Challenging Behaviour
what good support looks like
Tony Osgood
Lecturer in ID / Private Consultant
Challenging Behaviour:
social construction, visceral experience, impactful
Challenging Behaviour:
learning, biological, social, psychological influences
examined by functional (and other) assessments
Challenging Behaviour:
responding…? Behavioural model application
Records as Artefacts
“There seemed to be universal requirements for
goals to be measurable and for data to document
progress. As a result many people who created the
plans learned how to write goals that were
measurable but not meaningful. Value goals such
as ‘one community outing weekly of his choosing’
were met by activities like going through the
drive-through window at a fast-food restaurant.” ”
(p.383)
Smull, M., Lakin,K.C., (2002) Public Policy & Person-Centred Planning. In S.Holburn & P.Vietze Person Centred
Planning: research, practice and future directions, p.379-413, Baltimore: Brookes
Deciding What Counts
Some people’s ways of communicating leave the important
people in their lives unable to hear their views about a life
that would make sense. These other people have little
choice but to create a story with a valued and central role
for the person, whose preferences remain ambiguous.
Then, these people make adjustments based on the
person’s responses to the real settings and experiences
that resulted
(O’Brien, 2002, p.412)
O’Brien, J., (2002) The Ethics of Person Centred Planning. In S.Holburn & P.Vietze Person
Centred Planning: research, practice and future directions, p.399-414, Baltimore: Brookes
PBS practitioners, fluent in behavioural
technology, should be equally skilled at
listening hard to family members’ subjective
experiences that accrue from loving someone
whose behaviour is impactful.
We are privileged to hear family stories of
heartache and fear, joy and hope. When
challenging behaviour arises, the child regardless
remains at the heart of family life. Love doesn’t
disappear.
There is a difference
between knowing a family or team
and working with a family or team.
What we count might not count
to families or teams.
What matters to families or teams might not
matter to the metrics of effectiveness our
employers seek.
Families & teams want solutions and supports.
Person-centred practitioners are unfortunately
too often ‘remarkable events’: finding
someone with good technical knowledge who
will listen to family contexts and collaborate in
understanding and responding to challenging
behaviour is essential
The small things a family or staff group seeks
are not small things to them
Like research, no family or team is perfect
but then again neither are professionals
As well as being real and impactful,
challenging behaviours are a symptom of an
unquiet life, an unheard complaint or an
unmeasured joy.
They are a call to action to teach new ways of
doing, and a reminder for us to remember
what we’ve forgotten we know.
So, let’s design a competent ecology
physical
social-interactions & communication
crisis response
educational (home as a learning environment)
organisational structure
A competently designed ecology produces what?
quality of life?
quality of profits?
A competently designed ecology is produced by whom?
commissioners?
professional stakeholders?
CQC?
Remember
“People with severe handicaps rely on other
people’s cooperation to an unusual extent, and
human services play a larger than ordinary role
in their lives... People with severe handicaps
count on more able people’s planning and
organising skills...”
O’Brien, J, 1987, p.175
O’Brien, J., (1987) A guide to lifestyle planning : using the activities catalog to integrate services and natural support systems. In
B.Wilcox, & G.T.Bellamy, (Eds.) A Comprehensive Guide to the Activities Catalog : An Alternative Curriculum for Youth & Adults with
Severe Disabilities, Baltimore, Paul H Brookes Publishing Co.
Metaphors for Organisations (Morgan, 1986)
How we conceive of organisations influences our behaviour toward
them
Do you think of organisations as mechanistic, an organism, a brain, a
prison, a relationship hub, as cultures, as instruments of domination,
or as sites of transformation?
Knowing the metaphors operating helps our ability to think of ways of
changing culture. Identifying what individuals think about the
organisations they work within is important when seeking to establish
why performance is at it is.
Metaphors for Organisations
If we conceive of organisations as mechanistic things (input = output)
we treat people as components
This has happened in the UK - and resulted in leaders becoming
managers/administrators
The output in this model should be good lifestyle of people using
services, but because of the thinking about the purpose of
organisations, bureaucratic demands take precedence: the paperwork
is more important than the people (Mansell & Elliot, 2001)
Frederick Taylor, the American engineer who evangelised the approach
known as Scientific Management pointed out to workers: “You are not
supposed to think. There are other people paid to think around here”
(Morgan, 1986, p.32).
Organic Metaphor
Selfcommitment
Actualisation
Ego
workenhanced
identity
recognition
interactions
relationships
belonging
tenure
pension
career
opportunities
health &
wellbeing
salary
working
conditions
rest
Social
Security
Physiological
safety
Records as Artefacts
Many remain suspended in “nineteenth-century
patterns in twenty-first century places”
(O’Brien, 2005, p.261)
“The institution is a trap for people. Just getting out of
the institution doesn’t mean getting out of the trap”
(2005, p.259).
O’Brien, J. (2005) Out of the Institution Trap. In K.Johnson & R.Traustadottir (eds.) Deinstitutionalisation and
People with Intellectual Disabilities: in and out of institutions, p.259-273, London: JKP
What PBS Can Bring to the Party
• Better service commissioning
• engaging with managerialism
• upstream solutions
• Practice leadership
• showing, growing
• Service design expertise
• functional assessment of ego-cologies
• Data and Story
• numbers and faces
Kingdom of Numbers - Auden
The Kingdom of Numbers is all boundaries
Which may be beautiful and must be true;
To ask if it is big or small proclaims one
The sort of lover who should stick to faces
Modes of Knowing
•
Scientific - hypothesis guided empirical studies,
which lend themselves to nomothetic solutions
(data)
•
Narrative - meaning from experience, individual
and idiographic (stories)
Bruner, J., 1986, Actual minds, possible worlds, Cambridge: Harvard University
Press
Validity of Our Measures
‘the database (i.e., the 109 studies), more concerned with issues of
rigour and demonstrations of experimental control, generally
failed to focus on larger consumer goals’
(p.83, Carr, Horner & Turnbull, 1999 - positive behaviour support for people with
developmental disabilities- a research synthesis)
murder rates per 100,000 (2011/12, UNODC Study)
UK
Iceland
South Africa
Jamaica
Honduras
1.0
0.3
31.00
39.3
90.4
‘Behind every behaviour that a person shows lies a
story- a story about the person, the world she lives
in and the day to day interaction between her and
her world. The more elements of this story that we
can identify the more avenues will be open to us
for supporting her in constructive ways’
(Clements & Zarkowski, 2000)
stories
We hold our own stories, and those of the people we love. We write
our own stories and those of people around us each day
Who holds the ‘stories’ of people with disabilities? What do they say?
Is it written in data or words?
Who writes their stories? The person gathering data, publishing
research? The nursing notes or daily diaries?
‘Conceptualizing & documenting positive changes in
intervention goals such as personal fulfilment, selfdetermination, happiness, friendships and even
contributions to the social good will, no doubt, be
difficult… but these are the outcomes that matter,
and should become the goals of intervention if
persons with disabilities are to become full
participants in their family, community & culture’
Meyer & Evans (1993, cited in Fox and Emerson 2002)
Records as Artefacts
“the thousands of hours of effort required in the late
1990s to produce grade-A, inspector-approved
individual plans offered people little real
improvement over the experiences of people whose
diagnoses Wolfensberger anazlyzed 30 years before.
What makes the difference to a person who relies
on services is what the service offers every day, not
what the plan says”
O’Brien, J., (2002) The Ethics of Person Centred Planning. In S.Holburn & P.Vietze Person
Centred Planning: research, practice and future directions, p.399-414, Baltimore: Brookes
Bureaucratisation of Lives
“The shelves in the staff office are lined with binders that document
the lives of residents in multiple ways: daily, weekly, monthly, annually.
These books, and the forms they contain, are more than just
instrumental means of administrative and clinical operation; they are
technologies that organise group home work, in its course, as a central
aspect of the work. They involve many of the techniques for
monitoring, assessment, and intervention, that shape what (staff) can
see, know, or do…” (p.163)
Levinson, J., (2010) Making Life Work: freedom and disability in a community group home. Minneapolis: UMP
If a factory is torn down but the rationality which
produced it is left standing, then that rationality
will simply produce another factory. If a
revolution destroys a government, but the
systematic patterns of thought that produced that
government are left intact then those patterns
will repeat themselves.... There’s so much talk
about improving the system... and so little
understanding.
–Robert Pirsig
“Quality is determined by
responsiveness to the person
served rather than compliance
with organisational processes
or regulations and standards”
(Gardner & Nudler, 1999, p.13)