In this section you will learn to:
- Report incidents according to organisation policies and procedures
- Review incidents with appropriate staff and offer suggestions to appropriate area of responsibility
- Access and participate in available debriefing mechanisms and associated support/development activities
- Seek advice and assistance from legitimate sources and when appropriate
Supplementary materials relevant to this section:
- Reading D: Addressing behaviours of concern: The interplay of health, communication, limitations, and psycho-social factors
In the previous section of this module, you learnt about policies and procedures, effective communication, and strategies for responding to behaviours of concern. In this section, you will learn about how to report incidents of behaviours of concern, seek support, and the referral process.
Following a response to a behaviour of concern, workers should report incidents according to the organisation’s policies and procedures.
While organisational requirements may vary, reports generally include information on the type of behaviour of concern presented by the client. This includes a precise description of how the behaviour is presented and an assessment of the possible causes of the behaviour of concern. If behaviour of concern is repeated, include frequency and whether severity of behaviour of concern had increased or decreased. Workers should also include the date, time, and duration of the incident.
ABC Format for Reporting Incidents
To assist workers when reporting incidents, workers may use the ABC format (Chen, 2022). This format involves recording:
- Antecedents: Antecedents refer to the events or factors leading up to the behaviour of concern.
- Behaviour: Workers then state and provide description of the behaviour of concern.
- Consequence: Finally, workers report the consequences that follow the behaviour of concern. This would also include the response the worker had taken to manage the behaviour of concern.
A benefit of consistent reporting and recording incidents of behaviours of concern of a client is that workers gain a comprehensive understanding of the reasons underlying a behaviour of concern. Another benefit is that workers can identify if there is an emerging pattern of presentation of the behaviour of concern, thus allowing workers to better plan and manage future instances.
Below is an example of how a report an incident in the ABC format may look like:
| Date and Time | Duration |
Antecedent: What happened before the incident? |
Behaviour: What did the person do? |
Consequence: What happened after the behaviour? |
|---|---|---|---|---|
| xx | 5 minutes | Noisiness in the common area |
Raised voice at staff and other clients. Made threats towards other clients who were speaking. |
Worker used de-escalation techniques and listened to the client’s concerns. Guided client to a quieter space and provided diversion activities as suggested in client’s care plan. Client agreed with the worker and engaged in painting activity. |
READ
Reading D: Addressing behaviours of concern: The interplay of health, communication, limitations, and psycho-social factors
This reading covers assessing and reporting behaviours of concern. It discusses how workers can formulate and in-depth assessment and thus report of behaviours of concern in the context of intellectual disabilities.
Following an incident, an organisation should have a formal incident management and post-incident policy and procedure. Incident investigation is necessary for organisations to review the incident and minimise and prevent future incidents from occurring.
An investigation should consider the following (WorkSafe Victoria, 2019):
Involve the Appropriate Staff
In addition to reviewing the incident with the worker involved, the organisation may seek further information from other witnesses of the incident. This may include the other workers present in the incident or other service providers such as security.
Injuries Sustained
All injuries sustained during the incident needs to be reviewed. Further information on the support workers can receive following the incident will be discussed in the section Debriefing.
Factors that Contributed to the Incident
Factors that contributed to the incident include the various biopsychosocial factors and environmental factors that could have caused the behaviour of concern. These factors need to be reviewed and assessed in order to make recommendations or suggestions to minimise future incidents.
Offer Suggestions to the Appropriate Staff
Once the investigation is complete, outcomes and suggestions should be communicated to staff members in a timely manner. This can be done through an investigation report provided to relevant staff members who can implement suggestions made such as boards, senior leadership, and managers.
Organisations should provide workers with a debriefing meeting to discuss concerns workers may have surrounding the incident. As previously discussed, exposure to behaviours of concerns could lead to feelings of anxiety and stress, where workers feel less job satisfaction. Furthermore, inadequate support following an incident increases the risk of emotional exhaustion.
During the debriefing process, workers are given the opportunity to discuss thoughts and feelings about the incident and may also discuss the appropriate support needed to minimise stress reactions (Simons et al., 2021). Examples of support provided by an organisation include medical attention, psychological support, compensation claims, and return to work planning.
Providing adequate training or professional development to manage behaviours of concern can help improve the self-efficacy of workers. Self-efficacy refers to a person’s belief in whether he or she can perform a task well. Workers who reported higher levels of self-efficacy when managing behaviours of concern reported lower levels of burnout symptoms (Baby et al., 2018). For example, training could be provided to teach workers the communication skills needed for responding to behaviour of concern. This suggests the importance of dedicating resources to ensure workers receive the proper training to improve their self-efficacy when carrying out planned responses.
A referral involves a professional making a request to another professional or service asking them if they can provide further care for the client. Workers should practise within the scope of their role and responsibilities as stated in their organisation’s policy and procedures. Practising beyond one’s level of skills and knowledge can lead to significant harm towards the client. The client should be referred to the appropriate professional who has the necessary skills and knowledge. Clients may also be referred when they need long term and ongoing care.
Examples of client issues that may need a referral to an appropriate professional include:
Underlying Health Conditions
As behaviours of concern could signal underlying health conditions, a referral to a general practitioner can be made. This would allow the client to get an evaluation of their health and diagnosis for the underlying health condition.
Underlying Mental Health Disorders
Behaviours of concern could suggest underlying mental health concerns. For example, self-injurious behaviour is associated with mental health disorders such as depression and anxiety. A referral to a psychiatrist would allow the client to get a diagnosis and further support for mental health concerns.
Intellectual Disabilities
Clients with intellectual disabilities commonly present with behaviours of concern. Clients with intellectual disabilities may have difficulty communicating their needs verbally when they feel discomfort, pain or confusion. This may result in feelings of frustration and distress, which could lead to behaviours of concern such as shouting or aggression. A referral to a behavioural specialist could be made to further the support of the client by helping them develop strategies to manage behaviours of concern.
Substance Abuse
Substance abuse could be an underlying cause of behaviours of concern. When clients present as intoxicated with drugs or alcohol, the worker may gather information and assess the client’s substance use in line with the organisation’s policies and procedures. This would allow the worker to determine if a referral to a drug and alcohol service such as counselling or rehabilitation would be beneficial for the client for longer term support.
In this final section of the module you have learned how workers may report incidents of behaviours of concern. It is important to record these incidents accordingly to organisational policies and procedures to ensure that the sufficient and relevant information about the incident is recorded.
You have learnt about the importance of the debriefing process to minimise future incidents and reduce symptoms of burnout. You have also learned about the importance of attending developmental activities to ensure that your skills and knowledge are up to date.
Finally, you learned about practicing within the scope of your role and when further referrals are required.
