Managing Challenging Behavior: Supportive Environments
“You want to prepare and prevent, not repair and repent.” These are words to live by when working with individuals that engage in challenging behavior, but what does it mean? It boils down to anticipating and avoiding challenges before they happen. By doing this, we improve safety and quality of life for everyone. When you think about it, all the extra effort you put in to prevent isn’t extra at all. It’s just time better spent. Let’s look at an example with no prevention.
Today, administration bought doughnuts and coffee for staff appreciation. It was all placed in the rec room for staff to grab as they passed through. The rec room often hosts various group activities for patients. Later that morning, a group of patients were brought in for music therapy. Diego, one of the patients in the group, has diabetes and is on food restrictions. As music therapy starts, the box of doughnuts catches Diego’s eye and asks if he can have one. The staff leading group responds “no.” Diego asks again, and staff responds again with “no.” Diego walks towards the doughnuts, and the staff stops the activity to prevent Diego from getting a doughnut. The staff says “no, you know you can’t eat that,” then proceeds to remove the doughnuts from the room. This causes Diego to get very upset; he starts to scream and continues to reach for the doughnuts. This persists for about 15-minutes until another staff can help Diego calm down, and move to another room.
What caused the problem in this situation? The doughnuts. About how long did it last, from the first sight of the doughnut to calming down? Probably about 20-minutes. During that 20-minutes, the staff could not proceed with the group as planned because they were managing a behavioral challenge. The staff had to stop the activity, which affected the entire group.
What could have been done to prevent this? We might have several options. Doughnuts and coffee are only available from 8:00 – 9:00, after that they are removed because music therapy is at 9:15. Maybe Doughnuts and coffee could have been placed in another room, one that clients don’t have access to, such as a staff lounge. Why are these options better than managing the behavior? First, it’s less wasteful of time and resources. Removing the Doughnuts, or placing them in another room might take about 5 minutes. This is a big difference compared to the 20-minutes you would spend deescalating Diego. Second, it isn’t affecting other patients. If you don’t remove the doughnuts, the group is interrupted and stopped for everyone. Getting the doughnuts out before group means the activity will proceed as planned.
Preventing behavior incidents before they happen is a critical feature of Safety-Care Behavioral Safety Training. Staff are taught how to create supportive environments that decrease the likelihood of challenging behavior. Staff also learn how to identify and intervene to events that often “trigger” challenging behavior. The material presented in a manner that is understandable and applicable across various clinical settings. Visit our website for additional resources, webinars, and information about QBS, Inc’s behavioral training program, Safety-Care.