training ward staff in psychological approaches to challenging behaviours hannah wilson and isabel...
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Training Ward Staff in Training Ward Staff in Psychological Approaches to Psychological Approaches to
Challenging Behaviours Challenging Behaviours
Hannah Wilson and Isabel ClarkeHannah Wilson and Isabel ClarkeChartered Clinical PsychologistsChartered Clinical Psychologists
Hampshire Partnership NHS TrustHampshire Partnership NHS TrustWoodhaven, Loperwood, Calmore Woodhaven, Loperwood, Calmore
Hampshire, UK SO40 2TAHampshire, UK SO40 2TAHannah.Wilson@hants-sw.nhs.uk Hannah.Wilson@hants-sw.nhs.uk
OverviewOverview
Introduction to challenging behaviours and Introduction to challenging behaviours and training issuestraining issues
Description of the 2 day training deliveredDescription of the 2 day training delivered
Outcomes and feedbackOutcomes and feedback
SummarySummary
Reflections and ways forwardReflections and ways forward
Challenging behaviours Challenging behaviours
Typical and topical for inpatient workTypical and topical for inpatient work– Incident rate of Incident rate of – Responsible for Responsible for
Vanderslott, 1998; Owen et al, 1998; Vanderslott, 1998; Owen et al, 1998;
High arousal …..stress, burnout, time off, High arousal …..stress, burnout, time off, etc.etc.
Impact on the unit and individuals Impact on the unit and individuals considerable and often under-reportedconsiderable and often under-reported
Training IssuesTraining Issues
1.1. Practical issues Practical issues – Whole-unit staff training and MONEY (WDF funding) Whole-unit staff training and MONEY (WDF funding)
2.I2.Issues of scepticismssues of scepticism – Psychological training in a medic-led environmentPsychological training in a medic-led environment
3. I3. Issues of attitude ssues of attitude – Ownership of the training – Ownership of the training – (Hastings & Remington, (Hastings & Remington,
1995)1995)
4. I4. Issues of staff well-being ssues of staff well-being – Impact of the nature of the work – Impact of the nature of the work – (i.e. protection from (i.e. protection from
burn out)burn out)
Practical Issues Practical Issues
Work force development fundingWork force development funding
Away from the base –Minstead LodgeAway from the base –Minstead Lodge
Half away from unit on training while other Half away from unit on training while other half on shift back at base (2, 2 day half on shift back at base (2, 2 day workshops)workshops)
NEED SUPORRT FROM MANAGERS!NEED SUPORRT FROM MANAGERS!
Issues of Scepticism Issues of Scepticism
Introduction to evidence-based psychological Introduction to evidence-based psychological approaches.approaches.Recognise the strengths and diversity within the Recognise the strengths and diversity within the team as well as working towards a consistent, team as well as working towards a consistent, Recovery oriented, approachRecovery oriented, approach..
Promote development of positive care plans for Promote development of positive care plans for challenging behaviour using these approacheschallenging behaviour using these approaches ..– Teaching given on behaviour principles of behaviours to Teaching given on behaviour principles of behaviours to
increase, rewards and reinforcements vs. behaviours to increase, rewards and reinforcements vs. behaviours to decrease and punishment decrease and punishment
Be able to conceptualise challenging behaviours Be able to conceptualise challenging behaviours in helpful ways.in helpful ways.
Issues of attitude and ownershipIssues of attitude and ownership
Staff ownership of the training to improve application of Staff ownership of the training to improve application of the approach once training completethe approach once training completeBefore the training, allocated into teams of 5 and asked Before the training, allocated into teams of 5 and asked to bring a current case to discussto bring a current case to discussSmall group work to formulate the case they brought, Small group work to formulate the case they brought, develop a positive care plan with clear triggers, develop a positive care plan with clear triggers, reinforcements and integrated opportunity for desired reinforcements and integrated opportunity for desired change based on teaching receivedchange based on teaching received
Two days spread out over two weeks Two days spread out over two weeks – Try out the approach in the ward environment, record the Try out the approach in the ward environment, record the
results, and…..results, and…..– Be able to report back on and discuss the experience at the Be able to report back on and discuss the experience at the
second day.second day.
Issues of staff well-beingIssues of staff well-being
Team building exercisesTeam building exercises
Plus … “Looking at Roles” ExercisePlus … “Looking at Roles” Exercise
Practical tips on “High Arousal DO’s and Practical tips on “High Arousal DO’s and DON’Ts”DON’Ts”
Outcomes re: challenging Outcomes re: challenging behavioursbehaviours
All teams clearly able to develop a positive All teams clearly able to develop a positive care plan and implemented themcare plan and implemented them
Reduction of challenging behaviours for Reduction of challenging behaviours for duration of the training duration of the training
Case Study Case Study
Triggers: Visitors or Bored
High arousal
Shout out “Kill you” and make lunge at staff
Taken back to room and given PRN medication
New PlanNew Plan
Engage in relevant activity at regular time Engage in relevant activity at regular time slots slots
Client given cards to indicate when she Client given cards to indicate when she wanted PRN that she could hand in to wanted PRN that she could hand in to ward staff ward staff
When card handed in, all staff knew to When card handed in, all staff knew to react promptly so as to reward this more react promptly so as to reward this more functional request of her needsfunctional request of her needs
Case Study Results Case Study Results
14
5
0
2
4
6
8
10
12
14
16
2monthsbefore
2months
after
Reportedattacks on staff
Results/ FeedbackResults/ Feedback
Positive feedback from satisfaction Positive feedback from satisfaction questionnairesquestionnaires
Staff feeling valued and supportedStaff feeling valued and supported
““
Reflections and final thoughts Reflections and final thoughts
Sustaining the impact?!Sustaining the impact?!Weekly care planning/ psychology Weekly care planning/ psychology formulation meetings – raised profile of the formulation meetings – raised profile of the benefits of psychological approaches benefits of psychological approaches Use of service user presentations in the Use of service user presentations in the futurefutureInvite medics to attend in futureInvite medics to attend in futureOverall….A valued and worthwhile Overall….A valued and worthwhile exerciseexercise
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