Introduction to “Managing Behavior of Concern”

However, realistically until we better understand the function and/or nature of the behaviour, there may be occasions when it might be needed. The Studio 3 Walk-Around allows carers to talk to a client who has been able to calm down and so be let go of, giving the client some choice and control. Most other procedures we have seen are various ‘take down’ procedures giving the client no choice or control, often ending in a tangle of bodies.

Finally, the trainers will role-play a client with each course member, these role-plays will test the various skills learnt on the course and likely necessitate the use of the Studio 3 Walk-Around procedure.

Due to the topic covered on the course there is an emotional element and people may find some of the role-plays a little disturbing. The course tutors are there to support you throughout the three days should you find any parts of the course upsetting in any way.

Outcomes for the Three Day Course

Prevention and De-escalation Strategies

Key Learning Objective: The Participant will be able to understand the anatomy of a critical incident, identify triggers and cues that may indicate an increase in stress experienced by all parties and take appropriate reasonable measures to avoid, decelerate and de-escalate crisis situations.

The learner will be able to:

1. 1. Define behavior of concern and describe the role and responsibilities that they and their colleagues have in both preventing and managing these episodes, all within the framework created by the Law, Policies and Procedures.
   2. Understand the terms Proactive (Primary), Active (Secondary) and Reactive (Tertiary) Supports within the context of supporting distressed individuals.
   3. Understand that both our thoughts and feelings play a role in the way we will choose to either react or else respond to an individual in distress.
   4. Understand that the thoughts, feelings and therefore reactions/responses of others may be different to those we feel ourselves.
   5. Understand that changes in any person’s behaviour are caused by many factors.  Some of these factors are external to the person becoming distressed, others will be internal.
   6. Understand that stress will cause changes in behavior as a person tries to cope.
   7. Understand that stress is always transactional.
   8. Understand coping in terms of healthy or unhealthy rather than in terms of good and bad.
   9. Understand that coping depends upon the development of a range of different strategies.
   10. Describe the “Anatomy of an Incident” in the context of an understanding of arousal.
   11. Understand the concept of a Low Arousal Approach.
   12. Will be able to explain what we can do and consider changing in the environment, in the support offered,and in our own presentation to a distressed individual that helps to reduce the arousal load due to avoidable demands and reduce the likelihood that a person will become distressed.
   13. Recognize that when a person has already become distressed,we need to switch to a reactive set of plans that manage the crisis safely for all.
   14. Understand the socio-emotional cost of a crisis for all and how this can lead to further incidents in the future.
   15. Understand that there are different models of wellbeing and the use of PERMAH in creating better supports for ourselves and those we support.
   16. Understand how the development and control of movement and therefore behavior is affected by the other domains of development.
   17. Understand trauma and the principles of a trauma informed approach.

Decision Making in Managing Risk Using Appropriate Low-Tariff Physical Skills

Key Learning Objective: To be able to proactively and dynamically assess risk arising due to the escalation of distress and make safe and appropriate decisions to safely manage that risk without jeopardising the relationship between themselves and the supported individual.

The learner will be able to:

1. 1. Understand how to apply a Low Arousal Approach in real time in supporting a cared for individual.
   2. Explain the difference between proactive, active and reactive support.
   3. Understand why it is best to plan how to avoid, manage and recover from critical incidents and why this should always be person centred.
   4. Describe the principles of risk assessment and risk management.
   5. Understand the risks (legal, physical, emotional, social and psychological) in undertaking physical management of behaviours of concern.
   6. Understand the limit to relying on the physical management of behaviours of concern.
   7. Provide clear rationale for decision making and understand burdens of proof in relation to the use of all restrictive practices including the use of physical interventions.
   8. Explain the ongoing importance of professional values from a reflective social validity perspective ensures that the safety and welfare of all parties involved in a critical event.
   9. Describe what is meant by an aversive approach and therefore avoid their use and a solution to the management of critical events.
   10. Appreciate the role of state dependent learning in the development of safe to use and professionally appropriate physical skills.

Decision Making in Managing Risk Using Disengagement, Planned Escape and/or Appropriate Intermittent Physical Holding Skills (if taught)

Key Learning Objective: To be able to use safe and appropriate disengagement skills or to be able to facilitate safe planned escape to reduce the reliance of having to use unnecessary restrictive practices, including appropriate intermittent physical holding.

The learner will be able to:

1. 1. Describe why the use of any physical holding should only ever be considered when everything reasonable has been tried and failed to avoid or de-escalate the crisis and there is a clear and immediate danger to self and/or others.
   2. Understand the history of restraint and the use of physical interventions
   3. Appreciate that there are gentler models of restraint than those traditionally taught.
   4. Appreciate that the use of any form of holding may be contra-indicated for some people or in some situations.
   5. Demonstrate the ability to use de-escalation skills through both verbal and non-verbal skills to avoid the use of restraint.
   6. Demonstrate that the decision to use a significant restrictive practice, including all forms of restraint, must be the response to a presented and significant risk.
   7. Demonstrate the use of taught physical skills that are consistent with the psycho-physiological principles of a Low Arousal Approach.
   8. Describe risks associated with the use of physical interventions.

Post Crisis Supports and Approaches

Key Learning Objective: The learner will be able to identify the impact of crisis events and describe a range of post-event supports and responses which can be used for personal and/or organisational support and developing reflective learning.

The learner will be able to:

1. 1. Describe the potential impact that crisis events may have on both themselves, their colleagues and the people they support.
   2. Describe and use a model of Post Incident Emotional Debriefing as the first step in providing themselves and others (including the supported individual) with “emotional first-aid” that will promote closure, facilitate reflective practices and promote the re-establishment of better PERMAH for themselves and others (including the supported individual) involved.
   3. Understand the socio-emotional cost of a crisis for all parties involved in crisis events.
   4. Understand that developing and maintaining good post-incident support for all helps to create the optimal conditions to create resilience and fortitude for self, others, and the organization.
   5. Describe the absolute importance of recording and reporting key information that must be documented following a critical event and how this is not only a key legal and professional responsibility, but also a crucial part of developing good reflective practices.

Low Arousal Approach training operates throughout North America as Studio III Canada Inc. and is licensed by Studio III UK.