Challenging Client Behaviors

Posted by & filed under Risk Control.

Does your organization serve clients with challenging behaviors? If so, it’s important to recognize that the inability to manage these clients – and their environment – can have an adverse affect on the well-being of your clients, your staff, and your organization as a whole.

To better manage your risks in this area, we suggest you design and implement a comprehensive “behavior management program.” Consider the following components for such a program:

Written Policies and Procedures

Written policies and procedures regarding how to recognize, evaluate and respond to clients with challenging behaviors can help establish: (1) clear communication protocols and expectations for your staff; (2) consistent guidelines for your organization’s management and board to review and oversee; and (3) transparency with respect to your organization’s approach to challenging behaviors for an understanding by clients, their families and other client caregivers. These written policies and procedures can also help establish when more formal client behavioral observations, referrals or interventions may be necessary or appropriate.

Training

Training programs for your staff that are focused on identifying and addressing challenging behaviors can help minimize potential injuries to your staff and your clients. This training can include such things as learning better relationship-building skills; recognition of preceding or triggering events leading to challenging behaviors; and de-escalation techniques. Such training can also include learning appropriate self-defense and physical restraint techniques. Your training activities should be well-documented and on-going.

Behavior Intervention Plan

Particularly for clients known to have challenging behaviors, a pre-planned “Behavior Intervention Plan” (or “Behavior Management Plan”) outlining specific actions to better manage a client’s challenging behavior and environment may be appropriate. Such plans often suggest positive reinforcement techniques to promote appropriate behaviors, identify common pre-cursors to challenging behaviors, and include ways to change the client environment to prevent challenging behaviors from occurring in the first place. These plans are often developed by a team including representatives from your organization (senior management, clinical director, supervisor, and front-line staff), the parent(s)/guardian(s) of your client, outside clinicians, and, where appropriate, your client. These plans should be periodically reviewed and revised to help enhance their effectiveness.

Documentation

Thorough documentation of events involving challenging behaviors can help identify and evaluate trends or circumstances associated with the challenging behavior. With this information, better monitoring and management of individual clients and their environments can often occur. Moreover, this information might also be used to help reduce the frequency and severity of events of challenging behaviors organization-wide. Careful and consistent recording, review and response with respect to these events can lead to a better-managed client and environment, and can also help your defense if a claim is made against your organization or your staff related to a challenging behavior event.

Debriefing

Debriefing is appropriate after any physical restraint or challenging behavior event that causes property damage, or bodily injury to any of your staff or clients. All aspects of such an event should be reviewed within the debriefing process, including: (1) actions or circumstances seeming to precipitate the event; (2) de-escalation techniques utilized; and (3) consideration of what could have been done differently to help prevent the event. Lessons learned through debriefing should be appropriately shared with all of your staff responsible for managing clients with challenging behaviors.

Supervision and Coaching

Your organization’s management and supervisory staff should be actively involved in the entire behavior management program. They should also remain well-aware of how your font-line staff is adhering to established policies and procedures and related protocols. Feedback to front-line staff should include praise for well-managed events, as well as a constructive response for poorly managed events. Appropriate and consistent supervision, coaching and feedback should be done with all staff members.

Annual Review

We suggest that you annually (if not more frequently) review your behavior management program to evaluate the program’s effectiveness. This review should consider new goals for the program with corresponding action plans.

A broad range of publications and other training resources related to the development and implementation of effective behavior management programs are available. Contact our Risk Control Department for a more complete list of these resources.

Suggestions and comments contained herein are provided for purposes of general education only. Suggestions and comments are not intended for the purpose of providing you with legal advice or legal counsel, and are not intended to assure compliance with or complete analysis of any law, rule or regulation. In addition, suggestions and comments should not be interpreted to imply or infer that all exposures, hazards or loss potentials on any subject or issue were identified or considered. No warranty, or guaranty of accuracy, fitness or suitability, express or implied, is granted with respect to any of the information contained herein.