Behaviours of Concern and Physical Intervention Policy

1. Overview

Behaviours of concern

Behaviours of concern are a form of communication which reflects on the needs of the individual, and understanding these needs is the key to easing this communication and reducing behaviours of concern. Forging relationships with the individual and an understanding of individual approaches and de-escalation techniques are first and foremost employed where the behaviour of a service user challenges our service delivery. We take advice from the people around the service user about their understanding of this behaviour and how we respond to this. We develop individual redirection and de-escalation interventions based on the professional advice. We provide training to co-workers based on this advice and we seek to provide the same training and the same management approaches as other people in the person’s life to ensure consistent support. All incidents of behaviours of concern are reported through line management and managers are available at all times to advise co-workers.

Tigh a'Chomainn Camphill prioritises discovering the underlying causes of any behaviour of concern as this understanding may help to prevent it being repeated. A ‘trigger’, is a situation, a person or a way of approaching or talking to an individual that causes the individual to behave in a challenging manner. When this is identified and recognised action can be taken to avoid these triggers. It is therefore essential to observe and reflect on the situation as fully as possible, taking into account any information about the individual which might explain their reaction.

Managing Violence

The Health and Social Care standards definition of restrictive practice is “any restriction to independent movement or freedom of choice, such as a physical barrier”

Sometimes managing violence is part of our work in dealing with behaviours of concern. Guidelines for co-workers are developed and individual redirection and de-escalation interventions are agreed with Registered Managers. All incidents of violence are reported through senior co-workers and workshop leaders and the senior leadership team are available at all times to advise co-workers.

Co-workers in Tigh a'Chomainn Camphill will only use restraint where;

1. Clinicians or senior care practitioners have introduced an agreed intervention plan as the least intrusive option to keep the service user and others safe from harm. The clinician or senior care practitioner also needs to agree what co-worker training is necessary and when this intervention is to be reviewed. Any agreed use of restraint will be formally recorded in Risk Assessments and Support Plans.

2. There is an expressed right given to a named individual to limit someone’s freedom stated in a court order and, in order to provide the support which, we have contracted to provide, we must comply with its terms.

3. In an emergency, when there is a clear and direct danger to the service user or others, the co-workers will use reasonable force to restrain a person if no other intervention will keep the person safe. Any use of restraint in an emergency will be recorded as an incident and will be reported to the Care Inspectorate and to the relevant agencies under Protecting Vulnerable Adults: ensuring rights and preventing abuse guidelines.

2. What you need to know

Residents requiring Physical Intervention must be written up for this in the Risk Assessment and Support Plan.

Physical intervention and limits to freedom:

It must be noted that physical intervention may not always be physical. In Rights, Risks and Limits to Freedom, the Mental Welfare Commission discuss a different aspect of physical intervention, defining it as taking place when the planned or unplanned, conscious or unconscious actions of care staff prevent a resident or patient from doing what he or she wishes to do and as a result places limits on his or her freedom.

This type of physical intervention is also seen as a last resort measure and that co-workers should be vigilant against its unnecessary use. Physical intervention of this nature is only necessary when preventing harm to a person, which will be dependent on the personal and contextual risk. It must also be limited to occasions where that person has a significant degree of diminished capacity to understand the risk that he or she is putting themselves in.

3. What you need to do

In situations of behaviours of concern, the most important objective must be to de-escalate or de-fuse the situation. Because of the diversity of the individuals with whom we work, the way to manage the situation will depend greatly upon the relationships and understandings of those involved. Proactively forging and nurturing these relationships will help us to solve dilemmas such as whether or not to take a firm or gentle approach, or whether to address the matter immediately or give the individual time and space to calm down.

Specifically

• Refer to Risk Assessments in respect of identified behaviours for residents and work in accordance with them.

• Ensure residents have a Support Plan where required, co-workers should be aware of when these are in place.

• Be aware of behaviour trends, trigger factors and signals of distress or agitation through knowledge of the resident and as identified in Support Plans and Risk Assessments.

• Where situations are unforeseeable, use measures to positively alter the situation in which the behaviour may occur. For example:

• Physical presence may be reassuring and may de-escalate the situation

• Disengaging may ease the situation.

• Supporting the person away from the environment.

• Ask other residents and co-workers not directly involved to leave if possible.

• In the event of behaviours of concern which are alarming, ensure that other residents, co-workers and yourself are safe. Do not intervene if you do not consider it safe to do so.

• If you consider that you cannot manage the situation alone seek immediate assistance from another co-worker or manager.

• Be calm, confident and reassuring.

• Give the resident time to talk and to know that s/he is being listened to.

• Offer the resident a dignified ‘way out’ possibly by suggesting they go for a walk to calm down, or to another room.

• Once calm, when appropriate, talk with the resident about what happened, how the situation arose and how they might manage the situation differently in future. Help the resident to learn from the experience. This should be included in the Support plan.

• If all else has failed, and the resident begins to harm themselves or somebody else, damages property, or puts themselves in a situation in which they or others could be harmed, then an unplanned intervention may need to be used.

• Record the incident on an Incident Form giving detail of events leading up to the behaviour, the behaviour itself, who was present, how it was managed and discussions that took place subsequently. Any unplanned interventions, restrictions and physical interventions must be reported. This report must be provided to a manager as soon as possible.

• Discuss the matter with the manager/short term co-worker immediately, following an incident a manager will assess any updates to the Support plan or Risk Assessment. Serious incidents may need to be reported to the GP and Social work which may be followed by a referral to Psychologist or Psychiatrist. Any incidents involving Adult Support and Protection must be reported within 24 hours.

• It is good practice for employees to debrief after an incident, with a member of the Senior Leadership Team or trusted colleague. If the incident has had a significant impact on other residents or co-workers, including the co-worker directly involved, discussion will take place with all affected at the earliest opportunity.

• The incident will be communicated with the relevant co-worker, residents and manager where appropriate.

• Incidents may be discussed at the next review.

• In the event of a serious incident, consideration will be given to convening an additional review meeting.

4. Further Steps

Training

Tigh a'Chomainn Camphill operates a regular training program for supporting adults with Behaviours of Concern. This training includes: Protection of Vulnerable Adults, Behaviours of concern. Where residents are assessed as requiring any physical intervention, co-workers will be trained. Co-workers will only be trained in physical restraint if assessed as essential.

Recording of Incidents

Incidents and the use of physical intervention must be reported and recorded as soon as possible after the event has happened. The recording of an incident involving physical intervention must be included in a review of the support needs of that resident. This is the opportunity to develop a strategy to help prevent the occurrence of behaviour that necessitates the use of physical intervention, through the individual’s One plan.

Reducing restrictions

Where residents are assessed as requiring restrictions in any form, there should be a reduction plan in place in accordance with Rights, Risks and Limits to Freedom.

5. References

Misuse of Drugs Act 2010; Health & Safety at Work Act 1974

“Rights, Risks and limits to Freedom” Mental Welfare Commission