Welcome to our Managing Challenging Behaviour Training

1. Welcome to our Managing Challenging Behaviour Training Speaker: Eamonn Dennis

2. Key topics • Defining different types of behaviour • How to be assertive • Principles for managing difficult behaviour • How to listen effectively • How to keep calm • How to manage challenging behaviour • How to manage aggressive and abusive behaviour

3. Section 1: Section 1 Understanding conflict and difficult behaviour

4. Conflict Conflict occurs when we try to force another person to accept a point of view or take a particular course of action. ‘I’m ok, you’re not’. Angry behaviour A release of tension when we are frustrated. A survival instinct. The outward expression when other emotions are activated.

5. Assertive behaviour Is exercising your right to express your views and opinions in a respectful manner. You work towards respecting the views and opinions of others and encouraging them to respect yours. ‘I’m OK and you’re OK’. Passive behaviour The tendency to put the needs of others above one’s own on a consistent basis. “You’re OK, I’m not OK”.

6. Conflict behaviour I’M OK & YOU’RE NOT OK

7. Passive behaviour YOU’RE OK & I’M NOT OK

8. “Get me an appointment now” Passive behaviour “I Can’t” YOU’RE OK & I’M NOT OK

9. Assertive behaviour I’M OK & YOU’RE OK This is the position we are trying to reach. I have rights and so do you. This doesn’t tend to happen automatically in a conflict situation. It requires that you actively stay ‘ok’ and work at getting the customer to treat you ‘ok’.

10. Activity • Before or during a difficult conversation I say to myself ‘Stay OK’ which helps me to stay relaxed. ‘Staying OK’ • What could you do physically to stay ok during a difficult conversation with a patient? • What could you say to yourself to stay ok?

11. Staying okay - video Notice any changes in the… • Tone of voice and volume • Body language • Use of questions • Consistency of behaviour

12. Not the way to do it

13. Better

14. Principles for managing challenging behaviour

15. Principles 1: Everyone is okay 2: I am responsible for how I feel and react and I am not responsible for how you feel and react. 3: A person has a right to their opinions and feelings 4: Frequently I have to accept that I cannot fix the opinions or feelings of others By accepting I cannot fix everyone’s problems or feelings I can stop struggling, reacting and feeling negative. I aim to give great service but people have a right to how they respond.

16. Listening effectively

17. What are we listening out for? Content (what has happened) + Emotion (how the client feels about it). We are experts at managing the content but we often struggle with understanding and responding to the emotion.

18. What are we listening out for? Content (20%) + Emotion (80%). The client’s need to convey their emotions can become their overarching aim during a challenging conversation.

19. What is he feeling?

20. Why might clients feel we are not listening? • Explaining ourselves • Justifying our decision/action • Arguing back • Correcting them • Talking over them • Not listening • Saying very little • Sulking • Not acknowledging the facts or emotions

21. RAGE The Escalation Scale • 10 • 9 • 8 • 7 • 6 • 5 • 4 • 3 • 2 • 1 Right and Reacting Openness and Thinking CALM

22. Section 2Keeping calm

23. Strategies to keep calm Goal: To create some thinking space for you and the client. When clients are encouraged to think rather than react they tend to calm down. • Pause a moment before you respond (calms your instant reaction) • Slow down the pace of the conversation • Ask a question (buys time to think) • Take in the customer’s responses (a slight pause helps to convey that you are taking their information on board) • Lower your voice (people are pre-programmed to react to a raised voice) • Try to control your breathing • Rewind – ‘can we take a step back and look at this again?’ • Count to 1,2...3 • Take a time out (‘let me get your file’) • Physically relax (take a step back) • Use self-talk (‘it is not personal/stay Adult’) • Remember that you have the option to stop the conversation.

24. Section 3: Section 3 De-escalating Challenging Behaviour

25. Why use a structure? • Provides you with a plan to follow and a greater sense of control • The structure enables you to focus on developing understanding rather than solutions

26. A structured approach to de-escalating conflict • Step 1 - Gain control: Tell the client how we are going to proceed with the conversation. (“I can hear you are upset”). “Would you mind if I ask you some questions so I can understand the issue fully? After that I’ll see what I can do to resolve/advise on the matter. Would that be okay?”

27. A structured approach to de-escalating conflict • Step 1 - Gain control: Tell the client how we are going to proceed with the conversation. “May I ask you some questions so I can understand the situation fully? Then we can see what we can do”.

28. A structured approach to de-escalating conflict • Step 1 - Gain control: Tell the client the steps you are going to follow to handle the conversation. • Step 2 - Open up the conversation: Understand the facts and feelings by asking questions. • Step 3 - Summarise the facts and feelings. • Step 4 - Give advice or a solution (if you have one)

29. Step 1 - Gain control: Tell the client how we are going to proceed with the conversation. “May I ask you some questions so I understand the situation fully? Then we will see what we can do” • Step 2 – Open up the conversation Ask as many questions as possible

30. Step 3: Summarise the facts and feelings A summary is one of the only means of conveying your understanding of the client’s problem and feelings. Stick to the facts told to you by the client and do not provide advice or opinions at this stage.

31. Section 4: Section 4 Managing Aggression and/or Abuse

32. Refer the customer on • It works best if you refer a customer on to someone else before they demand it • Refer on to a manager/supervisor • Or to someone better able to assist... “We have a person who specialises in...”

33. DVD piece is from the video made for the British Retail Consortium entitled ‘Trouble in Store’. Dealing with Abuse – Racist Comments

34. Challenging unacceptable behaviour • Indicate a willingness to help. • Request a change in behaviour. • State your willingness to help again.

35. “I appreciate this situation is difficult. Please do not swear. I am happy to talk about this further as long as you are not swearing at me”. • “I do wish to help with this. I know this is not what you want to hear. If you could talk rather than shout at me we could sort this out”. • “I am happy to discuss this further. However, I have clear instructions from my organisation to deal with people who are calm and reasonable. If you could talk rather than raise your voice”.

36. Managing aggression or potential violence Legal Requirements Health and safety law applies to the risks from violence and aggression, just as it does to any other risks from work.

37. The Health and Safety at Work Act 1974 Employers have a legal duty under this Act to ensure, so far as it is reasonably practicable, the health, safety and welfare at work of their employees.

38. NHS zero tolerance policy • Writing letters to patients • Meeting with patients • Restrictions on service provision • Management of risk is needed

39. Potentially aggressive patients All staff likely to be exposed to potentially violent individuals should know the potential trigger situations and the prevention measures identified by the assessment and care plan. Particular care is needed when:• new members of staff or agency staff are involved;• new persons are admitted, especially those with a history of challenging behaviour; and,• there has been a change in a person’s mental or physical state, medication, behaviour, mood etc. www.hse.gov.uk/healthservices/violence/do.htm

40. Risk assessment – absolute minimum Answer some key questions • What are the risks? • Who is at risk? • How can we minimise the risks? • How often should we review this case?

41. Key topics • Defined different types of behaviour • How to be assertive • Principles for managing difficult behaviour • How to listen effectively • How to keep calm • Managing challenging behaviour • Managing aggressive and abusive behaviour

42. Keep in touch • info@conflict-training.co.uk • Knowledge Centre at www.conflict-training.co.uk