Preventing staff burnout is a key priority for services supporting adults with ‘challenging behaviour’ because of the adverse impact on clients of staff turnover, says guidance launched in response to Winterbourne View.
What is ‘challenging behaviour’?
“…culturally abnormal behaviour of such 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: Professor Eric Emerson, centre for disability research, Lancaster University(1995)
The loss of important relationships with staff can increase tensions among service users with behaviour that challenges, putting a premium on staff retention and well-being in care homes, supported living and other settings supporting adults with learning disabilites, autism, mental health problems or dementia.
The guidance said managers should take action to prevent burnout by supporting work/life balance for staff, encouraging them to speak freely if they feel unable to manage tasks and working with individual staff members to identify how they can build up their resilience, backed up with regular, effective supervision.
However, it also stressed that managers should tighten up recruitment practices to ensure they recruit staff committed to person-centred care; it suggested this could include using personality tools to identify the right people, testing candidates’ values at interview stage and offering trials prior to appointment.
Skills for Care commissioned the guidance from the National Development Team for Inclusion have published the guidance as part of the government’s programme to improve support for adults with learning disabilities or autism and behaviour that challenges services in the wake of the Winterbourne View scandal.
Service users at Winterbourne View were subject to inappropriate, punitive and excessive use of restraint, contrary to good practice in supporting adults with ‘challenging behaviour’ or ‘positive behaviour support’, which emphasises identifying and addressing the causes of the behaviour, person-centred support and using appropriate physical interventions as a last resort.
Communication skills key
The guidance said organisations should commit to using positive behaviour support, and to see behaviour that challenges as a form of communication on the part of service users that required a person-centred response.
Communication skills should be a core part of staff training for working with people who challenge, and they should have access to a wide range of communication techniques, such as cue cards and pictorial communication. There should also be a dedicated programme to train staff in non-punitive techniques and when and where to use them.
It said a core of staff within organisations should receive in-depth training in designing services for people with behaviour that challenges and act as a resource for the whole organisation. This should having expertise in the use of non-punitive physical interventions and supporting staff in using these where appropriate.
Commissioning the right training
The guidance places a strong emphasis on employers and managers commissioning effective training. It said they should ask themselves the following questions:
- Are you clear about the outcomes you need the learning to achieve?
- If using a training company or individual trainer, it is/are they accredited?
- Does the training provider state how it will encourage delegates to measure outcomes?
- Who is being trained and at what level?
- How will you know the outcomes have been achieved?
- Will the training match the learning styles of individuals undergoing it?
It pointed to the British Institute of Learning Disabilities’ code of practice on the use and reduction of physical interventions for guidance on commissioning positive behaviour support training. It also said feedback from staff, and from service users, was crucial in ascertaining the effectiveness of training.