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Complex Characters, Challenging Care
Working with people who communicate via often-extreme behaviours, a traditional approach was to seek out the cause of the behaviour by observing what happened immediately beforehand. The cause of the outburst could perhaps be identified, so that the response to it could be managed to reduce the frequency of it happening again. Behavioural theory is well-used and in practice it can and often does work.
If you are in an institutional setting, where routines and activities are repeated every day, and people have been sharing the living space for a long time, it may be easier to use antecedent, behaviour, consequence to work with challenges. People become conditioned to the environment and can manipulate it to meet their needs, so you may find the individual who always knows the optimum time to become noisy and destructive to achieve the most beneficial and rapid response!
When behavioural approaches don’t work
Some people display levels of such extreme behaviour that their health and wellbeing is at risk. Seeking out potential triggers may not have been successful in reducing the self-harm or violent outbursts. There are no consistent antecedents, and no consistent responses have made any difference. Whatever they are responding to, or communicating about, we cannot discern it in the care environment.
We find this perplexing, perhaps because we are looking for the effect of our behaviour on that of others, or perhaps because we want to understand and influence the environment to help reduce challenges.
Another way of looking at it?
Trauma-informed care (TIC), a systems-focused model for service delivery, recognises the prevalence and impact of trauma, and creates a culture of safety, trustworthiness, choice, collaboration, and empowerment. Trauma-informed care is a way of viewing the causes of behaviour as a consequence of traumatic events in a person’s life. Only by understanding this can we start to help them. Its not ‘what’s wrong with you?’ but, ‘what has happened to you?’
We are all the product of our life experiences and we all have a back-story. It’s not surprising that the history of individuals with learning disability can be peppered with difficult events; separation, anxiety, fear, pain. When you begin to unravel the story, the reasons for challenging behaviour begin to be clearer.
If you are faced with a complex character and you can’t identify the reasons for their challenges, consider what makes them so complex and how their story might have brought them to this. I recommend it to you and your team as an alternative to consider.
Ginny Tyler – QCS Learning Disability Expert Contributor