Corporate Health and Safety Policy
Section 3: Arrangements
Appendix 7: Protocol on Challenging Behaviour and Use of Physical Interventions
June 2013
This is a Brent Council Corporate Health and Safety document and the guidance within it is the minimum standard that must be followed.
Contents
1.0 Introduction 3
2.0 Definitions 3
Challenging Behaviour 3
Physical Intervention 4
Risk Assessment and Risk Management 4
3.0 Using Physical Interventions 5
4.0 Support Plans (Care Plans) 6
5.0 Implementing the Protocol 8
5.1 Service users with KNOWN physical &/or behaviour challenges 8
5.2 Guidanceon 5.1…….…………………………………..………….… 9
6.0 Learning and Development 14
7.0 References 14
Appendix 1: Risk Assessment and Risk Management Tool 15
Appendix 2: Risk Assessment and Risk Management Tool – Guidance Notes 16
Appendix 3: A B C Chart 18
Appendix 4: Behaviour Management Plan 21
Appendix 4a: Behaviour Management Plan – sample plan 22
Appendix 5: Post-incident Log 23
1.0 Introduction
The Protocol outlines London Borough of Brent’s framework governing the use of physical interventions as a last resort. It:
Provides guidance on specific work practices when service users present physical and/or behavioural challenges to staff and the general public
States which documents are required to report and record incidents.
This Protocol on Challenging Behaviour and the Use of Physical Interventions (April 2013) aims
To enable staff to work consistently together to ensure physical interventions are used as a last resort and with the minimum force necessary
To clarify when the appropriate use of physical interventions should be applied
To ensure staff working practices comply with legal requirements, service users’ behaviour management plans and London Borough of Brent’s corporate guidelines.
The Protocol should:
be read in conjunction with London Borough of Brent’s Corporate Health and Safety Policy Arrangements on Violence and Aggression in the Workplace (March 2012)
not be a substitute for attending relevant learning and development activities.
By following the guidelines in this Protocol, the benefits expected are:
Service users and staff engage positively and confidently in community-based as well as building based activities
Gradual reductions in incidents of challenging behaviour.
London Borough Brent seeks to support staff and service users, where physical interventions are required. It is envisaged that this Protocol will evolve in the light of experience. Staff are asked to forward any comments and feedback to Nancie Alleyne, Head of Service – Direct Services, who will be reviewing this Protocol frequently. Contact details are as follows:
Email:
Telephone number: 02089374042
Challenging Behaviour
2.1 When service users’ behaviours present a physical or behavioural challenge to staff and or the public, London Borough Brent has a duty of care to prevent serious harm from occurring and to act in a way that promotes the safety and welfare of the service users in their care
2.2 Challenging behaviour is defined as:
“culturally abnormal behaviour(s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of or result in the person being denied access to ordinary community facilities” (Source: Emerson, E. (1995) cited by Emerson, E. 2001)
Physical Intervention
2.3 Any method of physical intervention should be person-centred and not punitive or hurtful. Staff must ensure that the methods used are in line with the service user’s Behaviour Management Plan, current legislation, this Protocol and London Borough of Brent’s guidance and training.
2.4 Physical intervention is defined as:
“Any method of responding to challenging behaviour which involves some degree of direct physical force to limit or restrict movement or mobility” (Source: Harris, J. et al, 2008)
2.5 This definition underpins British Institute of Learning Disabilities (BILD) Code of Practice (2010) in Physical Interventions and the joint DoH / DfES document ‘Guidance for Restrictive Physical Interventions’.
2.6 Staff should understand that the use of appropriate force, which restricts a service user’s movement, should only be used in order to prevent serious harm to the service user themselves, and/or others, through their self-injurious behaviour or aggression and should always be the last resort.
2.7 De-escalation refers to the use of any method during the build up to a potential crisis situation to prevent damage or harm to the person themselves, members of staff and others. The aim is to prevent the situation from escalating further. This could include methods such as:
· Ignoring the behaviour (if low level of threat)
· Communicating with the person with empathy and in simple language, acknowledging they may be upset, asking if they need anything
· Reducing demands, eg avoid giving too many instructions
· Distracting the person by involving them in doing something else, having a change of scene, doing something they enjoy
· Helping the person relax, eg relaxing music, a hand massage, breathing exercises, anything else they find relaxing
(See: website of the Challenging Behaviour Foundation www.challengingbehaviour.org.uk)
Risk Assessment and Risk Management
2.7 A risk can be defined as ‘something that MIGHT happen that impacts on what you want to do or achieve’. It is the uncertainty of an outcome, and could be negative (a threat) or positive (an opportunity). It is important to note that the probability of the event occurring is less than 100%, i.e. it is not a certainty.
2.8 The Management of Health and Safety at Work Regulations (regulation 3) states:
“every employer shall make a suitable and sufficient assessment of the risks to the health and safety of his employees to which they are exposed to whilst at work, and other persons not in his employment, arising out of or in connection with the conduct by him of his undertaking”.
2.9 Risk assessment is defined as:
“The careful examination of what, in your work, could cause harm to people, so that you can judge whether enough precautions are in place to prevent harm” (Sue Emery, London Borough Brent, Health and Safety Services Manager, October 2010)
2.10 The assessment of risk in this context is the chance – high, medium or low – that someone (service users, staff, public) will be harmed by the service user’s behaviour
2.11 Risk management is the overall analysis of risk and planning to minimise risks identified and manage risks presented.
2.12 One method to manage risks presented and prevent harm to the service user or others, is physical intervention. See Appendix 1 and 2: Risk Assessment form and guidance.
3.0 Using Physical Interventions
3.1 Three broad categories of physical intervention may be identified:
· Direct physical contact between a carer and a person with challenging behaviour, for example, self-protective 'breakaway' techniques for escaping from grabs and chokes or minimal restraint to briefly immobilise the person
· The use of barriers, such as locked doors, to limit freedom of movement
· The use of materials or equipment to restrict or prevent movement for example, the use of arm splints to reduce self-injury (this would be used only in extreme circumstances and as an agreed part of the service user’s Behaviour Management Plan).
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3.2 Physical intervention should ONLY be used in the management of high risk behaviours when all other alternatives have been exhausted.
3.3 In some circumstances, such as holding a service user back from heavy traffic or preventing someone from falling, physical intervention may need to be used in a manner that cannot be planned in advance. Staff must be clear that this is distinct from a planned physical intervention. If unplanned physical intervention has been used in an unforeseen or emergency situation, then this should be carefully recorded and should trigger a more systematic monitoring and recording of the person’s behaviour, with a view to developing a behaviour management plan, if needed.
3.4 Physical intervention should be understood as a safety intervention - it should not become part of routine behaviour management or be used to ensure compliance.
3.5 Staff member’s working practice must also be in line with relevant health and safety legislation and in accordance with London Borough Brent’s corporate arrangements for managing violence & aggression at work. See Corporate Health and Safety Policy (managing violence and aggression in the workplace), March 2012.
3.6 All incidents of physical and / or behavioural challenges must be recorded and the relevant people informed. This will also help to ensure that safeguarding issues do not arise.
4.0 Support Plans (Care Plans)
4.1 The aim of a Support Plan is to enable the service user to live their life with dignity and have choice and control. A Support Plan may also include a Behaviour Management Plan which outlines the best approach for managing a service user’s behaviour, including when and how to use physical interventions (see Appendices 4 and 4a).
4.2 Support Plans and Behaviour Management Plans must be done with multi-disciplinary input, including professional colleagues in the ‘Adult Community Learning Disability Team’ provided by Central North West London Trust on behalf of the PCT. Family, friends and advocates must also be included. Consideration must be given to the service user’s cultural needs.
4.3 The plans will include, where agreed, physical interventions. If planned physical interventions are necessary, they should be recorded and carried out in a way which preserves the service user’s dignity, as much as possible, and ensures the safety of all those involved.
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4.4 Risk Assessment and Risk Management (see Appendix 1 and 2) - Risk assessments identify the level and nature of risk in a holistic and systematic way. These can be completed by staff teams in order to inform the next steps.
4.5 Behaviour Management Plan (see Appendices 4 and 4a) - Behaviour Management Plans outline the appropriate balance between proactive and reactive strategies. The Behaviour Management Plan should include steps required to prevent the service user’s behaviour from occurring at all, or to minimise it or prevent it from escalating. Any restrictive physical interventions must be written into the service user’s Behaviour Management Plan. Their Support Plan should be taken into consideration to ensure a holistic approach.
4.6 The Behaviour Management Plan must show that consent from the service user has been sought. Where consent is not possible, wide-ranging consultation should be conducted, including the individual’s advocate, relatives and appropriately qualified and experienced professionals. A best interests meeting should be held to agree the risk assessment and the Behaviour Management plan. See guidance, training on Mental Capacity Act / Deprivation of Liberty Safeguards, seek clarification from line manager and/or the Mental Capacity Act Code of Practice (available at: http://www.justice.gov.uk/downloads/protecting-the-vulnerable/mca/mca-code-practice-0509.pdf).
4.7 Where de-escalation has not worked, i.e. the behaviour continues and worsens, consideration must be given to applying physical interventions (preventing further harm to the service user and or others) and/or calling the police.
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5.1 Implementing the Protocol
5.2 Service users with KNOWN physical &/or behaviour challenges
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5.2 Guidance on Service users with KNOWN physical &/or behaviour challenges /Steps / Purpose and Actions Required / Who /
1. Support Planning (and review) / A service user’s Support Plan identifies their needs and outcomes in a person-centred and holistic way. It details how the person is to be supported to maintain their independence and live their life, at home and in the community.
The service user’s Support Plan is devised with the service user themselves, their family members and Adult Social Care, Direct Services staff. / Social Worker
Senior Practitioner
2. Implement Support Plan / Front Line staff / enablers should be able to read the Support Plan and get an understanding of who the service user is, their interests and hopes for the future. The Support Plan sets out:
· what the service user wants to change about their lifestyle.
· what kind of help or support they are going to use to make these changes.
· how they will make sure they stay safe and well.
· how they want their Individual Budget to be used.
· how they will stay in control of their own life. Where other people make decisions for them, it has to be clear how they involve the service user and get their agreement.
This will ensure that the person’s behaviour is understood and managed within the context of their whole life and their choices. / Front line staff
3. Risk Assessment and Risk Management / Consider relevant capacity issues / Risk assessment and risk management planning needs to happen to encourage service users to identify alternative ways of meeting their own needs and achieving their outcomes.
Front line staff are to assess the possible impact of the risk with the service user. If there is no safeguarding risk and what the individual wants to do and achieve could help them meet their outcomes, then we should feel comfortable in agreeing it. / Social Worker
Senior Practitioner
Front line staff
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3. Risk Assessment and Risk Management / Consider relevant capacity issues cont/…… / Unless a risk falls into one of these categories we should strongly consider agreeing to it:· The proposed course of action may cause harm to the service user or other people
· The proposed course of action is illegal
· The proposed course of action is not likely to support the individual to meet their identified needs or outcomes
A ‘risk assessment’ must be completed and a Risk Management Plan developed. See guidance notes (Appendix 2) for more information.
Staff in Adult Social Care are asked to assume that everyone has capacity to make decisions. If you think that the service user does not, then their capacity to make the decision in question, must be assessed.
The law says someone lacking capacity cannot do one or more of the following four things:
· Understand information given to them
· Retain that information long enough to be able to make a decision
· Weigh up the information available to make a decision
· Communicate their decision.
The person may lack capacity to make particular decisions at particular times. It does not necessarily mean that they lack capacity to make any decisions at all. Capacity must be assessed, as related to the decision in question at the time.
Those individuals who possess capacity should be fully involved in planning all aspects of their care, including risk assessment and behaviour management planning.
Where the individuals lack capacity, the risk assessment and behaviour management plan must be in the best interests of that person; utilising the least restrictive alternatives. / Front line staff
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