Sector:

OTHERS

Qualification Title:
CARETAKER

Unit of Competency

Respond effectively to difficulty/challenging behavior

Date Developed: Document No.

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 Module Title:

Responding effectively to difficulty/challenging behavior

How to Use This Competency – Based Learning Material

Welcome to the competency – based learning material on “Respond

effectively to difficulty/challenging behavior. This contains training
materials, information sheets and activities for you to read and accomplish.
The unit of competency “Implement and monitor infection control policies
and procedures” covers the skills, knowledge and attitude to identify the roles
and responsibilities of a team member.
You will be required to read reference materials or information sheets
and go through some activities in order for you to achieve each learning
outcome. You will do these activities at your own face and then answer the self-
check at the end of each information sheet. If you have questions please feel
free to ask your trainer for assistance.

Instruction Sheets:
• Information Sheet – this will provide you with information (concepts,
principles and other relevant information) needed in performing certain
activities.
• Worksheet – worksheets are the different forms that you need to fill-up in
certain activities that you performed.

Recognition of prior Learning (RPL)

You may have some knowledge and skills in this particular unit of
competency because you have had training in this area or you have worked in
an industry for sometimes.
If you feel that you already have the skills/knowledge in this competency
or if you have a certificate from previous training, you may show it to your
trainer and have your prior learning formally recognized.
A Trainee Record Book (TRB) is provided for you to record important
dates, jobs undertaken and other workplace events that will assist you in
providing further details to your trainer.
Date Developed: Document No.
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 DIRECTION FOR USE OF THE CBLM

This module was prepared to help you achieve the required competency:
Respond effectively to difficulty/challenging behavior. This will be the
source of information for you to acquire the knowledge and skills in this
particular module with minimum supervision or help from your trainer. With
the aid of this material, you will acquire the competency independently and at
your own pace.
Talk to your trainer and agree on how you will both organize the training
of this unit. Read through the module carefully. It is divided into sections which
covers all the skills and knowledge you need to successfully complete in this
module.

Work through all the information sheets and complete the activities in
each section. Do what is asked in the INSTRUCTIONAL SHEETS , ACTIVITY
SHEETS and complete the SELF-CHECK. Suggested references are included to
supplement the materials provided in this module.

Date Developed: Document No.

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 Most probably, your trainer will also be your supervisor or manager.
He/she is there to support you and show you the correct way to do things. Ask
for help.
Your trainer will tell you about the important things you need to consider
when you are completing activities and it is important that you listen and take
notes.

Talk to more experienced workmates and ask for their guidance.

Use the self-check questions at the end of each section to test your own
progress.
When you are ready, ask your trainer to watch you perform the activities
outlined in the module.
As you work through the activities, ask for written feedback on your
progress. Your trainer gives feedback/pre-assessment reports for this reason.
When you have successfully completed each element or learning outcome, ask
your trainer to mark on the reports that you are ready for assessment.
When you have completed this module and feel confident that you have
had sufficient practice, your trainer will schedule you for the institutional
assessment. The result of your assessment/evaluation will be recorded in your
COMPETENCY ACHIEVEMENT RECORD.

INFORMATION SHEET 1.1

RESPONDING TO CHALLENGING BEHAVIOUR

Challenging behavior’ describes negative behavior that is often complex, erratic,

unpredictable, and difficult to work with and/or control. Some types of
behaviors that are considered to be challenging for workers, and/or
problematic for a client’s functioning include:

• Self-harming
• Aggression and violence

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• Harming others
• Passive aggression
• Suicidal behavior
• Prolonged depression
• Hyperactivity
• Withdrawal
• Learned helplessness
• Forceful refusal to co-operate
• Severe lack of motivation/ procrastination
• Harassment (e.g. sexual advances, bullying, racism, stalking).

Challenging behavior can also mean negative behavior that is consistent with
particular life issues or conditions, such as:

• Mental health (e.g. irrational behavior, confusion, disorientation)

• Alcohol and other drug abuse
• Developmental stage (e.g. youth risk-taking experimentation, three-year-old
tantrums, aged person’s dementia).

Other challenging behaviors that can cause problems for human service
workers include behavior that:

• causes offence or distress

• is life threatening
• limits the person’s life opportunities (e.g. committing offences, sabotaging
case plan goals)
• does not comply with organizational procedure or policy
• threatens the emotional wellbeing of others.

Monitoring behavior
Observing and monitoring behavior can be required of community workers in a
range of situations and for a number of purposes. Behaviour can provide useful
information about clients for the purpose of:

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• Monitoring a client’s changing coping skills (e.g. with the onset of dementia
in an aged care client, or for a client recovering after acquired brain injury)
• Behaviour modification (e.g. supporting someone to change their behavior)
• Reporting to a psychologist or other clinician (e.g. career or human service
worker ticking off a daily checklist for a formal diagnostic report).

Observation and monitoring can be undertaken by:

• The client themselves (self-check)

• A career/parent
• A support worker
• A psychologist or other clinician.

As a support worker, you may be asked to monitor a client’s behavior over

time, and this can be achieved through both formal methods and informal
methods that could range from:

• Observation
• Interviewing clients and significant others
• Supporting someone to self-monitor
• Using a formal monitoring tool
• Checking in with colleagues and other service providers
• Researching case notes and client service plans/action plans.

Formal monitoring
All community services or agencies will have their own formal processes for
observing or monitoring client behavior, depending on the type of service
provided. Observation is a very valuable technique for collecting data.
Examples of formal observation include:

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• Behavioral observation charts to observe and monitor the client’s behavior
for a certain period of time, for the purpose of establishing the reason behind
the behavior.
• Checklists and inventories
• Case notes.

Observation over time provides opportunities to gain perspective about many

aspects of a client’s functioning, behavior, and their presenting issues. It can
identify the frequency of certain behaviors and help to determine treatment or
special needs.

The following guidelines should be followed when documenting your

observations:

• Record only what you see and hear

• Don’t make judgements
• Record the date, time and activity the client was participating in during the
observation session
• Document who the observer was
• Follow your organization’s policies and procedures closely to ensure the
correct protocols are being adhered to (e.g. confidentiality)
• Maintain clear and precise records, and where possible keep a typewritten
account of what happens
• Remain objective (i.e. no subjective interpretations of events)
• When documenting the observation session, place the information in
context.

Informal monitoring
Informal methods of observing and monitoring client behavior can assist
workers to get to know their clients better and to understand a client’s
particular issues and concerns. It is also very effective in the early
identification of challenging behavior, and recognizing when it is appropriate to
monitor behavior and record observations on a formal basis.

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The key is to understand what is going on with the client, and being aware of
the environment (e.g. noise, light, heat), and its effect on the client. The worker
should also consider his or her personal response to the behavior.

Some behavioral signs to watch out for include:

• Pacing
• Agitation or fidgeting
• Raised voices
• Certain tone of voice
• Sighing or rolling of the eyes
• Defensive posture – arms crossed
• Clenched fists
• Withdrawn or unusually quiet or distracted
• Staring in a confronting manner.

Assessing behavior
It is very important for workers to recognize risk factors in clients by knowing
the client’s history. This can be done by:

• examining case notes

• reading observational charts
• receiving handover reports from co-workers
• researching any relevant information available on the client.

Factors that may dispose clients to be in conflict with the service deliverer or
career and/or to act aggressively include:

• A history of aggression/violence/acting out

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• The presence of hallucinations (which are revealed as sensations of hearing,
seeing, smelling, tasting and feeling)
• Drug and alcohol abuse
• Incorrect use of medication
• Feelings of paranoia
• Feelings of entrapment and powerlessness
• High levels of frustration
• Lack of impulse control
• Anxiety arising from conscious/unconscious conflicts
• Delusions of persecution
• Use of inappropriate defense mechanisms (e.g. lying, projected hatred).

(Keane & Dixon 1999)

The behavior can develop slowly, with the client remaining unaware of their
conduct and the potential impact it may have on others. It is important that
workers are aware of the changing behavior in clients that may lead to conflict.

Classifying behavior
Workers sometimes need to take action to respond to client behavior as a result
of either:

• Evidence of a client’s negative behavior over time

• Crisis situation (act of violence or aggression).

EVIDENCE-BASED ASSESSMENT OF CLIENT BEHAVIOUR

Negative behavior can relate to a person’s coping skills or problem behavior.
Coping skills
Sometimes monitoring client behavior can be for the purpose of assessing a
client’s changing coping skills. As we indicated earlier, this can relate to
diminishing skills (e.g. through withdrawal, confusion, lack of motivation,
passive aggression, ageing, health condition), to regaining skills as a person
recovers from an injury or surgery, or to developing skills through training and
information sharing.

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Problem behavior
Sometimes client behavior may not be a risk to safety, but may still be a major
problem for the client in reaching their goals. An assessment of client behavior
over time, together with accurate knowledge about the client’s current situation
and issues, can go a long way towards taking the right action to prevent future
problematic behavior.

Responding to crisis situations or inappropriate behavior

Agencies usually have specific procedures in place to deal with crisis
situations, including acts of violence and aggression.
Regardless of the procedures in place to support workers in a crisis situation, it
is also important that aggressive incidents are managed at an agency level.
There are three phases to managing an aggressive incident – before, during,
and after an event.

• Before an incident, the workers (and agencies) need to be implementing

preventative measures.
• During the incident, the worker(s) involved must use strategies that will not
only assist the client to regain control, but will also prevent injury – to the
worker(s), to the client, to others, and to property.
• After the incident, a debriefing need to be conducted with all of those
involved (usually on an individual basis), and especially with the client to
help the client deal with the underlying issues and prevent further episodes.

ASSESSMENT METHODS AND TOOLS

Assessment methods
There are a number of assessment methods for monitoring client behavior and
each of these methods require specific tools, depending on the circumstances
and clients involved.
The types of assessment methods to monitor client behavior include:

• Client assessment
• Indirect assessment
• Interviews with clients and stakeholders

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• Risk assessment.

Client assessment
The client can take charge and observe their own behavior by directly
documenting when something occurs, or when they experience the negative
behavior coming on (e.g. feel aggressive and want to ‘hit out’ at someone), and
even by identifying what is happening to trigger that behavior.
Indirect assessment
This occurs when a human service worker, nurse, teacher or parent/career
observes behavior and records any behavior change over time.
Interviews with clients and stakeholders
Interviewing clients and others close to them can shed light on how a client is
feeling at present, and any current issues that are bothering them. Interviews
can also reveal how often a particular behavior occurs if relevant.

Risk assessment
Part of your assessment and evaluation of a client’s needs and issues may
require you to determine whether the client’s situation or behavior puts them
or others at risk.

Assessment tools
There are many types of tools for assessing and monitoring behavior depending
on the type of client and their behavior and the agency. Most of them are
typically in the form of checklists, forms or multiple choice questions, for
example:

• Incident report
• Self assessment tool
• Child behavior checklist
• Life status review checklist.

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Incident report
An incident report will typically contain information such as:

• Date of report
• Date of incident
• Time of incident (if appropriate)
• Description of problem
• Location of problem
• How the incident was managed
• Comments

Self assessment tool

This self-assessment tool will help clients or careers to monitor behavior over a
fortnight.

WARNING SIGNS OF CLIENT-INITIATED VIOLENCE

Early potential:
rapid breathing, clenched fists and teeth, flared nostrils, flushed expression,
panic, loud talking or chanting, restless and repetitive movements, clinging to
staff, pacing, aggressive gestures (e.g. pointing, hands on hips), swearing
excessively, use of sexually explicit language, veiled threats, verbal abuse,
unprovoked outbursts of anger or emotion, or sexual harassment.

Escalated potential:
argues frequently and intensely, blatantly disregards ‘normal’ behavior,
obsessional thinking and behavior, throws/sabotages/ steals equipment or
property, makes overt verbal threats to hurt employees, rage reactions to
frustration, violent or sexual comments sent via email, voicemail, SMS, or
letter, and blaming others for all difficulties.

Urgent signs:
fascination with weapons, substance abuse, severe stress, violent history,
marked changes in psychological functioning, exotic claims (losing touch with
reality), social isolation or poor peer relationships, poor personal hygiene, and
drastic changes in personality.

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Realized potential:
destruction of property, involvement in physical confrontations or assault,
display of or use of weapons, evidence of sexual assault, arson or suicide risk.
(Mayhew 2000, p.28)

Preventing and defusing conflict

It is always better to try to prevent aggressive behavior from occurring in the
first place, rather than having to intervene once the behavior has begun.
Agencies and workers need to be aware of factors that can contribute to
aggression. These include:

• physical climate
• emotional climate
• staff behavior
• actual or perceived poor service delivery
• inadequate design of the environment
• extreme anxiety, fear, anger
• illness (especially mental health issues)
• deficits in coping skills
• malicious intent.

There have been many strategies developed over a period of time for preventing
and defusing aggressive and other negative client behavior.
Some of the most effective include:

• Solution-focused behavioral change model (Molnar & de Shazer 1987, Walter

& Peller 1993)
• Reality therapy and Choice theory (Dr William Glasser began developing in
the 1960s, and developed further since)
• Negotiation and conflict management techniques (win–win solutions).

Challenging behavior can be passive or active and the above strategies move
away from the old ‘behaviour management’ concept. This related more to
control, discipline, and behavior modification. The old concept of managing
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client behavior was of the worker or career doing something to, rather
than working with, a client. The client was a problem and the worker
attempted to fix the problem – a very clinical approach.

EVALUATING BEHAVIOUR
When you are directly involved with a client’s unacceptable behavior, and when
you have been at the receiving end of abuse and/or aggressive behavior, it is
more difficult to report and evaluate their behavior objectively. It is still very
important, however, that you remain as objective as possible in your reporting.
Evaluations provide the most clarity when they are:

• Specific (so the client can relate to identifiable behaviors or actions)

• Accurate (so they lead to helpful insights and not to confusion or anger)
• Informative (so as to give insight into how to do things differently and
better next time)
• Controllable (so they relate to behaviors or actions that the client can
change).

Once you have identified the background of the behavior then you need to
follow your workplace policies and procedures as a guide to evaluating the
situation. For example:

• When did the behavior begin?

• What else was happening at the time?
• Who was present at the time?
• What type of behavior is presenting?
• Is there a risk to the person’s safety and your own safety?

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