Apply Response to Behaviour of Concern

(Van Tay Media, 2019)

When responding to behaviours of concern, workers should adhere to the organisation’s policies and procedures. Organisation policy and procedures consists of various elements that provide workers with clear expectations and guidelines on how they should respond to behaviours of concern. 

Organisation Policies                                                

Organisation policies provide workers with clear expectations on responses to behaviours of concern and demonstrate a commitment to workplace health and safety. Workers should be familiar with their organisation’s policies as they help workers understand and guide their responses when supporting clients presenting with behaviours of concern. As policies may be updated to better suit service delivery, it is important that workers are aware of any changes.

An organisation policy may include the following elements (WorkSafe Victoria, 2019):

Purpose Statement

A purpose statement should be included in the policy. It should outline the need to promote work health safety and commitment to provide workers with support following exposure to behaviours of concern.

Clear Definition of behaviours of concern

The organisation’s policy should clearly state the definition of behaviours of concern. This allows workers to have a clear understanding of the different presentations of behaviours of concern, which allow for quicker identification and response.

Policy Objectives

Policy objectives should be included to outline the desired outcomes of the policy. Examples of policies outcomes include zero tolerance for aggression and violence, appropriate action when responding to behaviours of concern, mandatory reporting of incidents, a no-blame approach when investigating an incident, to minimise risk of future incidents following an investigation, and to ensure ongoing training for workers.

Roles and Responsibilities

The organisation’s policy should outline the roles and responsibilities of staff members. This provides workers with clear expectations on how their scope of practice and thus the extent of their response to behaviours of concern and when to seek further support from their supervisor or specialist staff members.

Risk Management

The various areas of risk management should be addressed by the organisation’s policy. Examples of areas for risk management include risk identification, control measures to address risks, information and communication systems to manage client information of clients who have a history of behaviours of concern.

Authorisation

The organisation policy should also contain authorisation from a staff member of senior leadership to certify that the policy is up to date and that it reflects any changes to organisation and legislation needs. All updates and changes need to be dated.

Organisation Procedures

Accompanying organisation policies, organisation procedures provide more detail on arrangements made to manage risks and respond to behaviours of concern. Workers should refer to and be familiar with the relevant procedures that serve as a guideline for their response.

Work procedures may contain information on (WorkSafe Victoria, 2019):

When a Procedure Should be Followed

Organisation procedures should contain a clear description of situations of when a procedure should be followed. To ensure that the procedure is in line with a worker’s roles and responsibilities, the procedure should outline who should be following the procedure.

Specific Responses to Behaviours of Concern

Organisation procedures should describe specific responses to behaviours of concern. This includes emergency responses when behaviours of concern escalate and threaten the safety of the client, worker, and other members of the public.

Incident Reporting and Monitoring and Evaluating Effectiveness of Responses

Organisation procedures should provide guidelines on how workers record and report incidents and near misses. This would allow workers to monitor and evaluate the effectiveness of responses.

Incident Investigation and Debriefing

Organisation procedures should provide guidelines on how incidents of behaviours of concern are investigated to minimise future incidents. Guidance on how workers can seek further support through incident de-briefing should be also provided.

Professional teamwork is essential for ensuring effective care for clients (Truong et al., 2021). Workers should seek assistance from work colleagues and supervisors when responding to behaviours of concern. This would allow workers to gain insight on how another worker may respond to a situation or further knowledge and skills on how to best respond to a situation. Furthermore, having an open team culture in the organisation, where workers feel free to share their feelings, ideas and concerns, allows workers to feel comfortable with seeking assistance (Simons et al., 2021).

In an event of an emergency or when safety is threatened, workers should request for police or security assistance. Workers should also be aware of the relevant policies and procedures when seeking assistance.

Situation Awareness

Having a shared situation awareness plays an important role when seeking assistance from other workers and is especially important when seeking assistance from workers who are from a different team or role. A shared situation awareness involves workers having a shared understanding of the client’s current state and situation, despite having different worker roles and responsibilities (Nemeth, 2017). This ensures safe and ongoing service delivery from the client.

To achieve a shared situational awareness when seeking assistance, workers should communicate in a clear and concise manner. The use of standardised briefing formats and checklists to communicate information were found to promote better efficient communication and situational awareness.

Prompt Response

When dealing with behaviours of concern, workers need to adhere to the organisation’s policies and procedures. Being unfamiliar with organisation policy and procedures can slow down responses due to uncertainty on how to respond. Thus, being familiar with organisation policy and procedures ensures that workers respond promptly.

Negative emotions, such as feelings of frustrations and anxiety, from stress associated from encountering behaviours of concern were found to hinder a worker’s ability to respond to behaviours of concern (Simons et al., 2021). Workers may practise self-regulation skills to remain calm and reduce negative emotions when supporting clients. For example, taking several deep breaths before responding can reduce the effects of adrenaline and reduce the effects of anxiety (Arnold & Underman, 2011). This will encourage workers to carefully analyse the situation and respond to the situation rationally.

Having sympathy for clients was also found to predict the worker’s readiness to support clients presenting with behaviours of concern (Simons et al., 2021). Workers who understand that behaviours of concern are often out of the client’s control were more likely to sympathise with the client and were also less likely to feel angry at the client. This highlights the importance of understanding behaviours of concern and demonstrating sympathy for clients when ensuring prompt responses.

Firm and Diplomatic Response

A firm and diplomatic response to behaviours of concern would require workers to support clients with respect while letting the client know that their behaviour is inappropriate. Adhering organisation policies and guidelines would also allow workers to be firm but diplomatic with their responses as they would have a clear understanding of professional boundaries.

A person-centred approach to service delivery can also be used to achieve this. A person-centred approach involves valuing and respecting clients, understanding the unique needs of clients, understanding the perspective of the client, and promoting a positive social environment (Fazio et al., 2018). Through the person-centred approach, workers are able carry out firm but diplomatic responses that respect the personhood of the client.

Effective communication when responding to behaviours of concern includes both verbal and non-verbal aspects of communication. Verbal communication involves spoken language to convey information. On the other hand, non-verbal communication involves facial expressions, eye contact, gestures, proximity, and voice features.

Assertive Verbal Communication

Workers should use calm and assertive verbal communication when responding to behaviours of concern. Assertiveness involves an individual being able to express their opinions in a manner that respects the worth and rights of others to have that same right to express opinions (Craig & Banja, 2010). This promotes effective communication as it acknowledges and respects the rights of the self and others.

Assertive communication involves (O'Toole, 2020):

Establishing Focus of the Behaviour of Concern and its Effects

Workers should bring focus and attention to the behaviour of concern and the effects of the behaviour. This can be achieved by stating the facts of the situation in an objective and non-judgmental manner.

The Use of “I” Statements

The use of “I” statements communicates to the others that you take responsibility for your feelings and actions. Phrases such as “You must…” , “Don’t…”, “Stop” can be too harsh and aggressive. Alternatively, the worker may use statements such as “I would like you to…”, “It would help me if…”, “I feel scared when…”

Understanding the Client’s Perspective and Feelings

Workers should listen and observe the client’s verbal and non-verbal behaviours to understand their perspective and feelings. Workers should then communicate this understanding to the client.

Collaboration

Workers should emphasise collaboration with the client by checking in with the client for their thoughts throughout the discussion when possible.

Communicating with a Client who has Limited Verbal Communication Skills

As behaviours of concern are often associated with intellectual disabilities or cognitive impairment, clients may present with limited verbal communication skills. Workers should aim to encourage the self-expression of clients and understand the client’s preferred form of communication. The use of alternative forms of communication such as visual aids and symbols through electronic or non-electronic means can assist workers when supporting clients with limited verbal communication skills. While adhering to organisation policies and procedure, workers may also seek assistance from staff and the client’s care givers to meet the communication needs of clients.

Non-Verbal Communication

When communicating with clients, workers should be mindful of their own non-verbal behaviours while observing the client’s non-verbal behaviours (O'Toole, 2020):

Facial Expressions

Facial expressions can convey messages without the use of words. Workers may express respect and empathy and attention through facial expressions. It is important to be mindful of negative expressions such as frowning which may come off as too aggressive. There are also cultural variations in the use of facial expressions, where they may be perceived differently. For example, Western individuals are more likely to pay attention to mouth and eyebrows while Eastern individuals were more likely to pay attention to the eyes when perceiving facial expressions (Jack et al., 2012).

Eye Contact

Eye contact generally signals interest and attention when communicating with another person. Workers may maintain appropriate eye contact to demonstrate attentiveness to the client. However, workers should be mindful of cultural variations when using eye contact.

Gestures

The use of gestures can emphasise the verbal message an individual is converting. For example, hand gestures can be used to reinforce the meaning of words. For example, waving one’s hand while saying “no thanks”. Workers should be mindful of gestures that may communicate unhappiness or impatience such as folding one’s arms or tapping one’s foot.

Voice Features

When responding to behaviours of concern, workers should maintain a steady tone and speed when communicating to the client. However, it is important for workers to adjust their voice depending on the context of the situation. For example, noisier environments would require the worker to raise their voice to ensure clear communication.

Workers should implement strategies based on the behaviour of concern presented by the client. When implementing strategies, workers should also consider the client’s needs and organisation's policy and procedures.

Responding to Aggression, Noisiness, Verbal Offensiveness, and Intrusiveness

De-escalation

De-escalation aims to reduce client aggression or agitation and involves the use of effective communication strategies (Hallet & Dickens, 2017). Non-verbal communication plays an important role in the de-escalation process. Workers should respond to clients in a calm and gentle tone, along with an open posture and neutral facial expression. This conveys that the worker is not a threat to the client and that the worker is willing to listen to the client’s concerns.

When communicating with the client during the de-escalation process, workers may consider the acronym SHARE (Hallet, 2018):

Simplicity

When clients are in a heightened emotional state such as aggression, it may be difficult for them to process lengthy information or instructions. Workers are encouraged to use simple language and short sentences when communicating with clients.

Honesty

It is important that workers be open and honest about the impacts of the behaviour of concern. A client may not be aware that their level of aggression and noise may be seen as intimidating to others and it may not have been their intention to intimidate others. A client using offensive language may not be aware that their language is perceived as offensive by others and has made others uncomfortable Similarly, a client presenting with intrusive behaviour may not be aware that their behaviour or questions are overstepping a boundary or invading the privacy of others.

Authenticity

Authentic communication involves sincere and genuine engagement with the client. Workers may approach clients in a non-judgmental manner with willingness to understand their situation and unmet needs that have led to the behaviour of concern. Workers may also practise assertive communication while engaging clients to ensure that professional boundaries, as well as the worker’s safety and wellbeing are maintained.

Rapport

Rapport refers to establishing a harmonious client-worker relationship. Workers can achieve this through developing a shared understanding of the client’s situation and needs through authentic and honest communication. Rapport can also be established through inviting the client into the decision-making process by offering choices and getting their opinion on their preferred ways to meet their needs.

Empathy

Empathy refers to the ability to understand another person’s feelings. Workers can communicate empathy once they gain an understanding of the client's situation and concerns. This further contributes to rapport between the client and worker. Workers may empathise with clients without condoning their behaviour through assertive communication. For example, a worker may respond to a client: I understand your frustration and discomfort caused by the pain you are experiencing. However, I would like you to lower your voice as other clients may be disturbed or afraid.

Diversion

Diversion involves redirecting energy from a behaviour of concern to an alternative activity. This can be practised when there are no immediate health or safety concerns attributed to unmet needs. Diversion can be used when behaviours of concern, such as intrusiveness or noisiness, arise from boredom that commonly occurs in residential care settings. The worker may offer the client activities such as games, music, or snacks. Chosen activities should be in line with the organisation’s policy and procedures, as well as the client’s care or support plan.

Responding to Confusion and other Cognitive Impairment

When supporting clients presenting with confusion or cognitive impairment, workers should be sincere and understanding while listening carefully to the client. When speaking to the client, workers are encouraged to speak slower and use simple sentences. Patience is important as the client may need more time to respond or ask the same questions multiple times.

Workers should also minimise background noise or distractions. If the worker is unsure about what the client is trying to communicate, workers may seek assistance from the client’s caregiver or other staff members according to the organisation’s policies and procedures (Bohart et al., 2019).

Responding to Intoxication

Depending on the organisation's policies and procedures, workers may have to conduct a drug and alcohol assessment when a client presents with intoxication (Department of Health Victoria, 2023). With the use of appropriate screening tools, workers should look out for worsening intoxication or withdrawal symptoms and seek the appropriate assistance. When speaking to the client, workers should use simple and clear language while speaking at a slower pace.

Workers should reflect on their own personal beliefs and values surrounding drug and alcohol use and seek support from their supervisor and colleagues, as negative beliefs surrounding drug and alcohol use might interfere with their ability to provide non-judgemental support for the client. Workers should seek support from their supervisor when personal beliefs and values are preventing them from providing non-judgemental support for clients.

Responding to Self-Injurious Behaviour

As it is the worker’s duty of care to minimise or prevent harm or risk, workers should be aware of the organisation’s policies and procedures for managing self-injurious behaviour or threats of suicide. Workers should acknowledge the client’s emotions and may express their concerns for the client’s safety. Depending on the scope of the worker’s role, the worker should seek assistance from a supervisor or a staff member, such as a clinical psychologist or counsellor, who has the necessary skills and knowledge to manage self-injurious behaviour. Depending on the severity of the self-injurious behaviour and organisation policies and procedure, the worker should seek assistance from emergency services.

Responding to Manipulation

Assertive communication that involves communicating empathy to the client should be practised when responding to manipulation (Day et al., 2018). While the worker should communicate empathy and understanding of the client’s situation or unmet needs that led to the manipulative behaviour, the worker should set a boundary with the client by communicating that their behaviour is not appropriate. Workers may also set a boundary by refusing a client’s request if they engage in manipulative behaviour. When setting a boundary, the worker should bring attention to the manipulative behaviour and clearly explain the impacts of the behaviour. This would involve the use of “I” statements to respectfully communicate the consequences of their behaviour. Workers should also seek assistance and support from other workers or supervisors when unsure if the client is using manipulation.

Responding to Wandering

When workers notice that clients are missing, they should follow the appropriate organisation policy and procedure on how to search for the client. Workers should notify relevant staff members, security, police, and the client’s caregiver or family members. When encountering a wandering client, the worker should respectfully and calmly redirect the client back to where they are supposed to be. Workers should also notify the relevant parties when the client is found.

This section of the module we have outlined the purpose of organisation policies and procedures when responding to behaviours of concern, as well as how to ensure that your respond is prompt, firm and diplomatic. You learned how to use effective communication skills such as assertive communication and being mindful of non-verbal communication. You also learned various strategies on how to respond to behaviours of concern. In the next section of the module, more focus will be placed on the aftermath of the incident, where you will learn more about reviewing and reporting incidents of behaviours of concern.