Challenging Behaviour Strategy - Fostering Handbook april07

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Behaviour Strategy
and Guidance

Foster Care Services

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

Page 1


Section 1
General Guidelines
1.1 Introduction
1.2 Values
General Proactive Approach
1.4 Reactive

Section 2
Strategy for Crisis Intervention and Prevention (SCIP)
2.1 Introduction
2.2 Training

Section 3
Physical Intervention
3.1 Introduction
3.2 Documentation
3.3 The Use of Physical Intervention
3.4 Health and Safety
3.5 Physical Intervention Techniques
3.6 Risk

Section 4
Restriction of Liberty

Section 5
5.1 Support for Foster Carers and Young People
5.2 Complaints Procedure

Section 6
References and Supporting Material


SCIP Care Planning (Physical Interventions)
Physical Intervention Risk Assessment
LCC incident/physical intervention recording and guidance

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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1.1 Introduction
1.1.1 The Department of Health Guidance for Restrictive Physical Interventions
(Department of Health (DoH) 2002) recommends that the starting point for
establishing good practice in the use of restrictive physical interventions is the
development of organisational policies which reflect current legislation and case law
as well as Government guidance, professional codes of practice and local
1.1.2 Challenging behaviour causes great concern. It can directly cause pain, injury and
distress to individuals, their families and carers. The consequences can include
placement breakdown, early admission to residential care and risk of abuse.
Young People who challenge need to be seen in terms of their strengths, skills,
development and quality of life as well as their challenging behaviour.
1.1.4 The factors causing and/or maintaining challenging behaviour are varied and
complex. Behaviour occurs within a social context in an environment. Good
practice indicates that environmental factors need to be acknowledged. Equally
personal characteristics, whether inherited or acquired, must be recognised and
incorporated into the assessment and intervention.
Factors include:
• Lack of choice and control
• Boredom and lack of environmental stimulation
• Limited communication/understanding
• Over stimulation, noise and general disruption
• Overcrowding
• Antagonism, aggression or provocation on the part of others
• A generally unsuitable mix of individuals
• Feelings of oppression
• Frustration
• Interaction with/style of carers
• Intoxication, drug abuse
• The reinforcing of undesirable behaviour by inappropriate responses/
• The absence of clear reinforcement for positive behaviours
• Physical illness
• Psychiatric disorder
• Emotion/upset or bereavement
• Change in environment or situation resulting in insecurity
• Confusion or exhaustion
This list is not exhaustive.

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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1.2.2 Values
All Young People are entitled to:
• Be treated with dignity and respect.
• Help and advice to enable them to ultimately lead independent lives and be
encouraged to do so.
• Be enabled to make informed choices.
• The protection of the law.
• Have their rights upheld regardless of their ethnic origin, gender, sexuality,
impairment, disability or age.
• Personal privacy.
All services and actions should be based on the need to promote the welfare of the
child, whilst respecting the needs of the foster family.

General Proactive Approach
1.3.1 Much can be done to reduce/prevent challenging behaviours by examining all areas
accessed by the young person and developing both proactive and reactive
strategies. General measures include:

Identification of precursor behaviours i.e. tense muscles, pacing, sweating, facial
expression, increased rate of breathing.

b) Ensuring children and young people have personal space and privacy.

c) Providing structured activities.

d) Through planning and preparation help young people to achieve appropriate
levels of autonomy, personal identity and, where appropriate, take control of
their lives. To achieve this, carers will need the knowledge, training and
experience to adapt their communication skills to use the appropriate total
communication approach

e) Completion of an Intervention plan – see Appendix 2 for more guidance and
• By keeping young people fully informed of what is happening to them and
why in a way that is accessible to the individual, encouraging and promoting
• Using active listening skills and diversions to preferred activities.
• Reducing demands, especially at times of high anxiety.
• Allowing young people time to process information.
• Replacing the behaviour with a functionally equivalent alternative.
• Supporting the development of the young person’s own coping strategies

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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1.3.3 When selecting an intervention approach consideration needs to be given to the
• Known effectiveness in reducing challenging behaviour
• Additional benefits for the young person
• Ethical considerations
• Ease of application
• Evironment
Young People should never be ridiculed or subjected to any form of abuse, i.e.
verbal abuse, swearing, intimidation, physical assault, disrespectfulness etc.
Active/Reactive Approaches

1.4.1 The Assault Cycle
The assault cycle
Recovery phase
Possible additional

Triggering phase:
A young person may exhibit changes in their ‘baseline’ behaviour or mood. An individual
may appear upset, angry, withdrawn or demanding.
Escalation phase:
The young person progresses to the point where they show signs of clear agitation.
Adrenaline is building up in the body, which interferes with the ability to think and
react rationally.
Crisis phase:
An individual is now definitely out of control or physically threatening. At this point, the
safety of others is jeopardised.

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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Recovery phase:
An individual returns to baseline behaviour and mood. Heightened adrenaline remains in
the body for at least ninety minutes and can last up to 3 days, causing an individual to
react more forcefully if provoked or if demands are placed upon them.
Post-crisis depression phase:
An individual may feel remorseful, ashamed, humiliated about the incident/outburst.
1.4.2 Reactive strategies aim to offer a rapid and safe management of a situation i.e.
physical interventions. These interventions should always be used as part of a more
general behaviour management strategy.
1.4.3 Non-physical effective reactive strategies include:
• Not ignoring the behaviour.
• Active listening.
• Encourage alternative, more appropriate behaviours.
• Removing demands.
• Diversion to a reinforcing or compelling activity.
• Low arousal approaches e.g. remain calm, quiet and non-threatening, avoid
escalating the situation.
1.4.4 Young People should never be ridiculed or subjected to any form of abuse i.e. verbal
abuse, swearing, intimidation, physical assault, disrespectfulness etc.
There are two categories of physical intervention:
Planned intervention where foster carer’s employ, where necessary, pre-arranged
strategies and methods which are based upon a risk assessment and are recorded in
care plans and are considered reasonable in the circumstances. This should only be
used as part of an holistic strategy when the risk of employing an intervention is
judged to be lower than the risk of not doing so.
Emergency or unplanned use of force which occurs in response to an unforeseen
event (Department of Health Guidelines 2002, 3.4). For more detail regarding
good practice in the use of physical interventions see Section 3 (Physical

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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2.1 Introduction
The SCIP programme outlines a framework which supports foster carers to
develop awareness of the needs of young people with challenging behaviour. It
promotes a commitment to crisis prevention and is based on a whole approach to
individual’s with challenging behaviour. SCIP also recognises the need to
sometimes respond to behaviour and use physical intervention for temporary
support measures. The physical intervention techniques used are approved by
BILD (British Institute of Learning Disabilities) and monitored externally by the
Loddon School, Basingstoke* for use.

SCIP Instructors are trained to develop and deliver training that not only meets the
needs of the service and individuals, but ensures that the service develops in line
with local and national developments in the care of those who experience
*The Loddon School, Basingstoke The training delivered by the Loddon School was initially designed for adults/children
with autism and learning disabilities in New York, USA. It has been developed by PROACT-SCIPr-UK for use with other
client groups but lends itself best for working with both children and adults with severe challenging behaviour
Training Requirements for SCIP Instructors

Background with working in Social Care

Recognised teaching qualification

Full First Aid at Work Certificate

Completed a preceptorship – observing and assisting experienced trainers

Attend yearly update/conferences

Maintains professional qualification

Attained Link Worker level in the field i.e. Strategies for Crisis Intervention and
Prevention (SCIP) instructor, Studio III,
2.2.1 Level One Introduction Training (5 hour)
Training will be include understanding challenging behaviour, communication and
listening skills, de-escalation/defusion, proactive strategies, behaviour management
2.2.2 Level 2 Advanced Training (2 day/10 hour)
This will include physical intervention and disengaging techniques, risk assessment,
health and safety and legislation including reasonable force, pro-active strategies
for managing challenging behaviour and will dependent upon attendance of Level 1

2.2.3 Update Training (One Day)

Foster carer’s should receive support from the SCIP Lead Instructor approximately
every 6-8 months, and receive update training every 12-18 months.

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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3.1 Introduction
When planned physical intervention strategies are put in place they should be one
component of a broader approach to behaviour management.
3.1.1 Unplanned or emergency intervention may be necessary when a young person
behaves in an unexpected way. In such circumstances foster carers retain their
duty of care to the young person and any response must be proportionate to the
circumstances (reasonable force – See point 3.1.8).
3.1.2 If a proactive intervention is unsuccessful or not feasible and a child is in danger of
hurting themselves or others then physical interventions should be used only until
the child is calm and after other methods of intervention have been considered.
The least restrictive intervention required should be used. Foster carers should use
minimum force necessary to prevent injury and maintain safety consistent with
appropriate training received.
3.1.3 Physical Intervention is used on a young person only where it is necessary to
prevent likely injury to the young person or other persons or they are likely to
seriously damage property.
3.1.4 Whenever a restrictive physical intervention is used twice within a 30-day period
foster carers need to ask for a formal review, with support from the child’s
social worker and their fostering social worker. Foster carers should inform the
child’s social worker as soon as possible after they have used a restrictive
3.1.5 Proactive/active techniques should be used when the young person is showing
early signs of anxiety or change in behaviour.
3.1.6 Other family members/visitors etc, not involved in the incident, will be asked to
leave the area quietly, as appropriate.
3.1.7 Following an incident attempts should be made to re-establish relationships and, if
felt reasonable, discuss the incident encouraging the young person to express a
preference for future management. The recovery period can take from 90 minutes
to 3 days (for all parties involved in the crisis).
3.1 .8 There is no legal definition of ‘reasonable force’.
The use of force can be regarded as reasonable only if the circumstances of the
particular incident warrant it.

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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The degree of force and time employed must be in proportion to the circumstances
of the incident, the seriousness of the behaviour and of the consequences it is
intended to prevent.
Whether it is reasonable to use force, and the degree of force employed, will also
depend on the age, understanding, and gender of the individual.

3.2.1 Care plans should detail preventative strategies, i.e. diversion and defusion techiques,
and have clear information about the individuals’ known triggers and pre-cursors.
3.2.3 Care plans should include a description of the specific physical intervention
techniques which are sanctioned and the dates on which they will be reviewed.
(See Appendix 2).
3.2.4 An up to date copy of these guidelines should be available to all foster carers, child
care social workers, fostering social workers and Independent Review officers.
The Use Of Physical Intervention
3.3.1 The use of physical intervention should be recorded within 24 hours on the
appropriate form (see Appendix 1) which should include:
• Name of young person and other persons involved
• Reasons for using physical intervention rather than another strategy
• The type of physical intervention employed
• The date and duration of the physical intervention
• Whether the young person or anyone else experienced injury or distress and, if
so, what action was taken, i.e. First Aid Procedures
3.3.2 The views of the young person(s) involved in the incident should also be recorded
as far as possible.
3.3.3 Medical advice should be sought if physical intervention is required:
• Heart disease or heart problems
• Difficulty in breathing/respiratory illness
• Problems with digesting food
• Recent bone fractures, history of dislocation, brittle bones
• Downs Syndrome
Health And Safety
3.4.1 When considering the use of physical intervention consideration should be given to:
3.4.2 Foster carers must ensure that BBANC is observed (Body Alignment, Breathing,
Ability to Move, Noise and Colour). When a physical intervention is used the
individual’s circulation, respiration and conscious state should be monitored. A
physical intervention should be terminated immediately if the individual shows any
signs of physical distress

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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3.4.3 A visual check should be carried out for any weapons and the immediate
environment should be made as safe as possible.

3.4.4 The young person should also be observed for injury.
Physical Intervention Techniques

Core: Touch support, Stance, Protective stance, One person escort, Adapted two
person escort (SCIP). Disengagement techniques: Back head lock, front choke,
front choke to the wall, biting, one and two handed arm grabs

Risk Assessment

A full Risk Assessment should be carried out and included with the assessed care
plan. In conducting the risk assessment, consideration should be given to the
following possible risks:

To the young person:
To the foster carer/s:

Pain distress or psychological trauma
Distress or psychological trauma

Increased risk of abuse

Loss of dignity

Undermining of personal relationships


Potential Weapons
Consideration should also be given to the risks of not intervening e.g.

Breach of the Duty of Care

Injury or abuse
Serious damage to property
The risk assessment should identify the benefits and risks associated with different
intervention strategies and ways of supporting the person concerned.

Challenging Behaviour Strategy and Guidance
Staff Development, Social Care Services, Leicestershire County Council

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