CHC52015 Diploma of Community Services

CHCCCS009 Facilitate responsible behaviour

Case Study 1: Helping S to manage challenging behaviour

S is an 18-year-old man with Learning Difficulties, Autistic Spectrum Disorder traits, and Behaviours that challenge. He came to Ashdown Care from a long time spent living in a hospital environment. He demands a lot of positive social interaction and will force others to interact with him. S's challenging behaviour has included running away from support workers, destroying his own flat and the communal areas, and lashing out at support workers and strangers when out in the community. S finds it difficult to negotiate day to day demands and his capacity to monitor and control his impulses are limited.

S's behaviours were recorded on a daily basis and certain patterns were observed. Based on detailed records a Positive Behaviour Support Plan and corresponding risk assessments were developed.

As a result, S was offered a structured day time activity programme which was developed based on his preferred activities:

• Going for walks/runs in the countryside
• Playing video games
• Going out in the car
• Watching films
• Using a sensory room in an Activity Centre

S was given lots of positive attention and feedback throughout the day/evening. Staff continued to offer this regardless of any disruptive behaviour he may have shown. Initially the risks to the public and staff were minimised by only taking S to wide open spaces with very little community integration where he could walk and run. Over a period of several months the triggers for his behaviours were monitored as more community integration was introduced into his weekly activities. Eventually staff were able to support S to use public transport and attend a cinema.

By providing consistent support and positive approaches in a phased way by all members of staff the frequency of S's challenging behaviour in an internal and community setting was dramatically reduced and his quality of life improved. This experience changed our working practice because initially the professionals involved in S's care could not envisage this amount of progress being made with this individual and did not really encourage us to take positive risks. However, the support staff involved in S's care believed that they could achieve these outcomes for S, we decided to support their development plans under close supervision from both the Manager and Social Workers. This case study demonstrates that with sustained effort of a highly experienced staff team, the life of what may seem like a very difficult individual can be enhanced to a level which could not have been imagined in a hospital environment.

Task 1: Use information from case study and fill up S's Behaviour Log below

S's Behaviour Log Behaviour Log for: Medications:' Disability: Log begun (month, day, and year):
Date	What happened or what was the behaviour?	Where and when did the behaviour take place?	What was taking place right before the behaviour happened	Other comments, details, or factors involved.	What happened after the behaviour? (action taken by care staff, others or S)

Task 2: Develop Behaviour Intervention Plan for S.

Individual Behaviour Intervention Plan
Person's name:	S
Meeting date:	Xx/xx/xxxx
Action team members:	ABC
Intervention Strategies
Strategy 1	Strategy 2	Strategy 3	Strategy 4
Implementation Plan
Tasks and required resources	Person responsible	Timeline
Monitoring and Evaluation Plan
Behavioural goal (specific, observable, and measurable)	Data collection	Person responsible/timeline	Review date	Evaluation decision Monitor Modify Discontinue

Case Study 2:

Mrs A had just left the dining room during tea (barely touched her food). Mrs A was moving around the lounge room rearranging the cushion and chairs. The television was on a loudly and the curtains were drawn, making the room dark. Mrs A moved a cushion near Mr B. Mr B told Mrs A to "bloody get out of it". Mrs A then proceeded to call Mr B "a useless bastard and kicked and punched at him. Sarah (staff) attempted to hold Mrs A to stop her hitting Mr B at which point Mrs A bit Sarah on the arm.

The locum GP was called. John (staff) separated Mr B and Mrs A. Mrs A continued to call out "bloody murderers" and you are all crooks as she paced around the facility until the locum arrived. Mrs A's behaviour were observed from a distance and Donna (staff) offered her a warm drink and a snack but Mrs A refused this.

Mrs A may have been started by Mr B's response. Restraining to Mrs A to prevent her from harming Mr B may have made her more upset.

Mrs A could have been diverted to get her to move away from the situation instead of using physical restraint. Increased supervision and assistance for Mrs A to complete her meal and then provided with purposeful activity which may prevent the situation.

Requirement: Fill up the Incident Report based on the case study information.

Incident Report
Date:	Time:	Person reporting:	Others involved:
Where did the incident occur?
What happened before the behaviour of concern? (Consider cumulative stressors/unmet needs)
What happened during the behaviour incident? (Describe the behaviour incident objectively, including who was involved, where it occurred, and what the person with dementia did)
What happened following the behaviour incident?
What might have caused the behaviour to occur?
What strategies could you suggest or trial to help avoid the behaviour in the future?