Challenging Behaviour - An Outdated Term

published on D8:
https://de-escalate.com/post/challenging-behaviour-outdated

Challenging Behaviour is a term the healthcare sector has misused for years. When the term was originally introduced, it was an attempt to move away from the then widely used term "behaviourally disturbed". The healthcare sector recognised that the term had become associated with some very negative connotations and therefore should not, in good conscience, be given to an individual.

Labelling in this manner, we understand now, would be detrimental to relationship building between individuals on either side of the cared for / carer divide. Despite this however the term "challenging behaviour" was introduced and very quickly it fell into regular use. This term Challenging Behaviour followed the usual sector path of defaulting through ignorance into a label to assign to a "cared for" individual. There are many reasons why the assigning of this label is used, these range from financial to actively maintaining the power divide in the carer/cared for relationship. Sadly this has been the norm for the last 20 years of my experience, in that time I have repeatedly challenged the belief with thousands of staff on training workshops.

On training even today in introductions on courses staff still make several statements that follow one of these two patterns:

"I work with someone who has challenging behaviour"
"I work in the challenging behaviour unit"
Generally it does not take much teaching and interactive discussion for the group to realise that the term challenging behaviour is outdated. What one person finds challenging another may not. What is an expression of a need by one person may be perceived as a challenge by another.

How many times have you met people in life that you do not gel with due to them having some little quirks that you find irritating. If you believed they were doing this on purpose to cause you upset then you might say they are challenging you. However if you understand that their grinding teeth that drives you crazy is just part of the persons expression, you may say they grind their teeth which I find a challenge.

This leads to a wholly different perception of the behaviour.

He does not have challenging behaviour - he grinds his teeth which I find challenging, whereas you, another person, may not find it a problem.

These phrases set the whole philosophy of the work we do into a "them and us" mentality. This state of mind leads to more people in distress. Well being is achieved through many factors, most significantly having those significant relationships in our lives. Significant relationships are a big factor in all of us maintaining lower stress levels, leading to any one of us displaying less distress that other people may find difficult, disturbing or challenging.

SO WHAT IS IT?
If we look at some of the ways our sector use the term:

A policy

I worked with a policy that used the definition that a behaviour that challenges is any behaviour that enough of the staff group believe constitutes a management issue.

This cannot be considered bad and can be defined depending on the staff groups perceptions. One group worked with an individual who was bed-bound who shouted at them, to those staff he was extremely challenging, and it caused them a management issue. To other staff groups he may not have been challenging at all as he could not move and had never carried out a threat.

one common definition of challenging behaviour is defined by the Challenging Behaviour Foundation

“Culturally 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.”
or wikipedia

While these are cited as an Emerson definition in 1995 I can clearly state that prior to 1995 I was a trainer teaching "challenging behaviour" courses, even back in 1995 the definition was easy to pull apart. Someone picking their nose and chewing it will divide a group of staff emotionally but will not be considered challenging under the definition.

Times have moved on and most of the sector are accepting or starting to accept that the term should be used in a more appropriate context.

in recent years the term challenging behaviour has been used to reflect the fact that some of the behaviours that are seen are a challenge to us as professionals, teachers, carers and parents. That the person showing these behaviours is not a ‘problem’ to be fixed, or someone doing something wrong that needs to be sorted, but that the behaviour is a sign that something isn't working. It shows that there is some need being unfulfilled, or a problem with communication.

In essence it is that there is something going wrong that needs to be addressed, not that there is a person doing something wrong who needs to be stopped. Scope.org.uk

This is a common stumbling block in terminology, last year I met a healthcare professional who took an instant dislike to me when I said I was a challenging behaviour trainer. However her mind was aligned with mine and I soon resolved the confusion when she said she hated the term. Unfortunately stating what I do gets predictable reactions through preconceptions see blog post here

Therefore how do we proceed, the sector use the term and professionals in the sector given a bit of experience or training get the point, YET there it is, with every new member of staff setting up the divide in the relationship through the perception of the concept from day one in employment due to use of an outdated term. The invisible barrier sets in.

I propose a new concept, we find a new term. I have some suggestions however we should be careful here, language changes with time and linguistics are geographic in their perception. One service talk about their individuals "going into behaviour", which, from my background I see as just as problematic as using the term "he is becoming challenging". So our concept must address this balance as best we can to help new staff instantly perceive a role of a relationship builder rather than managing he / she who is displaying challenging behaviour. Often a staff member will say:

he is doing it because he is not getting what he wants !
to which I reply

you mean we are not meeting his needs
this is purely a perception issue, both statement mean the same however the second one puts the onus on the staff member to assist rather than blame.

ASSISTING INDIVIDUALS IN DISTRESS
If we used this phrase I believe we are more likely to instil a culture of compassion. Indeed I believe this area of training should be about developing relationships to better assist individuals in distress.

If you had a member of your family who had a head injury and could not communicate to their own satisfaction which therefore led to them displaying distress, would you say:

he is becoming challenging and we need to find a way of controlling him!
or

he seems distressed, what ways can we assist him to regain control to reduce his stress?
I do not think that needs an answer. Yet by using the term challenging behaviour with new staff that is the philosophy gap we ourselves are creating.

TRAINING
Our course Developing Positive Relationships with those in distress covers all you would assume is in a standard challenging behaviour / physical intervention training. However this is the only page on the site you will see the term challenging behaviour as our work is about the relationship building, despite stress, between each other including those we care for.

DEVELOP THE RELATIONSHIPS - REDUCE THE DISTRESS.
Notice from the content that to achieve this, staff support systems need to build in place to underpin relationship development, this works in the same way as the individual in distress needing significant relationships in their daily lives. Your staff group bond into a team, as a side effect of training in this manner, creating supportive staff helping each other assist in relationship building with those in distress.

Ultimately should this not be our goal? What terminology do you use and why?

REF
(taken from the web pages quoted from above)

Ref: Emerson, 1995, cited in Emerson, E (2001, 2nd edition): Challenging Behaviour: Analysis and intervention in people with learning disabilities. Cambridge University Press

^ Emerson, E. 1995. cited in Emerson, Eric (2001). "Challenging behaviour". Challenging Behaviour: Analysis and Intervention in People with Severe Learning Disabilities. Cambridge: Cambridge University Press. p. 3. ISBN 978-0-521-79444-2.