Preventing challenging behaviour of adults with complex needs in supported accommodation

Introduction

Some people with learning disabilities display “challenging” behaviour. This may involve aggressive, destructive or self-injurious behaviours. Staff find such behaviour difficult to manage and may use restrictive practices such as physically restraining the person. It is more costly to support an individual who shows serious challenging behaviour. They may need specialist provision and their quality of life may suffer. Challenging behaviour has many different causes. In particular, such behaviour is often related to the way in which carers support the person. Challenging behaviour is “functional” i.e. the behaviour enables people, with limited communication and other skills, to control what happens to them. One person becomes aggressive when asked to do something – carers retreat and the person “escapes” from the request. Another person hits themselves when alone – carers talk to the person, the behaviour has successfully gained their attention. In this analysis, there is no implication that the person’s behaviour is deliberate – mostly, the person is simply responding to their current and previous experiences. As a result, the treatment of challenging behaviour often requires changes in social care arrangements. Such changes are difficult to achieve, partly because many carers’ understanding of the causes of challenging behaviour are overly focused on factors within the individual.

This project sought to test this approach to the prevention of challenging behaviour. Social care improvements were facilitated in a number of accommodation settings. Settings were typically those that included individuals who already display challenging behaviour. Changes in these settings were contrasted with a control group where no attempt is made to change the quality of social care.