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1. The Malka Group Pty Ltd Trading as TMG College Australia
Registered Training Organisation #21694
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tmg.edu.au
CHCCCS020 Respond
effectively to
behaviours of concern
Start Learning

2. 3
1 2
Identify behaviour
and plan response
Report and review
incidents
Apply response
Topic Overview

3. Identify Behavior And Plan Response
Welcome to the unit CHCCCS020 - Respond effectively to
behaviours of concern.
This unit describes the skills and knowledge
required to respond effectively to behaviours of
concern of people. Skills are associated with
handling difficult incidents rather than managing
ongoing behaviour difficulties
The unit applies to workers in any context
exposed to difficult and challenging behaviour.

4. Identify Behaviours Of Concern In Line With
Work Role And Organisation Policies And
Procedures
• Behaviours of concern describe
behaviours that may be a problem for
others.
• They are any behaviours that cause
significant distress or danger to person
displaying these behaviours or to other
people.
§ Behaviours can include:
§ Hurting themselves
§ Hurting others
§ Destroying property
§ Refusing to cooperate with staff
§ Repetitive behaviours
§ Disruptive and annoying behaviours
§ Hiding from staff

5. Identify Behaviours Of Concern In Line With
Work Role And Organisation Policies And
Procedures
• Behaviours of concern are those
behaviours, which cause concern to the
staff and require intervention.
• In most community organisations your
work role will be defined by a position
description.
• This position description will describe the
duties and work tasks that you need to
undertake as well as any qualifications
that are required in order to perform the
role.
• Most organisations have policies and
procedures that address issues relating
to behaviours of concerns.

6. Identify Behaviours Of Concern In Line With
Work Role And Organisation Policies And
Procedures
• Many clients who have been engaging
with a service over a period of time and
have displayed behaviours of concern in
the past may already have individualised
program plans, which identify how to
address their particular known
behaviours of concern.
• For example a client with an intellectual
disability may hit themselves on the head
repeatedly and their individualised
program plan may in turn advice you on
what to say when the client behaves in
this manner.
• You need to follow the organisations
instructions in regards to particular
behaviours of concern as these
instructions will also enable you to
identify them.

7. The behaviours of concern that a
client may display can be due to:
• Aggression
• Confusion or other cognitive impairment
• Intoxication
• Intrusive behaviour
• Manipulation
• Noisiness
• Self-destructive behaviour
• Verbal offensiveness
• Wandering
Different Behaviours Of Concern

8. 1. What is a behaviour of concern? Give four (4)
examples.
2. How could your position description help you
respond to behaviours of concern?
Activity

9. Identify Appropriate Response
To Potential Instances Of
Behaviours Of Concern
• The reasons behind a client
displaying behaviours of concern
can vary.
• It is important to understand these
reasons when identifying
appropriate response to potential
instances of behaviours of concern.

10. Identify Appropriate Response
To Potential Instances Of
Behaviours Of Concern
• These reasons can include:
§ The client may be experiencing pain
§ The clients medication may not agree
with them
§ The client may be unwell
§ The client may have disability conditions
such as autism or Prader Willi syndrome
§ The client may be trying to communicate
that they want something
§ The client may be uncomfortable in the
environment as it may be too noisy or too
cold.
§ The client may be expressing emotions
relating to issues in their lives such as
grieving the loss of a loved one or
responding to someone who has yelled
at them.

11. Identify Appropriate Response
To Potential Instances Of
Behaviours Of Concern
• It is important that when behaviours
of concern occur that the worker:
§ Pause – stand back, take a moment
before approaching and assess the
situation.
§ Speak slowly and clearly in a calm voice
§ Explain your care actions
§ Try not to rush the person, act calmly
§ Show respect and treat people with
dignity at all times
§ Minimise boredom, social isolating and
irritating factors in the environment such
as noise and uncomfortable clothing.
§ Enhance comfort, exercise, and
participation in activities, decision-making
and dignity.

12. Strategies For Dealing
With Behaviours Of
Concern
• The strategies adopted to deal with
behaviours of concern are sometimes
known as behaviour support
strategies.
• These fall into the following
categories:
§ Proactive strategies
§ Immediate response strategies
§ Crisis response strategies

13. Strategies For Dealing With
Behaviours Of Concern
• The strategies adopted to deal with
behaviours of concern are
sometimes known as behaviour
support strategies.
• These fall into the following
categories:
§ Proactive strategies
§ Immediate response strategies
§ Crisis response strategies

14. Proactive Strategies
• These are aimed at preserving the
dignity of the client and include
proactive practices such as a
positive approach to behaviour
support.
• Positive behaviour support
includes increasing and
strengthening helpful behaviours
through reinforcement (not using
punishment or negative
consequences to reduce the
challenging behaviours).
• It involves anticipating where
things may go wrong and
preventing that from happening
rather than simply reacting when
behaviour of concern develops.

15. Immediate Response
Strategies
• These are strategies aimed at
deescalating or managing
behaviours of concern and
includes:
§ Redirection
§ Talking about the issues
§ Responding to early signs of
the behaviour
§ Anger management

16. Crisis Response
Strategies
These strategies involve a
response in situations
where the client begins to
engage in a behaviour of
concern and intervention to
avoid risks becomes
necessary.

17. Activity
1. What information might you find in
your organisation’s policies and
procedures relating to behaviours
of concern?
2. Why might a client display a
behaviour of concern? Give three
(3) reasons.

18. • These strategies can include
restrictive practices and
constitute emergency responses.
• They involve self-protective
strategies and occur as a last
resort when other strategies have
been attempted and failed.
• This can include control of
freedom such as the use of
chemical restraints.
Last Resort

19. • The role that human rights in
general perform in the community
services is that they are designed to
protect everyone regardless of
background, appearance or beliefs.
• They are based on principles of
equality and are shared across all
religions and cultures.
• It is important to keep in mind the
clients human rights when working
on responses to behaviours of
concern.
Human Rights

20. • The way in which we plan a response to the
behaviours of concern depends on the
approach that is adopted in understanding the
behaviours.
• Different theoretical approaches to behaviours
of concern involve different response strategies.
• When working with people who experience
dementia there are a number of theories that
endeavour to explain the cause of behaviours of
concern.
These include:
• Unmet needs
• ABC model
• Progressively lowered stress threshold
• Biomedical model
Ensure Planned Responses To
Behaviours Of Concern Maximise The
Availability Of Other Appropriate Staff
And Resources

21. • These include:
§ Unmet needs
§ ABC model
§ Progressively lowered stress threshold
§ Biomedical model
Ensure Planned Responses To
Behaviours Of Concern Maximise The
Availability Of Other Appropriate Staff
And Resources

22. • This theory argues that people may exhibit
behaviours of concern when their needs are not
met for example hunger, thirst, toilet, pain,
fatigue, temperature, over/under stimulation and
lack of social engagement.
• The strategy suggested in this theoretical
approach is to seek to understand the individual
unmet needs and manage these needs before
the behaviour occurs.
Unmet Needs

23. • ABC stands for Antecedents, Behaviour and
Consequence.
• This theoretical approach focuses on triggers
which are known as antecedents that precede
behaviours.
• This leads to consequences which reinforce the
behaviour.
• The strategy in this approach is to seek to
understand the antecedents that may have
triggered the client’s behaviour then target
interventions seeking to reduce the trigger.
• This may have the effect of modifying the
consequences.
ABC Model

24. • The view in this theoretical approach is that
dementia lowers a person’s ability to deal with
daily stress.
• This also increases the susceptibility to
environmental stressors.
• Stressors can include noise, temperature and
light and can all contribute to behaviours of
concern.
• The strategy in this theoretical perspective is to
identify and remove the stressors from the
environment.
• This includes scheduling rest breaks that allow
the client to cope with daily stress more
effectively.
Progressively Lowered Stress
Threshold

25. • The biomedical model views that pathological
changes occur to the brain in dementia which
impairs normal brain function and causes
behaviour symptoms arguing that behaviours of
concern are part of dementia.
• The strategy in this approach is to understand
that certain behaviours of caused by the
disease and not an intentional act.
Biomedical Model

26. • Some organisations and services offer the
support of specialised behaviour support
service teams that are trained in behaviour
management and can assist when called to
assess and advise relating to behaviour of
concern issues with clients.
• Within the mental health service system, Crisis
Assessment Treatment Teams (CATT) are
responsible for assessing all person who are
being considered for hospital admission and
determining whether or not a less restrictive
setting is more suitable.
• They can also provide treatment and support for
people whose acute mental illness can be
managed in the community as an alternative to
hospitalisation.
Maximising The Availability Of
Staff And Resources

27. • The safety of the people who are exposed to
behaviours of concern is paramount especially if
the behaviour involves aggression and
agitation.
• Adhering to safety issues can involve:
§ Providing free access to exits, telephones and
duress alarms
§ Ensuring that hazards relating to staff members
who work alone are
§ All workers should report threats, hostility or
incidence of violence and to keep detailed
records and reports of such incidents
§ Establishing relationship with local police to
ensure a prompt response in the event of serious
incidence
Give Priority To Safety Of Self And
Others In Responding To Behaviours Of
Concern

28. • It is important to recognise the signs
that a person is becoming hostile and
aggressive.
• These include:
§ Shouting and demanding or argumentative
speech
§ Erratic movements, inability or unwillingness to
sit or stand still
§ Clenching fists, pacing, tapping or banging on
walls or furniture
§ Angry and tense facial expressions
§ Extended eye contact or overt glare that
appears challenging
§ Rapid mood shift
§ Appearance of intoxication including rapid
speech, large pupils, sweatiness.
§ Lack of recognition of workers by regular
clients
Signs That A Person Is Becoming
Hostile Or Aggressive

29. • The workplace health and safety issues
associated with working in the community
service sector can be complex.
• It is important to understand the issues
associated with workplace health and safety in
order to protect both your own safety as a
worker, the safety of your co-workers and the
safety of your clients.
• Employers and workers in community services
have a legal obligation to take reasonable steps
to keep themselves and other people who are
accessing the service safe
Workplace Health And Safety

30. 1. Explain how human rights relate to dealing with
behaviours of concern.
2. What are some of the unmet needs that might result in
a client exhibiting behaviours of concern?
3. How does the biomedical model explain behaviours of
concern in clients with dementia?
Activity

31. Apply Response
The response strategies applied in the
instance of behaviours of concern can be
varied and it is important to respond to
these behaviours in a manner that
deescalates the situation.

32. • Most community organisations will have a series
of policies and procedures you will be
encouraged to apply in the instance of a client
expressing behaviour of concern.
• You need to be familiar with the policies and
procedures and ensure that you understand
how they are applied in different circumstances.
• After the incidence it is important to meet the
needs of those involves and re-establish the
services including submitting a detailed report
and review the incident.
Ensure Response To Instances Of
Behaviours Of Concern Reflect Organisation
Policies And Procedures

33. • The measure that can be adopted to
prevent risk to safety involve a range of
strategies which include:
§ Staff education and training
§ Attention to client
Risk Prevention And Control

34. • When a person does not respond to de-
escalation attempts it is important to seek
assistance.
• This is required when the behaviours of concern
risk the safety of workers, by standers and other
clients, which may include physical harm and
could involve aggression and violence.
• Assistance can be obtained from a range of
people including:
§ The police
§ Managers and supervisors
§ Work colleagues
§ Specialist teams
§ Psychologists
Seek Assistance As Required

35. • There will be instances when you will be
required to refer the client who is expressing
behaviours of concern to appropriate
professionals.
• This includes if your client is exhibiting
symptoms of:
§ Psychosis or psychiatric conditions such as
suicidal and self-harm behaviour
§ Alcohol and drug addictions
§ Medical issues relating to injuries such as burn or
cut.
Issues That Require Referral
To Appropriate Professionals

36. • When dealing with behaviours of concern it is
important to be firm and attempt to be
diplomatic.
• People who express behaviours of concern are
usually experiencing discomfort themselves.
• De-escalation techniques are strategies
designed to prevent an aggressive or violent
incident from occurring and they involve steps
to calm the person and manage the physical
environment.
Deal With Behaviours Of
Concern Promptly, Firmly And
Diplomatically In Accordance
With Organisation Policy And
Procedure

37. • There are a number of communication
strategies that can be applied when
working with people who are
expressing behaviours of concern.
• Using communication effectively to
achieve the desired outcome can be a
challenging process.
Use Communication
Effectively To Achieve The
Desired Outcomes In
Responding To Behaviours Of
Concern

38. • The following techniques can be helpful:
§ Use a calm tone of voice and lower your own
voice to respond to loud aggressive tones
§ If you know the person’s name, attempt to
establish a rapport with them by using their
name and introduce yourself by name to
remind the person that you are a person too.
§ Indicate that you acknowledge the grievance
and offer to help by asking open ended
questions about why the person is behaving
the way they are.
Use Communication
Effectively To Achieve The
Desired Outcomes In
Responding To Behaviours Of
Concern

39. Select Appropriate Strategies
To Suit Particular Instances
Of Behaviours Of Concern
• Not all behaviours of concern are violent
and aggressive.
• There are a number of different
instances of behaviours of concern,
which can include:
§Self-injurious behaviour
§Property destruction
§Fire lighting
§Withdrawn behaviour
§Repetitive questioning
§Playing loud music
§Refusing to eat particular meals
§Vocalising loudly
§Noncompliance with treatment and
interventions

40. Select Appropriate Strategies
To Suit Particular Instances
Of Behaviours Of Concern
• In turn there are a number of different
strategies to suit the particular instance of
behaviours of concern.
• These include:
§ Making changes to the environment
§ Skill development strategies
§ Short-term change strategies
§ Immediate response strategies

41. Select Appropriate Strategies
To Suit Particular Instances
Of Behaviours Of Concern
• Not all behaviours of concern are violent
and aggressive.
• There are a number of different
instances of behaviours of concern,
which can include:
§Self-injurious behaviour
§Property destruction
§Fire lighting
§Withdrawn behaviour
§Repetitive questioning
§Playing loud music
§Refusing to eat particular meals
§Vocalising loudly
§Noncompliance with treatment and
interventions

42. Report And Review Incidents
• REPORT INCIDENTS ACCORDING TO
ORGANISATION POLICIES AND PROCEDURES
• Reporting and reviewing incidents is important to
ensure that records enable workers to remember what
action was taken from one incident to the next.
• The records also enable supervisors to monitor the
progress of a client and the way in which the worker
services the client.
• On some occasions files are presented in court to
address justice related issues and in these cases it is
important that these notes are professionally
developed.
• Maintaining records about client interaction also
ensures that if a worker is absent and a client is
required to be seen by an alternative worker, that
worker is able to read the notes and be up to date on
the client’s progress in order to provide them with a
service.

43. Organisation Reporting
Processes
• Most community organisations provide
guidelines on how to report incidents.
• A common approach is to apply what is
known as the STAR chart.
• This chart reports the incident by
describing the Setting, Trigger, Action
and Result of behaviours of concern:

44. Organisation Reporting
Processes
• Victorian Government Department of
Human Services 2009, Positive
behaviour support Getting it right from
the start ,
§ Setting
§ Trigger
§ Action
§ Result

45. Setting
• This involves recording where the
incident occurred and who was there.
• It includes asking what has happened.
• When recording the Setting aspect of
the STAR chart you should describe
where the incident took place and
where the person had been.
• It is also important to provide details
about the environment including
whether it was hot, cold, crowded and
busy etc.
• should include details of what the client
was engaged in before the behaviour
such as watching TV, talking to others,
listening to music etc.

46. Trigger
• Recording the trigger involve
explaining who was with the person
and what they were doing or not
doing at the time of the incident.
• This includes identifying whether
the client had a routine that was
disrupted at the time of the incident
and whether the client was feeling
unwell.
• It is important to try to gauge
whether the client was attempting
to communicate something such as
a need or a want.

47. Action
• Recording the action involves
describing what happened and what
the behaviour looked, sounded and
felt like.
• It is important to write this aspect
down clearly so that someone who
has never seen the behaviour before
could clearly imagine what the
behaviour episode looked like.

48. Result
• Recording the result involves
identifying what steps you took to
de-escalate the situation.
• This includes describing the
strategy that was employed such as
whether you used active listening,
redirection or negotiation etc.
• As discussed earlier, each
organisation will have its own
policies and procedures on how to
report incidences, so you may find
that you are required to provide a
verbal report to your supervisor
after the incident as well as written
reports.
• There may also be template forms
to complete that may vary from
organisation to organisation.

49. Review Incidents With
Appropriate Staff And
Offer Suggestions
Appropriate To Area Of
Responsibility
• Reviewing the incidents of
behaviour of concern involves
working with other staff to discuss
the behaviours and identify
strategies to prevent them from
reoccurring. It is important to work
within your job role and this is often
defined in a position description.

50. • When reviewing incidence with other
staff ensure that you:
§ Discuss the behaviour you observed
yourself
§ Ask questions about what other staff
have observed
§ Consider the function of the behaviour –
did the client gain access to more
stimulating activities as a result of the
behaviour? Or did the client get staff to
hear what he or she was trying to
communicate?
§ Identify who is responsible for
addressing the various aspects of the
behaviour; it is important that the staff
work as a team when responding to
behaviours of concern.
Review Incidents With
Appropriate Staff And
Offer Suggestions
Appropriate To Area Of
Responsibility

51. Review Incidents With
Appropriate Staff And
Offer Suggestions
Appropriate To Area Of
Responsibility
• Some of the suggestions that you
could offer when reviewing the
behaviours of concerns include:
§ Teaching the client replacement
skills
§ Reducing or changing the setting
events and triggers
§ Incentive programs

52. • The concept of duty of care is related to a
community service workers responsibility
towards their clients.
• It comes under the legal concept of negligence
and is part of common law.
• It is known as judge made law because the
decision of about whether someone is guilty of
breaching their duty of care is determined
through precedence and community attitudes
and expectations rather than by a piece of
legislation.
Duty Of Care

53. Access And Participate In
Available Debriefing Mechanisms
And Associated Support And/Or
Development Activities
• Debriefing from incidence of behaviour
of concern may be necessary in order to
cope with the emotional impact
especially if the behaviours were violent
or hostile.
• Accessing debriefing involves working
with trained debriefs to explore and
understand a range of issues including:
§ The sequence that the events took
place
§ The causes and consequences of
the behaviours
§ The experience that each person
involved in the behaviours had, this
may simply be as an observer
§ Identifying any memories that may
have been triggered by the incident

54. Access And Participate In
Available Debriefing Mechanisms
And Associated Support And/Or
Development Activities
• Other activities that you may need
to undertake after an incident of
behaviours of concern can include
further training and development.
• might be because you did not
respond to the incident affectively
or simply because you require
assistance in understanding and
reviewing the incident.

55. Access And Participate In
Available Debriefing Mechanisms
And Associated Support And/Or
Development Activities
• Further training and development
can include:
§ Facilitated discussions to analyse the
incident of behaviour of concern
§ Training on issues such as self-
defence or how to intervene in
behaviour of concern situations
§ Opportunities to work with other staff
to discuss strategies for prevention
of future behaviours of concern

56. Seek Advice And Assistance
From Legitimate Sources As
And When Appropriate
• Some of the people you could obtain
advice and assistance from include:
• Families of client
• Other staff
• Case managers
• Key workers
• Behaviour support workers
• Therapists
• Medical practitioners
• Educations
• Managers
• Staff supervisors
• Unpaid carers and volunteers

57. Seek Advice And Assistance
From Legitimate Sources As
And When Appropriate
• In particular the following sources
of assistance have specific roles to
perform:
§ Families of clients – they often
require training and support to
implement behaviour strategies.
§ Behaviour support worker – they
should receive regular supervision
to conduct assessments plan and
consult on positive behaviour
support.
§ Supervisors – it is their role to
monitor the implementation of
positive behaviour support
strategies and ensure that
consistency in their implementation
occurs.

58. Now that you have completed this unit, you should
have the skills and knowledge required to respond
effectively to behaviours of concern of people.
Summary