thinking beyond the label – “challenging behaviour”, autism, and reflective practice

Thinking beyond the Label –

“Challenging Behaviour”, Autism, and Reflective Practice

Introductions

• Zoe Armstrong – Service Delivery Director

• Pete Cross – Head of Strategy

ACUK

• Values and outcomes based support provider

• Pathway provision for people with autism and more complex / “challenging” needs

Coming up..• “Unpicking the Label”

• How its not the person who has challenging behaviour, it’s the situation

• What good practice looks like (team tips in red!)

• CB and the “individual biography”

• Reflective Practice

The art of being…tired and emotional• Some renowned incidents of highly challenging behaviour

Elton visits the airport…

Diana “doesn’t do” airport security

Maria Callas “has a word” with her agent…

George takes to the wheel…(again)

They got bad press…

But they didn’t end up in Winterbourne View

The “rules” are different for different groups!

• Why is it that if you are rich and famous, that your externalisation is seen as a “diva strop”, whereas mine is seen as “challenging behaviour”??….. and then the behaviour becomes defining of me??

• Whenever the ‘rules are different’ we must be highly questioning and cautious – if we care about social justice

Two concepts of CB..

• A non elective label, that non learning disabled people would not choose for themselves…

•…but also a set of very ‘real’ presenting needs for the individual and for caregivers.

The physical reasons!• So…what are you frightened of?...

• What makes you angry?....

• What happens to you physically?....

Common Reactions• Pale• Clammy• Heart races• Butterflies• Breathing• Loss of appetite• Dizziness• Impulsivity…need to escape

The task!

How did it feel?• Now add how you felt when you were frightened or angry with the frustration from not being understood

• Fear+ frustration= challenging behaviour

• Now add the fact that you might be surrounded by people who don’t know you and who you maybe don’t even like.

Challenging Behaviour? • There is maybe no such thing as CB, only a challenging situation• Pete does not have challenging behaviour BUT if Pete is on a train and a person sits next to him with a green T shirt on who smells of Brut, the situation is challenging.• So as providers we need to recognise that every episode of “CB” is a customer complaint of some kind• Intervention then is changing something that WE currently do or could do better

Practical examples• “My CD player is BROKEN – I don’t know if it can ever be fixed or if I can get a new one”• “Red T-shirts – do I love them or hate them?”• “You really stink!!”• “they will bite my hand off and I’m terrified”• “I notice very small changes”• “HELP! something is dropping off my body”

• Tip – encourage staff to put the “behaviour into the first person” in this way

Key practice issues for staff • Verbal language is not the primary form of communication for people on the Autistic spectrum• Its not even the second or third

• Remember as well that even if someone can tell you what they want when they are feeling OK - they may start to loose those verbal skills as they become anxious..• .. because verbalising is something they may do to fit in with OUR needs, not something that comes naturally in terms of theirs.

Key practice issues for staff• Learning from the person is a constant process and each episode has to be exploded to find the distressing factor and then intervention is the elimination of the distressing factor.

• What was different between today and yesterday?

• Where elimination of stressors is not practicable, ask how can we adjust to alleviate

Key practice issues for staff• Be sensitive to sensory needs….but not YOUR sensory needs.

• Accept that you will not be able to identify the sensory stimulus unless you know the person inside out and accept that you will learn something new about them each and every day.

• You will never fully “see” everything the person experiences… you just have to learn from them and share what you learn.

CB and personal biography• One action can become wholly defining (danger that the “worst thing” becomes the “first thing”)

• 15 years ago, I did something really silly and something that I would never repeat……its not on my CV!

• Why then does our system define people that we work for in such negative ways?

• “Deficit” as opposed to “asset” approach to prove eligibility

“the way that UK social care has been traditionally organised haemorrhages gifts and talents”

“I’m referring a 23 year old with 2:1 and challenging behaviour”

Put the gifts and talents first• People should be described and understood in terms of their gifts and talents.. FIRST and ALWAYS FIRST.

• This approach saves money!!

• If you focus on the negative, and the needs, then your model of support will be risk averse, disempowering and may even reinforce the physical reactions

• Would you want three people following you around every day?....Thinking and relating to ones own life can be powerful…

The power of reflection…• If you always want to do better• If you are looking to develop rather than stay static• If you want quality of life to improve• If you want to provide rather than contain• If you want a thoughtful staff team and happiness to reign supreme

If you want those things…walk a mile in my shoes

Sector Innovation / 5 easy steps

Questions / Contact details

zoe.armstrong@autismcareuk.com

pete.cross@autismcareuk.com

www.autismcareuk.com