Training Ward Staff in Psychological Approaches to Challenging Behaviours

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Training Ward Staff in Psychological Approaches
to Challenging Behaviours

• Hannah Wilson and Isabel Clarke
• Chartered Clinical Psychologists
• Hampshire Partnership NHS Trust
• Woodhaven, Loperwood, Calmore
• Hampshire, UK SO40 2TA
• Hannah.Wilson_at_hants-sw.nhs.uk

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Overview

• Introduction to challenging behaviours and
  training issues
• Description of the 2 day training delivered
• Outcomes and feedback
• Summary
• Reflections and ways forward

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Challenging behaviours

• Typical and topical for inpatient work
• Incident rate of
• Responsible for
• Vanderslott, 1998 Owen et al, 1998
• High arousal ..stress, burnout, time off, etc.
• Impact on the unit and individuals considerable
  and often under-reported

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Training Issues

• 1. Practical issues
• Whole-unit staff training and MONEY (WDF funding)
  
• 2.Issues of scepticism
• Psychological training in a medic-led environment
• 3. Issues of attitude
• Ownership of the training (Hastings
  Remington, 1995)
• 4. Issues of staff well-being
• Impact of the nature of the work (i.e.
  protection from burn out)

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Practical Issues

• Work force development funding
• Away from the base Minstead Lodge
• Half away from unit on training while other half
  on shift back at base (2, 2 day workshops)
• NEED SUPORRT FROM MANAGERS!

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Issues of Scepticism

• Introduction to evidence-based psychological
  approaches.
• Recognise the strengths and diversity within the
  team as well as working towards a consistent,
  Recovery oriented, approach.
• Promote development of positive care plans for
  challenging behaviour using these approaches.
• Teaching given on behaviour principles of
  behaviours to increase, rewards and
  reinforcements vs. behaviours to decrease and
  punishment
• Be able to conceptualise challenging behaviours
  in helpful ways.

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Issues of attitude and ownership

• Staff ownership of the training to improve
  application of the approach once training
  complete
• Before the training, allocated into teams of 5
  and asked to bring a current case to discuss
• Small group work to formulate the case they
  brought, develop a positive care plan with clear
  triggers, reinforcements and integrated
  opportunity for desired change based on teaching
  received
• Two days spread out over two weeks
• Try out the approach in the ward environment,
  record the results, and..
• Be able to report back on and discuss the
  experience at the second day.

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Issues of staff well-being

• Team building exercises
• Plus Looking at Roles Exercise
• Practical tips on High Arousal DOs and DONTs

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Outcomes re challenging behaviours

• All teams clearly able to develop a positive care
  plan and implemented them
• Reduction of challenging behaviours for duration
  of the training

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Case Study
Triggers Visitors or Bored
High arousal
Taken back to room and given PRN medication
Shout out Kill you and make lunge at staff
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New Plan

• Engage in relevant activity at regular time slots
  
• Client given cards to indicate when she wanted
  PRN that she could hand in to ward staff
• When card handed in, all staff knew to react
  promptly so as to reward this more functional
  request of her needs

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Case Study Results
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Results/ Feedback

• Positive feedback from satisfaction
  questionnaires
• Staff feeling valued and supported

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Reflections and final thoughts

• Sustaining the impact?!
• Weekly care planning/ psychology formulation
  meetings raised profile of the benefits of
  psychological approaches
• Use of service user presentations in the future
• Invite medics to attend in future
• Overall.A valued and worthwhile exercise