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Catherine Evers and Nigel Pilling review ways to achieve best practice in assessment and care provision for clients who may put themselves or others at risk
Abstract
Since 2008, a group of professionals in the UK have collaborated to implement national guidelines on working with people who exhibit challenging behaviours in their region. They have established a formulation planning process for use throughout the region, an audit of clients placed out of area, and a good-practice standards checklist for care managers and social workers to use at annual review. The professionals are also working with commissioners to ensure that the formulation planning process is audited annually, and that the checklist is used at reviews, on entry to new placements and in community teams.
Keywords
Challenging behaviour, quality of services
Challenging behaviour is defined in this article as that which is 'of such intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others, and which is likely to lead to responses that are restrictive, aversive or result in exclusion' (Royal College of Psychiatrists (RCP) et al 2007). This, a modification of Emerson's (2003) definition, emphasises the importance of quality of life and physical safety, and is based on the idea that challenging behaviour can occur when services are restrictive or aversive.
The Michael report (Department of Health (DH) 2008) states that about 15 per cent of the intellectual disability population display challenging behaviours, although such estimates vary according to how such behaviour is defined. People with severe challenging behaviour typically display more than one form and the prevalence of behaviours is often correlated positively with the extent of their learning disabilities (Rojahn 1994). Thus, the more severe the learning disability, the more likely that multiple forms of challenging behaviour are exhibited.
Severe challenging behaviours such as aggression or self-injury can have far-reaching effects on the lives of people with learning disabilities and those who support them.
Access to services and community facilities may be reduced because of concerns about safety or suitability of environment. The need for additional staffmay further reduce the range of activities available to clients, and their opportunities for development and participation. Meanwhile, the behaviours themselves can cause distress in the individuals...