Behaviours that Challenge – The National Picture
Due to recent investigations into the care of people with learning disabilities and or Autism whose behaviours challenge in institutional based settings, it has come to light that the care in such places are at times inadequate and at worst abusive e.g Winterbourne View (Winterbourne View- Time for Change, 2014). Due to such findings, there is a national plan to close inpatients facilities for people of learning disabilities and or autism who display behaviours that challenge including those with mental health conditions and provide the right to care at the right time whilst supporting them in community-based settings (Building the Right Support, 2015).
A number of recent local and national Guidelines (e.g. Transforming Care 2) have highlighted the need to significantly reduce reliance on institutional care to support people with LD and or Autism including those with mental health and decrease dependency on in patient treatment as evidence has shown that given the right support and care individuals with learning disabilities can be cared for in the community or at home they can be close to love ones.
The benefits of this to the individual are often an improvement in their physical and mental health, reduction in behavioural challenges and an improvement in their overall quality of life.
How All Behaviour Consultancy can support the National service model:
The goal is that a minimum of 45-65% of CCG commission inpatient services will be closed and 25-40%of NHS-E commissioned capacity will be close capacity, overall 35%-50% of inpatient provision will be closed nationally with alternative care being provided in the community.
However in order to ensure that individuals are successfully transitioned into the community staff supporting them will need to have to be trained in how to recognise, understand and respond to behaviours that challenge.
Positive Behaviour Support (PBS)
We provide PBS training and implementation for staff (including education and health care staff) and organisations. We conduct functional behaviour assessments and behaviour support plans to reduce behaviours that challenge in individuals with LD and/or Autism who may also have mental health condition.
Positive Behaviour Support is a person centered approach to supporting individuals with neurodevelopmental disorders such as learning disabilities Autism, ADHD, whom as a result of the impact of their disorder may present with behaviours that challenge.
The aim of PBS is to understand the person as a whole – medical, physical, mental and environmental history in trying to establish the reasons why he/she is engaging in behaviours that challenge.
PBS teaches alternative behaviour/ communication, training and support for staff and organisations that can help to support individuals to lead enhanced quality of lives with a reduction in behaviours that challenge.
Behaviours that challenge are extremely complex and often require an assessment to understand the triggers and consequences that maintain the behaviours. For some individuals, one behaviour can occur for multiple reasons and for others several different behaviours can occur for the same reason.
By understanding the reasons people display behaviours that challenge we can start to develop evidence based behaviour intervention plans to support the individual to have alternative means of communication.
There are many different causes of behaviour that challenge; and these vary widely between individuals. The person’s unique circumstances and history (in particular where trauma, abuse or neglect have been experienced) must be considered to fully understand the behaviour that is challenging.
To appropriately manage challenging behaviour, you must understand why the behaviour is presented in the first place.
If the behaviour is not understood and is solely eliminated, then another (possibly more severe) behaviour may take its place as an attempt to communicate their needs.
There are different factors that are taken into account when managing challenging behaviours:
The definition of problem behaviour – every single person the child interacts with will have their own definition of what is appropriate and inappropriate behaviour. Which can be dependent on culture, childhood experiences. It is important that the parents, school teachers and student have a standardised definition of what the problem behaviour is.
Behaviour is dependent on the student behaviour and the situation – we will expect the outcome of a management strategy on each child to be different due to their age, level of functioning, and awareness.
To successfully manage problem behaviour behavioural analysts will need to assess the behaviour across all situations. It is important that both the school and home environment provide the child with consistency.
At All Behaviour Consultancy, we begin by conducting a comprehensive functional behaviour assessment followed by an individualised Behaviour Support Plan based on the results of a functional assessment.
Our support plans tie in strategies that match the reason for the behaviour that challenge. We provide high quality training for staff and support for people with LD and/or ASD who display behaviours that challeng. We offer a flexible needs based model of training for local staff teams.
Our support means that CCGs can place experts at the frontline of service delivery providing evidence based positive behaviour support interventions that match the needs of the individual. Our support is “not a one size fits all” as we understand that that as individuals vary in their presentation, the local picture of service provision also differs across boroughs and counties.
To reduce community placement breakdowns we can provide awareness training to schools, support staff, hospital staff on the causes of behaviours that challenge and advice on proactive strategies that can be implemented to reduce the occurrence of behaviours that challenge.
We can work jointly to support transitions between settings for individuals with behaviours that challenge to ensure that placements are successful.
We are highly experienced in providing evidenced based training for parents. The evidence is strong that that parenting programmes in intervening early for children with behavioural challenges is a key component in not only supporting families but also a significant cost saving to the system as a whole.
We are passionate about developing personalised support and treatment approaches based on functional behaviour assessments that lead to non-aversive behaviour support plans.
Our training and practice ensure the dissemination of evidenced based practice for supporting individuals whose behaviour challenge.
Outcomes and effectiveness of our service:
There is strong evidence to support that investing in specialist and effective training provision can help to decrease or eliminate the need for admissions, avoiding unecessary use of highly specialised provision such as residential schools, hospitals or prisons.
To prevent terrible cases such as Winterbourne view and prevent individuals who present with behaviours that challenge from being admitted into hospitals and residential care that can impact on their mental health in the long term, it is paramount that this group of people have access to services that have the expertise to provide functional behaviour assessment that can lead to a greater understanding of their needs as recommended by NICE guidance.