Early years: Getting risk support

Managing risk alongside a graduated approach to skill development.

Introduction

This document has been produced to be used alongside the main Special Educational Needs and Disability (SEND) Thrive document. The main SEND Thrive tool covers the 'Getting advice', 'Getting help' and 'Getting more help' parts of the THRIVE framework (see diagram below). This document covers the fourth part, 'Getting risk support'.

It covers aspects of SEND that typically present early years settings with challenges, such as responding to self-injurious or distressed behaviours. It is intended as an initial guidance and signposting document, rather than an all-encompassing document with detailed advice of how to respond to each need.

Due to the complex nature of the needs described within this document, it will be necessary to take an individualised approach to children’s needs and involve relevant professionals in planning how best to respond, but we hope that this guidance will be helpful in getting you started.

A common thread that runs through each section of this document is the importance of working closely with others in relation to risk. It is important that professionals do not work in silo around matters relating to safeguarding and always involve the Designated Safeguarding Lead within their setting. Not only does a team approach benefit the child, as there is increased opportunity for effective support, it also contributes positively to staff wellbeing, as staff working within teams around risk are more likely to feel well supported. It is essential that there are clear structures in place within all settings in relation to safeguarding children and transparent plans for managing any safeguarding concerns that are regularly reviewed alongside national and local guidance.

For any safeguarding concern or concern relating to risk, The Bridge Partnership can be contacted for initial advice, support and signposting.

Self-injurious behaviours

What are self-injurious behaviours?

Self-injurious behaviours can be defined as any actions or behaviours through which a child causes harm to themselves. This might include but is not limited to: head banging or shaking; biting of the limbs; face or head slapping; hair pulling and skin picking. These behaviours can understandably cause alarm for staff supporting young children.

Why might children engage in self-injurious behaviours?

There are a number of reasons why a child might engage in behaviours that cause themselves harm and it is important for adults working with young children to consider the possible functions of the behaviour.

Considering the functions of the behaviour will help in deciding how best to support the child. The child is likely to be communicating a need through their behaviour. This may include:

• A physical need, such as feeling hungry, thirsty, tired, wet or unwell
• A sensory need, including feeling over stimulated (eg too much noise, too much light, specific smells, too cold, too warm etc.) or under-stimulated (leading to sensory seeking). The behaviour may provide the child with sensory feedback that they find satisfying;
• Expressing an emotion, such as feeling excited, worried, scared or frustrated; or
• Expressing that they want or do not want something (eg a toy, game or activity)

Reducing the occurrence of self-injurious behaviours

• Explore the function of the child’s behaviour by completing structured observations (see ABC Charts and STAR in the appendix)
• Work closely with the child’s family to explore when/ where the behaviour occurs outside of the setting to better understand patterns and the function of the behaviour
• Increase structure and routine – establishing clear routines and structure can help to reduce anxiety. Provide additional support around transitions throughout the day
• Consider the sensory demands of the environment – create small, contained, break-out spaces for the child to access at planned times
• Provide opportunities for alternative sensory experiences throughout the day that could meet the same need for the child (eg jumping on a trampoline, swinging, or biting on soft or edible items)
• Support communication with visuals – try to give the child other ways to communicate what they want or need (eg objects of reference, pictures of different items or body parts)
• Offer praise that is sensitive to the child’s individual preferences (eg not too overwhelming if a child struggles with praise) and provide meaningful rewards for the behaviour that you want to see

How to help when the behaviour occurs

• Reduce any demands on the child – if they have been given an activity or an instruction, come back to this when they are calm
• Reduce uncomfortable physical or sensory stimuli where possible
• Keep responses low key - it is important to respond very calmly, reduce your language, speak in a consistent tone and limit your expression of emotion
• Do not ask or tell the child to stop engaging in the behaviour. If it is safe to do so, you can give the child clear instructions to redirect their behaviour towards what you want them to do (eg ‘Jack, hands down’). This could be supported with a visual prompt
• Keep the child safe – create a barrier between the child and what is causing them harm. For example, provide a soft mat between a child’s head and a wall, or a pillow between the child’s head and hand. Offer replacement items such as a soft item to bite on
• Gently redirect the child’s attention if it is safe to do so (eg towards a favoured toy or activity)

Signposting and further information

It can be helpful to discuss a child’s self-injurious behaviour within a multiagency group. Contact your Early Years Inclusion Adviser for support in the first instance.

Specialist Learning Disability Nurses can offer support to develop individualised plans for children, based on a robust understanding of the function of the behaviour (what need it is meeting or expressing for the child). Examples of sensory checklists are available online.

The Out of Sync Child website includes links to books, articles and resources around sensory processing difficulties.

The National Autistic Society has information about self-harm.

Distressed behaviour

The Arousal Curve

Creating a calm environment:

Developing an emotionally friendly approach to wellbeing can be supportive in creating a calm environment that may reduce the likelihood of children displaying PAB (you can contact the Educational Psychology Service for further information about Emotionally Friendly Settings).

Creating a calm environment can also help in promoting feelings of safety in setting. Things that can help to achieve this include the below (please also see the SEMH section within the main EY SEND Thrive tool):

• Using behaviour management techniques that help children to understand and manage their emotions such as Emotion Coaching (see appendix)
• Creating predictable routines (eg through use of visual timetables)
• Use of softer lighting/ natural light and reducing brightly coloured displays
• Regularly engaging in class mindfulness or yoga
• And creating calming corners or sensory spaces

De-escalation and Proactive Support:

In addition to the above, some children identified as being more likely to display PAB may benefit from: direct teaching of emotional regulation skills and relaxation techniques; the identification of a specific Key Adult with whom they can build a supportive and trusting relationship; the use of Social Stories in relation to PAB; and the development of an agreed planned response to PAB developed with the child’s parent/carers, emphasising de-escalation and preventing PAB.

Developing a planned response:

There may be occasions where, despite using de-escalation strategies, children may continue to move up the arousal curve and display PAB. When this happens, adults may be required (in extreme circumstances) to use positive handling techniques. These should only be used when absolutely necessary and for as short a time as possible, in order to keep the child and others safe. It is important there is a planned response that is agreed with the child’s family and consistently applied by all staff when responding to the child’s behaviour throughout the day. This should consider all stages of the arousal curve and is sometimes called a Reducing Anxiety Management Plan (RAMP). It is important to involve relevant professionals and support services at an early stage when exploring the underlying reasons for a child’s PAB in setting, which may include:

• Early Years Inclusion Adviser
• Speech and Language Therapist
• Educational Psychologist
• Paediatrician
• Social Care (Children with Disabilities)

Risk assessment prompts

Most children who display PAB can be managed safely in settings with appropriate levels of support and clear risk management plans. If you are concerned that a child is showing PAB, please refer to the prompts below to ensure you are involving the right people and services to assess and manage the risk appropriately:

• Have you developed a calm and emotionally friendly setting environment?
• Does your setting’s behaviour policy outline a planned and approved response across the setting for responding to PAB? Is this policy well understood and consistently applied by all staff?
• Have you considered the functions underlying the child’s behaviour and provided them with alternative methods to communicate and meet these needs?
• Have you tracked the occurrence of PAB, identifying antecedents and consequences (eg using the ABC Chart or STAR approach), to identify any potential triggers to this behaviour?
• Have you considered the arousal curve and how you can utilise de-escalation strategies with the child to prevent PAB?
• Where PAB is displayed, are you using a multi-agency approach to inform a holistic assessment in order to provide a support plan for the child? Have you made referrals to external services eg Educational Psychology, Speech and Language Therapy, Paediatrician as appropriate?
• Have you considered the immediate safety of children and staff? It is important to be guided by relevant national legislation and guidance; organisational policies, procedures and guidance; human rights; the identified risks or needs of the child; and the potential or real risks to others.
• Have you considered how to support the wellbeing of staff who regularly work with the child displaying PAB?

Signposting and further information

• What is Emotion Coaching?
• The Three R's
• What Is A Social Story?
• Kaye A.J., Erdley C.A. (2011). Physical Aggression. In: Goldstein S., Naglieri J.A. (eds) Encyclopaedia of Child Behaviour and Development. Springer, Boston, MA
• Using social stories to decrease aggression Tricia M. Benish & Ronald K. Bramlett (2011).
• Kaye A.J., Erdley C.A. (2011). Physical Aggression. In: Goldstein S., Naglieri J.A. (eds) Encyclopaedia of Child Behavior and Development. Springer, Boston, MA

Getting risk support appendices

ABC Charts - Antecedent-Behaviour-Consequences

If a child’s behaviour is confusing or concerning, it can be helpful to gather information over time, so that you can better understand the behaviour and spot any patterns. The antecedent - behaviour - consequence (ABC) chart is a direct observation tool that provides information about what is happening in the child’s environment. It helps to:

• Collect information on what is causing the behaviour (what happens before the behaviour starts?)
• Gain a clear understanding of the behaviour itself (what actually happens?); and
• Identify anything which is maintaining the behaviour (how is the behaviour responded to/ what happens afterwards?)

Keeping it simple. This should not take a lot of time; the shorter and clearer it is, the easier it will be to spot patterns.

Build up evidence. By building up evidence over several observations, patterns in the behaviours that are happening start to appear. Depending on the individual child, five to ten ABC charts may be a good place to start.

Identifying patterns. Once charts are completed, identify patterns across the ABC charts to give a clear understanding of the behaviours and think about effective solutions.

Developing solutions:

Antecedents

• What are the triggers for a behaviour happening? Think about short and long-term triggers.
• Think about exceptions, when does this antecedent / trigger not create the behaviour? How can we use this information to help the child?
• How can we remove the antecedent / trigger?
• If we cannot remove the trigger, can we help the child to feel more comfortable with it?
• Is there something this antecedent / trigger tells us about the child (eg limited language leading to frustration and ‘lashing out’; not wanting to try something which may indicate low self-esteem)?

Behaviours

• Describe very factually what happens.
• How could the child react differently when feeling this way or in this situation?
• When we have planned out how we would like the child to react, it is particularly important that these alternative behaviours are practised / role-played. Doing so will increase confidence, help them to learn these new skills and increase the chances of these positive behaviours being used in the future.
• Make sure the child is provided with lots of supported opportunities for success, and praise!

Consequences

Consequences can be pleasant or unpleasant. A pleasant consequence will encourage the behaviour and increase the chance that it happens again (eg “When I scream, everyone gives me what I want”) while a negative consequence will discourage behaviour (eg “When I shout, everyone ignores me”). Creating effective responses can bring about positive change.

• Can we remove any pleasant / positive consequences of the inappropriate behaviour?
• Can we provide a pleasant / positive consequence for a positive behaviour?
• Can we respond differently to de-escalate the behaviour (eg calm voice, distract or re-direct the child to another activity, teach an alternative behaviour).

STAR Approach

What is the STAR Approach?

The STAR approach was designed to address what are described as distressed behaviours or Physically Aggressive Behaviour (PAB) in settings. The approach recognises that all behaviour is communication and acknowledges the importance of identifying triggers to develop solutions. The STAR approach involves several interrelated strategies.

1. ‘Unlearning’ inappropriate behaviour that is:

• preventing the current behaviour from achieving positive results for the child;
• finding a way of communicating to the child that the behaviour is unacceptable.

2. Often, distressed or Physically Aggressive Behaviours (PAB) are unacceptable ways of achieving quite acceptable outcomes (eg the child screams because he wants a toy another child has taken from him, or the child hits others to get attention). Often, the child does not have the right skills for achieving these outcomes (eg hits because they don’t have the language skills to gain attention in a verbal way). Therefore, it may be necessary to teach acceptable alternative behaviours which achieve the same outcomes for the child as the behaviour you want to reduce.

This can be done by:

• finding ways of encouraging any existing appropriate behaviours which he or she does not use much;
• teaching new skills.

3. It may be necessary to find ways of helping a child with a personal problem (eg ear ache, illness, side effects of medication, emotional upset).

4. Often, it helps if we can change any aspects of the environment and routines which may be contributing to the occurrence of the behaviour (eg room is too crowded, too much noise, too many distractions).

The STAR approach offers a mix of principles and strategies and involves analysis and intervention at the following levels:

S

Settings are defined as the general contexts in which behaviour occurs. They determine the individual’s motivation to achieve, and work for, results which might be available to him at any time. Every attempt is made to find out why the behaviour arose initially. Settings can be internal or external to the individual.

The external influences might be:

• life events (eg loss, change, trauma, abuse)
• current social environment (eg close relationships, exposure to conflict, hostility or domestic abuse, lack of routine, lack of control, unnecessarily strict control)
• current activities (eg level and type of stimulation, access to preferred activities)
• current physical environment (eg noise level, temperature, levels of lighting)

Internal and personal influences may include, a lack of self-esteem; anxiety; sadness; boredom; communication problems; pain; tiredness and poor physical health; a lack of social understanding; underdeveloped play skills, etc.

T

Triggers are defined as the particular signals which set off specific actions.

They occur just before the behaviour and either increase a personal want, suggest a likely threat, or signal the availability of a desired reward.

Examples include a change in activity, a new instruction, a high noise level, a memory of an event, the presence of a person who always responds in a desired way.

A

Actions are the behaviours themselves. The STAR approach emphasises that the behaviour to be reduced must be defined in term of observable behaviours.

R

Results are the consequences which immediately follow the behaviour. Results may be positive, negative or neutral. The important step is to clearly define what is causing a concern in terms of observable behaviours (ie describe very clearly what can be seen happening). Some behaviours may occur as a cluster (eg a temper tantrum may include spitting, screaming, self-injury). Therefore, a decision has to be made whether to describe the behaviours separately or as a group. Several behaviours may form a sequence escalating in intensity and so a description of the sequence will be necessary (eg cries then throws).

Gathering the information

The first crucial step is to clearly describe observable behaviours which are causing concern (the target behaviour). This maybe an individual behaviour, a cluster or sequence of behaviours. Observations and discussions with parents/carers and key workers are used to gather information to help explore and understand the function of the child’s behaviour.

This is explored by looking at what the behaviour appears to achieve/ gain for the child and/or the triggers which seem to set it off. The STAR observation chart has four columns headed Settings, Triggers, Actions and Results. There are also columns for date and time. Each time the target behaviour occurs you should note the situation at the time and the context (Setting), what occurred just before the behaviour (Trigger) and what happened just after (Results) as well as the behaviour itself (Action). Please see the table below.

Understanding the information

In addition to use the table above, it is helpful to use the discussions and observations of the child to also develop a strengths list (Zarkowska and Clements, 1994).

A list of strengths should show:

• The child’s skills and relative strengths in their development tracker
• The child’s preferences and strong motivators
• The conditions which evoke positive behaviour from the child
• The conditions in which the child learns best

The next step is to arrive at a formulation or an understanding of what the behaviour is communicating, or the function it has for the child. This will include details about:

• The behaviour(s) that cause concern
• The results the behaviour appears to achieve
• Apparent triggers for the behaviour
• Environmental triggers (things that happen in the environment around the child)
• Skills the child needs support to develop which will reduce reliance on current behaviours to communicate or meet their needs (eg language, emotional expression, play skills, motor skills)

The table below provides a template for recording the STAR process of information gathering and analysis.

Creating a Support Plan

Targets should be set based on the skills the child needs as identified through the STAR process. Targets need to be SMART targets (ie they are specific, measurable, achievable, realistic and time-related).

The management of behaviour usually involves support at a number of levels. First focus on changing the results of behaviour/s, so less wanted behaviours are discouraged and alternative behaviours are encouraged and rewarded. This often requires support to teach and help the child practice the new skills needed to engage in the appropriate behaviour.

Risk factors are reduced by being aware of the triggers and being able to avoid these where possible, until the child has better developed skills, or put extra support in place or respond at an earlier stage when triggers can’t be avoided. It is important to involve the child’s family at all stages and involve them in reviews of the child’s support plan, highlighting and celebrating small steps of progress and achievements as they occur.

Supportive conversations

What are supportive conversations?

They are a way of structuring conversations around the sharing of information after a specific event has taken place. This is usually when the event has been highly unusual or very stressful. The purpose is to support the re-building of relationships, ensuring everyone’s wellbeing. They also provide opportunities to learn from the event and plan for the future.

How can they help?

• After a stressful event at work it is important staff feel supported by one another.
• Supportive conversations allow those involved to process the event and reflect on its impact. They allow feelings to be discussed, shared and acknowledged.
• They can help identify ways to repair relationships (between adults, and adults and children).
• They can help to figure out what has been learnt from the event, which can help to improve processes or systems in the future.

What can you do?

• Offer a supportive conversation to a member of staff if they have experienced a very stressful event at work. This may be around a safeguarding concern, a difficult conversation with a parent (for example raising concerns for the first time), or as a result of a child’s distressed behaviour.
• Agree a time and a confidential place to meet. As there is usually a ‘dip’ in energy and mood following a highly stressful event, it can sometimes help to meet later in the day rather than straight away. But check with each practitioner what they would prefer, as we all respond to events in our own way.
• Agree who will lead the supportive conversation. This will need to be someone who is a good listener and can offer support non-judgementally.
• Use a template to structure the conversation.
• Agree how the notes from the meeting are going to be taken, stored and shared.
• It may be helpful to include the supportive conversations process in your staff supervision or wellbeing policies.

This can help establish:

• What circumstances may lead to a supportive conversation being offered
• Where the conversations will be held and which staff will lead them
• What structure or template will be used; and
• How the meeting and any future actions will be recorded

Supportive conversations template example

(Adapted from Page, D. (2009). Multi-Element Plans, Derbyshire County Council)

Moving Forwards