CHILDRENS BEHAVIOUR SERVICES

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CHILDRENS BEHAVIOUR SERVICES
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The Childrens Services Assessment and Treatment
Centre is based at Muckamore Abbey Hospital.It
consists ofThe Childrens Residential
Ward.The Behaviour Nurse Therapy
Department.There is a Multi-Disciplinary
approach to the childrens assessment, treatment
and everyday care needs.
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The Multi-Disciplinary Team consists
of-Consultant Psychiatrist.Medical Staff
Senior House Officer.Clinical Psychologist.Behav
iour Nurse Therapist.Nursing.Social
Work.Teaching staff.
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The children are also able to access-Speech
and Language Therapy.Physiotherapy.Dental
Care.Dietitian.Art Therapy.Music
Therapy.Swimming classes.Social Skills Group.
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Referral SystemReferrals are generally made
byParents/other carers.Community Nursing
Staff.Social Workers.Consultant
Psychiatrists.Consultant Psychologists.Teachers.
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Reason for ReferralChildren referred to our
service generally have a history of challenging
and difficult behaviour.Parents/siblings/teacher
s/respite carers may no longer be able to cope
with the effects of the childs behaviour.
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The term challenging behaviour has been defined
asCulturally abnormal behaviour(s) of such an
intensity, frequency or duration that the
physical safety of the person or others is likely
to be placed in serious jeopardy, or behaviour
which is likely to seriously limit use of, or
result in the person being denied access to
ordinary community facilities.(Emerson, 1995).
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The children admitted for assessment and
treatment come from a variety of backgrounds and
Health and Education catchment areas.Age range
6 years 18 years.There is a higher
percentage of boys.
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Behaviours may include-Temper tantrums and
physical aggression.Destructive and threatening
behaviour.Severe non-compliance and oppositional
behaviour.Obsessional behaviours.Self-injury.Re
stlessness and hyperactivity.Stereotyped/repetiti
ve body movement.Socially inappropriate
behaviours.Inappropriate sexual
behaviours.Running away/absconding.Lack of fear
of real danger.Resistent to change.Problems
with eating.Problems with sleeping.
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Possible causes for challenging
behaviours-Cognitive ability degree of
learning disability.Emotional Life
experiences, low self-esteem, family tensions
etc.Physical Hearing/visual difficulties.Senso
ry impairment.Mental Health.Lack of social
skills/understanding.Communication
difficulties.Autism.Epilepsy.Environmental
issues.Abuse.Fear.Historical learned
behaviour patterns.
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ASSESSMENTFunctional Assessment/Analysis.A
functional behavioural assessment is a process by
which we seek to identify the problem behaviours
that the child/adolescent may exhibit. We
attempt to identify the function and purpose of
the behaviour.This assessment process enables
us to develop interventions and behaviour support
plans that will teach acceptable alternatives to
the behaviour.
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This process is as follows-Identify the
behaviour that needs to change.Collect all the
data on the behaviour.Historical
analysis.Develop a hypothesis (best guess)
about the reason for the behaviour.Develop an
intervention to help change the
behaviour.Evaluate the effectiveness of the
intervention.Have patience.(Pacer Centre
1994)
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Assessments completed as part of this
processRisk Assessment.Antecedent
Behaviour Consequences (ABC).Motivation
Assessment Scale (MAS).Adaptive Behaviour
Scale (School) ABSS2.Functional Assessment
Interview (FAI).Functional Assessment
Observation (FAO).Communication Assessments.
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Connors - A.D.H.D.CARS - Childhood
Autism Rating Scale.PEPR -
Psychoeducational Profile Revised. A Day in
The Life Of.Circle of Friends.As far as
possible parents are involved in the
assessment process.
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When defining behaviour as challenging we need to
look at the effects it has on the individuals
quality of life.Does it restrict their
community presence, ie school, youth clubs,
holidays, outings, playing with peers?Does
their behaviour cause self-harm?Direct injury
to others.Environmental damage.What effect
does the behaviour have on their family, ie
parents/siblings/extended family?How does it
effect their schooling and their learning
potential?
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Before you commence the assessment process, you
must clearly identify and give a topography of
the behaviour of concern.The ABC Assessments
will provide an analysis of environmental factors
which may influence a behaviour The time of
day. The people involved. Their interactions,
activities, demands on the person.ABC also
provide a detailed description of the
behaviour/event and helps to identify the
maintaining consequence of the behaviour.
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Positive Programme PlanningConsideration should
be given to the ethical issues when we attempt to
change anothers behaviour.Children and
adolescents with learning disability have the
same rights as their peers.As far as possible
we should involve them in the process of
programme planning.
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Positive Programming Involves-Adequate
assessment.The teaching of replacement
behaviours.Meaningful age-appropriate activities
and functional skills development.An effective
communication system.Environmental
changes.Routines/structures.Rules/boundaries.Be
haviour Management Strategies.Anger
Management.Relaxation techniques.Social
skills.Social stories.
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Types of ProgrammesStructured daily
schedules/timetables,TEACCH.STAR
Programmes.Token Economy.Incentive Plans.
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Important considerations in programme planning
and implementationAn agreed consistent
approach.Team working.Positive
attitude.Everday good practice.Monitoring and
evaluation.Family work.Transfer of programme
to community settings, ie Home/School.
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How to deal with difficult situationsRemain
calm and in control.Do not use confrontational
techniques.Use positive body language and tone
of voice.Do not always demand compliance.Use
re-direction.Limit verbal communication.Give
the individual time to calm.Restore the
relationship.Consider the consequence of the
behaviour.
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Qualities for working with children who
challengePositive attitude.Sense of
humour.Confident.Not easily stressed.Consistent
in approach.Accept that you sometimes get it
wrong.Never take it personally.
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Difficulties facing schoolsLack of specialist
behaviour staff support.Home
School.Parental expectations.Class
size.Range of abilities/problem behaviours.