Management of Behaviours of Concern

Management of Behaviours of Concern

Behaviours of concern Some of you may know this as: Challenging Behaviours This term is now known as Behaviours of Concern

Behaviours of Concern OBJECTIVES: At the end of this session you will have more information on how to: Define inappropriate or difficult behaviour Understand the reasons why some clients/people display these behaviours Recognise the symptoms Devise strategies for coping effectively with difficult, demanding, anxious, demented and depressed clients/people

Reflection Before you commence this PowerPoint just reflect on your own behaviour How do you respond to situations that challenge you? How do you respond when someone says something to you, that you don t like?

What is behaviour? A behaviour is known as the way in which an individual acts or performs.

Behaviours of concern When working in the community services industry (CSI), we have a duty of care to monitor behaviours of concerns to provide support. A behaviour of concern is any type of problem that is harmful, potentially harmful or disturbing to the person performing the action, or to others. Such problems are common among people with intellectual disabilities, people with dementia (due to damage to the brain caused by the disease process) and people with mental health.

What influences behaviour Behaviour is developed from our past experiences, family influence, cultural background, religion and learning Our personalities are demonstrated in the way we behave.

What determines our behaviour?

How does behaviours of concern affect an individual? Often people are labelled as difficult when it is in fact their behaviour that we find difficult Difficult behaviours may be: Limiting the person s ability to participate in daily life Harmful to the person Harmful to staff or family members Upsetting to the person with the behaviour Socially unacceptable Making the carer s job stressful Other definitions inappropriate, unacceptable, maladaptive Different people find different behaviours more difficult than others

Examples of behaviours of concern Repetitive speech Hitting Verbal abuse Physical abuse Spitting Faeces/urine smeared on you Shadowing

Why do people exhibit behaviours of concern? Biological /Organic - mental health, epilepsy, dementia, sensory deficits, pain Psychological - self esteem, isolation, value / worth, hope, confidence, lack of achievement, frustration Medication - side effects, multiple meds, over / under administration Social - relationships-friends, interpersonal environment, physical environment, safety / security, consistency / routine Skills - problem solving, insight, coping / tolerance, self care, decision making Triggers - environment, noise, pain, lack of sleep, senses, memories, restraint, workers/carer stress

Key Points in Management Accept the client as valuable even though certain behaviours may not be acceptable Always look for the cause behind the behaviour and or try and identify the trigger Do NOT punish the person who is exhibiting the difficult behaviour

LIFESTYLE MANAGEMENT / PLANNING Modify environmental factors avoid overstimulation reduce noise avoid crowds appropriate lighting create comfortable setting Interpersonal factors show respect Dignity empower the client if possible Activity factors give choices modify the task or activity review instructional method modify the routine

PREVENTION STRATEGIES Identify risk areas Identify risk clients Establish protocols Trained / experienced staff Improve communications Include the family / carer / health team in planning strategies

Changes in behaviour Changes in behaviour may involve inappropriate behaviours. These behaviours may introduce a risk to the client or impinge upon the rights of others. As a care worker you can respond by trying to identify the situation of risk or potential risk. Minimise risk as far as possible while respecting the rights of the client.

When working in the CSI, it is also important to remember to document /report any behaviours of concern and/or risks/ triggers. Ensure you report these to your manager as this is part of your duty of care. In the event you have not reported and a client injures themselves you could be sued for negligence.

The DO s R.E.S.P.E.C.T- Respect, Enable, Safety and Security, Person-Centred, Environment and equipment, Communication, Team work Be polite and smile Treat the person as an individual Actively listen Communicate effectively Be consistent as a team Be non-directive Be calm and reduce stress Review your strategies

The DON Ts Lose your temper Lose patience Restrain / contain Keep clients waiting Be inconsistent Be demanding Be inflexible Lose professional perspective

Demanding Behaviour Demanding behaviour may include: Giving orders Constantly seeking attention Throwing items across the room Asking numerous questions Taking up large amounts of staff time Often stating that they need help

Causes of Demanding Behaviour We need to understand the reason for the behaviour by identifying possible causes and or triggers. Some of these may be due to: Overwhelming loss A need for attention Feeling out of control and reliant on others Acute / chronic illness Confusion Frustration

Managing Demanding Behaviour Identify the cause Set realistic goals (1-2 small ones at a time if necessary) Encourage participation in activities Be firm, consistent and kind Make the client aware of unacceptable behaviour Where possible, ignore inappropriate behaviour (making an issue of the behaviour reinforces it) Do not be angry or defensive

Managing Demanding Behaviour-cont Praise and give support Don t avoid the client Interact regularly when the client is not being demanding Respond to needs Spend time listening to the client Use a team approach

Dealing with Anxious Behaviour Anxiety is an emotional and physical response to a stressor It can be a very normal response but if it becomes severe, may interfere with daily life.

Symptoms of anxiety A keyed up feeling Selective hearing Short attention span Inability to concentrate or cope Narrowed or distorted perceptions Fear, nervousness, agitation, dizziness, nausea, tension and perspiration Panic feeling overwhelmed Unwillingness to participate / socialise Disrupted sleep Wandering

Managing Someone s Anxiety Remain Calm Maintain a quiet environment Relaxation techniques Diversional activities Identify causes Develop coping mechanisms Medication (if required)

Dementia Related Behaviour Angry/ Agitated Aggression Verbal Physical Wandering Verbal noises

Management strategies Medical evaluation rule out physical and/or medication problems Check vision and hearing Alternate quiet times with more active periods Ensure comfort - client not in pain Simplify the environment Maintain a daily routine Orientate to time and place Ensure the client is safe Use gentle touch

Strategies cont Verbal Aggression Do not argue, restrain or touch the client this may have been the trigger to the verbal aggression. Be calm and approach the client slowly Utilise all your communication skills and be firm. Do not invade the clients personal space. Try to divert the person s attention Take them to a quiet room if necessary Physical Aggression As above plus: Ensure own personal safety Back away from the client Re-approach slowly and gently.

Strategies cont Wandering Thorough medical evaluation (especially if wandering begins suddenly) Allow the person to wander if the environment is safe and secure (e.g. a secure front or back yard) Ensure adequate lighting throughout the home Decrease noise levels Label rooms Remove items that trigger a desire to go out shoes, purse, coat etc. Try to involve the person in household activities (20-30 mins or less) Verbal Noises Thorough medical evaluation Provide adequate meals frequently Regular toileting schedule (if required) Change promptly after incontinence Try rest periods to minimise fatigue. Maximise sensory output Lower stress Use relaxation techniques Medication as a last resort

In general (in any situation) ensure the client is: warm not in pain not hungry does not need to use the toilet not constipated

Depression We all experience sadness and hurt Depression occurs when this sadness is prolonged and prevents us from performing our daily activities. Clinical depression is a form of mental illness

Signs of Depression Low mood Guilt Self reproach Low interest in usual daily activities No pleasure in daily activities Crying Irritability Short concentration span Poor motivation Negative thoughts Disorientation Indecisiveness Confusion Self destructive thoughts Fatigue Low energy Headaches Sleep disturbances Withdrawn Anxious Forgetfulness

What causes Depression Depression is caused by a combination of environmental, physical and emotional events. Heredity The tendency to develop depression does run in families Biochemical Imbalance Depressive episodes are thought to be due in part to a chemical imbalance in the brain (serotonin) Stress An increase in stress levels can be a trigger for a depressive episode Personality Some people have certain personality traits that make them more prone to depression Environment An individual is more at risk to suffer from depression if they reside in residential care. Loneliness Withdrawal from society, lack of support structure, the elderly are particularly vulnerable (www.vic.gov.au/mental_health) (Kumm, R (ed) Stress and Behavioural Management in Long Term Care. National Health Publishing, Baltimore)

Managing Behaviours related to Depression Behaviour Decreased communication Uncooperative Isolation/Withdrawn Anxiety Suicidal tendencies Decreased interest in daily life Management Strategy Ask open ended questions, be supportive, be non-critical Be warm and caring, do not judge or blame Encourage participation in activities or small groups. Start slowly. Remember that a small task may seem huge Convey acceptance & hope. Sooth anxiety by slowly encouraging the person Always take seriously. Watch/listen for signs. Report any indications that the person may attempt self-harm Monitor food intake, sleep patterns, elimination & personal hygiene

Other interventions Psychological assessment General counselling Medical review Anti-depressive medications Lifestyle changes

Conclusion We have defined the following: Difficult behaviours Demanding behaviours Dementia Anxiety Depression We have discussed possible causes of these behaviours. We have learnt how to identify the symptoms of these behaviours We have proposed interventions and formulated strategies for coping effectively with the management of these behaviours