Course Outline
Value Base
This session describes the values which underpin good quality, person centred planning and action. The emphasis is on a proactive model of adult care with a focus on quality of life and wellbeing interventions rather than reactive approaches. Evidence shows that such an approach nurtures capable environments within which needs are better understood and met. A natural corollary of this is reductions in restrictive practices and behaviour that challenges.
The principles of reducing restrictive practices and social validity are set out as core values and the insidious relationship between restrictive practices, diminished quality of life and increased behaviours of concern is highlighted. Within this model punishment-based strategies are rejected as counter-therapeutic, ineffective, and inappropriate in working with adults. Rather the model works by holding adults in unconditional positive regard, building on strengths to teach new skills and behaviours, defending rights, improving quality of life, and changing environments to ensure peoples needs are met. Our job is not to ‘fix’ people, it’s to fix environments that aren’t working for them.
This is brought to life through looking at the often-torrid treatment people with learning disabilities experienced in the past. More recent examples of what happens to staff and service users when Human Rights and person-centred values are abandoned are also discussed (Winterbourne View 2011, Whorlton Hall 2019).
We also look at what it means to be a ‘trauma informed’ practitioner and why this is so important.
Understanding Behaviour
This session uses Darren Bowring’s reinterpretation of The Bio/Psychosocial Model to identify some of the biological and social factors which mean that people with learning disabilities may be more vulnerable to behaviours of concern. Factors such as genetics, past trauma, impoverished social networks and lack of meaningful activity are examined. The negative impact of these behaviours on the quality of life of the service user and those around them are examined as is the cyclical nature of the process as behaviours are reinforced by either our responses to them or naturally occurring reinforcers.
Building on the foundation level course or prior learning additional vulnerabilities for people with learning disabilities to be exposed to trauma are examined. Therapeutic responses to trauma are also covered, in particular the centrality of relationships and connections over talking therapies as appropriate for adults with learning disabilities. This session takes into account Wigham and Emerson’s (2015) research which cautions us not take a disempowering, paternalistic perspective which casts people with learning disabilities as lacking in resilience and agency.
Capable Environments
This session looks at the importance of including practices and interventions designed to improve quality of life outcomes. Reducing restrictive practices and engaging people in meaningful activities, building relationships, and enabling choice and control are key concepts here.
Participants will look at the key characteristics of capable environments. People with learning disabilities can live more fulfilling lives in their community when we work hard to make sure we create an environment that meets their needs. This includes staff engaging in positive interactions in a way the person enjoys and understands, consistent and predictable environments and encouraging independence and opportunities to learn new skills.
Staff will have access to a range of tools and strategies to assist them with this including The 5 Service Accomplishments (O’Brien & O’Brien 1998).
Functional Assessment
The concepts of form and functions of behaviour are discussed. Functions are looked at through a trauma informed lens and staff will learn how to use SE-ABC charting approaches and the Motivation Assessment Scale to add clarity to their understanding of the purpose of specific behaviours of concern
Participants will gain an understanding of the importance of linking proactive and reactive strategies to known functions of behaviour to improve positive outcomes. They will also be able to identify strategies to use in their behaviour support plans.
Individualised Positive Behaviour Support Plans (IPBSP)
IPBSP’s are intended to ensure consistency of approach in delivering proactive strategies aimed at reducing restrictive practices and improving quality of life outcomes. Implementing behaviour support plans with fidelity means that services users’ needs are better met, they can do more things for themselves, are meaningfully engaged and happier. A natural corollary of this is reductions in behaviours of concern.
This session looks at the structure of behaviour support plans and what information and strategies go in each section. Participants will be able to identify who requires a plan (and who does not) and why. The difference between proactive preventative, proactive developmental and reactive strategies will be clearly outlined. Participants will understand that the proactive strategies will form the largest element of the plan.
Reactive Strategies (de-escalation)
When proactive strategies fail, reactive strategies are used to try and de-escalate behaviours of concern and in worst case scenarios, restrictive physical interventions (RPI) may be used for rapid safe situational management.
This session uses the Arousal Cycle as a platform for understanding what’s going on for an individual as they traverse the stages. We can then apply this understanding to determine what strategies might be useful at each level in helping a distressed individual regain their equilibrium.
There is a strong focus on maintaining a low arousal approach and engaging empathic attunement to reassure the service user that they are both safe and in safe hands.
Generic de-escalation strategies are identified as well as strategies known to work well specifically for people with learning disabilities.
‘None aversive reactive strategies’ (NARS) are presented as potential alternatives to physical restraint for behaviours that have escalated to crisis level.
Post crisis support is also discussed, and participants will understand the critical importance of reattunement and reassurance and that once an incident is over relationships are intact and the person is still a valued member of their peer group.
Reducing Restrictive Practices
Key characteristics of restrictive practices are described in this session. Participants will focus on both overt restrictions (restraint, seclusion, mechanical, medical and psychological) as well as more ‘subtle’ institutionalised practices all of which diminish quality of life and result in increases in challenging behaviour. Staff will acquire knowledge in evidence-based approaches designed to reduce restrictive practices.
Wellbeing and Quality of Life Interventions
Strategies aimed at improving quality of life and wellbeing are cat the heart of proactive approaches, improving quality of life and reducing restrictive practices. This session identifies what is meant by quality of life, wellbeing and happiness as an intervention. Staff will leave with knowledge of a number of tools designed to assess and improve the wellbeing and quality of life of the people they support.