Promoting Positive Behavior in Health & Social Care: Contexts & Interventions, Exercises of Communication

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Health and Social Care – Cambridge Technicals

Unit 12 – Promote positive behaviour

The table below shows all the topics you will cover. Learning outcomes What you must know 1.Be able to promote positive behaviour Understand the contexts where the promotion of positive behaviour is required ✓ Acute psychiatric settings ✓ Residential units for people with learning disabilities ✓ Services for people who are elderly an confused ✓ Some child care settings ✓ Foster care Positive behavioural support – ‘a framework to understand the context and meaning of behaviour in order to inform the development of supportive environments and skills that can enhance a person’s quality of life’. (Positive and Proactive Care, reducing the need for restrictive interventions, Department for Health, 2014) Best practice ✓ Use person-centred, values-based approaches ✓ Assessment – must understand probable reasons why a person presents behaviours of concern. Knowing the individual’s personal and medical history – health issues that contribute to behaviour, personal likes and dislikes, possible triggers. Assessments must have input from the individual, their carers, relatives or advocates. Identifying patterns of behaviour ✓ Identifying precursor behaviours – tense muscles, pacing, sweating, facial expressions, increased breathing rate

significant risk of harm to the individual or others around them Evaluation of best practice ✓ Peer review ✓ Formal observation of practice ✓ Supervision ✓ Self-reflection on your practice 2.Understand situations in which staff are required to use reactive and restrictive interventions Situations ✓ Preventing someone from harming themselves ✓ Holding a person to receive a medical treatment in a planned situation ✓ Holding someone to receive medical treatment in an emergency situation ✓ Self-defence ✓ Escaping from violence ✓ Protecting vulnerable people from violence Recognising stages of behaviour ✓ The green ‘Proactive’ phase – where the person is feeling mostly calm and relaxed and is able to engage positively with you in a meaningful way – no action required ✓ The amber ‘Active’ phase – where the person may be starting to feel anxious or distressed and there is a chance that he/she may need to challenge you in some way – self-management can reduce this or secondary strategies may need to be implemented ✓ The red ‘Reactive’ phase – where challenging behaviour actually occurs and there is a need to do something quickly to achieve safe and rapid control over the situation to prevent unnecessary distress and injury –

tertiary strategies to be applied in the least restrictive way possible. Certain strategies can only be applied in hospitals and with individuals detained under the Mental Health Act ✓ The final blue ‘Post Reactive’ phase

• where the incident is over and the person is starting to recover and become calm and relaxed again. Caution as there is a risk of behaviour escalating again 3.Be able to use interventions to promote positive behaviour, considering the impact on the individual Proactive interventions ✓ Effective communication – awareness of verbal and non-verbal communication ✓ Maintenance of good interpersonal relationships – building positive relationships ✓ Follow any plan made to monitor and control behaviour ✓ Recognising early triggers and respond
• reduce the occurrence of challenging behaviour ✓ Prevention and early de-escalation – adopt strategies planned to de- escalate behaviour Reactive interventions – interventions that are brought into play once unforeseen behaviour that challenges occurs ✓ Appear calm ✓ Be aware of body language ✓ Distraction and redirection ✓ Theory of proxemics – demonstrate the effect invading personal space will have on escalating or de-escalating challenging behaviour Restrictive interventions

positive behaviour ✓ Section 3 Criminal Law Act 1967, Common Law ✓ Health and Safety at Work Act 1974 ✓ Human Rights Act 1998 ✓ Police and Criminal Evidence Act 1984 Guidance ✓ Positive and Proactive Care – reducing the need for restrictive interventions (2014) ✓ A positive and proactive workforce (2014) Key terms ABC chart The aim of ABC charts is to identify between the behaviour and its antecedent and consequent events, to aid understanding of the function that a particular behaviour serves for an individual. A stands for Antecedent, B for Behaviour and C for Consequence Acute psychiatric settings Advocates of individuals An acute psychiatric setting is where people are admitted when they are in crisis and who may need safety, monitoring and assessment as well as therapy and medication management Advocates of individuals Advocates represent the views, needs and interests of individuals who are unable to represent themselves. This involves advocates working closely with individuals and on some occasions with others who know the individual well. Advocates may represent individuals bother verbally and in writing. Occasions when this may occur may include at a young person’s review meeting or when there is a change in the health needs of an individual who have dementia

Amber ‘Active’ phase The Amber ‘Active’ phase is where the person may be starting to feel anxious or distressed and there is a chance that he/she may challenge you in some way. In this phase the person is expressing that they are anxious; wanting something they are unable to ask for; not liking something; feeling bored, etc. These are early warning signs and provide the opportunity to intervene before the behaviour escalates to challenging behaviour Assessment An assessment of behaviour is usually called a functional assessment or functional analysis and aims to identify possible causes of an individual’s behaviour and determine the best ways to promote their positive behaviour Autonomy Autonomy is allowing individuals to make decisions and choices about their own life Behaviour support plans Behaviour support plans are developed after an individual has had an assessment. They:

• Provide carers with clear strategies for promoting an individual’s positive behaviour
• Aim to achieve rapid, safe, and effective control of risky behaviour Behaviour support plans include:
• Primary preventative strategies
• Secondary preventative strategies
• Tertiary strategies Blue ‘Post Reactive’ phase The Blue ‘Post Reactive’ phase is where an incident is over and the person is starting to recover and become calm and relaxed again Body language This refers to a form of non-verbal communication in which thoughts, feelings and intentions are expressed. For example

De-escalate De-escalation refers to reducing the intensity of a conflict or potential challenging situation Diabetes (^) A disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. There are two main types of diabetes; in Type 1 diabetes, the body lacks the cells which produce insulin in the pancreas; in Type 2 diabetes (which is common, and often develops later in life) the cells of the body fail to respond to insulin normally and the pancreas does not produce enough insulin Diversity The concept of diversity means positively recognising and understanding that each individual is unique and different. For example, this may be in relation to an individual’s abilities, sexual orientation or religious beliefs Epilepsy A neurological disorder marked by sudden recurrent episodes of sensory disturbance, e.g. loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain Green ‘Proactive’ phase The Green ‘Proactive’ phase is where the person is feeling mostly calm and relaxed and is able to engage positively with you in a meaningful way Interpersonal skills Interpersonal skills are the life skills we use every day to communicate and interact with other people, both individually and in groups Legislation Refers to the process of making or enacting laws. Laws are debated and passed by Parliament and are upheld by the judicial

system. There are a number of laws that promote positive health including;

• Mental Health Act 1983
• Mental Capacity Act 2005
• Deprivation of Liberty Safeguards (DOL’s)
• Section 3 Criminal Law Act 1967 common law
• Health and Safety at Work Act 1974
• Human Rights Act 1998
• Police and Criminal Evidence Act 1984 Mechanical restraint Mechanical restraint refers to; ‘the use of a device to prevent, restrict or subdue movement of a person’s body, or a part of the body, for the primary purpose of behavioural control’. The use of mechanical restraint to manage extreme violence directed towards others could be exceptional, and seldom used in this or other context outside of high security settings Mental health (^) Refers to the condition of a person’s psychological and emotional wellbeing Pain This refers to the physical or emotional sensation of suffering or distress that can be caused by an illness or an injury. For example, an individual could experience both physical and emotional distress after having a fall; the individual may have sustained a broken bone as well as being no longer able to walk unaided which may lead to the individual feeling unhappy Person-centred approach The person-centred approach was developed from the work of the psychologist Dr Carl Rogers and involves believing in the potential and ability of individuals who require care or support to make their own

of communication such as signs or picture cards to indicate they have finished an activity or to ask for a drink Positive relationship Positive relationships are meaningful ways of interacting with others that result in positive emotions such as happiness, enjoyment and peacefulness as well as a sense of wellbeing. Positive relationships are constructive and beneficial for all those involved Precursor behaviours Precursor behaviours can sometimes precede a specific challenging behaviour e.g. tense muscles, pacing, sweating, facial expressions, increased breathing rate. Identifying precursor behaviours can assist in developing effective strategies to promote positive behaviour Primary preventative strategies These consist of changing aspects of a person’s living, working and recreational environments so that the possibility of challenging behaviour is reduced – reducing noise levels for some individuals may reduce levels of anxiety and distress Reactive interventions Reactive interventions are brought into play once unforeseen behaviour that challenges occurs;

• Appear calm
• Be aware of body language
• Distraction and redirection
• Theory of proxemics Red ‘Reactive’ phase The Red ‘Reactive’ phase is where challenging behaviour occurs and there is a need to do something quickly to achieve safe and rapid control over the situation to prevent unnecessary distress and injury Restrictive interventions Examples of restrictive interventions;
• Physical restraint

• Mechanical restraint
• Chemical restraint Secondary preventative strategies This is where distraction or diversion activities are undertaken by staff to prevent escalation Social environment The social conditions that influence the building of relationships such as individuals and professionals background, education, interactions with others Technological aids Technological aids are designed to enable children and adults to communicate more easily. For example, a Dynavox, that resembles a tablet PC, can be used by children and adults who are unable to speak by providing them with words and messages that they can access via touching a screen that contains text, pictures and symbols; it then converts those that are touched into speech. Light writers are text-to-speech devices, also designed for individuals who cannot speak but who are able to write and type a message on the keyboard that is then displayed; the message is then converted into speech Tertiary strategies Tertiary strategies are reactive measures such as restrictive interventions which should only be used when there is significant risk of harm to the individual or others around them Theory of proxemics Proxemics is a theory of non-verbal communication that demonstrates the effect that physical distance will have on escalating or de-escalating challenging behaviour, e.g. it is important not to invade an individual’s personal space Tone This refers to the pitch and strength of a vocal sound made by a person in a