Did you know that it is relatively common for people with a learning disability to develop challenging behaviours? Did you also know that these challenging behaviours are not a symptom of a person’s learning disability, but rather as a result of factors such as internal and external triggers, communication difficulties, sensory impairments, sensory processing difficulties or physical and mental health problems?
According to the Royal College of Psychiatrists, challenging behaviour is any sort of behaviour “of such an intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others.” These challenging behaviours are not limited to, but often include severe levels of aggression, self-injury or injury to others, destructiveness or other disruptive behaviours. Sadly, challenging behaviours among people with learning disabilities, autism or mental health problems often lead to a range of negative effects, including physical injury to themselves and others, exclusion from activities or society in general, abuse, neglect, punitive approaches and restrictive practices.
In recent years however, as health and social care progresses, improves and moves away from institutionalised to more community-based models for care and support, Positive Behaviour Support has become a major role player in how those with challenging behaviours are supported. Used as a therapeutic, values-led approach to support, Positive Behaviour Support is focused on achieving behavioural change where, instead of punishment, restriction and isolation, the goal of is to achieve enhanced community presence, choice, personal competence, respect and community participation.
Since Positive Behaviour Support is based on the moral questioning of the use of antipsychotic medication, restraint and physical punitive measures and promotes more ethical practice, Positive Behaviour Support has linked up with key intervention strategies that are both ethical and effective, such as the Management of Actual and Potential Aggression, also known as MAPA®.
As a nationally recognised and leading programme, MAPA® is a behaviour management system that teaches skills for assessing, managing, and responding to challenging behaviours. What sets MAPA® apart from other behavioural intervention strategies is the fact that MAPA® focuses on verbal de-escalation, prevention, and early intervention. Safe physical intervention options, such as disengagement skills and holding skills, are also taught, but are always only to be used as a last resort.
Through our certified in-house MAPA® instructors, every employee at Happy Futures is expertly trained in all aspects of the MAPA® programme which gives them a solid framework for decision making and problem solving when individuals have challenging behaviours, ensuring all practices are always values-based and person-centred.
As Positive Behaviour Support is an integrated experience, so too is the main focus of the MAPA® programme, and therefore, for each stage of the individual’s behaviour, the MAPA® programme teaches an appropriate response from staff through the Crisis Development Model, illustrated with the example of Individual Thomas and Support Worker Sarah in this blog post.
Usually, challenging behaviours start with the anxiety phase, where a change in the individual’s behaviour can be detected. In response to this, Support Workers will adopt a supportive attitude and implement an empathic, non-judgemental approach as they support the individual and hopefully decelerate an escalating behaviour.
For instance, Individual Thomas starts to feel anxious and stressed, which he communicates by tapping his hands on his legs and looking around nervously. He is worried about taking his medication – something that Support Worker Sarah knows he doesn’t like. In response, Support Worker Sarah reassures Individual Thomas and offers him support, comfort and distraction. She makes sure he is comfortable and lets him know that she is there for him.
Should the staff’s supportive attitude not be effective and the individual’s challenging behaviour escalate, the defensive stage of the model will come into play, where individuals start to lose rationality. In response, the Support Worker’s approach will become directive in order to decelerate the escalating behaviour.
For instance, Individual Thomas is becoming more anxious and will not listen or respond to Support Worker Sarah’s de-escalation efforts. Individual Thomas is now walking away from Support Worker Sarah and shouting at her, asking why she is always making him take his medication. In response, Support Worker Sarah now becomes directive, and gives Individual Thomas the information he asked for. Support Worker Sarah explains that his medication is there to keep him happy and healthy, and sets limits by using the if-and-then method: If you take your medication, then you will feel better and we can go out to the park.
If the Support Worker’s directive approaches are not successful, the individual may start to present risk behaviours, where the behaviour presents an imminent or immediate risk to the individual themselves or to others. In response, the Support Worker will use the MAPA® decision-making matrix and, if absolutely necessary, use physical intervention techniques, such as disengagement and/or holding skills to manage the risk behaviour. However, great emphasis is placed on the fact that all disengagement and holding skills are only and always be used as a last resort, be reasonable and proportionate to the risk, and be the least restrictive for the least amount of time.
For instance, Individual Thomas’ behaviour is escalating and he has now grabbed Support Worker Sarah’s shirt sleeve. In response, based on her assessment and training, Support Worker Sarah uses a low-level disengagement technique as a last resort.
Towards the end of a challenging behaviour, the individual will go into tension reduction, where the individual will have a decrease in physical and emotional energy. In response, the Support Worker will create a therapeutic rapport and re-establish communication between themselves and the individual.
For instance, after Support Worker Sarah used a disengagement technique and continued to be supportive and directive, Individual Thomas’s behaviour de-escalates and he now feels bad about grabbing Support Worker Sarah, so he lies down on his sofa and cries a little. Support Worker Sarah now has the opportunity to talk to him and rebuild a good, supportive connection with Individual Thomas.
It is important to note that all of the above cannot be successful without many other factors taken into consideration and additional skills taught. During each MAPA® training session, staff are introduced to the concepts of non-verbal and paraverbal communication, verbal intervention and empathic listening – all powerful tools that can be used during Positive Behaviour Support. Staff are also educated on precipitating factors, rational detachment, the importance of an integrated experience along with discussions on how to best support each of the individuals supported at Happy Futures before, during and after challenging behaviours.
One of the greatest things about the MAPA® programme is its focusses not only on the challenging behaviours, but also on what happens after them. Through training, staff can post-crisis establish therapeutic rapport with the individual in order to prevent future crisis. Through proper debriefing, recording and reflection, new frameworks can be set up to improve future staff interventions, all which will be recorded in the individual’s Positive Behaviour Support Plan.
When taught, implemented and used correctly with the individual’s wellbeing, dignity and rights in mind, the MAPA® programme is a wonderful tool that allows Happy Futures Support Workers to really offer the best support for all individuals. If you know someone who would benefit from outstanding support to improve their quality of life, help them to become more independent and confident and give them a happy future, get in touch with us today!
Allen, D. 2005. Guest Editorial. Learning Disability Review, 10:2. Pavilion Publishing Ltd, Brighton.
Allen, D., James, W., Evans, J., Hawkings, S & Jenkins, R. 2005. Positive Behaviour Support: Definition, current status and future directions. Learning Disability Review, 10:2. Pavilion Publishing Ltd, Brighton.
Emerson, E. 2001. Challenging Behaviour Analysis and Intervention in People with Learning Disabilities. Cambridge: Cambridge University Press.
Lowe, K., Allen, D., Brophy, S & Moore, K. 2005. The Management and treatment of Challenging Behaviours. Learning Disability Review, 10:2. Pavilion Publishing Ltd, Brighton.
National Institute for Health and Care Excellence. 2015. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. https://www.nice.org.uk/guidance/ng11
Royal College of Psychiatrists. Challenging behaviour: a unified approach. London: Royal College of Psychiatrists, British Psychological Society and Royal College of Speech and Language Therapists; 2007. College Report CR144.