Principles and Practice of Positive Behaviour Supports Workshop 1 Presented by the Psychology Department and the Open Training College
Welcome § Blended approach to delivering training § § Two assessed QQI Level 5 modules – Challenging Behaviour & Person Centred Focus (Both sit on the Certificate in Intellectual Disability Practice) Completed over 12 weeks § In the classroom and online 2
PBS Training Ø Level 1 – Orientation Ø Level 2 § QQI Level 5 – in-service staff, e-learning and face-toface, assignments and projects, OTC and Psychology § QQI Level 7 Ø Level 3 – Therapeutic Interventions Promoting Safety (TIPS) Ø Level 4 § TIPS-R (Restrictive Practices) § CALMS – for children (external) 3
The Four Workshop Topics 1: Overview of PBS and PCF 2: Policy 3: Positive Behaviour Practices 4: Your role and Wellbeing 4
Workshops and Online Work 1. Workshop 1 – Course Overview and Introduction to PBS and PCF 2. Online 1 – PCF & PBS 3. Workshop 2 – Policy 4. Online 2 – PBS – Review of ABC and Behaviour definition 5. Workshop 3 – Positive Behaviour Practices 6. Online 3 – PCF 7. Workshop 4 – Your Role and Positive Behaviour 5
Assessment ü ü ü Assignment 1 – PCF (40%) Assignment 2 – PBS (20%) Assignment 3 – PBS (20%) Project* – PBS (60%) Learner Record – PCF (60%) *For the project you will have to identify a service user in conjunction with your manager and a psychologist and get consent to work from the person or an advocate for the person. 6
Course Supports ü Online supports ü Tutorials ü Manager ü Psychology 7
Online Ten Minute Rule When working with the online modules. If things do not work for you and you have tried to progress things, but you have had no luck for 10 minutes, email: elearning@opentrainingcollege. com 8
Expectations Activity In groups of 3 or 4 discuss the following: § What are you expecting to get from the course? § Have you any fears about your course of study? 9
Person Centred Focus to Disability Presenter: The Open Training College
PCF Learning Outcomes 1 By the end of this section, you will be able to: § Outline the principles of a person centred focus to disability § Define what is meant by a medical model, biopsychosocial model and a social model of support § Compare the medical, biopsychosocial and social models of service delivery using examples of this in the lives of individuals with disability 11
PCF Learning Outcomes 2 § Analyse the differences between adopting an individualised approach and one that sees individuals with disabilities as a homogenised group § Identify issues arising from the language and stereotyping which is used in relation to people with disabilities § Adopt the use of people first language in their work practice 12
The Principles of a Person Centred Focus to Disability What does person centredness mean? Person centredness is an approach, which puts the individual service user at the centre of the planning and decision making process in relation to their life. Activity – Do you think St. Michael’s House is a person centred service? Discuss. Examples of where they are and where they are not? 13
Assignment Alert The next set of slides relates to a part of the assignment. 14
Disability can be seen in different ways: Medical Model Social Model Biopsychosocial • sees the individual as responsible • sees the society as responsible • biological, individual and society all lead to outcomes for the person’s wellbeing 15
Traditional Medical Model Ø Sees the individual as a passive receiver of services and the impairment as being the problem. Ø This results in a society that segregates. 16
Social Model Ø Sees the individual as an active fighter for equality, working in partnership with circles of support to create a society which is truly inclusive. 17
Biopsychosocial Model Ø Sees the individual’s quality of life as being an outcome of a combination of three areas, the person’s biology, the person’s capacity and the society. 18
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The Label Race § 6 candidates/volunteers § Each presented with a label they keep secret § The presenter reads out a series of questions § What determined where people finished? § Where people end up in life - is it pre-determined by the label they have? 20
A Person Labelled as Challenging and the Models Supporting a person who has been labelled as challenging can be through the 3 models: Medical Model Social Model Biopsychosocial • person and the challenging behaviour is the problem that needs to be cured • can we be creative and provide supports for the person so they can do not have to resort to challenging behaviour • working with an individual and their environment to increase wellbeing 21
Person First Language Ø Puts the person first Ø What labels do you use at work for the people you support? Ø What do they want to be called? Ø Their NAME Ø Person, Positive First 22
People with disability, this large minority group is the only one which any person can become part of, at any time! Some join at birth— others in the split second of an accident, through illness, or during the aging process. If and when it happens to you, will you have more in common with others who have disabilities? How will you want to be described? And how will you want to be treated?
When we describe people by their medical diagnoses only, we devalue and disrespect them as individuals. Would you want to be known primarily by your psoriasis, the warts on your behind, or any other condition? 24
The Label ‘Challenging Behaviour’ – Do not use the label lightly Affects the person’s: § § Rights Image Community access Number of friends/people they have contact with etc, Is there any other way the label affects the person’s life? 25
When you hear the term challenging behaviour, think of the challenge being ours. The service we are providing is not suitable for the person, how can we change what we do. How can we do things differently to provide the quality of life the person wants and support the person’s wellbeing? 26
Making the Change Isn’t it time to make this change? If not now, when? If not you, who? People First Language is right. Just do it—NOW! 27
In a group discussion state what is the most common experience for the individuals you work with? Is it a Mass Managed or Person Centred experience: 1. How do people come into your service? 2. How are they allocated to a particular residential house or day service? 3. How did they choose who to live with? 4. How did they choose what to work at? 5. How did they choose where to work? 6. How do they choose to leave a house or day service if they do not like it? 7. How do they choose their cereal? 28
Key Principles of a Person Centred Focus Ask the group what these terms mean. And have they seen them in practice in SMH? § § § Advocacy Circle of Support Service Brokerage Service Quality Consumerism 29
Key Definition of Person Centredness For the person to develop their own vision of a desirable future. 30
Introduction to Positive Behaviour Supports and Wellbeing Presenter: Psychology Department
PBS Learning Outcomes By the end of this section you will be able to: § Define the concept of challenging behaviour § Explain how internal factors, related to a person’s health and wellbeing, can underlie challenging behaviour § Explain how external factors related to the environment and the reactions to behaviour, can underlie challenging behaviour 32
Understanding Human Behaviour Human behaviour is everything people do, including how they move and what they say, think, and feel. 33
Our Behaviour in Everyday Life Our behaviour reflects our attempts to: § Meet our basic needs § To access experiences that we enjoy § To avoid unpleasant experiences 34
Why we behave as we do? Our physical/ biological make-up How we behave Our experiences in life Our environment 35
Examples of Behaviour in Everyday Life § § § Making tea Getting dressed Making a phone call Doing our work Opening the window Driving Taking a walk Saying ‘hi’ Watching TV Slamming a door Shouting 36
How would you feel? How would you behave/react? Attending a busy shopping centre with limited time to buy present for your significant other on Christmas Eve. At a concert of an artist you hate for 4 hours with your partner. You are so bored. Periods of time where you feel unwell with no way to communicate this in a foreign country. 37
Inappropriate and Challenging Behaviour
Behaviours That Cause Concern § There are many terms and definitions used to describe behaviours of concern that are observed and experienced by the person, family members, staff and society in general § ‘Problematic’, ‘inappropriate’, ‘challenging’ § These terms are subjective and can be used to label different types of behaviours 39
Inappropriate Behaviour § There are many implicit and unwritten rules about how we interact with others in our lives, in our workplace, in the community and at home § Some individuals may have difficulties understanding the complexity of these situations and may be more likely to respond in social situations in ways that are deemed ‘inappropriate’ 40
Case Study § John is a young man with an intellectual disability who likes a neighbour called Orla § John has difficulties understanding the steps that are usually taken to get to know someone to build a relationship § He finds it difficult to shift his focus from this girl § When John is at home he often leaves his house and looks in the window of Orla’s house to see if she’s there 41
Understanding Inappropriate Behaviour § Some times individuals display behaviours due to lack of understanding including difficulties recognising personal boundaries, managing social interactions or coping with aspects of the environment § It is important to remember that for individuals with an intellectual disability there a number of personal factors that influence how they behave including: Ø cognitive factors (e. g. , understanding, memory, attention) Ø sensory sensitivities or impairments Ø communication difficulties 42
Understanding Behaviour as a Continuum The person has a good quality of life and wellbeing. They do not experience difficult or challenging behaviours. Behaviour that causes some concern but does not impact significantly on the person’s quality of life or wellbeing. 43 Behaviour that severely impacts on the person’s quality of life and wellbeing.
So what do we consider as CHALLENGING BEHAVIOUR? 44
A Definition of Challenging Behaviour “Severely challenging behaviour refers to behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or delay access to and use of ordinary community facilities. ” (Emerson, 1987) 45
Human behaviour, even the most severe problem behaviour shown by people with developmental disabilities, is not the result of some accidental process. Behaviour occurs because it typically serves a purpose for the individual displaying it; that is why problem behaviour occurs so frequently, why it lasts so long, and why it is often so difficult to deal with’ (Carr et al. , 1994, xix) 46
Assignment Alert The next set of slides relates to a part of the assignment. 47
What factors affect a person’s wellbeing? Group activity: Consider what factors may affect a person’s wellbeing and behaviour. Johnny is screaming on the sofa. Why? 48
Factors Affecting a Person’s Wellbeing and Behaviour Internal Factors External Factors 49
Internal Factors 50
Physical and Wellbeing § § § § § Pain Constipation Reflux Diet Mobility issues Toothache Head/ear ache Menstrual cycle Epilepsy Sleep disturbance 51
Psychological Factors (Cognitive) How I understand the world around me § Difficulties understanding what is happening in the world around me: Ø Understanding: Difficulties understanding what is happening which leads to confusion and frustration Ø Attending: In order to attend, the person must feel comfortable, relaxed to enable them to filter out distractions, and know what is relevant 52
Psychological Factors (Cognitive) How I understand the world around me § Difficulties with remembering information provided § Planning and organising sequences of steps or actions § Difficulties integrating verbal and non-verbal information in meaningful and flexible ways: Ø Tendency to process information one piece at a time leads to a more restricted understanding of information Ø Information often stored at a whole rather than integrated and flexible manner 53
Psychological and Emotional Factors How I respond to the world around me § Bored and uninterested in what I do everyday § Unhappiness and depression § Tired and lack of energy § Difficulties communicating feelings leading to frustration and/or withdrawal 54
Psychological and Emotional Factors How I respond to the world around me § The nature and quality of interactions with others in everyday life § Worry and anxiety § Loss and bereavement § Relationships and sexuality § Mental health difficulties 55
Psychological and Emotional Factors How I respond to the world around me § Changes in personal life situation § Changes in the wellbeing of others around me (e. g. parents with health or psychological issues) 56
Communication How I communicate with the world around me § Difficulties communicating needs (i. e. , expressive language) § Difficulties understanding what others say (i. e. receptive language) § Not having the language to express emotions § Inability to ask a question or express a choice 57
Important Point Challenging behaviour should always be seen as the person trying to communicate something to us. 58
Sensory Sensitivities and Sensory Processing How I sense the world Individuals may have sensitivities in one or more of the following areas: § Visual § Tactile § Auditory § Olfactory § Pain § Temperature Sensory processing difficulties cause distractibility, 59 disorganisation, discomfort.
Tolerances ‘people have different thresholds for noticing, responding to and becoming irritated with sensations; reflected in their mood, temperament and ways of organising their lives’ (Dunn, 2001, p 609) 60
External Factors 61
Environment § § § Temperature Lighting Time of the day Routine changed Crowded environment Physical layout of space § § Group tasks Change in activities Lack of structure Is the person living where they want, with who they want and doing what they want in life? 62
There are multiple causes but communication is a constant § Difficulties with expressive language (telling you) § Difficulties with receptive language (understanding what is said) § Not having the language to express emotions § Inability to ask a question or express a choice § Frustrations due to an inability to communicate is inevitable 63
Multiple Perspectives
Multiple Perspectives Whether we call a behaviour ‘problematic’, ‘inappropriate’, or ‘challenging’ will depend on: § § § what the behaviour is who is displaying the behaviour where the behaviour occurs 65
Multiple Perspectives § What– the form (e. g. throwing, self-injury, hitting, touching) of the behaviour will influence our perception of the behaviour § Who – who displays the behaviour will also impact on our perception of it, whether a young child or adult service user displays the behaviour § Where – whether the behaviour occurs at home, on the bus, in the community will impact on our perception of the behaviour 66
Multiple Perspectives Impact of Environment: § § Historically, challenging behaviour was seen as a problem intrinsic to the person Current approaches are holistic and person-centred We are encouraged to modify the environment to meet the person’s needs rather than seeing them as a problem Therefore the “challenge” is to us, our systems and services 67
Multiple Perspectives Impact of Context: § We need to consider behaviour within the context. The same behaviour may not be a problem at home, but is a problem in the community. Therefore, the definition of ‘challenging’ depends on the context. 68
Multiple Perspectives Our Attitudes: § How we view the person will influence our acceptance e. g. of what they do, “They know what they are doing” or “they can’t help what they are doing”. § Our attitudes can influence what we define as challenging. 69
Multiple Perspectives Tolerance Levels: § The experience of what is challenging behaviour is subjective; it is behaviour we find hard to tolerate § We all have different tolerances, attitudes, personalities and past experiences which affect our tolerances § How we feel on the day affects our tolerance of behaviour 70
Nails on a Blackboard What puts you on edge at home? What puts you on edge when you are at work? What behaviours put you on edge? What can you tolerate, what can you not tolerate? 71
Multiple Perspectives Complexity of Emotions: § Service User awareness of our tolerance levels can affect their behaviour § Finally, dealing with the emotional effects of behaviour, as well as the emotions that produce the challenging behaviour, increase the impact of the challenging behaviour on those affected by it 72
Multiple Perspectives Attitude and understanding: § If we understand why the person may be engaging in a particular behaviour , we will be in a better position to develop a positive and helpful attitude toward the person. Our attitudes will also influence what we define at challenging. 73
All Behaviour Has Meaning § All behaviour is purposeful and serves a function for the individual displaying the behaviour § Individuals with disabilities who have limited communication skills will use a wide variety of behavioural forms to communicate their basic needs § Some of these forms may be difficult for us to understand § Some prove to be difficult for us to manage and cope with § Despite this they occur for a reason 74
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Online 1 Where we look at Understanding and Responding to Challenging Behaviour and the value base of Person Centredness plus start to ask you about the SMH Policy underpinning all this. Any issues with your online learning please email: elearning@opentrainingcollege. com 76
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