Positive Behaviour Support Policy Launch Safe management of challenging behaviour in children and young people with le

1. Positive Behaviour Support Policy Launch Safe management of challenging behaviour in children and young people with learning disabilities and autism

2. Positive Behaviour Support Policy Launch Morning session 09.30 Registration and coffee 10.00 Dr Martin Hanbury Welcome and morning programme 10.05 Councillor Morris (Lead member for Children’s Services) 10.10 Sally Rees (Chair of Salford Safeguarding Children Board) 10.15 Vivien Cooper (Challenging Behaviour Foundation) Keynote speech 11.00 Sue Woodgate & Tim Plant Policy and implementation plan 11.30 Panel Question and Answer session 12.00 Lunch Afternoon session 12.45 Sue Woodgate Introduction to afternoon programme 13.00 Workshops 14.30 Plenary session and closing remarks 15.00 Finish

3. Objectives for the day To explore the complex safeguarding issues which emerge in the domain of challenging behaviour To inform delegates of the Positive Behaviour Support Policy To raise awareness of the strategic implementation plan for the Positive Behaviour Support Policy To work with colleagues to identify the support needs of all services obliged to comply with this policy To secure positive working relationships across all parties supporting the needs of children and young people who exhibit challenging behaviour

4. Councillor Morris Lead member for Children’s Services

5. Positive Behaviour Support Policy

6. Sally ReesChair of Salford’s Safeguarding Children Board

7. Challenging behaviour as a safeguarding issue • Indication of unmet need • Non-verbal or significantly impaired communication • Atypical sensory problems (e.g. touch/pain) • Associated medical conditions can preclude some physical interventions • It can prevent children from accessing the healthcare they need • Physical injury, psychological trauma, loss of ordinary opportunities • Can provoke unreasonable, disproportionate response from others

8. Positive Behaviour Support Policy

9. Vivienne CooperChallenging Behaviour Foundation

10. Positive Behaviour Support Policy

11. Sue Woodgate & Tim Plant Policy rationale and Implementation plan

12. Legal framework • Offences Against the Person Act 1861 • The Children and Young Persons Act 1933 • Health & Safety at Work Act 1974 • The Children Act 1989 • United Nations Convention on the Rights of the Child (ratified 1991) • Manual Handling Regulations 1992 • Section 550A of the Education Act 1996 • Human Rights Act 1998 • Disability Rights Act 2001 • Violence at Work 2003 • The Children Act 2004 • Education and Inspection Bill 2006

13. Guidance for Restrictive Physical Interventions

14. Policy development • May 2007 Lack of policy framework identified • Oct. 2008 Initial planning meeting • Dec. 2008 Multi-agency policy working group • Jan. 2010 First draft complete • Jan. 2011Policy submitted to SSCB • April 2011Policy ratified by SSCB • July 2011 Challenging Behaviour Strategy Group

15. Broad aims of the policy and implementation plan Ensure all agencies have policies on the use of RPI’s Establishing & maintaining accurate records & a system of reporting/reviewing incidents Establishing a system to monitor trends over time with regard to individuals and agencies Monitoring and reviewing local practice within systems of clinical governance and systems of accountability Developing staff training programmes Ensuring staff recruitment, training and work rotas make appropriate expertise available

16. Key Responsibilities in policy Employers are responsible for staff safety; policies, procedures, training; recording and reporting; organisational learning Managers are responsible for the implementation of good practice; written care plans; guarding against poor practices Staff are responsible for ensuring their training is adequate and updated; being aware of the policy; how to raise concerns

17. Policy Standard - Prevention of violence & aggression RPI’s can only be used when other less intrusive options have been tried and found to be inadequate t meet the child’s needs The child’s environment should be altered to reduce the likelihood of challenging behaviours Establish primary and secondary prevention strategies Any child with a foreseeable likelihood of challenging behaviour must have a positive behaviour support plan

18. Policy Standard- Achieving best interests PRI’s must never be used as punishment Establish individual procedures to respond to challenging behaviour Actions should be based on evidence from an expert body of knowledge and established good practice After an incident, PBSP and risk assessments must be reviewed PBSP & risk assessments must be reviewed every 3 months

19. Policy Standard - Risk assessment Identify activities or environments associated with risk Establish the likelihood of adverse outcomes Establish the consequences & take steps to avoid unreasonable risk Record all relevant information Minimum review 3 months or more frequently

20. Policy Standard- Minimising risk and promoting well being Where RPI’s are used the short term goal is to return them back to having person control Level of restriction systematically changes in proportion to risk RPI’s are short term measures & once in place plans made to reduce the need to use them RPI’s should be used for minimum time period Individual assessment of contraindications RPI’s should use minimum force and never cause pain

21. Legal defences for use of physical force • As a general rule nobody has the right to touch, move, hold or contain another person • However, people with a duty of care operate in exceptional circumstances where it is sometimes necessary to act outside the norm • Whenever they do so they should be clear about why it is NECESSARY • The best legal defence would be to show that any actions taken were in the client’s BEST INTEREST and that they were REASONABLE AND PROPORTIONATE

22. Protocol in policy • Safe situational management • Dynamic risk assessment • Planned use of RPI’s (Positive Handling Plans) • Emergency/unplanned use of RPI’s must be justified • Immediate actions to treat injury/distress • Informing parents • Post incident management • Recording and reflection • Debriefs with staff and child • Reporting safeguarding concerns • Care planning • Positive Behaviour Support Plans • Review • External support

23. Positive Behaviour Support Plan Description of behaviour sequence and typical settings in which it occurs Describes likely function of behaviour Describes primary and secondary strategies Identifies what RPI and which staff Accompanied by risk assessment and health screen A record of the views of parents Frequency of reviews

24. Definition of challenging behaviour “ Behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour that is likely to seriously limit the use of, result in the person being denied access to, ordinary community facilities.” Eric Emerson 1995

25. Definition & prevalence of learning disabilities • Permanent condition arising in childhood • Arrested or incomplete development of mind • Significant impairment of intelligence • Significant impairment of social functioning • 1/1000 young people in general population has a learning disability

26. Definition and prevalence of Autism • Spectrum of conditions arising in infancy or childhood • Impaired social interaction/development • Delayed or disordered language development • Restricted & repetitive interests, inflexible thinking processes • 0.6 % of general child population • 50-60% children with severe learning disabilities have autism

27. Prevalence of challenging behaviour in Salford 10-15 % children with LD/ASD will develop challenging behaviour In Salford we have 252 children with learning disabilities 85 children with ASD Estimate that at any one time 34-51 children in Salford presenting challenging behaviour Register of disabled children records 201 with challenging/hyperactive behaviour

28. Challenging Behaviour Functional It does something for the person Effective It works for them Learnt It is a consequence of previous experiences Ingrained It is part of the person’s repertoire Communicative It is telling us something Subjectively defined A product of personal history Context specific Varies according to settings and situations Socio-culturally constructed Impact variesbetween groups

29. Understanding Our Responses to Challenging Behaviour We are the product of many different influences in our lives Under stress, we may often return to deep seated values we thought we had outgrown The physiological responses we experience under stress are controlled by stress hormones In turn, these stress hormones affect our thinking and ultimately our behaviour Developing our understanding enables us to question these values

30. Reactive Active Active Proactive A r o u s a l Proactive Time

31. Needs Sensory – enjoyable, pleasurable sensations Attention – acknowledgement, recognition Tangible– a ‘must have’ Escape – literally, metaphorically

32. ‘Restrictive physical intervention’ Restrictive physical intervention involves limiting a person’s freedom of movement and continuing to do so against resistance. It involves the use of force to restrict movement or mobility or the use of force to disengage from dangerous or harmful physical contact initiated by pupils or service users.” Direct physical contact between a member of staff and a child. The use of barriers, such as locked doors, to limit freedom of movement. Materials or equipment that restrict or prevent movement. Restraint - the positive application of force by staff, in order to overcome rigorous resistance; completely directing, deciding and controlling a person’s free movement. The purpose of its application should be to safeguard the person, other people or prevent significant damage to property.

33. Direct physical contact Restraint use of force to overcome rigorous resistance directing, deciding, controlling free movement To safeguard the person, other people or prevent significant property damage

34. Physical barriers that limit freedom of movement

35. Materials or equipment that restrict or prevent movement.

36. Poor practice Failed to prevent aggression Staff actions escalated behaviour Poor situational management resulted in injury. Poor post incident management No evidence of organisational learning No safeguarding policy and lack of capacity to scrutinise poor practice Out of full time education for 2 yrs. Expected practice PBSP should be in place with parents views sought Need to respond with RPI’s could have been avoided Unplanned interventions should be justifiable as reasonable, proportionate, necessary & some practices prohibited Physical injury documented, treated. Debrief and repair relationships Parents should be informed Openness and transparency Case study 1

37. Before intervention Complex needs LD/ASD/Sensory/Physical Need for postural support but restrictive elements of equipment not seen as such. Wheelchair fitted with harness, foot sures and belt. Feeding chair, safe space and arm splints. Wheelchair used as static seat Rocking in wheelchair causing injury to self & damage to chair Following intervention Multi-agency co-ordinated response (8 agencies) Person centred assessment Sensory assessment Function/s identified / needs met Risk assessment – remove harness & reduced restriction Risk assessment justified safe space as necessary Provide alternative wheelchair seat Increase access to free movement Increased sensory opportunities Partnership with parents Case study 2

38. Implementation plan for policy • Challenging Behaviour Strategy Group • SSCB Policy launch and scoping exercise • Post launch support for all agencies • Web site • SSCB seminars e.g. Policy workshop • Training strategy • Practitioners group • Data gathering and Annual SSCB Report • Benchmarking & Quality assurance • Monitoring and review

39. Question and answer session

40. Thank You