How Exemplar supports residents with challenging behaviour

Mark, one of our service users, used to display what is often called “challenging behaviour.”

Five years ago, when he first moved to Pathways, our Sutton-in-Ashfield complex needs care home that supports eight adults, Mark would injure himself regularly.

His self-inflicted wounds needed dressing almost daily.

But over the years, we’ve supported Mark by giving him less damaging ways to manage his sensory needs. We’ve helped him develop non-verbal tools to initiate interaction and communicate with us.  

Unique needs

Mark’s support needs are unique – like the complex, unique needs of each of our 690 service users.  

Many of the people who use our service have been described at some time or another as engaging in “challenging behaviour.”

This can often be a label that has many negative connotations – and one that follows a person from service to service.

Other common phrases you may hear include ‘behaviours that challenge’, ‘distressed or risky behaviour’ and ‘behaviour of concern.’

All of these terms describe behaviours that restrict a person’s access to ordinary, community facilities and have a negative effect on the person’s quality of life. 

Specialist support

Supporting service users with challenging behaviour requires a specialist approach. And these approaches have a significant impact on how the person is perceived and valued.

Tragically, individuals with behavioural difficulties can be vulnerable to abuse from others, as the shocking events in some care homes shown in the Panorama documentaries of 2011 and again this year show.

These are, thankfully, extreme examples. Yet people who engage in behaviours of concern are more likely to experience frequent placement breakdowns, over-medication and overly restrictive practices.

At Exemplar, we use the person-centered Positive Behaviour Support (PBS) model to guide us in how and when to intervene if behaviours of concern are causing problems for an individual.

Benchmark model

According to several medical societies, including the Royal College of Psychiatrists and British Psychological Society, the PBS model is the benchmark for intervention in the field of challenging behaviours.

PBS is founded on the belief that all behaviour happens for a reason. Challenging behaviour is no different. To the individual, behaviours of concern are often the most effective way they currently have to get their needs met.

We work within the values framework of PBS, which aims to improve the person’s quality of life by providing meaningful daily activities.

Boosting self-worth

The main goal is to increase the person’s self-worth to reduce their need to engage in challenging behaviour. Working alongside the person every day, we help the person develop living skills - while also involving their family and people who know them.

We also use Applied Behavioural Analysis, a science devoted to the understanding and improvement of human behaviour, among other approaches.

Applied Behavioural Analysis accepts that behaviour is shaped by the environment and selected and maintained by the consequences that have followed it.

An evidence-driven approach

To start, Applied Behavioural Analysis requires a data and evidence-driven approach. This means we gather facts over a period of time on what happens around the person before they engage in challenging behaviour. We also record what happens to them immediately after.

Then, we use this data to develop interventions using a functional behaviour assessment.

Multiple interventions are tried in order to change behaviour proactively - and to manage behaviour reactively in the least restrictive way possible. 

However, there’s not always an easy or quick fix.

Attempting to replace ingrained behaviours of concern that work for the individual and which may have been working for years can prove difficult.

We may think we have a good idea as to why a behaviour is happening - but we don’t always get it right!

But with our long-term commitment to understanding and supporting our service users, we accept occasional setbacks as part of the journey in making every day better.

This article was authored by Simon Cooper, Clinical Nurse Manager at Pathways. Simon is also a coach for the Centre for the Advancement of Positive Behaviour Support (CAPBS), run by the charity British Institute of Learning Disabilities (BILD).