Whole System Approaches to Working with Challenge in Dementia Care (Level 5)

Positive Behaviour Support (PBS) – Dementia Care Accredited Course (Level 5)

Dementia affects people in different ways, and some may not be able to express what they need or say what is wrong.In these instances, behaviour is a valid and necessary form of communication. However, behaviour that causes distress for the person, or others or is deemed a ‘behaviour of concern’ can be detrimental, particularly where the intensity, frequency or duration creates risk or disruption for the person and others around them.

What is required is a ‘whole system’ approach to identifying, preventing, and minimising such behaviours. However, many services fail to adopt these processes but instead end up fighting fires and dealing with crisis. This can cause high staff burnout and is costly for the whole health and care system. The MARQUE study identified that the excess annual cost associated with agitation per resident with dementia was £1,125.35. The MARQUE study also identified that training alone may not reduce incidences of ‘challenging behaviour’ but what is required is a multi-model approach. Therefore, this training programme sits alongside specific practice activities.

Course Information Sheet

Download the course information sheet here.

Individuals signing up to this programme are required to complete the practice work and to participate in the assessment of the impact of this programme on their service. This course is practice based rather than ‘academic’. It will support the cultivation of practice leadership within an organisation, and impacts will be measured.

Expected impacts of the programme are (but not limited to):

Tier 3 Impacts

  • Completing and/or improving the use of documents to record behaviour using a structured method.
  • Implementing a structured debrief protocol.
  • Implementing a new Communication Support Plan that draws on life history.
  • Contributing to the review and revision of an individual’s Behavioural Support Plan.
  • Identifying and/or implementing possible secondary prevention strategies that may be used with an individual.
  • Identifying and/or implementing effective communication and positive interaction in primary prevention for individuals.
  • Completing a restrictive practice audit tool.
  • Introducing a new quality of life and wellbeing monitoring tool.

Tier 4 Impacts

  • Reduction in medication used to control or subdue behaviour.
  • Reduction in safeguarding incidences between people that use services.
  • Measurable improvement in quality of life.
  • Reduction in restrictive practice.
  • Improved staff retention and reduction in staff sickness.

Dementia is a complex condition that transcends health and care, and therefore, this programme delivers an integrated approach to exploring ‘behaviours of concern’ in context of the interplay between environmental, physical, social and psychological factors. It will address culture changes in an organisation and encourage learners to consider how the term “challenging behaviour” suggests disobedience, defiance and non-compliance, suggesting the behaviour is something to be managed rather than understood. Instead, learners are given the opportunity to embed therapeutic, person-centred or strength-based approaches in primary and secondary interventions. They will get the opportunity to explore how the appropriate procedures in the workplace can empower and support, rather than limit them.

This programme draws from PBS models and incorporates in this a Level 5 PBS accredited programme. The PBS model has been criticised in the use of dementia care, with critics sighting organisational barriers, differences in language and terminology and an inappropriate focus on developing new skills, rather than the maintenance of skills.

However, the PBS approach offers a lot of benefits to dementia care services, such as:

  • Provides framework for preventative approaches 
  • Links values/theory/ practice into an integrated frame
  • Provides foundation for creating a ‘capable environment’
  • Provides an organisational focus sitting micro-practices within macro practices
  • Advocates the use of data and evidenced-based practices. Can be used as a framework for change management/quality improvement 
  • Identifies the role that ‘trauma’ can play in the presentation of behaviour
  • Focuses not only on behaviour but also quality of life
  • Data to demonstrate the reduction in intensity, frequency, or duration
  • Identifies preventative strategies

In this programme, we have drawn from existing models of good practice such as the Enriched Model, Clear Dementia and the Newcastle Model, and identified where these could apply alongside the framework. We have also considered how to adapt the framework to consider dealing with ‘different realities’, progressive changes in presentation and how loss impacts emotions, and consequentially behaviours.

The programme includes two accredited modules:

J/616/5450: Understand the Role of Communication with Individuals Who Have Dementia

H/616/9327: Implement the Positive Behavioural Support Model

Individuals that have achieved the ‘Understand the role of communication with individuals who have dementia’ as part of a previous qualification will receive recognition of prior learning.

How will this programme be delivered?

During this 12-week programme, practitioners (course participants) will be supported by experienced facilitators with extensive experience within practice in both dementia and PBS. They will guide practitioners through each of the component parts of PBS, considering specifically how these relate to the care of someone with dementia. The key concepts of PBS will be considered at both an operational and strategic level and key steps to implementation will be set out.

Prior to and in between sessions, practitioners will be asked to undertake a variety of activities, including introducing new tools and practices to their organisation.

There will be seven taught sessions throughout the programme, each of which will be delivered over three hours. The sessions will provide an introduction to key ideas and concepts but also provide the opportunity to further develop from independent learning through access to further resources. Peer learning will be actively cultivated in the taught sessions.

 What is included in the programme?

 J/616/5450 – Understand the Role of Communication with Individuals Who Have Dementia

There will be three taught sessions on this element of the programme.

Taught Session 1 (Live Session)

This session covers how dementia impacts on communication and focuses specifically on other factors that can be modified to increase connection and engagement. It explores creative approaches to communication, including the usage of environmental techniques and ‘mindful’ practice. It provides a platform for practitioners to explore unconscious bias, and challenge inappropriate terms that are used to describe behaviour which can impact negatively.

Taught Session 2 (Pre-recorded Session)

This session explores physical factors that can contribute to distress. We identify the disorders that might co-exist with dementia and describe why managing these conditions may present additional challenges. The session also includes the types of delirium and depression and how these might impact on behaviour. It also covers positive approaches to pain management in dementia care, and the risks and benefits of anti-psychotic medication.

Taught Session 3 (Live Session)

In this session we explore how cognitive loss might impact on managing emotions and developing coping strategies/resilience. Practitioners are given the opportunity to reflect on social, psychological, physical and environmental factors that impact negatively on mental health, and ways to minimise these. Throughout the activities, we will also contrast medical and social models of care in context of supporting symptoms of dementia. Practitioners will also have the opportunity to reflect on strategies that create environments that ‘feel’ safe and secure, promote self-esteem and minimise difficulties related to sensory impairment.

H/616/9327 – Implement the Positive Behaviour Support Model

There will be four taught sessions on this element of the programme.

Taught Session 4 (Live Session)

This introductory session focuses on gaining a shared understanding of what PBS is and is not, specifically in context of dementia care. It will also cover the national context of the development/inclusion of PBS and the specific values base it is built upon. This is an understanding that can be shared with staff, multi-professional teams and commissioners to support a consistent approach to individuals’ support. The underpinning values base of PBS will be explored, how this informs intervention strategies and supports the overall primary aim of PBS, which is the development and maintenance of quality of life and wellbeing for all.

Taught Session 5 (Live Session)

PBS has a strong evidence-based focus, which is the theme of this session. During the session, the model of functional assessment will be introduced and explored and will include an understanding of why behaviour of concern may occur. The PBS evidence base is supported through robust data collection, and learners will have the opportunity to consider different formats for this and how this can support the development, implementation and evaluation of a Positive Behaviour Support Plan.

Taught Session 6 (Live Session)

The programme will introduce the concepts of proactive and reactive strategies and specifically the difference between the two. Reactive strategies manage risk at the time of an individual’s heightened levels of distress but do not result in behaviour change. It is through the use of proactive strategies that an individual’s behaviour of concern can be positively supported through increases in quality of life, communication strategies, changes to the environment and quality of service delivery. It is only through proactive interventions that long term meaningful change can occur for an individual rather than short term management of risk during periods of distress. This session will focus on the use and implementation of proactive strategies at both an individual and service level, with a specific focus on quality of life and the relationship between trauma and the Positive Behaviour Support Model.

Following this session, the practitioner will be asked to complete an exercise within their own practice environment to support the content of Taught Session 7.

Taught Session 7 (Live Session)

This session specifically focuses on the role of the practice lead and the creation, implementation and support of capable environments. These are fundamental to the successful implementation of PBS within a service. A specific focus will be on one of the primary components of a capable environment which is restrictive practice reduction and how this needs to be supported at an organisational and service level. The restrictive practice audit that learners have previously undertaken will provide them with a context within which to consider the content of the session.

Following this session, learners will be asked to complete an exercise within their own practice environment to support own thinking around the practical application of PBS within their service.

Who is this programme suitable for?

This programme will benefit Deputy Managers, Managers, Operational Managers and Regional Managers working operationally within services as well as Managers working at a strategic level who would like to explore the implementation of the PBS model of support across their organisation.

What is the cost of this programme?

The cost of the course is £728 + VAT per person; £874 in total (5% of all revenue will go to the Care Workers Charity). Full payment is required before the start of the training. Refunds will only be applicable if at least 30 days’ notice is given before the course start date. Tickets cannot be transferred to alternative course dates.

You can pay over termly instalments. Please do contact us to discuss payment options that would be suitable to you. You can contact us via email at info@3spirituk.com or call us on 01442 368464.

Book a Place on the Programme

To book a place on the programme, please click here.

To learn more about the programme, please email us at info@3spirituk.co