Positive behaviour support Getting it right from the start

Positive behaviour support: Getting it right from the start - Facilitators reference manual 85
Case study: ROSIE TYLO
*A clear description of the behaviours of concern is required
Hitting others with a closed fist (using her right hand), usually to the upper body.
Possible triggers for
the behaviour:
• New staff
• Noisy environments
• Staff changes
• Tiredness
• Constipation
• Headache
Remember: potentially difficult situations may be
avoided if you minimise these possible triggers
(see do’s & don’ts list)
Remember: intervene early when you see early warning signs, in order to prevent behaviour escalating.
Phase 1 Response: Rosie is red-faced and paces excessively
Strategy: Encourage communication, for example, ‘What’s wrong?/Can I help you?
If R positively, encourage Rosie to engage in problem solving as per Problem Solving Program, This
should be done in a quiet area, without interruptions.
Phase 2 Response: Rosie continues pacing plus muttering under her breath.
Possible warning
signs that the person
may display:
• Red-faced
• Excessive pacing
• Muttering under her
breath.
• Using threatening
language
• Erratic behaviour that
does not settle
• Avoids eye contact
Strategy: Encourage relaxation in her bedroom as per Relaxation Program.
Provide as much assistance to Rosie with this program as she requires.
Check with her as to whether she wants you to stay with her or be left alone.
If she chooses to complete the program alone, check in periodically without disturbing her.
If Rosie refuses to engage in relaxation, but the precursor behaviours cease, provide positive
reinforcement in the form of verbal praise for her calming down. Continue to observe her from a
distance for a period of 15 minutes.
If Rosie refuses to engage in relaxation, and the precursor behaviours continue, encourage her to
complete an alternative, preferred activity (see Rosie’s menu of activities). Continue to observe her
from a distance for a period of 15 minutes.
If Rosie refuses to engage in relaxation and attempts to, or actually succeeds in, carrying through
with the target behaviour, proceed to Phase 3.
Phase 3 Response: Rosie engages in target behaviour: Hitting others with a closed fist (using her right
hand), usually to the upper body.
Strategy: PRN VALIUM.
a) Redirect Rosie to another room (away from other clients). Instruct her to sit down. One staff member
should stay with Rosie (at a safe distance, that is, on the other side of a table but not engage in
conversation with her).
b). The second staff member should attend to the person who was target of Rosie’s aggression. If the
person was a staff member, they should not be the one to stay with Rosie, but be allowed some
time away from the person.
c). Once 15 minutes has passed with no precursor or target behaviours being displayed, usual activities
should be resumed.
Staff should ensure that the individual needs of both clients and staff are met.
Staff should not, at this time, enter into discussion with Rosie about the behaviour that she has
displayed. When the time comes to fill out her incentive chart, Rosie and staff will discuss her behaviour
across the whole day.
Talking to Rosie about the episode whilst in Phase 4 Recovery, can actually escalate Rosie’s behaviour.