “NDIS Practice Standards: NDIS Practice Standards and Quality Indicators.” (n.d.) Web. 02 July 2019. https://www.ndiscommission.gov.au/sites/…07/NDIS%20Practice%20Standards.pdf

References