Psychologically Informed Environment Principles in Adult Residential Care by Iain Boag

Author:Iain Boag [Boag, Iain]
Language: eng
Format: epub
ISBN: 9780367436940
Google: GQRUzQEACAAJ
Barnesnoble:
Goodreads: 49156270
Publisher: Routledge
Published: 2020-01-15T01:38:10+00:00

Time-outs

A key aim of elastic tolerance is to avoid eviction, and the constant passing on of ‘problem’ clients from service to service, or service to street. Instilling flexible boundaries rather than rigid rules supports this aim. Sometimes behaviour can become so anti-social that the client begins to put their placement at risk if they stay in the building. Examples might be threatening to throw a chair at staff, to break windows or punch another resident. If the threat is deemed to be serious (it is often only bluster caused by shame or social embarrassment – the worker should be intuitive as to how intent the resident is to do actual harm) and giving the resident a choice to calm down isn’t working then other measures will need to be used. Remember, our primary aim is to keep the resident safe, and allowing their behaviour to escalate to the point of eviction does not fulfil this goal. Being evicted is the least safe, emotionally and physically, that a resident can ever be.

At Highwater House we use graded time-outs to work with this type of behaviour. Ensuring the resident is always given the choice to calm down and the chance to redress any ills is an important feature of the process.

Time-outs are exclusions from the building to give the resident a chance to calm down and reflect, it removes them from a situation where they might cause damage or harm to themselves or others. At no point should time-outs be used in a reflexive or punitive manner; they should be used as a last resort, and as part of a wider package of behavioural support. At Highwater we find that, if a resident is becoming increasingly aggressive, a cup of tea and being listened to by a trusted worker is more often than not the answer, even in very explosive situations. Using optimistic and solution-focussed language, creating a narrative of success and separating the behaviour from the person gives them the opportunity to ‘win’. We recognise that feelings of tension and rage are part of the human condition and cannot be suppressed, only accepted and moderated.

Time-outs can work as controlled exposure for the resident; a brief, contained connection to their fear of abandonment coupled with a realisation that they are, despite behaving in a very challenging or disruptive way, ultimately accepted in the community. It is likely that a client’s life experience will have led them to believe that after a flare up they will be punished by being emotionally isolated; and they are likely to test this reality repeatedly. Our understanding of attachment theory ensures we use time-outs to lead the resident from an expectation of abandonment (through eviction) to an expectation of inclusion (choosing to moderate behaviour). Over time the need for time-outs will reduce as they begin to believe they will be authentically cared for. In the case study of Sean, as follows, there were numerous time-outs used before he finally accepted that he was cared for.

Using the PIE approach has had great impact on our use of time-outs, as the statistics in the table show.

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