Transcript PBS & Physical intervention

PBS & PHYSICAL
INTERVENTION
A CHILD AND ADULT SUPPORT PERSPECTIVE
PBS & Physical Intervention
• ‘Positive Behavioural Support (PBS) is an approach that
blends values about the rights of people with disabilities
with a practical science about how learning and
behaviour change occur. The overriding goal of positive
behavioural support is to enhance quality of life for
individuals and their support providers’
(Horner, 1999)
• Restrictive Physical intervention is the use of force to
control a person’s behaviour.
What does PBS mean in practice?
• Practical & effective way of responding to challenges
caused by problem behaviours.
• Reverse relationship with Physical intervention.
• Focus is on early intervention
What does Physical Intervention mean
in practice
• Focus should always be on non- physical reactive
strategies.
• Risks assessment including medical risks.
• The purpose of physical intervention.
• It is not a sign of failure.
• Routine assessment for physical or psychological
distress.
• Clearly documented.
• Debrief with all involved.
Working With Children & Young
People in Schools
Legal Guidelines
Working with adults
Legal guidelines
Some things are the same
Physical Intervention good practice
• Why does Physical Intervention have a place as part of
Positive Behavioural Support?
Use of Physical Intervention
• How can we ensure Physical intervention is used only
when necessary for both children and adults?
• What needs to be in place to safe guard children and
adults?
Policy
Development & Review
Annual
Review
Recording
&
reporting
Shared
Policy
Planned
approach
Clear
Definitions
Training
• Honesty
• Open
• Treated fairly
• Clear
• Verbal/nonverbal
• Transparent
• Safe
• Respect
• Dignity
• Understanding
Shared Values
Holistic
Approach
Communication
Reduce Risk
• Minimal Force
• Minimal Time
• Last resort
Behaviour Support Plans
Briarwood Positive Handling Plan
DRAFT
Strategies to use
Individual attributes
Name:
Child X
Date: July 2011
Escalation – move from baseline
Baseline indicators
Known triggers
Individual
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Happy
·
Smiling
·
Relaxed body language
Class/Staff
·
Cooperative
·
Joining in
·
Interact with staff & peers
Teaching
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Verbally communicating
·
Following 2 step
instructions
Individual
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End of a favourite
activity/toy – esp. snacks
·
Repetitive behaviours –
repeating Sponge Bob
quotes & having these
interrupted or having to stop
·
Hunger
·
Feeding off and repeating
other’s anger
Class/Staff
·
Sexual behaviour/ cuddles
Teaching
·
Changes in routine
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Sometimes unknown
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Individual
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Opportunity to have regular
healthy snacks during the
day (3 selections each time)
·
Access to Sponge Bob
resources during free time
Class/Staff
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Adapt environment –
remove mirrors & clutter
·
Always keep voice calm,
clear and cheerful, use
distraction & ‘jollying along’
, Teaching
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Verbally explain changes
and use timetable
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Reassure X during the day
of any changes
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Individual
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Choice of activity at free
time
·
Choose which task to
complete first during 1:1
& workstation sessions
Class/Staff
·
Consistent staff rota &
approach
·
Opportunities to interact
with staff
Teaching
·
TEACCH approach
·
Consistent structure
·
Visual timetable
·
“First / Then’
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Clear expectations
·
Count down from 10 to
end an activity
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·
·
·
Vocalisations – deep ‘angry’
repetition of sounds
‘wide eye’ stare
Agitated
Complete change in body
language & facial expressions
– looking angry
Kicking doors, chairs and
possibly staff
Behaviour if crisis is reached
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Reassure X ‘you’re fine,
its….’
Redirect to the next activity or
back on task – jolly him along
(make it sound fun!)
Talk to him calmly and
cheerfully. Always encourage
communication.
Swap staff if needed – use
word ‘swap’ at anytime to
signal a change of adult
Staff to wear long sleeve tops
and long trousers
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Kicking - Kicking objects and staff.
Usually part of escalation. During
incident kicking staff on shins.
Threatening to kick and VP ‘no kicking’
can occur during escalation
Pinching/grabbing - Initial grabs lead to
pinching – usually on upper and lower
parts of arms but can be stomachs
Biting- During incident – will threaten to
bite and at crisis will bite adults on top
of arms and shoulders. Will target
individual students to bite
Barging – using body weight
Crying/screaming – continues
throughout
Punching- Punching staff on upper
body or head– usually one of the first
behaviours at the start of an incident.
Threatening to punch and VP ‘no
punching’ can occur during escalation
Headbutting
Continue to reassure X using clear,
basic language
Block behaviours initially – Lead
person to continue but request to
nd
‘swap’ if they want the 2 person to
lead the intervention
st
1 person to VP ‘stop’
If behaviour continues to escalate
remove to safe area using a two
person single elbow hold & move to
chairs (situated under timetable) & hold
Continue to reassure X during the
intervention ‘you’re fine’, ‘relax’
Once X begins to relax (change in
breathing, body language &
vocalisations) 1 st person to assess &
lead the release - keep talking to X &
reassure him – move to post incident
strategies
If the behaviour escalates again return
to the two person single elbow hold &
repeat above
Post-incident
recovery indicators
·
Becoming more
relaxed
·
Quieter &
calmer
vocalisations
·
Apologising
‘sorry, sorry’
Possible function of
behaviour
·
Anxiety
·
Communication
– not wanting to
finish something
·
Sensory
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Attention
·
Links to Behaviour for
Learning Plan
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·
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Offer X his
choice board
(found under the
chairs) choice of
relax, drink or
choosing
Sit in the
choosing area &
give X time to
relax
Continue to
reassure
Redirect to a low
demand activity
Do not place too
many demands
on X until he is
completely calm
·
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Communicate
how he is feeling
Introduce
flexibility
*
Unmanaged Risks:
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Unprovoked attacking of other students with no build up – need close staff supervision and keep him away from
students where possible.
Completed by:
Signed:
Review Date: September 2011
Individual Risk Assessments
Briarwood School Risk Assessment
Assessing and managing foreseeable risks for pupils who present challenging behaviours
Name:
Class:
Teacher:
Identification of Risk
Potential level of risk
(see Table 1 of Risk Rating Matrix)
Describe the foreseeable risk
What likelihood / probability is
there of the risk occurring?
List who is effected by the risk
Aggressive and self injurious
behaviour – banging head,
gouging, biting, kicking
Medium - possible
Medium
self, peers, staff
Assessment of risk
Potential level of risk
(see Table 1 & 2 of risk rating matrix)
In which situations does the risk
usually occur?
How likely is it that the risk will
arise?
If the risk arises, who is likely to
be injured or hurt?
What kinds of injuries or harm are
likely to occur?
How serious are the adverse
outcomes?
Changes in routine &/or staff, ending a favourite activity,
transitions, food & meal times
Medium - possible
self, peers, staff
Bruising, broken skin,
swelling
Serious
Medium
Agreed Behaviour Management Plan & School Risk Management Strategy
Focus of measures
Measures to be employed
Level of risk
Proactive interventions to
prevent risks
TEACCH approach, consistent routines,
consistent staffing, positive &
enthusiastic approach
Transition cues & songs, countdown to
end a session, reward system
Low
Remove objects and other students
within proximity. Wear long sleeves &
have legs covered. Have cushion ready
to place under his head.
T-wrap if force and frequency increases
Low
(see Table 3 of risk rating matrix)
Early interventions to
manage risks
Reactive interventions to
respond to adverse
outcomes
Assessment completed by
Agreed by
Date
Low
Recording & Reporting for children
Behaviour
Frequency
ABCC Charts
Bound &
Numbered
Book
Physical
Interventions
Recording
Governors
Parents/carers
OFSTED
25 Years
Local Authority
Reporting
Recording and reporting Adults
Behaviour
Frequency
Within
organization
ABCC Charts
Physical
Interventions
Care records
Recording
Parents/carers
CQC
25 Years
Local Authority
Reporting
Monitoring & Assessment
Trends
Individual
targets
RAG
Training
needs
Level of
Support &
Intervention
Conclusion
Workshop
• How can the successful use and assessment of
physical interventions (PI) help support PBS in
your setting?
How is PI delivered in your setting?
Is it part of a proactive / positive approach?
How is it monitored? Could this process be more rigorous?
Are all PI carried out consistently as part of an individual
plan developed in the service users best interest?
• How up to date is your policy?
• Can you think of examples that highlight PBS and PI?
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