BLOG: Straight into Crisis: Supporting Sudden Escalations of Behaviour

Sometimes, the behaviours we encounter from the individuals in our care appear to come out of nowhere.

Following our hugely popular webinar on this topic, we explore the key points raised during the session, thinking more about responding to sudden escalations of behaviour and how we can offer the most effective support.

Why are we seeing this behaviour?

While sudden changes or escalations may feel unexpected, it’s far more likely that what we are seeing is driven by experiences and triggers that we simply may not have witnessed ourselves, or that could have occurred at an earlier point in time.

When responding to sudden changes, the ‘what’, or describing an individual’s behaviour, can be simple to decipher, but the ‘why’ can be much harder to identify, especially in the heat of the moment. At times like this, there are several factors we need to consider in helping us decide what to do next.

The triggers leading towards crisis

When evaluating behaviour, there is often a clear connection between a triggering experience and the resulting reaction. When an experience causes a dramatic shift in behaviour almost straight away, we sometimes refer to this as a ‘fast’, or immediate, trigger. When underlying reasons are evident to us, it can be easier to decide on appropriate support measures in the moment and for the future.

However, looking at the most obvious or recent experience may not give us all the answers. We could, instead, be witnessing the impact of ‘slow’, or cumulative, triggers. This constant ‘drip, drip’ effect can result in a build-up of emotions, eventually causing an individual to reach crisis point. For those experiencing a crisis driven by a series of cumulative triggers, the most recent experience may not be the main underlying factor, but simply the one that tipped them towards rapid escalation.

For example, some individuals may find the word ‘no’ to be triggering. But on reflection, we can consider whether it’s the word ‘no’ offered as a one-off that is problematic, or whether the individual has repeatedly been told ‘no’, perhaps by a range of staff members over the course of the day, and they are now frustrated because they feel they have no choice or control within their environment.

Arriving on the scene: conducting a dynamic risk assessment

When robust support plans are in place, we can operate in line with them, helping us to offer a consistent and predictable response in times of distress. However, when encountering sudden changes or escalations in behaviour, some of which we may not have seen before, we need to conduct a dynamic risk assessment, taking into account a number of factors:

• considering the potential long-term impact of our actions
• identifying whether anyone is at risk of harm
• considering the communication that we are offering through our stance, body language, tone, pace, intonation, gestures and facial expressions
• thinking about what the best outcome is for the individual, and how we can help them to get there
• weighing up the risk of doing something versus doing nothing
• deciding who the best person might be to offer support
• reflecting on the best interests of those involved.

Once we have assessed and evaluated the situation in real-time, we can make more informed decisions about appropriate next steps.

Providing person-centred support

Whether we work in education or health and social care, we all want the same thing: for the individuals in our care to feel safe and respected, and live happy and fulfilling lives. So, when it comes to responding to behaviours that cause concern or risk, we’re focused on offering personalised help and support, rather than making generalised demands of compliance and correction.

To that end, it’s important to develop strategies that meet an individual’s specific needs. Incorporating a person’s interests, areas of strength, character, and personality into our support plans reinforces connection, and strengthens relationships during moments of crisis, increasing the likelihood of a positive outcome.

Choosing the right person to respond

Some days are harder than others, and sometimes, despite our best efforts, we might not feel equipped emotionally to offer the best support to those in our care. As always, we need to keep the individual’s best interests front and centre.

For example, if a particular exchange between ourselves and an individual has contributed to or exacerbated the escalation, it may be beneficial to consider a change of face rather than continue the existing cycle of interaction.

Seeking support is a sign of professional strength, and we should feel comfortable asking for help, rather than reacting impulsively. If an individual’s safety is at risk, and other staff are not available, then we must, of course, act. However, if we have access to teams or colleagues who are able to offer support, it can be helpful to introduce an alternative member of staff.

When our colleagues arrive, they may not always understand the situation so far, meaning they have to think on their feet, and quickly consider how best to respond. If the situation allows, there may be an opportunity to brief those called to assist us, thinking carefully about how we talk about what’s going on, and the language we’re using, to prevent any further escalation.

Consider what the individual is trying to communicate

In times of distress, it’s important to look beyond the immediate behaviour. When we better understand the experience or function driving the behaviour we’re seeing, it allows us to address these concerns with the most appropriate support measures. This knowledge, in turn, enables us to be more responsive at times when immediate presentations of behaviour change, but the underlying functions and experiences remain the same.

In future, even if the behaviours presented were to change, we can always ask ourselves this: while the behaviour has changed, is the function of the behaviour we’re seeing the same? If so, our planned support measures may still be successful.

Staff support to move forward

Regardless of our role, it’s important to consider what we might be bringing to a situation. We tend to place a lot of emphasis on the behaviour of the individuals we care for, but the expectations we communicate through our own behaviour play a pivotal role in our ability to de-escalate situations.

When it comes to our response, we must consider what we’re looking to achieve: what is the most positive outcome we can move towards in this scenario?

It’s often necessary to adjust our expectations and remind ourselves that we’re not necessarily looking for an immediate change in behaviour. Instead, we’re striving to find a way forward that’s constructive and positive, while allowing us to offer further support through guided restoration. When thinking about what we expect to happen, a useful question to consider is, “How would I respond if I were in their position?”

Rehearse, rehearse, and rehearse again

In an ideal world, our interventions and support mechanisms would be successful every time. This means that we need to truly understand the intention and outcomes that are built into how we offer help; that way, we can think on our feet if something isn’t working.

We may need to rehearse our responses and practise our help scripts, in order to feel confident around offering support in moments of distress and crisis. A bit like a dress rehearsal, practising scenarios involves considering which elements are required to be successful. For example, if our chosen strategy relies on using a trusted item or object to distract or redirect a behaviour, we need to know where that item can be found. Do we have multiple items that would work? Do we check that we have returned these items to their ‘home’ at the end of each day, ready for tomorrow?

Incorporate flexibility and reflection time into our plans

We also need to know when to adjust plans if they’re not working. When we try something new, naturally we need to allow time for it to ‘bed in’ before we can tell if it’s having the kind of impact we had hoped for. This doesn’t mean we keep trying to make something work if all the signs are showing us that the intervention is not helping us achieve our intended outcome.

Reflecting post-incident is just one way we take stock of what’s working, what isn’t, and what new information we have available to us. We can also gain valuable insight from evaluating the data within our incident reports, handover meetings, reflection sessions, observations, and so on.

In our busy settings, finding the time to reflect is always a challenge; however, coming together to debrief can be a powerful way to share ideas and reinforce why we do what we do. Sudden changes or escalations in behaviour enable us to evaluate current practice, apply new learning, plan for foreseeable risks, and update strategies to ensure that we are in the best place possible to support every individual in our care.

If you’d like to talk to us about your requirements when it comes to supporting behaviour in your setting, please get in touch any time.