How to effectively track and manage behaviour decline in service users

Having worked for most of my career in mental health and learning disability services, I spent my early days in my career watching managers and hearing families struggle to get the appropriate support to reflect the needs of the people being caring for.  

I remember my first role as a turnaround Registered Manager, taking over a service where the commissioned hours were not reflective of the needs of the people, and the challenges in getting this put into place.  

In this blog post, I discuss the different ways care teams can accurately track behaviour decline in service users, and how services can manage these challenges to meet their needs.  

Why should you track behaviour decline in service users?  

Documentation is key for care providers.  

Remember, if it isn’t recorded, it didn’t happen. With many cash-strapped local authorities, it is important you have the evidence required to argue your case.  

You should also be able to evidence records to the regulator during inspections that you have been advocating for, and trying on behalf of, the service user to assist them. This is why it’s important that care teams track signs of behaviour decline.  

How to track challenging behaviour in service users

Firstly, you will need to check that your documentation records relevant information. For most learning disabilities and/or mental health services, this will be in the form of an Accident, Behaviour and Consequence chart (ABC chart).  

If you can record the ABC charts digitally, you are one step ahead as you will be able to use the data (more on this later). However, if you are a paper recording service, do not worry, this will be okay.  

All behaviour happens for a reason, and understanding why service users with challenging behaviour display such behaviour is vital.  

ABC charts ensure that your team capture behaviours and observations in three elements:  

• Antecedents (A): what happened directly before the behaviour occurred.  
• Behaviour (B): the specific action(s) or behaviour of interest.  
• Consequences (C): what happened directly after the behaviour occurred.  

Functional assessments of behaviour may be carried out by specialists as part of the process of addressing challenging behaviour for people living with autism and/or a learning disability, as recommended by the National Institute for Health and Care Excellence (NICE) guidelines. However, according to section 1.5.9, you need to make the referral to the appropriate team.  

It is worth contacting your local crisis team for further information on how to make a referral or for support.

How to track declines in cognitive impairment  

When documenting declines in cognitive impairment, it’s important to address any changes in an older person’s memory, language abilities, or personality. These can be caused due to medication side effects, infections such as urinary tract infections (UTIs), dementia and depression.  

This list is not exhaustive, which is why documentation is key: to help establish and identify the cause.  

One effective tool I used in the care home was the DECIDE tool, which is a document that has 6 key areas:

1. Describe the distress. What did you see and hear? For example, if the person was repetitive, obsessive, withdrawn, aggressive, self-injurious, disruptive, walking, hitting, spitting, arguing, anti-social behaviour, swearing, shouting, etc.  

2. Explore and empathise. Why might the distress have occurred?  

3. Consider the care approach. What can we do to prevent this distress?  

4. Implement an approach that could help prevent further distress.  

5. Disseminate to the team.

6. Evaluate and/or expand, using any further information and actions taken. For example, visiting or informing doctors, psychiatrists, etc.  

How to manage behaviour and cognitive decline in service users

1. Regularly review care plans, support plans, and risk assessments    

To manage declines in behaviour and cognitive impairment, it is important that we continue to review and adapt care plans and risk assessments – such as behaviour risk assessments – so they are up to date and reflective.  

Not only does this inform care teams about the support service users require and that needs can be met, but it also provides factual evidence should it be needed of the care and support being provided.  

2. Using digital data to identify trends

Keeping records enables you to identify trends and patterns to develop effective management strategies, find solutions and make informed decisions which, in turn, will help to improve people's lives.  

The benefits of recording on a digital care system is that they often come with the added bonus of:

• Using the software to identify trends
• Exporting the data into excel to do your own analysis  
• Feeding into an AI tool that supports you with identifying trends.  

3. Tackling funding challenges to compensate your staff

I used to help a service go from relying on staff to volunteer their time to help manage behaviour and cognitive decline, to ensuring adults' needs are met and staff are appropriately compensated.

Before you do anything, the best thing you can do to receive financial support is to pick up the phone to the funding local authority/CCG and ask.  

I say ask first, as the funder is likely to give you the answer of what they need in return.  

I would aim to leave the call with two things:

1. A date in the diary for a meeting, with the funder(s) and the person requiring social care support. Once you have this, you can invite next of kin, the person’s key worker, and anyone else the service user wants to attend.  

2. A clear idea of what it is you need, to ensure you can put the best case forward for the service user.  

Seeking additional support  

It might not always feel like there are others supporting you.  

I remember vividly sending strongly worded emails, ranting down the phone and trying to get anyone I could to listen, to try and ensure that the care needed was put into place.  

Here are two angles to getting extra service assistance that I would recommend:  

1. Seek support from funders, healthcare professionals (i.e. doctors, district nurses, psychiatrists, and behaviour therapists) and advocacy services that can help support the service users and put things into place to ensure good outcomes of care.  

2. Seek support for yourself. Advocating for someone is tiring and can take more energy than you realise. When supporting someone, you can become passionately invested. That is not a negative since that passion drives you to ensure the best, but remember to take breaks, reflect, and lean on family and friends, your supervisors, managers or fellow peers to offload and share concerns. Do not take on this challenge in silence.  

Summary  

Navigating funding challenges in the world of mental health and learning disability services requires a strategic and proactive approach. The key to success lies in the documentation and open communication with funders.  

To effectively track and manage behaviour decline in service users, remember the golden rule of documentation.  

Ensure all support, changes in needs and concerns are recorded and escalated appropriately, because this combined with analysing data to identify trends will allow you to present factual evidence when advocating for change.  

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