Tag Archives: support worker

Privileged glimpses 18: Behaviours that harm the individual

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

Behaviours that harm the individual

For those of us who work in health and social care it can be very distressing and frustrating to see our service-users undermine their health, their social situation or their state of mind. At times like these there is a temptation to intervene and simply try to prevent the behaviour. Of course sometimes this is appropriate and necessary, for example if the service-user appears to be actively suicidal, but not always. Often there is a judgement to be made between potential damage or harm and the benefit of experience that will help the service-user to learn from their mistake. Everyone learns best from consequence and it’s not necessarily helpful to shield people from the consequences of their actions. The more we intervene and prevent people from making mistakes the less they grow and develop in our care.

This might seem like a simple point to make but it’s also a fundamental principle that goers to the very heart of health and social care work.

If we accept that our job is to help people to be all that they can be and in most cases to grow beyond the need for our help then we must also help them to learn how to cope without us. They need the skills and understanding necessary to survive in the ‘real world’. It’s our job to help them to develop these skills before they leave us. After all, there’s no point expecting them to survive outside our care if we haven’t helped them to prepare, to take a few (managed) risks, and to learn how to deal with disappointment too.

Part of that preparation, that development is to learn how to take responsibility, understanding that actions have consequences and that in the ‘real world’ we all have to face them. We do our service-users no favours by teaching them that they don’t need to face the consequences of their actions.

This is why, for example, a service-user who damages property should be given a bill. This is why the young person who sulks and refuses to come down for dinner should go hungry (provided that there’s no physical or psychiatric reason behind the refusal). People learn from the consequences of their actions and it is not the job of social care staff to prevent that learning process from happening.

So when the challenging behaviour is detrimental to the service-user themselves the first decision to be made is whether to intervene at all. If you do intervene it should be because the risk of harm to the individual is greater than the benefit of them learning from their experience. Often a debrief after a mistake is much more productive than intervening to avoid the mistake in the first place.

I’m assuming that, before we even begin to consider behaviours as challenging the normal process of discussion and ‘advice’ (always something to be cautious about) has been followed and the service-user has not responded to that.

This is why most of the time we focus very little of our attention on the challenging behaviour itself. Much more time and effort should go into the debrief and the process of encouraging behaviours we want to maintain rather than trying to discourage behaviours that we want to reduce. Generally speaking the more that we focus upon a behaviour the more it recurs anyway so only intervene if you have to.

Remember that our duty of care doesn’t ask us to prevent the development of coping skills and independence – only to assess and manage the risks associated with that growth so far as is reasonable and lawful.

Privileged glimpses 17: Challenging behaviour means …

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

There are many different definitions of challenging behaviour. Some rely upon long lists of activities and behaviours that society sees as unacceptable. Others attempt to define the concept philosophically by referring to the works of ethical or moral authorities, sometimes dating back thousands of years. Throughout this series we shall use a fairly simple definition.

Challenging behaviour means

Challenging behaviour is a combination of two criteria:

  1. Behaviour that we don’t like;
  2. Behaviour that we think we need to respond to.

According to this definition both criteria must be met before we can say that the behaviour is challenging. For example, someone somewhere has been attacked within the last thirty seconds (a statistical certainty). I am not challenged by that because I am not in a position to respond to it. Therefore the behaviour is merely something I disapprove of but it is not actually challenging to me because there is nothing for me to do about it.

It’s important to get the sense of this definition clearly in mind before we go any further with this topic. Much of what people think of as challenging behaviour is not really challenging at all. We don’t have to respond in every case. Arguably, if we do respond and try to prevent people from doing things that they have a perfect right to do then the truly challenging behaviour is our own – not that of the service-user. Disagreeing with the care staff is not necessarily a challenging behaviour – it’s just a choice.

One of the most common problems among health and social care workers is the assumption that they have to ‘deal with’ behaviours that they do not personally agree with. This isn’t always true and by adopting a more flexible approach to the choices of service-users we can avoid many of the conflicts that make this work so difficult in practice.

Another important theme is the right of the worker (and others) to be free from abuse, assault or harassment. The law in UK, in particular the Health & Safety at Work Act (1974), is very clear on the responsibility we all have to keep ourselves safe and the need for proper assessment of risk. This is intended to ensure the safety of the service-user but also that of the worker and the person’s other carers or relatives. We’ll also consider ways to strike a realistic and reasonable balance between the needs of all concerned and the rights of all people to be safe and free from abuse.

Different types of challenging behaviour require different types of approaches. This is one of the most fundamental principles of challenging behaviour work and yet it is overlooked with alarming regularity. Just as with other challenges we come across in life, behavioural regimes and strategies are most effective when we take the trouble to understand the problem before we begin work on the solution.

In the broadest sense behaviours can be divided into two basic categories:

  • Behaviours that harm the individual;
  • Behaviours that harm other people.

Of course some behaviours will fall into both these categories so it’s not quite so simple as all that but this way of thinking does, at least provide us with a starting place. In the next post we’ll begin to look at these categories in turn.

 

Privileged glimpses 14: You’re probably not an emergency service

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

In the last post we covered the saviour fantasy and the importance of sticking to what we know, what we’re trained for and what we are equipped to do. This post has a similair theme but with far more obvious consequences. But before we get into that let’s begin with a little definition.

In the social care context an ‘emergency’ is something that requires emergency services to deal with it. Non emergency staff may have a supporting role to play in the proceedings but they are not responsible for sorting out emergencies and they are not expected to place themselves at risk by ‘going in’ untrained, unequipped and unprepared.

Emergency services

If it doesn’t need emergency services it’s not an emergency. It may be something that’s better sorted out sooner than later but it’s not worth putting yourself or others at risk simply because other people don’t want to wait until it’s safe or until the appropriate staff are present.

If you work in healthcare the same basic rules apply although you may legitimately be the appropriate person to deal with it. If so you will have been trained to do so and you should know the limits of your responsibilities very clearly. If you’re not able to deal with the emergency then call someone who can.

Emergency services are:

  • Fire
  • Police
  • Ambulance
  • Coastguard
  • Mountain Rescue

All can be contacted by calling 999 or whatever internal emergency code your organisation uses (for example to summon the identified crash team in a general hospital).

If you’re a support worker in sheltered housing or a community care assistant for example then it’s not your job to deal with emergencies. Your job is to offer what assistance you can whilst help is on the way but only so long as it is safe to do so.

If you doubt this consider…

Would a fireman prefer to deal with one unconscious casualty or with one unconscious casualty and a disorientated amateur with no respirator or training in how to deal with smoke?

Would a paramedic prefer to deal with your injured colleague immediately or when you got around to calling 999 after trying to apprehend the assailant?

Would a policeman prefer to apprehend an assailant or deal with an assailant and organise help for a second vicitm as well?