Positive Support Improving Quality of Life Part 3

Positive Support – Improving Quality of Life Part 3 A 2 Day training program for Disability Support Workers

Positive Support – Improving Quality of Life Section 2 – Power Recognising and Reporting Abuse

POWER: Whose life is it, anyway? Vulnerability – • limited communication skills • learnt over-compliance • limited physical mobility • low self-esteem • limited opportunity for sexual or intimate relationships • lack of understanding of abuse and individual rights

POWER: Whose life is it, anyway? Vulnerability – • being very innocent • limited opportunity to form friendships • limited contact or relationships outside of those with people who provide care • no-one in the person’s life to represent them and advocate on their behalf • segregation and congregation with others who are also vulnerable to abuse

POWER: Whose life is it, anyway? Abuse The violation of an individual’s rights where they are subjected to emotional or physical actions that results in significant harm or injury to that person.

POWER: Whose life is it, anyway? Neglect The harm caused as a result of failure of those responsible for the person, to provide adequate personal care, support, food, shelter, clothing, safety or hygienic living conditions.

POWER: Whose life is it, anyway? Exploitation When someone is taking an unfair advantage of a vulnerable person for financial or some other gain.

POWER: Whose life is it, anyway? Indicators of Abuse or Neglect What is meant by an ‘indicator’? An indicator does not necessarily ‘prove’ that abuse or neglect has occurred.

POWER: Whose life is it, anyway? Physical signs of abuse – • bruises • burns • fractures • scratches • cuts perhaps at varying stages of healing

POWER: Whose life is it, anyway? Signs of sexual assault or interference – • torn or missing clothing • sexually transmitted disease • unexplained pregnancy • discomfort in sitting and/or walking • Bruises or bleeding in genital areas • genital infection • sexualised behaviours

POWER: Whose life is it, anyway? Behavioural signs of abuse – • avoidance or fear of a particular person • changes in sleep, appetite, mood swings • withdrawal, unusually passive, out of character, depression • aggression, self-abuse, extreme behaviour • excessively compliant and low self esteem • extreme attention seeking behaviour

POWER: Whose life is it, anyway? Signs of neglect of safety – • repeated injuries • left alone in car Signs of neglect of diet – • frequent illnesses • weight loss or gain • constipation • hunger, stealing food

POWER: Whose life is it, anyway? Signs of neglect of hygiene – • body odour • sores • bad breath • greasy hair • tinea • soiled, smelly clothes • head lice • hunger, stealing food

POWER: Whose life is it, anyway? Signs of neglect of health – • tooth decay • deteriorating health • medication not given

POWER: Whose life is it, anyway? Abuse or Neglect may be criminal. You must report it to your Coordinator.

POWER: Whose life is it, anyway? If someone tells you of abuse, you may be the first person they have talked to. • Your reaction needs to be reassuring. • Find a private place to talk. • Listen and let them tell it in their own words. • Assume they are telling the truth. • Make notes of what they actually said. • Let them know that you will have to tell someone else who can help them.

POWER: Whose life is it, anyway? REMEMBER: You must report it to your Coordinator. You may also need some counselling yourself, and your employer will refer you to a workplace counsellor if you require it. If you have a concern, you must communicate it. Failure to communicate concerns or allegations is an omission in duty of care.

Section 3 POSITIVE SUPPORT a Good Life Positive Support aims to – • Improve the quality of someone’s life • Meet their needs • Happier and more fulfilled • Reduce challenging behaviours by using less restrictive practices

Section 3 POSITIVE SUPPORT a Good Life Eliminating Restrictive Practices “Restrictive practices are those practices which are used to limit, restrict or control aspects of a person’s behaviour, which any other person in the community would consider to be an infringement of their human rights and civil liberties. ”

POSITIVE SUPPORT a Good Life Restrictive practices are – Unethical and inconsistent with internationally accepted human rights Ineffective in bringing about positive, longterm behaviour change A cause of physical and psychological harm for people subject to restrictive practices A cause of physical and psychological harm to those people applying restrictive practices.

POSITIVE SUPPORT a Good Life Remember: People are trying to communicate when they engage in challenging behaviours.

POSITIVE SUPPORT a Good Life In WA the disability sector has adopted a Code of Practice for the Elimination of Restrictive Practices. What practices are restrictive? • • • Psycho-social Restraint Seclusion Chemical Restraint Mechanical Physical Restraint Environmental

POSITIVE SUPPORT a Good Life Psycho-social restraints – • the use of ‘power-control’ strategies • directing a person to stay in one area or room until told they can move • ignoring a person • being left alone • taking away privileges, or using punishment, as a consequence of non-cooperation

POSITIVE SUPPORT a Good Life Social restraints may be subtle – • not allowing choices, decisions, opportunities • coercion, domination, threats • intimidation • imposing your values on the person you support No blame – we need recognise them before we can choose not to do them.

POSITIVE SUPPORT a Good Life Seclusion – placing a person in another room or place and they cannot leave when they want to. Locking a person in a room is unacceptable. ‘Time out’ or sending somebody to their room secludes them from being involved in their environment. ‘Social isolation is thought to be one of the worst types of punishment. ’ Activity

POSITIVE SUPPORT a Good Life Chemical restraint – is the use of mood changing medication to control a person’s behaviour. Consider whether the medication is being used to treat a diagnosed psychiatric condition or simply to sedate the person to control behaviour. Activity

POSITIVE SUPPORT a Good Life Mechanical restraint – using a device to control unwanted movement when it– • restricts free movement • prevents or reduces self-injurious behaviour Other options should be considered first. Adopt a ‘what will it take’ approach rather than starting with thoughts about constraints and restraints. Activities

POSITIVE SUPPORT a Good Life Mechanical restraint – Exceptions include – • something which prevents injury from involuntary body movements, such as seizure, • a therapeutic device for the proper treatment of a physical condition • bed rails to prevent injury while asleep, • postural support • harness for safe transport

POSITIVE SUPPORT a Good Life Physical restraint – using your body or hands to lessen the person’s ability to move, to control a person’s behaviour. It does not mean physical assistance or support related to duty of care or daily activities. Gently holding a person is different to forcefully holding someone’s arms etc. The restraining must be planned, and using the least restrictive means. Activity

POSITIVE SUPPORT a Good Life Environmental Restraint This is restricting a person‘s free access to any part of their environment and objects, when they want it. • locking the person’s fridge or pantry, or • locking away personal items eg a person’s TV Activities

POSITIVE SUPPORT a Good Life Is any form of restraint really needed? Ask yourself: Are the restraints being used in the best interests of the person being supported, or to make things easier for the Support Worker? Least restrictive alternative A person has the right to live in an environment which is the most supportive and the least restrictive of his/her freedom.

POSITIVE SUPPORT a Good Life Where restrictive practices do occur they must: • be the action of last resort • be accompanied by a comprehensive plan to reduce, and ideally eliminate the need for such restrictive practices in the longer-term • be strictly time limited and subject to monitoring and regular review • be accompanied by strategies that promote positive alternatives.

POSITIVE SUPPORT A Good Life From Restrictive Practice to Positive Support • Celebrating individuality and meeting needs • Inclusion through social networks and relationships • Being of value and belonging to the community • Truly listening and communicating on their terms • Getting to know the person well • Supporting them in their hopes and dreams • Offering people control of their own life

POSITIVE SUPPORT A Good Life So how does this work in practice? Example: Melinda has a compulsion to overeat, so for health and safety, we have been restricting access to foods by locking her fridge and pantry.

POSITIVE SUPPORT A Good Life What are some questions we might ask about the person and the reasons for their behaviour?

POSITIVE SUPPORT A Good Life ? Has Melinda always overeaten? If not, when did she start to overeat? ? Has anything changed for her? Has her medication been changed? Have her supports changed? Have her routines changed? ? Is there another way we could assist Melinda? Could we stock the fridge and pantry with healthy lower calorie foods that she enjoys? ? Could we support her to take more exercise? ? Could the fridge and pantry be re-stocked with consumables every day?

POSITIVE SUPPORT A Good Life The key is to uncover what is driving the person’s need to eat and to find a strategy to meet this need in a more appropriate way.

POSITIVE SUPPORT A Good Life Positive Support is all about pro-actively meeting someone’s needs, by supporting them where possible, without restriction, to live in a supportive environment that maximises choice, freedom & quality of life. What would it take for the person to have the kind of life they want to live?

POSITIVE SUPPORT A Good Life What’s a Good Life? Activity

POSITIVE SUPPORT A Good Life Why do people engage in challenging behaviour? • Behaviour is not random. • It’s the person’s way of communicating their needs. We need to learn how each person communicates and what they are trying to communicate to us.

POSITIVE SUPPORT A Good Life 1. All behaviour that persists serves some purpose. 2. Every person is unique. 3. The best way to help someone change their behaviour is to first understand the reasons behind the behaviour.

POSITIVE SUPPORT A Good Life Some behaviours we regard as not acceptable in the context of the environment in which they occur. Activity

POSITIVE SUPPORT A Good Life • Withdrawn • Uncooperative • Aggressive • Socially inappropriate • Safety of person and others • Lead to social isolation

POSITIVE SUPPORT A Good Life • How do we know when the person likes or doesn’t like something? • How do we know when a person prefers one thing to another? • How do we know when the person is happy or unhappy? • How do we know when the person likes or dislikes someone?

POSITIVE SUPPORT A Good Life The Function of the Behaviour • So if behaviour is a person’s attempt to communicate and we concentrate on shutting the behaviour down, we have lost an opportunity to find out what the person is trying to communicate with us. • If we can uncover the function behind a behaviour, we can put in place strategies to better meet someone’s needs.

POSITIVE SUPPORT A Good Life We should not jump to conclusions.

POSITIVE SUPPORT A Good Life Behaviour Recording • ABC Recording Chart • Case study - George

POSITIVE SUPPORT A Good Life Behaviour Support Planning Range of consistent strategies – • Routines and structure • Modifying their environment to meet needs • Interactive communication strategies • Proactive strategies • Consistent reactive strategies • Developing skills to take part in community

POSITIVE SUPPORT A Good Life Behaviour Support Planning • Reasons or functions behind behaviours, with the aim of supporting a person to communicate their needs in a way that is more socially acceptable and easily understood. • By improving the quality of someone’s life, we are supporting them to live a more fulfilled and happy life. This is Positive Support in action.