General /

There are instances when caregivers, family members or paid professionals, are in situations where someone they are responsible for exhibits challenging behaviors. In those situations, decisions have to be made about when it is necessary to intervene and how to do so when it is necessary. This is a particularly crucial question to ask and answer when the intervention considered involves one person putting their hands on another in an involuntary situation. It is a positive sign when caregivers struggle with the question because it indicates an attempt understand the risks and benefits of their actions and avoid restrictive physical interaction when possible. When one person places their hands on another person without the individuals consent, the likelihood that the situation will escalate is great.

There are some things we can consider to help make this determination.

First an assessment must be made and in order for the assessment to be accurate, the assessor must be objective. Our own perceptions may be skewed if we do not first correctly assess ourselves. If we are angry, frightened, resentful, or controlling, those emotions may influence our assessment of the situation and the other person and cause the caregiver to over react. In The Mandt System, we encourage individuals to first affirm their feelings and then choose their behaviors.

Is there a risk of harm, if so who might be harmed by the behavior and how immediate is that risk of harm? If the behavior is simply annoying and/or considered to be inappropriate in that situation or setting, perhaps it is best to wait to intervene when the person is actually able to listen to the caregiver. Sometimes the behavior involves yelling, cursing, pacing, or even turning objects over. That does not mean that there is a risk of harm that requires any type of physical interaction. In that situation, there may be time for the caregiver to try to understand the reason for the behavior, what need is being met. If the caregiver understands the purpose of the behavior, the better approach is to help the individual learn more effective ways to get the need met in the future. The focus should be on teaching how to be more successful in the future, not disciplining the individual for past behaviors. However in order for the individual to learn they will require time to de-escalate first.

If there is a risk of harm, how immediate is the risk? There are times when the risk is so immediate that a physical intervention may be necessary. However we must also examine the risks and benefits of the interventions we consider. If someone is threatening to hurt themselves, based on your knowledge of the individual and their history, a determination must be made as to whether or not getting closer to the person and in an attempt to modify their behavior might in fact be perceived as a challenge and create an atmosphere where the person must “prove” they meant what they said. In those situations maintaining a safe distance while attempting to reassure the person by both verbal and nonverbal communication might be preferable.

If someone is threatening to hurt someone else could the situation be resolved simply by removing the object of the threat? Often service providers and family members are reluctant to “back down” and feel the need to prove that they can control the situation. The truth is that we generally can only control ourselves. More importantly part of our goal should be not to control the person but to help them learn ways to better control themselves, not only in the moment but in the future when the person experiences similar stressors.

If an assessment and individualized plan has been developed that identifies the challenging behavior and providers direction about how to best intervene, then the caregiver should know and follow the behavior plan.

In all instances where interventions have occurred, regardless of the form the intervention takes, when the individual has regained control of themselves and is capable of talking through the incident, the caregiver and individual should take time to review what happened, how it felt, what was done and what might be more successful means for either entity to intervene in the future. The act of “processing” about the situation not only helps the person learn problem solving skills that may be of use in the future, it also helps each person to better understand the motivation of the other and continue or restore the trusting relationship that is vital for the individual to feel safe.

Aaryce Hayes – Mandt COO

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