“A person’s behaviour can be defined as “challenging” if it puts them or those around them (such as their carer) at risk, or leads to a poorer quality of life. It can also impact on their ability to join in everyday activities. Challenging behaviour can include aggression, self-harm, destructiveness and disruptiveness. Challenging behaviour is often seen in people with conditions that affect communication and the brain, such as learning disabilities or dementia.” http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/challenging-behaviour-carers.aspx
Complete the Following Table:
Types of Challenging Behaviour
When Chloé wanted her carer to help her get dressed, she could not undo her buttons and the carer slapped her across the face. Instantly, she slapped her carer back. This is called reflex behaviour.
When Nigel taunted Frank by calling him names, Frank pushed his carer out of fear of something else happening. This is reactive behaviour because Frank was provoked by his carer.
When a carer came to help Masie by making her bed, Masie was still in bed. The carer asked her politely to leave the bed so that she could get on with her duties and usually Masie complies, however today she bit her and began screaming at her to leave. This is intentional behaviour because Masie was not provoked and she was not hit first. She intended on hurting her carer.
Emily was asked by David to help him get up from the chair and as she went to hold his hand and support him by placing her hand on his back, he pushed her back towards the wall and began acting aggressively by smashing his ornaments on the floor.
Finn was going around the rooms to collect the rubbish and Rachel was not allowing him to do his job because she repetitively shouted for him to leave until he did what she wanted. http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/challenging-behaviour-carers.aspx Challenging Behaviour has its own triggers that can cause service users to display challenging behaviour in such a way that it affects more than one person.
Complete the Following Table:
Why may People Display Challenging Behaviour?
Past Life Experiences
Previous life events and experiences that may have been traumatic to the service user may cause them to develop ‘challenging behaviour’ which may have resulted from unresolved emotions that may be difficult to confront. Traumatic events may have angered or upset the service user so much that they channel their emotions into behaviour that is aggressive, dysfunctional and endangering.
Resentment for being placed in a health or social care environment may cause the service user to take their anger or frustration out on members of staff in order to influence their carers in to doing things they may not normally do. Resentment can cause some professionals to avoid helping their service user at risk of having to deal with their service users’ challenging behaviour.
Medical Conditions (e.g. Alzheimer’s)
People with learning disabilities and/or medical conditions may sometimes have very little choice or control over their lives, which can cause challenging behaviour to develop. A service user who is not given choice, and is capable of controlling daily activities could develop challenging behaviour as a way in which they are able to influence changes. Common conditions such as infections, etc. may all cause or contribute to challenging behaviour which may result in behaviours becoming aggressive, etc.
Frustration can happen when there is little cooperation (for example, at mealtimes) where there may be displays of challenging behaviour because a highly physically dependent service user may find it difficult to show emotions and ask for help. Anger from being unable to do activities for oneself, they may display challenging behaviour because they are too angry to express it in another way, so use it as an aggressive outlet.
Something is Wrong
If a service user finds that something is wrong they may exhibit challenging behaviour as a way of dealing with that issue. When they are unable to express how they are feeling, service users may be hiding from the issue rather than confronting it because they take their anger out on others.
Write a Short Paragraph about what might Trigger Challenging Behaviour to Occur
Service users who may display challenging behaviour may need to be observed in order to find their individual triggers that could be avoided to prevent challenging behaviour from being used to harm themselves and their carers. Some challenging behaviour is triggered by tough, confusing and unresolved emotions that may cause confusion and pain. If these situations are near the service user, they may respond by acting violently which should be taken away from the service user so that they can adapt their behaviour to the situation, regaining control over their behaviour.
For example, if a service user is in a noisy environment/situation which may be upsetting to them or may cause them to become distressed and unable to control their emotions, the carer should take the situation and change it to suit everyone and their responsibility is to take the service user away from the noisy environment. The service user could have counselling and learn techniques to remain calm and try not to seem angry or upset, even though they might be feeling it, so that they can avoid reacting with ‘challenging’ behaviour.
Josephine is 24 years old and she has demonstrated challenging behaviour since she was a child diagnosed with autism with a severe learning disability and extreme, challenging behaviour. Josephine arrived at Autism Care under the terms of an aftercare plan following countless unsuccessful placements in secure and residential settings. At this point the only consistent thing in her life was very short, unsuccessful placements and this has resulted in Josephine expecting placements to end after a period of approximately two months. For the first three months of her placement Josephine displayed some extreme cycles of challenging behaviour which included aggression towards staff, self-injury and serious destruction of property. Therefore Autism Care recognised that it was vital to introduce a scheduled timetable enabling Josephine to have a better concept of time.
We divided her time into two-day periods and completed a behavioural assessment. This enabled us to identify agitation at the earliest possible stage, allowing staff to intervene and refocus her attention onto a meaningful activity in order to de-escalate her anxieties. Over time Josephine built trust with staff and developed therapeutic relationships with them which, over the course of approximately two years, improved her life immensely. Her anxieties gradually decreased and her community presence increased. With our support to maintain family contact and develop a person centred care package, the difficult challenges that she faced throughout her life previously, steadily decreased and the number of incidents of challenging behaviour are now a rare occurrence.
Case Study is from the above website