Four questions to ask when supporting a person with challenging behaviour
Answering “no” to any of them will help you pinpoint issues you should address through Active Support.
1. Does the challenging behaviour happen as often when your best support worker is on duty?
This is the most useful question you can ask because there is always some variation across a team, and as soon as you’ve identified anything that could be related to the challenging behaviour, you can change it.
It may not actually be down to the level of skill of your best support worker – it could be a range of characteristics that staff display at work that are affecting the person – but both are relevant.
Teams often know very well what’s going on, but we don’t always recognise how important different support styles are or how we should change them. In these sorts of discussions, staff say to me: “Well, of course there’s less challenging behaviour when Joan’s on duty – he likes Joan” as if that has no bearing on the situation, when in fact they’ve hit the nail on the head. The person is responding to what Joan does and the way she does it, and if the rest of the team were more like her, the person would exhibit less challenging behaviour.
2. Is the person busy successfully doing a range of things they enjoy, both out and about, and at home?
If they’re not, challenging behaviour is inevitable. Human beings crave activity and interaction, and without them we start to behave in ways that others find unacceptable.
Often, managing challenging behaviour can create an all too common vicious circle: because the most logical response to risk is remove it, a person we support’s relatively fulfilling life can become diminished over time, leaving long ‘empty’ periods of inactivity during which everyone just waits for an episode of challenging behaviour to occur. And due to this lack of engagement, challenging behaviour will happen, which of course justifies our caution: “You see, he can’t go to the pub because of the challenging behaviour!”
No matter how hard it is, the response to any activity going wrong is to work out how to make it more successful for the person (easier, jollier, quicker, longer, earlier, later – whichever applies) and, if that doesn’t work, to do something else instead – not nothing. And this connects with our third question…
3. Is life predictable for the person?
Again, if it’s not, challenging behaviour is almost guaranteed. If the person is uncertain about what’s going to happen, when and how, their anxiety and stress will inevitably be expressed as challenging behaviour.
Of course you need plenty of things happening, as question 2 attests, but when we have a range of possible events and activities, we need to line them up so that they form a map of how life works for the individual. Engagement and predictability must go hand in hand.
4. Does the person have as much control as possible over the things that matter most to them?
Active Support makes it clear: we must maximise choice and control for people we support. This is ethical and also practical because people who don’t experience sufficient control over their lives are very likely to display challenging behaviour.
This means we need to strike a balance of control that respects a person’s rights, regardless of any challenging behaviour. Choosing how to do something can make a really significant difference to them.
Our Active Support guide and Promoting Person-Centred Support and Positive Outcomes video resource give a fuller explanation of the issues around control, predictability and engagement, and by subscribing to our Best Practice newsletter you’ll receive valuable tips and techniques.
Why do we recommend Active Support as the default approach when supporting people whose behaviour is challenging?
Because if staff are good at Active Support, they pay attention to consistency and detail, remain objective and plan more carefully; they develop a shared understanding of their purpose and make a commitment to working together to produce high-quality outcomes for the people they support.
These are conditions that will generally reduce the chances of challenging behaviour occurring, while the skills and habits required of staff make it easier for them to implement Positive Behaviour Support where it remains necessary.
From every angle you look, it just makes sense to concentrate on Active Support with people whose behaviour is challenging.
John Ockenden is practice development coordinator at United Response.