When we are supporting individuals who sometimes exhibit challenging behavior, caregivers must sometimes intervene to prevent harm to the individual or someone else. The caregiver must consider which is going to be the most effective, most supportive and least restrictive intervention at that time. This can be challenging because when the individual we are supporting is stimulated, that will stimulate the person providing the support. When opportunities are presented, the caregiver needs to affirm their emotions and choose their behaviors, in order to respond instead of reacting. Responding instead of reacting allows choices to be made based on the caregiver’s values and belief system.

Too often we do not realize how our interactions actually contribute to the individual’s reaction and ultimately whether the person escalates or de-escalates. When someone’s behavior is challenging, too often the reaction of the caregiver is to tell the person to “stop that”. If we are not affirming our emotions and choosing our behaviors, the tone of voice come across as controlling and demeaning. The caregiver’s body language may be perceived as confrontational. If the caregiver moves closer to the person, he or she may perceive the action as invading their space or attacking. When an individual’s space is invaded often the reaction from the individual is to push the person away. When the push occurs, the caregiver feels threatened and justified in the use of a manual restraint, failing to realize that their action provoked the individual. When the caregiver is presented with challenging behavior, their focus should be on understanding the purpose behind the behavior and providing reassurance to help the person feel safe. When individuals feel safe, we can invite them to de-escalate and manage their own behavior. This is explored more fully in the relational chapters of the Mandt System.

A rule of thumb is that as soon as a person puts their hands on another without consent, the opportunity for a physical conflict is dramatically increased. This can occur even if the intention was to physically display comfort or reassurance. Unless there is an immediate risk of harm to that individual or someone else, we should take time to think through the pros and cons of the various strategies available to us before using physical interventions.

Below are some examples to illustrate situations and choices. As you read the situation determine for yourself, based on the information given, what is the least invasive intervention that could be used. The strategies must be individualized and based on knowing what works best for that individual.

EX 1: Several children are together in a room in a house. The adult uses their senses (their mommy or daddy hearing) to determine the noise level is too loud or more likely too quiet. In checking the room, the adult finds the children are involved in behaviors that need to change. Options to consider may include:
1. Non verbal communication – the mommy or daddy look
2. Increase proximity using body positioning– move closer into the room
3. Verbal intervention which could be inquiring, directive, or demanding
4. A general physical response – taking away the toy or separating the children.
5. A specific physical response – redirection, restraint of a limb, restraint of the entire body

The individual is best served by using the intervention which best allows the child to make the choices for themselves. When they do, so it affirms they know the right thing to do and can implement that knowledge and can control their own behavior. It also allows the child to save face with their peers more than if the child is directed by the adult.

EX 2: In a home setting, the caregiver realized the individual being served was angry and was going to throw a glass object at him. His response was to remove himself by going through a door into another room and closing the door. By doing so the caregiver avoided being hit and removed the stimulus, himself. When the caregiver heard the glass break, he realized the individual was barefoot. The caregiver returned to the room and used body positioning to keep the individual away from the broken glass until his feet were protected or the broken glass removed. In both situations, instead of using a manual restraint, the caregiver weighed the pros and cons and used the least invasive intervention.

EX 3: If a person is about to run into an area that might be dangerous to them, instead of physically holding the individual, use body positioning to serve as a barrier between the dangerous area and the person. It is less likely to be seen as confrontational as a manual restraint by the individual.

EX 4: If an individual who was physically aggressive drops to the floor, the caregiver should take a step out of the reach of the individual to address the immediate risk, rather than using a manual restraint.

In our role as supporting others, caregivers should focus on helping the person feel safe and helping them learn to make good choices independent of the caregiver, not on disciplining or controlling them. Using the least intrusive intervention allows the person the ability to make choices and decisions that will keep them safe long term.

Aaryce Hayes – Mandt System COO