Training Ward Staff in Training Ward Staff in Psychological Approaches to Psychological Approaches to

Challenging Behaviours Challenging Behaviours

Hannah Wilson and Isabel ClarkeHannah Wilson and Isabel ClarkeChartered Clinical PsychologistsChartered Clinical Psychologists

Hampshire Partnership NHS TrustHampshire Partnership NHS TrustWoodhaven, Loperwood, Calmore Woodhaven, Loperwood, Calmore

Hampshire, UK SO40 2TAHampshire, UK SO40 2TAHannah.Wilson@hants-sw.nhs.uk Hannah.Wilson@hants-sw.nhs.uk

OverviewOverview

Introduction to challenging behaviours and Introduction to challenging behaviours and training issuestraining issues

Description of the 2 day training deliveredDescription of the 2 day training delivered

Outcomes and feedbackOutcomes and feedback

SummarySummary

Reflections and ways forwardReflections and ways forward

Challenging behaviours Challenging behaviours

Typical and topical for inpatient workTypical and topical for inpatient work– Incident rate of Incident rate of – Responsible for Responsible for

Vanderslott, 1998; Owen et al, 1998; Vanderslott, 1998; Owen et al, 1998;

High arousal …..stress, burnout, time off, High arousal …..stress, burnout, time off, etc.etc.

Impact on the unit and individuals Impact on the unit and individuals considerable and often under-reportedconsiderable and often under-reported

Training IssuesTraining Issues

1.1. Practical issues Practical issues – Whole-unit staff training and MONEY (WDF funding) Whole-unit staff training and MONEY (WDF funding)

2.I2.Issues of scepticismssues of scepticism – Psychological training in a medic-led environmentPsychological training in a medic-led environment

3. I3. Issues of attitude ssues of attitude – Ownership of the training – Ownership of the training – (Hastings & Remington, (Hastings & Remington,

1995)1995)

4. I4. Issues of staff well-being ssues of staff well-being – Impact of the nature of the work – Impact of the nature of the work – (i.e. protection from (i.e. protection from

burn out)burn out)

Practical Issues Practical Issues

Work force development fundingWork force development funding

Away from the base –Minstead LodgeAway from the base –Minstead Lodge

Half away from unit on training while other Half away from unit on training while other half on shift back at base (2, 2 day half on shift back at base (2, 2 day workshops)workshops)

NEED SUPORRT FROM MANAGERS!NEED SUPORRT FROM MANAGERS!

Issues of Scepticism Issues of Scepticism

Introduction to evidence-based psychological Introduction to evidence-based psychological approaches.approaches.Recognise the strengths and diversity within the Recognise the strengths and diversity within the team as well as working towards a consistent, team as well as working towards a consistent, Recovery oriented, approachRecovery oriented, approach..

Promote development of positive care plans for Promote development of positive care plans for challenging behaviour using these approacheschallenging behaviour using these approaches ..– Teaching given on behaviour principles of behaviours to Teaching given on behaviour principles of behaviours to

increase, rewards and reinforcements vs. behaviours to increase, rewards and reinforcements vs. behaviours to decrease and punishment decrease and punishment

Be able to conceptualise challenging behaviours Be able to conceptualise challenging behaviours in helpful ways.in helpful ways.

Issues of attitude and ownershipIssues of attitude and ownership

Staff ownership of the training to improve application of Staff ownership of the training to improve application of the approach once training completethe approach once training completeBefore the training, allocated into teams of 5 and asked Before the training, allocated into teams of 5 and asked to bring a current case to discussto bring a current case to discussSmall group work to formulate the case they brought, Small group work to formulate the case they brought, develop a positive care plan with clear triggers, develop a positive care plan with clear triggers, reinforcements and integrated opportunity for desired reinforcements and integrated opportunity for desired change based on teaching receivedchange based on teaching received

Two days spread out over two weeks Two days spread out over two weeks – Try out the approach in the ward environment, record the Try out the approach in the ward environment, record the

results, and…..results, and…..– Be able to report back on and discuss the experience at the Be able to report back on and discuss the experience at the

second day.second day.

Issues of staff well-beingIssues of staff well-being

Team building exercisesTeam building exercises

Plus … “Looking at Roles” ExercisePlus … “Looking at Roles” Exercise

Practical tips on “High Arousal DO’s and Practical tips on “High Arousal DO’s and DON’Ts”DON’Ts”

Outcomes re: challenging Outcomes re: challenging behavioursbehaviours

All teams clearly able to develop a positive All teams clearly able to develop a positive care plan and implemented themcare plan and implemented them

Reduction of challenging behaviours for Reduction of challenging behaviours for duration of the training duration of the training

Case Study Case Study

Triggers: Visitors or Bored

High arousal

Shout out “Kill you” and make lunge at staff

Taken back to room and given PRN medication

New PlanNew Plan

Engage in relevant activity at regular time Engage in relevant activity at regular time slots slots

Client given cards to indicate when she Client given cards to indicate when she wanted PRN that she could hand in to wanted PRN that she could hand in to ward staff ward staff

When card handed in, all staff knew to When card handed in, all staff knew to react promptly so as to reward this more react promptly so as to reward this more functional request of her needsfunctional request of her needs

Case Study Results Case Study Results

14

5

0

2

4

6

8

10

12

14

16

2monthsbefore

2months

after

Reportedattacks on staff

Results/ FeedbackResults/ Feedback

Positive feedback from satisfaction Positive feedback from satisfaction questionnairesquestionnaires

Staff feeling valued and supportedStaff feeling valued and supported

““

Reflections and final thoughts Reflections and final thoughts

Sustaining the impact?!Sustaining the impact?!Weekly care planning/ psychology Weekly care planning/ psychology formulation meetings – raised profile of the formulation meetings – raised profile of the benefits of psychological approaches benefits of psychological approaches Use of service user presentations in the Use of service user presentations in the futurefutureInvite medics to attend in futureInvite medics to attend in futureOverall….A valued and worthwhile Overall….A valued and worthwhile exerciseexercise