Challenging Behaviour what good support looks like Tony
Challenging Behaviour what good support looks like Tony Osgood Lecturer in ID / Private Consultant
Challenging Behaviour: social construction, visceral experience, impactful Challenging Behaviour: learning, biological, social, psychological influences examined by functional (and other) assessments Challenging Behaviour: responding…? Behavioural model application
Records as Artefacts “There seemed to be universal requirements for goals to be measurable and for data to document progress. As a result many people who created the plans learned how to write goals that were measurable but not meaningful. Value goals such as ‘one community outing weekly of his choosing’ were met by activities like going through the drivethrough window at a fast-food restaurant. ” ” (p. 383) Smull, M. , Lakin, K. C. , (2002) Public Policy & Person-Centred Planning. In S. Holburn & P. Vietze Person Centred Planning: research, practice and future directions, p. 379 -413, Baltimore: Brookes
Deciding What Counts Some people’s ways of communicating leave the important people in their lives unable to hear their views about a life that would make sense. These other people have little choice but to create a story with a valued and central role for the person, whose preferences remain ambiguous. Then, these people make adjustments based on the person’s responses to the real settings and experiences that resulted (O’Brien, 2002, p. 412) O’Brien, J. , (2002) The Ethics of Person Centred Planning. In S. Holburn & P. Vietze Person Centred Planning: research, practice and future directions, p. 399 -414, Baltimore: Brookes
PBS practitioners, fluent in behavioural technology, should be equally skilled at listening hard to family members’ subjective experiences that accrue from loving someone whose behaviour is impactful. We are privileged to hear family stories of heartache and fear, joy and hope. When challenging behaviour arises, the child regardless remains at the heart of family life. Love doesn’t disappear.
There is a difference between knowing a family or team and working with a family or team. What we count might not count to families or teams. What matters to families or teams might not matter to the metrics of effectiveness our employers seek.
Families & teams want solutions and supports. Person-centred practitioners are unfortunately too often ‘remarkable events’: finding someone with good technical knowledge who will listen to family contexts and collaborate in understanding and responding to challenging behaviour is essential
The small things a family or staff group seeks are not small things to them Like research, no family or team is perfect but then again neither are professionals
As well as being real and impactful, challenging behaviours are a symptom of an unquiet life, an unheard complaint or an unmeasured joy. They are a call to action to teach new ways of doing, and a reminder for us to remember what we’ve forgotten we know.
So, let’s design a competent ecology physical social-interactions & communication crisis response educational (home as a learning environment) organisational structure
A competently designed ecology produces what? quality of life? quality of profits? A competently designed ecology is produced by whom? commissioners? professional stakeholders? CQC?
Remember “People with severe handicaps rely on other people’s cooperation to an unusual extent, and human services play a larger than ordinary role in their lives. . . People with severe handicaps count on more able people’s planning and organising skills. . . ” O’Brien, J, 1987, p. 175 O’Brien, J. , (1987) A guide to lifestyle planning : using the activities catalog to integrate services and natural support systems. In B. Wilcox, & G. T. Bellamy, (Eds. ) A Comprehensive Guide to the Activities Catalog : An Alternative Curriculum for Youth & Adults with Severe Disabilities, Baltimore, Paul H Brookes Publishing Co.
Metaphors for Organisations (Morgan, 1986) How we conceive of organisations influences our behaviour toward them Do you think of organisations as mechanistic, an organism, a brain, a prison, a relationship hub, as cultures, as instruments of domination, or as sites of transformation? Knowing the metaphors operating helps our ability to think of ways of changing culture. Identifying what individuals think about the organisations they work within is important when seeking to establish why performance is at it is.
Metaphors for Organisations If we conceive of organisations as mechanistic things (input = output) we treat people as components This happened in the UK - and resulted in leaders becoming managers/administrators The output in this model should be good lifestyle of people using services, but because of the thinking about the purpose of organisations, bureaucratic demands take precedence: the paperwork is more important than the people (Mansell & Elliot, 2001)
Frederick Taylor, the American engineer who evangelised the approach known as Scientific Management pointed out to workers: “You are not supposed to think. There are other people paid to think around here” (Morgan, 1986, p. 32).
Organic Metaphor Selfcommitment Actualisation Ego Physiological workenhanced identity recognition Social interactions relationships belonging Security tenure pension career opportunities health & wellbeing safety salary working conditions rest
Records as Artefacts Many remain suspended in “nineteenth-century patterns in twenty-first century places” (O’Brien, 2005, p. 261) “The institution is a trap for people. Just getting out of the institution doesn’t mean getting out of the trap” (2005, p. 259). O’Brien, J. (2005) Out of the Institution Trap. In K. Johnson & R. Traustadottir (eds. ) Deinstitutionalisation and People with Intellectual Disabilities: in and out of institutions, p. 259 -273, London: JKP
What PBS Can Bring to the Party • Better service commissioning • engaging with managerialism • upstream solutions • Practice leadership • showing, growing • Service design expertise • functional assessment of ego-cologies • Data and Story • numbers and faces
Kingdom of Numbers Auden The Kingdom of Numbers is all boundaries Which may be beautiful and must be true; To ask if it is big or small proclaims one The sort of lover who should stick to faces
Modes of Knowing • Scientific - hypothesis guided empirical studies, which lend themselves to nomothetic solutions (data) • Narrative - meaning from experience, individual and idiographic (stories) Bruner, J. , 1986, Actual minds, possible worlds, Cambridge: Harvard University Press
Validity of Our Measures ‘the database (i. e. , the 109 studies), more concerned with issues of rigour and demonstrations of experimental control, generally failed to focus on larger consumer goals’ (p. 83, Carr, Horner & Turnbull, 1999 - positive behaviour support for people with developmental disabilities- a research synthesis)
murder rates per 100, 000 (2011/12, UNODC Study) UK Iceland South Africa Jamaica Honduras 1. 0 0. 3 31. 00 39. 3 90. 4
‘Behind every behaviour that a person shows lies a story- a story about the person, the world she lives in and the day to day interaction between her and her world. The more elements of this story that we can identify the more avenues will be open to us for supporting her in constructive ways’ (Clements & Zarkowski, 2000)
stories We hold our own stories, and those of the people we love. We write our own stories and those of people around us each day Who holds the ‘stories’ of people with disabilities? What do they say? Is it written in data or words? Who writes their stories? The person gathering data, publishing research? The nursing notes or daily diaries?
‘Conceptualizing & documenting positive changes in intervention goals such as personal fulfilment, self-determination, happiness, friendships and even contributions to the social good will, no doubt, be difficult… but these are the outcomes that matter, and should become the goals of intervention if persons with disabilities are to become full participants in their family, community & culture’ Meyer & Evans (1993, cited in Fox and Emerson 2002)
Records as Artefacts “the thousands of hours of effort required in the late 1990 s to produce grade-A, inspectorapproved individual plans offered people little real improvement over the experiences of people whose diagnoses Wolfensberger anazlyzed 30 years before. What makes the difference to a person who relies on services is what the service offers every day, not what the plan says” O’Brien, J. , (2002) The Ethics of Person Centred Planning. In S. Holburn & P. Vietze Person Centred Planning: research, practice and future directions, p. 399 -414, Baltimore: Brookes
Bureaucratisation of Lives “The shelves in the staff office are lined with binders that document the lives of residents in multiple ways: daily, weekly, monthly, annually. These books, and the forms they contain, are more than just instrumental means of administrative and clinical operation; they are technologies that organise group home work, in its course, as a central aspect of the work. They involve many of the techniques for monitoring, assessment, and intervention, that shape what (staff) can see, know, or do…” (p. 163) Levinson, J. , (2010) Making Life Work: freedom and disability in a community group home. Minneapolis: UMP
If a factory is torn down but the rationality which produced it is left standing, then that rationality will simply produce another factory. If a revolution destroys a government, but the systematic patterns of thought that produced that government are left intact then those patterns will repeat themselves. . There’s so much talk about improving the system. . . and so little understanding. –Robert Pirsig
“Quality is determined by responsiveness to the person served rather than compliance with organisational processes or regulations and standards” (Gardner & Nudler, 1999, p. 13)
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